joint co-commissioning committee agenda · 1/25/2018 · emily perry, project officer, east and...

Joint Co-Commissioning Committee Agenda

Thursday 25 January 2018, 10:00am-12:00pm Beales Hotel, Comet Way, Hatfield, Hertfordshire, AL10 9NG - Salisbury Suite

Part I – Public Meeting Chair – Yvette Twumasi-Ankrah

Item Subject

Report Action Indicative Timings

1. WELCOME AND APOLOGIES FOR ABSENCE

Chair -

Oral 2

2. DECLARATIONS OF INTERESTS To receive any new declarations of interest or declarations relating to matters on the Agenda.

Chair -

Oral 2

3. MINUTES OF: 12 October 2017 (part 1)

Chair Agree the minutes

Enclosed

5

4. MATTERS ARISING ACTION TRACKER To note the latest part one action tracker.

Chair Information and Discussion

Enclosed

5

QUALITY/SAFETY 5. QUALITY REPORT

Patient Safety, Effectiveness and Experience, to include: CQC Improving quality of primary

care workshop - feedback

Director of Nursing, NHSE / Director of Nursing ENHCCG

Information and discussion

PAPER Enclosed

15

OPERATIONAL 6. CONTRACTS UPDATE

To include: APMS Procurement Mergers JCOG decisions since last

JCC / list closures

Locality Director, NHSE


PAPER Enclosed

20

STRATEGY/POLICY 7. NHSE PRIMARY CARE BUDGET

2017-18 Head of Finance, NHSE

Information Paper to be sent late

15

8. GP FORWARD VIEW Extended Access / shared

clinical record

Programme Director ENHCCG


PAPER enclosed

20

Resolution to exclude members of the press and public

• The Joint Co-Commissioning Committee resolves that representatives of the press, and other members of the public, be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest, in accordance with the Public Bodies (Admissions to Meetings) Act 1960.

INFORMATIONAL

9. GP FORWARD VIEW To include: Care Navigation Online Consultation GP resilience programme

Programme Director ENHCCG

Information

SLIDES enclosed

20

10. NEW RISKS IDENTIFIED Business Clinical

Chair/All 5

11. ANY OTHER BUSINESS To consider any other matters which, in the opinion of the Chair, should be considered as a matter of urgency

All

4

12. DATE, LOCATION & TIME OF NEXT MEETING TBC

All

13. QUESTIONS FROM THE PUBLIC Chair 5

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Agenda Item No: 3

Date of Meeting: 25 January 2018

Joint Co-Commissioning Meeting - Public

Paper Title: Joint Co-Commissioning Committee Minutes for: 10 October 2017, meeting in public

Decision or Approval Discussion Information

Report author: Emily Perry, Project Officer, East and North Hertfordshire CCG

Report signed off by: Yvette Twumasi-Ankrah, Lay Member, Chair Co-Commissioning Committee, East and North Hertfordshire CCG

Executive Summary:

This paper contains the minutes taken from the JCC meeting that took place in public on 10 October 2017.

Does this paper need to contain any decisions / recommendations/ updates escalated from JCOG or requested at previous JCC meetings?

Yes No

Recommendations to the members:

To approve

Page | 2

Conflicts of Interest involved:

None identified

Conflict of Interest Definitions

The following table describes the sub-classifications of interests:

Type Description Financial Interests This is where an individual may get direct financial benefits from the

consequences of a commissioning decision. Non-Financial Professional Interests

This is where an individual may obtain a non-financial professional benefit from the consequences of a commissioning decision, such as increasing their professional reputation or status or promoting their professional career.

Non-Financial Personal Interests

This is where an individual may benefit personally in ways which are not directly linked to their professional career and do not give rise to a direct financial benefit.

Indirect Interests This is where an individual has a close association with an individual who has a financial interest, a non-financial professional interest or a non-financial personal interest in a commissioning decision.

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Joint Co-Commissioning Committee Meeting in Public Thursday 12th October 2017

AT1 & AT4, Charter House, Welwyn Garden City Present from ENHCCG Hayder Bolat [HBo] GP Lead, Lower Lea Valley

Harper Brown [HB] Director of Commissioning

Dianne Desmulie [DD] Lay Member, Patient and Public Engagement

Linda Farrant [LF] Lay Member, Governance and Audit

Alan Pond [AP] Chief Finance Officer

Nabeil Shukur [NS] GP Lead, Stort Valley and Villages

Yvette Twumasi-Ankrah [YT] Chair, Lay Member, Co-Commissioning

Nicky Williams [NW] Deputy Chair (ENHCCG) / GP Lead, Upper Lea Valley

In Attendance from ENHCCG: Denise Boardman [DB] Programme Director

Robin Christie [RC] Clinical Lead Primary Care Workforce Planning & Education

Beverly Flowers [BF] Chief Executive Officer

Sue Fogden [SF] Assistant Director – Premises

James Gleed [JG] Associate Director of Commissioning Primary Care

Maryla Hart [MH] Project Officer – Primary Care Projects

Zaid Ismail [ZI] GP, IT Lead

Tracey Middleton [TM] Minute Taker

Emily Perry [EP] Project Officer – Primary Care Projects

Martina Vogel-Matthews [MV] Head of Digital Transformation Present from NHS England Dominic Cox [DC] Locality Director In Attendance from NHS England Miriam Coffie [MC] Head of Quality

Nicola Ensor [NE] Assistant Director - Fitness to Practise (via telecon)

Caroline Goulding [CG] GP and Pharmacy Contract Manager, Primary Care

Andrew Tarry [AT] Assistant Contract Manager, Primary Care

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In Attendance all other organisations and members of the Public Peter Graves [PG] Local Medical Committee

Michael Taylor [MT] Patient Representative

Clare Hawkins [CH] Acting CEO & Chief Nurse – HCT – attended to present 1 x agenda item only

Marion Dunstone [MD] Director of Operations – HCT - attended to present 1 x agenda item only

MINUTES

ITEM SUBJECT ACTION 1. WELCOME AND APOLOGIES FOR ABSENCE

The meeting opened at 09.42. The Chair welcomed all present to the meeting.

1. Apologies were received from:

ENHCCG: • Sharn Elton [SE], Director of Operations • Sheilagh Reavey [SR], Director of Nursing and Quality • Lucy Eldon [LE], Primary Care Nurse Coordinator • Maria Masiyandima [MM], Quality Lead Primary Care NHSE: • Manjit Derby [MD], Director of Nursing • Stephen Makin [SM], Head of Finance • Aly Rashid [AR], Medical Director

2. DECLARATIONS OF INTERESTS

The updated Register of Interest was circulated in advance of the meeting. The Chair invited the Joint Co-Commissioning Committee members to declare any new declarations of interest or declarations relating to matters on the Agenda;

1. B Flowers – In attendance.

2. It was noted that conflicts of interest have been identified on the cover note with the supporting papers.

The Joint Co-Commissioning Committee noted the updated Register of Interest.

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3. MINUTES OF PREVIOUS MEETING

The minutes of the meeting held on 13th July 2017 (part 1) were approved as an accurate record with the following amendments.

• Page 9, bullet point 2 - amend Ware Road to Ware.

4. MATTERS ARISING AND ACTION LOG

The contents of the Action Tracker were discussed The following actions were agreed as closed:

1. Item 8C – Premises Update – Closed.

2. Item 14 - Quality And Information & Risk Sharing Group Report: Supporting Practices – Closed.

3. Item 17 - Quality Report - Benchmarking - Closed.

4. Item 19 – Colleague attending remotely – Closed.

5. Item 25 - Quality Report - GP Practice Inspections –

Update to be provided on 25.01.18 – Action 41 raised and this action closed.

6. Item 26 - High risk medication – Colleagues incorporated

in meetings – Closed.

7. Item 29a - Contracts - GP Resilience Programme & Procurement - Any practices receiving support have been included – Closed.

8. Item 30 a,b,c – TOR - JCOG – Closed.

9. Item 31a – TOR - JCC - Closed.

10. Item 31b – TOR - JCC – This will be implemented from

October JCC onwards – Closed.

11. Item 36 – GP Forward View - Premises Update – Closed.

12. Item 37 – GP Forward View – Premises Update – Closed.

13. Item 38 - Patient Participation Group (PPG)

Engagement: Public engagement in the commissioning model – information is shared with Health Watch as appropriate. Closed.


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Engagement: Public engagement in the commissioning model - information is shared with Health Watch as appropriate. Closed.


Engagement: Public engagement in the commissioning model – an evaluation will be undertaken in March and feedback will be provided. Closed.

The following updates were given:

16. Item 23 - GPFV – ETTF: A meeting is being held tomorrow – ongoing.

17. Item 29b - Contracts - GP Resilience Programme and

Procurement - GPRP update has been provided as part of the JCC Contract Update paper. It may be that further detail is required for future JCCs – ongoing.

18. Item 32 – NHSE Finance - The Resilience Fund to be

identified in the CCG’s national allocation – ongoing.

19. Item 33 – NHSE Finance - The Annual budget and forecast to be more visible in the reporting – ongoing.

20. Item 34 – NHSE Finance - to review and report the

position on accruals relating to 2016/17 – ongoing.

21. Item 35 - NHSE Finance - data regarding committed recurring and non-recurring commitments to be provided – ongoing.

The Joint Co-Commissioning Committee noted the Action Tracker.

QUALITY/SAFETY 5. QUALITY REPORT

The Quality Report was circulated in advance of the meeting.

The paper was presented as read and further discussion elicited that:

1. 3 practices have moved to a more positive position and

support by all partners and a willingness to engage by the practices was acknowledged.

2. 2 practices (Sollershott and Stockwell Lodge) are inadequate and the report outlines the support required.

3. 3 practices require improvement and one of them has

had a draft rating of good (Church Street).

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4. The Friends and Family Test has received an increase in responses and informs good practice to be shared.

5. The Annual GP Survey has been published and the

colour rating informs targeted strategies – Stockwell Lodge was rated poor across the board.

6. Quality Visits continue to provide practices with support.

The Memorandum of Understanding between NHSE and the CCG has been strengthened. There has been engagement made with the National Association of Patient Participation (NAPP).

7. Stanhope Surgery was not visited however a lighter

touch support has been in place.

8. It was acknowledged that Healthwatch Reports are informative and thorough.

The Joint Co-Commissioning Committee noted the actions being taken to support practices which continue to be monitored by ENHCCG. The Joint Co-Commissioning Committee agreed that NHSE and ENHCCG continue working jointly to agree quality priorities.

OPERATIONAL 6. CONTRACTS UPDATE

The NHSE Contract Update which was circulated in advance of the meeting was presented as read and further discussion elicited that:

1. The Limes - the practice partners gave 6 months’ notice on their contract together with an application to close their list until the end of the contract. This was further discussed at the extraordinary JCC on 1st September whereby it was agreed that procurement of a 5 year APMS Contract was the preferred option in order to maintain the required primary care capacity & premises in the town. The closing date for bids is 13.10.17 after which the evaluation and moderation process commences. The contract will be in place 01.02.18.

2. The contractual merger for Dolphin House/Maltings

Surgery was formally approved on 01.10.17.

3. Partial closures were outlined as detailed in the report and it was noted that patients are being assigned when required. New patients will be accepted.

4. Sollershott Surgery remains under caretaker contract

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which commenced in January 2017 and ends on 30.06.18. Other practices are aware of the unstable environment and patient transfers.

5. The ITT for Spring House closed on 20.10.17.

Responses to patient consultation and engagement has been considered and reflected in the service specification.

The Joint Co-Commissioning Committee noted the report.

7. TERMS OF REFERENCE (TOR)

The Joint Co-Commissioning (JCC) TOR were circulated in advance of the meeting and amendments highlighted. ACTION: It was agreed that names are removed from the documents and job titles used. ACTION: It was agreed that a patient representative in non-voting capacity is added.

Nicola Ensor joined the meeting via teleconference at 10.13am

The Joint Co-Commissioning Committee approved the Joint Co-Commissioning (JCC) TOR with the agreed amendments above. The Joint Commissioning Operational Group (JCOG) TOR were circulated in advance of the meeting and amendments highlighted. The Joint Co-Commissioning Committee approved the Joint Commissioning Operational Group (JCOG) TOR.

JG

JG

8. STP UPDATE – PRIMARY AND COMMUNITY CARE WORK

STREAM

Clare Hawkins and Marion Dunstone from HCT arrived at 10.17am

The presentation on Place Based Care (PBC) was presented including:

1. Elements of the PBC framework include engaged communities, local primary care models, integrated neighbourhood teams, single plan of care, care coordination, access to specialist advice and social prescribing.

2. Local initiatives include – established locality forums with

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statutory and non-statutory organisations including social care, aligned leaders from key agencies, CCG transformation managers, CCG GP lead, senior manager and executive, localities event, each locality determining priorities, developing relationships and leadership, sharing of good practice, Stort and Lower Lea Valley have joined the NAPC network.

3. Examples of good practice in the locality were outlined

D Boardman arrived at 10.26am

4. Place based care STP work stream priorities were explained including the macro, meso and micro levels.

5. The way forward is to focus on capacity and capability to

effect change, agreed outcomes, delivering impact with one agenda that everyone is working towards commissioning and applying the learning from the mapping work.

6. Colleagues agreed that alignment and avoiding

duplication is key to success. RC agreed to have further discussions with MD regarding workforce and education.

7. NS highlighted the requirement for links with the Acute

Trust’s capacity concerns and community support was discussed. In some localities, there are multiple Acute Trusts in different STPs to work with which leads to inconsistencies.

8. NW commented that localities are not all currently

working at the same level as each other – they have different levels of support etc and it is important to realise that some practices are struggling. This influences place based care and impacts on primary care delivery and vice versa. It is recognised that there are costs to be considered when delivering additional services in the community.

9. The priorities and aligning of strategies in the STP work

streams were considered and it was noted that improving the health and wellbeing of the community will lead to fewer admissions and impact on social care. Some services delivered locally will have local ownership however some services will be centralised.

10. The additional costs of duplication in smaller

geographical areas was noted and how the disadvantages would be overcome were challenged.

11. An explanation of how priorities in one locality were

agreed and how they fit in with key performance

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indicators in the STP was given. The finances and impact on activity were discussed in line with community needs and the requirement for service level agreements.

Zaid Ismail and Martina Vogel-Matthews arrived at 10.41am

12. It was acknowledged that partnerships and stakeholder

involvement for longer periods of time can be challenging. A focus on what is key for the population and where the biggest impact can be made is needed. AP stressed the importance of local ownership and integration, although some services will always be delivered centrally. This will take time and effort and there will be challenges along the way.

13. HB reminded group of the importance of work on UTIs and pathways. Most acute trusts are in deficit and need activity to get income. We need to look at quality of care issues to avoid unnecessary pneumonia and UTI admissions.

14. ACTION: Presentation to be made available to

Healthwatch and other interested groups such as Patient Participation Groups.

15. The presenters were thanked for the clarity in the presentation.

The Joint Co-Commissioning Committee noted the report. Clare Hawkins and Marion Dunstone left at 10.53am

MD/EP

STRATEGY/POLICY 9. GP FORWARD VIEW – Part A

The presentation was delivered including:

Extended Access 1. The CCG is mandated to deliver a regional target around

extended access- ENHCCG are part of Central Midlands. Phase 1 and Phase 2 were outlined. The extended access offer is underpinned by 7 requirements which are in place in the CCG. The target is currently set for 50% of the CCG’s population to offer extended access by 2018/19 and for 100% of the population to have access to extended access by April 2019. West Essex CCG is already offering 100% extended access as they were a pilot site.

2. Federation working is actively in place and locality feedback is positive regarding providing extended access services. The CCG wants to support federation and

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collaborative working rather than going out to the market and localities are in agreeance with this. North Herts have gone out to the public and asked them what they want extended access in the area to look like and will see if this is deliverable.

3. The technical challenges were acknowledged and it was

noted that a dedicated team is working to progress this.

CCG £1.50 transformation non-recurrent monies

4. This is being utilised to achieve agreed objectives and for localities to think about transformation.

5. Examples of strategies introduced in localities were

explained including: silicon footfall, training, developing integrated workforce strategies, leadership courses, remote booking, extended access, locality business management support and clinical roles.

6. NHSE funding is awaited for the rollout of online

consultations across the entire CCG, however data collection across practices on any individual current use of online consultation technology has been undertaken.

Workflow Optimisation 7. This is part of the GP Forward View 10 high impact

actions. All practices in ENHCCG will have gone through training by January 2018.

8. Workflow optimisation feedback has been considered and how the work has been redistributed across the practice.

Active Signposting (Care Navigation) 9. This is the initial signposting for patients and connects

with the STP Social Prescribing Offer.

10. A communication is expected this week. Medical Assistants 11. The role of medical assistants requires further clarity

from NHSE before we commit money to it.

12. A GPFV event took place at Herts Valleys recently where Medical Assistants in practice meant a GP and trained admin doing Skype consultations together.

13. JG commented that in some parts of county voluntary

sector and PPGs are being used to help signpost in GP practices.

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10. GP FORWARD VIEW – PART B

The Technology / Digital Roadmap paper was circulated in advance of the meeting. ZI talked the paper through, some of the key points highlighted were:

1. Some practices have implemented IT strategies of their own which is not universal across the CCG at this stage. Colleagues acknowledged that the ground-breaking work being undertaken by the CCG is significant and the initiatives of reworking the algorithms and addressing risk factors is an exciting development.

2. Colleagues discussed in detail the unique developments which have been made to support the CCG in fully understanding the population within the MedeAnlaytics platform using a variety of sources of data including Population Health Segmentation. An example of this is looking at the needs of a group of frail patients and children with LTCs and working out the population in the locality. ZI wants to establish ENHCCG as a data first CCG - all of the planning, commissioning and monitoring decisions should be driven by data.

3. The facilitation and promotion of self-care and self-management which involves a variety of local and national programmes was considered. The lack of patients engaging was acknowledged as a possible risk.

4. JG highlighted that it is important to note that some of the work that ENHCCG is doing has not been done before elsewhere.

5. DD asked about use of technology to enable self-care and self-management. There are lots of programmes locally and nationally – there is a huge difference between patients who are enabled to make appointments on line – DD believe that - there is a risk that patients will miss out if they do not enrol on line and have access to their records. It is also important to have these records available to all professionals in the home of the patient.

6. It was recommended that a target is set locally regarding accessing patient records. NW highlighted that this was a lot of work for practices and isn’t a priority at the moment however should be in practices work plan. Extended access is more of a priority.

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7. PG stated that eventually patients could become custodians of their own records. Extended access/out of hours do not have access to these records - vulnerable patients should have an iPad in their home with records available for healthcare professionals to have access to – as has been achieved in parts of Kent and London.

8. ACTION: The management ownership of My Care Record Programme is to be clarified.

9. ACTION: IT Steering Group to further discuss priority of the various programme work streams and consider the value of setting additional local targets.

10. Action: Clear definition of online consultation needed.

11. It was noted that HUC has signed up to the ‘My Care Record’ programme and should be referred to in the report if other organisations are referred to.

12. NS informed the group that Princess Alexandra Harlow (PAH) cannot access records of his patients. JG will raise this. NS also highlighted that getting patients to access records is a significant piece of work for GPs but that they are happy to implement this over time.

13. ACTION JG to raise records access with David Hodson

14. Peter Graves noted that Silicon Practices are working with the Department of Health to set up standards to ensure that online consultations are safe.

15. Recommendations included:

• commence a separate recording of patient access to care records or distinguish from online access to appointments and repeat prescriptions.

• clarify that the 20% target currently is solely for appointments and repeat prescriptions.

• review obstacles to granting patient access to Care Record and plan implementation of solutions.


Zaid Ismail and Martina Vogel-Matthews left at 12.10pm

JG

JG

ZI

JG

11. NHSE PRIMARY CARE BUDGET 2017-18

The Financial Report for Primary Medical Services (Month 5 2017/8) was circulated in advance of the meeting. The paper was presented and further discussion elicited that:

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1. The position is reported as a small underspend versus

the year-to-date budget. The following should be noted: - Contingency is phased in twelfths; The 0.5% Non-Recurrent Reserve is phased in Month 12; The 0.5% Systems Resilience Reserve is phased in Month 12;

• The negative budget and positive spend line on

Trainees/Pensions/Levies require further clarification

• The Budgets without spend e.g. parental leave costs were reviewed and a response is required on whether there are any costs being incurred or they are captured in the lines above

• The non-recurrent spend (345) and Other (1058) and

JCOG Agree Programmes (665) = £2m. £600k for the primary care winter capacity has not yet been transferred resulting in £1.4m of current headroom. A response is required on the process and discussion to utilise this in the current year.

2. ACTION: A further discussion will take place between AP and DC to clarify the above, the outcome of which will be shared at the upcoming NHSE-CCG Assurance meeting.

The Joint Co-Commissioning Committee noted the report

DC, AP

12. NEW RISKS IDENTIFIED

1. There is a risk that the self-care and self-management

objective will not be achieved and patients will not benefit from investment in Primary Care if there is a failure to enable patient access to patient care records.

13. ANY OTHER BUSINESS

1. None

14. DATE OF NEXT MEETING

25TH JANUARY 2018 10:00 - 13.30 Venue TBC

15. Questions from the Public

No members of the public present

The meeting closed at 11.37am

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Agenda Item No: 4



Paper Title: Action Tracker – Part 1, meeting in public


Report author: Emily Perry, Project Officer, East and North Hertfordshire CCG

Report signed off by: James Gleed, Associate Director Commissioning Primary Care, East and North Hertfordshire CCG

Executive Summary:

This paper contains the most recent JCC part one Action Tracker.


Yes No


To approve

Page | 2


None identified









of 3

Joint Co-Commissioning Committee in Public: Action Tracker

Meeting date

No. Subject Action Responsible manager

Current Deadline

Past deadlines (Since Revised)

Current position Status

26-Jan-17

14 Quality And Information & Risk Sharing Group Report: Supporting Practices

There is a need to share learning and be proactive with practices so they don’t fall foul of CQC. The CCG could work with practices on this and link to training opportunities such as TARGET. RC to consider as part of his review of TARGET.

Robin Christie Jul-17 Apr-17 24-03-17: The review of Target is ongoing . The team is gathering data and will be preparing a paper about TARGET to go to governing body.20-04-17: A draft paper will be available within 4 weeks.02-10-17: The Protected Learning Time document which sets out the delivery of TARGET events was presented to the Governing Body in July and is now in use by Localities. Quality Team reviewed TARGET agendas to look at feasibility for including CQC topics/learning however agendas full with other priorities. Therefore planning specific stand-alone events involving CQC, NHSE and a number of other speakers. Programme drafted and currently identifying dates to deliver.12-10-17: Report presented to GB, it is being used and implemented. Meeting held for GPs and nurses. Information on Target included in Quality Report.

Close on 25-01-18

20-Apr-17

23 GPFV - ETTF Knebworth Surgery to be discussed at JCOG Sue Fogden Oct-17 Jul-17 13-06-17: This was picked up at JCOG on 2nd May and 26th June. SF hopes to bring a paper with a position statement to October JCC.13.07.17: On agenda - ongoing12-10-17: The district value should be increased. Meeting arranged for this week.

This has been transferred to private meeting and action tracker - close on 25.01.18

13-Jul-17

25 Quality Report - GP Practice Inspections

NHSE attends Quality Surveillance Group (QSG) and both NHSE and CCG attend Quality and Risk Sharing Group. NHSE to feed back the experience described by DK and encourage the CQC to conduct similarly supportive visits.

Miriam Coffie Oct-17 02-10-17: MC advised: "I have discussed with CQC regarding how they can be more supportive during inspection and action planning period and follow up inspections. This will be reflected in a workshop “improving the quality of primary care” planned for December 2017 across ENHCCG and jointly facilitated by ENHCCG/NHSE/CQC/LMC and NAPP.12-10-17: This is going to a planned workshop in January and feedback to be given at January JCC meeting as per action 41.

Close on 25-01-18

13-Jul-17

29b Contracts - GP Resilience Programme and Procurement

A summary report of support given to practices under GPRP to be provided for JCC with the level of detail given reflecting the sensitive nature of some of this data.

Caroline Goulding / James Gleed

Jan-18 Oct-17 03-10-17: A GPRP update has been provided as part of the JCC Contract Update paper. It may be that further detail is required for future JCCs.12-10-17: paper received by committee, this will continue to be part of the regular contracts paper

close on 25.01.18

13-Jul-17

31b TOR-JCC Actions agreed at JCC meetings to be rounded up and circulated in the week following the meeting.

Maryla Hart Oct-17 05-10-17: This will be implemented from October JCC onwards. Close on 25-01-18

13-Jul-17

32 NHSE Finance Update The Resilience Fund to be identified in the CCG’s national allocation. Dominic Cox Oct-17 12-10-17: DC to pick up with Stephen Makin No update received since last meeting.

Ongoing

of 3


Meeting date


Current Deadline



13-Jul-17

33 NHSE Finance Update The Annual budget and forecast to be more visible in the reporting. Dominic Cox / Alan Pond

Oct-17 12-10-17: DC to pick up with Stephen Makin No update received since last meeting.

Ongoing

13-Jul-17

34 NHSE Finance Update SM to review and report the position on accruals relating to 2016/17 to AP.

Stephen Makin / Alan Pond

Oct-17 12-10-17: DC to pick up with Stephen Makin No update received since last meeting,

Ongoing

13-Jul-17

35 NHSE Finance Update Data regarding committed recurring and non-recurring commitments to be provided.

Dominic Cox Oct-17 12-10-17: DC to pick up with Stephen Makin.No update received since last meeting.

Ongoing

13-Jul-17

38 Patient Participation Group (PPG) Engagement: Public engagement in the commissioning model

ME to draft a role description to be developed for a Patient Representative at JCC. The NHSE board and CCG Governing Body to be consulted. Clarity around the role and relationship to lay member for public and patient engagement to be provided. The patient representative to be “in attendance” at JCC meetings.

Mark Edwards Oct-17 12-10-17: Outstanding. No update received since last meeting.

Ongoing

13-Jul-17

39 Patient Participation Group (PPG) Engagement: Public engagement in the commissioning model

The relationship with Healthwatch is to be encouraged and it is to be established why they do not routinely attend JCC.

Lynda Dent / Mark Edwards

Oct-17 12-10-17: MT clarifed that he is the Healthwatch Representative and attends regularly, with the exception of last meeting when he was unable to attend.

Close on 25-01-18

12-Oct-17

41 Quality And Information & Risk Sharing Group Report: Supporting Practices

Feedback on progress to be given at January meeting on shared learning and be proactive with practices so they don’t fall foul of CQC

Robin Christie Jan-18 This has been captured in action 14 - to be closed on 25.01.18

12-Oct-17

42 The Joint Co-Commissioning (JCC) TOR

Names are removed from the documents and job titles usedpatient representative in non-voting capacity is added

James Gleed / Emily Perry

Nov-17 24-10-17 - completed by MH Close 25-01-2017

12-Oct-1743 Place Based Care

PresentationPresentation to be made available to Healthwatch and other interested groups

Emily Perry Jan-18 19-10-17 - EP emailed to JCC part 1 members (alongside GPFV presentation by DB)

Close 25-01-2017

12-Oct-17

44 GP FORWARD VIEW – PART B. The Technology / Digital Roadmap paper

The management ownership of My Care Record Programme is to be clarified

Harper Brown Jan-18 No update received since last meeting. new

12-Oct-17

45 GP FORWARD VIEW – PART B. The Technology / Digital Roadmap paper

IT Steering Group to further discuss priority of the various programme work streams and consider the value of setting additional local targets.

Clear definition of online consultation needed.

James Gleed / Zaid Ismail

Jan-18 16-11-17: Discused at IMT steering group meetingNo update received since last meeting.

new

of 3


Meeting date


Current Deadline



12-Oct-17

46 Financial Report for Primary Medical Services (Month 5 2017/8)

AP and DC to discuss further matters raised by AP in relation to the underspend in the PMS budget potentially available for investment in primary care. AP to document points and send to SM.

Alan Pond / Dominic Cox

Dec-17 No update received since last meeting. new

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Agenda Item No: 5



Paper Title: Quality and Information & Risk Sharing Group Report


Report author: Maria Masiyandima – Quality Lead, Primary Care, ENHCCG

Report signed off by: Sheilagh Reavey, Director of Nursing and Quality, ENHCCG

Miriam Coffie – Head of Quality, NHSE Central Midlands Executive Summary:

Executive summary. This report reviews the latest information available for a number of quality indicators relating to GP Practices in ENHCCG, it highlights the themes identified through the CQC visits that have already taken place to ENHCCG practices and outlines some of the actions taken to support practices to address these. The work undertaken to support workforce initiatives in primary care is also detailed. Background The CCG works with NHSE to monitor the quality of service provision in primary care in line with an established risk based approach to monitoring. Issues The report outlines practices where there are ongoing concerns following CQC inspections and key actions that are underway to support improvement are described. Options N/A Resources implications N/A Risks/Mitigation Measures Each practice with a CQC rating of Inadequate or Requires Improvement has been offered support by NHSE & the CCG, working with the LMC to provide a range of support to meet individual practice’s needs. Recommendations: To note the actions being taken to support practices Next Steps For ENHCCG & NHSE to continue to monitor quality and report to the JCC.

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Yes No Please list these below.


For NHSE and ENHCCG to continue working jointly to agree quality priorities.


GP’s in attendance may have an interest in Practices discussed in the paper – to be declared









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This report reviews the latest information available for a number of quality indicators relating to GP Practices in ENHCCG.

The timing of the JCC meeting and the risk sharing meetings this quarter has meant that this report highlights a number of issues that have yet to be discussed at the risk sharing meeting, which in the interests of providing an updated position have been agreed and signed off by the Head of Quality for NHSE outside of the risk sharing meeting for the purposes of inclusion in this report.

1. Care Quality Commission (CQC) Inspections To date a total of 53 Practices have been inspected under the new CQC regime. Of the practices inspected to date whose reports have been published, the following outcomes have been achieved:

Correct as at 03/01/18 The current situation across the CCG is as follows: 50 practices rated as ‘Good’. 2 practices are currently rated as ‘Inadequate’ • Sollershott Surgery (Letchworth) • Stockwell Lodge (Cheshunt)

Practice Overall Rating

Safe Effective Caring Responsive Well-Led

Sollershott Surgery

Inadequate Inadequate Requires Improvement

Good Requires Improvement

Inadequate

Stockwell Lodge

Inadequate Inadequate Requires Improvement

Inadequate Inadequate Inadequate

2 practices are currently rated as ‘Requires Improvement’

• Abbey Road (Waltham Cross) CQC re-inspection scheduled for January 2018 • Stanhope (Waltham Cross) recently inspected, results published June 2017

Locality Outstanding Good Requires Improvement

Inadequate Inspected awaiting publication

Archived inspection – will be reviewed under new practice lead.

Comments

North Herts

0 11 0 1 0 0

Stevenage 0 7* 0 0 0 0 WelHat 0 9 0 0 0 0 ULV 0 13 0 0 0 3 Maltings

Ware Road Orchard

LLV 0 5 2 1 0 0 SVV 0 5 0 0 0 0 CCG Area 0 50 2 2 0 3 TOTAL = 57

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Practice Overall Rating Safe Effective Caring Responsive Well-Led Abbey Road (CQC due 01/18)

REQUIRES IMPROVEMENT

Inadequate Good Good Requires Improvement

Requires Improvement

Stanhope (Waltham Cross) (Inspected 05/17)

REQUIRES IMPROVEMENT


Good Requires Improvement



The CQC are part of the Information and Risk Sharing Group so information can be shared regarding any concerns or issues, the CQC is also part of a monthly NHSE/CCG conference call to share information. At each meeting a risk log containing a number of key quality indicators/metrics including General Practice High Level Indicators (GPHLI), complaints, friends and family test, serious incidents, practitioner performance, CQC inspection ratings are presented and discussed.

Action being taken by the CCG: • The CCG continues to offer support to practices in respect of their CQC inspection action plans.

This has been offered to all practices with an overall rating of Requires Improvement or Inadequate and those who have had a domain rated as Requires Improvement.

• In response to those practices who are rated as inadequate, joint NHSE and CCG visits have been undertaken to offer support in the form of:

o Providing help with prioritising actions o Developing action plans o Sourcing specialist colleagues to visit the practice e.g. infection control nurse specialist,

medicines optimisation and safeguarding o Providing templates and information to help address the actions identified. o Regular monitoring of progress

From the visits carried out to practices rated as Requires Improvement/Inadequate, the key emerging themes identified were mainly management of high risk medication, infection control and clinical leadership. Whilst recognising the individual needs of practices, the themes described above were used to form the basis of a CQC workshop arranged by ENHCCG and NHSE (see section 4). A package of information from the CCG pharmacy team was developed to support practices with some of the processes that need to be in place to ensure safe management and recording of patients on high risk medications.

2. Friends and Family Test – GP Data The FFT results for the 3-month period July–September 2017 show the following: July August September Number of patient responses submitted in CCG area

736 1,262 1,251

% Recommend in CCG area 89% 90% 89% Practices submitting no data 10 10 8 Practices submitting data 47 47 49

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(nil returns) 10) (4) (3) Practices submitting <10 patient responses 18 21 22 Practices submitting =>10 patient responses 19 22 24 Of those - range of responses 10 - 123 10 - 146 10 - 154 Of those - % Recommend 89% 90% 89% England recommend % 89% 89% 89%

There has been an increase in a number of patient responses submitted for this quarter with the highest number of 1,262 submitted in August. On average there is a slight improvement noted in the number of practices submitting data compared to the previous quarter. A reduction in the number of practices submitting no data also continues to be noted as indicated above. The CCG continues to seek improvement by continuing to remind the practices to submit FFT data for quality improvement. Actions being taken by the CCG: • To continue monitoring and following up with practices not submitting data and those which

may still be encountering problems with data submission to ensure any issues of concern are addressed.

• Continue to remind practices the need to enter a nil return where no responses are received and encourage them to regularly review their current process for compliance and quality improvement.

3. CCG Quality Visits Update The CCG and NHSE continue to carry out visits to relevant practices offering support in implementing their action plans and sourcing specialist support from various speciality areas internal and external (Healthwatch and LMC) to support practices where required. Intensive visiting programmes have taken place where needed and for others telephone support has been available. Visits are jointly carried out with the CCG working closely with NHSE.

4. General Quality issues CCG quality monitoring structure and processes

The Quality Lead for primary care continues to work jointly with the Quality Lead for NHSE, specialists within the CCG and the LMC in supporting practices rated as Requires Improvement/Inadequate for their CQC Inspections. Outcomes and salient information is shared at JCOG and Risk sharing meetings discussing any risks identified and making joint decisions to mitigate the risks.

CQC/NHSE/ENHCCG Conference

The CCG and NHSE arranged a half day CQC conference event which generated a lot of interest from practices. The event was held on 5th December 2017 and the aim was to raise awareness amongst practices of the expectations of CQC and to share good practice from other areas and some of the CCG’s own success stories. The event was targeted at GPs, registered managers and practice managers responsible for preparations of the CQC inspections. Topics covered included:

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• CQC themes & trends identified • CQC new inspection format • Live story sharing - one from a practice’s journey from special measures to good and another

from an outstanding practice. • The role of the quality teams for both NHSE & CCG • Role of Healthwatch • Role of PPG • LMC support

About 60% of the practices attended the workshop and it was very interactive with group discussions. Verbal feedback from delegates was positive and the delegate completed evaluation results indicated the need for similar future events with suggestions to focus on in-depth specific topic areas for maximum benefit. NHSE and the CCG plan to run a range of sessions going forward on topics raised by practices in relation to delivering quality. The CCG will be developing the primary care area of the CCG website to enable templates, policies and updates to be shared and easily accessed by practices.

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Agenda Item No: 6



Paper Title: NHS England Contract update


Report author: Lisa Martin, Support Contract Manager, NHS England

Report signed off by: Dominic Cox, Locality Director, Central Midlands, NHS England

Executive Summary:

Update on NHS England GP contractual matters; including requests received for contractual mergers & practice list closures; APMS procurement update; GP Resilience Programme update.




To note


No Conflicts of Interest to declare

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Headings for main body of paper

1. Executive summary (half page maximum) Update on NHS England GP contractual matters; including requests received for contractual mergers & practice list closures; APMS procurement update; GP Resilience Programme update. Practice Contractual Resignation The Limes – The practice partners gave 6 months’ notice on their contract together with an application to close their list until the end of the contract. A paper was considered at the virtual JCC on 1st September whereby it was agreed that procurement of a 5 year APMS Contract was the preferred option in order to maintain the required primary care capacity & premises in the town.

Update Jan 2018 The Limes procurement completed in November with the successful bidder being Lea Valley Health who is a Federation of 8 independent GP Practices in Lower Lea Valley, Hertfordshire. The new provider commences on 1st February 2018. Mobilisation is currently progressing well with weekly telecon meetings between NHSE, CCG and the Federation.

Contractual Mergers

Dolphin House / Maltings Surgery Update Jan 2018

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The merger concluded on 1st October 2017 with The Maltings Surgery now a branch surgery of Dolphin House.

Practice List Closures Hoddesdon Practices – The Limes list closure was approved at the 7 August JCOG meeting a period of 6 months. Due to this scenario & concerns about destabilisation the closest surrounding practices - Amwell Street, Hailey View and Park Lane Surgery submitted a partial list closure applications to limit patients transferring between practices in the area. This was agreed for an initial 3 month period to be subsequently reviewed. Hoddesdon Practices - Update Jan 2018 The Limes patient list will reopen on 1st February 2017. Amwell Street and Park Lane have partially closed lists and are due to reopen on 1st January 2018, however, they have both applied for an extension to this for 6 months. Awaiting a decision from virtual JCOG. Hailey View have reopened their partially closed list in December. Letchworth Practices – the JCOG recognising the continued pressure in Letchworth approved Birchwood Surgery’s application for full a list closure for 6 months, commencing on 1st August 2017. The Group also agreed that the arrangement previously agreed with Garden City and Nevells Road in relation to limiting the transfer of patients between practices could be maintained for the same period, subject to a review of the situation in 3 months’ time. Letchworth Practice – Update Jan 2018 The closed list situation for the above three practices remains as above with lists due to reopen February 2018. A review of the closed list status will take place in January. Hertford Practices– in light of the ongoing workload in the town, a list closure request was agreed in late March 2017 for Hanscombe House Surgery. This was for an initial period was then extended for a further 3 months. Castlegate Surgery applied to have an open list for new to area patients, but closed to patient transferring between practices in Hertford. Hanscombe House had agreed to re-open their patient list, but on a similar basis to 31st December 2017 with the position to be subsequently reviewed. Both these applications were accepted on this basis. NHSE and East and North CCG is cognisant of patient choice and will retain the right to assign individual patients if necessary in the above areas. Under Clause 254 of the GMS

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Standard Contract, Assignment of patients to open lists, NHSE have the right to assign a new patient to a contractor if that patient resides within the catchment area. Hertford Practices – Update Jane 2018 Remains as above. APMS Contract Procurements

The Limes

The procurement for The Limes was published on the 15th September 2017, with the new contract to go live for 1 February 2018. The contract is offered for a total of 5 years on a 2 years + 2 Years + 1 year basis.

Update The Limes – Jan 2018 Successful procurement concluded with the contract being awarded to Lea Valley Health, which is a Federation of GP’s in the Lower Lea Valley area. Lea Valley Health commences providing services at The Limes on 1st February 2018. Mobilisation is underway with regular telecom meetings to update on progress. Spring House Medical Centre The procurement for Spring House was published on the 26 September 2017, with the new contract to go live for 1 April 2018. The contract is offered for a total of 5 years on a 3 years + 2 Years basis.

NHS England & the CCG have worked closely to take into account the feedback from the patient consultation regarding the planned reduction in hours. Consequently a staged reduction in the extended hours opening has been included under the contract in the first 2 years of service provision. NHS England & the CCG will liaise closely with the selected provider to confirm the opening hours arrangements & will in turn be able to clearly communicate these to patients.

Update Spring House Medical Centre – Jan 2018 Successful procurement concluded with the contract being awarded to Ephedra who are the incumbent providers. New contract commences on 1st April 2018 and therefore mobilisation ongoing. NHSE and CCG working with Ephedra in relation to a transition plan to reduce from and 8 to 8 service, 7 days per week.

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Sollershott Surgery

The current APMS caretaker contract is due to end on 30 June 2018. Work is scheduled to commence in October to consider the options & commence procurement as necessary.

Update Sollershott Surgery – Jan 2018 The preferred option agreed at the extraordinary JCC on 23 November, was the option to procure an APMS Contract with a term of 5 years (3+2). Preliminary work is underway on the procurement ITT phase which will include a market event prior to the procurement going live. General Practice Resilience Programme 2017/18 – Update The NHSE Central Midlands GPRP Panel met in early July 2017 and received 47 applications for funding, totalling over £1.3m. When assessed and scored against national criteria, informed by the comments and views of CCGs and LMCs, 25 practices were prioritised for funding. This committed £538k of the allocation, which is now being transferred to practices. 3 ENHCCG applications were received and reviewed, with one practice being successful in obtaining support.

This means that NHSE Central Midlands have approximately 20% of the allocation remaining. This funding will be used as a contingency for practices that get into difficulty in-year and require urgent rapid intervention. CCG assistance has been requested in prioritising those practices in greatest need of this support. We will be bringing a ‘lessons learnt’ report to the Central Midlands GP Forward View Steering Group in October 2017. However, it is apparent that resilience funding could be better utilised a little further upstream rather than at the point of crisis. Many practices could be more resilient if they worked at scale and there is an opportunity for CCGs to compliment the GPRP funding by using the £3 per head CCG primary care transformation funds to support such schemes. Update GPRP Jan 2018 Following a review the Central Midlands GP Resilience Team have confirmed additional financial resources have been put into the Central Midlands GP Resilience programme 2017/18. The review proposed a shift away from practice by practice application and instead adopting principles of:

1) The majority of resilience funding should be focused on groups of practices rather than individual practices. 2) Resilience funding should be targeted at localities most likely to be sustainable with intervention in the long term.

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3) Resilience funding should support fragile practices to engage in primary care at scale. Enabling them to participate in the transformation funding from CCGs when the locality otherwise would be consumed by operation problems.

This offers the greatest potential of the GP Resilience Programme (GPRP) aligning with CCG and STP efforts to develop primary care at scale. Furthermore, the funding needs to target groups of practices that are likely to be sustainable in the long term. Clinical Pharmacists Wave Three applications - Update Jan 2018 The following three Clinical Pharmacist Applications were successful in East & North Herts:

• Upper Lea Valley, Hertfordshire • Potterells & Hall Grove Practices, Hertfordshire • Central Surgery, Bishops Stortford

Wave four applications A deadline for submission of Wave 4 applications has now been set as 19th January 2018.

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Agenda Item No: 7



Paper Title: Financial Report for Primary Medical Services: Month 9 2017/18


Report author: Stephen Makin, Head of Finance NHS England (Central Midlands)

Report signed off by: Chris Ford, Director of Finance NHS England (Central Midlands)

Executive Summary:

This paper sets out the financial position of Primary Medical Services (GP Services) in East & North Hertfordshire CCG: Year-to-Date M9 2017-18




To note

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None









Choose an item.

1

Central Midlands Financial Report for Primary Medical Services: 2017/18 FOOTPRINT: EAST & NORTH HERTFORDSHIRE CCG

Month 9 – December 2017

Choose an item.

2

1 Introduction This paper sets out the summary financial results for Primary Medical Services (GP Services) in East & North Hertfordshire as at Month 9 (December).

Where assumptions regarding the impact of contractual or other changes have been made – these are clearly marked in the document.

2 Assumptions Used in Preparing the Financial Position

The planning rules require commissioning organisations to plan for 0.5% contingency. In 2016/17 all commissioning organisations were required to set aside 1% of total allocation to create a national systems resilience reserve. In 2017/18 commissioners must ensure that

1% of their allocation is planned to be spent non-recurrently, but only half of this has to be uncommitted at the start of the year, with the other half being available for immediate investment.

The majority of Primary Medical Services expenditure can be allocated directly to a CCG based upon the GP Practice Code. However, there are some costs that cannot be directly allocated to GP Practices (and thereby CCGs); these costs have been apportioned to CCGs using the following approach:-

Translation fees: apportioned based upon total 16/17directly allocated cost Clinical waste: allocated based upon alignment of CCG to Local Authorities/ District

Councils + a component is based on total 16/17 cost

3 Summary of Year-to-Date Financial Position: The year-to-date (YTD) and forecast financial position of Primary Medical Services in E&N Hertfordshire is shown in the table below. The YTD position shows a £592k underspend

versus the year-to-date budget. The following should be noted:

- The forecast includes as estimate of Q4 list size inflation. - The impact of the reconciliation of prior year accruals versus actual expenditure is

minor and predominantly relates to the resolution of QOF payments. - The position includes non-recurrent costs associated with practice caretaking. - Contingency is phased in twelfths; the forecast assumes contingency will be utilised

in full.

- The 0.5% Non-Recurrent Reserve is phased in Month 12. - The 0.5% Systems Resilience Reserve is phased in Month 12; and is forecast to be

fully committed. - The impact of co-commissioning investment is included in the YTD and forecast.

Choose an item.

3

Summary Financial Performance for General Practice in East & North Hertfordshire: Month 9 2017-18

Annual

Budget

YTD

Budget

YTD

Spend

YTD

Variance

Forecast

Spend

Forecast

Variance

Comments

£000s £000s £000s £000s £000s £000s

Total Expenditure

GMS/APMS/PMS Contract Payments 47,608 35,706 35,074 632 46,980 629 Phasing of practice list size movements to be reviewed

Primary Care Other 1,402 1,051 871 180 1,161 241 Mainly GP Seniority Payments

Enhanced Services 2,033 1,525 1,454 71 1,947 86

QOF 6,454 4,840 5,021 (180) 6,723 (269)

Premises 6,676 5,007 5,021 (13) 6,754 (78)

Prescribing/Dispensing 1,001 751 790 (39) 1,054 (52)

Corporate 325 244 254 (10) 338 (13)

Other 8 6 284 (278) 379 (371) Caretaking, Practice Doc Retainer Costs

Trainees/Pensions/Levies (291) (218) 7 (225) 9 (301)

Excluded from Practice Level Reporting

Cost that cannot be allocated directly to Practices 180 135 135 0 180 0

Recurrent Impact of Rent Reviews 75 56 0 56 75 0 Phased in 12ths but commitments will be unevenly distributed throughout year

Recurrent Impact of Legacy Premises Developments 224 168 0 168 224 0 Phased in 12ths but commitments will be unevenly distributed throughout year

GPFV Costs not in Practice Level Budget Setting Sheet

Parental Leave Costs 380 285 351 (67) 469 (89) Budget set at CCG level; costs captured at practice Level

GP Retainer & Returner 30 23 0 23 30 0 Phased in 12ths but commitments will be unevenly distributed throughout year

BID Levies 20 15 0 15 20 0 Phased in 12ths but commitments will be unevenly distributed throughout year

Reserves and Contingency

Contingency 345 259 0 259 345 0 Phased in 12ths

0.5% Non-Recurrent Spend 345 0 0 0 0 345 Currently no commitment; can be committed up-front

0.5% Systems Resilience National Reserve 345 0 0 0 345 0 Business Rules Requirement

Other 1,058 0 0 0 0 1,058

JCOG Agreed Programmes 665 600 600 0 665 0

Total Expenditure 68,882 50,453 49,861 592 67,697 1,185

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Agenda Item No: 8



Paper Title: Extended Access programme update.


Report author: Denise Boardman Programme Director James Gleed Associate Director Primary Care Commissioning.

Report signed off by: Beverley Flowers CCG Accountable Officer.

Executive Summary:

NHSE have mandated that all CCGs’ in England have to commission extended access to 100% of their population by March 2019. A paper was presented to the Governing Body in May 2017 outlining the options for the CCG to commission this service; (a) working in partnership with the six locality federations to pilot extended access at scale across locality footprints or (b) the CCG to competitively procure the service from the market. It was agreed that there should be a period of engagement with the localities to help inform the approach the CCG would take to meet this target. This was completed early autumn and culminated in each locality confirming their decision to pilot extended access through their federations. The first locality scheduled to go live by March 2018 is Welwyn & Hatfield via their Federation (Ephedra) and a multi-agency project group has been established to oversee the timely delivery of this service working on the extended access 7 core requirements ready for go-live. All learning from the Welwyn and Hatfield project is and will support (noting the phasing) the work in the remaining localities and is based on the principle of “do once and share”. There are risks associated with this work programme due to its scale and complexity especially the ICT requirements which underpin the fundamental ability of practices to work collaboratively to deliver this service and feel confident in doing so. Therefore a programme management approach is being taken providing the necessary mitigations, supported by a detailed Extended Access delivery plan. This has been reviewed by NHSE Central Midlands and rated Green, providing the necessary assurance on the approach being taken. An extended access update paper was presented to the CCGs’

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Governing Body meeting on the 21st December, where following discussion, the Governing Body supported and approved the actions outlined in Section 8.


Yes No


1. Joint Co-Commissioning Committee members are asked to discuss and note the content of the paper and progress this far, including the next steps underway in section 8.


The CCG Governing GP leads have a Financial conflict of interest as they are shareholders in their GP federations and are also practising GPs in their localities.









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1. Executive summary NHSE have mandated that all CCGs’ in England have to commission extended access to 100% of their population by March 2019. A paper was presented to the Governing Body in May 2017 outlining the options for the CCG to commission this service; (a) working in partnership with the six locality federations to pilot extended access at scale across locality footprints or (b) the CCG to competitively procure the service from the market. It was agreed that there should be a period of engagement with the localities to help inform the approach the CCG would take to meet this target. This was completed early autumn and culminated in each locality confirming their decision to pilot extended access through their federations. This also allows the CCG, as a non GP Access Fund (GPAF) site, to pilot extended access as part of informing the service model for a potential future procurement. In September 2017, all CCGs’ had to submit to NHSE Central Midlands an Extended Access “Trajectory” outlining the phasing of extended access roll-out during 2018 to meet the 100% target by March 2019. The phasing schedule is outlined in Section 2.1 of this paper. The first locality scheduled to go live by March 2018 is Welwyn & Hatfield and a multi-agency project group has been established to oversee the timely delivery of this service working on the extended access 7 core requirements ready for go-live. The work of the project group includes the clinical service model, clinical protocols, information governance, ICT, staffing and skill mix and premises requirements. All learning from Welwyn and Hatfield is and will support (noting the phasing) the work in the remaining localities and is based on the principle of “do once and share”. In October 2017 all CCGs submitted to NHSE Central Midlands an Extended Access Delivery Plan. This is a comprehensive excel spreadsheet outlining all key requirements, actions and milestones, it is from this that the GPFV team sets its work plan. On 12th December 2017 the CCG received notification from NHSE Central Midlands GPFV team that it has been rated as Green and therefore no further amendments need to be made at this point. The Joint Co-Commissioning Committee members are asked to support the work so far and work being undertaken as part the actions outlined in Section 8 of this paper. 2. Background To deliver the NHSE mandate by March 2019 an extended access project group has been established including core members of the GPFV team and HBLICT colleagues led by the programme director. This also includes co-optees from the CCG’s information governance and communications and engagement team to support the different elements of the project as it progresses. Additionally supporting this are two locality project groups (Welwyn & Hatfield and latterly Stevenage) meeting monthly with CCG officers to deliver the extended access requirements per locality as per phasing trajectory outlined in Section 2.1. The phasing trajectory was designed to support the implementation of the project over a two year period and takes into account managing the different project requirements e.g. engagement with the public and information technology solutions to support each locality and their IT systems. As advised previously the first locality to go live is Welwyn and Hatfield (Ephedra) and learning from this locality will support (noting the phasing) the work in the

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remaining localities and is based on the principle of “do once and share”. There is some flexibility regarding the phasing in the latter stages and as required will be discussed with individual localities. 2.1 ENHCCG Extended Access Locality Phasing Trajectory:

2.2 Funding For non-General Practice Access Fund Scheme sites (such as ENHCCG) the nationally set funding is £3.34 per patient from 2018/19 in order to commission 30 minutes consultation time per 1,000 population. However, NHSE have advised ENHCCG the actual funding will be £3.17 per head of population, on raising this discrepancy, the CCG were advised by NHSE “that the populations used to calculate the allocation were in some instances incorrect”. Therefore despite being raised multiple times it still remains unresolved at present, so a close watching brief is being maintained. Based on this CCG funding envelope to support 30 consultation time /1,000 population for 2018/19 is £1,874,524.10. For prudence the current calculations have been based on the figure of £3.17 and localities are being advised through an extended access checklist of any other potential costs that might require funding through this allocation e.g. ICT licences etc. The phasing of the extended access service also means that locality federations will receive this funding once their service goes live. Costs incurred prior to this such as project management costs are being funded through the GPFV £1.50 monies, please refer to section 5 for further details.

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2.3 Contractual Framework NHS England Central Midlands have stipulated that CCGs must utilise the NHS England Standard Alternative Provider of Medical Services (APMS) Contract, a link to this is provided here: https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2015/06/apms-2015-16.pdf A Schedule 2 Service Specification has also been prepared and is available on request. The preparation of the service specification has included contributions from CCG directorates, including Information Governance, Information Communications & Technology, Pharmacy & Medicines Optimisation and Finance. There has also been external GP review from Lincolnshire CCGs’ to provide a non-conflicted clinical review and oversight by NHSE Central Midlands. The service specification has also been cross referenced with relevant NHSE Urgent and Emergency Care guidance to support future service synergies with NHS111 and Urgent Treatment Centres. 2.4 All providers of an extended access service have to meet NHSE 7 Core requirements to be considered compliant and these have been incorporated into the Service Specification in section 1.6:

2.5 Information management and information governance. The work already underway across East and North Hertfordshire on “My Care Record” also provides the foundations for the sharing of records in General Practice. Sharing of an electronic clinical patient record is critical to the delivery of safe and efficient Extended Access services. The CCGs’ Head of Information has supported the drafting of the service specification (section 5.1.12. - 5.1.34) in relation to information governance, system compliance and

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reporting requirements; as part of this they are supporting the project team with some amendments to existing Fair Processing Notices that need to be displayed in GP practices, Extended Access needs to be more explicitly referenced in this patient information. 2.6 Information Technology- Record sharing Four options were looked at for the Extended Access project in Welwyn and Hatfield in respect of the Clinical System and functionality available. The challenge being that this locality has two different Clinical Systems being used in the Practices, SystmOne and EMIS Web, where currently there is no interoperability between the systems. Therefore a work-around ‘best fix’ solution had to be found. All options investigated revolved around SystmOne and EMIS Web hub units, the various add-on options and functionality available. However, EMIS Web Hub has no Spine connectivity resulting in reduced functionality all-round. The preferred solution gives the simplest, cheapest and most importantly the most functionality for the staff delivering this service. The preferred solution is a SystmOne hub; this means all SystmOne records will be shared to the hub and have full access to normal functionality available, e.g. E-referrals, Electronic Prescribing and Pathology tests. This has now been ordered, with Shared Administration functionality and full patient record access enabled at a cost of £1003 plus VAT per annum. Booking Process

• Patients will ring their own practice to access the Extended Access appointments & staff will discuss consent at this point.

• Staff booking the appointments will also be aware of the Inclusion/Exclusion list of treatments (see section 2.8)

• The SystmOne hub will be made available in the EMIS Web practices so that patients can be booked directly into the Extended Access rotas as a Textual appointment.

• Staff in the EMIS Web practices require and will receive training on the appointment functionality within SystmOne.

Patient Appointment

• When a SystmOne patient arrives at the appointment, the clinician will access their full record via the hub.

• When an EMIS Web patient arrives the clinician will access their record by logging into the registered practice unit, giving them the same access as if they were seeing the patient at their own surgery. This does mean that the clinician will need to log in and out of each unit as patients arrive, however this has been tested and takes approx. 20-30 seconds

Day to day processes are still to be decided, a workshop is being held on 14th December to agree these:

• Allocation of slots to practices • Process for Electronic Referral • Process for Pathology requests / when results are received back • Process for Electronic prescribing

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• Booking for follow up appointments • Tasking procedure / etiquette • Standardisation of practice units.

2.7 Welwyn & Hatfield Public Consultation & Engagement 3,338 people responded to the questionnaire (3% of Welwyn Hatfield population) 86% of responders felt extended hours should be available for all patients – with the majority wanting a face-to-face appointment with a clinician – specifically a GP. Two thirds of patients were happy to visit a different practice to their own. The open comments from the public focussed on prioritising the service for workers/commuters, concern about over-working primary care and the need for a better appointment making system. Using the calculation of 30 minutes consultation time per 1,000 population, the Welwyn and Hatfield federation are required to offer just over 57 hours per week. 2.8 Service Model The following outlines the principles and service offer that Welwyn and Hatfield locality (Ephedra) are including in their service model: Principles:

• To provide consistent patient centred care. • Offer an Extended Access service model that reflects inclusion criteria (see next

section) supported by a multi-disciplinary skill mix. • A service offer that reflects the public consultation & engagement outcomes

undertaken during summer 2017. • Offer the service from a single site initially, Spring House Medical Centre and then

review requirements in due course. A GP & Practice Nurse extended access service will include appointments for:

• Pre-bookable chronic illness • Acute illness i.e. everything a GP generally does • Minor illness • Palliative Care • Mental Health • Follow-ups and medication if appropriate.

A Practice Nurse & Health Care Assistant extended access service will include appointments for:

• Health checks • Frailty checks • QOF work – e.g. Diabetes • Removal of sutures • BP checks • ECG • Dressings • Cervical screening • Dressings.

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The Extended Access service provided by Ephedra will be available Monday – Friday 6.30pm -8.00pm, Saturday 8.00am-4.00pm and Sunday: 8.00am- Midday.

3. Issues As part of the NHS England review of NHS urgent treatment services, NHSE are committed to removing the confusing mix of walk in centres, minor injury units and, urgent care centres. To end this confusion NHSE have established core standards for urgent care treatment centres to establish as much commonality as possible. This could include the extended access hub being provided from one of these facilities. These integration opportunities between the wider primary and urgent care, seek to rationalise the service offer, reduce duplication and flex the workforce to provide urgent and primary care services which meet the needs of the local population. Therefore with specific regard to Welwyn and Hatfield locality, as detailed work had already commenced on the premises options and preferred site prior to the release of UTC guidance, it has been raised with Ephedra should the Extended Access service require a second site, QEII Urgent Care Centre will need to be considered and the project group have received NHSE Urgent Treatment Centre (UTC) guidance. Additionally as discussions commence with Stort Valley and Villages and Lower Lea Valley federations, the same discussions will be held regarding the opportunity to co-locate the extended access service into the Herts and Essex Community Hospital and Cheshunt Community Hospital. 4. Options N/A. 5. Resources implications The GPFV £1.50 (transformation monies) are being utilised to support the extended access work programme by (a) funding GP federation project management costs (b) following agreement by the Governing Body GP leads, ENHCCG has top sliced £95,000 from the total budget to fund additional HBLICT project managers for one year to support this work programme.

6. Risks/Mitigation Measures The CCG has a detailed Extended Access Delivery plan and a risk register, both of which are available on request. The following table gives high level detail: Risk Mitigation Meeting the phasing deadline & NHSE target. Extended Access is a standing item at the weekly

GPFV Team meetings. The phasing of Locality extended access services are supported by regular locality project meetings. The CCG Extended Access Delivery Plan has provided sufficient assurance to NHSE Central Midlands and has been rated Green.

Information Governance- GP practices anxious and unwilling to share records.

CCG officers are working closely with GP federations on this requirement ensuring the necessary “Fair Processing” communications are in place. This is also building on the “My Care Record” work to date.

Service Model doesn’t meet need.

The project team will work with providers to undertake service audits (fill rate, DNAs etc) & 6 month review.

Insufficient existing local primary care workforce – As part of service preparation, locality federations are

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localities unable to deliver the service. asking all staff for their availability to deliver an extended access service.

Individual practices fail to engage. The CCG is commissioning the extended access service from locality federations with the explicit requirement this is practices working collaboratively at scale. As part of this work programme locality federations are asked to review their partnership agreements to mitigate this issue. The service offer is underpinned by an Extended Access service specification and APMS contract. The APMS contract stipulates co-operation of all practices to ensure that 100% of locality population can access the service.

7. Recommendations Joint Co-Commissioning Committee members are asked to discuss and note the content of the paper and progress this far, including the next steps underway in section 8.

8. Next Steps These are the next steps being taken forward by the project group: December & January 2018:

1. Sharing of the Extended Access service specification and APMS contract with Ephedra with a view to signing the contract in January/ early February 2018.

2. Share the Extended Access service specification with Stevenage Health. 3. Amend Fair Processing Notice and circulate to practices. 4. Complete IT system configuration and testing. 5. Commence next phase of communications and engagement as per NHSE

communications guide and resource pack. 6. Hold CCG Extended Access workshop for the locality federations scheduled for 31st

January 2018. 7. Continue work with Stevenage Health as part of their extended access go-live

scheduled for Q2 2018/19. 8. Review and refresh as appropriate roll-out timetable across the other 4 localities.

February- March 2018.

1. Complete IT system configuration and testing. 2. Continue with Communications and engagement work programme. 3. In relation to point 8 outlined above, commence next set of pilot(s) accordingly.

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Agenda Item No: 9



Paper Title: GPFV Update


Report author: Denise Boardman -Programme Director James Gleed Associate Director Primary Care

Report signed off by: Denise Boardman -Programme Director

Executive Summary:

A PowerPoint presentation will be presented to the JCC to provide an update on the following GPFV work streams:

1. Active Signposting Training (Care Navigation) 2. General Practice Online Consultations 3. GP Resilience Programme

The first 2 items of the presentation are part of the GPFV 10 High Impact actions to support and address rising General Practice work load. The update provided describes what items 1 and 2 aspire to offer, impacts they have or are making elsewhere and local plans.


Yes No


To discuss and note the update.

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No Conflicts of Interest identified.

General Practice Forward View (GPFV) Update

Joint Co-commissioning

Committee

Denise Boardman CCG Programme Director James Gleed Associate Director Primary Care

GPFV Update 3 areas to be covered: 1. Active Signposting Training (Care Navigation)

2. General Practice Online Consultations

3. GP Resilience Programme

Active Signposting (Care Navigation)

• West Wakefield 1st April 2016- 31st October 2016: 13, 684 interventions made;

• Saving 1,685 GP appointments;

• 2017/18: 18 Practices: 92% of signposts accepted by patients & 97% happy with the outcome.

Success is General Practice forming close working relationships with other primary care and 3rd sector providers.

https://www.google.co.uk/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiS8In3067WAhVJOBoKHf9TDHUQjRwIBw&url=https://www.slideshare.net/rvarnam/161129-future-of-primary-care-wessex-ahsn&psig=AFQjCNFr-dSzL2ZXxVzbrfDtuQaqtZePsw&ust=1505821117460134

Active Signposting Training

• Clerical staff are trained to actively signpost patients to the most appropriate service.

• Studies show this can free up – 5-10% GP time to care and improving patient access through improve coordination and integration with other services.

• Receptionists acting as care navigators can ensure the patient is booked with the right person first time.

• Reception staff are given training and access to the directory of information about services, in order to help them direct patients to the most appropriate source of help or advice.

• This may include services in the community such as pharmacy and Herts Helps as well as within the practice (such as practice nurse appointments).

3 Months

Designing Local Model Workshop • Introduction to CN • Mapping Services • Creating a DOS • Review Access Pathways • Prioritisation of Service • Identify top six care navigation services • Data Quality, GP leads, Comms, PM,

Receptionists, Providers

Task & Finish Group • 6 Provider Groups • Access criteria • 10-12 per table • Demo local clinical

template • WW practice visit

feedback • Same participants

Face to Face Training Event ‘Go Live’

• 50 Per event • 3 hours • 2 Sessions Per Day • Can do this multiple times

Evaluation & Rolling

Programme

On-Line Training • 30 Mins – 2 Hrs • Can dip in and out

Developing service

pathways

West Wakefield Health & Wellbeing Care Navigation Timeline

Workshops

Independent

No more than 6 weeks between these

Practice Visit • Max 4 people per visit

Go Live

General Practice Online Consultations • NHS England is using technology to empower patients and make it easier for clinicians

to deliver high quality care and enabling patients to seamlessly navigate the service as part of its digital transformation strategy

• General Practice Forward View, a £45 million fund has been created to contribute towards the costs for practices to purchase online consultation systems, improving access and making best use of clinicians’ time.

• All 3 STP CCGs have put a bid in – ENHCCG £148,000 for project support to take this forward.

• Rapid development of a number of online consultation systems for patients to connect

with their general practice.

• Using a mobile app or online portal:

o Patients can tell the practice about their query or problem, and receive a reply, prescription, call back or other kind of appointment

o Access information about symptoms and treatment, supporting greater use of self care.

https://www.england.nhs.uk/digitaltechnology/info-revolution/empowering-people/

http://www.england.nhs.uk/gpfv

General Practice Online Consultations In early adopter practices have found:

o Popular with patients of all ages

o Enable patients to access information about symptoms, conditions and treatments, and connect to self help options

o Free up time for GPs, allowing them to spend more time managing complex needs

o Some issues are resolved by the patient themselves, or by another member of the practice team

o Others are managed by the GP entirely remotely, with about 1/3 of online consultations being followed up with a face to face consultation.

GP Resilience Programme (GPRP) o NHSE England wrote to CCGs in December 2017 advising additional allocation

for 2017-18 to support groups of practices and primary care at scale.

o Stipulated must be a single STP submission. Estimated allocation £60-70K per STP. WECCG was excluded for the purposes of this exercise.

o Process required localities or groups of practices to be prioritised based on need for resilience and likelihood of a sustainable difference being made.

o HVCCG and ENHCCG worked with the LMC to agree STP priority: 2 groups of

ENH practices selected and put forward with rationale that the planned use of the resource would work well across two groups.

o NHSE GPRP panel met 17 January 2018; outcome of Herts STP bid is awaited.

o LMC has scheduled a meeting with CCGs to review outcome of the practice diagnostic work completed to-date under the GPRP and agree future collaborative plans to take this work forward.

Any Questions?

joint co-commissioning committee agenda · 1/25/2018 · emily perry, project officer, east and...

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