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MINUTES

Meeting: Stevenage Locality Commissioning Meeting

Date: 8th March 2016, 12.30‐2.30

Venue: Cromwell Hotel, High Street, Stevenage, SG1 3AZ

Attendee Organisation Present Dr Russell Hall (Chair) GP Chells Way Surgery Dr Prag Moodley (Chair) GP Stanmore Medical Group Michelle Myers PM Chells Way Surgery Dave Myers Chells Way Surgery Teresa Sutherill Chells Way Surgery Tina Timlett Chells Way Surgery Dr Jeremy Evans GP Chells Way Surgery apols Mary Bishop PM Stanmore Medical Group Dr Rajeev Kaja GP Stanmore Medical Group apols Ann Wagg Nurse Stanmore Medical Group Susan Lincoln PM Canterbury Way Dr Naomi Selvadurai GP Canterbury Way apols Stephen Murphy PM St Nicholas apols Dr Joseph Turner GP St Nicholas apols Vickey Basey‐Holt St Nicholas Mark Banks PM King George Surgery Dr Vishen Ramkisson GP King George Surgery Dr R Mahalingam GP King George Surgery apols Dr Rini Saha GP King George Surgery Jackie Watson King George Surgery Fiona Lucas Symonds Green apols Dr Masood GP Symonds Green apols Dr Shazeb GP Symonds Green apols Elaine Cook PM Bedwell Medical Centre Abi Suckling Bedwell Medical Centre Dr Alison Holt GP Bedwell Medical Centre Dr P Raveendran GP Bedwell Medical Centre Karen Smith Nurse Manor House apols Sandra Copping PM Manor House Dr M Duggan GP Manor House Dr Anabel Harries GP Shephall Way Surgery apols Manjit Phugura PM Shephall Way Surgery Dr A Cormack GP Shephall Way Surgery Noreen Coles Deputy Chief Finance Officer CCG apols Sharn Elton Director Operations and Resilience CCG Helen Edmondson AD CCG Ruksana Parkar Locality Manager CCG Mary‐Anne Gregory HCT David Cadogen PPG Rep Maxine Davis Prescribing Adviser CCG apols Imon Chakraborty GP Stanmore Medical Group Mark Knowles Business Info Lead ‐ CCG apols

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Marie Barnes Primary Care Improvement Lead Tina Glamolm Primary Care Improvement Lead Theresa McAree Primary Care Improvement Lead

1. Apologies and Introductions

Apologies are noted above.

No conflicts of interest declared.

2. Action notes from previous meeting & matters arising not on the agenda

Notes agreed as accurate. Action Log agreed as accurate: Action 1 – Session at A&E – Harper Brown is leading on this and trying to secure a project manager.

Action: Action HE take forward A&E front door proposal

Action 2 – One practice confirmed not on target for the LD healthchecks. Please see page 5 in the minutes to find the actions following this meeting.

3. Provider Updates HCT ‐ MAG shared the following:

All vacant post has been recruited to, new band 6 nurse and matron Some McMillan nurses are leaving as they have been promoted within the team.

Currently actively recruiting for the vacancies. Rapid Response figures have tripled for the month of February. (Please see

document below) Achieved 1 hour response rate. March implementation group to include clinical lead. Any issues to be discussed at the implementation group meetings. The implementation meeting is to discuss how to design the model of the rapid

response according to the localities needs. SC confirmed that no district nurse is attending the GSF meeting. MAG confirmed

she will try to allocate someone to attend the next meeting. Home First model – virtual ward – plan to have this in place by this October. MAG asked how the locality would want to design the service through the virtual

beds with enhanced discharge. In North Herts they are intending to have GP involvement in the pilot.

LLV currently do not have virtual wards.

Action: M‐A G to ensure all practice managers invited to RR implementation group

Action: M‐A G follow up issues with opening up record for HCT staff

Stevenage Rapid Response Service Feb

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4. Patient Online Contractual Requirements 2015‐16 – Detailed Record Access

Contractual requirements for practices to provide access to patients record by the

end of March

Packs were provided

Practices to review online appointments slot s and suggestion was made to release

as many online slots as possible.

Benefits of online services were discussed and practices were encouraged to

promote their online services to patients.

Email address for support to be shared with the practice. Please see attached.

HBL GP IT Chart.docx

Each practices should have protocol in place for coded record

Suggestion were made to practices to think collaboratively as a locality to build up

policies and procedures

Practices who are not offering this service needs to produce statement by end of

March 2016 informing when service will begin.

Please see attached pack and newsletter with full details.

Patient Online Programme HBLICT C

ENHCCG Patient Online GP Bulletin Upd

5. Integrated Urgent Care (NHS 11 and OOH) ‐ Update VR provided the following update:

To share specification of the Integrated Urgent Care Model. Contract to be awarded in September 2016 Practices to read the specification and to feedback at locality

IUC - Draft Specification

Nationally still a lot of work to be done on urgent care moving activity into planned care of works.

Need to divert people away from A&E Need to make sure we do not dilute the quality of the service Please see attached with full details of the timetable of the procurement process.

IUC - Update

6. GP Lead Update LTC:

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IC confirmed Diabetes audit 50% target achieved Consolidating funding is encompassing commissioning framework 20% financial balance and 80% clinical Podiatry services might be expanded and this requires up skilling of nurses

Action: HE provide an update on podiatry business case

Warfarin is cheaper than NOAC. Looking into community service in the future.

Mental Health: PM said there was nothing much to update however, he requested practices to do as many LD healthchecks as possible. Prescribing: RS said next year KPIs have not been decided yet Script switch ‐ lots of messages from Herts Valley. Audit – MD provided info to practices.

In house pharmacist post out to advert. They will eventually carry out deep dive.

7. LIP Report Update MK was unable to attend. Update to be provided at next meeting.

8. £1pp Locality Budget. PM & RH asked the locality what they would like to invest the £1pp into. It was agreed at locality that the money will be used to support the care home

project for a further year. The analyst post will be covered by the last financial year’s budget.

Action: Practices put forward ideas for using £1pp for 2016‐17

9. Patient Participation Group Update DC confirmed majority of the surgeries are providing reps to PCG however, a number

have struggled to provide representation. DC added if you have a virtual group and you want to send a rep to the PCG then

contact myself. DC to attend Manor House PPG. There is a better flow of communication from practices to patient quality network

group at the CCG. Will be looking at antibiotic awareness at the next meeting.

10 Practice Update Reports

Bedwell Update

11 AOB:

Action: RP follow up issues raised by Elaine Cook regarding discharge information from Pinehill

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Action: HE to follow up issue with children’s commissioner regarding school policy for getting sick notes Action: RP clarify process for agreeing slides shown in waiting rooms. RP to confirm that GP leads are meant to sign off the content.

Dates of Next Meeting: Locality: 12th April 2016

ACTION Person Responsible

DATE

1 HE take forward A&E front door proposal

HE ASAP

2 Ensure all practice managers invited to RR implementation group

ST/MAG ASAP

3 HE provide an update on podiatry business case

HE ASAP

4 Practices put forward ideas for using £1pp for 2016‐17

All Practices

ASAP

5 RP follow up issues raised by Elaine Cook regarding discharge information from Pinehill

RP ASAP

6 HE to follow up issue with children’s commissioner regarding school policy for getting sick notes.

HE ASAP

7 RP clarify process for agreeing slides shown in waiting rooms. RP to confirm that GP leads are meant to sign off the content.

RP ASAP

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MINUTES


Date: 12th April 2016, 12.30‐2.30


Attendee Organisation Present Dr Russell Hall (Chair) GP Chells Way Surgery apols Dr Prag Moodley (Chair) GP Stanmore Medical Group Michelle Myers PM Chells Way Surgery Dave Myers Chells Way Surgery Teresa Sutherill Chells Way Surgery apols Tina Timlett Chells Way Surgery apols Carol Saul Chells Way Surgery apols Dr Jeremy Evans GP Chells Way Surgery apols Mary Bishop PM Stanmore Medical Group Dr Rajeev Kaja GP Stanmore Medical Group apols Susan Lincoln PM Canterbury Way Dr Naomi Selvadurai GP Canterbury Way apols Stephen Murphy PM St Nicholas apols Dr Joseph Turner GP St Nicholas Vickey Basey‐Holt St Nicholas apols Mark Banks PM King George Surgery apols Dr Vishen Ramkisson GP King George Surgery apols Dr R Mahalingam GP King George Surgery apols Dr Rini Saha GP King George Surgery Jackie Watson King George Surgery apols Fiona Lucas Symonds Green Dr Masood GP Symonds Green apols Dr Shazeb GP Symonds Green apols Elaine Cook PM Bedwell Medical Centre Abi Suckling Bedwell Medical Centre apols Dr Alison Holt GP Bedwell Medical Centre Dr P Raveendran GP Bedwell Medical Centre apols Karen Smith Nurse Manor House apols Sandra Copping PM Manor House Dr M Duggan GP Manor House Dr Anabel Harries GP Shephall Way Surgery apols Manjit Phugura PM Shephall Way Surgery Dr A Cormack GP Shephall Way Surgery Noreen Coles Deputy Chief Finance Officer CCG apols Sharn Elton Director Operations and Resilience CCG Helen Edmondson AD CCG apols Ruksana Parkar Locality Manager CCG Mary‐Anne Gregory HCT David Cadogen PPG Rep apols Ronald Walker PPG Rep Maxine Davis Prescribing Adviser CCG Imon Chakraborty GP Stanmore Medical Group

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Mark Knowles Business Info Lead ‐ CCG apols Anna Cason Contract Hotline Coordinator Ed Bosonnet GP Sabina Tai HCT Rachael Lea LMC Dr El Safa GP Manor House Rachel Cowley ENHT Dr N Bajaj ASD Lead, Community Peads Consultant ENHT Dr S Ozer ADHD Co Lead, Community Peads Consultant

ENHT





Notes agreed as accurate. Action Log agreed as accurate: Action 1 – Session at A&E – RP shared that HE confirmed that there is a meeting in the pipeline to move this project further. MB confirmed federation is involved and Stevenage Health is interested. Action 3 – Podiatry business case – current business case is based on diabetic patients. Discussion has taken place that the business case should be based on the general podiatry service rather than specific. Further LTC meeting is taking place to move the business case forward. Action 5 – Pinehill discharge issue – SE has escalated this issue, Pinehill is being contacted and contract hotline is aware of this. Action 6 – School policy for getting sick notes – Children commissioner confirmed she will escalate this to the Schools Heads forum in Herts and the Head of Education at Herts County council. Update to follow. Action 7 – process for surgery slides – practices added that the slides should be locality based. Communications team is already looking into this and EB to discuss this at governing body.

Action: EB and PM to discuss at the governing body to make the practice slides more localities based.

Please see page 6 in the minutes to find the actions following this meeting.


All vacant post has been recruited to, new band 6 nurse and matron

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Palliative care post all recruited to starting week commencing 11th April. 1 matron vacancy being interviewed this week. All practices are able to send electronic referrals only Symonds Green has not joined

the process yet. M‐A G confirmed that district nurse should now be attending the GSF meeting.

Rapid Response (RR)– Update

Rapid Response figures have gone up for the month of March. 20 referrals recorded which averages 1 referral a day.(Please see document below)

Staffing looking good. All band 6 post filled. Therapy staffing complete. Stevenage in a good position in terms of staffing. UTI and Mobility is main theme for referral Still confusion with the respiratory service. This will now be part of the RR service Homecare provider changing. Any issues to be escalated to M‐A G. SE confirmed there are talks about commissioning a coordination centre that will

divert the patient to the right service like a one stop shop service. PMs complimented the level of service provided by RR. Any issues to be discussed at the implementation group meetings.

Home First – Implementation

Julie Hoare presented the Home First Model at Target. Similar model will apply as LLV. Please see below.

Risk stratification will be carried out using the risk stratification tool to case manage risky patients. This service will include virtual wards and discharge beds.

The service will be designed to the localities needs and this will be designed through the implementation group.

The service will be open from 8am to 8pm. Hope to embed the service in October.

Home First Model - Presentation

4. GP Data Extraction Dr Ed Bosonnet discussed the following & shared a document (see below): The GP Data Extraction Project will enable the CCG to add primary care data to the

other range of health and care data available creating an integrated data set that will support GP’s to identify patients who might be ‘at risk.

Risk stratifying will enable early intervention to manage patient care which will prevent unavoidable admissions to the hospital.

Data control has been approved and data sharing agreement is required from all practices.

This is being piloted in 4 practices in LLV MM added this is far safer than Care Track. Some practices still have concerns about data sharing security and confidentiality

Action: EB to provide reassurance on security of data sharing and to also provide feedback from the piloting practices. Action: EB to answer FAQs before sending out GP data packs to all practices.

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GP Data Extraction - Presentation

5. East & North Herts Trust Rachel Cowley Primary Care Customer Relations Manager introduced Dr N Bajaj ASD Lead, Community Peads Consultant ENHT & Dr S Ozer ADHD Co Lead, Community Peads Consultant ENHT. They shared lots of documents which included community paediatric referral criteria, ADHD guidance notes for health professionals, quick reference guide to ADHD pathway. They added they are there to build positive relationships and happy to help if any queries, issues are needed to be answered or advice is needed. Practices found there attendance very useful.

6. GP Lead Update LTC: Not much to report IC mentioned and praised the Tartan Rug spreadsheet which is an amalgamation of

data. Identifies LTC patient and how well we are doing. This would be good to use for audit purposes and also to identify where we currently

need to improve in key areas of LTC by practice.

Action: RP to ask Grant Neofitou if the Tartan Rug spread sheet will be shared with all the practice.

Practices asked for an update on diabetic service. SE confirmed a lot of work has been done by the LTC group and update could be provided through the GP bulletin.

Mental Health: PM praised the practices on number of LD healthchecks carried out. He believed the

locality will get praised for the dedication put into this project. Audit on anti‐psychotic drugs on people who have learning disabilities is being

carried out. PM requested all practices to complete the forms. Prescribing: MD reported the latest (January) prescribing data has been circulated. The locality

has a forecast overspend of £390K (3.22%) a slight improvement on previous month. Antibiotic audits have been received from all practices and will be discussed at the

next prescribing meeting. MD reminded the group that if prescribing clerks add medicines to patients repeat

and do not have access to Scriptswitch then potentially alerts will be missed such as not for primary care prescribing etc.

The care home pharmacists have worked in Pinelodge, Woodlands and Wisden Court and have just started work in Martins House. Across Stevenage to date 156 patients have had medication reviews , there were a total of 1564 medicines , 99 drugs have been stopped 25 of which are linked to increased risk of falls including 4 antipsychotics for BPSD. This equates to annual savings of £20k.

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SE asked about RIO scoring, MD explained that the team are currently scoring all interventions in line with a recognised risk scoring tool (RIO). A score of 3 indicates that there is a reasonable chance that a hospital admission may have resulted if the intervention had not been made. It has been calculated that the average hospital admission in this age group costs approx. £2600.

MD asked which care homes the locality would like the team to work with next, Wymondley, Jubilee Ct and the Old Rectory were suggested.

Practice based pharmacists have been recruited and we hope to have them in post in the next few months.

7. Integrated Urgent Care (NHS 111 and OOH) ‐ Update

VR sent his apologies Feedback from PMs was that they were concerned about the contract.

Action: All practices to email there concerns to RP about the Integrated Urgent Care contract. RP to feed this back to VR.

8. LIP Report Update MK was unable to attend. Update to be provided at next meeting.

9. £1pp Locality Budget. MB sent her proposal to HE. Other suggestion is to carry on with the care home rounds and MBanks suggestion

on e‐learning courses for the practices.

10 Locality Commissioning Plans Priority The locality agreed the following suggested areas by the CCG are the key priority for the Stevenage locality going forward: A&E Cancer Respiratory

11 Patient Participation Group Update David Cadogan sent his apologies and sent a representative on his behalf, Ronald Walker RW confirmed lots of things coming from the CCG need to push back upwards

12 Practice Update Reports

King George Update Report

PRACTICE UPDATE.docx 2.docx

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Shephall Way - Practice Report

13 AOB: AC from Contract Hotline went through the current issues being reported to the

contract hotline. Please see attached report.

Hotline Update for Stevenage Locality Ap EC request RP to add Rachael Lea from the LMC to the distribution list for all locality

meetings

EC discussed issues of dealing with the Syrian refugee healthchecks. Proper processes and funding should be in place. She confirmed healthchecks are initially done by a HCA and if it is really complex it is done by a GP. Interpretation is required face to face rather than over the phone. SL described her practice experience as atrocious.

MB confirmed she had a conversation with Sue Fogden in regards to premises and it went really well. They are hoping there will be a plan in place for Stanmore and Manor House.

MM asked about over 75s healthchecks and RH confirmed it is still carrying on. MM also asked about the minor injuries pilot evaluation which RP confirmed it has been written up but it is in the review process.

Dates of Next Meeting: Locality: 10th May 2016


DATE

1 Update following meeting on A&E front door proposal

MB ASAP

2 Further update to follow on issue with children’s commissioner regarding school policy for getting sick notes.

Kate Barker

ASAP

3 EB and PM to discuss at the governing body to make the practice slides more localities based

EB & PM ASAP

4 EB to provide reassurance on security of data sharing and to also to provide feedback from the piloting practices.

EB ASAP

5 EB to answer FAQs before sending out GP data packs to all practices.

EB ASAP

6 RP to ask Grant Neofitou if the Tartan Rug spread sheet will be shared with all the practice.

RP ASAP

7 All practices to email there concerns to RP about the Integrated Urgent Care contract. RP to feed this back to VR.

All Practices

ASAP

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MINUTES


Date: 10th May 2016, 12.30‐2.30


Attendee Organisation Present Dr Russell Hall (Chair) GP Chells Way Surgery Dr Prag Moodley (Chair) GP Stanmore Medical Group Michelle Myers PM Chells Way Surgery Dave Myers Chells Way Surgery Teresa Sutherill Chells Way Surgery Tina Timlett Chells Way Surgery Dr Jeremy Evans GP Chells Way Surgery apols Mary Bishop PM Stanmore Medical Group Dr Rajeev Kaja GP Stanmore Medical Group apols Imon Chakraborty GP Stanmore Medical Group Susan Lincoln PM Canterbury Way apols Dr Naomi Selvadurai GP Canterbury Way apols Stephen Murphy PM St Nicholas apols Dr Joseph Turner GP St Nicholas Mark Banks PM King George Surgery Dr Vishen Ramkisson GP King George Surgery apols Dr R Mahalingam GP King George Surgery apols Dr Rini Saha GP King George Surgery apols Jackie Watson King George Surgery apols Fiona Lucas Symonds Green apols Dr Masood GP Symonds Green Dr Shazeb GP Symonds Green apols Elaine Cook PM Bedwell Medical Centre Abi Suckling Bedwell Medical Centre Suma Granom GP Bedwell Medical Centre Dr Alison Holt GP Bedwell Medical Centre apols Alison Seymour PM Bedwell Medical Centre apols Dr P Raveendran GP Bedwell Medical Centre apols Karen Smith Nurse Manor House apols Sandra Copping PM Manor House Dr M Duggan GP Manor House Dr Anabel Harries GP Shephall Way Surgery apols Manjit Phugura PM Shephall Way Surgery apols Dr A Cormack GP Shephall Way Surgery apols Noreen Coles Deputy Chief Finance Officer CCG Sharn Elton Director Operations and Resilience CCG Helen Edmondson AD CCG Ruksana Parkar Locality Manager CCG Mary‐Anne Gregory HCT David Cadogen PPG Rep Maxine Davis Prescribing Adviser CCG apols Mark Knowles Business Info Lead ‐ CCG apols

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Rachael Lea LMC Grant Neofitou PMO Head CCG Elaine Lagdon Project Manager CCG




RP requested to see key practice managers to discuss declaration of interest form completion for key partners.


Notes agreed as accurate. Action Log agreed as accurate: Action 1 – Session at A&E – MB confirmed they are closely working with HUC and are planning a pilot in September. Action 2 – School policy for getting sick notes – HE updated the locality; she said she met up with RL. Following that discussion it was agreed that Jeremy Cox will be meeting up with the head of primary care. Action 3 – process for surgery slides – HE confirmed that the Communication Director sent a very comprehensive email which covered all the queries. Please see attached email.

RE Slide Shown In Waiting Room - msg 1 - Nuala.msg Waiting room slides..msg 2 - Nuala.msg

Please see page 7 in the minutes to find the actions following this meeting.

3. Procurement Community Ophthalmology Service – Update

Information on new community Ophthalmology Service went out in the last GP bulletin.

5.4% of the flow goes to Herts Eye Hospital

Looking to tighten up the contract, in terms of quality, governance and outcomes.

Going to be firm with the new provider of what is expected of the new service

Current AQP contract will be extended until the new provider is in place.

Aim for mobilisation, January 2017.

Please see attached document for further details:

Community Ophthalmology Servic

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Staffing is great. Nearly fully recruited. MAG asked if all practices are able to send electronic referrals. Bedwell shared system 1 sharing

issues, still not receiving end task. Action: MAG asked if all practices are able to send electronic referrals. Bedwell shared system 1 sharing issues, still not receiving end task. MAG to look into this.

Rapid Response (RR)– Update

Issues raised about clinician of the day not being available all the time. MAG confirmed that we cannot have clinician of the day sitting waiting for a call and the clinician goes out to work. However, its about getting the balance right.

Action: MAG to look into a solution in terms of how to manage the clinician of the day to improve their availability to the practices.

PMs complimented the level of service provided by RR. Any issues to be discussed at the implementation group meetings. EC confirmed at the new practice representative for Rapid Response.

5. GP Lead Update

Mental Health: PM said to have a local dementia service we require a GPWSI. A locality Dementia Lead is required.

All interest to be notified to RP.

Action: A locality Dementia Lead is required. All interest to be notified to RP by practices. LTC: See agenda item 7

Prescribing: HE updated the locality on prescribing on behalf of MD

Year‐end data not available yet. Practices have had their month 11 data already.

Care home pharmacists currently in Stevenage – Martins House and revisiting Pine Lodge re new patients, one house at Woodland View outstanding

New pharmacist coming to give practice based support in Stevenage – Rebecca Thomas,

very experienced but relatively new to primary care. MD has contacted practice managers to ask them to sort smartcard access out so they can get going as soon as possible after MD is back. They will start with easy cost saving work as part of training then tackle the more tricky things.

6. Integrated Urgent Care (NHS 111 and OOH) ‐ Update VR unavailable to provide update Please see attached document for information:

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Integrated Urgent Care - 111 Update

MM confirmed the regular messages that go out in regards to the 111 procurement, it still shows up the message that the service can directly book an appointment through the surgery which has been confirmed is not the case.

Action: RP to email the project manager to find out how the 111 coms can be amended to correct the statement of direct booking

Finance Update

NC provided the finance update from the latest month 12 report. Please see attached:

M12 Finance Report

MM raised a concern that A&E rates are low but conversion rates are high. Noreen said she will

look into this.

Action: NC to look into the finance data to understand if A&E rates are low why is the conversion rates are high.

7. CFF

IC discussed the components of the CFF.

The Consolidated Funding Framework is a key vehicle to allow investment through localities, thereby allowing practices and collaborations between practices and federations to develop the capacity and support needed to meet and improve the health needs of its population. Localities over the coming months will be developing their plans for the implementation of the CFF and the plans will need to detail how they will develop capacity and systems to make the improvements needed against the priority areas.

A total budget of £10.10 per patient based on practice registered patient list size December 2015.

2016‐17 will be a shadow/development year to create time for locality planning for the remaining three years. Locality plans for CFF must be credible, measurable (with clear locality agreed targets) and meaningful by September 2016. In order to secure a commitment a three year recurrent spend on CFF the plans will need to be agreed by the CCG Governing Body in December 2016 for the 2017‐2020 period

The clinical elements of the 2016‐17 shadow year of the framework will be an amalgamation of the existing CCG over 75s health checks and CCG Enhanced Commissioning Framework with some minor changes to improve targeting and reporting. Essentially we will roll forward the majority of both these enhanced services as they are but with improvements.

A new element will be introduced and this is the creation of a dedicated investment budget for primary care capacity planning, education and training and supporting pressures in primary care such as risk stratification, NHS England changes to PSU support, participation in HSCIC National Diabetes Audit, Map of Medicine implementation and other pressure areas at locality level. The budget will be managed and accounted for at locality level reporting to the new CCG Primary Care Steering Group as part of a Joint Co‐commissioning arrangement with NHS England.

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Localities and Practices may choose to deliver one or more elements of the shadow year framework e.g. over 75s health checks at locality level to ensure that all patients benefit equally from enhanced primary care services.

A total budget of £10.10 per patient consolidated from the following funding streams:

Enhanced service for over 75s =£5 per patient

CCG Commissioning Framework =£5 per patient

PMS reinvestment =£0.10 per patient

Framework budgetary breakdown (this is the maximum amount available for each area).

The overall aim of the 2016‐17 is to invest in collective actions at locality level which will enable primary care in East and North Herts to lead integrated care and develop local services to meet locality and practice population health and care needs. 2016‐17 is a shadow year in moving towards an outcome based enhanced service for 2017‐28 to 2019‐20.

Following this it was agreed at locality to develop the priorities for the coming years and this would require a task and finish group. RP to email PMs to email interest from practices to be part of the task and finish group.

Action: CFF ‐ RP to email PMs to email interest from practices to be part of the task and finish group. Please see attached document:

Locality Priorities Template

CFF - Components

Area

① Engage-ment

② Financial Balance

③Edn + Training/ Development Plans

Total Clinical Elements 75+/Health Checks

Cancer LTC & End of Life

Total

Amount £0.50 £0.50 £2.10 £3.10 £4.00 £1.00 £2.00 £7.00Level Practice Locality Locality Practice Practice Practice

8. £1 per patient locality budget

Locality went to discussion to discuss the 3 proposals put forward for the £1pp.

We have a rough budget of £94,000

Care home project has been agreed to go ahead for 2016‐2017. This will take up most of the funding.

We will be left with £25,000

HE asked if there were set criteria for what we use the £1pp for. PM & NC confirmed there is a local flexibility for what it could be used for.

E‐learning was agreed at locality which is unlimited use across all modules. Clinical leads requested we support this for a year costing ££22,000 for all practices or £2,533 per practice.

MBanks to proceed with the E‐learning courses.

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9. Target Event Discussion

Knebworth house was agreed as not suitable venue for the Target Event to take place

It was agreed to go back to the Stevenage Football Club with the agreement the MB will negotiate on the price.

Action: MB to contact Stevenage Football Club to negotiate with the price for Target Event.

Locality went into discussion whether to have 2 target events or 3. Practices to email RP whether they want 2 or 3 events over the year. It was thought the money spent for HUC cover and venue could be saved as a locality as the locality is already overspent. Action: Practices to email RP to provide opinion on whether to have 2 or 3 target events a year.

Locality came to the conclusion that they want the event to accommodate all clinicians, HCA, practice managers and Administrative staff.

Practices to provide RP with advance notice on what they want on the agenda for clinicians, admin staff and PMs.

Action: Practices to provide RP with advance notice on what they want on the agenda for clinicians, admin staff and PMs for July’s Target Event.

10. Patient Participation Group Update

DC said the group last met in April

Erika Grayson carer support lead at Lister Hospital discussed the movements internally.

David Brewer added the actions taken by Lister since the last CQC visit.

Stevenage day – big representation from Bedwell and Roebuck. Looking for broad representation.

There were concerns relating to GP workload and not enough GPs providing service.

RW confirmed lots of things coming from the CCG need to push back upwards

11. Practice Update Reports

King George

Chells

12. AOB:

Dr Turner raised concerns in regards to St Nicholas practice. Senior partner is off on long‐term sickness; Joe is leaving and only left with Dr Rabia. Federation meeting to discuss how they could support the practice and PM asked the locality to support the practice as much as they can. St Nicholas are talking to the federation and other practices to come up with a locality based solution.

TPP contract – Issues were raised in regards to practices ordering blood bottles. This was not

previously practice responsibility. MM confirmed this is now in the contract and other Hertfordshire practices have been operating like this for years. PM said the contract needs to be double checked.

Action: RP to double check TPP contract to see if it is practice responsibility to order blood bottle

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equipment.

Larwood and Hilltop project – confirmed it was running from the PCT days which got unofficially transferred over to CCG. NC to check which budget the previous invoices were paid from.

Action: Larwood and Hilltop project ‐ NC to check which budget the previous invoices were paid from.

Dates of Next Meeting: Locality: 14th June 2016


DATE

1. Update following meeting on A&E front door proposal

MB ASAP

2. Further update to follow on issue with children’s commissioner regarding school policy for getting sick notes.

Kate Barker ASAP

3. EB and PM to discuss at the governing body to make the practice slides more localities based

EB & PM ASAP

4. EB to provide reassurance on security of data sharing and to also to provide feedback from the piloting practices.

EB ASAP

5. EB to answer FAQs before sending out GP data packs to all practices. EB ASAP6. MAG asked if all practices are able to send electronic referrals. Bedwell

shared system 1 sharing issues, still not receiving end task. MAG to look into this.

MAG ASAP

7. MAG to look into a solution in terms of how to manage the clinician of the day to improve their availability to the practices.

All Practices ASAP

8. A locality Dementia Lead is required. All interest to be notified to RP by practices

RP/All Practices

ASAP

9. NC to look into the finance data to understand if A&E rates are low why is the conversion rates are high.

NC ASAP

10. CFF ‐ RP to email PMs to email interest from practices to be part of the task and finish group.

RP/All Practices

ASAP

11. MB to contact Stevenage Football Club to negotiate with the price for Target Event.

MaryB ASAP

12. Practices to email RP to provide opinion on whether to have 2 or 3 target events a year

All Practices ASAP

13. Practices to provide RP with advance notice on what they want on the agenda for clinicians, admin staff and PMs for July’s Target Event.

All Practices ASAP

14. RP to double check TPP contract to see if it is practice responsibility to order blood bottle equipment.

RP ASAP

15. Larwood and Hilltop project ‐ NC to check which budget the previous invoices were paid from.

NC ASAP

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MINUTES


Date: 14th June 2016, 12.30‐2.30

Venue: Business & Technology Centre, Bessemer Drive, Stevenage SG1

Attendee Organisation Present Dr Russell Hall (Chair) GP Chells Way Surgery Dr Prag Moodley (Chair) GP Stanmore Medical Group Michelle Myers PM Chells Way Surgery Dave Myers Chells Way Surgery Teresa Sutherill Chells Way Surgery Wendy Hewsa Chells Way Surgery Dr Jeremy Evans GP Chells Way Surgery Mary Bishop PM Stanmore Medical Group apols Dr Rajeev Kaja GP Stanmore Medical Group apols Imon Chakraborty GP Stanmore Medical Group Susan Lincoln PM Canterbury Way Dr Naomi Selvadurai GP Canterbury Way apols Stephen Murphy PM St Nicholas apols Dr Joseph Turner GP St Nicholas apols Mark Banks PM King George Surgery Dr Vishen Ramkisson GP King George Surgery Dr R Mahalingam GP King George Surgery apols Dr Rini Saha GP King George Surgery Jackie Watson King George Surgery apols Fiona Lucas Symonds Green Dr Masood GP Symonds Green Elaine Cook PM Bedwell Medical Centre Suma Granom GP Bedwell Medical Centre apols Alison Seymour PM Bedwell Medical Centre apols Dr P Raveendran GP Bedwell Medical Centre Karen Smith Nurse Manor House apols Sandra Copping PM Manor House Dr M Duggan GP Manor House Dr Anabel Harries GP Shephall Way Surgery apols Manjit Phugura PM Shephall Way Surgery Dr A Cormack GP Shephall Way Surgery Noreen Coles Deputy Chief Finance Officer CCG Sharn Elton Director Operations and Resilience CCG Helen Edmondson AD CCG Ruksana Parkar Locality Manager CCG Mary‐Anne Gregory HCT David Cadogen PPG Rep Maxine Davis Prescribing Adviser CCG apols Mark Knowles Business Info Lead ‐ CCG apols Rachael Lea LMC Sabina Tai HCT – Home First Sara Kumari Team Administrator ‐ CCG

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RP requested to see key practice managers to discuss declaration of interest form completion for key partners.


Notes agreed as accurate. Action Log agreed as accurate: Action 1 – Session at A&E – MD confirmed Harper Brown requested Stevenage Health to go into A&E. As a federation they need two doctors to go into A&E to carry out triage. Planning a pilot in September. MD agreed to see if he could allocate two doctors for this project. Action 9 – Finance Data – Stevenage have the highest conversion rate for non‐elective admissions.

Action: NC to send governing body paper on finance outcome to the leads. Action 12 – Number of Target Events – The locality agreed on 2 target events. 3rd event was discussed as clinicians only event based on learning for CFF. Also suggested to keep the time protected for the admin staff for in‐house training. Please see page 5 in the minutes to find the actions following this meeting.

3. Target Agreement

The locality agreed to have 2 target events.

3rd target event was discussed as being an event for clinicians only with aspects of learning for CFF.

Locality went into discussion that the protected time should stay for admin for in house training. However, SL mentioned that this should be reduced to accommodate patient care later on in the day.

Action: Practices to email RP with suggestions of format of the 3rd target event if any.


Staffing is great. Nearly fully recruited. Manor House reported issue to hotline in regards to the Rapid Response service. Issue is being

dealt with. PM shared an issue which he agreed to share with MAG

Action: PM to share issue with Rapid Response service to MAG.

ST confirmed there were 20 referrals in March and 40 referrals in April. Referrals are increasing however; the service still has capacity for more referrals. Practices are

encouraged to use the service more frequently. NC was asked to share the cost of each referral. SE confirmed there is a business case outlining the

cost.

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Action: NC to share Rapid Response business case with Ravi P.

5. GP Lead Update Mental Health: PM praised the locality to say we have nearly reached out dementia diagnosis target and requested

the locality to carry on. PM as if the practice managers have had any difficulties with the Single Point of Access Service

(SPOA). EC confirmed that they couldn’t get through to the clinician of the day. PM asked EC to report this to the hotline.

LTC: IC confirmed there was nothing to update

Prescribing:

RS confirmed the care home pharmacists are working well. Rebecca Thomas is part time and providing in‐house support to practices. Emergency scripts – has decreased OOH attendance. Will be re‐commissioning it again. Locality overspent by 426k 3 particular practices are over spent; Chells was confirmed as the golden practice with the

least spent on prescribing. Workforce:

Only 1 person recruited in the first phase 2nd phase 6 applicants were interviewed, 5 of which were successful. 3 practices to host GP fellows. VR to provide update later in the year.

6. Finance – Locality Allocations

NC said 3 options were discussed

a. Option 1 ‐ applies the average uplift of 5.92% to all localities. b. Option 2 ‐ This option takes account of list size changes since 2012. c. Option 3 ‐ This option combines Option 1 and 2 by taking an average of the two options.

Governing body went with option 3. Please see attached Governing Body paper for full details on Locality Allocations.

Locality Allocations

Stevenage growth is at 3.8% were the average is seen as 3.4% Option 3 provides the advantage to Stevenage getting extra funding.

7. Integrated Urgent Care (NHS 111 and OOH) ‐ Update Please see attached document for information:

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Integrated Urgent Care (111 and OOH)

If there are any questions regarding the update contact, [email protected]

8. CFF

Ravi P confirmed he was selected to lead on the CFF task and Finish Group The first group met on the 2nd June. Over 75 healthchecks capped at £4 – task and finish group decided to extend the healthchecks to

over 65’s‐ 74 & to also include vulnerable, carers and housebound patients. More remuneration was discussed for visits to housebound patients (£80) New template required with the additional criteria IC discussed the components of the CFF.

Action: Ravi P to review over 75’s template and to look into embedding new criteria. Action: RP to contact practices to get over 75s breakdown for forecast.

£2.10 planning and development – to be discussed at the next task and finish group taking place on

the 7th July at Stanmore Medical Group The development money will be based on Stevenage current priorities. Suggestion made to work along other localities with the same priorities IC to get feedback at the next LTC meeting to understand what other localities are doing

Action: IC to get feedback at the next LTC meeting to understand what other localities are doing with the £2.10 development fund.

9. Review ToR

Symonds Green Surgery practice manager to be updated to Fiona Lucas

St Nicholas Surgery practice manager to be updated to Stephen Murphy

Ann Wagg to be removed as a nurse representative as she has retired.

10. Patient Participation Group Update

DC confirmed next PPG meeting in on 26th July

Draft letter being sent to practices requesting practices to be more involved in patient groups.

Last week confirmed next PPG meeting in on 26th July

Draft letter being sent to practices requesting practices to be more involved in patient groups.

Last week was carer’s awareness week.

Carer’s event was successful with multiple supports from practices, Manor House, King George and Bedwell Medical Centre.

DC confirmed he has as the group to find a new Vice Chair. DC wants to step down from the roll.

11. Practice Update Reports

King George

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Manor House

12. AOB:

Independent review being carried out on TPP. Date still to be confirmed.

E‐Referral for cancer not going through in time. Leads confirmed to report this to the hotline.

Over the counter drugs – how to manage patients expectation to self‐manage. Requires CCG support. Action: RS to speak to MD about CCG support that can be provided on over the counter drugs to manage patient expectation.

27th June CCG wide Practice Managers meeting is being held at the Fielders Centre

Practices who have not signed to CFF need to in order to release payment.

Care home audit is complete – practices queried when the payment will be released.

Action: Care home audit is complete – practices queried when the payment will be released ‐ Fiona to report back to practices with a timeframe.

Dates of Next Meeting: Locality: 12th July 2016 – Cromwell Hotel, High Street, Stevenage, SG1 3AZ


DATE

1. Update following meeting on A&E front door proposal

MB ASAP

2. EB and PM to discuss at the governing body to make the practice slides more localities based

EB & PM ASAP

3. EB to provide reassurance on security of data sharing and to also to provide feedback from the piloting practices.

EB ASAP

4. EB to answer FAQs before sending out GP data packs to all practices. EB ASAP 5. NC to send governing body paper on finance outcome to the leads. NC ASAP 6. Practices to email RP with suggestions of format of the 3rd target event

if any. All Practices/RP

ASAP

7. PM to share issue with Rapid Response service to MAG PM ASAP 8. NC to share Rapid Response business case with Ravi P. NC ASAP 9. Ravi P to review over 75’s template and to look into embedding new

criteria. Ravi P ASAP

10. RP to contact practices to get over 75s breakdown for forecast. RP ASAP 11. IC to get feedback at the next LTC meeting to understand what other

localities are doing with the £2.10 development fund. IC ASAP

12. RS to speak to MD about CCG support that can be provided on over the counter drugs to manage patient expectation.

RS ASAP

13. Care home audit is complete – practices queried when the payment will be released ‐ Fiona to report back to practices with a timeframe.

FO ASAP

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