nhs north derbyshire ccg primary care co · pdf filedentith, jill non-voting lay member for...

NHS NORTH DERBYSHIRE CCG PRIMARY CARE CO-COMMISSIONING COMMITTEE PUBLIC SESSION

Date & Time: Thursday 22 February 2018, 10.30am

Venue: Robert Robinson Room, Scarsdale

Date and time of next meeting: Thursday 29 March 2018, 10.30am, at Scarsdale

Item Subject Paper Presenter

Time

PCCCC/1718/01

Welcome & Apologies Apologies received from Mr Gary Apsley, Dr Ben Milton, and Dr Carolin Shearer

Verbal IS 10.30

PCCCC/1718/02

Declarations of Interest • Primary Care Co-Commissioning

Committee Register of Interests • Summary Register for Recording

Any Interests During Meetings

Enclosed (Paper A)

ALL 10.35

PERFORMANCE PCCCC/1718/03

Primary Care Co-Commissioning Quality And Performance Assurance Report

Enclosed (Paper B)

JD 10.40

FOR INFORMATION PCCCC/1718/04

The Grange Family Health Centre/Royal Primary Care Update

Verbal HB 10.50

MINUTES AND MATTERS ARISING PCCCC/1718/05

Minutes of the meeting held on Thursday 25 January

Enclosed (Paper C)

IS 11.00

PCCCC/1718/06

Matters arising from the minutes not elsewhere on agenda

Enclosed (Paper D)

IS 11.05

PCCCC/1718/07

AOB

Verbal ALL 11.10

PRIMARY CARE CO-COMMISSIONING COMMITTEE

22 February 2018

PAPER NO. A

PRIMARY CARE CO-COMMISSIONING COMMITTEE – 22 February 2018

TITLE Declaration of Interest Register

PRESENTER Isabella Stone, Vice-Chair

AUTHOR Suzanne Pickering, Head of Governance

SPONSOR Louise Bainbridge, Chief Finance Officer

IS THIS PAPER FOR: Decision Assurance X Discussion

RECOMMENDATIONS The Committee is asked to: To review the Declaration of Interest for the Finance and Performance Committee to ensure that it is correct and consistent REPORT SUMMARY A Declaration of Interest Register is required under the Code of Accountability and the interests declared will be reported to the North Derbyshire CCG Finance and Performance Committee and will be available for public inspection. Key matters for consideration To provide a Declarations of Interest Register for North Derbyshire Clinical Commissioning Group (NDCCG). IS THERE A FINANCIAL IMPACT?

None

HAVE ANY QUALITY & COMPLIANCE ISSUES BEEN IDENTIFIED/ACTIONS TAKEN?

None

HAVE ANY CONFLICTS OF INTEREST BEEN IDENTIFIED/ACTIONS TAKEN?

Conflicts of interest will be declared as appropriate in relation to the agenda.

LINK TO BOARD ASSURANCE FRAMEWORK/ RISK REGISTER

1

Reference Number: BAF/ RR N/A Current Risk Score N/A

How does this paper provide assurance to the Committee that the risk is being managed? Requirement to embed into the CCG to ensure sound corporate governance structures and transparent decision-making processes within NDCCG.

CCG IMPROVEMENT & ASSESSMENT FRAMEWORK Please describe how this report and/or the services described within it supports CCG performance in the following domains: Better health outcomes for all N/A Improved patient access and experience N/A Empowered, engaged and well-supported staff N/A Inclusive leadership at all levels N/A

CLINICAL PRIORITY AREAS (please tick) Mental Health Dementia Learning Disabilities Cancer Diabetes Maternity

EQUALITY AND DIVERSITY IMPACT

Due Regard to the proactive duties of the Equality Act 2010 has been taken in development of this paper and:

It is judged that it is not proportionate on the basis that the register of interest is not a decision making tool, this completes the due regard required.

NOTE: Policies/decisions may need to be adjusted in line with any equality analysis or due regard that is brought back at a future date. Any decision that is finalised without being influenced by appropriate due regard could be deemed unlawful.

2

NHS NORTH DERBYSHIRE CCG REGISTER OF INTEREST

FEBRUARY 2018

Fin

an

cia

l In

tere

st

No

n F

inan

cia

l

Pro

fessio

nal

Inte

rest

No

n-F

inan

cia

l

Pers

on

al

Inte

rest

From To

Alla, Praveen

Governing Body GP Member,

Finance & Performance Committee Member

GP Partner at Welbeck Road Health Centre P Direct On going On going

Withdraw from all discussion and

voting if organisation Is potential

provider unless otherwise agreed by

the meeting chair

Welbeck Road Health Centre is a member of the North

Derbyshire GP Federation P Direct On going On going No action required

Apsley, Gary

Lay Member Patient and Public Involvement Governing

Body Member, Chair Primary Care Co Commissioning

Committee, Audit Committee Member

No relevant interests Apr-13 On going

Finance and Performance Committee Member No spouse with relevant interests

Austin, Debbie Deputy Clinical Chair, Governing Body GP

School Governor Taxal and Fernilee Primary School, Whaley

Bridge

P Indirect On going On going No action required

Primary Care Co Commissioning Committee Member,

Clinical Commissioning Committee Member

Spouse is Employee of DCHS, Associate Director of

Transformation


Locum GP P Direct On going On goingWithdraw from all discussion and


Belcher, Hannah Head of Primary Care No relevant Interests

No spouse with relevant interests

Bainbridge, Louise

Chief Finance Officer, Governing Body Member, Finance

and Performance Committee Member, Audit Committee

Member, Primary Care Co Commissioning Committee

Member,

Clinical Commissioning Committee Member

No relevant interests Nov-17 On going

Bhatia, Upendra Clinical Commissioning Committee Member GP Partner at Newbold Surgery, Chesterfield

P

Direct 2009 On going




the meeting chair

Action taken to mitigate risk

Type of Interest Date of Interest

Name

Current Position(s) held in CCG i.e. Governing Body

member, Committee member, Member Practice, CCG

Employee or other

Declared Interest (Including direct/ indirect Interest)

Direct or

Indirect

Interest

GP Practice part of Chesterfield Health Provider Company P Direct 2009 On going On going

Director Veincare Ltd P Indirect Apr-13 On going No action required

Consultant Surgeon NUH P Indirect 2000 On going No action required


Braithwaite, Bruce Specilaist Secondary Care Dierctor of Clinical Services, Alliance Surgical PLC P Indirect 2007 On going No action required

Governing Body Member, Clinical Commissioning Director BD Braithwate

Committee Member Director Veincare Ltd P Indirect 2003 On going No action required

Consultant Surgeon Nottingham University Hospitals P Indirect Apr-13 On going No action required

No spouse with relevant interests P Indirect 2000 On going No action required

Butler, Richard Clinical Commissioning Committee Member GP Partner at The Valleys Medical Partnership

P Direct On going On going




the meeting chair

Clayton, Chris

Derbyshire CCG Chief Executive Officer

Governing Body Member, Audit Committee Member,

Primary Care Co Commissioning Committee MemberSpouse is a Director at PWC.

Finance and Performance Committee Member, Clinical

Commissioning Committee Member

Clarey, Richard Member of Prescribing Sub Committee No relevant interests

Dentith, Jill Non-voting Lay Member for Audit & Governance

Lay member for Audit & Governance (Voting) & Vice Chair of

NHS Hardwick CCGP

Direct 2012 31/03/2018

To be mindful of the conflict of

interestMember of Governing Body, Audit Committee,

Remuneration Committee, Chair of Finance & Performance

Committee

Self-employed through own Management Consultancy

business trading as Jill Dentith Consultancy

P

Direct 2012 On going


interest

Emslie, Carolyn Dr Member of Prescribing Sub Committee Practice member of NDCCG

Partner at Springs Health Centre, Clowne

Springs Health Centre is part of North Derbyshire GP

Federation

P

P

Direct

Direct

On going

On going

On going

On going




the meeting chair

Ennis, Adrian Turnaround Director No relevant interests

Fitzsimons, Diane Dr Member of Prescribing Sub Committee Director of Darley Private Healthcare

Partner at Darley Dale Medical Centre

Darley Dale Medical Practice is a member of North

Derbyshire GP Federation

P

P

Direct

Direct

On going

On going

On going

On going




the meeting chair

Fleming, Isobel Service Director – Countywide Commissioning Director of Child Outcomes Research Consortium (CORC).

CORC is a not for profit organisation. The Director position is

not paid.

Member of National Group. NHS England – Measuring

Children and Young People’s Mental Health Outcomes

Group.

P

P

Direct

Direct

Current

Current

On going

On going

Should CORC tender for contracts any

interests to be clearly declared and

may result in Isobel Fleming

withdrawing from involvement in the

process.

Should CORC tender for contracts any

interests to be clearly declared and

may result in Isobel Fleming

withdrawing from involvement in the

process.Gibbard, Ian Audit Committee Chair No relevant interests Apr-13 On going

Finance and Performance Committee Member No spouse with relevant interests

Gillott, Aaron Assistant Chief Finance Officer, Member of Senior

Leadership Team NDCCG

No relevant interest

no spouse with relevant interest On going On going

Indirect 2001 On going As per conflicts of interest policy.

Green, Darran Assistant Chief Finance Officer, Primary Care Co

Commissioning Member No relevant interestsApr-13 On going

Gregory, Helen Medicines Management Technician No relevant interests On going On going


Harvey, Chris Member of the Clinical Commissioning Committee Locality Lead for High Peak

GP Partner Stewart Medical Centre, Buxton Derbyshire Aug-09 On going

OOH Sessional GP 2012 On going

GP Appraiser Dec-15 On going

Jordon, Louise Clinical Commissioning Committee Member GP Partner at Baslow Health Centre

P Direct On going On going




the meeting chair

Chair of the Dales Community Meeting Chair of the Board of Trustees for Helen's TrustP

Indirect 2001 On going


interestThe Valleys Medical Partnership is a member of the North

Derbyshire GP Federation P

Direct On going on going No action required

Knight, David Primary Care Manager NHS England No relevant Interests


Linfoot, Amanda Clinical Commissioning Committee Member Member of ND CCG Lay Reference Group P Direct May-16 On going No action required

Lunn, Joe Primary Care Co Commissioning Member Head of Primary Care, NHSE North Midlands

Markus, Kath Primary Care Co Commissioning Member Chief Executive, DERBY and Derbyshire LMCP Indirect On going No action required

GP Partner at Calow and Brimington Practice P Direct On going On going




the meeting chair

Merriman, Louise Clinical Commissioning Committee Member GP P Direct On going On going




the meeting chair

Lead GP for Cancer On going On going

Member of Pathology liaison group On going On going

G2 locality lead GP On going On going

Miller, Roger Local Authority Representative, Governing Body Assistant Director Derbyshire Adult Care Mar-16 On going


Milton, Ben Clinical Chair Sessional (locum) GP in North Derbyshire CCG Practices P Direct Oct-16 On going




the meeting chair

Governing Body Member, Primary Care Co Commissioning

Committee Former Partner at Darley Dale Medical CentreP Direct Oct-03 Sep-16 As above



Darley Dale Surgery is a member of the Primary Care

Research Network and is funded to carry out research

projects accordingly

P Indirect Apr-13 On going As above

Unpaid support to the Medical & Health Coaching Academy

Member of the Advisory Board Medical Health Coaching

Academy

P Indirect Apr-13 On going As above

Monck, Kelly Member of Prescribing Sub Committee No relevant interests On going On going

Moore, Laura Assistant Chief Nurse and Quality Officer


No spouse with relevant interest On going On going

Needham, Kate

Assistant Chief Quality Officer Medicines Management,

Member of Senior Leadership Team NDCCG. Member of

Prescribing Sub Committee

Director/ Secretary (10% Shareholder) of Hollowmoor

Consultancy Ltd


North, Maxine

Lead Medicines Management Pharmacist

Member of Prescribing Sub Group No relevant interests

Parkin, Tim Dr Member of Prescribing Sub Committee Owner/Partner Blackwell Pharmacy, Gloves Lane, Blackwell

Derbyshire.

Partner Limes Medical Centre, Blackwell.Blackwell Medical

Centre, Village Surgery (Pinxton & South Normanton)

Member of Hardwick CCG, Prescribing Lead, Learning

Disabilities Lead and Research Lead.

P

P

Direct

Direct

On going

On going

On going

On going




the meeting chair

Pickering, Suzanne Head of Governance


No spouse with relevant interest

Phillip, Tracey Primary Care Support Officer NHS England No relevant Interests


Riches, Elizabeth Dr Member of Prescribing Sub Committee

Partner of GP Practice at Chatsworth Road Medical Centre

GP Partner NDCCG

Chatsworth Road Medical Centre is a member of North

Derbyshire GP Federation

P

P

Direct

Direct

On going

On going

On going

On going




the meeting chair

Richards, Jean

Hardwick CCG employee, member of Prescribing Sub

Group No relevant interestsOn going On going

Rutter, Eleanor

Public Health Specialist Local Authority, Governing Body

Member, Clinical Commissioning Committee Member Consultant in Public Health Derbyshire County Council

P Indirect Jan-17 On going No action required

Scouse, Marie Assistant Chief Nurse Officer Primary Care No relevant interests

Shearer, Carolin Primary Care Co Commissioning Member Board member of Healthwatch Derbyshire P Direct On going On going




the meeting chair

Shepherd, Martin Member of Prescribing Sub Committee No relevant interests

Spooner, Anne-Marie Governing Body GP Member GP Partner at Hasland Medical Centre P Direct On going On going




the meeting chair

Clinical Commissioning Committee member

Hasland Medical Centre is a member of the North Derbyshire

GP Federation.P Direct On going On going No action required

Hasland Medical Centre is a member of the Chesterfield GP

Federation.P Direct On going On going No action required


Shaw, Denise Medicines Management Technician No relevant interests On going On going

Stone, Isabella

Lay Member Patient and Public Involvement Governing

Body Member, Deputy Chair Primary Care Co

Commissioning Committee, Audit Committee Member,

Finance and Performance Committee Member

No relevant interests On going On going


Street, Jocelyn Clinical Commissioning Committee Member

Member of NDCCG Lay Reference Group

ND CCG Clinical Commissioning Committee

Member of DCHS Lessons Learned Committee Tideswell

Surgery PRG Dales PLACE Group

Cross Reference Group

ND CCG Equalities Committee

Chapel-en-le-Frith Parish Councillor P

On going

On going

On going

On going

Stringfellow, Jayne

Chief Nurse Officer

Governing Body Member, Primary Care Co Commissioning

Member

Partner Governor Chesterfield Royal Hospital Foundation

TrustP Direct Apr-13 On going No action required



Interim Chief Nurse and Director of Quality for Southern

Derbyshire CCG from 1 January 2017P Direct Jan-17 On going No action required

Interim Chief Nurse and Director of Quality for Erewash CCG

from 3 July 2017P Direct Jul-17 On going No action required

Spouse is an employee of Mansfield and Ashfield CCG P Indirect Jun-17 On going No action required

Spouse is Trustee of Carers Trust East Midlands P Indirect Apr-12 On going No action required

Interim Chief Nurse and Director of Quality for Hardwick CCG

from 1 September 2017P Direct Sep-17 On going No action required

Soultana, Lisa Primary Care Co Commissioning Member Alexin Healthcare Ltd –Non-Executive Director P Direct On going On going No action required

Sutherst, Adam

Head of Planning and Performance, Member of Senior

Leadership Team NDCCG


No spouse with relevant interest On going On going

Taylor, Vikki Locality Director NHS England No relevant interest

No Spouse with relevant interests

Twibey, Carl Head of Financial Management

Partner is employed by Derbyshire Community Health Care

Services NHS TrustP Indirect On going On going No action required

Whitworth, MichaelInterim Director for Contracting and Performance

Development

Owner and Director of Michael Whitworth Consultancy

LimitedP Jul-16 On going

Woods, Kerrie Primary Care Co Commissioning Member No relevant Interests


Wooster, Lorraine Dr Member of Prescribing Sub Committee Partner to be at Stubley Medical Centre

Stubley Medical Centre is s member of North Derbyshire GP

Federation

P

P

Direct

Direct

On going

On going

On going

On going




the meeting chair

Wright, Angela Interim Deputy Director (Place) Derbyshire CCGs on

secondment from ECCG to NDCCG

Trustee and Board member of Ashgate Hospicecare a

provider that has a contract with NDCCG

P

Direct Jan-13 on going

No involvement in direct contracting

arrangements. Interest to be declared

at formal meetings where the

provider is discussed. No involvement

in the decision making process or

presence in the discussion regarding

the contract or investment

PRIMARY CARE CO-COMMISSIONING COMMITTEE

22 February 2018

PAPER NO. B

PRIMARY CARE CO-COMMISSIONING COMMITTEE– 22.02.18

TITLE Primary Care Co Commissioning Committee Quality and Performance Assurance report.

PRESENTER Judy Derricott Head of Primary Care Quality

AUTHOR Judy Derricott Head of Primary Care Quality

SPONSOR Marie Scouse Assistant Chief Nurse Primary care

IS THIS PAPER FOR: Decision Assurance Discussion

RECOMMENDATIONS The PRIMARY CARE CO-COMMISSIONIGN COMMITTEE is asked to: The Primary Care Co Commissioning Committee is asked to accept and note the contents of the attached paper REPORT SUMMARY In April 2016 NHS NDCCG became responsible for Co-Commissioning of Primary Medical Services. As part of this delegated responsibility NDCCG is required to provide assurance as to the Quality and Performance of membership practices to Primary Care Co Commissioning Committee and NHS England. The attached Primary Care Quality and Performance Assurance report is submitted to provide assurance to the Committee that North Derbyshire Clinical Commissioning Group is fulfilling its responsibility under delegated authority to monitor and support primary care quality and performance. Key matters for consideration are highlighted below with additional information contained within the attached full report. NDCCG is working closely with the newly commissioned North of England Commissioning Support Unit (NECCSU) to develop the Primary Care Quality and Performance Quality Matrix to support the triangulation of information at the monthly Primary Care Quality and Performance Review Committee (PCQ&PRC) meetings. The matrix will be Derbyshire wide and will provide a consistent approach to the triangulation of information pertinent to primary care. A small working group was established to review the content of the matrix and further develop

this into the Derbyshire Wide Approach. We now have all CCG agreement as to the content of the matrix and are awaiting a timeline detailing availability of information with agreement for completion February 2018 Key matters for consideration are highlighted below with additional information contained within the attached full report. Monthly meetings with Royal Primary Care (RPC) continue to be held providing the opportunity to review the CQC action plan, gain assurance as to progress towards achievement of action plan and other areas identified at the meeting. Care Quality Commission Actions – All identified actions completed December 2017. These have been reviewed monthly with RPC. The Care Quality Commission carried out an announced comprehensive inspection at Darley Dale Medical Centre on 1 November 2017. Overall inspection rating GOOD The ratings in response to CQC inspections for the reporting period up to 31st December 2017 for all practices are detailed below: Outstanding 9 practices Good 25 practices Inadequate 1 practice Practices in NDCCG continue to perform well against the NHS England antibiotic quality premium. CCG figures for the 12 month period to November 2017. Friends and Family Test (FFT) In January 2017 37% North Derbyshire Practices submitted Friends and Family data, after a targeted piece of work with practice’s, by December 2017 83% of practices submitted data. IS THERE A FINANCIAL IMPACT?

There is no direct financial impact on the CCG with regards this report.

HAVE ANY QUALITY & COMPLIANCE ISSUES BEEN IDENTIFIED/ACTIONS TAKEN? The Clinical Commissioning Group has a statutory obligation to support the quality of services delivered through Primary Care. To meet this requirement the availability and triangulation of available information and local intelligence is integral to good decision making. The development of the Primary Care Quality and Performance Review Committee supports this, the committee meets monthly and information to support the meeting and is updated monthly or when available. HAVE ANY CONFLICTS OF INTEREST BEEN IDENTIFIED/ACTIONS TAKEN?

No

LINK TO BOARD ASSURANCE FRAMEWORK/RISK REGISTER Reference Number: BAF/ RR

* Current Risk Score

How does this paper provide assurance to the PRIMARY CARE CO-COMMISSIONING COMMITTEE that the risk is being managed?

CCG IMPROVEMENT & ASSESSMENT FRAMEWORK

Please describe how this report and/or the services described within it supports CCG performance in the following domains:

Better health outcomes for all This report provides the Primary Care Co Commissioning Committee with an overview of the Clinical Commissioning Group’s Quality and performance position across Primary Care.

Improved patient access and experience Empowered, engaged and well-supported staff Inclusive leadership at all levels

CLINICAL PRIORITY AREAS (please tick)

Mental Health Dementia Learning

Disabilities Cancer Diabetes Maternity

PRIVACY IMPACT ASSESSMENT NOT APPLICABLE

QUALITY IMPACT ASSESSMENT NOT APPLICABLE

PATIENT, PUBLIC AND STAKEHOLDER INVOLVEMENT NOT APPLICABLE

EQUALITY AND DIVERSITY IMPACT

Due Regard to the proactive duties of the Equality Act 2010 has been taken in development of this paper and:

1. It’s influence on the decision is evidenced in: The Clinical Commissioning Group has a statutory obligation to support the quality of services delivered through Primary Care.

OR 2. It is judged that it is not

proportionate on the basis that………………………….

This completes the due regard required.

OR 3. Further equality analysis is

required and it is recommended that the Governing Body receives this by…………………(date)

NOTE: Policies/decisions may need to be adjusted in line with any equality analysis or due regard that is brought back at a future date. Any decision that is finalised without being influenced by appropriate due regard could be deemed unlawful.

*Delete as appropriate

Primary Care Co-Commissioning Committee

PUBLIC SESSION

Primary Care Quality and Performance Review Committee Assurance Report. This report covers the time period 1st October to the 31st December 2017 and is intended to provide the Primary Care Co Commissioning Committee with assurance that North Derbyshire Clinical Commissioning Group (NDCCG) is fulfilling its responsibility under delegated authority to monitor and support primary care quality and performance. Primary Care Quality and Performance Review Committee To comply with the delegated authority powers the Clinical Commissioning Group has established a Primary Care Quality and Performance Review Committee to provide assurance to the Primary Care Co Commissioning Committee (PCCCC) as to the performance of the Clinical Commissioning Group’s membership practices. The group has been established to review available quality and performance intelligence to identify those practices where additional support from the CCG may be required. The key responsibilities of the Primary Care Quality and Performance Review Committee are to:

• Review practice level data and dashboard matrix • Identify and review practices that are highlighted as outliers within the dashboard matrix • Identify practices that require support as per recovery model process • Identify practices that have performance or contractual concerns • Identify and triangulate practice level information from NHS England, Primary Care Contracting,

Primary Care Quality, Patient Experience, Finance, Workforce • Monthly review all individual agreed action plans • Produce exception report to Primary Care Co Commissioning Committee (PCCCC) quarterly • Produce report to PCCCC monthly for practices requiring intense support

NDCCG is working closely with the newly commissioned North of England Commissioning Support Unit (NECCSU) to develop the Primary Care Quality and Performance Quality Matrix to support the triangulation of information at the monthly Primary Care Quality and Performance Review Committee (PCQ&PRC) meetings. The matrix will be Derbyshire wide and will provide a consistent approach to the triangulation of information pertinent to primary care.

A small working group was established to review the content of the matrix and further develop this into a Derbyshire Wide Approach. We now have all CCG agreement to the content of the matrix; the CCG was assured that the matrix would be completed by January 2018; this has now been further extended until February 2018. In addition to the Matrix information additional reports will be reviewed to support the Primary Care Quality and Performance Review Committee meetings

PCQ&PRC PUBLIC Assurance Report FEBUARY 2018

Practice Summary

The following five areas have been chosen to be included into the Practice summary. Inclusion of this information is liable to change as new information becomes available which may be felt to reflect a quality summary of primary care more appropriately.

• Procedure of Limited Clinical Value (PLCV) • GP Experience (Patient Survey) • Care Quality Commission (CQC) rating • Antibiotic Prescribing • Quality Outcomes Framework (QOF)

Data has been rated according to the CCG median and used Inter Quartile Range (IQR) (The difference between upper (3) and Lower (1) quartiles for outliers) unless otherwise stated.

High Outliers are worked out by Quartile 3 + (1.5 X IQR) and Low Outliers Quartile 1 – (1.5 X IQR). The workings can be found on the PLCV tab within the spread sheet.

• Green = less than median • Amber = Between Quartile 3 + (1.5 X IQR) and Median • Red = Greater than Quartile 3 + (1.5 X IQR) NDCCG average has been used as the baseline


1. Procedures of Limited Clinical Value -Referrals –referrals per 1000 weighted population:

Data Indicator: Inter Quartile Range

This data highlights the number of referrals per 1000 weighted population by practice for conditions which are included within the Clinical Commissioning Referral Policy formerly known as PLCV. This data shows overall referrals for conditions covered within the policy and does not differentiate between appropriate and inappropriate referrals.

2. GP Patient Experience Survey:

Data Indicator: Inter Quartile Range

Comparative Analysis of National GP Patient Survey by NHS North Derbyshire CCG GP Practice On behalf of the CCG Arden Gem Commissioning Support Unit ( now NEC CSU) updated the comparative analysis on key questions resulting from the July 2016 GP Survey alongside that of the July 2017 GP Patient Surveys at GP practice level. The data is derived from the GP Patient Survey of July 2016 and July 2017. The data is weighted and aggregated from a survey collected during July-September 2015 & January-March 2016 [July16 update] and January-March 2017. The July 2017 update generated 4,190 responses to the survey. This equated to a response rate of 51%. Nationally, England had a response rate of just over 37%. The July 2016 update had 4,233 responses at a response rate of 51%. Improvement to the response to; Overall Experience of Making a GP Appointment contributes to the CCG Quality Premium for 2017/2018, a 3% increase (baseline 76%) on previous year or 85% of responders reporting that they had a good experience of making an appointment. Makes up 17% of overall Quality Premium with a financial value set against achievement of £244,800 and will be based upon the annual publication of the GP Patient Survey. The Quality Premium (QP) scheme is about rewarding Clinical Commissioning Groups for improvements in the quality of the services they commission. The scheme also incentivises CCGs to improve patient health outcomes and reduce inequalities in health outcomes and improve access to services. Access is discussed at all Support for Quality Improvement Visits and the latest report has been shared with all practices.

3. Care Quality Inspection Outcome:

The Care Quality Commission overall outcome has been included and rated as below:

Data Indicators: National

• Green - Outstanding • Light Green - Good • Requires Improvement – Amber

4. Antibiotic Prescribing:

Antimicrobial resistance (AMR) is an ever-increasing problem and it is estimated that by 2050 worldwide deaths directly attributable to AMR will outnumber any other single cause. Any use of antimicrobials, however PCQ&PRC PUBLIC Assurance Report FEBUARY 2018

appropriate and conservative, contributes to the development of resistance, but unnecessary and excessive use exacerbates the issue.

Practices in NDCCG continue to perform well against the NHS England antibiotic quality premium. CCG figures for the 12 month period to November 2017.

NHSE Quality Premium indicator NDCCG NHSE QP target

Total antibacterial prescribing (items per antibacterial STAR PU)

1.136 1.161

Broad Spectrum % age 7.7% 10% Number of trimethoprim items for patients over 70 years

5,197 7,525

Trimethoprim items : nitrofurantoin items ratio 0.523 1.137

Practice level prescribing figures are shared regularly, and practices who are high in any area are offered audits, guideline updates and patient information resources to try and reduce prescribing levels.

European antibiotic awareness week ran from 13th to 19th November and European (and World) antibiotic awareness day was on the 18th November. To coincide with this Public Health England (PHE) have recently launched a national ‘Keep Antibiotics Working’ campaign including television and radio adverts as well as media resources. All practices have received posters to support the campaign and are being encouraged to add campaign materials to their surgery screens.

Campaign materials and other antibiotic messages have also been shared with North of England Commissioning Support Unit communications to use throughout the winter months.

The figures have been shared down to practice level at prescribing leads’ meetings and, although overall results are below the CCG target, the medicines management team are continuing to work with the higher prescribing practices

Data indicators: Local CCG average

• Green – prescribing is below NDCCG average • Amber – prescribing is above CCG average but below National average • Red – prescribing is above National average

5. Quality Outcomes Framework

This reflects practice achievement against available Quality Outcomes Framework (QOF). The Primary Care Quality and Performance Review Group have worked with Arden Gem CSU (now North of England Commissioning Support Unit) to identify a measure to include overall practice exception rates within the information. There have been no changes to the QOF 15/16 16/17, exception reporting has been added to the public summary to provide context. This is reviewed with all practices as part of Support for Quality Improvement Visits.

Data Indicator: Inter Quartile Range - Where exception rates are identified as red/amber this demonstrates a higher exception rate than the CCG average.


Care Quality Commission Update and Inspection Update 1st October to 31st December 2017

Royal Primary Care Update

The Care Quality Commission (CQC) carried out an announced comprehensive inspection at The Grange Family Health Centre on 24 May 2017. This was the first inspection of Royal Primary Care at this location as the new provider of this service. The Care Quality Commission Quality Report was published on the 10th of August Overall Rating for the service – Inadequate Domain Rating Are services safe? Inadequate Are services effective? Inadequate Are services caring? Requires Improvement Are services responsive to people’s needs?

Inadequate

Are services well-led? Requires Improvement On the basis of the ratings highlighted above the practice has been placed into special measures. This will be for a period of six months. CQC will inspect the practice again in six months (follow up visit planned for January 2018) to consider whether sufficient improvements have been made. The CCG have continued to meet monthly with Royal Primary Care (RPC) providing the opportunity to review the CQC action plan, to gain assurance as to progress towards achievement of action plan. Care Quality Commission Actions – All identified actions completed December 2017. Darley Dale Medical Centre The Care Quality Commission carried out an announced comprehensive inspection at Darley Dale Medical Centre on 1 November 2017. A previous inspection was undertaken October 2014

Domain Rating 2014 Rating linked to inspection 2017

Are services safe? Good Good Are services effective? Good Good Are services caring? Good Good Are services responsive to people’s needs?

Outstanding Good

Are services well-led? Good Good

Summary of findings from published CQC report:

Overall inspection rating GOOD

The partners invested high levels of funding in their practice team to provide sufficient capacity, and ensure there was adequate and trained administrative support to relieve pressures on clinical time. There was strong clinical leadership and CQC saw how this impacted positively upon the quality of the service. For example, the GP prescribing lead had overseen cost effective prescribing, and lower rates of PCQ&PRC PUBLIC Assurance Report FEBUARY 2018

antimicrobial prescribing. The practice had a live strategy which focussed on the new challenges faced by general practice. This was supported by the appointment of a strategic business manager, and a new premises development to provide an environment to respond to local patients’ needs. CQC spoke with community based health, social and care home staff who overwhelmingly provided us with positive feedback about their interactions with the practice team, In particular, CQC observed that the relationship with social care was driving responsive and compassionate care for patients, including keeping those at risk from harm safe. The practice had received the Derbyshire Dignity Award in 2013 and continued to aspire to maintain this achievement. At the time of inspection, the practice had submitted an application to the county council as part of the biennial renewal which focused on their work with local care homes. Results from the latest national GP patient survey showed that the practice had performed above local and national averages in the majority of the questions about patient experience. This was particularly evident in relation to GP access and comments regarding being cared for in a dignified and respectful manner. Patients who responded that they were satisfied with the practice’s opening hours was marginally below the local and national averages. The practice was proactively looking to address this via a collaborative approach with other practices to implement an 8am-8pm hub service locally. The practice encouraged and supported staff to report incidents and near misses. When incidents did happen, the practice learned from them and improved their processes. Positive events were also recorded in recognition that sharing best practice was an equally valid means of learning, and a way to celebrate success. The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines. Care planning was embedded within the practice to reflect individual’s patients’ needs and their own wishes. We saw that 8% of patients had at least one care plan in place at the time of our inspection. There was a strong focus on continuous learning and improvement at all levels of the organisation. Staff training records were up to date, and regular appraisals encouraged development at all levels. The practice had an established quality improvement programme. This included involvement in research.

The ratings in response to CQC inspections for the reporting period up to 31st December 2017 for all practices are detailed below:

Outstanding 9 practices Good 25 practices Inadequate 1 practice CQC next steps

Quarterly meetings arranged between the Clinical Commissioning Group and Care Quality Committee to review practices visited.

• Every practice has been visited and all new inspections will be in the new format. • The new way of inspecting commenced on Nov 1st 2017 – Darley Dale have been the first in

Derbyshire to be inspected this way. • The regulation by CQC will stay the same. • More emphasis on well-led in future inspections as this filters into all areas.


Future Visiting Regime

• For practices that have a good or outstanding report, a fully focused visit will take place up to every five years.

• Practices who are rated Requires improvement will now have a return visit within 12 months, with the 6 month time frame being abolished.

• Inadequate practices will still have a revisit within 6 months Support for Quality Improvement Visits Support for Quality Improvement Visits. Support for Quality Improvement Visits (SQI) were introduced by North Derbyshire Clinical Commissioning Group in 2014 to support membership practices to review current health care information in relation to individual practice quality and performance, share good practice, learn from visiting peer GPs, understand the information available and make change where needed to improve the quality of care for their registered population. SQI supports the Clinical Commissioning Groups commitment to continuously improving the quality of healthcare for its population with a focus on the needs of the registered population of our membership practices. Aims:

• To hold up the mirror of data and get the practice to reflect on its performance Re. resource utilization; sharing best practice, learning from others and seeking to understand the information more completely in order to change where necessary.

Outcomes:

• Reduce Clinical Variation • Continue to be a mechanism for encouraging practice development and sharing good practice.

Peer to Peer Review:

Peer Review is integral to Support for Quality Improvement Visits, all practices reflect on available information about practice performance, one of these areas are referrals and practices will often conduct a retrospective review where data is not consistent or felt to be reflective of activity. We will add the following to future agendas: Does the practice have a system of Peer to Peer review – formal or informal? How does the practice share any learning/ learning needs identified as part of this? Can the practice share any identified learning with the CCG. The Primary Care Team will also: Work with North of England Commissioning Support Unit (NECCSU) to develop Peer to Peer Supporting analysis to be shared with practices. PCQ&PRC PUBLIC Assurance Report FEBUARY 2018

Support the development of a HOT TOPICs approach to sharing educational material on a monthly basis. Key themes from this quarters visit are:

• Care of Respiratory patients and referral to Support networks. • Patient Survey results • Increasing demand on GP practices • Peer to Peer review. • Available support offered to General Practice by the Cancer Research Network.

NHS England Complaints NHSE Patient Complaints re; Primary Care are received monthly; any themes highlighted within the report are raised with the practice and discussed at Support for Quality Improvement visits if appropriate. Serious Incident When serious incidents occur, the National Health Service (NHS) has a responsibility to ensure that there are systematic measures in place for safeguarding people, property, NHS resources and reputation. This includes responsibility to learn from these incidents to minimise the risk of them happening again. All providers of NHS funded care services, for which the NDCCG is lead commissioner are required to report Serious Incidents (SIs) as per NDCCG Serious Incident Policy.

NDCCG via the Primary Care Clinical Quality Team offers guidance and support to all member practices, to report, investigate and to complete the required documentation for SIs. All Primary Care SIs are reported via the Strategic Executive Information System (STEIS) data base to NHS England by NDCCG

For events categorised as Patient Safety Incidents, the practice will be asked to conduct an internal Audit and report learning from the audit to the CCG.

For events categorised as Serious Incidents, the CCG will work alongside the practice to support the completion of a Route Cause Analysis. The CCG will report findings to NHS England via STEIS. Further detail is outlined in the report below.

Learning from Serious Incidents

Learning from Serious Incidents is a standard agenda item within Clinical Governance Leads meetings offering the opportunity for discussion/ reflection and shared learning identified as part of the Serious Incident process. Incidents shared are not only from NDCCG but from Derbyshire and wider if there is identified learning.

Access Friends and Family Test (FFT)

Submission of Friends and Family Test data to NHSE is a contractual requirement and a 0 submission is accepted as completion.


Enhanced Services Participation

Extended Hours: 32/35 practices providing – no additions or withdrawals in the first quarter, new conditions will be introduced from 1 October 2017 - regularly close for a half day (weekly) will not ordinarily qualify (Stubley MC, Killamarsh MP and Arden House MP do not offer extended hours)

Learning Disabilities: 35/35 practices providing – no additions or withdrawals in this quarter.

Author: Judy Derricott Head of Primary Care Quality Sponsor: Marie Scouse Assistant Chief Nurse Primary care Date: 14.02.18


NHS North Derbyshire CCG Primary Care Co-Commissioning Committee 22 February 2018

Paper B

NORTH DERBYSHIRE CCG PRIMARY CARE CO-COMMISSIONING COMMITTEE Robert Robinson Room, Scarsdale

Thursday 25 January 2017

MINUTES

Present Gary Apsley (Chair) Lay Member (Patient and Public Engagement) Isabella Stone Lay Member (Patient and Public Engagement) Ian Gibbard Lay Member (Audit) Ben Milton CCG Chair and Clinical Lead, GP Debbie Austin GP (High Peak and Dales Locality) Louise Bainbridge Chief Finance Officer Jayne Stringfellow Chief Nurse & Quality Officer Marie Scouse Assistant Chief Nurse Hannah Belcher Head of Primary Care Commissioning Carolin Shearer HealthWatch Representative David Knight GP Contract Manager, NHS England Apologies Minute-Taker

Rosalind Combes PA to Chief Nurse & Quality Officer

Opening of Business

PCC001.18 The Chair welcomed Primary Care Co-Commissioning Committee Members; introductions were not required, and no members of the public attended.

PCC002.18 Apologies for Absence No apologies for absence had been received.

PCC003.18 Declaration of Interests The Register of Interests was noted. It was noted for complete transparency that Dr Austin was working at Thornbrook Surgery under winter pressures funding. It was reported for the avoidance of doubt Dr Austin had been approached by the practice to undertake locum work. Dr Austin

NHS North Derbyshire CCG Primary Care Co-Commissioning Committee 25 January 2018 Page 1 of 3


Paper B agreed to withdraw from discussions should it be deemed appropriate by the Chair, but no such need was foreseen as there was no conflict of interests against any item on the agenda. No further declarations were made.

PCC004.18 Minutes of the Primary Care Co-Commissioning Committee meeting of 21 December 2017 The minutes were agreed as an accurate record of the meeting, and were signed by the Chair.

PCC005.18 Matters Arising from the Primary Care Co-Commissioning Committee Meeting of 21 December 2017/Action Log PCC0086.17 – SBS Report re Missing Patient Information The item was CLOSED and could be removed from the active action log. PCC0096.17.1 The Grange Family Health Centre/Royal Primary Care Update The matter appeared on the main agenda; the action log item could therefore be CLOSED. PCC0097.17 Avenue House & Hasland Partnership Contractual Merger with Hasland Medical Centre No update was due until October 2018; item to be RETAINED. PCC0098.17.1 NHS Annual Complaints Report The matter was deferred owing to issues of capacity in the Primary Care Team and would be presented instead in February; the action log entry was to be RETAINED. PCC0098.17.2 NHS Annual Complaints Report Mrs Scouse had contacted NHS England as requested; the action could be CLOSED. A number of typographical errors including incorrect dates were noted in the Action Log. The Decision Log was NOTED.

PCC006.18 The Grange Family Health Centre/Royal Primary Care Update Miss Belcher presented the paper and summarised key points. It was noted that the CQC follow-up inspection had taken place on Tuesday 23 January; an update would be provided at the February Committee meeting. The matter was also to be discussed during confidential session. The Committee NOTED the report.



Paper B PCC007.18 Finance Update Report

Ms Bainbridge presented the report, highlighting Year To Date and forecast overspend on QOF and outlining reasons for this overspend. NHS England support in ensuring an appropriate budget for 2018/19 had been requested. Section 4 of the paper (Analysis of Risk) was considered. Ms Bainbridge confirmed that the CCG was close to the limit of its budget and advised that concerns had been raised with NHS England accordingly. A response from NHS England was awaited. The Committee recognised that NHS England’s guidance on contingencies, usually issued before Christmas, had not yet been received. Discussion took place around the effect of good performance in Primary Care, and Dr Shearer suggested that it appeared from a lay perspective that the CCG was being penalised for general practice overperformance. Dr Milton noted that CCGs which performed well on QOF were generally at a disadvantage. The Committee NOTED the report.

PCC008.18 Any Other Business Apologies Mr Apsley and Dr Milton gave advance apologies for the meeting on 22 February; it was noted that Ms Stone would chair the meeting in Mr Apsley’s absence and that Dr Austin would be present. No further business was transacted.

Date and time of next meeting: Thursday 22 February 2018 in the Robert Robinson Room, Scarsdale, Chesterfield, Derbyshire at 10.30am.

Signed by: …………………………………………………. Dated: ………………… (Chairman)


MATTERS ARISING MATRIX

NHS NORTH DERBYSHIRE CCG PRIMARY CARE CO-COMMISSIONING COMMITTEE – 22 February 2018: Matters Arising Action Matrix Meeting Date

Item number Item Title and Issue Owner Actions Status Forecast Closed Date

21.12.17 PCCC/1718/01 Formerly PCC0097.17

Avenue House & Hasland Partnership Contractual Merger with Hasland Medical Centre

DK The outcome of the stakeholder and patient engagement following the merger will be presented to the October 2018 meeting

Open 21.10.18

21.12.17 PCCC/1718/02 Formerly PCC0098.17.1

NHS Annual Complaints Report MS A separate annual report to be provided for the January 2018 Committee from the information on the dashboard.

Open 22.02.18

Items that have been actioned and closed since the previous Primary Care Co-Commissioning Committee remain on the list (highlighted in grey) for completeness for one month only and are then removed.

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