leicester city clinical commissioning group west leicestershire...

Leicester City Clinical Commissioning Group

West Leicestershire Clinical Commissioning Group

East Leicestershire and Rutland Clinical Commissioning Group

`

Meeting Title

Primary Care Commissioning Committees meetings (meetings in common) – held in Public

Date Tuesday 3 December 2019

Meeting no. 1 Time

9:00am – 9:30am – pre-meet of the LLR CCGs’ PCCC Chairs 9.30am – 12.00pm – PCCC meetings in common

Chair Ms Fiona Barber Deputy Chair and Independent Lay Member (ELR CCG)

Venue / Location

LOROS Professional Development Centre, Groby Road, Leicester, LE3 9QE.

REF AGENDA ITEM ACTION PRESENTER PAPER TIMING

PCCCs/19/1 Welcome and Introductions

Fiona Barber 9:30am

PCCCs/19/2

Apologies for Absence: Leicester City CCG:

o Ms Fay Bayliss o Nainani Sulaxni

West Leicestershire CCG: o Ash Kothari

East Leicestershire and Rutland CCG: o Mr Clive Wood

Fiona Barber verbal 9:30am

PCCCs/19/3 Notification of Any Other Business Fiona Barber verbal 9:30am

PCCCs/19/4 Declarations of Interest on Agenda Topics

Fiona Barber verbal 9:35am

PCCCs/19/5

To receive questions from the Public in relation to items on the agenda only

Fiona Barber verbal

9:40am

PCCCs/19/6

Terms of reference for the Primary Care Commissioning Committee meetings in common

To receive

Richard Morris

A 9:50am

PCCCs/19/7

Minutes of the meetings held: Leicester City CCG PCCC meeting held on 5

November 2019

West Leicestershire CCG PCCC meeting held on 26 November 2019 (minutes will therefore be presented to the next meeting)

East Leicestershire and Rutland CCG meeting held on Tuesday 5 November 2019

To approve

Fiona Barber

B1

B2

10:00am

PCCCs/19/8

Matters arising and actions for the meetings held: Leicester City CCG PCCC meeting held on

West Leicestershire CCG PCCC meeting held on 26 November 2019 (actions log will therefore be presented to the next meeting)

East Leicestershire and Rutland CCG meeting held on Tuesday 5 November 2019.

To receive

Fiona Barber

C1

C2

10:10am

Leicester City Clinical Commissioning Group

West Leicestershire Clinical Commissioning Group


`

REF AGENDA ITEM ACTION PRESENTER PAPER TIMING

ITEMS FOR DECISION, ACTION AND ESCALATION

PCCCs/19/9 LLR International GP Recruitment Programme To

approve Tine Julhert

D 10:20am

PCCCs/19/10 GP Five Year Forward View Investment update

To receive

Tim Sacks E 10:40am

PCCCs/19/11 Training Hubs update To

approve Ian Potter F and

Presentation 10:55am

PCCCs/19/12 Out of area patient registration arrangements To

receive Cal Deane G 11:15am

PCCCs/19/13 Primary Care Network (PCN) development plan update

To receive

Tim Sacks H 11:25am

PCCCs/19/14 Christmas and New Year 2019/20 cover arrangements for GP Practices across LLR

To receive

Tim Sacks I 11:40am

ANY OTHER BUSINESS

PCCCs/19/15 Items of any other business. To

receive Fiona Barber

verbal 11:50am

The next meeting of the LLR CCGs’ Primary Care Commissioning Committee meetings in common will take place on Tuesday 4 February 2020, venue to be confirmed

12:00pm

Blank Page

Leicester City Clinical Commissioning Group West Leicestershire Clinical Commissioning Group


Name of meeting: LLR CCGs’ Primary Care Commissioning Committee meetings in common

Date: 3 December 2019 Paper: A

Public Confidential Report title:

LLR CCGs’ Primary Care Commissioning Committee meetings in common terms of reference, work programme and meeting dates

Presented by: Richard Morris, Director of Operations and Corporate Affairs, LC CCG

Report author: Daljit K. Bains, Head of Corporate Governance and Legal Affairs, ELR CCG Jo Grizzell, Head of Corporate Affairs, LC CCG Stuart Fletcher, Head of Governance, WL CCG

Executive lead: Richard Morris, Director of Operations and Corporate Affairs, LC CCG

Action required: Receive for information only: Progress update: For assurance: For approval / decision:

Executive summary: 1. In October 2019, the Governing Bodies of Leicester City CCG, West Leicestershire CCG and East Leicestershire and Rutland CCG approved a new collaborative governance structure across the three CCGs. The new governance arrangements provide a more efficient structure supporting further collaborative decision making across the three CCGs.

2. The Primary Care Commissioning Committee (PCCC) of each CCG has been established by NHS England through a Delegation Agreement with each respective organisation. It is through this agreement that NHS England has delegated some of its primary care functions to be fulfilled by the respective Primary Care Commissioning Committees. This means that these committees should only be overseeing and be responsible for the areas of responsibility in line with the Delegation Agreement and that the delegated functions cannot be delegated onwards to another committee. The remaining primary care functions and budgets remains the responsibility of each CCG’s Governing Body.

3. The respective Governing Bodies agreed for the three Primary Care

Commissioning Committees to meet separately on a bi-monthly basis, and on alternate months meet in common to discuss matters common across each of the PCCCs (i.e. month 1 CCG specific meetings, month 2 PCCC meetings in common, and so on). The rationale for this is that the delegated functions from NHS England are the same across all three CCGs so there are common areas of discussion and decision. By holding meetings in common on alternate months it would enable each of the CCGs to learn from the experiences and knowledge of others and ensure a more common and consistent approach where desirable, including around policy application. The CCG specific PCCC meetings will enable each organisation to continue to review the matters specific to its geographic footprint.

4. As a CCG specific committee or committees in common, there are

minimal changes to the terms of reference as each PCCC will still be

Aligned to Strategic Objectives Leicester City CCG West Leicestershire CCG East Leicestershire and

Rutland CCG

Implications a) Conflicts of

interest: None identified.

b) Alignment to Board Assurance Framework

The Committees support with oversight and management of primary care co-commissioning risks and escalate to the Governing Bodies as appropriate.

c) Resource and financial implications

None identified.

d) Quality and patient safety implications

None identified.

e) Patient and public involvement

None identified.

f) Equality analysis and due regard

Due regard has not be undertaken in respect of this report, however the reports considered by the Committees in common will ensure due regard to the public sector equality duty as required.

required to make its own decisions, although the meetings will be held in a common place and time.

5. The terms of reference to support the meetings in common are as at

Appendix 1; the work programme as at Appendix 2 which will assist with planning for the Committee meetings in line with its terms of reference. The work programme will be reviewed annually.

6. Appendix 3 contains the dates for future meetings.

Appendices: • Appendix 1 – Primary Care Commissioning Committee (committees in common) terms of reference

• Appendix 2 – Primary Care Commissioning Committee (committees in common) work programme

• Appendix 3 – meeting dates

Recommendations:

The LLR CCGs’ Primary Care Commissioning Committees are asked to: • RECEIVE the terms of reference and work programme for the meetings in

common as approved by the Governing Bodies of the respective CCGs.

• NOTE the dates of future meetings.

Report history and prior review:

• LLR CCGs’ Governing Body meetings in October 2019 where approval was received.

2

Appendix 1



1

LEICESTER CITY, WEST LEICESTERSHIRE, AND EAST LEICESTERSHIRE AND RUTLAND CLINCIAL COMMISSIONING GROUPS

PRIMARY CARE COMMISSIONING COMMITTEE

(Committees-in-common)

Terms of Reference (v6, October 2019) Constitution 1. In accordance with its statutory powers under section 13Z of the National Health

Service Act 2006 (as amended), NHS England has delegated the exercise of the functions specified in Schedule 2 of the Delegation Agreement to East Leicestershire and Rutland CCG. The delegation is set out in Annex 1 of these terms of reference.

2. NHS East Leicestershire and Rutland Clinical Commissioning Group, NHS

Leicester City Clinical Commissioning Group and NHS West Leicestershire Clinical Commissioning Group (collectively referred to as the “LLR CCGs” or individually “CCG”) have each established the Primary Care Commissioning Committee (“Committee”). All three Primary Care Commissioning Committees will meet in common (collectively referred to as the PCCCs or the Committees). The Committees will function as a corporate decision-making body for the management of the delegated functions and the exercise of the delegated powers. These terms of reference shall effect as if incorporated into the respective CCG’s Constitutions.

3. The Committees comprise representatives from the respective CCGs. Statutory Framework 4. NHS England has delegated to each CCG authority to exercise the primary care

commissioning functions set out in Schedule 2 of the Delegation Agreement (see Annex 1 to the terms of reference) in accordance with section 13Z of the NHS Act.

5. Arrangements made under section 13Z may be on such terms and conditions

(including terms as to payment) as may be agreed between the Board and the CCG.

6. Arrangements made under section 13Z do not affect the liability of NHS England for the exercise of any of its functions. However, the CCGs acknowledge that in exercising its functions (including those delegated to it), it must comply with the statutory duties set out in Chapter A2 of the NHS Act and including: a) Management of conflicts of interest (section 14O); b) Duty to promote the NHS Constitution (section 14P);



2

c) Duty to exercise its functions effectively, efficiently and economically (section 14Q);

d) Duty as to improvement in quality of services (section 14R); e) Duty in relation to quality of primary medical services (section 14S); f) Duties as to reducing inequalities (section 14T); g) Duty to promote the involvement of each patient (section 14U); h) Duty as to patient choice (section 14V); i) Duty as to promoting integration (section 14Z1); j) Public involvement and consultation (section 14Z2).

7. The LLR CCGs will also need to specifically, in respect of the delegated functions

from NHS England, exercise those set out below:

Duty to have regard to impact on services in certain areas (section 13O);

Duty as respects variation in provision of health services (section 13P).

8. The Committees are established as a committee of each of the respective CCG Governing Bodies in accordance with Schedule 1A of the “NHS Act”.

9. The members acknowledge that the Committees are subject to any directions

made by NHS England or by the Secretary of State. Role of the Committees 10. The Committees have been established in accordance with the above statutory

provisions to enable the members to make collective decisions on the review, planning and procurement of primary care services in each of the respective CCG areas under delegated authority from NHS England.

11. In performing its role each of the Committees will exercise its management of the functions in accordance with the agreement entered into between NHS England and each of the respective CCGs, which will sit alongside the delegation and terms of reference.

12. The functions of the Committees are undertaken in the context of a desire to

promote increased co-commissioning to increase quality, efficiency, productivity and value for money and to remove administrative barriers.

13. The role of the Committees shall be to carry out the functions relating to the

commissioning of primary medical services under section 83 of the NHS Act.

14. This includes the following:

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



3

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

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

Decision making on whether to establish new GP practices in an area;

Approving practice mergers; and

Making decisions on ‘discretionary’ payment (e.g., returner/retainer schemes). 15. The CCGs will also carry out the following activities:

a) To plan, including needs assessment, primary medical care services in each

of the respective CCG area;

b) To undertake reviews of primary medical care services in each of the respective CCG area;

c) To co-ordinate a common approach to the commissioning of primary care

services generally;

d) To manage the budget for commissioning of primary medical care services in each of the respective CCG area.

Geographical Coverage 16. Each Committee will comprise of its respective CCG. Membership 17. The membership of the Committees of each of the CCGs will be as follows:



4

Members / attendees

ELR CCG WL CCG LC CCG

Members Independent Lay Member – Chair of Committee

Independent Lay Member – Vice Chair of Committee

Chief Operating Officer

Chief Finance Officer

Chief Nurse and Quality Officer

Independent Lay Member – Chair of Committee


Executive roles covering: primary care; finance and planning; Board Nurse; and performance and assurance (4 Executive Leads)

Independent Lay Member – Chair of Committee


Director of Finance

Deputy Director of Nursing and Quality,

Director of Operations and Corporate Affairs

Director of Strategy and Implementation

Attendees 3 x GP Governing Body members and / or clinical leads as appropriate

Head of Corporate Governance

Heads of Primary Care

Heads of Primary Care Contracts (NHS England) – advisory role

A representative from Health and Wellbeing Boards (Rutland and Leicestershire)

A representative from Healthwatch (Rutland and, Leicestershire)

A representative from the Leicester, Leicestershire and Rutland Local Medical Committee

Representatives from Public Health (e.g. Public Health Consultant)

3 x GP Governing Body members

Heads of Primary Care

Heads of Primary Care Contracts (NHS England) – advisory role

A representative from Health and Wellbeing Boards (Leicestershire)

A representative from Healthwatch (Leicestershire)



3 x GP Governing Body members and / or clinical leads as appropriate

Head of Primary Care

Head of Primary Care Contracts (NHS England) – advisory role

A representative from Health and Wellbeing Boards (Leicester City)

A representative from Healthwatch (Leicester City)



18. The Chair of the Committees shall be an independent lay member, who is not the

Chair of the Audit Committees of the respective CCGs, as the Audit Committees will be responsible for reviewing and scrutinising the decision-making processes of the PCCCs.

19. The Vice Chair of the Committees shall be an independent lay member who is

not the Chair of the Audit Committees.



5

20. The role of the Chair of the meeting (when meetings held in common) will be rotated every four months between the three CCGs.

21. Those in attendance cannot vote at meetings, this will include representatives from the local Health and Wellbeing Boards and the local HealthWatch. Representatives from these organisations will be sent a standing invite.

22. Should members of the Committees not be able to attend, nominated deputies,

with appropriate delegated authority, may take their place in agreement with the Chair of the Committee.

Meetings and Voting 23. The Committees will operate in accordance with the respective CCG’s Standing

Orders. The secretarial support for the Committees will be provided by the corporate affairs lead(s). The secretary to the Committees will be responsible for giving notice of meetings. This will be accompanied by an agenda and supporting papers and sent to each member representative no later than 7 days before the date of the meeting. When the Chairs of the Committees deem it necessary in light of the urgent circumstances to call a meeting at short notice, the notice period shall be in line with the respective CCG Standing Orders.

24. Each voting member of the Committees shall have one vote. The Committees shall reach decisions by a simple majority of members present, but with the respective Chairs having a second and deciding vote, if necessary. However, the aim of each of the Committees will be to achieve consensus decision-making wherever possible.

Quorum 25. The quorum for each of the Committees will be the following from each CCG (the

titles may vary across the CCGs):

Chair of the Committee or Vice Chair

Chief Operating Officer / Director of Operations and Corporate Affairs or equivalent across the three CCGs (individual with executive lead for primary care) or deputy

Chief Finance Officer / Director of Finance or respective deputies

Chief Nurse and Quality Officer (ELR CCG) / Chief Nurse and Quality Lead 9(WL CCG) / Deputy Director of Nursing and Quality (LC CCG) / or respective deputies

3 x GP members from each CCG (although GP members are in attendance and cannot vote, the Committees will ensure there is representation from one of the GPs from each CCG at the meetings, unless they are conflicted, in which case the meeting will proceed). Meetings will be quorate without a GP member present.



6

26. Where there are specific decisions to be made on behalf of individual

organisations, the quoracy for each CCG must be met. Frequency of meetings 27. The Committees will meet in common on alternate months with a CCG specific

meeting held in the intervening months in line with the Constitutions of the respective CCGs.

28. Meetings of the Committees shall:

a) be held in public, subject to the application of 23(b);

b) the Committee may resolve to exclude the public from a meeting that is open to the public (whether during the whole or part of the proceedings) whenever publicity would be prejudicial to the public interest by reason of the confidential nature of the business to be transacted or for other special reasons stated in the resolution and arising from the nature of that business or of the proceedings or for any other reason permitted by the Public Bodies (Admission to Meetings) Act 1960 as amended or succeeded from time to time.

29. Members of the Committees have a collective responsibility for the operation of

the Committees. They will participate in discussion, review evidence and provide objective expert input to the best of their knowledge and ability, and endeavour to reach a collective view.

30. The Committees may delegate tasks to such individuals, sub-committees or

individual members as it shall see fit, provided that any such delegations are consistent with the parties’ relevant governance arrangements, are recorded in a scheme of delegation, are governed by terms of reference as appropriate and reflect appropriate arrangements for the management of conflicts of interest.

31. The Committees may call additional experts to attend meetings on an ad hoc

basis to inform discussions. 32. Members of the Committees shall respect confidentiality requirements as set out

in the respective CCG’s Constitution and information governance policies. 33. The Committees will present its minutes to Central Midlands Local Team of NHS

England and the respective Governing Bodies of East Leicestershire and Rutland CCG, Leicester City CCG and West Leicestershire CCG following each meeting for information, including the minutes of any sub-committees to which responsibilities are delegated under paragraph 30 above.



7

34. The CCG will also comply with any reporting requirements set out in its Constitution.

35. It is envisaged that these Terms of Reference will be reviewed from time to time,

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

Accountability of the Committees 36. Budget and resource accountability arrangements and the decision-making scope

of the Committees are as delegated. In the event of any conflict between the terms of this Scheme of Delegation and Terms of Reference and the respective CCG’s Standing Orders and Prime Financial Policies, the Delegation will prevail.

37. The appropriate consultation will take place with members of the respective CCG

and members of the public in line with the respective CCG’s Constitutions.

Procurement of Agreed Services 38. The detailed arrangements regarding procurement will be set out in the

delegation agreement. Decisions 39. The Committees will make decisions within the bounds of its remit.

40. The decisions of the Committees shall be binding on NHS England and each of

the respective CCGs. 41. The Committees will produce an executive summary report which will be

presented to Central Midlands Local Team of NHS England and the Governing Body of East Leicestershire and Rutland of the CCG each month for information.

Administration 42. The administration and minute taking for the Primary Care Commissioning

Committees is the responsibility of the Corporate Affairs function.

Conduct of the Committee and Conflicts of Interest 43. The Committees shall conduct their business in accordance with national

guidance, relevant codes of practice including the Nolan Principles and the Management of Conflicts of Interest Policy.

44. Members are required to state for the record any interest relating to any matter to

be considered at each meeting. These conflicts will be recorded in the minutes,



8

and where necessary an individual may be asked to withdraw from the meeting for that part of the agenda.

45. The corporate affairs leads of each CCG will be responsible for reviewing the agendas and papers in advance of the meeting and advising on conflict matters accordingly ahead of the meeting to enable the Chair of the Committee to manage effectively any actual or perceived conflicts of interest in an open and transparent way.

46. Should the Chair of the meeting have a conflict of interest which necessitates his or her absence from the meeting, the role of Chair should be undertaken by one of the other Lay Members present.

47. A review of the Committees membership and terms of reference will be submitted

to the Governing Bodies on an annual basis. Equality Statement 48. The CCGs are committed to promoting equality in all their responsibilities – as

commissioner of services, as a partner in the local economy and as an employer. All committees of the Governing Bodies have a duty to ensure that it contributes to ensuring that all users and potential users of services and employees are treated fairly and respectfully with regard to the protected characteristics of age, disability, gender reassignment, marriage or civil partnership, pregnancy and maternity, race, religion, sex and sexual orientation.

Review 49. These Terms of Reference will be reviewed on an annual basis or sooner if

required with recommendations made to the CCG Governing Bodies for approval.

Date approved: 8 October 2019 by LLR CCGs’ Governing Bodies Review date: October 2020



9

Annex 1 – Delegated Functions, Schedule 2 of the Delegated Agreement

Schedule 2

Delegated Functions

Part 1: Delegated Functions: Specific Obligations

1. Introduction

1.1. This Part 1 of Schedule 2 (Delegated Functions) sets out further

provision regarding the carrying out of each of the Delegated Functions.

2. Primary Medical Services Contract Management

2.1. The CCG must:

2.1.1. manage the Primary Medical Services Contracts on behalf of

NHS England and perform all of NHS England’s obligations

under each of the Primary Medical Services Contracts in

accordance with the terms of the Primary Medical Services

Contracts as if it were named in the contract in place of NHS

England;

2.1.2. actively manage the performance of the counter-party to the

Primary Medical Services Contracts in order to secure the needs

of people who use the services, improve the quality of services

and improve efficiency in the provision of the services including

by taking timely action to enforce contractual breaches and serve

notice;

2.1.3. ensure that it obtains value for money under the Primary Medical

Services Contracts on behalf of NHS England and avoids making

any double payments under any Primary Medical Services

Contracts;

2.1.4. comply with all current and future relevant national Guidance

regarding PMS reviews and the management of practices

receiving Minimum Practice Income Guarantee (MPIG) (including

without limitation the Framework for Personal Medical Services

(PMS) Contracts Review guidance published by NHS England in



10

September 2014 (http://www.england.nhs.uk/wp-

content/uploads/2014/09/pms-review-guidance-sept14.pdf));

2.1.5. notify NHS England immediately (or in any event within two (2)

Operational Days) of any breach by the CCG of its obligations to

perform any of NHS England’s obligations under the Primary

Medical Services Contracts;

2.1.6. keep a record of all of the Primary Medical Services Contracts

that the CCG manages on behalf of NHS England setting out the

following details in relation to each Primary Medical Services

Contract:

2.1.6.1. name of counter-party;

2.1.6.2. location of provision of services; and

2.1.6.3. amounts payable under the contract (if a contract sum

is payable) or amount payable in respect of each

patient (if there is no contract sum).

2.2. For the avoidance of doubt, all Primary Medical Services Contracts will

be in the name of NHS England.

2.3. The CCG must comply with any Guidance in relation to the issuing and

signing of Primary Medical Services Contracts in the name of NHS

England.

2.4. Without prejudice to clause Error! Reference source not found.

(Financial Provisions and Liability) or paragraph 2.1 above, the CCG

must actively manage each of the relevant Primary Medical Services

Contracts including by:

2.4.1. managing the relevant Primary Medical Services Contract,

including in respect of quality standards, incentives and the QOF,

observance of service specifications, and monitoring of activity

and finance;

2.4.2. assessing quality and outcomes (including clinical effectiveness,

patient experience and patient safety);

http://www.england.nhs.uk/wp-content/uploads/2014/09/pms-review-guidance-sept14.pdf

http://www.england.nhs.uk/wp-content/uploads/2014/09/pms-review-guidance-sept14.pdf



11

2.4.3. managing variations to the relevant Primary Medical Services

Contract or services in accordance with national policy, service

user needs and clinical developments;

2.4.4. agreeing information and reporting requirements and managing

information breaches (which will include use of the HSCIC IG

Toolkit SIRI system);

2.4.5. agreeing local prices, managing agreements or proposals for

local variations and local modifications;

2.4.6. conducting review meetings and undertaking contract

management including the issuing of contract queries and

agreeing any remedial action plan or related contract

management processes; and

2.4.7. complying with and implementing any relevant Guidance issued

from time to time.

Enhanced Services

2.5. The CCG must manage the design and commissioning of Enhanced

Services, including re-commissioning these services annually where

appropriate.

2.6. The CCG must ensure that it complies with any Guidance in relation to

the design and commissioning of Enhanced Services.

2.7. When commissioning newly designed Enhanced Services, the CCG

must:

2.7.1. consider the needs of the local population in the Area;

2.7.2. support Data Controllers in providing ‘fair processing’ information

as required by the DPA;

2.7.3. develop the necessary specifications and templates for the

Enhanced Services, as required to meet the needs of the local

population in the Area;

2.7.4. when developing the necessary specifications and templates for

the Enhanced Services, ensure that value for money will be

obtained;



12

2.7.5. consult with Local Medical Committees, each relevant Health and

Wellbeing Board and other stakeholders in accordance with the

duty of public involvement and consultation under section 14Z2

of the NHS Act;

2.7.6. obtain the appropriate read codes, to be maintained by the

HSCIC;

2.7.7. liaise with system providers and representative bodies to ensure

that the system in relation to the Enhanced Services will be

functional and secure; and

2.7.8. support GPs in entering into data processing agreements with

data processors in the terms required by the DPA.

Design of Local Incentive Schemes

2.8. The CCG may design and offer Local Incentive Schemes for GP

practices, sensitive to the needs of their particular communities, in

addition to or as an alternative to the national framework (including as an

alternative to QOF or directed Enhanced Services), provided that such

schemes are voluntary and the CCG continues to offer the national

schemes.

2.9. There is no formal approvals process that the CCG must follow to

develop a Local Incentive Scheme, although any proposed new Local

Incentive Scheme:

2.9.1. is subject to consultation with the Local Medical Committee;

2.9.2. must be able to demonstrate improved outcomes, reduced

inequalities and value for money; and

2.9.3. must reflect the changes agreed as part of the national PMS

reviews.

2.10. The ongoing assurance of any new Local Incentive Schemes will form

part of the CCG’s assurance process under the CCG Assurance

Framework.



13

2.11. Any new Local Incentive Scheme must be implemented without prejudice

to the right of GP practices operating under a GMS Contract to obtain

their entitlements which are negotiated and set nationally.

2.12. NHS England will continue to set national standing rules, to be reviewed

annually, and the CCG must comply with these rules which shall for the

purposes of this Agreement be Guidance.

Making Decisions on Discretionary Payments

2.13. The CCG must manage and make decisions in relation to the

discretionary payments to be made to GP practices in a consistent, open

and transparent way.

2.14. The CCG must exercise its discretion to determine the level of payment

to GP practices of discretionary payments, in accordance with the

Statement of Financial Entitlements Directions.

Making Decisions about Commissioning Urgent Care for Out of Area

Registered Patients

2.15. The CCG must manage the design and commissioning of urgent care

services (including home visits as required) for its patients registered out

of area (including re-commissioning these services annually where

appropriate).

2.16. The CCG must ensure that it complies with any Guidance in relation to

the design and commissioning of these services.

3. Planning the Provider Landscape

3.1. The CCG must plan the primary medical services provider landscape in

the Area, including considering and taking decisions in relation to:

3.1.1. establishing new GP practices in the Area;

3.1.2. managing GP practices providing inadequate standards of

patient care;



14

3.1.3. the procurement of new Primary Medical Services Contracts (in

accordance with any procurement protocol issued by NHS

England from time to time);

3.1.4. closure of practices and branch surgeries;

3.1.5. dispersing the lists of GP practices;

3.1.6. agreeing variations to the boundaries of GP practices; and

3.1.7. coordinating and carrying out the process of list cleansing in

relation to GP practices, according to any policy or Guidance

issued by NHS England from time to time.

3.2. In relation to any new Primary Medical Services Contract to be entered

into, the CCG must, without prejudice to any obligation in Schedule 2,

Part 2, paragraph 3 (Procurement and New Contracts) and Schedule 2,

Part 1, paragraph 2.3:

3.2.1. consider and use the form of Primary Medical Services Contract

that will ensure compliance with NHS England’s obligations

under Law including the Public Contracts Regulations 2015/102

and the National Health Service (Procurement, Patient Choice

and Competition) (No. 2) Regulations 2013/500 taking into

account the persons to whom such Primary Medical Services

Contracts may be awarded;

3.2.2. provide to NHS England confirmation as required from time to

time that it has considered and complied with its obligations

under this Agreement and the Law; and

3.2.3. for the avoidance of doubt, Schedule 5 (Financial Provisions and

Decision Making Limits) deals with the sign off requirements for

Primary Medical Services Contracts.

4. Approving GP Practice Mergers and Closures

4.1. The CCG is responsible for approving GP practice mergers and GP

practice closures in the Area.

4.2. The CCG must undertake all necessary consultation when taking any

decision in relation to GP practice mergers or GP practice closures in the



15

Area, including those set out under section 14Z2 of the NHS Act (duty for

public involvement and consultation). The consultation undertaken must

be appropriate and proportionate in the circumstances and should

include consulting with the Local Medical Committee.

4.3. Prior to making any decision in accordance with this paragraph 4

(Approving GP Practice Mergers and Closures), the CCG must be able to

clearly demonstrate the grounds for such a decision and must have fully

considered any impact on the GP practice’s registered population and

that of surrounding practices. The CCG must be able to clearly

demonstrate that it has considered other options and has entered into

dialogue with the GP contractor as to how any closure or merger will be

managed.

4.4. In making any decisions pursuant to paragraph 4 (Approving GP Practice

Mergers and Closures), the CCG shall also take account of its obligations

as set out in Schedule 2, part 2, paragraph 3 (Procurement and New

Contracts), where applicable.

5. Information Sharing with NHS England in relation to the Delegated

Functions

5.1. This paragraph 5 (Information Sharing with NHS England) is without

prejudice to clause 9.4 or any other provision in this Agreement. The

CCG must provide NHS England with:

5.1.1. such information relating to individual GP practices in the Area as

NHS England may reasonably request, to ensure that NHS

England is able to continue to gather national data regarding the

performances of GP practices;

5.1.2. such data/data sets as required by NHS England to ensure

population of the primary medical services dashboard;

5.1.3. any other data/data sets as required by NHS England; and

5.1.4. the CCG shall procure that providers accurately record and

report information so as to allow NHS England and other

agencies to discharge their functions.



16

5.2. The CCG must use the NHS England approved primary medical services

dashboard, as updated from time to time, for the collection and

dissemination of information relating to GP practices.

5.3. The CCG must (where appropriate) use the NHS England approved GP

exception reporting service (as notified to the CCGs by NHS England

from time to time).

5.4. The CCG must provide any other information, and in any such form, as

NHS England considers necessary and relevant.

5.5. NHS England reserves the right to set national standing rules (which may

be considered Guidance for the purpose of this Agreement), as needed,

to be reviewed annually. NHS England will work with CCGs to agree

rules for, without limitation, areas such as the collection of data for

national data sets and IT intra-operability. Such national standing rules

set from time to time shall be deemed to be part of this Agreement.

6. Making Decisions in relation to Management of Poorly Performing GP

Practices

6.1. The CCG must make decisions in relation to the management of poorly

performing GP practices and including, without limitation, decisions and

liaison with the CQC where the CQC has reported non-compliance with

standards (but excluding any decisions in relation to the performers list).

6.2. In accordance with paragraph 6.1 above, the CCG must:

6.2.1. ensure regular and effective collaboration with the CQC to

ensure that information on general practice is shared and

discussed in an appropriate and timely manner;

6.2.2. ensure that any risks identified are managed and escalated

where necessary;

6.2.3. respond to CQC assessments of GP practices where

improvement is required;



17

6.2.4. where a GP practice is placed into special measures, lead a

quality summit to ensure the development and monitoring of an

appropriate improvement plan (including a communications plan

and actions to manage primary care resilience in the locality);

and

6.2.5. take appropriate contractual action in response to CQC findings.

7. Premises Costs Directions Functions

7.1. The CCG must comply with the Premises Costs Directions and will be

responsible for making decisions in relation to the Premises Costs

Directions Functions.

7.2. In particular, but without limiting the generality of paragraph 7.1, the CCG

shall make decisions concerning:

7.2.1. applications for new payments under the Premises Costs

Directions (whether such payments are to be made by way of

grants or in respect of recurring premises costs); and

7.2.2. revisions to existing payments being made under the Premises

Costs Directions.

7.3. The CCG must comply with any decision-making limits set out in

Schedule 5 (Financial Provisions and Decision Making Limits) when

taking decisions in relation to the Premises Costs Directions Functions.

7.4. The CCG will comply with any guidance issued by the Secretary of State

or NHS England in relation to the Premises Costs Directions, including

the Principles of Best Practice, and any other Guidance in relation to the

Premises Costs Directions.

7.5. The CCG must work cooperatively with other CCGs to manage premises

and strategic estates planning.

7.6. The CCG must liaise where appropriate with NHS Property Services

Limited and Community Health Partnerships Limited in relation to the

Premises Costs Directions Functions.



18

Schedule 2

Part 2 – Delegated Functions: General Obligations

1. Introduction

1.1. This Part 2 of Schedule 2 (Delegated Functions) sets out general

provisions regarding the carrying out of the Delegated Functions.

2. Planning and reviews

2.1. The CCG is responsible for planning the commissioning of primary

medical services.

2.2. The role of the CCG includes:

2.2.1. carrying out primary medical health needs assessments (to be

developed by the CCG) to help determine the needs of the local

population in the Area;

2.2.2. recommending and implementing changes to meet any unmet

primary medical services needs; and

2.2.3. undertaking regular reviews of the primary medical health needs of

the local population in the Area.

3. Procurement and New Contracts

3.1. The CCG will make procurement decisions relevant to the exercise of the

Delegated Functions and in accordance with the detailed arrangements

regarding procurement set out in the procurement protocol issued and

updated by NHS England from time to time.

3.2. In discharging its responsibilities set out in clause Error! Reference

source not found. (Performance of the Delegated Functions) of this

Agreement and paragraph 1 of this Schedule 2 (Delegated Functions), the

CCG must comply at all times with Law including its obligations set out in

the National Health Service (Procurement, Patient Choice and

Competition) (No. 2) Regulations 2013/500 and any other relevant

statutory provisions. The CCG must have regard to any relevant



19

guidance, particularly Monitor’s guidance Substantive guidance on the

Procurement, Patient Choice and Competition Regulations

(https://www.gov.uk/government/uploads/system/uploads/attachment_data

/file/283505/SubstantiveGuidanceDec2013_0.pdf).

3.3. Where the CCG wishes to develop and offer a locally designed contract, it

must ensure that it has consulted with its Local Medical Committee in

relation to the proposal and that it can demonstrate that the scheme will:

3.3.1. improve outcomes;

3.3.2. reduce inequalities; and

3.3.3. provide value for money.

4. Integrated working

4.1. The CCG must take an integrated approach to working and co-ordinating

with stakeholders including NHS England, Local Professional Networks,

local authorities, Healthwatch, acute and community providers, the Local

Medical Committee, Public Health England and other stakeholders.

4.2. The CCG must work with NHS England and other CCGs to co-ordinate a

common approach to the commissioning of primary medical services

generally.

4.3. The CCG and NHS England will work together to coordinate the exercise

of their respective performance management functions.

5. Resourcing

5.1. NHS England may, at its discretion provide support or staff to the CCG.

NHS England may, when exercising such discretion, take into account,

any relevant factors (including without limitation the size of the CCG, the

number of Primary Medical Services Contracts held and the need for the

Local NHS England Team to continue to deliver the Reserved Functions).

Approved by: Review:

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/283505/SubstantiveGuidanceDec2013_0.pdf

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/283505/SubstantiveGuidanceDec2013_0.pdf

Appendix 2

AGENDA ITEMS CCG Lead Author Nov Dec Jan Feb March April May June July Aug Sept Oct Nov Dec Jan Feb March

Terms of Reference (review annually)

Work Programme (review annually)

To receive Conflicts of Interest register on at least an annual basis (for onward

reporting to the Audit Committee). (ELR CCG)

To approve sub-group(s) Terms of Reference annually

To receive monthly financal reports for co-commissioing primary medical care

services.

Comment on the draft Primary Care Strategy and commissioning intentions and

make recommendations to the Collaborative Commissioning Committee.

To plan and review primary medical care services in each CCG area including

needs assessment (as required).

Undertake APMS procurements as required (LC CCG)

To review and approve policies and procedures to support the primary care co-

commissionig function (as required).

To receive contractual updates from NHS England (as required).

To review and approve newly designed enhanced services (e.g. Local Enhanced

Services, Directed Enhanced Services) - as required.

To review and approve the design of local incentive schemes as an alternatvie to

the Quality and Outcomes Framework (QOF) - as required.

Receive and review primary care risks and risk highlight report.

To receive and approve Practice mergers (as required).

To receive and approve Practice / Branch closures (as required).

To receive and approve Practice boundary changes (as required).

To receive and approve Practice change in opening hours (e.g. Easter,

Christmas and New Year) (as required).

To receive and approve Practice new builds (as required).

To approve on 'discretionary' payments (e.g. returner / retainer schemes) - as

required

Receive an update on s106 funding (six-monthly). (ELR CCG)

To receive an annual update on Notional Rent Review

East Leicestershire and Rutland CCG,

Leicester City CCG, and West Leicestersire CCG

Primary Care Commissioning Committees - CCG specific and

meetings in common

Work Programme (v2 October 2019)

PRESENTERS AND AUTHORS

1. COMMITTEE ARRANGEMENTS

2. FINANCE

2020/21

5. OPERATIONAL ITEMS

2019/20

3. COMMISSIONING AND STRATEGY

4. POLICY REVIEW

FDR / PMS Investment Resources (as required)

Estates, Technology and Transformation Fund (ETTF) updates

GMS Contract Negotiations update (as required)

GP Patient Experience Survey Results

GP workforce updates (including GP International Recruitment Scheme)

GP resilence work progress updates (as required)

Quality related reports e.g. CQC inspections (as required)

IM&T updates

To receive and comment on the sub-group(s) Terms of Reference annually

Receive reports and approved minutes from the sub-groups

REPORTS FROM SUBGROUPS

Appendix 3

LEICESTER, LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUPS

PRIMARY CARE COMMISSIONING COMMITTEE MEETINGS IN COMMON

Meeting dates 2019 and 2020

Month Meeting Date / time

December 2019 Tuesday 3 December (9:30am-12:30pm) (venue: LOROS)

February 2020 Tuesday, 4 February (9:30am-12:30pm) Room TBC

April 2020 Tuesday, 7 April (9:30am-12:30pm) Room TBC

June 2020 Tuesday, 2 June (9:30am-12:30pm) Room TBC

August 2020 Tuesday, 4 August (9:30am-12:30pm) Room TBC

October 2020 Tuesday, 6 October (9:30am-12:30pm) Room TBC

December 2020 Tuesday, 1 December (9:30am-12:30pm) Room TBC

Page 1 of 1

Blank Page

Paper B1 LLR CCGs’ Primary Care Commissioning Committees meetings in common

3 December 2019

LEICESTER CITY CLINICAL COMMISSIONING GROUP

Minutes of the Primary Care Commissioning Committee held on Tuesday 5 November 2019 at 10.00 am, 4th Floor Conference Room, St Johns House, 30 East Street,

Leicester, LE1 6NB PRESENT: Mr Nick Carter Independent Lay Member/ Chair Dr Avi Prasad Assistant Clinical Chair Dr Tony Bentley North & East HNN Chair Dr Sulaxni Nainani South HNN Chair Dr Rajesh Kapur Central HNN Chair (item 19/161 onwards) Dr Raj Than Left Shift/Integration Lead (item 19/161 onwards) Professor Jeffrey Knight Independent Lay Member Mr Zuffar Haq Independent Lay Member Ms Sue Lock Managing Director (until item 19/159) Mrs Michelle Iliffe Director of Finance (from 19/163 onwards) Mr Richard Morris Director of Operations and Corporate Affairs Ms Sarah Prema Director of Strategy and Implementation Dr Rajiv Wadhwa LMC Representative Mr Jo Johal Healthwatch Leicester and Leicestershire IN ATTENDANCE: Mr Jon Richmond Primary Care Contract Support Manager Mr Cal Deane Interim Head of Primary Care Ms Wendy Hope Lead Nurse Quality & Clinical Care Mr Tom Bailey Primary Care Commissioning NHS England Ms Clare Mair Board Support Officer

ITEM DISCUSSION LEAD RESPONSIBLE

PCCC/19/152

Welcome and Introductions Mr Nick Carter welcomed everyone to the meeting and introductions were made for the one member of public who was present. The Chair advised the Primary Care Co-Commissioning Finance Report for Month 6 would be taken at a later point in the agenda as Ms Iliffe would be late in joining the meeting.

PCCC/19/153

Questions from the Public in relation to items on the Agenda There were no questions from the public.

PCCC/19/154

Quoracy and Apologies for Absence Apologies for absence were received from Professor Azhar Farooqi, Clinical Chair, Dr Gopi Boora, North and West HNN Chair and Mrs Priya Pandya, Primary Care Commissioning Manager.

PCCC/19/155

Declarations of Interest Members were reminded of their obligation to declare any interest they may have on issues arising at committee meetings which might conflict with the business of NHS Leicester City. Declarations of interest by members of the Primary Care Commissioning Committee were listed on the CCG’s Register of Interest. The Register was available either via the Board Support Officer or the CCG website at the

1


3 December 2019

following link: https://www.leicestercityccg.nhs.uk/about-us/primary-care-co-commissioning-public-meeting/2019-primary-care-commissioning-committee-2/primary-care-commissioning-committee-november-2019/ The following declarations of interest were noted: 19/161 - Primary Care Contracts update report A conflict of interest was noted for Dr A Prasad but as the paper was to receive and note it was agreed he could remain for the item. 19/162 – FDR/PMS Reinvestment 2019/20 scheme There was no paper to support this item however all GPs had an interest and dependent on the content of the discussion may need to be excluded for part of the discussion.

PCCC/19/156

Notification of any other business The Chair was not notified of any other business.

PCCC/19/157

Minutes of the Primary Care Commissioning Committee held on Tuesday 1 October 2019 The minutes of the meeting of the Primary Care Commissioning Committee held on Tuesday 1 October 2019 (Paper B) were accepted as an accurate record.

PCCC/19/158

Action Log and Matters Arising from the meeting held on Tuesday 1 October 2019 The action log was reviewed (Paper C). 18/150 – GP Forward View Mr Carter asked if the December PCCC would meet as a committee in common to which Mr Morris advised those arrangements would either commence December 2019 or January 2020. 19/126 – Primary Care Strategy A city representative was needed for the primary care workforce group. Ms Lock advised all clinical representation was currently being discussed by the three LLR clinical chairs. 19/131 - Digital First Primary Care Policy Consultation An update was on the agenda. It was agreed to close the action.

PCCC/19/160

General Practice Quality Highlight Report Ms Wendy Hope, Lead Nurse Quality & Clinical Care, presented a high level report on the number of practices receiving increased support and monitoring (Paper E) and reported that; • 5 practices were currently on the risk log. • No new CQC inspection reports had been issued since the last meeting. As requested at the last meeting Ms Hope had looked at retrospective CQC ratings of Leicester City practice inspections back to April 2017. Ms Hope advised it had been difficult to draw conclusions around percentage of patients

2

https://www.leicestercityccg.nhs.uk/about-us/primary-care-co-commissioning-public-meeting/2019-primary-care-commissioning-committee-2/primary-care-commissioning-committee-november-2019/




3 December 2019

who were with a practice rated as outstanding, good, requires improvement or inadequate because it could take just one practice with a large list size to move from inadequate to good to change the overall position. Mr Carter recapped that the question had been asked because it was perceived the CQC may be becoming more stringent in its inspection process. Ms Hope supported that assertion but also felt practices were responding to the expectations of the CQC. Mr Carter noted that the percentage of the practice population who were now with a practice rated as ‘requires improvement’ had improved. It was RESOLVED

- To receive and note the information contained in the report.

PCCC/19/161

Primary Care Contracts Update Report Mrs Priya Pandya, Primary Care Commissioning Manager reported a number of GP Contract variations had been finalised by end of September 2019 (Paper F) and reported there had been two contract variations; Inclusion of Dr I Farooqi to East Leicester Medical Practic (C82063) and withdrawal of Dr A Nana from Hockley Farm Medical Practice (C82053). It was RESOLVED

- To note the contract variations that had taken place by 30 September 2019.

PCCC/19/162

FDR/PMS Reinvestment 2019/20 scheme Cal Deane, Interim Head of Primary Care reminded the committee that the October PCCC had agreed to delegate a review of the scheme to himself, Sue Lock and Richard Morris. Discussions on the proposals had also taken place with the Leicester City PCN Clinical Directors. The Primary Care Team was now in the process of sending a communication to invite practices to sign up to the FDR/PMS 2019/20 scheme for two years (ending 20/2021) with practices asked to respond by 6 December 2019. Dr Bentley asked if by April 2022 all practices in Leicester City would be receiving the same level of funding per patient, as by that point the seven year differential funding programme would have concluded. Mr Morris said 2019/20 only committed part of the funding and there was a further residual element for 2020/21 and if it was decided to invest that to practices that would then eradicate the funding differential gap. It was RESOLVED

- To note the progress to date.

PCCC/19/163

Digital-First primary care consultation response Cal Deane, Interim Head of Primary Care reported on the local LLR response submitted in August 2019 to the NHSE consultation on the Digital First Primary Care Policy (Paper G), the outcomes of that and the next steps. Overall NHS England have advised they will be launching a programme of work to develop a revised proposal, for which the date was not known, and they will be looking at how to standardise the APMS contract terms, identify CCGs in which providers could be placed, design a national assessment process and the associated criteria. In 2020/21 accredited providers would be able to set up services in areas of greatest need. From 2020 there will be an evaluation process to review the impacts of the new contracts.

3


3 December 2019

Dr Bentley spoke of the service gap that would remain because a practice would be able to register a patient some distance away but would not undertake home visits. He felt it would be useful to discuss that as an LLR-wide issue when meeting as a committee in common. Mr Deane said that practices registering patients from outside of their area would make the patient fully aware that home visits may not take place so the patient would be informed and sign up to that. Dr Bentley said regardless of the patient understanding that, if the patient was in need of a home visit, it was not clear who would deliver that and so a gap in service remained. Mr Deane recognised that as a problem and suggested the patient could access NHS111 or register as an immediate and necessary patient outside of area. Dr Prasad said the digital service was primarily for young and well patients and his practice did not register patients outside of his practice area at all. He felt if a patient needed a number of home visits during a period then they should be de-registered and move to a more local practice who could meet their needs. Dr Than felt that practices would be left delivering services to co-morbid patients because the digital offer was mostly suitable to young, well patients. He said if that was the case the GMS payments would not be enough to deliver care to mostly complex patients and therefore practices needed a balanced patient population. Dr Kapur advised he had a number of out of area patients and that was an agreement between the patient and the practice. Mr Deane advised if a practice took on an out of area patient then they did so on the terms of the out of area scheme. If the patient resided inside the practice boundary then the practice would deliver care within the bounds of the GMS contract and that included home visiting. It was agreed Mr Deane would provide the PCCC with a paper explaining the process to help the committee have an informed discussion. Dr Prasad asked for consistency for the system and then consistent application of the rules. Dr Than felt there might be issues if practices sought to change their boundaries with out of area patients in mind. Mr Deane was clear that the PCCC would consider boundary applications from practices and would ensure all of the population was covered and no artificial gaps created. Mr Haq felt it was reasonable that patients registered with a practice outside of their area on the understanding that if they required a home visit, the GP was not bound to provide that. The GP was then covered and the patients were clear on the positon. It was RESOLVED

- To note and receive the paper for information.

Cal Deane

PCCC/19/159

Primary Care Co-Commissioning Finance Report Month 6 Ms Michelle Iliffe, Director of Finance, set out the financial position of the Primary Care Co-Commissioning budgets of Leicester City CCG as at the end of September 2019 (month 6) (Paper D) and highlighted the following; • The transfer of funding for Narborough Road Practice benefited the CCG

by £3k due to a difference in the expected value and finalised value. • There was a forecast underspend of £114k on the locums expenditure.

4


3 December 2019

• There was a £180k forecast underspend from the PCN additional roles that had not been recruited to.

• The budget had available a £508k contingency to manage risks in year should they emerge, such as emergency caretaking, practice support and finalisation of property charges.

It was RESOLVED

- To note the month 6 finance position for primary care co-commissioning as at the end of September 2019.

PCCC/19/164

Minutes of the Primary Care Board held on 20 August 2019 The minutes of the Primary Care Board held on 20 August 2019 were received for information (Paper H).

PCCC/19/165

LLR GP IM&T Work Programme update The LLR GP IM&T work programme update was received (Paper I). Dr Wadhwa asked when the IM&T support to PCN hubs would be delivered to which Mr Deane advised the funding had been committed to clinical hubs for PCNs to support extended hours and that was being rolled out by LHIS. There were a number of actions outstanding to resolve with PCNs to be able to implement the clinical hubs in the PCNs; two PCNs have not completed the data sharing agreement, some PCNs are to provide LHIS with confirmation of a visit date and one PCN decided to put the clinical hub implementation on hold for a period of time to which Mr Deane would ask that they provide clarification on that and arrange for an installation date. The CCG had agreed to support and fund the PCNs to help them with the delivery of their extended hours service so PCNs would be encouraged to progress the outstanding actions as soon as possible. Dr Wadhwa, as chair of the ACD forum, requested information on PCNs who had outstanding actions and he would impress on them the need to respond to the CCG. Mr Deane has requested PCNs share their redesigned plans for extended out of hours so the CCG was sighted on plans and could link with other out of hours providers. Dr Bentley asked if PCNs were being encouraged to use the national ISA to which Mr Deane advised the purpose of the clinical hubs was to allow people to see clinical records, dependent on the quality of the practice clinical records, but full access should be available. The consent to access records was implicit but the patient request to make an appointment would assume the permission to review the record. Dr Bentley advised all PCNs had signed up to the ISA which was nationally and locally compliant.

Cal Deane Dr Wadhwa

PCCC/18/166

Any Other Business There were no other items of business.

Date of Next Meeting The next meeting of the Primary Care Commissioning Committee would be held on Tuesday 3 December 2019 in the Conference Room, 4th Floor, St John’s House.

5

Paper B2 LLR CCGs Primary Care Commissioning Committees meetings in common

2 December 2019

Minutes of the Primary Care Commissioning Committee held on Tuesday 5 November 2019 at 9:30am in the Framland Committee Room, ELR CCG, County

Hall, Glenfield, Leicester, LE3 8TB

Present: Mr Clive Wood Independent Lay Member Dr Nick Glover GP Locality Lead, South Blaby and Lutterworth Dr Girish Purohit GP Locality Lead, Syston, Long Clawson and Melton Mr Tim Sacks Chief Operating Officer (from item PC/19/90 onwards) Mr Richard George Senior Primary Care and Non-Acute Commissioning Accountant

(deputising for the Chief Finance Officer) Mrs Tracy Burton Interim Chief Nursing and Quality Officer Dr Katherine Packham Public Health Consultant In attendance: Mr Jamie Barrett Head of Primary Care (from item PC/19/90 onwards) Mrs Seema Gaj Senior Primary Care Contract Manager Dr Fahreen Dhanji Leicester, Leicestershire and Rutland Local Medical Committee

(LLR LMC) Representative Mrs Amardip Lealh Corporate Governance Manager (Minutes)

ITEM LEAD

RESPONSIBLE PC/19/94 Welcome and Introductions

Mr Wood welcomed all members to the Primary Care Commissioning Committee (PCCC) meeting.

PC/19/95 To receive questions from the Public in relation to items on the agenda There were no questions from members of the public present at the meeting and no questions had been received.

PC/19/96 Apologies for absence: • Ms Fiona Barber, Deputy Chair of the CCG and Independent

Lay Member • Dr Vivek Varakantam, GP Locality Lead, Oadby and Wigston • Mrs Donna Briggs, Chief Finance Officer

PC/19/97 Notification of Any Other Business Mr Wood had not received notification of any other business.

PC/19/98 Declarations of Interest GP members present declared an interest in items relating to commissioning of primary care where a potential conflict may arise noting the register of interest contains the current declarations and this is published on the CCG website. There were no specific

Page 1 of 8


2 December 2019

ITEM LEAD RESPONSIBLE

declarations in relation to items on the agenda. It was RESOLVED to:

• NOTE the conflicts of interest declared.

PC/19/99 To Approve minutes of the previous meeting of the ELR CCG Primary Care Commissioning Committee held on 1 October 2019 (Paper A) The minutes of the meeting held in October 2019 were accepted as an accurate record of the meeting, subject to the following:

• PC/19/91: Leicester, Leicestershire and Rutland (LLR) GP Information Management and Technology (IM&T): Work Programme Update (Page 6, 2nd paragraph): Mrs Bains queried whether NHS England had mandated for 75% of each Practice to offer eConsultations by April 2020, or whether this related to 75% of all Practices. Mr Sacks confirmed the latter was correct as documented within the minutes.

It was RESOLVED to:

• APPROVE the minutes of the meeting.

PC/19/100 To Receive Matters Arising following the meeting held on 1 October 2019 (Paper B) Mr Wood noted there were no outstanding actions, which was positive. It was RESOLVED to:

• RECEIVE the matters arising.

PC/19/101 Governance Arrangements: Update (Verbal) Mrs Bains provided an update following the Governing Body decision in October 2019. She informed that a review of the committee arrangements across the 3 CCGs within Leicester, Leicestershire and Rutland (LLR) has been carried out to enable a more efficient and collaborative way of working. It was noted that the Governing Body approved the recommendation for the ELR CCG PCCC to meet in common with the PCCCs of both Leicester City CCG and West Leicester CCG on a bi-monthly basis from December 2019. The purpose of the PCCC meeting in common would be to review matters in common across the LLR CCGs.

Page 2 of 8


2 December 2019


Mrs Bains confirmed the membership of the PCCC remains unchanged and confirmed that the functions for the Committee remains as delegated to this Committee by NHS England, which cannot be delegated to another Committee. Therefore, the PCCC is not permitted to be established as a joint committee. The only change to this Committee will be the frequency of the meetings moving to a bi-monthly basis going forward. Mr Sacks welcomed the change in governance arrangements for the PCCC across LLR, which will create an opportunity to review matters in common. It was RESOLVED to:

• RECEIVE the report.

PC/19/102 Primary Care Finance Report 2019-20 (Month 5, August 2019) (Paper C) In the absence of Mrs Briggs, Mr George presented this report, and confirmed the annual budget for Primary Care Services totals £101.7m for 2019-20; with a year to date overspend of £855k; and forecast outturn overspend of £1,679k being forecast as at Month 6. The Committee were also informed that in comparison to the previous month, the position has worsened by £618k, which was summarised in the table of movements on page 2 of the report listed across the following service areas:

• Prescribing • Community Based Services • Co-commissioning • GP Support Framework • Other Primary Care

Mr George drew the Committee’s attention to the following sections of the report:

• Delegated Co-commissioning (section 2) Despite removing £1m of cost from this budget for the Oadby Urgent Care Centre in 2019-20, a forecast outturn overspend of £314k is anticipated. The Committee were reminded this was largely due to the pressures relating to the reimbursement of locum costs within Practices. In addition, an underspend of £126k is also being forecast sue to a slippage in the employment of additional roles within the new Primary Care Networks (PCNs).

Page 3 of 8


2 December 2019


• GP Prescribing (section 3) The overspend within this budget was largely attributable the increase of Category M drug prices in August 2019, which is outside of the control of the CCG, and the ‘deep dive’ previously reported has been undertaken by the Finance Team within some Practices. The ‘deep dive’ has highlighted that the increase in costs was not in relation to the number of prescriptions received, but the cost of the items being prescribed. The number of prescriptions received has increased by 1% year on year, which is in line with increased number of patients. It was therefore agreed that further work is required to support Practices.

• Community Based Services (section 4) A small underspend of £46k is forecast against this budget due to an element of over claimed activity by Practices identified within the Post-Payment Verification (PPV) audit process undertaken by the CCGs Internal Auditors.

• GPFV – GP Online Consultation (section 5) It was noted this budget has a forecast underspend of £64k as the contract for the service has been awarded, however, the planned roll out programme means the whole allocation from NHS England will not be required in 2019-20. Any slippage will be carried forward to future planning the following year.

Mr Wood thanked Mr George for the report and noted a small number of underspends and the large overspends identified. Dr Glover noted the comments made in relation to the slippage for PCNs, and GP Prescribing. Dr Glover felt there was not enough time left within the remainder of the financial year to review and implement learning in relation to prescribing activity; and queried whether Practices were prescribing the more expensive items for their patients, or whether the costs of the items prescribed have increased. Dr Glover also stated that on occasions, prescriptions are returned from the Pharmacy as the item prescribed is not available. Pharmacists are advised to liaise with other Pharmacies who may have the items in stock, however, due to stock availability; GPs are required to prescribe the more expensive items. Mr George confirmed the CCG is forecasting an overspend of £1,578k of which £645k is due to the increase of Category M drug prices and drugs listed on the NCSO list. In light of this, Dr Glover suggested a review of prescribing activity across all Practices is undertaken.

Page 4 of 8


2 December 2019


Mr Wood thanked Dr Glover for the comments made which were helpful as he was going to request for a GP perspective. It was also useful to note the external factors that impact the service, and where alternative items are unavailable, patient care and treatment remains the same. Mr Sacks agreed with comments made and confirmed information is also available from the Prescribing Pricing Authority (PPA) in relation to items that can, and cannot be issued. In addition, it would be helpful to undertake a review of all prescription activity to identify themes and trends, including areas of discrepancy on a monthly basis as one Practice has been identified as doubling the number of prescriptions between July to August 2019, which has subsequently dropped in September 2019. Mr George confirmed this will be included within the next finance report for Month 7. It was RESOLVED to:

• RECEIVE the report and the update provided.

PC/19/103 Digital First: Consultation Outcome (Paper D) Mr Barrett presented this report, which provided an update on the outcome of the consultation on the Digital First Primary Care Policy that was first published in June 2019. The same report has been submitted to the PCCC meetings for LC CCG and WL CCG, which would be an agenda item for the PCCC meetings in common going forward. The Committee were reminded that the following a review of the document, a joint response was submitted by the LLR CCG PCCC meetings, in conjunction with the LLR GP IT Steering Group and the LLR Primary Care Board back in August 2019. It was noted that more a total of 234 submissions were made in response to the consultation, which were widely supported by NHS England and NHS Improvement; and more than 240 people attend their engagement events. A high level summary of the feedback was included in appendix 1 of the report, which were broadly agreed and supported by NHS England and NHS Improvement. Mr Barrett noted the comments provided by Dr Packham from a health and inequality perspective have been reflected within the outcome, which was positive. Going forward, it was noted NHS England and NHS Improvement will launch a programme of work to deliver the revised proposal, within which CCGs will be identified to establish new providers – further details will be provided in 2020. Mr Wood noted patients have varying degrees of needs, some of which are more complex than other. Therefore, the difficulty in

Page 5 of 8


2 December 2019


sustaining a balanced patient list was noted as patients with less complex needs may register elsewhere. GP members agreed with the comment made, which could potentially disadvantage Practices who are less sustainable; and noted it was difficult for some Practices to change how services are delivered. Mr Barrett stated some controls are in place to support Practices who are less sustainable, for example, such as the Primary Medical Care Risk Log, which is helpful. It was RESOLVED to:


PC/19/104 Leicester, Leicestershire and Rutland (LLR) GP Information Management and Technology (IM&T): Work Programme Update (Paper E) Mr Sacks presented this report, which provided an update on the IM&T work programme across LLR that supports the delivery of the Local Digital Roadmap and the implementation of the GP Five Year Forward View requirements. This also include the IM&T Newsletter for October 2019 and LLR Digital Roadmap – Plan on a page for information. Dr Purohit confirmed a suite of templates are available to Practices to use within primary care via their clinical systems, which were provided by Arden and GEM CSU that could be adapted for use by the Practice. Due to issues raised with templates provided by the Leicestershire Health Informatics Services (LHIS) who provide IT services to Practices, Dr Purohit queried how this could be raised at the IM&T Board. Mr Sacks confirmed that as the Chair the IM&T Board, all agenda items can be forward to him direct. It was RESOLVED to:

• RECEIVE the report and the update provided.

PC/19/105 Sustainability and Transformation Partnership (STP): Primary Care Network (PCN) Development Programme (Paper F) Mr Sacks presented this report, which provided an update at a point in time. Mr Sacks reminded the Committee that NHS England and NHS Improvement funded LLR for a current period of 5 years with £799k for the development of Primary Care Networks (PCNs) and the Accountable Clinical Director (ACD); for which a PCN Development Support – Guidance and Prospectus has been published in August

Page 6 of 8


2 December 2019


2019. Following a review of the guidance, the following actions have been undertaken to date:

• discussions held with the ACD Forum and the Primary Care Commissioning Group (PCCG)

• the high level PCN organisational and ACD leadership development proposals have been developed into a 5 year investment plan (at Appendix 1);

• The Plan also presented to the LLR CCGs Executive Leadership Team (ELT) in October 2019, which focused on the recurrent financial commitment and elements of succession planning; ELT approved the finances for 2019/20 only;

• Final version of the Plan presented to the LLR CCGs Collaborative Commissioning Board for approval in October 2019, however, following specific concerns raised in relation to the involvement of the PCN within the Plan, it was agreed for further work to be undertaken.

Mr Sacks confirmed key elements of the Plan related to the requirements for the development of the PCN, including its responsibility, delivery and ownership. This is due to be discussed further at the LLR CD Forum in November 2019, including outcomes for patients and the PCN per each area of the Plan. The Committee were informed that the Plan should be owned by the PCNs as the LLR CCGs are required to support with their development; however, will need formal sign-off. Dr Glover welcomed the Plan which demonstrated a positive step towards a collaborative process across the LLR CCGs and PCNs; and felt it included a number of areas for the professional development of ACDs and individuals, which had not been the case in the past. However, Dr Glover informed the Committee that a number of other organisations such as Health Education England are also keen to support with the development of PCNs and suggested this is not duplicated. Dr Glover queried how the Plan will be established within PCNs and suggested a key contact or lead is assigned at Practice level to increase engagement of all Practices within each PCN so that the same vision is shared. Mr Sacks agreed with comments made by Dr Glover and agreed the element of training and development needs to be broadened to meet the needs of all Practices within each PCN, as some are further developed than others. Dr Dhanji agreed with comments made in relation to a number of support mechanisms available to PCNs; and confirmed the LMC

Page 7 of 8


2 December 2019


CD Forum is also in place too. However, information in relation to PCNs is required earlier as they are expected to deliver. Mr Sacks agreed with comments made and stated the current number of sessions available are not enough to consider all business activities, especially training and development. Therefore, a greater need to have further connection and increased communication channels would prove beneficial. Members of the Committee agreed that all support offered should remain within the NHS and accessed locally. Dr Purohit added that some PCNs have struggled to recruit to the ACD roles, however, agreed succession planning is required as there appears to be a real disconnect between the more Senior Partners and younger GPs; and the increase in communication may improve the current situation. Mr Sacks agreed with comments made and stated the age range of GPs are between 30 and 60 years of age and from previous Practice experience, some Practices are really keen to succession planning and the chance for opportunities. However, Mr Sacks echoed the need for PCNs to take ownership, which was agreed by the ACDs. It was RESOLVED to:


PC/19/106 Any other business There was no other business to discuss.

PC/19/107 Date of next meeting The date of the next Primary Care Commissioning Committee meeting will be held on Tuesday 7 January 2020 at 9:30am – 12:30pm, Framland Committee Room, County Hall, Glenfield, Leicester, LE3 8TB. Mr Wood reminded the Committee of the new governance arrangements as mentioned at the beginning of the meeting – the first LLR CCG PCCC meetings in common will take place on 3 December 2019 for which Mrs Bains confirmed details will be disseminated shortly. Mr Wood confirmed his apologies for this meeting. As the administration of the PCCC meetings has also changed going forward, Mr Wood thanked Mrs Lealh for her support, which was reiterated by members of the Committee.

Page 8 of 8

Blank Page

Paper C1 LLR CCGs’ Primary Care Commissioning Committee meetings in common

3 December 2019

LEICESTER CITY CLINICAL COMMISSIONING GROUP

Primary Care Commissioning Committee – Action Notes

Minute No.

Meeting Item Responsible Officer

Action Required To be completed

by

Progress as at December 2019

Status

PCCC/18/150

Sept 2018

General Practice Forward View Monthly Update

Professor Farooqi

The Programme Board was developing a standard report and Mr Morris agreed to follow this up.

August 2019 September 2019 October 2019 November 2019

PCB work would be subsumed by a PCCC meeting in common – arrangements to commence December 2019. ACTION COMPLETE

Green

PCCC/19/115 and 19/126

Sept 2019

Primary Care Strategy Azhar Farooqi A city GP representative was needed for the primary care workforce group. Professor Farooqi would be reminded of the action.

October 2019

5.11.19 - Clinical representation was being discussed by the three CCG clinical chairs – AF to include this requirement in the discussions.

Amber

PCCC/19/131

Sept 2019

Digital First Primary Care Policy Consultation – LLR response

Cal Deane To check Professor Farooqi had been sighted on/satisfied with response prior to submission.

October 2019

5.11.19 – update on the agenda. Agreed to close the action. ACTION COMPLETE

Green

PCCC/19/163

Nov 2019

Digital-first primary care consultation response

Cal Deane To provide a paper explaining the process for out of area patients and home visiting requests.

January 2020

Work in progress. Amber

PCCC/19/165

Nov 2019

LLR GP IM&T Work Programme update

Cal Deane Dr Wadhwa

Dr Wadhwa to support the CCG in following up on outstanding actions with PCNs and requesting that they submit information to the CCG as a matter of urgency.

December 2019

Verbal update to be provided at the meeting

Amber

No progress

On-Track Completed

Key

1


3 December 2019

Blank page

2


3 December 2019

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 5 November 2019

Status

No outstanding actions.

No progress made On-Track Completed

Key

Page 1 of 1

Blank Page




Date: 3 December 2019 Paper: D


LLR International GP Recruitment Programme

Presented by: Ian Potter, Director Primary Care, WL CCG

Report author: Tine Juhlert

Executive lead: Ian Potter, Director Primary Care, WL CCG


Executive summary: 1. The LLR International GP Recruitment (IGPR) Programme is delivered under the NHS England National IGPR Central Midlands Expansion Programme (an expansion of the Lincoln Pilot). The LLR IGPR approach is co-designed by us and Prof Aly Rashid’s expansion team and we have successfully been delivering the objectives outlined in the GP Resilience Board, as well as all three PCCC approved Programme PID (appendix B) since January 2019.

2. The NHS England allocation of International GPs (IGPs) to LLR is 30 doctors, which as outlined in the PID was to be delivered in two tranches. The 1st tranche was commenced in February 2019 and on its successful completion, we would commence delivery of the 2nd tranche.

3. The 2019 International GPs on the programme came with a full funding

pack from NHS England; funds have been transferred to the CCG budget lines ahead of delivery. The 2020 financial envelope is identical, except that at this point due to a NHS England review of the national IGPR programme, commitment to fund the 8b project manager post is currently only available until 30th Sep 2020.

Appendices: • None

Recommendations:

The LLR CCGs’ Primary Care Commissioning Committees are asked to support the following: 1. We recommend drawing down a second cohort from the Central Midlands

Expansion Programme, despite the current lack of clarity of funding for the 8b post passed 30th September 2020.

2. Extend the 8b post until 30th September 2021 3. The JD and PS for the 8b post includes ‘other workforce work-streams’, as

such we propose (should it be necessary) to backfill the potential shortfall of salary funding with funds we already hold to deliver the NHSE Four Pillars of Retention in LLR.

4. The 8b has a dual delivery responsibility of overseeing a. The LLR Workforce Programme – LLR Recruitment, Development


Rutland CCG


interest: Indirectly


To support the management of GP workforce related risks.


Detailed within the report.


None identified.


None identified.


Due regard has not be undertaken in respect of this report.

and Retention Plan b. And the IGPR delivery, This would mean; c. Recruit additional temporary project managers to support and

enable a greater focus on delivering equally important workforce agendas in LLR


2

Leicester, Leicestershire and Rutland

Managing a Stage Boundary

Programme Name LLR International GP Recruitment Programme

Release Version 1.0

Date: 13th Nov 2019

Author: Tine Juhlert

Owner: LLR Workforce Workgroup

Client: LLR primary care and patients of LLR

IGPR in LLR short film https://youtu.be/ne815ztIQDs 1

https://youtu.be/ne815ztIQDs

Executive Summary

Brief programme summary;

The LLR International GP Recruitment (IGPR) Programme is delivered under the NHS England National IGPR Central Midlands Expansion Programme (an expansion of the Lincoln Pilot). The LLR IGPR approach is co-designed by us and Prof Aly Rashid’s expansion team and we have successfully been delivering the objectives outlined in the GP Resilience Board, as well as all three PCCC approved Programme PID (appendix B) since January 2019.

The NHSE allocation of International GPs (IGPs) to LLR is 30 doctors, which as outlined in the PID was to be delivered in two tranches. The 1st tranche was commenced in February 2019 and on its successful completion, we would commence delivery of the 2nd tranche.

The 2019 International GPs on the programme came with a full funding pack from NHSE; funds have been transferred to the CCG budget lines ahead of delivery. The 2020 financial envelope is identical, except that at this point due to a NHSE review of the national IGPR programme, commitment to fund the 8b project manager post is currently only available until 30th Sep 2020.

The CCG communication team has developed a NHS YouTube film to showcase the programme benefits in LLR https://youtu.be/ne815ztIQDs following on from that, on Wednesday 6th November we were featured on the East Midland’s Today and Evening news https://www.bbc.co.uk/iplayer/episode/m000b25d/east-midlands-today-evening-news-06112019 (14:10 – 16:08).

We ask the board to note;

1. The 1st tranche of the programme has met all targets, on time and within budget we have filled 14 LLR vacancies with 14 IGPS, we have done so within scope of the programme objectives by applying an agile Prince2 methodology.

2. The LLR IGPR PID outlines a commitment to commence the 2nd tranche by January 2020, please note that we intent to commence the expression of interest campaign to all LLR practices following the closure of this meeting.

3. Due to the intensity and demands of the programme, the project manager (though in a dual delivery role) has had to focus solely on the IGPR programme, to the exclusion of other LLR Workforce challenges, and as such please expect an additional paper suggesting a solution to this.

4. Joint workforce and IGPR delivery recommendations are made on page 7 of this paper, with a further proposal to be tabled for your comments as soon as possible




https://www.bbc.co.uk/iplayer/episode/m000b25d/east-midlands-today-evening-news-06112019


Background, nationally and locally;

A key commitment in the General Practice Forward View (GPFV) is to strengthen the workforce. This includes recruiting suitably qualified overseas doctors into general practice. While GP training places are increasing year-on-year and many GPs are returning to practice, some practices continue to face recruitment issues and newly qualified GPs are often locuming rather than joining a practice as a permanent GP. Some Experienced GPs are also leaving the profession early. This is leaving a gap between the number of doctors practices want, and the numbers they are successfully recruiting and retaining. That is why in addition to other ways we are expanding the workforce, we are working with partners to recruit at least 2,000 overseas doctors into general practice by 2020. The International GP Recruitment Programme The NHS in England is recruiting at least 2,000 suitably qualified overseas doctors into GP practices by 2020. This is called the International General Practitioner Recruitment (IGPR) programme. The IGPR programme was piloted in Lincolnshire, Essex, Cumbria and Humber, Coast and Vale. Building on learning from these pilots, the programme has been expanded into areas across England with the aim being to now recruit at least 2,000 doctors into general practice by 2020 Initially this will focus on doctors from the European Economic Area (EEA) whose training is recognised in the UK under European law and who get automatic recognition to join the General Medical Council’s (GMC) GP Register. But now the Royal College of General Practitioners is also working with the General Medical Council, to review the curriculum, training and assessment processes for GPs trained outside the EEA, beginning with Australia, to identify whether the GP registration process can be streamlined for those doctors whose training is seen as equivalent to the UK GP programme. While the initial focus is on recruiting doctors from within the EEA, doctors from outside the EEA can still register their interest Principles of the IGPR Programme

• Doctors will need to meet the highest standards of practice and speak good English • Recruitment will be bound by the World Health Organisation Global Code of Practice

on the International Recruitment of Health Personnel • We will look to attract UK-trained doctors back to the UK wherever possible and UK-

trained doctors will not be disadvantaged as a result of this programme • We will target those countries where there is likely to be the best chance of

affordable supply

LLR and IGPR Within the LLR Workforce Plan (Jan 2018) we are highlighting the need to recruit 98 GP across LLR between now and March 2020, within the plan it was established that international GP could be one answer to filling some of those workforce vacancies. During the early part of 2018, several CCG lead practice engagement event resulted in 24 practices coming forward to register their interest in appointing international GP’s into permanent posts within their practices. And a joint LLR CCG application went to NHSE



https://www.england.nhs.uk/publication/general-practice-forward-view-gpfv/

https://eastleicestershireandrutlandccg.nhs.uk/wp-content/uploads/2018/02/LLR-GP-Workforce-Plan_Jan-18-FINAL.pdf

The LLR CCG application was successful, and an initial quota, and the associated funding for IGP salaries and recruitment, training and relocation costs, for 30 international General Practitioner candidates was allocated for delivery into LLR practices. Moreover the confirmed funding also enabled the LLR CCGs to appoint an IGPR Programme Manager, who started in post in September 2018, this post is time limited but fully funded by NHSE. In November 2018, due to national delivery delays which have also impacted the LLR delivery timescales, the decision was made by the NHSE central team and the Midlands and East Responsible Officer; Dr. Aly Rashid to deliver the LLR IGRP programme under the Central Midlands GP Expansion Model, which is based on the Lincoln Pilot. In LLR we put ourselves forward as the early adopters of this still to be defined, frameless delivery model. It is fair to say many of the now in place process maps, approaches and frameworks incl. the financial control methodology has been delivered by us in LLR, and these are now used by the expansion team and other STP’s in the Central Mids. Expansion Programme. The other STPs in the expansion programme are, Bedfordshire, Luton and Milton Keynes, Hertfordshire and West Essex, Lincolnshire and Northamptonshire. The LLR STP Workforce Workgroup oversees the delivery of the IGPR programme in LLR. Project progress is reported there and at the GP Resilience Board (national and local governance in appendix A) Communication The LLR IGPR Programme works closely with the NHSE communication team, as well as being skilfully supported by the CCG communication team for local coverage. The CCG communication team has developed a NHS YouTube film to showcase the programme in LLR https://youtu.be/ne815ztIQDs following on from that on Wednesday 6th November we were featured on the East Midland’s Today and Evening news https://www.bbc.co.uk/iplayer/episode/m000b25d/east-midlands-today-evening-news-06112019 (14:10 – 16:08). Programme Definition; Financial Envelop

The 2019 International GPs on the programme came with a full funding pack from NHS England; funds were transferred to the CCG budget lines ahead of delivery. Expenditure was managed by the project manager, reconciliation and financial control was provided by Andrew Roberts, WLCCG. Both working closely with the NHSE financial controller

2019 financial envelop

• £2,000 per candidate for recruitment • £2,500 per candidate for Induction and retention • £8,500 per candidate relocation budget • First years’ salary (£70,000 plus on cost, top up indemnity and a supervision fee) • IGP practices commit to take on the IGPs as salaried GPs for at least 3 years

o salary increasing to £80,000 in the second year, o and £90,000 in the third






• 18 months’ salary payment for an 8b CCG hosted Programme Manager

2020 financial envelope

• As above, except at this point due to a NHSE review of the national IGPR programme, commitment to fund the 8b post is only currently available until 30th Sep 2020

Objectives

Objective from PID Progress on target in first stage

To work in partnership with NHSE, HEE and local practices to recruit IGPR as per the LLR Workforce objectives, by applying the Central Mids. IGPR delivery model

On Target and ongoing

Employ 30 international GP’s to LLR practices, in two cohorts

1. First cohort (14 GPs) to be in practices from July 2019 2. Second cohort (16 GPs) to be in practices by 2020

1. Achieved 2. Recommendations

made by PM Retain 90% of IGPR GP’s within LLR for at least 3 years On Target and ongoing Ensure effective communication engagement with relevant stakeholders as outlined in the communication strategy

Recommendations made by PM

Establish effective delivery approach to ensure the Programme is delivered within Programme tolerances, i.e. on time and to budget

On Target and ongoing

Give consideration and ensure alignment to all LLR retention initiatives

Recommendations made by PM

Improve workforce pressures in LLR practices On Target for the 11 practices employing an IGP

Method of delivery approach Pragmatic PRINCE2 is the overarching framework of Programme management approach. The positive aspect of this is that PRINCE2 can be tailored to the needs of the LLR IGPR programme, as it is ideally suited for the management of Programmes with clearly defined and attainable goals. Moreover, as an approach to Programme management it is understood by internal and external partners. We have augmented the PRINCE2 approach with agile management, incorporating business Programme roles that more appropriately reflect the NHS organisation and procedures. This enabled us to be more agile in reacting to requirements changes without compromising time, quality and cost. This turned out to be of great value to the delivery of the programme in LLR, as being early adopters of an unformed programme meant we often has to think on our feet to ensure we didn’t miss out on opportunities to secure the 14 IGPS arriving in LLR. The LLR IGPR Programme document suite includes a Gantt chart and a Risk Register, within the RAID log, a change management approach and a communication strategy (all appendices further down this document). The risk log is fully aligned to the National Programme, but equally able to standalone to ensure the workforce prioritise within LLR STP are safeguarded



Programme Quality and Assurance,

The LLR Programme Q&A hinged on a strict quality adherence to change management to ensure we did not experience scope creep, and the assurances were

1. stakeholder satisfaction 2. 30 IGPR’s in LLR vacancies by June 2020

Lessons Learned following the 1st tranche;

The 1st Stage of the LLR IGPR programme has met the target we were set; we have delivered 14 permanent International GPs into LLR practices and achieved stakeholder satisfaction. It has been extremely rewarding programme to deliver, but it has been enormously challenging and time consuming, these are some of the reasons why;

• LLR were early adopters of the Central Midlands Expansion Programme, we had to blaze a trail for LLR and the four partner STPs and in some instances for the National Programme as well. We set up many of the frameworks and models of mobilisations now used by the Expansion Programme and other STPs.

• We established early on that our internal processes, in place to safeguard our business as usual approach, could jeopardise the delivery of IGPR in LLR. We therefore had to work closely with Finance, HR, Communication teams, Commissioning teams, Contracting team, Quality Teams to reassure them of the value added and benefits of the programme to LLR patients

• Likewise we established our external partnerships did not initially see the benefits or even if they did, their internal processes restricted them from helping as well. Most things we did were done for the first time.

• The International GPs worked up until they joined the programme, then they spend a full back to back 12 weeks at Paragona and then straight into LLR practice; as such they could not make relocation arrangements during business hours. This meant the LLR IGPR Programme Manager had to be available around the clock during the recruitment stage, the Paragona campus stage BUT especially once they arrived in UK, and still has to be to some extend as there is no one to hand the cohort over to, and without that support we know from the UHL led International Nurses Programme that we will not achieve the high retention rates we aim for.

• Balancing the expectations of the international GPs with the reality and complexity of moving to UK was challenging. One issue among others, was supporting the doctors with children who naturally wanted to apply for school places as soon as possible, with the reality that most LLR schools have a shortages of spaces had to be carefully managed to alleviate anxiety and concern. Moreover the disparity in readiness and thought given to moving, meant every mobilisation was different from the previous one

• Relationships and networks were paramount to making the LLR Programme a success, but most of these relationships and networks were not established before the LLR Programme Manager started, building them took time and effort

• Due to the size of the task it was decided for the LLR IGPR Programme Manager (as the only allocated resource to the LLR initiative) to focus ONLY on the IGPR programme, to the exclusion of all other LLR Workforce challenges

But we have been successful because we applied an agile approach to a Prince2 methodology, drawing on resources not officially allocated to the programme i.e. good will



from internal and external colleagues who has believed and acted on the ‘Art of the Possible’, never saying no when an invoice needed paying at 17:30 on a Friday to secure a tenancy, supporting neighbouring finance teams to understand the value of a process, rather than just see the risk, answering phone calls at 11pm, working countless weekends and evenings, which has reassured and supported IGPs, practices and family members when necessary. We did it, but it was hard work. To achieve the same result again we will have to review the resource allocation and approach

Recommendation for the next stage; 2nd tranche and other LLR workforce challenges

We cannot pinpoint an alternative recruitment approach which delivers the same results with so little financial risk to the LLR CCGs, so with this paper we ask you to note that we will progress with the second cohort. However, we also recommend that additional resources will have to be temporarily appointed to support a wider workforce delivery programme.

We therefore recommend;

1. We recommend drawing down a second cohort from the Central Midlands Expansion Programme, despite the current lack of clarity of funding for the 8b post passed 30th September 2020.

2. Extend the 8b post until 30th September 2021 3. The JD and PS for the 8b post includes ‘other workforce work-streams’, as such we

propose (should it be necessary) to backfill the potential shortfall of salary funding with funds we already hold to deliver the NHSE Four Pillars of Retention in LLR.

4. The 8b has a dual delivery responsibility of overseeing a. The LLR Workforce Programme – LLR Recruitment, Development and Retention

Plan b. And the IGPR delivery,

This would mean; c. Recruit additional temporary project managers to support and enable a

greater focus on delivering equally important workforce agendas in LLR



Appendix A

National IGPR Structure

LLR local reporting structure – accurate in Feb 19 PID

The LLR IGPR programme is delivered by the IGPR Programme Manager, who is a member of the Workforce Workgroup, which is in place to deliver the priority programmes, Programmes and objectives of the LLR GP Resilience Board



Blank Page




Rutland CCG


interest: GPs are conflicted.


Yes


National LLR system Allocation


Yes


Yes


Completed


Date: 3 December 2019 Paper: E


LLR GP5YFV Funding and work Programmes 2019/20

Presented by: Tim Sacks, Chief Operating Officer, ELR CCG

Report author: Tim Sacks, Chief Operating Officer, ELR CCG

Executive lead: Tim Sacks, Chief Operating Officer, ELR CCG


Appendices:

Recommendations:

The LLR CCGs’ Primary Care Commissioning Committees are asked to:

• RECEIVE the paper.


• Primary Care Group monthly • ELR CCG PCCC.



LLR GP5YFV Funding and work Programmes 2019/20

1. Summary: The General Practice five Year Forward View was published in June 2016, as a clear national direction for the development of General Practice. An LLR strategy for the delivery of this national programme was published in February 2017, with some very specific work streams and funding for the delivery of these. This work progressed across LLR with a system wide oversight group chaired by Prof Azhar Faroqi. In early 2019 a new NHSE plan was released for the further development of General Practice and Primary Care Networks. With this came significand funding proposals and an expectation of a renewed and focussed local STP Strategy on how LLR would deliver on this renewed agenda. This strategy was published in July 2019 and has formed the basis for the programme of work to develop General Practice and PCNs within LLR. Both the GP5YFV and PCN programmes come with certain elements of funding that is allocated at an LLR basis with an expectation of system delivery. Each of these work programmes has a detailed delivery plan and the operational delivery is scrutinised in various system meetings;

• General Practice Workforce Group • General Practice IM&T Group • Primary Care Group

The attached spreadsheet (Appendix 1) provides an overview of these work areas, the funding to support them and the monthly progress report.

The intention is to bring this highlight report to the PCCC in common at every meeting and undertake a deep dive into one or more areas at each meeting to provide assurance. On December’s agenda are papers providing detail on the topic of International GP recruitment and Training hubs.

The PCCC in Common is asked to:

• NOTE the report and Programme Tracker

Appendix 1

GPFV 19/20 Programme TrackerFunding Area Description 19/20

£'000

Carry Forward

£'000

Total Funding

£'000

2019/20 Planned

Expenditure

Host CCG SRO Reports to

Programme Update Rag Status

GP Practice Resilience

Funding to deliver support to practices to become more sustainable and resilient for the future

146 0 146 146 ELR CCG Tim Sacks PCB / PCCCs

Six practices were successful (2 in East, 2 in West and 2 in the City) and have been notified. The unsuccessful applicants have also been notified and processes underway to signpost to other funding that they could apply for.

GP Retention Funding to support retention activity. 232 TBC 232 232 ELR CCG / Carry forward with LC CCG?

Ian Potter GPWG / PCB/ PCCCs

The LLR Recruitment, Development and Retention Programme with its 16 delivery projects is being discussed at the 19th Nov PCG. On approval we will commence delivery from 1st Dec4 of the projects are Retention projects

Clerical and Reception Staff Training

Funding to support training of practice staff to implement the 10 High Impact Actions

191 TBC 191 ELR CCG / Carry forward within each CCG.

Ian Potter GPWG / PCB/ PCCCs

•Active Signposting Procurement - Training provider contract is being developed by WL CCG. •Training - Stage 1 Module - An introduction to active signposting - has been completed by all practices that have taken part in cohorts 1, 2 and 3. Cohort 3 - Practice Manager Workshop took place on 31 October 2019 with 31 delegates from LLR in attendance. East – 9 delegatesCity – 8 delegatesWest – 14 delegates •Communication - a programme for delivery communication to patients, practices and stakeholders is in development in conjunction with Melanie Shilton from LCCCG. •Steering Group - Work is underway to complete the local active signposting offer and finalise the specification ready for procurement. •The Correspondence Management Service Specification has been agreed by the steering group for progression to procurement. •Agreement is required on how each CCG will procure correspondance management this service if we deviate from PCNs.

Online Consultation Funding to deliver the commitment that all practices will be offering on-line consultations by April 2020 and video consultation by April 2021

311 TBC 311 ELR CCG / Carry forward within each CCG.

Tim Sacks GP IT / PCB / PCCCs

Additional practice has come on board for the early adoption of the solution. 14 early adopters are now planned. 3 of the 14 sites are now live. 6 sites have had install meetings. 1 install meeting booked with 4 practices still to confirm install dates. 18 further practices have expressed interest to adopt the solution.

Primary Care Networks

Funding to support PCNs to build relationships with community partners and implementation of development plans

799 0 799 ELRCCG Tim Sacks PCB / PCCCs

Draft PCN Development proposal presented at the Clinical Director Forum on 14 November 2019.

International GP Recruitment (IGPR)

Funding to support the recruitment drive to attract qualified GPs from overseas

960 TBC 960 960 WLCCG Ian Potter GPWG / PCB/ PCCCs

1. To work in partnership with NHSE, HEE and local practics to recruit IGPR as per the LLR Workforce objectives, by applying the Central Mids IGPR delivery model. 2. Employ 30 international GPs to LLR practices, in two cohorts: a. First cohort (16 GPs) to be in practices from Jul 2019). b. Second cohort (14 GPs) to be in practices from Jun 2020).

3. Retain 90% of IGPR GPs within LLR for at least 3 years. 4. Ensure effective communication engagement with relevant stakeholders as outlined in the communication strategy). 5 . Establish effecive delivery approach to ensure the programme is delivered within programme tolerances, ie on time and to budget. 6. Give consideration and ensure alignment to all LLR retention initiatives. 7. Improve recruitment pressure in practices. The first cohort delivered to time and on schedule. Cohort 2 is scheduled to start in February 2020. Brexit could have an impact on the number of potential recruits.

Workforce Training Hubs

Funding to support the development of the wider workforce within GP Practice

183 0 183 ELR CCG Ian Potter GPWG / PCB/ PCCCs

The LLR Recruitment, Development and Retention Programme with its 16 delivery projects is being discussed at the 19th Nov PCG. On approval we will commence delivery from 1st Dec1 delivery project is to establish the remit and strategic outputs from the training hubs

Fellowships Core Offer

Funding to support the roll out of new post-certificate of completion of training (CCT) fellowships to provide training opportunities in areas of poorest GP recruitment


The LLR Recruitment, Development and Retention Programme with its 16 delivery projects is being discussed at the 19th Nov PCG. On approval we will commence delivery from 1st Dec2 delivery project form part of the plan, 1 fellowship project for GP and 1 for Nurses

Fellowships Aspiring Leaders

Funding to support the roll out of new post-certificate of completion of training (CCT) fellowships to provide training opportunities in areas of poorest GP recruitment


The LLR Recruitment, Development and Retention Programme with its 16 delivery projects is being discussed at the 19th Nov PCG. On approval we will commence delivery from 1st Dec2 delivery project form part of the plan, 1 fellowship project for GP and 1 for Nurses

3,197 0 3,197

Blank Page



Aligned to Strategic Objectives

Leicester City CCG West Leicestershire CCG East Leicestershire and Rutland CCG

NHS Long Term Plan Interim People Plan Primary Care Strategy




Date: 3 December 2019 Paper: F


Training Hub Programme

Presented by:

Representative of the Training Hub / Ian Potter

Report author: Tine Juhlert

Executive lead: Ian Potter

Action required: Receive for information only:

Progress update:

For assurance: For approval / decision: Executive summary: The paper is to be viewed in conjunction with the presentation made by

representatives of the Training Hub and is to update the Committees on the progress made to date and seek support for the further development of a single Training Hub for Leicester, Leicestershire and Rutland in line with national guidance from NHS England and Health Education England (HEE).

Appendices: Appendix 1 – Core Functions of Training Hubs Appendix 2 – Training Hub presentation

Recommendations:


• NOTE the contents of the report • APPROVE the allocation of STP funding to the Training Hub during

2019/20


• Presentation to Primary Care Group 19.06.19. • Discussed by GP Workforce Group

Implications a) Conflicts of interest GP members on the Committees are conflicted, in particular the GPs

from the Training Hubs.


This supports in managing workforce and capability risks.


As detailed within the report.


None identified.


None identified.


Not undertaken in respect of this report.

2

Training Hub Programme

Purpose of the paper

1. The paper is to be viewed in conjunction with the presentation made by representatives of the Training Hub and is to update the Committee on the progress made to date and seek support for the further development of a single Training Hub for Leicester, Leicestershire and Rutland in line with national guidance from NHS England and Health Education England (HEE).

Background

National Context:

2. The NHS Long Term Plan sets out an ambitious 10 year vision for healthcare in England. It sets out a new service model where we will take more action on prevention and health inequalities, where we will improve the quality of care and health outcomes across all major health conditions, where the NHS harnesses technology to transform services, and where we get the most out of tax payers investment. The interim People Plan sets out our vision for people who work for the NHS to enable them to deliver the NHS Long Term Plan with a focus on immediate actions we need to take.

3. The development of Training Hubs is integral to Health Education England’s core purpose of supporting the delivery of excellent healthcare and health improvement to patients and the public by ensuring the primary care workforce of today and tomorrow is trained in the right numbers and have the necessary skills.

4. HEE conceived the development of Training Hubs in 2015 and as outlined in the

presentation good progress has been made locally. Following an external audit and review HEE have identified the potential for Training Hubs to develop further and are ideally positioned to enable a ‘place-based’ delivery of education, training and workforce development of the wider NHS primary care workforce.

5. To support this NHSE and HEE are committing resource to support the development of

Training Hubs at an LLR level. As part of this process, on 29th July 2019 the STP was allocated £183k of ring fenced funding to support the development of a Training Hub in LLR.

6. In addition to the information provided in the presentation, details of the existing and new

core functions of Training Hubs are provided in Appendix 1. Local Context:

7. Our response to the NHS Long Term Plan and the interim People Plan clearly identifies workforce as a key issue and sets out how we will ensure we have the right people with the right leadership capability, behaviours and skills to deliver high quality healthcare in LLR and show how we will prioritise and address critical workforce gaps and drive system efficiencies.

3

8. As outlined in the presentation (Appendix 2), a wide range of excellent work has been taken forward by the three Training Hubs in LLR and work is now advancing rapidly on the creation of a single Training Hub for LLR. A single Training Hub operating on an STP footprint will be able to play a key role in tackling our primary care workforce challenges and support system workforce priorities.

9. The Primary Care Group recently received an update and presentation by the Training

Hub and is supportive of releasing the ring fenced funding to enable the Training Hub to develop and play a greater role in the LLR workforce plans.

10. As identified the proposal is clearly embedded in national policy and aligns at an LLR

level with our response to the Long Term Plan and our Primary Care Strategy. Going forward, the Training Hubs have an opportunity to build on the excellent work completed to date and play a greater role supporting the primary care workforce at an STP level.

Next Steps

11. Subject to the approval of the PCCC, further work will take place with the Training Hub to agree an MOU setting out priorities for delivery and governance arrangements. This will need to recognise the contribution to system workforce and for primary care workforce development, in both cases linking to and adding value to existing governance arrangements.

12. Regular updates on progress will be made to the GPWF Group, the Primary Care Group and an update report will be presented to PCCC in April 2020.

Conclusion

The PCCC are asked to:

• NOTE the contents of the report • Approve the allocation of STP funding to the Training Hub during 2019/20

subject to development of an MOU setting out priorities and funding.

4

Appendix 1 Existing Core Functions of Training Hubs

1. The development and expansion of capacity of high-quality learning placements at undergraduate and postgraduate levels, including provision, training and development of faculty of multi-professional educators.

2. Supporting better understanding of workforce planning needs and their realisation across the STP/ICS and at primary care network level, across health and social care.

3. Supporting the development and realisation of educational programmes to develop the primary/ community care workforce at scale to address identified population health needs or support service re-design and delivery of integrated care.

Core Functions by March 2020

The contribution Training Hubs have made, particularly in responding to local future workforce needs through the expansion of training placements, has been acknowledged: such that they are now included in the Long Term Plan and referenced in the new GP contract. HEE and NHSE will be working in collaboration to develop shared understanding of how these functions are delivered and what level of support is required.

It has been noted that there has been variation in both their levels of maturity and adoption of workstreams. The significant investment from HEE requires the appropriate governance and accountability and evidence of delivery.

With a significant investment in Training Hubs, their existing functions will be built on to provide a consistent England wide offer to include:

1. Further development and expansion of placement capacity to create innovative and high- quality clinical placements for all learners to meet the workforce needs of “the place” in line with the Long Term Plan: thus, maximising the effective use of educational resources across the network.

2. In addition to the continuation of the role in supporting understanding of workforce planning, assisting in the co-ordination and realisation of the health and social care workforce across the STP/ ICS system.

3. Support recruitment of the primary care workforce through:

o Developing, expanding and enhancing recruitment of multi-professional educators together with developing their capabilities to support the delivery of high-quality clinical learning placements and high-quality teaching and learning environments.

o Supporting the development and realisation of educational programmes to develop the primary/ community care workforce at scale to address identified population health needs, support service re-design and the delivery of integrated care (through, for example, rotational placements and integrated educational programmes of learning).

4. Enable, support and embed “new roles” within primary care.

5. Supporting the retention of the primary care workforce across all key transitions including promoting primary care as an employment destination to students, through schools and higher education institutions.

6. Enable both workforce planning intentions and placement co-ordination through the active management of clinical placement tariffs – moving towards “place-based tariffs”.

5


East Leicestershire and Rutland Clinical Commissioning Group Appendix 2 – Training Hub Presentation

LLR Training HubI Fantastic Foxes I Jubilee Training Hub I West Leicestershire I

NHS England and Health Education England mandate: Proposal for the Establishment of 1 Training Hub Per STP

Outline• Training Hubs and current structure• Initiatives so far…• Local context• Immediate priorities• Next steps

7

Current Structure• 3 Training Hubs – 1 in each CCG area (City, West, East)• Fantastic Foxes in Leicester City first implemented in 2015 as one of the

original Community Education Provider Network (CEPN)• Jubilee Training Hub in East Leicestershire and Rutland followed in late

2015• West Leicestershire Training Hub in 2016 delivered via a federated

approach• Named GP and Managerial Lead with input from multidisciplinary teams• Historically held contracts with HEE to deliver specific training

– Increase capacity – Improve quality of training and education in LLR

• Innovation and collaboration with HEI

8

Initiatives so far…• Inter-professional Education Programme (IPE) with University of Leicester and De

Montfort University for Pharmacists and General Practitioners• Undergraduate clinical Pharmacy placements to support the development of

future Pharmacists in General Practice• Student Nurse placements • Year 6 and schools programmes• Investment in apprenticeships and educating a new generation• Supporting and shaping the Physician Associate undergraduate course, and hosting

these students• Developed new roles in primary care e.g. Epilepsy Nurse, Community Paramedics,

mental health facilitators • GP placements from University of Nottingham and London Universities • Worked with a network of practices across LLR on a wide range of projects• National presentations at various conferences: RCGP, BJGP, Medical Educators

9

National Context• HEE Mission - To establish 1 training hub per STP

with multi-professional board by 31 March 2020 – Chaired by HEE – Head of Primary care – Accountable to HEE & STP – Aligned to Primary Care Networks

• Guided by HEE Common Operating Guidance and Maturity Matrix for Training Hubs to assess and track process

10

HEE Expectations“Training Hubs are integral to Health Education

England’s core purpose of supporting the delivery of excellent healthcare and health improvement to

patients and the public through ensuring theprimary care workforce of today and tomorrow are

trained in the right numbers, have the necessaryskills, NHS values and behaviours at the right time

and in the right place as described”

11

Common Operating Guidance• Existing Core Functions of THs

– Development and expansion of placements– Support development of education programmes to support service redesign

and integrated care• Core Functions of THs by March 2020

– Support understanding of workforce planning, assist in the co-ordination across the STP/ICS

– Support recruitment of primary care workforce– Enable, embed, and support new roles within primary care– Support retention of the primary care workforce

• The Training Hub Offer– By March 2020 all PCN will have access to the resources of a training hub

• Above enabled by £183,000 of ring fenced funding to support TH in achieving the above

12

Suggested Governance

13

Local Context• The 3 LLR Training Hubs are involved in a joint

programme supported by HEE and EMLA to develop our vision, plan, and infrastructure

• The proposal is that the 3 existing TH will remain as locality hubs with reps from each TH forming the board of the new umbrella organisation

• Ensures we can maintain the right balance of strategic development plus grass roots input, local focus and specific areas of skills and interest

14

Immediate Priorities• Development of Infrastructure

– Appoint a Business Manager– Development board and Governance Processes

• Agree links with STP/ICS• Develop plans to respond to requirements and offer by March 2020

– Engagement with PCNs• Develop and implement specific agreed plans on an LLR level

– Nurse Programme– Expansion of Pharmacist programme– consider potential Band 6

rotational scheme to support next wave of PCN recruitment– GP resilience– Supporting new qualified GPs and retaining within the system

15

Next Steps and Questions• See attached proposal of a further breakdown• Invite feedback• How do you see TH linking into overall workforce development plans?• What do you see as the priorities for the training hub?• How do we ensure a co-ordinated response to multiple offers?

16

Blank Page




Rutland CCG


interest: All Board GPs as it may impact on the Out of Area registration process. Dr Wadhwa as Clinical Director of Leicester Central PCN and member of the LLR Local Medical Committee, and similarly for Dr Farheen Dhanji as a PCN Clinical Director and a member of the LLR Local Medical Committee.


N/A


N/A


N/A


Date: 3rd December 2019

Paper:

G Public Confidential

Report title:

Out of Area Patient Registration Arrangements

Presented by: Cal Deane, Interim Head of Primary Care

Report author: Nafisa Bhana, Primary Care Support Officer

Executive lead: Richard Morris, Director of Operations and Corporate Affairs, LC CCG


Executive summary: This paper explains the national Out of Area patient registration arrangements in place across Leicester, Leicestershire and Rutland (LLR).

Appendices: NA

Recommendations:

The LLR CCGs’ Primary Care Commissioning Committees are requested to: NOTE: The current position of the Out of Area patient registration process.


None


N/A


N/A

2



Out of Area Patient Registration Arrangements

Introduction

1. From 5 January 2015, in line with national guidance, all GP practices are able to register new patients who live outside the practice area; without any obligation on the practice to provide home visits or services out of hours, when the patient is unable to attend their registered practice. Out of area patients are made aware of these conditions when enquiring and or registering with a practice.

2. Leicester, Leicestershire & Rutland (LLR) Clinical Commissioning Groups(CCG’s)

through their delegated co-commissioning arrangements, with NHS England, must ensure that patients who choose to register out of area, without home visits, can continue to access primary medical services if they have an urgent care need during core hours and if they cannot reasonably be expected to attend their registered practice.

3. The purpose of this report is to inform the Primary Care Commissioning Committee in Common (PCCC) as to the out of area patient registration arrangements in place across LLR. This paper was requested by the Leicester City Primary Care Commissioning Committee in November 2019.

Background to Out of Area registration

4. GP practices have always had the discretion to register patients who live outside

their practice area. Under the contract GP practices were required to either accept the registration as any other normal patient registration (recognising this may mean undertaking a home visit) or refuse registration on the grounds that the patient lives out of area.

5. While many GP practices exercised their discretion to register patients who live outside the practice area this was largely confined to the immediate vicinity of the practice due to concerns about providing services further outside of the practice boundary area.

6. Where a registration was refused, patient choice was not fully realised, principally because of concerns, by the practice, about the practicalities of fulfilling their contractual obligations to the patient when the patient was ill at home or could not be expected to attend the practice.

7. 2012/13 saw the Department of Health test an ‘out of area registered patient’ scheme to extend choices for patients who live outside of a practice boundary area. This was initially tested under a pilot scheme, the ‘Patient Choice Scheme’.

8. An ‘out of area registered patient’ was a new classification of registered patient, who could have access to the full range of primary medical services as any other patient except home visits, out of hours or immediately necessary treatment due to accident or emergency when outside the practice area.

9. Implementing the out of area registration element of the Patient Choice Scheme was

a priority for NHS Employers (on behalf of NHS England) and General Practitioners

Committee (GPC). Consequently, with effect from 1 October 2014, changes to the General Medical Services (GMS) were made to support this, providing practice participation remained voluntary.

The contract changes and impact on practices

10. The ‘Choice of GP Practice - Guidance on the new out of area patient registration

arrangements’ published in December 2014 explains the changes to the process with effect from 5 January 20151, which meant that all primary medical services contracts (General Medical Services, Personal Medical Services and Alternative Provider Medical Services) have consistent contractual terms that provide practices the option to register out of area without obligations to provide: (i) Home visits; (ii) Immediately necessary treatment following accident or emergency when the

patient is at home; (iii) Access to out of hours services (if not opted out) when the patient is at home

(and it is not reasonable to expect the patient to attend); or, (iv) Other such services provided by the contractor, which for clinical or practical

reasons it is not reasonable to expect the patient to attend their registered practice, e.g. this could include follow up care following hospital discharge.

11. When patients who live outside a practice’s area requests to register with the

practice, the practice will need to decide whether to:

(i) Register the patient as an out of area registered patient with no obligation on the practice to provide home visits etc, assuming it is satisfied it is clinically appropriate and practical to register the patient in this way; or,

(ii) Register as any other registered NHS patient. This will continue to provide access to the full range of services and will involve no change in the obligations on the practice to provide home visits etc. This will continue to be appropriate, for example, for patients who live just outside the practice area.

(iii) Not register the patient. The ability for GP practices to refuse registration on

the grounds the patient lives outside the practice area remains unchanged.

12. GP practices must ensure that when registering new patients under these arrangements, the patient is fully aware and understands the terms of their registration – that is that the practice will not provide a home visit or any other form of urgent care unless the patient is able to attend to the practice. The patient should also be informed on how to access care when at home; in the event they are too unwell to attend the practice.

13. Practices must consider applications to register people living out of area on an individual basis. In particular, whether it is clinically appropriate and practical for the individual patient.

1 While the contract changes came in to force 1 October 2014, it was not clinically appropriate or practical for GP practices to register patients who live out of area without access to home visits until NHS England’s arrangements to deliver urgent care were in place.

4

14. If the practice decides it is not clinically appropriate or practical for the patient to be registered away from home it must explain its reasoning for this. There is no right of appeal for the patient against the decision but the practice must be able to give reasons as to why registration was declined.

15. While there is no obligation on the practice to provide home visits etc. there is an obligation to ensure the position is kept under review and should it become apparent it is no longer clinically appropriate or practical; the GP practice should, following discussion with the patient, invite them to register with a GP practice closer to where the patient lives or if appropriate offer to re-register as any other patient i.e. with access to home visits.

16. GP practices will receive the same GMS global sum/PMS baseline funding, and other payments (Quality and Outcomes Framework, Enhanced Services etc.) for out of area registered patients as they would for any other registered patient. Implications for existing patients

17. Existing registered patients who move home from inside the practice area to outside the practice area may be granted continued registration by GP practices. However, continuing registration would mean no change in their status, and therefore home visiting duties .etc. must still be carried out by the practice. Out of area registration with no home visiting duties can only be applied to new patient registrations.

18. If the GP practice wishes for the new out of area registration arrangement to apply, the GP practice can (after initial discussion with the patient) remove the patient from the practice list (on the grounds they have moved out of area). The patient may then be invited to re-register under the new arrangement (providing they agree with the terms) and it is clinically appropriate and practical to do so. The implications of the conditions of re-registering in respect of home visits etc. must be made clear prior to the change.

19. GP Practices must support the patient to make an informed choice by making it clear

that they are free to register with a practice close to where they live who would be responsible for providing home visits if needed.

20. Existing registered patients who live out of area (those registered with the practice prior to 1 October 2014) will continue to be registered in the same way with access to home visits when needed. The new arrangements do not apply retrospectively to such patients.

Advantages and disadvantages of out of area registrations (after the 2014 contractual changes):

21. The out of area patient registration scheme benefits patients by providing additional flexibility. These patients include:

• People in remote areas who don’t live near a GP surgery or don’t have enough GPs in their area

• people with long-term health conditions, who need regular contact with a GP

5

• Commuters who wish to register with a practice near their place of work or parents to register with a practice near their child’s school

• It also enables GP practices to continue to care for a patient who has moved into a care home.

22. Although the out of area system enables patients to be registered across vast

geographical areas, having large numbers of patients miles away from their home can make it challenging to deliver integrated local health services.

23. The current system also risks creating complexities in delivering reliable screening arrangements.

24. It makes it challenging for commissioners to plan and budget for local services because of the interaction between arrangements for charging costs to responsible commissioners.

Local LLR Positon

25. Leicester City CCG is working with Primary Care Support England (PCSE) in attempting to understand and identify the number of out of area patient registrations, by practice across LLR.

26. Some practices in the city have implemented a process whereby existing or historic out of area patients are requested to sign a disclaimer confirming that they understand the implications of being registered out of area and that the patient will not be entitled to home visits.

27. According to Section 3.11 of the GP of Choice guidance;

‘CCGs will continue to secure out of hours services for their resident population, which will now include those patients categorised as out of area registered patients.’

28. Currently, DHU Healthcare CIC provides an Integrated Urgent Care (IUC) Home Visiting Service across all localities within LLR. The service offers urgent care at home (including care homes, prisons, and community hospitals) for housebound patients and an urgent primary care visiting service out of core hours.

29. The service receives referrals from various sources, including LLR Clinical Navigation hub, NHS 111, General practitioners’ (GP) partners and care home staff. A patient's GP practice will triage patients and assess whether they meet the referral criteria. Referrals should be those patients who, in a clinical opinion, require an urgent visit, and, if delayed, would result in an emergency attendance or admission, which would not be in the best interest of the patient.

LLR CCGs’ Primary Care Commissioning Committee members are asked to:

• NOTE the current position of the out of area registration process

6

Blank Page




Rutland CCG

Implications


Date: 3 December 2019 Paper: H


Primary Care Network Development update

Presented by: Tim Sacks, Chief Operating Officer, ELR CCG

Report author: Paula Vaughan, Deputy Chief Operating Officer, ELR CCG



Executive summary: In August 2019, NHSE/I published the PCN Development Support – Guidance and Prospectus. The document outlines both the expectations for ICS development programmes for PCNs and the support offer from CCGs to PCNs. The document is published in the context of a confirmed 799K (5 year recurrent) funding for PCN and ACD development for LLR. The LLR PCN and CD Development Support proposal was developed with support from the CD Forum and feedback from various LLR committees and groups. An initial 18 month plan (for the period up to 31.3.21) was presented to the Collaborative Commissioning Committee (CCC) on 21 November 2019 and approved. It should be noted that recommendations 2 and 3 for approval were amended by CCC to agree that an evaluation report be received in April 2020. The CCC paper, and approved PCN and CD Development proposal are here presented for information.

Appendices: (list if included)

Recommendations:

The LLR CCGs’ Primary Care Commissioning Committees are asked to: • RECEIVE the approved PCN and Clinical Director Development proposal.


These papers were presented to the Collaborative Commissioning Committee (CCC) on 21 November 2019 and approved.

a) Conflicts of interest:

GP members are conflicted, however no decision is being made the report is for information only.


Aligned to primary care capacity and capability risks.


As detailed within the report.


N/A


N/A


Not undertaken in relation to this report.

Appendix 1

LEICESTER, LEICESTERSHIRE AND RUTLAND

PRIMARY CARE NETWORK AND CLINICAL DIRECTOR DEVELOPMENT PROPOSAL

2019/20 – 2020/21

Introduction We want our PCNS to become the building blocks of the NHS. This LLR PCN and CD Development Prospectus is proposed with the aim of supporting our new leaders and neighbourhood level organisations to understand their role within a ICS whilst building both capacity and capability to innovate and deliver. The expectations of PCNs as vehicles for transformation and integration at a neighbourhood level require PCNs to be supported to think and behave very differently. This change in behaviour will be based on new relationships between teams, individuals and most importantly, patients. PCNs will need to understand the journey they need to go on to enable them to deliver for both patients and staff and articulate this in a PCN strategic plan. CDs are the leaders who will lead this local strategic planning. Bringing together both a primary care team of multiple practices and a wider Integrated Neighbourhood Team (INT) to enable the PCN to deliver is a complex and challenging role. CDs will need to understand the role of a PCN within an ICS, the developmental future of a PCN embracing the INT concept and be able to embrace the relationships required to make this happen. The NHSE PCN Development Prospectus (page 13) lists the skills and areas of understanding each CD is required to achieve. The NHSE PCN Maturity Matrix is a useful tool in helping CDs understand the journey their PCN must go on. The CD Development Offer is designed to give these leaders access to the right training, support and opportunity to develop the skills necessary to support those PCN developmental journeys. The PCN Development Offer is designed to offer facilitated and tailored opportunity for the primary care providers and the wider INT within each PCN to work together to deliver the neighbourhood level ambitions of our ICS. This offer includes several chapters of help, training and support in kind from the CCG to give both PCNs and CDs access to the right information, communication tools and insight to make decisions which are right for their patients. This offer is a reciprocal arrangement. CDs and PCNs are expected to demonstrate and evidence the impact of this development plan with particular reference to patient engagement, delivery of the service specifications and the NHSE Maturity Matrix. The plan details a framework for PCN and CD development. Detail of later elements of the offer will be informed by both a PCN and an CD training needs analysis (TNA).

Chapter 1 – Clinical Director Development

Offer Element

Offer Specifics Delivery Mechanism & Timescale

Potential Providers

Aim of Element

CD and Aspiring CD Leadership Course

Leadership course for LLR CDs and aspiring CDs preceded by a training needs analysis (TNA) to enable tailoring of the offer for each cohort

18 month, 6 session facilitated course – 3 cohorts

NHS Leadership Academies Various CSUs

• To understand the training needs of CDs in the context of PCNs and an ICS

• To give CDs an opportunity to reflect in a facilitated environment on their own leadership behaviours and values their impact on their PCN

• To help CDs understand the value of networks and how to build those at different levels and with key stakeholder groups

• To help aspiring CDs understand the challenge and ready themselves

LLR CD Forum & Masterclasses

CCG Facilitated CD Form focussing on planned dialogue and collaborative working with key partners within the ICS

CD Forum – whole day, quarterly events

LLR CCGs

• To give CDs direct and protected access to CCGs, key information and support

• To enable CDs to have planned dialogue with potential key partners in delivery of specific elements of the DES

• An opportunity to share ideas, innovations and successes

Action Learning Set Formation

To support CDs and Aspiring CDs in long term behavioural change through reflective practice and ownership of self-development

Small cohort (7-8) per learning set delivered between leadership course sessions


• To ensure the leadership journey continues after the leadership course • To embed and encourage ongoing leadership reflective practice and

behaviour change • To enable CDs and Aspiring CDs to take additional ownership of their

leadership development and practice

Executive Coaching

Support for all CDs to find a suitable executive coach and attend regular sessions to support their individual leadership development

2 sessions per year for first 2 years, rising to 4 per year from 2021/22

EMLA • Personal executive level coaching to help CDs clarify their own goals and objectives, better understand when and how to influence their own behaviours and communications and to achieve purpose

Peer Support Opportunity to be “twinned” with an Acute CD Set up during

2019/20 UHL / LPT Other Acute Trusts

• Emphasis on creating an opportunity for both CD peer support and cross-organisational learning

• Starts to develop key relationships within a future Care Alliance 360º Appraisal

All CDs will have access to a 360º Appraisal with executive level facilitation and coaching to understand the results and impact on PDP

Biennial exercise to include appraisal and facilitated reflexion

EMLA Various CSUs

• To enable CDs to baseline their perceived leadership skills and behaviours • To enable CDs to develop their PDP aligned to their PCN’s Maturity Matrix

self-assessment and development plan

Success Outcome Measures & Expectations

• MOU with CDs attending Leadership course focussed on attendance, participation, behaviours and commitment to self-reflection, learning and personal development

• Completion of a CCG ratified CD PDP based on leadership behaviours/skills, values and key competencies as detailed in the NHSE PCN Development Prospectus

Indicative Financial Resource Required

2019/20 2020/21 2021/22* 2022/23* 2023/24* £53,333 £106,667 £64,100 £64,900 £69,600

Chapter 2 – Primary Care Network Development

Offer Element


Potential Providers

Aim of Element

Whole PCN PLT Events

Session themes will be linked to the outputs of the PCN’s maturity Matrix self-assessment and PCN development plan Sessions will include:

• Understanding the PCN’s needs • Collaborative working with patients • Collaborative working with each other • Population Health Management

Twice annual event for each PCN (one in 2019/20) –primary care only 19/20, wider INT from 20/21 PCN to source appropriate venue (within budget and venue aligned to community interest)


• To support PCNs understand their training and development needs aligned to the Maturity Matrix and demands of an ICS

• To support PCNs in listening to and designing services with patients • To support PCNs in their journey from a primary care based PCN to a

wider INT • To introduce PCNs to the concept of Population Health Management,

understanding the needs of patients and innovating new ways working to meet need

• To bring together key people within each PCN, enabling dedicated time to focus on the right collective behaviours, values and priorities

Local PCN PLTs

Session themes will be decided by the PCNS and can focus on the whole or specific elements of the developing INT 3 cohorts to enable cover

Quarterly event for each PCN (two in 2019/20) PCN to source

CCGs to support with key local partners include organisations represented by INTs and Public Health

• To enable PCN-led learning • To enable PCN directed development sessions aligned to learning from

service provision, developing the PCN’s place within a Care Alliance, specific professional group meetings/training and

• To enable PCNs protected time to refocus on the PCN Development Plan and evidencing progress

PCN Individual Support

Facilitator assigned to the PCN over 2 days to provide 1-2-1 support, exploring PCN specific issues

2 tailored support pack

CSUs • Improved confidence in PCN organisational skills • Evidence of ability to address immediate issues

Personal Centered Leadership

Outcomes-based Quality Improvement (QI) support, training and advice for PCNs Person centered leadership tools and training Regular induction and support for QI leaders

Info package Access sessions Regular induction and support for QI leaders

LLR CCGs

• Creation of a Quality Improvement golden thread throughout PCNs and their service improvement work

• Creation of Quality Improvement capacity and capability within all PCNs • To create an outcome based focus on service improvement and a

reference point for PCNs for key work streams Including population Health Management


• Development of Primary Care led PCNs into multi-agency INTs • Clear development plans for PCNs and their readiness to provide as part of a Care

Alliance • PCNs able to adopt and deliver a QI approach to planning, innovation and delivery

• Completion of a published and CCG ratified PCN Strategic Plan based on the PCN’s self-assessment against the Maturity Matrix, the NHSE PCN Development Prospectus and the PCN ambitions as set out within the LLR Primary Care Strategy

• List of PCN trained QI and Person Centered Leadership champions


2019/20 2020/21 2021/22* 2022/23* 2023/24* £139,975 £279,950 £220,200 £220,200 £220,200

Chapter 3 – Patient Engagement and Communication

Offer Element


Potential Providers

Aim of Element

Co-Design and Awareness Training

Five PCNs in Leicester, Leicestershire and Rutland are already working with the LLR CCGs’ Engagement Team, NHS England and an organisation called Co-Create on a pilot project to test out a range of ways of co-designing services with their patients.

Support in Kind offer to all PCNs

CCGs • A report upon which recommendations and a toolkit can be created for all LLR PCNs.

• Support for on-going of co-design of services with patients and families throughout the life of the DES

Stakeholder Mapping

Prior to creating communication and engagement plans, primary care networks are advised to produce a map of their stakeholders

Workshop part of a Masterclass session and/or CD Forum

CCGs • Clarity of key stakeholders for all CDs and PCNs • Time to consider best ways to communicate, engage with and involve

stakeholders (also to form part of each PCN Development Plan)

Engagement and Consultation Duties

All NHS organisations have a duty to involve patients and the public in their work. These duties also apply to Primary Care Networks.


CCGs • CD awareness of engagement and consultation duties • To develop CD awareness of when and how to seek advice and help • To ensure CDs and PCNs are kept safe with regard to their duties to

engage and consult Communications Planning

Building on your stakeholder map, PCNs may require support about how to communicate with priority groups.


CCGs • Clarity of key stakeholders for all CDs and PCNs • Time to consider best ways to communicate, engage with and involve

stakeholders (also to form part of each PCN Development Plan)

Media Training As the PCN develops clinical directors may wish to use the media to promote the good work they are doing. They may also be called upon by the media to respond to negative news about the PCN or constituent practices.

Specialist training session

Via CCGs • To equip CDs with the right tools to respond successfully and positively to media enquiries including powerful messaging and relationship management

Communication and Engagement Advice

Dedicated CCG-provided Communication and Engagement management capacity

Access to dedicated support on an on-going basis

CCGs • To ensure CDs and PCNs have access to specialist support as and when the need arises to best manage relationships with stakeholders and patients

Communications Toolkit

To support PCNs in communicating with their identified target groups, a toolkit of materials will be developed for them to adapt.

Ad hoc material development

CCGs • To ensure PCNs have access to quality communications material at scale when the need arises.


• Evidence of strong and improving relationships between PCNs and their key stakeholders including patients

• Completion of a published and CCG ratified PCN Development Plan including a stakeholder map and communications strategy


2019/20 2020/21 2021/22 2022/23 2023/24 £34,500 £43,500 £10,500 £10,500 £10,500

Chapter 4 – Information and Business Intelligence

Offer Element


Potential Providers

Aim of Element

PCN Reporting and Insight

Continuous development of the PCN Intelligence Pack (PIP) in partnership with the local CSU Publication of data monthly on accessible platform Will include minimum dataset (3 years’ activity data, QOF, locally collected information and JSNA/Public Health information) providing a comprehensive data picture for each PCN Each month data presentation will be analysed and narrated to offer Insight and suggested areas of focus by PCN

Monthly update report and PIP Monthly Insight reporting

Mids and Lancs CSU

• Provision of relevant and accessible information to each PCN • Provision of analysis and insight helping PCNs to focus on key areas for

development, consideration and improvement • Provision of performance data enabling PCNs to focus on Quality

Improvement and accountability • Provision of sufficient information and intelligence to enable PCNs to

embrace the concept of Population Health Management in 2020/21 in readiness for the 2021/22 national specifications

Business Intelligence Training

ACD and PCN Business Intelligence training Annual session for both ACDs and the wider PCN team

Aligned to the ACD and PCN development offers including Masterclass Sessions and whole PCN PLT events

Mids and Lancs CSU

• Ensure each ACD has the skill set required to access both published information (PIP) and insight guiding priorities and areas for innovation

• Ensure each PCN has the skills within the organisation to access both published information (PIP) and insight

• PCN priorities guided by local intelligence and insight wider than primary care data sets

• PCNs’ ability to narrate priorities and plans based on evidence and insight

Dedicated Business Intelligence and Insight Support

Dedicated support from an intelligence and insight manager for all PCNs and ACDs Accessible during working hours via telephone and email LLR PCN Business Intelligence group

Full time dedicated intelligence and insight manager for PCNs Monthly forum with CD partners

Mids and Lancs CSU CCG & CSU partnership

• Nurture and retain PCNs’ commitment to using intelligence and insight in decision making and priority setting

• Ensure timely responses to ACD and PCN enquiries relating to intelligence, data and insight

• Support developing Population Health Management Agenda


• Intelligence, evidence and insight-based discussions at a PCN level feeding into PCN strategic and innovation plans

• PCNs led by ACDs with access to the appropriate information and training to use the available intelligence

• Evidence of monthly review of PIP and accompanying insight at PCN meetings • Evidence of incorporation of PIP and insight into the published and CCG ratified PCN

Strategic Plan • Register of PCN staff trained in accessing and interpreting business intelligence data

(minimum one from each practice and 2 other members of the INT)


2019/20 2020/21 2021/22* 2022/23* 2023/24* £86,076 £118,229 £118,229 £118,229 £118,229

Chapter 5 – Workforce Planning

Offer Element


Potential Providers

Aim of Element

New Roles Planning

Funding is made available through the Network Contract DES for PCNs to recruit additional new full-time posts over the next 5 years. The intention is to grow additional workforce capacity through new roles, and by doing so, help solve the workforce shortage in general practice.

Dedicated support from the LLR Workforce Group in specific elements of workforce planning and understanding quality improvement

CCGs • Provision of relevant and accessible information to each PCN in future planning, accessing training/induction at scale, recruitment and retention strategic support and evaluation of the impact of new roles for patient experience and clinical outcomes

Additional Roles Implementation Support

Clinical Pharmacists - Series of resources to assist PCNs with the recruitment, training and development Social Prescriber Link Workers - In Leicestershire, through the engagement with PCNs / Federations, Public Health are developing a proposal to help facilitate joint working between PCN SPLw

Maria Gilbert, Pharmacist Ambassador

HEE LLR PH

• Establishment of an informal community of practice across Leicestershire for additional roles

• Enabling best practice sharing, informal mentoring and peer support to ensure quality of new role implementation

Additional Roles Induction

Clinical Pharmacists - Group GP Practice training package. The benefits attained by delivering the objectives above will include: Social Prescriber Link Workers – facilitated group induction programme

1 cohort in 19/20 - 2 further cohorts for the 4 years following

PILS LLR PH

• A standard baseline training of additional roles across LLR • Peer support for new roles preventing professional isolation • Faster rate of adoption of new processes and Population Health

Management approaches • Maximisation recruitment and retention of additional roles, maximising

impact of new roles

Other Additional Roles

Support for PCNs in their work with other new roles, linking with Universities and other training establishments

Dina Bateman, Physician Associate Ambassador

HEE • Nurture and retain PCNs’ commitment to using intelligence and insight in decision making and priority setting

• Ensure timely responses to ACD and PCN enquiries relating to intelligence, data and insight


• Recruitment, induction and implementation of the right additional roles in each PCN • PCNs to collaborate with key system partners to deliver effective, safe and efficient

recruitment and implementation of additional roles

• Completion of a published and CCG ratified PCN Workforce Ambitions based on the PCN’s self-assessment against the Maturity Matrix, the NHSE PCN Development Prospectus and the PCN ambitions as set out within the LLR Primary Care Strategy


2019/20 2020/21 2021/22* 2022/23* 2023/24* £11,600 £21,200 £21,200 £19,200 £19,200

Chapter 6 – IT Infrastructure

Offer Element


Potential Providers

Aim of Element

Shared Clinical System Facilitation

Mobilisation of a SystmOne (D1) hub unit to support PCNs to share their patients and support activities such as extended hours delivered collaboratively

Offered to all PCNs with the exception of the single PCN who are currently 100% EMIS within 2019/20 in readiness for 20/21

LHIS This hub unit: • is the solution to sharing work such as extended hours across S1 practices within a primary care network • ensures that the treating clinician has full access to the records and can see and treat the patient and enabling PCNs to work effectively within their network footprint. • operates within the Information Governance sharing agreements which are in existence.

• Enable and facilitate collaborative working and delivery of services at scale within each PCN

• Enable delivery of single PCN/Neighbourhood level services where ‘critical mass’ facilitates betters services for patients

Shared Drive Functionality

To explore the ability to share files across PCN footprints a pilot has been underway looking at Office 365 One drive functionality.

Offered to all PCNs in 2019/20

LHIS / Microsoft • Delivery of a standardised and best-practice email, file storage, instant message and sharing of non-clinical information within each PCN

• Information and data security for PCNs

IT Hardware Support

PCN budget for CD IT hardware Annual budget from which CD can draw-down

LHIS/CCGs • Ensure CDs have access to the necessary equipment enabling communication within and across PCNs within LLR


• PCNs using One drive to enable safe, information sharing and collaborative working as part of everyday working practices

• PCNs enabled to use patient information sharing to deliver services at scale

• PCN data sharing agreements in place • Evidence of incorporation of data sharing into services planning and delivery • PCN system migration plan (where appropriate)


2019/20 2020/21 2021/22* 2022/23* 2023/24* £144,221 £81,394 £63,194 £63,194 £63,194

Chapter 7 – Management Capacity

Offer Element


Potential Providers

Aim of Element

Dedicated PCN Project Management and Management Support Capacity

Investment for PCNs to source dedicated management capacity to focus on specific tasks including business support tasks related to service delivery, readiness and business planning

Offered to all PCNs from 2019/20 onwards – to be arranged as a network of PCNs

CCGs • Enable a network of PCNs to access and fun additional management capacity to support the formation and day to day working of PCNs

• Enable PCN networks to work across PCNs where possible to create some standardisation to approach business planning and service delivery (focussed on health inequalities) whilst also enabling local variation to meet population need.

Dedicated CCG Management Support - Operational and Medicines Optimisation

Designated management point of contact hosted by the PCN's host CCG. Examples include: • Interpretation of NHSE/I guidance and writing of recommendations to PCN (e.g. support to complete Maturity Matrix, New Roles Guidance) • Point of CCG contact and support for named PCN and ACD - both managerial and medicines optimisation

Offered to all PCNs from 2019/20 onwards

CCGs • Enabling all PCNs to access additional and dedicated general and medicines management support from their host CCG

• Ensure all PCNs have access to a minimum standard of management support and capacity

• Ensures all PCNs have a dedicated contact based in the host CCG

Dedicated PCN Financial Advice and Support

Dedicated management capacity to include: • General Financial advice and support • Interpretation of financial guidance • Financial Induction in how the funds flow within the NHS • Receipt and processing of payment claims • Responding to PCN financial queries

Offered to all PCNs from 2019/20 onwards

CCGs • Enabling all PCNs to access additional and dedicated financial management support from their host CCG

• Ensure all PCNs have access to a minimum standard of management support and capacity

• Ensures all PCNs have a dedicated finance contact based in the host CCG


• PCNs reach key mobilisation and operational milestones aligned to the DES contract • PCNs supported to access the maximum possible additional investment including

Additional Roles funds

• Completion of a published and CCG ratified PCN Development Plan including a workforce, finance and mobilisation plan.

• Demonstration of affordability of Additional Roles invested and impact of Additional Roles including additional capacity, improvements in continuity of care and patient experience


2019/20 2020/21 2021/22* 2022/23* 2023/24* £154,334 £246,006 £246,006 £246,006 £246,006

Chapter 8 – Specialist Advice

Offer Element


Potential Providers

Aim of Element

Access to Legal Advice Capacity

Funded Primary Care specialist Legal Advice for two projects over the remainder of 2019/20. Advice Could be used for: • Creation of a Memorandum of Understanding • Employment contract • Staff sharing agreement

Offered to all PCNs as a collaboration. CDs expected to work together to ensure best value for money support is accessed for LLR PCNs

Health Systems Support Framework

• Enable PCNs to access specialist support including legal advice for specific pieces of work to be carried out at scale

• To encourage CDs to work as a collaboration to acquire value for money specialist support for LLR PCNs as a collective


• PCNs reach key mobilisation and operational milestones aligned to the DES contract

• Demonstration of value for money in accessing specialist support for LLR PCNs • Evidence of working collaboratively to jointly decide priorities and appropriate support

representing value for money


2019/20 2020/21 2021/22 2022/23 2023/24 £14,700 £29,400 £14,700 £0 £0

*Note – figures for 2021/22 are indicative only.

Blank Page




Rutland CCG


Date: 3 December 2019 Paper: I Public Confidential

Report title:

Christmas and New Year 2019/20 cover arrangements for practices across LLR

Presented by: Jamie Barrett, Head of Primary Care

Report author: Seema Gaj, Senior Primary Care Contract Manager



Executive summary: This report sets out the proposed arrangements for opening hours expectations over the 2019/20 Christmas and New Year period. At the respective LLR PCCC meetings in October, a report was presented seeking approval for Leicester Medical Committee (LMC) to arrange sub-contracting primary care provision during Christmas and New Year’s eve from 16:00 to 18:30 with Derbyshire Health United. This was approved by the LLR PCCC’s and LMC have now provided the CCG with a list of those practices that have signed up to this arrangement. The purpose of this report is to inform the LLR PCCC’s of those practices that have signed up and note that an update will be provided in the new year on the outcome of this arrangement, usage and analysis.

Appendices: NA

Recommendations:


• NOTE the list of GP Practices across LLR who have signed up to the sub-contracting arrangement with LMC to close at 16:00 till 18:30 on Christmas Eve and New Year’s Eve.

• NOTE LLR PCCCs will be provided with an update in 2020 on the outcome of the sub-contracting arrangement and usage or issues identified across LLR.


PCCC Paper presented in October 2019


interest: All GPs present are conflicted.


N/A


N/A


N/A


N/A


Not reviewed in relation to this report.

2


East Leicestershire and Rutland Clinical Commissioning Group Christmas and New Year 2019/20 cover arrangements across Leicester,

Leicestershire and Rutland (CCGs)

3 December 2019

Introduction

1. In October 2019, a report was presented to respective Leicester, Leicestershire and Rutland PCCCs informing them of an option that would be made available to practices on Christmas and New Year’s Eve.

2. The report informed PCCC that the Local Medical Committee (LMC) would arrange for sub-contracting services to be made available at a fee for primary care sub-contracting services to be offered on Christmas Eve and New Year’s Eve from 16:00 to 18:30.

3. Based on the learning and feedback from Christmas and New Year 2018/19, it was recommended that the PCCC approve the proposal submitted by the LMC to allow practices to sub contract primary medical care services from 16.00 – 18.30 on Christmas Eve and New Year’s Eve. PCCC’s across LLR approved this proposal and LMC thereafter contacted practices inviting them to sign up to this option.

4. The purpose of this report is to provide LLR PCCC’s with an update on those practices across LLR that have signed up to this sub-contracting arrangement and the requirements they would need to adhere to.

5. The LMC have confirmed that the cover arrangements will include the following: • Derbyshire Health United will provide cover from 16.00 – 18.30 on Christmas Eve

and New Year’s Eve • This will include home visits if required.

6. Based on the proposal submitted by the LMC and the information from previous years

this arrangement provides the CCG’s with assurances that reasonable needs of patients will be met. To facilitate the assurance on provision of care to patients during this period, LMC will instruct practices who sign up to this arrangement to adhere to the following;

• Practices signed up are required to auto-divert to the DHU number, rather than leaving the number on a voicemail for patients to redial. This usually can be very easily done by the practice contacting their phone provider (small fee usually required from phone provider)

• Divert must be removed at 6.30pm • LMC has a different tier for costing which is based on the workforce required by

DHU • Practices should not be signposting patients to the 111 service, but should be

using the DHU number. Further communication will be sent out to practices week commencing 2nd December reminding them of their responsibility.

7. Practices have been given till 6th December to confirm sign-up and make necessary

payment. LMC have provided a provisional list of those practices that have signed up which include the following:

Practice sign up for Christmas Eve & New Year's Eve Sub-contracting arrangement 2019

Practice code CCG Practice Name & Address

Leicester City CCG: 31 Practices Signed up out of 58 practices

C82005 City Groby Road Medical Centre, 9 Groby Road, Leicester LE3 9ED

C82116 City Highfields Surgery, 25 Severn Street, Leicester, LE2 0NN

C82660 City St Peters Health Centre, Sparkenhoe Street, Leicester, LE2 0TA

C82094 City Beaumont Lodge Medical Practice, Leicester , LE4 0QR

C 82073 City Merridale Medical Centre, 5 Fullhurst Avenue, Leicester, LE3 1BL

C82053 City Hockley Farm Medical Practice, Leicester LE3 1HN

C82105 City Ar Razi Medical Centre, 1 Evington Road, Leicester, LE5 5PQ

C82018 City Manor Park Medical Practice, 122 Parker Drive, Leicester, LE4 0JF

C82124 City Victoria Park Health Centre, 203 Victoria Park Road, Leicester, LE2 1XD

C82662 City Walnut Medical Centre, 110 walnut Street, Leicester, LE2 7LE

C82086 City Fosse Medical Centre, 344 Fosse Road North, Leicester. LE3 5RR

C82031 City Johnson Medical Practice, 22 Maidenwell Avenue, Leicester, LE5 1BL

C82080 City Shefa Medical Practice, St Peters Health Centre, Leicester, LE2 0TA

C82122 City Clarendon Park Medical Practice, 296 Clarendon Park Road, LE2 3AG

C82643 City Dr Osama and Patners, Community Health Centre, Leicester, LE2 0GU

C82676 City St Eliazabeth's Medical Centre, Netherhall Road, Leicester, LE5 1DR

C82046 City Saffron Health, 509 Saffron Lane, Leicester, LE2 6UL

C82100 City The Hedges Medical Centre, Pasley Road, Leicester, LE2 9BU

Y00137 City Willows Medical Centre, Coleman Road Leicester LE5 4LJ

C82626 City Pasley Road Health Centre, Pasley Road Leicester

C82029 City Dr Astles & Partners, Willowbrook Medical Centre Leicester

C82063 City East Leicestershire Medical Practice, Leicester, LE5 4BP

4


Y02686 City Bowling Green Street, 29-31 bowling green st leicester,le1 6as

C82060 City Sayeed medical practice, 352-354 East Park Road

C82033 City Humberstone Medical Centre, 150 Wycombe Road,

C82639 City Westcotes Health Centre (Dr Taylor), Leicester, LE3 OLP

Y03587 City Westcotes Medical Practice, Fosse Road South, Leicester, LE3 OLP

C82107 City Belgrave Health Centre, 52 Brandon Street, Leicester, LE4 6AW

C82092 City Aylestone Health Centre, 15 Hall Lane, Leicester, LE2 8SF

C82008 City Oakmeadow Surgery, 87 Tatlow Road, Glenfield, Leiceter, LE3 8NF

C82667 City The Charnwood Practice, Section E, Merlyn Vaz Health & Social Care

ELR CCG Practices: 24 Practices signed up out of 29

C82055 ELR The Limes Medical Centre, 65 Leicester Road, Narborough, LE19 2DU

C82039 ELR Kingsway Surgery, 23 Kingsway, Leicester, LE3 2JN

C82048 ELR Rosemead Drive Surgery, 103 Rosemead Drive, Oadby, Leicester, LE2 5PP

C82098 ELR Hazelmere Medical Centre, 58 Lutterworth Road, LE8 4DN

C82109 ELR Husbands Bosworth Medical Centre, 1 Marsh Drive, Leics, LE17 6PU

C82077 ELR Uppingham Surgery, North Gate, Uppingham, Rutland, LE15 9EG

C82038 ELR Latham House Medical Practice, Sage Cross Street, Leics, LE13 1NX

C82066 ELR Forest House Medical Centre, 2a Park Drive, Leicester, LE3 3FN

C82068 ELR Northfield Medical Centre, 12 Villers Court, Blaby, Leics, LE8 4NS

C82042 ELR The County Practice, Syston Health Centre, 1330 Melton Road, LE7 2EQ

C82631 ELR Enderby Medical Practice, Shortridge Lane, Enderby Leicester, LE19 4LY

C82079 ELR South Wigston Health Centre, 80 Blaby Road, Wigston, LE18 4SE

C82021 ELR The Central Surgery, Brooksby Drive, Oadby, Leicester, LE2 5AA

C82067 ELR The Croft Medical Centre, 2 Glen Road, Oadby, Leicester, LE2 4PE

C82078 ELR Jubilee Medical Practice, Syston Health Centre, 1330 Melton RD, LE7 2EQ

C82002 ELR Countesthorpe Health Centre, Central St, Countersthorpe, Leics, LE8 5QJ

C82056 ELR The Glenfield Surgery, 111 Station Road, Glenfield, Leicester, LE3 8GS

5


C82022 ELR Billesdon Surgery, 4 Market Place, Billesdon, Leics, LE7 9AJ

C82649 ELR Market Overton and Somerby Surgeries, Overton, LE15 7PP

C82010 ELR Oakham Medical Practice, Cold Overton Road, Oakham, LE15 6NT

C82001 ELR South Leicestershire Medical Group, Smeeton Road, Leicester, LE8 0LG

C82009 ELR Market Harborough Medical Centre, 67 Coventry Road, LE16 9BX

C82013 ELR Bushloe Surgery, Two Steeples Medical Centre, Wigston, LE18 2EW

C82071 ELR Wigston Central Surgery, Two Steeples Medical Centre, LE18 2EW

West Practices: 34 practices signed up out of 47

C82064 West Forest House Surgery, 25 Leicester Road, Shepshed, LE12 9DF

C82041 West Charnwood Community Medical Group, LEICS, LE11 5DX

C82121 West Dr C.J Moncrieff and Partners, Heath Lane Surgery, Leicester, LE9 7PB

C82644 West Highgate Medical Centre, 5 Storer Close, Loughborough LE12 7UD

C82051 West Newbold Verdon Medical Practice, Newbold Verdon, Leicester, LE9 9PZ

C82111 West University Medical Centre

C82047 West Maples Family Medical Pratice, 35 Hill Street, Hinckley, LE10 1DS

C82011 West Pinfold Medical Practice, Pinfold Gate, Loughborough, LE11 1DQ

C82070 West Woodbrook Medical Centre, 28 Bridge Street, Loughborough, LE11 1NH

C82034 West Quorn Medical Centre, 1 Station Road, Quorn, LE12 8BP

C82095 West Alpine House Surgery, 86 Rothley Road, Mountsorrel, Leicestershire

C82061 West Barwell and Holycroft Medical Centre, Jersey Way - LE9 8HR

C82007 West Castle Donnigton Surgery, 53 Borough Street, DE74 2LB

C82120 West Dr Virmani and Dr Bedi, Whitwick Health Centre, North Street, LE67 5HX

C82043 West Station View Health Centre, Southfield Road, Hinckley, LE10 1UA

Y00252 West The Cottage Surgery, 37 Main Street, Leicestershire. LE12 8RY

C82600 West The Banks Surgery, 9 The Banks, Sileby, Leicestershire. LE12 7RD

C82035 West Park View Surgery, 24-28 Leicester Road, Loughborough, LE11 2AG

C82050 West Long Lane Surgery, Beacon House

6


C82012 West Ibstock & Barlestone Surgeries, 132 High Street, Ibstock, Leics, LE67 6JP

C82102 West Manor House Surgery, 1 Mill Lane, Belton, Loughborough, LE12 9UJ

C82628 West Groby Surgery, 26 Rookery Lane, Groby, Leicester LE6 0GL

C82072 West Broom Leys Surgery, Broom Leys Road, Coalville, Leics, LE67 4DE

C82075 West Castle Mead Medical Group - awaiting form

C82017 West Measham Medical Unit, High Street Measham Derbyshire, De12 7HR

C82082 West Centre Surgery, Hinckley Health Centre, Hill Street , Hinckley LE10 1DS

C82103 West Dishley Grange Medical Practice, 32 Maxwell Drive LE11 4RZ

C82054 West Burbage Surgery, Burbage Surgery, Burbage, Hinckley, LE10 2SE

C82627 West Silverdale Medical Centre, 6 Silverdale Drive, Thurmaston, LE4 8NN

C82028 West Markfield Medical Centre, 24 Chitterman Way, Markfield, LE67 9WU

C82003 West Greengate Medical Centre, 1 Greengate Lane, Birstall, LE4 3JF

C82093 West The Orchard Medical Practice, Orchard Road, Leicester, LE9 6RG

C82027 West Dr S E Kitchin & Partners, The Old School Surgery, Leics, LE9 4LJ

C82032 West The Anstey Surgery, 21a The Nook, Anstey, Leicester, LE7 7AZ

8. LMC will provide the CCGs with a final list of those practices that have signed up to the

sub-contracting arrangement with DHU for Christmas and New Year’s eve.

9. The above issues will need to be managed across the LLR footprint with support from the communications team, primary care across LLR CCG urgent care team. However the impact of these for the time periods indicated are predicted to remain low.

Conclusion 10. LMC have provided a preliminary list of those practices across LLR who have signed up

to the sub-contracting arrangements that will be put in place on Christmas and New Year’s Eve.

11. Further work needs to be undertaken to ensure that PCNs and practices are fully aware of the requirements for extended opening hours and general opening hour’s arrangements.

12. In addition, key stakeholders will be notified of the sub-contracting arrangement, this includes 111, LPT, Pharmacies, etc.

13. In the New Year, LLR PCCC will be provided with a report summarising the sub-contracting arrangement, which will include, usage, list any issue identified, note

7

feedback received from practices and provider, which will be used when considering future arrangements.

Recommendations The Primary Care Commissioning Committee are requested to:

• NOTE the list of GP Practices across LLR who have signed up to the sub-contracting arrangement with LMC to close at 16:00 till 18:30 on Christmas Eve and New Year’s Eve.

• NOTE LLR PCCCs will be provided with an update in 2020 on the outcome of the sub-contracting arrangement and usage or issues identified across LLR.

8

leicester city clinical commissioning group west leicestershire...

Documents