meeting: primary care commissioning committee · date:27/11/2019 primary care workstream update...

Date:27/11/2019

Primary Care Workstream Update Date of meetings:

02/10/19 & 06/11/19 of 5

Meeting: Primary Care Commissioning Committee

Meeting Date 26 November 2019 Action Consider

Item No. 13 Confidential No

Title Primary Care Workstream Update

Presented By Dr Jeff Schryer, CCG Chair & Clinical Director – Primary Care

Author Dr Jeff Schryer, CCG Chair & Clinical Director – Primary Care

Clinical Lead Dr Jeff Schryer, CCG Chair & Clinical Director – Primary Care

Executive Summary

The attached Primary Care Workstream briefing has been prepared to provide PCCC with an overview of the schemes and progress currently being delivered/supported by the team.

Recommendations

It is recommended that the Primary Care Commissioning Committee:

Note the briefing being presented

Links to CCG Strategic Objectives

SO1 People and Place To enable the people of Bury to live in a place where they can co-create their own good health and well-being and to provide good quality care when it is needed to help people return to the best possible quality of life

☐

SO2 Inclusive Growth To increase the productivity of Bury’s economy by enabling all Bury people to contribute to and benefit from growth by accessing good jobs with good career prospects and through commissioning for social value

☐

SO3 Budget To deliver a balanced budget for 2019/20

☐

SO4 Staff Wellbeing To increase the involvement and wellbeing of all staff in scope of the OCO. ☐

Does this report seek to address any of the risks included on the Governing Body Assurance Framework? If yes, state which risk below:

GBAF [Insert Risk Number and Detail Here]

Implications

Are there any quality, safeguarding or patient experience implications?

Yes ☐ No ☐ N/A ☒

If you have ticked yes provide details here. Delete this text if you have ticked No or N/A

Date:27/11/2019


02/10/19 & 06/11/19 of 5

Has any engagement (clinical, stakeholder or public/patient) been undertaken in relation to this report?



Have any departments/organisations who will be affected been consulted ?


< If you have ticked yes, Insert details of the people you have worked with or consulted during the process : Finance (insert job title) Commissioning (insert job title) Contracting (insert job title) Medicines Optimisation (insert job title) Clinical leads (insert job title) Quality (insert job title) Safeguarding (insert job title) Other (insert job title)>

Are there any conflicts of interest arising from the proposal or decision being requested?


If you have ticked yes provide details here. <Include details of any conflicts of interest declared> <Where declarations are to be made, include details of conflicted individual(s) name, position; the conflict(s) details, and how these will be managed in the meeting> <Confirm whether the interest is recorded on the register of interests- if not agreed course of action> Delete this text if you have ticked No or N/A

Are there any financial Implications? Yes ☐ No ☐ N/A ☒


Has a Equality, Privacy or Quality Impact Assessment been completed?


Is a Equality, Privacy or Quality Impact Assessment required?


Are there any associated risks including Conflicts of Interest?


Are the risks on the CCG’s risk register? Yes ☐ No ☐ N/A ☒

Date:27/11/2019


02/10/19 & 06/11/19 of 5

Governance and Reporting

Meeting Date Outcome

Name of meeting

These boxes are for recording where the report has also been considered and what the outcome was. This will include internal meetings like SMT.

If the report has not been discussed at any other meeting, these boxes can remain empty.

If you have ticked yes provide details here. If you are unsure seek advice from Lynne Byers, Email - [email protected] about the risk register.

mailto:[email protected]

Date:27/11/2019


02/10/19 & 06/11/19 of 5

Primary Care Workstream Update

1. Introduction

This briefing has been prepared in order to provide Primary Care Commissioning Committee (PCCC) with an overview of the work currently being discussed/progressed via the Primary Care Workstream Group (PCWG).

2. Primary Care Workstream Group Meetings (October/November 2019)

2.1 Primary Care Work programme highlight reports

Reports highlighting areas of concern (i.e. schemes that had been RAG rated as amber or red in the workplan) were provided to PCWG. These issues were discussed individually with actions agreed to progress where appropriate. 3. Performance Monitoring

3.1 Contractual Issues/Information No contractual issues were raised or discussed. 3.2 Contractual changes processed by NHSE (Appendix 1) October – Attached November – nothing to report 4. Primary Care Risks Report (Appendix 2) October – Nothing to Report November - attached 5. Primary Care Workstream Group Reporting Structure (Appendix 3) A draft of the proposed PCWG reporting structure was presented to the PCWG. It was decided to continue to use the PC workflow as it is before deciding next steps eg does it work, if so roll out to the Medicines Optimisation Team. 6. Learning from Datix – Update A backlog of Datix issues are now being worked through led by James Sheard, with the categorisation of incidents being confirmed as part of this process. All incidents allocated to a workstream to ensure themes are captured and agree how to progress if appropriate. Dashboards are being redesigned to align to workstreams. Dashboard for feedback to General Practice on issues/incidents logged also being developed for inclusion in primary care communications eg e-news.

Date:27/11/2019


02/10/19 & 06/11/19 of 5

From looking at the issues it was felt that most of them were not down to Primary Care to look at and that JS and ZA would meet outside the PCWG to discuss the outstanding Datix issues in order to agree a process moving forward.

7. GP Federation Update (Apendix 4) A report was presented to provide an update to the Primary Care Workstream Group with regards to the contracts and projects currently commissioned by the CCG for operational delivery by the GP Federation as follows:

Bealey Community Hospital

Extended Working Hours

GP and Nurse Retention Programme 8. BARDOC Antibiotic Prescribing The Medicines Optimisation team met with BARDOC around their antibiotic prescribing both within OHH and Prestwich WIC. There is some initial thinking that locums use is driving the increase amongst other things. Actions have been agreed and an update will be provided to the PCWG in January 1920. Dr J Schryer CCG Chair & Clinical Director – Primary Care November 2019

Appendix 1

9.1 FW Bury CCG

Contractual Changes.msg Appendix 2

11.1 Risk Report

Primary Care Workstream.docx Appendix 3

7.0 PCWG Proposed

Reporting Structure.pptx Appendix 4

5.0 GP Federation

Update Paper Nov 2019.docx

Appendix 1

Date:06/11/2019 Primary Care Workstream Risk Report Page 1 of 7

Primary Care Workstream Risk Report

1. Introduction

1.1 The attached brief has been prepared to provide the Primary Care (PC) Workstreamwith an overview of the risks that have been assigned to this workstream and providesoversight in respect to those risks identified, and assessed between the risk owner andrisk manager on a schedule appropriate to the level of risk.

1.2

1.3

This report presents the risk position and status as at 15 October 2019.

During this reporting period the one risk assigned to the PC Workstream has undergonea risk assessment. As an agreed process any risks which undergo a risk assessmentmust be reviewed to gain a group consensus.

WS_ALL*_CE_PE_HIM_03 - LeDeR (Learning Disability Mortality Reviews)Programme 2019/20 (New)

2. Overview

2.1 The risk register (see Appendix A) captures all risks, irrespective of risk level, that havebeen categorised by the risk owner with the potential to impact on the workstream.

2.2 Appendix B provides an increased level of detail on all those risks, including controls,assurances, gaps and mitigating actions to reduce the risk with updates highlighted. Therisk matrix is also provided at Appendix C for ease of reference.

3. Main Report

3.1

3.2

Risk Review Process

To ensure that the workstream risk registers have clearly defined risks the workstreammeeting will be instrumental to aid the development of the risk register through horizonscanning by cataloguing actual and potential threats to service delivery.

Meeting: Primary Care Workstream Meeting Date 06 November 2019 Action Receive

Item No. Confidential No

Title Primary Care Workstream Risk Report

Presented By Lynne Byers, Risk Manager

Author Lynne Byers, Risk Manager

Clinical Lead

Appendix 2


3.3

Appendix B will support the group in discussion and provide an opportunity to look in more detail at controls, assurances, gaps and actions and to also seek multiple viewpoints to encourage a positive debate and consensus. Furthermore this process will help to prompt identification of new risks through horizon scanning as new risk(s) will arise as activities and projects progress.

4. Workstream Considerations

4.1 Some questions which members of the workstream might consider when looking at

individual risks are:

Is this risk as it is currently described, the real risk to the CCG?

Is the scoring domain the one with the most impact (e.g. Quality, Safety, Financial)?

Using the matrix provided is the current and target risk score based on the information provided an accurate position?

Are the existing levels of assurance (i.e. evidence that controls have been reviewed) sufficient? Are there any other meetings where the risk is being reviewed and discussed?

Are the existing controls (i.e. what is being done to manage the risk) still relevant? Are they controlling the risk? Do they articulate how they contribute to managing the risk (prime deliverable)?

Have any other controls been identified which will help to mitigate the risk further?

Are the gaps identified correctly? Are they still a gap or have they moved to a control or an assurance?

With regard to those risks which have gaps what further action needs to be taken to ensure these become controls or assurances? – The less gaps which are identified may ultimately mean the risk is closer to target score.

Lynne Byers Risk Manager [email protected] October 2019



Risk remains at its current level 12

CCG funding of 10K has been confirmed by NHSE however not received as yet (7/10/2019)

A memorandum of understanding is currently being reviewed for submission to NHSE outlining the terms on receipt of the funds.

Once received the funds will be ring-fenced to tackle the backlog cases

It is anticipated that once the resource is issued and reviewers employed the gaps identified will be addressed and the risk reduced

Appendix A: Primary Care Workstream Risk Register: Summary

Risk Management

Risk Id Risk Description Date Risk Identified

Original Risk

Score

Risk Last Reviewed

Current Risk

Score

Target Risk

Score

Direction of Travel

Next Risk Review

CCG WS_ALL*_CE_PE_HIM_03

LeDeR (Learning Disability Mortality Reviews) Programme 2019/20

07-Jun-2019 12 14-October-

2019 12 6

Dec-2019

Risk update: LeDeR Review (New)


Appendix B: Primary Care Workstream Risk Register: Detailed Summary Risk Code & Title WS_ALL*_CE_PE_HIM_03 LeDeR (Learning Disability Mortality Reviews) Programme 2019/20

Risk Statement The LeDeR planning guidance deliverables published May 2019 has identified that LeDeR reviews have become part of the standards in the NHS core contract for

2019/20. There is a risk that the required 4 standards will not be achieved due to limiting timescales (six months) and capacity to deliver both the backlog and unreviewed cases, resulting in reduced clinical effectiveness, service improvement and

patient experience in being able to make the necessary reasonable adjustments

Assigned To

Current Risk

Status

Direction of Travel

Annual profile

James Sheard

Current Issues . LeDeR Programme is deemed a must-do for 2019/20 . Latest LeDeR Programme action from learning report 2018 cites concerns with quality of care and average deaths are 20+ years

younger than expected for people without a Learning Disability . Reviews for new death notifications must be completed within six months . Bury CCG has 9 backlog cases, (timeframe for backlog is end March 2020)

. No resources available to undertake current or future reviews

. Full system review is required to establish best model of approach including sustainability (in line with funding allocation from NHSI /

NHSE) . Guidance still awaited on the 4 requirements as outlined in the NHS Operational Planning and Contracting Guidance 2019/20

Original Risk Current Risk

Next Risk Review

Target Risk

Date Risk Identified

Impact Likelihood Rating Current

Risk Review Date

Impact Likelihood Rating Impact Likelihood Rating Target Date

07-Jun-2019

3 4 12 14-Oct-2019

3 4 12 Nov-2019 3 2 6 31-Mar-

2020

Existing Assurance Existing Controls Gaps in Assurance / Gaps in Control

. Quarterly GM Local Area Contact (LAC)

Operational Group meetings . LeDeR reviews undertaken by Bristol

University to ensure quality standards are maintained - external assurance . Quality and Performance Committee

. Workstream meetings

. LeDeR annual report

. Governing Body oversight via quarterly Quality Dashboard and annual LeDer report)

. Risk owner (Quality and Performance Manager) is a member

of the GM Local Area Contact (LAC) steering group . LeDeR reviewers prior to 31st May 2019 were a dedicated

resource. Process was not an add on to another role in the CCG.

Gaps in current controls:

. GM proposal for future LeDeR review process (including closure of backlog notifications)

currently being discussed with CCG Exec Nurses. (3a) . Potential to use a GM wide or national model

approach not yet confirmed. (3a) . Future reviews are hindered by financial and

workforce pressures. (3a) . Uncertainty of future CCG involvement in

LeDeR reviews following recent HSJ article relating to wider review of guidance by NHS England. Timescales for NHSE review are not

yet known.(3a)

Gaps in current assurances: . Evidence received through PAHT SI panel that assurances on reasonable adjustments to

care pathways are not routinely provided to patients with LD/autism

Action Due Date Assigned

To 'Action' progress update (latest)

% Progress

Status

WS_ALL*_CE_PE_HIM_03a Scope future model

31-Dec-2019

James Sheard

On the 07/10/19 the CCG received

confirmation that a bid for more money was successful and the CCG will receive £10,000 in the next month or so. This

money will be used to undertake reviews and remove the current backlog of cases.

10%

In Progress


Appendix C: Risk Matrix

Quantitative Measure of Risk – Impact / Consequence Score

Impact / Consequence score (severity levels) and examples of descriptors

1 2 3 4 5

Domains Very Low Minor Moderate High Severe

Serv

ice Q

ua

lity

–P

ati

en

t S

afe

ty

Minor injury or illness requiring no medical attention and no long term impact.

Minor injury or illness requiring minor medical intervention with impact limited to 1-3 days.

Moderate injury requiring professional intervention. Requiring time off work for 4–14 days. Increase in length of hospital stay by 4–15 days. RIDDOR/agency reportable Incident. An event which impacts on a small number of patients

Major injury leading to long-term incapacity/ disability. Requiring time off work for >14 days. Increase in length of hospital stay by >15 days. Mismanagement of patient care with long-term effects.

Incident leading to death. Multiple permanent injuries or irreversible health effects. An event which impacts on a large number of patients

Serv

ice

Qu

ali

ty –

Cli

nic

al

Eff

ecti

ven

es

s

Minor breach of guidance – no impact on patient outcomes.

Breach leading to minor harm or impact on patient outcomes for an individual or a small number of patients

Significant breach of guidance leading to moderate harm for an individual or small number of patients.

Significant breach leading to serious harm (as defined by the SI framework) for an individual or group of people.

Significant breach leading to fatality or permanent disability.

Serv

ice

Qu

ali

ty –

P

ati

en

t

Exp

eri

en

ce Minor

inconvenience to single individual.

Minor inconvenience too many individuals. Significant inconvenience to single individual.

Significant inconvenience to many individuals. Patient experience impact on health outcomes for a few.

Patient experience impact on health outcomes for a significant number.

Fatality or permanent disability.

Serv

ice Q

ua

lity

–

Op

era

tio

nal

Minor reduction in quality of treatment or service. No or minimal effect for patients.

Single failure to meet national standards of quality of treatment or service. Low effect for a small number of patients if unresolved.

Repeated failure to meet national standards of quality of treatment or service. Moderate effect for multiple patients if unresolved.

On-going non-compliance with national standards of quality of treatment or service Significant effect for numerous patients if unresolved.

Gross failure to meet national standards with totally unacceptable levels of quality of treatment or service Very significant effect for a large number of patients if unresolved.

Healt

h

Ine

qu

ali

ties Possible

increase to inequalities.

Probable small increase to inequalities.

Probable significant increase to inequalities.

Actual small increase to inequalities.

Actual substantial increase to inequalities.

Healt

h

Imp

rovem

en

t

Possible slowing of decline of prevalence.

Probable slight slowing in rate of improvement in death rates. No decline or significant slowing in prevalence.

Probable significant slowing in improvement of death rates. Slight increase in prevalence.

Slight increase in death rates. Substantial increase in prevalence.

Substantial increase in death rates.

Op

era

tio

nal

an

d L

eg

al

Co

mp

lian

ce

No or minimal impact or breach of guidance /statutory duty. Minor breach of standards with no impact on organisation.

Breach of statutory legislation. Breach of broader health standards or minor targets.

Single breach of statutory duty. Breach leading to discussion with National Commissioning Board (NCB).

Multiple breaches in statutory duty. Breach leading to DH improvement team intervention. Breach leading to threat of court action.

Multiple breaches in statutory duty. Breach leading to court action against executive.



1 2 3 4 5

Domains Very Low Minor Moderate High Severe

Fin

an

cia

l

Bala

nc

e /

Cla

ims

<£50,000 loss. Small loss risk of claim remote.

£50,001 - £250,000 loss. Claims less than £10,000.

£250,001 - £1M loss. Claims between £10,000 & £100,000.

£1,000,001 - £3M. Claims between £100,000 & £1 million.

>£3M. Claims >£1million.

Fin

an

cia

l G

overn

an

ce

Small loss>£100 Isolated technical breach with minimal impact.

Loss > £1,000 Numerous minor technical breaches. Technical breach leading to financial loss.

Loss>£10,000 Limited assurance on single key financial systems.

Loss> £100,000 Failure to get Statement on Internal Control agreed. Fraud leading to imprisonment of staff member. No assurance on single key financial system. Limited assurance on multiple systems.

Loss > £1,000,000 Investigation by the National Audit Commission. No assurance on multiple financial systems.

Bu

sin

ess

Ob

jecti

ves/

Pro

jects

Insignificant cost increase/ schedule slippage. No impact on delivery of objectives.

<5 per cent over project budget / Schedule slippage. Minor impact on delivery of objectives.

5–10 per cent over project budget / Schedule slippage. Moderate impact on delivery of objectives.

10–25 per cent over project budget / Schedule slippage. Key objectives not met.

>25 per cent over project budget / Schedule slippage. Failure of strategic objectives impacting on delivery of business plan.

Info

rmati

on

an

d

Te

ch

no

log

y

(In

form

ati

on

Go

vern

an

ce)

Minor technical breaches of standards not directly impacting on members of the public.

Single loss of data or other breach affecting a single individual.

Multiple losses of data or other breaches of governance standards impacting on small numbers of people. Single loss of data impacting on many people.

Multiple losses of data or other breaches of governance standards each impacting on hundreds of individuals.

Breach leading to court action against executive.

Rep

uta

tio

n

Complaint /concern only. Not relevant to mandate priorities. No adverse media. No negative recognition from the public.

Minor impact on achieving mandate priorities. Low level of adverse media coverage. Small amount of negative public interest.

Moderate impact on achieving mandate priorities. Moderate amount of adverse media coverage. Moderate amount of negative public interest.

High impact on achieving mandate priorities. High level of adverse media coverage. Negative impact on public confidence.

Mandate priorities will not be achieved. National adverse media coverage. Total loss of public confidence.

Serv

ice

Bu

sin

ess

Inte

rru

pti

on

Loss/interruption for >1 hour.

Loss /interruption for >8 hours.

Loss /interruption for >1 day.

Loss /interruption for >1 week.

Permanent loss of service or facility.

Sta

ff S

afe

ty a

nd

W

ell

bein

g

Minor cuts and bruises. Isolated incidence of low morale.

Medical treatment required. Less than three days’ absence. Low morale among a number of staff groups.

Single admittance to hospital for less than 24 hours. Absence of three days or longer. Sickness rates increasing.

Single fatality or permanent disability. Rapid increase in sickness rates threatening service delivery.

Multiple fatalities or cases of permanent disability.



1 2 3 4 5

Domains Very Low Minor Moderate High Severe P

eo

ple

an

d C

ha

ng

e

(Hu

man

reso

urc

es/

org

an

isati

on

al

de

velo

pm

en

t/sta

ffin

g/

co

mp

ete

nc

e)

Short-term low staffing level that temporarily reduces service quality (< 1 day).

Low staffing level that reduces the service quality.

Late delivery of key objective/ service due to lack of staff. Unsafe staffing level or competence (>1 day). Low staff morale. Poor staff attendance for mandatory training.

Uncertain delivery of key objectives due to lack of staff. Unsafe staffing level (>5 days). Loss of key staff. Very low staff morale. No staff attending mandatory/ key training.

Non-delivery of key objective/ service due to lack of staff. Ongoing unsafe staffing levels or competence. Loss of several key staff. No staff attending mandatory training /key training on an ongoing basis.

Qualitative measure of risk – Likelihood Score

Descriptor 1 2 3 4 5

Rare Unlikely Possible Likely Almost certain

Frequency

Time framed

descriptors

Not expected to

occur for years

Expected to occur

annually

Expected to occur

monthly

Expected to occur

weekly Expected to occur daily

Frequency

Broad descriptors

Will only occur in

exceptional

circumstances

Unlikely to occur

Reasonable chance

of occurring

Likely to occur More likely to occur than not

occur

Probability <15% 15-39% 40-59% 60-79% =>80%

Quantification of the Risk – Risk Rating Matrix

Likelihood

1 2 3 4 5

Rare Unlikely Possible Likely Almost certain

Imp

act

/

Co

ns

eq

ue

nce 5 Severe 5 10 15 20 25

4 High 4 8 12 16 20

3 Moderate 3 6 9 12 15

2 Minor 2 4 6 8 10

1 Very Low 1 2 3 4 5

Primary Care Workstream Group

Proposed Reporting Structure

Create Plan on a page

Start Risks & Issues Log

Primary Care Workstream

Group

PCCC Paper Required

Agree frequency of

updates

Draft Paper & Submit to PCCC

Approval

Paper Supported

New Project Add to PC Planning on

teams

Yes

Existing Project

Complete required actions

Paper Not Supported

Resubmit to PCWG

End

No

Appendix 3



Existing Project

Update tasks on Planner

Update RAG label

Update comments

Mngmt team review

project/work item

Mitigation paper

Assurance to PCWG

Include in update briefing

to PCCC

Off Track

Slippage

On Track

If Applicable

Primary Care Workstream

Group Escalation Required

Project lead to action

mitigations Managed within team

Update Risks & Issues

End

Escalation Required

Escalate to PCCC if

Required

Add to Risk to PCWG Risk &

Issues log if req

End

End

Escalation Required

Managed within team

New Work item Add to PC

Planning on teams

Start Risks & Issues Log

Update RAG label

Existing Work item

• Primary Care Workstream Group

• Proposed Reporting Structure



Mitigation paper

Update Risks & Issues Log Primary

Care Workstream

Group

PCCC Paper Required

Assurance to PCWG

Add to PCWG Risk & Issues

log

Agree new frequency of

updates

Draft Paper & Submit to PCCC

Include in update briefing

to PCCC

Tasks On Track

Escalate to PCCC if

Required

Existing Work item

Update RAG label

Off Track

Update comments

Slippage

Mngmt team review work item

Project lead to action

mitigations

Escalation required

Managed within team

Escalation Required

If Applicable

End End

Date:06/11/2019 Bury GP Federation Update Page 1 of 6

Executive Summary

The following report has been written to provide an update to Primary Care Workstream Group with regards to the contracts and projects currently commissioned by the CCG for operational delivery by the GP Federation as follows:


Extended Working Hours

GP and Nurse Retention Programme

Recommendations

It is recommended that the Primary Care Workstream:

Receive the report for information and the information therein as assurance thatcontracts in place between the CCG and GP Federation are being delivered andadequate assurance is being received from the Provider to support this.

Meeting: Primary Care Work Stream Group

Meeting Date 06 November 2019 Action Receive

Item No. Confidential No

Title Bury GP Federation Update Paper

Presented By Rachele Schofield, Primary Care Manager

Author Rachele Schofield, Primary Care Manager

Clinical Lead Dr Jeff Schryer, Clinical Lead Primary Care

Appendix 4


Bury GP Federation Update

1. Introduction 1.1 The following report has been written to provide an update to Primary Care

Workstream Group (PCWS) with regards to the contracts and projects currently commissioned by Bury Clinical Commissioning Group (CCG) for operational delivery by the Bury GP Federation (GP Federation) as follows:


Extended Working Hours (EWH)

GP and Nurse Retention Programme (GPNR)

2 Background 2.1 The CCG began commissioning services directly from the GP Federation in 2017 and,

during that time, the GP Federation have held stable sub-contracting agreements with Rock Healthcare. The CCG has received adequate assurance since that time that the sub-contractor has delivered the services as commissioned and quarterly reports were submitted to the PCWS in support of that.

2.2 Across the course of 2019/20, the relationship between GP Federation and Rock

Healthcare destabilised, dissolving fully on 24 October 2019. The GP Federation have now changed their sub-contracting arrangements and appointed Horizon Primary Care Network and Tower Family Healthcare as service providers.

3 Bealey Community Hospital and Extended Working Hours (EWH) 3.1 Rock Healthcare wrote to the GP Federation on 17 October 2019 stating that they

were no longer able to fulfil the terms of the Bealey Community Hospital Contract and wished to serve notice on the contract or be released early from its terms.

3.2 In response to the letter, on 18 October 2019, the GP Federation approached all

Primary Care Networks (PCN) within Bury to explore the option in working in partnership with one of them to fulfil the contract. Expressions of interest were requested; 3 PCN’s responded, one of which expressed an interest.

3.3 The GP Federation wrote to Rock Healthcare on 22 October 2019 to inform them, in

line with their email request, that they would be released them from their contractual obligations on 25 October 2019. Rock Healthcare confirmed they would cease delivery of the contract at close of play 24 October 2019 and the new sub-contract provider, Horizon Primary Care Network, confirmed they would commence delivery of the contract from Friday 25 October 2019.

3.4 In 2019, the GP Federation went out to reprocurement to obtain a sub-contractor for

the EWH contract and Tower Family Healthcare (TFH), part of Horizon Primary Care Network, were successful and began delivery of EWH from 1 October 2019.


3.5 The CCG remained reasonably arm’s length during the change of sub-contractor for both the EWH and Bealey Community Hospital as this did not change our contracting arrangements with the GP Federation.

3.6 To seek assurances, we have received the 2019/20 Quarter 2 (Q2) service monitoring

data for EWH which has been submitted to PCWG for review. There is no downward trajectory in service provision during the last 3 months that Rock Healthcare delivered the contract and we will closely monitor activity within the service during TFH’s first term in Q3 2019/20.

3.7 We have not received Q2 data for Bealey Community Hospital from the GP

Federation, being advised that this has not been received from Rock Healthcare. We will monitor performance of this contract closely and have been assured that:

Horizon PCN have contacted Bealey Community Hospital directly to undertake introductions

Horizon PCN GPs visiting the Hospital are already known to Bealeys and familiar with the hospital

Q3 data will be submitted as contracted and expect this to show that service has not been negatively impacted by the change

4 GP & Nurse Retention Programme 4.1 In December 2018, Bury Clinical Commissioning Group (CCG) submitted a bid to

Greater Manchester Health & Social Care Partnership (GMH&SCP) to secure £35K 2018/19 funding to deliver a GP Retention project across Bury. The aim of the GP Retention Scheme was to facilitate initiatives to retain GPs in the workforce that would otherwise leave for roles elsewhere in the healthcare system or through retirement, through promoting new ways of working and offering additional support. The objectives for the project were:

Providing increased opportunities for GPs to work in more varied roles

Targeting newly qualified GPs and GPs seriously considering leaving general practice

Providing backfill for GPs to enable them to work in different ways

Creation of a pool of GPs able to work in a variety of settings

Providing facilitated peer support to GPs that want to widen their roles 4.2 The project focus was on increasing the overall capacity of the local GP workforce

and the bid was secured on the following criteria:

The application should be a joint application from the CCG and lead provider organisation (with at least one signatory being a GP)

Schemes should focus on increasing the overall capacity of the general practice workforce

Applications should demonstrate that they intend to work flexibly, across a neighborhood or locality

Schemes should target GPs who are newly qualified / within their first five years and GPs who are seriously considering leaving general practice / changing their


roles / working hours

Ideally GPs accessing the scheme would need to continue to do (at least) 5sessions in general practice. Sessions should include provision for CPD

2.4 In addition to the above, further funding became available in February 2019 which GMH&SCP aligned to this project. The CCG asked that the GP Federation deliver this additionality which added a further £8K to the project envelope:

Nurse Clinical Leads:o Nurse clinical lead for those areas which don’t have this leadership; initial

ask for the remaining of 2018/19 is for one individual per CCG (previous bidalready funded one area). It is believed by working with the nurse workforcethis will enable GP's to take on additional roles such as mentoring, skillmixing, portfolio. Whilst this request is made for 2018/19 and may be achallenge, it is hoped this work can commence and could be extended into2019/20 should the opportunity arise

GM Focus Groups:

o Survey & focus groups with local Primary Care staff, including GPs andnurses who are considering leaving practice or nearing the end of theircareer: we wish to target at least 100 GP's to open discussions andunderstand how wider plans can help shape their decisions to remain insome capacity within primary care

3.1 The GP Federation commenced work on the project in July 2019 since this time, GM have confirmed that the GM Focus Group monies attached to this project can be absorbed into the main retention projects and that we are not required to report on this separately.

3 Plan on a Page and Project Plans

3.2 The CCG created a plan on a page (PoP) to support the launch of this project (Appendix 1). The GP Federation used this as a building block to move forward with delivery of this project and, in October 2019, appointed 2 GP Leads to deliver the GP Retention Project and 2 Nurse Leads to deliver the Nurse Retention Programme.

3.3 The project plan for the GP Retention Programme is detailed in Appendix 2 and the second project plan for the Practice Nurse Development Need Programme is displayed in Appendix 3.

3.4 The GP and Nurse Leads for GP retention have linked in with the CCG in line with their project plans and all supplementary documentation and data has been provided to facilitate delivery of the projects. The GP Leads are meeting with the GMH&SCP Workforce Leadership Team on 4 November 2019 to progress the project in line with the GM Workforce Strategy and to establish where links into other GM GP Retention programmes can be made.

3.5 In addition to this, the GP Leads are currently undertaking fact finding work with their GP Peer group, trainers’ group, Registers, local Royal College of GPs (of which they


are both Fellows). They will provide updates to the GP Federation on progress who will, in turn, advise the CCG as commissioners of progress.

3.6 The Nurse Leads are attending the Practice Nurse forum in November 2019 to progress conversations with their peer groups.

3.7 The GP Federation have also submitted a bid to secure £40K funding to enable the continued deliver of the GP Retention Programme into financial year 2019/20 (Appendix 4) which was submitted to GMH&SCP in October 2019 and we await the outcome.

4 Next Steps

4.1 A progress return will be submitted by the CCG to GMH&SCP upon request and a further meeting between the CCG and GP Federation will be arranged for December to receive a face to face update on the progress of both work programmes and to discuss implementation of further funding should it have been awarded at that point.

5 Associated Risks

5.1 There are risks associated to all agreements held between the CCG and GP Federation given the change to sub-contracting arrangements for the EWH and Bealey Community Hospital Contract and due to the GP and Nurse Retention Programme being new venture across GM.

5.2 We are assured regarding the delivery of the retention programmes given the:

appointment of the GP and Nurse Leads

submission of project plans

links with GMH&SCP

links with PN Forum

5.3 We are also assured regarding the new sub-contracting arrangements in place between the GP Federation, Tower Family Healthcare and Horizon Primary Care Network. Both the Practice and Network have robust processes in place and established relationships within Bury to ensure delivery of both the EWH and Bealey Community Hospital contracts. Further assurance will be received during Q3 as performance reporting begins to come through to the CCG for monitoring purposes.

5.4 During this time of change, the Chief Executive of the GP Federation remains in contact with both the Deputy Director of Primary Care and Primary Care Manager to raise issues and concerns as they arise to ensure they do not escalate and impact the new sub-contracting agreements in place. Face to face meetings to resolve any issues will be convened during this time as necessary.

6 Actions Required


6.1 The PCWG is required to:

receive the report and the information therein as assurance that contracts inplace between the CCG and GP Federation are being delivered and adequateassurance is being received from the Provider to support this.

Rachele Schofield Primary Care Manager [email protected]

Appendix 1

PoP GP Retention

July 2019 V2.docx

Appendix 2

GP Retention

Project Outline.docx

Appendix 3

PN Project

Brief.docx

Appendix 4

Retention

Application 1920 (2).docx


meeting: primary care commissioning committee · date:27/11/2019 primary care workstream update...

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