name of meeting th meeting date report author · rate. any accrual of backdated rent could...

Airedale, Wharfedale & Craven CCG

Bradford City CCG

Bradford Districts CCG

Name of Meeting

Primary Care Commissioning

Committee meeting as Committees

in Common

Meeting Date 12th November 2019

Title of Report and

Agenda Reference

Contract Assurance and

Performance Report Report Author

Debbie Oxley, Senior

Contracts Manager

(Primary Care) and Sue

Wilby Contracts Manager

(Primary Care)

Governing Body

Lead Robert Maden, Chief Financial Officer

Report Lead at

Meeting

Debbie Oxley, Senior

Contracts Manager

(Primary Care)

Group(s)/

Committee (s) that

have previously

considered this

paper

Contracts Assurance Group Meeting Date 15th October 2019

Meeting Date

Executive Summary

Paper Summary / Key

Discussion Points

Key points

This paper provides the committee with a high level summary of primary

care performance of the primary medical contracts held in Bradford City

CCG, Bradford Districts CCG and Airedale, Wharfedale and Craven

(AWC) CCG.

This paper provides a summary of the Primary Care Dashboard, including

some additional narrative describing the metrics used.

Appendix 1 Bradford City CCG Primary Care Performance Dashboard

Appendix 2 Bradford Districts Primary Care Performance Dashboard

Appendix 3 Airedale, Wharfedale and Craven Primary Care Performance

Dashboard

Primary Purpose

Assurance

Information

Decision

Action

Review

Recommendation(s)

The Primary Care Commissioning Committees (CiC) are asked to:-

Note the actions taken by the Primary Care Contracting and Quality Team

(PCT) in the management of the contract assurance process.

Group(s)/ Committee

(s) that this paper

now needs to be

submitted to

Not applicable Meeting Date

Not applicable Meeting Date

Supporting Information

Strategic Objectives

This supports the delivery of the primary medical care commissioning

strategy and the delivery of its objectives in being a co-commissioner

of primary medical services.

Quality and Safety implications

(how will the contents of this paper

impact on safety, effectiveness

and experience going forwards?; is

an equality impact analysis

required?)

The quality assurance process will support GP practices in delivery of

their primary medical care contract; the process will ensure that

lessons learned are shared with practices.

Public / Patient / Other

engagement or involvement

undertaken or planned (including

with the Bradford CCG’s People’s

Board or the AWC CCG Hub

where applicable) or experience

insight used to inform the paper

Public and patient feedback is used to triangulate the analysis of data

used when reviewing delivery of general medical services.

Resources / Finance

implications (including staffing /

workforce considerations)

Not applicable.

Legal / Constitutional

implications

The primary care team work within the agreed quality assurance

framework and the regulatory bodies are involved when risks are

identified.

Link to Corporate Risk Register /

Governing Body Assurance

Framework

(a) Does this paper mitigate against or provide assurance on the

management of a strategic risk(s) included in the Governing Body

Assurance Framework? No

(b) Does this paper mitigate against or provide assurance on the

management of a risk(s) included in the Corporate Risk Register?

If yes, please specify which risk(s): No

(c) Does this paper identify any new risks that require inclusion in the

GBAF or Corporate Risk Register? If yes, please provide details:-

Potential Conflicts of Interest

and Proposed Management These will be managed in the meeting.

Contract Assurance and Performance

The Contract Assurance Group (CAG) was presented with a detailed breakdown of the practices visited

and was alerted to any concerns raised during visits and any updates on action plan reviews.

CQC Inspection Ratings

A summary of the current practice CQC ratings are listed below;

Bradford Districts currently have 2 practices rated as Outstanding, 1 rated Requires Improvement

and 1 rated in adequate (there is one rating pending).

Bradford City have 1 practice rated as Outstanding and 1 Requires Improvment.

AWC have 1 practice rated as Outstanding.

The remaining 65 practices are currently all rated as Good.

In April 2019 the CQC introduced a change to their inspection regime, this included the Annual

Regulatory Review (ARR’s) (via a telephone questionnaire, using a set of 22 questions). Below

providdes a summary of the ARR’s.

The GP Indicators (National dashboard indicators – defining review requirements)

The patient experience indicators have been amended slightly for 2019/2020 and this has meant some

movement in practice achievement.

The Primary Care Dashboard Explained (Local Dashboard)

A summary of the Primary Care Dashboards was presented to the Contracts Assurance Group for

discussion. Please see appendix 4 for details.

Bradford Districts CCG (BDCCG)

BDCCG Primary Medical Care Dashboard (Appendix 1).

Quality and Contract Assurance Reviews

Visits have been scheduled for:

Bowling Highfield Medical Practice,

Horton Park Medical Practice,

Manor Medical Practice,

Moorside Medical Practice and

Tong Medical Practice

Wibsey and Queensbury Medical Practice

The CQC carried out a focussed inspection on the 2nd July 2019. The CQC rated the practice as

inadequate in the safe, effective and well led domains. This means that the practice have a rating of

inadequate overall. It should be noted that as this was a focussed inspection and the domains, caring

and responsive were not inspected. This means that the practices previous ratings of ‘Good’ in these

domains are carried forward. The practice has been moved to enhanced surveillance and more detailed

information will be reported as a separate item on the agenda.

Bradford City CCG (BCCCG)

BCCCG Primary Medical Care Dashboard (Appendix2)

Bilton Medical Practice

The practice has recently had a CQC ARR which in turn has triggered a CQC inspection, this will be in the next 6 months. The CCG has continued to monitor the practices progress against their quality assurance action plan on a regular basis. The practice has moved from achieving to approaching review on the GPI indicators and after a review of the practice data it was agreed that a further visit and a refresh of the practice action plan was required. There were a number of issues identified during the visit and it was evident that the practice did not have robust systems and processes in place. The practice was advised that following the trend of recent CQC inspections should the CQC have reviewed this information in its current format it is likely that the practice would be rated inadequate. The practice has been asked to apply for resilience funding to support the required improvements in advance of the CQC visit. Due to the time taken at the initial meeting, a follow up meeting to review progress and to review the practices clinical indicators has been scheduled for the 11th December 2019.

City Medical Practice

The CQC inspected the practice in October 2019. – Awaiting outcome

Clarendon Medical Practice

The CQC inspected the practice on 2nd July 2019. The practice received a rating of ‘Good’ in all five

domains.

Avicenna Medical Practice (AMP)

The CCG remedial breach notice has been lifted and the practice has been returned to routine

surveillance.

Farrow Medical Practice

(For Further information see separate agenda item - Enhanced Surveillance Report)

Dr Akbar’s Surgery – Hillside Bridge

The CCG remedial breach notice has been lifted and the practice has been returned to routine

surveillance. A CCG routine quality and contract assurance review visit took place on the 27th August

2019 and a new action plan has been agreed which the practice is now working towards. The CQC

inspected the practice in October 2019 – awaiting outcome.

Bradford Student Health

The practice has agreed KPIs that they work towards in place of the Bradford City CCG Managing Demand Scheme. For 2018/19 the practice has achieved a majority of the targets however there has been some issues extracting reports due to the lack of available read codes - new KPI’s to replace these for 2019/20 are currently being investigated.

Quality and Contract Assurance Reviews

Visits have been scheduled for:

Peel Park

Valley View (date tbc)

Airedale Wharfedale and Craven (AWC)

AWC CCG Primary Medical Care Dashboard (Appendix 3).

Haworth Medical Practice

The PCT have reviewed the data and a visit has been scheduled for November 2019.

Farfield Medical Practice

The PCT have reviewed the data and a visit has been scheduled for November 2019

WACA (Federation)

The CQC are due to inspect the provider in November 2019. WACA currently contracted to provide the

Extended Access Service.

Contract Breaches

Friends and Family Test

No breaches were recorded for the period September 2019 – October 2019. Monthly reminders

continue to be sent to Practice Managers prior to the submission deadline as a prompt to ensure

practices are not in breach for non-submission of data.

Contract Assurance Group

The Contracts Assurance Group (CAG) met in October 2019, and below is a highlight report from this

meeting, where items are reported to PCCC within separate papers they are excluded from this report.

RAP (Report a Problem/Positive)

A summary of the themes and trends identified in Q1 RAP reporting was reviewed, 33 RAPs received in

total for Q1 from City and Districts practices. All had been forwarded to the Heads of Commissioning for

comment/investigation. AWC practices were informed that RAP could be reported through GP Assist.

Changes to GP Performers List

CAG discussed changes to the GP performers list received from NHSE, changes to the GP Performers

list as recorded by the West Yorkshire Area Team (WYAT) on Sharepoint are listed below.

AWC CCG Practice Practitioner Nature of Variation I G Medical Dr McCulloch Partner resigning City CCG No new variations for City CCG were reported on Sharepoint for September 2019 Districts CCG The variations for partner inclusions for Westcliffe MC are due to the merger with Shipley MP. Practice Practitioner Nature of Variation Parklands Medical Practice Dr Parry Partner inclusion Parklands Medical Practice Dr Moncrieff Partner resigning Horton Bank Practice Dr Ward Partner inclusion Horton Park Surgery Dr Clarke Partner inclusion Leylands Lane MP Dr Thandi Partner inclusion Clinical Waste The Group were informed there was a significant variation between practices on the cost of Clinical Waste and the variation by provider. A review was underway to look at expenditure on clinical waste, who the contract holders were and of what alternative arrangements might be available. NHSE – Premises Audit (Update) The group noted that the records held by NHSE and the CCGs to be reviewed still needed to be brought into alignment/agreement. NHSE are administering the process for undertaking rent reviews in line with the Premises Directions, these are in the main undertaken every 3 years, however, they were not being undertaken in a timely manner, and therefore practices might not be receiving the correct reimbursement rate. Any accrual of backdated rent could represent a cost pressure for the CCGs. Changes to Local Policies following the revised Policy Guidance Manual The group was informed that an action from the previous CAG meeting held in August 2019 was to recommend for approval by email any changes to the Primary Care Local Policies following publication of the revised Policy Guidance Manual. The policies listed below have been reviewed and an indication placed at the side of each policy if there were any changes to implement. Policy Name

Closures & Relocations Policy – No changes

Contract Mergers – No changes

Managed Patient Allocation Policy – No changes

Practice List Closure Policy – No changes

Statement of Opening Hours – No changes

Temporary Assignment of List – No changes

PMS Local Contract and Quality Assurance Framework – Changes to Stage 1 (page 2) – amendment to wording ‘Primary Care Web Tool’ removed and replaced with ‘GPI/GPIT Dashboard’ Policy attached appendix 5

SAS (Safe Haven) Appeals Policy – Changes listed below Section 4.3 – notice changed to 28 days

4.8 – notice changed to 28 days 4.14 & 4.15 – new additions to policy to strengthen to appeals process 6.1 – notice changed to 14 days 6.5 – new addition to strengthen the appeals process Policy attached appendix 6 No objections to these changes were received and the group recommended they be approved at the PCCC meeting in November 2019. Primary Care Networks DES Update The group noted the update with development and implementation of the Primary Care Network Contracts in Bradford District and Craven, some general information to note was

PCN Development Support Prospectus has been published

PCN workforce baseline templates were sent to CCG’s on the 10th June and submitted to NHSE &I by the deadline of 28th June 2019.

Extended Hours Access – from 1st July 2019, each PCN is responsible for the delivery of extended hours across 100% of their population. PCN’s have confirmed their arrangements for delivery of extended hours cover.

During 2019 and 2020, NHSE will develop seven service specifications and seek to agree these as part of the annual contract changes. The annual funding increase under the Additional Roles Reimbursement Scheme will be tied to agreeing the service specifications nationally.

Primary Medical Services Contract Signature Process The group were informed by NHSE that from the 1st November 2019 CCGs will take on responsibility for the signing of new contracts, national and local contract variations. This will align with the legal guidance for CCGs with delegated responsibilities for Primary Medical Services and the processes already in place in other local teams across the North East and Yorkshire region. It will cover the signature process for new contracts, national contract variations and local contract variations due to partnership changes, the local team will continue to administer the process. Bradford District CCG and Bradford City CCG Review of Standard Access Scheme The group were asked to note that the Standard Access Scheme, one of the service areas agreed under the Equitable Funding Review (EFR) was to be reviewed, the current scheme is in place until 31st March 2020. The scheme was deemed to have run its course and it was suggested that the funding should be re-allocated to some other scheme and CAG agreed that alternatives could be considered.

8

Appendix 1

Bradford CCGs - Primary Care Dashboard

Contracting Assurance dashboard

GPIT Achievement CQC overall ratingPrimary Care

Contract breaches

Effective Patient

Engagement

Overall [good] exp.

of GP surgery

FFT - %

recommended

Date Period: Sep-19 Sep-19 2017/18 Sep-19 Jul-19 YTD (Jul-19)

Targets:

National Position

(82.9%)

- 5%

National Position

(89.5%)

- 5%

Bradford City CCG 1 95.2% q 20.1% q 69.6% 90.7% 0.21 q 7.63 q

Bradford Districts CCG 0 98.1% p 20.0% q 79.8% 86.1% 0.25 q 8.67 q

Bradford Combined CCGs 0 96.9% q 20.0% q 76.7% 88.0% 0.24 q 8.33 q

B83007 - THE HEATON MEDICAL PRACTICE Review Identified Inadequate No 90.9% p 20.5% q Red 49.4% No Data 0.12 q 8.50 p

B83009 - SUNNYBANK MEDICAL CENTRE Achieving Good No 98.6% p 23.1% q Amber 70.4% 81.2% 0.18 q 8.10 p

B83010 - PARKLANDS MEDICAL PRACTICE Achieving Good No 96.3% q 23.3% q Amber 66.1% 81.6% 0.23 q 11.55 q

B83012 - MANOR MEDICAL PRACTICE Achieving Good No 97.5% q 19.8% q No Data 54.6% 46.2% 0.23 q 11.92 p

B83014 - BINGLEY MEDICAL PRACTICE Achieving Good No 100.0% p 16.8% q No Data 91.0% 98.5% 0.18 q 5.57 p

B83015 - TONG MEDICAL PRACTICE Achieving Outstanding No 99.6% p 21.9% q Green 77.3% 86.8% 0.30 p 9.97 p

B83017 - HORTON BANK PRACTICE Achieving Good No 96.8% q 25.0% q Amber 67.1% 60.7% 0.24 q 9.56 q

B83018 - IDLE MEDICAL CENTRE Achieving Good No 100.0% p 20.1% q Amber 84.3% 96.1% 0.23 q 8.62 p

B83020 - THE WILLOWS MEDICAL CTR. Achieving Good No 99.8% q 20.5% q Green 79.7% 90.4% 0.22 q 8.18 p

B83022 - BAILDON Achieving Good No 99.0% p 16.5% q No Data 95.7% 98.0% 0.20 p 7.09 p

B83028 - WIBSEY & QUEENSBURY MED P Approaching Review Inadequate No 90.1% q 21.3% q Red 84.2% 73.7% 0.23 p 7.11 q

B83029 - LOW MOOR SURGERY Achieving Good No 99.3% p 21.4% q Green 90.2% 99.0% 0.20 q 6.30 q

B83030 - THORNTON & DENHOLME MEDICAL PRACTICE Achieving Good No 100.0% u 19.6% q Green 86.0% 90.1% 0.22 p 7.52 q

B83031 - OAK GLEN SURGERY Higher Achieving Good No 99.9% p 16.7% q No Data 93.9% 96.9% 0.17 q 7.23 p

B83035 - HORTON PARK MEDICAL PRACTICE Achieving Good No 97.4% p 22.2% q Red 80.1% 74.9% 0.24 p 9.82 p

B83037 - THE WILSDEN MEDICAL PRACTICE Achieving Good No 97.8% q 17.0% q No Data 72.7% 81.8% 0.20 q 7.13 p

B83038 - LEYLANDS LANE MEDICAL PRACTICE Achieving Good No 96.6% q 21.4% q No Data 83.2% 100.0% 0.28 p 9.14 p

B83039 - WINDHILL GREEN MEDICAL CENTRE Higher Achieving Outstanding No 99.5% q 18.2% q Red 95.2% 91.1% 0.26 p 8.26 q

B83040 - SALTAIRE MEDICAL PRACTICE Achieving Good No 98.9% q 17.3% q Amber 91.9% 83.3% 0.18 q 7.35 p

B83041 - BOWLING HALL MED PRACTICE Achieving Good No 99.6% p 23.1% q Red 69.3% No Data 0.20 q 10.43 q

B83042 - ROOLEY LANE MED. CENTRE Achieving Good No 99.8% p 20.9% q Green 88.1% 100.0% 0.22 q 10.38 p

B83045 - HOLLINS HEALTH & WELLBEING Achieving Good No 97.8% q 21.0% q No Data 78.6% 68.0% 0.22 q 10.27 p

B83049 - COWGILL SURGERY Higher Achieving Good No 99.9% q 15.9% q Green 82.5% 95.2% 0.21 q 7.82 p

B83054 - HAIGH HALL Higher Achieving Good No 100.0% p 21.3% q Red 89.6% 98.0% 0.25 p 4.89 p

B83055 - THE RIDGE MEDICAL PRACT. Approaching Review Good No 98.8% p 21.6% q Amber 71.9% No Data 0.23 q 9.27 q

B83056 - MOORSIDE SURGERY Achieving Good No 99.4% p 20.9% q Red 95.9% 91.6% 0.21 q 7.30 q

B83062 - ASHCROFT SURGERY Approaching Review Good No 97.2% p 20.7% q Amber 62.6% 54.5% 0.21 q 9.98 q

B83063 - SHIPLEY MEDICAL PRACTICE Achieving Good No 99.7% q 18.9% q Amber 70.7% 78.7% 0.21 p 7.88 p

B83064 - THE ROCKWELL AND WROSE PRACTICE Approaching Review Good No 96.7% q 23.6% q Amber 94.8% 95.5% 0.26 q 9.31 p

B83067 - THE SPRINGFIELD SURGERY (BINGLEY) Higher Achieving Good No 99.4% q 14.3% q No Data 96.1% No Data 0.21 p 3.57 q

B83641 - ASHWELL MEDICAL CENTRE Achieving Requires improvement No 99.3% p 20.4% q No Data 48.8% 68.4% 0.16 p 9.04 q

Y01118 - ECCLESHILL VILLAGE SURGERY Achieving Good No 97.1% q 20.0% q Red 88.3% 90.4% 0.14 q 11.44 q

QOF achievement

85.0%

YTD (Aug-19)

Average of all practices

(8.26)

- 5%

ACSC admissions (YTD)

rate per 1000Antibiotic Prescribing

Jul-19

0.27

Rate of discharge at first

appointment (OP)

YTD (Aug-19)

NHS Bradford

Districts CCG

Average of all

practices (20.1%)

- 5%

‘Please note that from Oct 2017 activity at BTHFT has been recorded on

their new EPR System. Consequently, you may notice changes in activity

numbers which are as a result of differences in the way the new EPR

system records activity compared to the old PAS System.’

p - Higher than same period last year

u - Same as same period last year

q - Lower than same period last year

9

Appendix 2

Bradford CCGs - Primary Care Dashboard


GPIT Achievement CQC overall ratingPrimary Care

Contract breaches

Effective Patient

Engagement

Overall [good] exp.

of GP surgery

FFT - %

recommended

Date Period: Sep-19 Sep-19 2017/18 Sep-19 Jul-19 YTD (Jul-19)

Targets:

National Position

(82.9%)

- 5%

National Position

(89.5%)

- 5%

Bradford City CCG 1 95.2% q 20.1% q 69.6% 90.7% 0.21 q 7.63 q

Bradford Districts CCG 0 98.1% p 20.0% q 79.8% 86.1% 0.25 q 8.67 q

Bradford Combined CCGs 0 96.9% q 20.0% q 76.7% 88.0% 0.24 q 8.33 q

QOF achievement

85.0%

YTD (Aug-19)

Average of all practices

(8.26)

- 5%


rate per 1000Antibiotic Prescribing

Jul-19

0.27

Rate of discharge at first

appointment (OP)

YTD (Aug-19)

Average of all

practices (20.1%)

- 5%

‘Please note that from Oct 2017 activity at BTHFT has been recorded on

their new EPR System. Consequently, you may notice changes in activity

numbers which are as a result of differences in the way the new EPR

system records activity compared to the old PAS System.’




B83005 - THORNBURY MEDICAL PRACTICE Approaching Review Good No 98.9% p 20.8% q Green 65.6% 92.3% 0.21 q 6.96 q

B83016 - FARROW MEDICAL CENTRE Approaching Review Requires improvement Yes 92.3% q 21.9% q Amber 87.2% 78.9% 0.24 q 7.59 q

B83025 - DR I M RAJA AND PARTNER Achieving Good No 94.4% p 17.3% q Red 84.3% 95.7% 0.22 q 7.23 q

B83026 - PRIMROSE SURGERY Approaching Review Good No 97.6% p 20.6% q Amber 78.8% 95.5% 0.25 q 7.30 q

B83032 - BRADFORD MOOR PRACTICE Achieving Good No 95.4% p 16.8% q Amber 64.7% 100.0% 0.18 q 8.40 p

B83034 - GRANGE MEDICAL CENTRE Review Identified Good No 95.7% p 17.6% q Green 54.6% 91.2% 0.15 q 7.28 q

B83051 - BRADFORD STUDENT HEALTH SERVICE Achieving Good No 86.8% q 22.1% q Red 74.1% 93.2% 0.04 p 1.28 q

B83052 - KENSINGTON PARTNERSHIP Approaching Review Good No 97.2% q 20.4% q Amber 65.8% 0.0% 0.28 p 8.64 p

B83058 - THE AVICENNA MEDICAL PRACTICE Achieving Good No 95.6% q 22.5% q Amber 69.8% 91.0% 0.24 q 10.07 p

B83604 - THE LISTER SURGERY Achieving Good No 96.7% q 21.9% q Amber 69.8% 80.4% 0.17 p 9.14 q

B83611 - DR AKBARS SURGERY Higher Achieving Good No 98.9% p 17.9% q Amber 73.5% 93.7% 0.19 q 8.21 p

B83614 - PICTON MEDICAL CENTRE Achieving Good No 98.2% p 18.5% q Amber 57.5% 96.5% 0.20 q 7.24 q

B83617 - THE FAMILY PRACTICE Achieving Good No 98.5% p 19.9% q Red 72.7% 80.6% 0.21 p 12.12 p

B83621 - PARKSIDE MEDICAL PRACTICE Achieving Good No 97.1% q 19.5% q Amber 81.7% 97.6% 0.25 p 7.60 p

B83622 - KENSINGTON STREET Approaching Review Good No 93.7% q 18.7% q Red 78.4% 100.0% 0.24 p 8.06 q

B83626 - VALLEY VIEW SURGERY Review Identified Good No 93.6% q 23.8% q Green 61.0% 74.8% 0.16 q 6.87 q

B83627 - FRIZINGHALL MEDICAL CENTRE Approaching Review Good No 87.9% q 22.6% q Amber 78.9% 92.9% 0.19 q 5.26 q

B83628 - CLARENDON Approaching Review Good No 96.5% p 17.4% q Amber 63.7% 88.8% 0.20 q 9.87 q

B83629 - PEEL PARK SURGERY Achieving Good No 98.0% q 17.3% q Red 85.6% 88.0% 0.19 p 9.02 p

B83642 - THE CITY PRACTICE Achieving Good No 97.7% q 22.2% q Amber 86.2% 82.4% 0.24 q 7.20 q

B83653 - LITTLE HORTON LANE - DR GILKAR Achieving Good No 95.1% q 23.7% q Red 62.3% 94.7% 0.26 p 6.71 q

B83657 - BEVAN HEALTHCARE CIC Review Identified Outstanding No 79.2% q 19.2% q Red 92.6% No Data 0.25 q 11.36 q

B83659 - PARK GRANGE MEDICAL CENTRE Achieving Good No 97.1% q 19.8% q Amber 70.9% 82.7% 0.11 p 5.47 p

B83660 - BILTON MEDICAL CENTRE Approaching Review Good No 97.5% q 18.0% q Red 53.4% 80.9% 0.19 q 10.07 q

B83661 - MOOR PARK MEDICAL PRACTICE Achieving Good No 99.3% q 19.2% q Green 70.1% 93.4% 0.27 p 11.36 p

NHS Bradford City

CCG

10

Appendix 3


GPI AchievementCQC overall

rating

Primary Care

Contract

breaches

Effective

Patient

Engagement

Overall satisfaction

with the GP surgery

(GP survey)

FFT - %

recommended

Date Period: Sep-19 Sep-19 2017/18 Sep-19 Jul-19 YTD (Jul-19) Jul-19

Targets:

National Position

(82.9%)

- 5%

National Position

(89.5%)

- 5%

Airedale, Wharfedale and Craven CCG 0 97.6% q 18.5% q 83.7% 81.6% 0.21 q 7.65 q

B83008 - LING HOUSE MEDICAL CENTRE Approaching Review Good No 97.8% q 17.0% q 0 72.8% 61.9% 0.20 q 9.76 p

B83021 - FARFIELD GROUP PRACTICE Approaching Review Good No 88.6% q 17.4% q 0 85.4% 54.2% 0.26 p 8.57 q

B83023 - HOLYCROFT SURGERY Approaching Review Good No 99.0% q 18.9% q 0 83.7% 16.7% 0.22 q 9.62 p

B83027 - HAWORTH MEDICAL PRACTICE Achieving Good No 97.4% q 19.6% q 0 90.3% No Data 0.19 q 9.58 p

B83033 - KILMENY GROUP MEDICAL PRACTICE Achieving Good No 95.7% q 15.4% q 0 83.2% 73.2% 0.22 q 9.06 p

B83061 - OAKWORTH MEDICAL PRACTICE Achieving Good No 95.6% q 21.4% p 0 70.9% 82.9% 0.18 q 4.83 q

B83602 - NORTH STREET MEDICAL PRACTICE Approaching Review Good No 99.5% q 18.5% q 0 60.7% 63.9% 0.23 q 5.77 q

B82007 - TOWNHEAD SURGERY Higher Achieving Good No 100.0% u 18.4% q 0 86.0% 93.7% 0.19 q 6.73 q

B82020 - CROSS HILLS GROUP PRACTICE Achieving Good No 100.0% u 20.1% q 0 77.8% 75.3% 0.25 p 7.61 q

B82028 - FISHER MEDICAL CENTRE Achieving Good No 100.0% u 19.5% q 0 87.2% 86.4% 0.20 p 7.21 p

B82053 - DYNELEY HOUSE SURGERY Higher Achieving Outstanding No 99.4% q 17.2% q 0 92.5% 94.0% 0.16 q 6.44 p

B83002 - ILKLEY & WHARFEDALE MEDICAL PRACTICE Achieving Good No 98.8% p 20.5% q 0 79.4% 100.0% 0.18 q 4.67 q

B83006 - SILSDEN & STEETON MEDICAL PRACTICE Achieving Good No 97.8% q 18.5% q 0 79.2% 80.0% 0.20 q 8.94 q

B83019 - GRANGE PARK SURGERY Achieving Good No 94.4% q 21.0% q 0 89.9% No Data 0.16 p 6.41 p

B83620 - ADDINGHAM SURGERY Achieving Good No 98.2% p 18.6% q 0 96.7% 100.0% 0.15 q 6.62 p

B83624 - I G MEDICAL Achieving Good No 100.0% q 18.8% q 0 88.8% 27.3% 0.21 q 5.85 q

QOF achievement

85.0%

Airedale

Craven

Wharfedale

Airedale, Wharfedale and Craven CCG - Primary Care Dashboard

Rate of discharge at

first appointment (OP)Please Note: The arrow

indicates performance v

the same point last year

YTD (Aug-19)

Average of all

practices (18.8%)

- 5%


rate per 1000

YTD (Aug-19)

Average of all

practices (7.36)

- 5%

Antibiotic

Prescribing

0.27




This

mea

sure

is

curr

entl

y u

nd

er d

iscu

ssio

n

11

Produced: 28 October 2019

Practice Code: QOF: Achivement (% of Max Total Achieved) Diabetes: % Achieving all 9 Care Processes

GPs (wte per 1000 pop) (Jun-19)Practice

(2017/18)

CCG

(2017/18)

England

(2017/18)

Practice (Sep-

19)

CCG

(Sep-19)

Nurses (wte per 1000 pop) (Jun-19) Overall 90.9% 98.1% 96.3% Type 1/Type 2 #DIV/0! 55.64%

Clinical 92.0% 97.9% 96.1% For Heaton Medical Practice, no diabetes data has been provided this month

Registered List Size: (Sep-19) 3,319 Public Health 88.9% 99.2% 96.9% due to practice mergersDirect ion of Travel is based on comparison with [selected] CCG* PH Additional Services 78.8% 97.5% 97.0%

Patients Under 20 (CCG 28.45%): 25.3% q

Patients Over 65 (CCG 12.92%): 14.1% p POMI: Patients Registered to use these services

Deprivation score (IMD 2015) (CCG 41.93): 35.79 qPractice

(1899/00)

CCG

(Aug-19)

England

(Aug-19)2019/20 2018/19 CCG (2019/20) Trend

Appt Booking/ Cancellation 0.0% 37.0% 13.8% ACS_Influenza_PnuemoniaInfluenza/Pnuemonia 1.42 0.53 1.51 p 1

Latest CQC Overall Rating Repeat Prescription Ordering 0.0% 37.2% 13.7% ACS_COPDCOPD 1.77 0.71 1.04 p 2

GPI Achievement (Sep-19) View Online Detailed Records 0.0% 6.1% 3.9% ACS_ENT_InfectionsENT Infections 1.59 2.30 1.42 q 3

ACS_AsthmaAsthma 0.53 0.89 0.45 q 4

ACS_CellulitisCellulitis 0.18 0.53 0.86 q 5

Community Partnership: (CPS10) South 10 Community Partnership ACS_Heart_FailureHeart Failure 0.00 0.18 0.52 q 6

ACS_AnginaAngina 0.18 0.18 0.30 u 7

ACS_DiabetesDiabetes 1.06 0.00 0.49 p 8

ACS_ActivityA ll A C S 8.50 6.91 8.67 p 9

6 12

* Includes those who haven't tried

Friends and Family YTD (YTD Jun-19) Childhood Vaccs & Imms 5 Year (2018/19)Rec - 86.1% 89.5% Practice Level HCAI - MRSAM RSA 0 3 3 1 Year Pediacel % 89.25% 93.35%

- 8.2% 5.9% Practice Level HCAI - CDIFFC-Diff 0 0 16 5 Year M M R x2 % 88.79% 90.54%

GP Survey (Jul-19) Practice level HCAI - MSSAM SSA 0 1 11

resp Response Rate 24.9% 32.4% 33.1% Practice level HCAI - EcoliE. Coli 0 2 31

Appt. 37.0% 61.4% 67.4%

Overall 49.4% 79.7% 82.9%

M RSA Previous M onth 0 0 0

C-Diff Previous M onth 0 0 0

M SSA Previous M onth 0 0 2

E. Coli Previous M onth 0 0 5

Practice level Prescribing ABs items star PUAntibio tic Items per STAR PU 0.12 0.22 0.24

Prescribing spend per patientTotal Spend per Patient £7.16 £12.23 £11.80

* Direct ion of Travel is based on previous month

Cervical Cervical Cancer Screening (Jul-19)

3.5 Year Coverage % Age 25 - 49 52.9% 62.8% 71.5% Lower Age Range (25-49)

5.5 Year Coverage % Age 50-64 67.3% 74.7% 77.6% Higher Age Range (50-64)

3.5/5.5 Year Coverage % Age 25 - 64 56.5% 66.2% 73.5% Target Age Range (25-64)

Bowel Cancer Screening Bowel Cancer Screening (Mar-19)

Uptake % Age 60-69 44.1% 48.3% 53.8% Standard Age Range (60-69)

Uptake % Age 60-74 46.8% 50.9% 56.3% Extended Age Range (60-74)

Breast Cancer Screening Breast Cancer Screening (Mar-19)

20.0% 68.3% 72.2% Standard Age Range (50-70)

27.3% 68.4% 72.0% Extended Age Range (47-73)

3yr Uptake - Standard Age Range (50 - 70)

3yr Uptake - Extended Age Range (47 - 73)

Bradford Districts CCG - Primary Care Dashboard

THE HEATON MEDICAL PRACTICE>> About the Practice << Contracting/Quality

Non-Elective Admissions for ACS Conditions per 1000 Pop YTD (Aug)

Would not recommend

Overall [good] exp. o f GP surgery

Ease of getting through to someone at GP

surgery on the phone *

CCG

29.7% 57.0%

Practice CCG England Practice

Patient Feedback

Disease Management in Primary Care

>> Immunisation <<

Inadequate

Review Identified

0.0

0.0

B83007

65.4%

Would recommend

Overall exp. o f M aking an Appt.

>> HCAI <<

Practice

>> Outpatient Attendances << >> Elective Admissions <<>> GP Referrals <<

Tele

>> A&E Attendances <<

Locality

>> Emergency Admissions <<

CCG

Bowel

Breast

Cervical

Locality CCG

Health Care Associated Infections YTD (Sep-19)

Practice

Practice

Locality CCG

>> Screening <<

>> Prescribing <<

0%

100%

Apr

May

Jun Jul Aug

Sep Oct

Nov

Dec

Jan Feb

Mar

Total Referrals* for 6 Focus Specialties

General Surgery

Trauma & Orthopaedics

ENT

Opthalmology

Paediatrics

Gynaecology

-50 0 50 100 150

LEEDS TEACHING HOSPITALS NHS TRUST

THE YORKSHIRE CLINIC

AIREDALE NHS FOUNDATION TRUST

BRADFORD TEACHING HOSPITALS NHS FOUNDATIONTRUST

YTD (Aug-17) Shift in Referrals for 4 main Providers

0.0%

50.0%

100.0%

Rec resp Appt. Overall Tele

Practice

CCG

England

0

50

100

150

Apr

May Jun Jul Aug

Sep Oct

Nov

Dec

Jan Feb

Mar

Total Admissions by Month

2018/19

2019/20

020406080

100120140

YTD (Aug-19) Admissions per 1000 Population

THE HEATO NMEDICAL PRACTICE

Other practices

CCG

0

100

200

300

Apr

May

Jun Jul Aug

Sep Oct

Nov

Dec

Jan Feb

Mar

Total Attendances by Month

2018/19

2019/20

0

10

20

5 6 7 8 9 10 11 12+

No of

Patie

nts

No of Attendances in last 12 months

A&E Frequent Flyers: Patients with 5 or more attendances in the last 12 months

0.8% of the Practice Population are responsible for 15.6% of A&E Attendances in the last 12 months

0

200

400

Apr

Ma y Jun Jul Aug

Sep Oct No v Dec

Jan Feb Ma r

First Attendances (all specialties) by Month

2018/19

2019/20

0%

20%

40%

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

Outpatients Discharged at First Attendance

Practice

Partnership

CCG

Prev Yr

0

50

100

Apr

May

Jun Jul Aug

Sep Oct

Nov

Dec

Jan Feb

Mar

Total admissions by Month

2018/19 2019/20

0

20

40

60

80

100YTD (Aug-19) Admissions per 1000 Population

THE HEATONMEDICAL PRACTICE

Other practices

CCG

80%

85%

90%

95%

100%

1 Year Pediacel 5 Year MMR x2

Practice

CCG

Target

0

5

10

15

20

25

30

35

MRSA C-Diff MSSA E. Coli

Practice

Locality

CCG

50.0%

100.0%

Practice

0.00

0.10

0.20

0.30


Antibiotic Items per STAR PU2019/20Pract ice

2019/20 CCG

Target

£0

£5

£10

£15


Total Spend per Patient

2019/20 Practice

2019/20 CCG

0

20

40

60

80

100


District

City

SelectedPractice

CCG

0

50

100

150


District

City

SelectedPractice

CCG

• The Dashboard is made up of two elements: Contracting and Quality/Performance • Behind the dashboard is more detailed data which practices can access and this data is discussed at Contract and Quality

Assurance visits.

Appendix 4 – Primary Care Dashboard Explained

12

Contracting GPI Achievement: This information is extracted from the NHS Digital Information Platform and is used in the initial part of the contract and quality assurance process. GP Indicators (GPI) represents a consolidated group of indicators following review and merge of the GPHLI and GPOS data sets. Indicators draw on existing data sources to avoid creating any additional burden on practitioners to report new data. As a result there are limitations to the data that is available across a number of indicators. It is intended that the indicator set is updated quarterly. CQC Overall Rating: This is the practice overall rating following the most recent CQC visit. The primary care dashboard is updated quarterly and therefore more up to date ratings may be presented to CAG in advance. Contract Breaches/Remedial Notices: These are issued by the CCG contracting team e.g. following a CQC rating of inadequate. A contract remedial notice is usually issued when the breach is determined to be capable of remedy. The remedial notice is issued setting out the actions that must be taken to remedy the breach and these are followed up by the PCT within a specified timescale. The primary care dashboard is updated quarterly and therefore more up to date information may be presented to CAG via the contract assurance update or enhanced surveillance paper. Quality/Performance

QoF Achievement: The QOF is a voluntary reward and incentive programme. It rewards GP practices, for the quality of care they provide to their patients and helps standardise improvements in the delivery of primary care. The results are published on an annual basis. Rate of discharge at first appointment: Represents the proportion of patients who are discharged back to primary care following their first outpatient appointment. The measure is designed to identify potential inappropriate referrals i.e. where the patient should not have been referred to secondary care. The exceptions may include fracture clinic and rapid access breast clinic. Across Bradford and Airedale the current performances ranges from 15% to 21.4%. The planned care system wide programme is currently reviewing as part of the outpatients work stream.

13

Effective Patient Engagement: There are numerous elements to this rating including: Attendance and engagement of practice with the patient network; Responses to patient feedback on NHS Choices and Patient Opinion; How easy it is to find information (how to join PPG, the chair and/or key contact details for the group) on the practice website?; The practice website contains Information on what Practice volunteers have been doing e.g. self-care events etc. and How easy is it to find information (on You said / we did) on the practice website. Overall Experience of GP Surgery

Taken from the national GP survey, this metric represents the proportion of responders who were very or fairly satisfied with their GP surgery. A number of initiatives have been undertaken with a view to improving individual practice scores. Results of the GP survey can adversely affect the practices CQC rating unless the practice can demonstrate other ways of collecting patient experience. FFT

Data should be submitted on a monthly basis. Monthly reminders continue to be sent to Practice Managers prior to the submission deadline as a prompt to ensure practices are not in breach for non-submission of data. Antibiotic Prescribing

This measure shows the amount of antibacterial drugs that have been prescribed, in relation to what would be expected given the number and characteristics of patients registered at the practice, for example, recognising some drugs are generally prescribed more for older patients. This national calculation and the local target is set at 0.27. During 2019/20 there is project across West Yorkshire and Harrogate. ‘Lowering Antimicrobacterial Prescribing’. Information is extracted from SystmOne and thereafter targeted information is sent to the individual practice bi monthly – to date this project has proved very successful and the National Team are visiting to gain further knowledge of the project. There is an IT solution behind this so practices can download the info to share at practice meetings, with the CQC etc. To note: when reviewing this data season fluctuation should be considered.

Ambulatory Care Conditions Admissions

This is a measure of the number of admissions under the 19 categories of ambulatory conditions. These conditions are considered to be manageable outside of the hospital environment and as such are considered to be a marker of the quality of primary care provision for people with a long term condition. The main conditions in this category include: respiratory disease, asthma and cellulitis.

15

Appendix 5

Version Control Sheet

Document Title Primary Medical Services Local Contract

Quality Assurance Framework

Author Senior Contracts Manager (Primary Care)

Lead Officer Head of Primary Care Contracting

Version 2.0

Date of Production January 2018

Review date November 2020

Post holder responsible for revision

Senior Contracts Manager (Primary Care)

Version History

Version no.

Author/Reviewer Status / Approval Group Circulation

1.0

Contracts & Quality Team (Primary Care)

Final Version Contract Assurance Group (CAG)

1.1 Jan 2018

Contracts Manager (Primary Care)

Final Version – revised due to changes in Primary Medical Care Policy Manual - Nov 17

CAG/PCCC

1.2 Feb 2018

Deputy Director of Quality & Nursing

Further amendments CAG/PCCC

1.3 Jan 2019

Senior Contracts Manager

Revised CAG/PCCC

1.4 April 2019

Senior Contracts Manager

Revised as per PCCC comments

n/a

1.5 Sept 2019


Revised due to updated PGM v2 Apr 19 – Stage 1 amendment to wording ‘Primary Care Web Tool’ removed, replaced with ‘GPI/GPIT Dashboard’

CAG – 15th October 2019

2.0 Nov 2019


Policy to PCCC CIC for ratification with effect from 12th November 2019

PCCC – 12th November 2019

16

Primary Medical Services Local Contract and Quality Assurance Framework Through delegated authority the Bradford Districts and Craven CCG’s are responsible for the quality, safety and performance of services delivered by GP providers within their locality. Whilst it is recognised that most health care professionals and providers of Primary Medical Care operate to a very high standard, it is essential that as commissioners we have robust monitoring arrangements in place and it is our statutory duty to conduct a routine annual review of every primary medical care contract we hold. GP practices as providers are required to have their own quality monitoring processes in place and through the duty of candour and the contractual relationship with commissioners they are required to provide information and assurance to commissioners and engage in this approach to improving quality. Following recent NHSE guidance, there is a requirement for commissioners to undertake a risk based approach to reviewing contracts, along with a rolling programme of deep dive contract reviews. Depending on the number of practices within the commissioning area and types of contract, a rolling programme could span one to three years. The quality assurance framework describes our approach to monitoring and assuring quality in all Primary Care commissioned services. The three domains of quality: patient safety, clinical effectiveness, and patient experience alongside our CCG strategic priorities, will be monitored through routine internal contractual processes and clinical governance structures and external sources such as CQC, peer reviews, national surveys etc. (See Appendix 1)

Monitoring arrangements should create a balance of support, and oversight, supporting a culture of openness and transparency, promote peer to peer improvement and the sharing of best practice, with intervention when necessary enabling us to highlight when things are going wrong at an early stage.

The following describes the process and escalation in relation to Quality Assurance. (See Appendix 2).

Stage 1 - Routine Quality Monitoring for Primary Care (See appendix 1 and 3)

Each CCG is required to conduct a routine annual review of every primary medical care contract it holds, this will be done through the annual GP Practice self declaration (eDec) following submission (usually during December) and any subsequent national analysis produced (e.g. NHS England’s eDec outlier report).

The e-Dec alongside a suite of other measures will determine whether a practice quality assurance visit is required. Please find a detailed list below;

GPI/GPIT Dashboard

Routine Quality Metric Monitoring (primary care dashboard),

Patient Safety Indicators including: for example monitoring of HCAI, safeguarding vulnerable children and adults, reporting of patient safety incidents, workforce numbers, skills and training, Uptake of vaccinations and Immunisations

Patient Experience Indicators including: complaints, Friends and Family test, Access to appointments/services (Grass roots reporting)

Effectiveness Indicators including: Emergency admissions data, referral rates, and partnership working arrangements.

17

CQC compliance

Soft intelligence The use of these measures and indicators is a starting place for conversations, asking questions along the way as to why variation may be occurring and acknowledging that variation may be warranted or unwarranted depending on the context and wider supporting information available. A practice visit may be needed to support further understanding when high levels of variation are occurring. Routine Quality Assurance Visits – (CCG review). These review visits are intended to be an informal way for practices to have an open discussion about areas of their practice. This is intended to be a supportive process and part of the on-going dialogue with practices and the CCG. Practices will be sent a pre-visit data set to validate. Following the visit a summary of the key discussion points and actions for the practice and the CCG will be sent to the practice. Action points will be reviewed on a regular basis.

Where concerns are not addressed, and the practice fails to engage this will be raised at the Contracts Assurance Group for discussion with a view to invoking the next step in our process (Stage 2a – Deep Dive Contract Review).

Other visits to practices may be required, these may originate from:

List closure application

CQC report

New contractor visits

Practice support

Investigation of concerns / complaints raised

Annual review of provider

Contractual concerns e.g. boundary changes

Practice mergers

Performer concerns that may be impacting on contract

In addition to the routine quality assurance visits the CCG’s must undertake a rolling programme of ‘deep dive reviews’ of practices that are not identified through other intelligence led approaches. Due to the number of practices within the 3 CCG’s this programme of visits will span over a 3 year period (2018-2021) This means that each year we will visit a proportion of GP practices that are not highlighted as ‘review identified’ through the Contract and Quality Assurance process.

Enhanced Quality Assurance Reviews

Bradford CCGs has adapted and localised the NHSE Quality Concerns Triggers Tool to support identification of practices that may require further review following findings from routine monitoring. Where the CCG identifies this is required, the Quality Concerns Triggers Tool is followed and is split into 3 further stages;

Stages 2a – CCG Enhanced Quality Assurance Monitoring (Deep Dive Contract Review) Appendix 2

If a practice is identified with performance concerns in respect of the assurance process and where concerns are not being addressed, and or the practice fails to engage in this process concerns would be discussed at the next Contracts Assurance Group meeting with a view to invoking stage 2a of the CCG quality assurance process. This would mean that an increased risk is identified that would require further investigation and review and the CCG is not currently assured therefore it may be necessary to undertake further regular

18

quality assurance visits to gain assurance of the quality of provision and the safety for patients. The provider is informed of this process.

Stage 2b – Enhanced Quality Surveillance (appendix 2)

If a provider continues to fail to address the improvements required and persistent concerns remain as part of this process, then the provider may be moved onto Stage 2b. The Contracts Assurance Group will recommend the course of action at this point and it will be reported through to the Primary Care Commissioning Committee, utilising the NHSE Quality concerns Trigger Tool pathway (see appendix 2) and the provider will be informed.

Stage 2b - The NHSE Quality Concerns Trigger tool, requires that the provider’s performance is taken through a Desk Top Quality Risk Profile Tool (QRP) (this is an assessment process of the metrics and findings from enhanced monitoring and as such a risk score is applied).

At this point the CCG is required to inform NHSE of the intention to take a provider through the QRP. The QRP is completed initially with the information intelligence gathered by the CCG, subsequent to completion of the QRP, the findings would be discussed within an enhanced quality review meeting with representatives from the CCG, NHSE, CQC and the LMC to agree the next steps.

If evidence is received and the meeting is assured that the concerns will be resolved within a reasonable timeframe, then continued Enhanced Surveillance monitoring will be undertaken with the practice for a minimum of 3 months and until assurance is gained.

If evidence and assurance is not received that the concerns will be resolved within a reasonable timeframe then a face to face QRP will be undertaken and the findings would be discussed within an enhanced quality review meeting with representatives from the CCG, NHSE, CQC and the LMC to agree the next steps. At this point the CCG will assess if the practice has breached terms of their contract. If the meeting concludes that the practice has breached one or more terms of its contract then a remedial/breach notice will be served.

In significant, exceptional circumstances, the contract breach may be so severe that it is escalated immediately to a Risk Summit as described in the Quality Assurance Framework and/or require counter fraud intervention.

Stage 3 - Risk Summit

As per the quality concerns trigger tool pathway and quality assurance process, should the identified risk remain or is increased a Risk Summit will be considered. A Risk summit provides the mechanism for key stakeholders to come together collectively to share and review information when a serious concern about the quality of care has been raised. A Risk Summit should be considered when:

serious failings within a practice/provider are raised by any organisation or part of the system; and

When the organisation or part of the system believes that there is a need to act rapidly to protect patients and / or staff.

Serious quality concerns about a provider may be identified through a range of routes, for example:

individual organisations’ routine quality and operational performance monitoring systems;

Quality Surveillance Groups;

CQC Chief Inspectors;

19

Rapid Responsive Reviews (see How to Organise and Run a Rapid Responsive Review3);

Safeguarding Boards;

information sharing meetings; or

A single, material event.

Further national guidance available from the National Quality Board: https://www.england.nhs.uk/wp-content/uploads/2017/07/risk-summit-guidance-july-2017.pdf

Please note: Individual practitioner performance: If the performance issue is of individual medical practice, it remains NHSE’s responsibility to investigate and take relevant actions in relation to the relevant practitioner.

Contractual Action (Appendix 4)

When a practice fails to improve or concerns have been highlighted by the CQC following a practice inspection contractual action may need to be considered. In most cases matters will be resolved through the development and implementation of practice improvement plans. However, there will be occasions when the CCG’s will need to take contractual action to resolve matters either alongside the CQC regulatory arrangements or completely independently from them. A consistent, proportionate and appropriate approach should be taken when considering contractual action in response to any concerns and CQC ratings. Patient safety, continuity of services and choice are considered at all times throughout the processes.

Conclusion of the Quality Assurance process

On the whole, the outcome of the Quality Assurance process and associated reviews is received very positively. The CCG provides regular support during this process to help practices to achieve the required improvement.

If the outcome of the quality assurance review is the practice being placed on ‘enhanced quality surveillance’ then this is reported through to the CCG CAG, PCCC and the CCGs Joint Quality Committee. Although this may be disappointing for practices, it is there to enable transparent identification of practice areas that require further support.

In addition, the outcome of the enhanced quality surveillance is reported to the West Yorkshire Quality Surveillance Group (WYQSG) as there may be a wider ‘system’ impact of a practice remaining on ‘enhanced surveillance’. Where practices remain on enhanced surveillance for 6 cycles (12 months) of reporting to the WYQSG, then this is escalated to the Yorkshire and Humber Quality Surveillance Group for consideration of wider system impacts. Though this is extremely rare, this is a line of reporting.

Next Steps

Primary care is evolving and the way care is delivered is changing with GP practices being

part of federations, community partnerships or merging and creating super-partnerships,

https://www.england.nhs.uk/wp-content/uploads/2017/07/risk-summit-guidance-july-2017.pdf

20

albeit working as large scale organisations. This means we will need to take a flexible

approach to this changing environment and consider amending our Quality Framework to

review these providers in a different way. This could be through federations or community

partnerships supporting the delivery of quality improvement with peer support. This

arrangement would need to be developed over time and alongside guidance around how the

CQC will inspect these larger scale organisations going forward.

**Please note the Primary Care Team (PCT) can consist of representatives from the

contracting team, quality team and medicines management team

21

Appendix 1

22

Appendix 2

24

Appendix 4 – Performance Oversight and Contractual Action

Concern raised by CQC

Registered (usually within one working day of visit)

Concerns raised CQC Un-registered following magistrates action

(Suspension of registration means the provider is suspended from providing the regulated activity at all

locations)

CCG to Consider Risk/ Further investigation

Open Closed

Inadequate in one or more of the five areas

Moderate Level

Practice Visit

(QA process – stage 2a)

Minor Level Assurance

(Tele/email/engagement visit)

Major Level

Detailed Investigation

(QA process-stage 2b)

Action 1: No

contractual action

Action 2: Contractual Compliance Breach/ Remedial (also notify

NHSE)

Action 3: Terminate

(Enact TAL)

Assurance received/notice satisfied Assurance not received/remains in breach/remains on

enhanced surveillance

CCG inform CQC

RI in one or more of the five

areas

Provide written weekly updates to

SMT

Update CQC on regular basis

Suspension of registration –

CCG to discuss options for

ensuring continuity of

service

Individual

update papers

to CAG and

PCCC

25

Appendix 6

Version Control Sheet

Document Title Bradford City-Districts-AWC SAS Appeals

Process Policy

Author Contracts Manager (Primary Care)

Lead Officer Head of Primary Care Contracting

Version 1.3

Date Approved 7th January 2019 (v1.0)

Review date November 2020

Post holder responsible for

revision


Version History

Version Date Author Changes/Status

0.1 15/11/18 Contracts Manager (Primary Care)

First draft


Changes to policy include 2.2 include Airedale and Wharfedale catchment area on behalf of AWC 2.4 include APMS contracts 3.2 details of SAS Liaison Team

4.5 contact details for appeals

4.14 ensure papers do not include PID, are in

PDF form and are password protected.


All changes accepted – Draft recommended

for approval by CAG on 11th December 2018

0.4 12/12/18 Contracts Manager

(Primary Care)

Policy to PCCC CIC for ratification on 7th

January 2019

1.0 12/01/19

Contracts Manager

(Primary Care)

Policy ratified by PCCC 7/01/19 with minor

changes

4.5 generic email included for appeals

6.6 contact details where patients can make a

complaint or need support when appealing

1.1 15/07/19

Contracts Manager

(Primary Care)

Amendment to address at section 4.5 to read

2nd Floor.

26

Removal of 4.9.1.4. – Removing Practice

Representative as a member of the SAS

Review Panel

1.2 25/09/19

Contracts Manager

(Primary Care)

Amendments to policy due to changes to

PCG Manual v2 April 2019

4.3 notice period amended


4.14 & 4.15 new additions to the policy


6.5 new addition to the policy

Draft recommended for approval by CAG on

15th October 2019

2.0

24/10/19 Contracts Manager

(Primary Care)

Policy to PCCC CIC for ratification with effect

from 12th November 2019

Special Allocation Scheme

Process for Patient Appeal, Provider Challenge or Exceptional Discharge Review Panel

Introduction and purpose

1.1. The Special Allocation Scheme (SAS) previously known in Bradford Districts and

Craven as Safe Haven was introduced as a Directed Enhanced Service (DES) in 2004.

The DES has not been nationally agreed for some time, and although there are

Directions for the scheme these only put in place a legal duty for NHS England and

subsequently fully delegated clinical commissioning groups to offer or establish such

services. This scheme is therefore subject to local agreement and variation to address

the needs of the patients. NHS Bradford City, Districts and Airedale, Wharfedale and

Craven Clinical Commissioning Groups (CCGs) have agreements in place.

1.2. The main aim of the scheme is to provide a secure environment in which patients

who have been violent or aggressive towards staff in their GP practice can continue to

receive general medical services.

27

1.3. The scheme is only available to patients who meet the criteria for inclusion and

cannot be used for any other circumstance.

1.4. This paper sets out the process to be followed should a patient allocated to the

scheme wish to appeal, the SAS Provider challenges a referral as not appropriate or a

patient has been registered with the SAS scheme for longer than 2 years.

Background

2.1. In November 2017, NHS England published the Primary Medical Care Policy and

Guidance Manual

(PGM) which superseded the policy book for primary medical services which had been

published in January 2016.

2.2. The policy refers to a number of recommendations regarding the commissioning of a

robust Special Allocation Scheme (SAS) which is currently provided by:

2.2.1. Local Care Direct from Shipley Health Centre, Alexandra Road, Shipley, BD18

3EG on behalf of Bradford City, Districts CCGs and for Airedale, Wharfedale part of

Airedale,Wharfedale and Craven CCG

2.2.2. Dyneley House Surgery, Newmarket Street, Skipton, BD23 2HZ for the Craven

part of Airedale, Wharfedale and Craven CCG.

2.3. Whilst the service specification appears significantly different due to the level of

detail included there are no material service changes for the provider. What has changed

is the role the CCG will play as the new policy states that Commissioners must set up a

Special Allocation Scheme Liaison Team and a Review Panel.

2.4. The Regulations regarding the removal of patients who are violent is specific in

terminology and the

Regulations require that APMS (Alternative Provider Medical Services), GMS (General

Medical Services) and PMS (Personal Medical Services) contracts provide for "Removal

from the list of patients who are violent".

2.5. Within the Regulations the grounds on which a GP contractor may request a patient

to be removed from its list of patients with immediate effect are that "the person has

committed an act of violence against any of the persons or has behaved in such a way

that any of those persons has feared for their safety".

2.6. The CCGs are clear that violence does not have to be physical or actual. It can be

perceived, threatened or indeed a perceived threat of violence. A person's fear for their

safety can also be actual or perceived. If a patient's behaviour is such that it warrants

removal from the patient list and placing them on a SAS, then the Regulations require

that the incident is reported to the police.

2.7. It is recognised that GP practices report incidents to the police and request an

immediate removal where there is due cause and to protect the safety of practice staff,

patients and visitors.

2.8. An example patient pathway is included as Appendix 1.

28

SAS Liaison Team

3.1. It is proposed that members of the Primary Care Contracting Team will act as the

SAS Liaison Team who will be the main contact for NHS Bradford Districts and Craven

CCGs with regards to any action, communication, information and notifications regarding

the SAS from the NHS England or Primary Care Services England (PCSE) teams.

3.2. It is proposed that the SAS Liaison Team will consist of the following people:

3.2.1. Primary Care Contracts Manager

3.2.2. Primary Care Contracts Support Officer

3.3. The Primary Care Contracts Manager will report aggregated data to the Contract

Assurance Group (CAG) on a quarterly basis as part of routine contract monitoring.

3.4. The SAS scheme itself will be reviewed annually and this will be undertaken by the

Primary Care Contracting Team as part of the contract monitoring and performance.

Appeal, Challenge and Review Process

4.1. The PGM determined in section 6.4.21 that each Commissioner should have an

appeals process in place that any patient who wishes to appeal their allocation to the

scheme can access.

4.2. The appeals process must recognise that a practice has already fulfilled its obligation

under the Regulations by reporting the incident to the police and notifying the

Commissioner.

4.3. The patient referred to the SAS has a right of appeal and should they wish to do so,

can appeal against the decision by putting this in writing within 28 working days of the

notification of the referral. Appeals raised outside this timescale may be considered due

to exceptional circumstances.

4.4. The SAS Provider has a right to challenge a referral they feel is inappropriate and

should they wish to do so, can challenge the referral by putting this in writing within 14

days of the notification of the referral.

4.5. All appeals from patients or the provider should be addressed to the Commissioner

at Safe Haven Service Liaison Team, NHS Bradford City, Districts and Airedale,

Wharfedale and Craven CCGs, Scorex House, 1 Bolton Road, 2nd Floor East Wing,

Bradford, BD1 4AS or by email to [email protected]

4.6. The Primary Care Contracts Manager will contact the removing practice to notify

them of the appeal/challenge and invite them to provide any supplementary information

in relation to the removal. The GP practice will be advised to contact Local Medical

Committee for advice and support if needed.

4.7. The appeals process does not delay the immediate removal of a patient following an

incident that has been reported the police and PCSE (Primary Care Services England).

mailto:[email protected]

29

4.8. The appeal will be reviewed at a SAS Review Panel and this can be either virtually

or at a meeting. The SAS Review Panel should be convened within 28 working days of

receiving the appeal.

4.9. The SAS Review Panel must include the following representatives

4.9.1. Commissioner

4.9.1.1. Head of Primary Care Contracting

4.9.1.2. Primary Care Contracts Manager

4.9.1.3. GP Advisor or GP Clinician

4.9.2. Local Medical Committee

4.9.3. CCG Lay Member

4.10. Appropriate deputies may attend on behalf of Panel Members and must be

confirmed in advance of the Review Panel.

4.11. In exceptional circumstances, at the request of the Contractor or following a Service

Review meeting with the Commissioner, a SAS Review Panel can be held to determine

the discharge of a patient on the grounds of the SAS Service no longer meeting the

needs of the patient (Exceptional Discharge).

4.12. SAS Review Panels for Exceptional Discharge must be convened when an active

patient has been registered for two or more years. This is to enable multi-organisation

discussions about what is needed to facilitate patient rehabilitation into mainstream

general practice.

4.13. It is the responsibility of the SAS Review Panel to review the evidence provided by

the patient in support of their appeal. The SAS Review Panel where it has reasonably

considered if a removal under the regulations was made in error, or inappropriately, in

line with the agreed NHS England Standard Operating Policies and Procedures for

Primary Medical Services will uphold or reject the appeal.

4.14. The panel should be assured that:

The identity of the removed patient and that of the patient that was involved in the incident should be confirmed as the same and be without any doubt.

Where the reported incident occurred during a clinical consultation, the removed

patient had an appointment at the practice on the same day.

A police incident number has been provided, either at the time of the removal or

within 7 days as part of the written report.

That a written report has been submitted to the Board (usually via PCSE)

The information provided in the report is consistent with the requirements for an

immediate removal, as set out in the GMS/PMS regulations.

The content and strength of any evidence provided by the removed patient does

not wholly support their claim they should not have been removed (for example –

clear and incontrovertible evidence they were out of the country at the time of the

incident or at another location e.g. in-patient in hospital).

4.15. The panel should also:

Invite the patient to submit any further relevant information or a statement in relation

to the alleged incident. This will ensure all parties are considered to have been

treated fairly an equally should the matter be escalated to the Parliamentary and

Health Service Ombudsman (PHSO) or through a legal route.

30

Seek confirmation from the practice, which member of staff was involved in the

incident

Seek confirmation from the practice which member of staff requested the deduction

Discuss the incident with the practice

Re-confirm with the practice, the details of the patient involved in the incident and

cross check this with the details of the patient making the appeal.

4.16. Secretarial support will be provided to ensure appropriate support to the panel

members in relation to the organisation and conduct of meetings. Any appeal papers

sent shall not include patient identifiable data (PID) and that papers circulated would be

in PDF form (apart from the templates that panel members are to complete) and are

password protected. Formal minutes will be taken to ensure there is an appropriate

governance trail for decisions made.

4.17. Pending the outcome of any appeals process, should the patient need to access

GP services, this will be provided by the SAS Provider to which the patient had been

allocated.

Conduct of the Panel

5.1 Members of the Panel shall at all times comply with the standards of business

conduct and managing conflicts of interest as laid down in each of the CCG Constitution

and the Managing Conflicts of Interest Policy.

5.2 All declarations of interest will be declared at the beginning of each meeting and

actions taken in mitigation will be recorded in the minutes.

Process following Review Panel

6.1. The Primary Care Contract Manager will notify the patient of the decision in writing

within 14 working days of the SAS Review Panel. The Primary Care Contract Manager

will discuss first the outcome with the practice from which the patient was removed.

6.2. If the appeal is not upheld the patient will usually remain on the SAS scheme for a

minimum of 12 months, unless the provider invokes the break clause of six months,

which is considered only when the patient has been reviewed on a minimum of three

face to face occasions within the previous six months.

6.3. At this point, the patient could be removed from the scheme if there is clear evidence

of changed behaviour, with the aim being to try and tackle the underlying causes of their

behaviour, and rehabilitate them, as far as possible, through counselling and/or other

forms of treatment.

6.4. If the appeal is upheld the patient should be removed from the SAS scheme and

supported to register with a GP practice. Ordinarily this would not be the removing

practice unless there were exceptional circumstances that meant a negotiated re-

allocation was necessary i.e. only one practice serving patient’s address etc.

6.5. SAS providers should be encouraged to support patients (if requested) in finding an

alternative GP Practice upon discharge from the scheme. In doing so, this may help to

break a cycle of registration and removal, as patients are supported with the transition.

31

In addition, the SAS provider can allay any concerns a newly registering practice may

have about registering the patient.

6.6. If the patient feels that the appeal process has not been followed, the patient can

make a complaint to NHS England complaints team at [email protected] for

investigation.

i. When a patient has been removed following an appeal: they can if still unhappy

make a complaint to the Parliamentary and Health Service Ombudsman, 51

Mosley St, Manchester, M2 3HQ, or access their website at

www.ombudsman.org.uk

ii. When a patient needs support in making an appeal they can use the advocacy

service by contacting http://nhscomplaintsadvocacy.org/

References

7.1. Primary Medical Care Policy and Guidance Manual (PGM) v1.0 November 2017

7.2. The National Health Service (General Medical Services Contracts) Regulations 2015

7.3. The National Health Service (Personal Medical Services Agreements) Regulations

2015 – Schedule

2 – Part 2

Appendix 1: Patient Pathway Green arrows represent data transfer flows

PATIENT PATHWAY

http://www.ombudsman.org.uk/

http://nhscomplaintsadvocacy.org/

32

Referral made to Primary Care Support England (PCSE)

from Referring GP Practice and flag placed on patient

record

Within 1 working day PCSE sends

the SAS Contractor referral form

PCSE confirms:

Referring GP Practice can deduct patient, SAS

Contractor can request patient notes.

PCSE notifies the patient in writing of the

It is important that all

relevant organisations /

contractors are informed of

registrations, deductions and

any appeals in a timely

manner

If confirmed not

appropriate

Commissioner informs

and engages further

with Referring GP

Practice and SAS

Contractor

SAS Contractor

contacts referring

practice for details of

incident

Patient completes registration

and consents to data sharing

with other NHS organisations

Patient ready to be

discharged

Review of patient at 12 monthly intervals (6 if

appropriate / relevant)

Ongoing service provision and

rehabilitation

SAS contractor writes to patient to

confirm placement and to arrange 1st

appointment for initial assessment

SAS Contractor confirms

referral with PCSE

SAS Contractor contacts

Commissioner if referral

considered not

appropriate. This would

be an exception rather

than a rule. Commissioner

should consider

convening a panel to

review e.g. in the same

way a patient appeal

Patient not ready to be

discharged

Patient supported to find alternative

GP practice

Exceptional Discharge Panel

review for patients registered for

more than 2 years

The SAS Contractor receives

and reviews the referral

name of meeting th meeting date report author · rate. any accrual of backdated rent could...

Documents