A meeting of the Primary Care Commissioning Committees of the

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A meeting of the Primary Care Commissioning Committees of the Eastbourne, Hailsham and Seaford (EHS) and Hastings and Rother (HR) Clinical Commissioning Groups to be held together on Wednesday 26 April 2017 from 10.30am in the Wiltshire/ Dorset room, Kings Centre, 27 Edison Road, Eastbourne, East Sussex, BN23 6PT Eastbourne, Hailsham and Seaford CCG Frances Hasler, Lay member, Patient and Public Involvement (Chair – and meeting Chair) (FH) Allison Cannon, Chief Nurse (AC) Graham Dodge, Independent member, Secondary Care Doctor (GD) Rose Durban, Lay member (RDu) Karen Keane, Independent member, Registered Nurse (KK) John O’Sullivan, Chief Finance Officer (JOS) Amanda Philpott, Chief Officer (ALP) Julia Rudrum, Lay member, Governance (Vice Chair) (JR)

Voting Members

Hastings and Rother CCG Barbara Beaton, Lay member, Patient and Public Involvement (Chair) (BB) Allison Cannon, Chief Nurse (AC) Rajeev Dhar, Independent member, Secondary Care Doctor (RD) Rose Durban, Lay member (RDu) Karen Keane, Independent member, Registered Nurse (KK) John O’Sullivan, Chief Finance Officer (JOS) Amanda Philpott, Chief Officer (ALP) Alan Rummins, Lay member, Governance (Vice Chair) (AR) Non-voting members

Tim Caroe, GP member (TC) Julie Fitzgerald, Executive Director, East Sussex Community Voice (JF) Ian Harper, Medical Director, East Sussex Local Medical Committee (IH) Stephen Ingram, Head of Primary Care, NHS England South East (SJI) Susan Rae, GP member (SR)

In Attendance

Jessica Britton, Chief Operating Officer (JeB) Luke Blackwell, Governance and Corporate Services Officer (LB) (minutes) Fiona Kellett, Head of Finance and Primary Care Commissioning (FK) Clive Mellor, Head of Governance and Business Planning (CM) Members of the Public

AGENDA Questions from the public will be taken prior to the formal opening of the Primary Care Commissioning Committees’ meeting. There will also be the opportunity for members of the public to ask questions after the meeting has finished, in response to any items discussed. A record of these discussions will be appended to the minutes of the meeting. Item No 16/17

Item Welcome and apologies for absence

Action Note

NHS Eastbourne, Hailsham and Seaford Clinical Commissioning Group NHS Hastings and Rother Clinical Commissioning Group

Lead FH

Paper Attached Verbal

Time 10.30 1

17/17 18/17

19/17 20/17 21/17 22/17 23/17

24/17 25/17

Declarations of interest Note FH Minutes of the 22 February 2017 meeting Approve FH  HR to ratify the decisions of the meeting  Committees to approve the minutes Action Log Approve FH Committee Chairs’ opening remarks Note FH/BB Section 1 – Governance of the Committees Risk Register Agree JeB Work plan Agree FK Primary Care Commissioning Operational Review JOS Group (PCCOG) Terms of Reference Section 2 – Quality, Performance and Delivery General Practice Forward View – progress report on sustainability of Primary Care Finance: i) Finance Report 2016/17

Verbal Yes

Yes Verbal Yes Yes Yes

Note

FK

Yes

Note

JOS

Yes

ii)

Primary Care Delegated Commissioning Budget 2017/18 26/17 Primary Care Performance Dashboard Note FK Yes 27/17 Monitoring Performance and Quality in AC Yes Primary Care: 28/17 Primary Care Commissioning Operational Note JOS Yes Group (PCCOG) update Section 3 – For information 29/17 Any Other Business Note FH Verbal 12.00 Public reflection or feedback on the discussions of the Committee during the meeting will be taken prior to the formal closing of the meeting. A record of these discussions will be appended to the minutes of the meeting. To consider a motion: “That representatives of the press and other members of the public be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest”. (Section 1(2) Public Bodies (Admissions to Meetings Act 1960)).

Freedom of Information Act: Those present at the meeting should be aware that their names and designation will be listed in the minutes of this Meeting which may be released to members of the public on request. Conduct of meetings in relation to attendance by members of the public: Members of the public are asked to note that meetings of the Eastbourne, Hailsham and Seaford and Hastings and Rother Clinical Commissioning Groups’ Primary Care Commissioning Committees are meetings of the Committees held in public. They are not ‘public meetings’ where members of the public can speak at any point. Agendas identify when the Chair will receive questions and comments from the public. For all other agenda items speaking rights are reserved to Committee members and agreed representatives sitting at the table; members of the public should not speak or intervene in proceedings unless invited to do so. In all matters the Chair’s decision is final. The introduction by the public or press representatives of recording, transmitting, video or similar apparatus into meetings of Eastbourne, Hailsham and Seaford and Hastings and Rother Clinical Commissioning Groups together is not permitted. Written questions from the public: Any questions relating to Committee meeting papers which are received in writing three or more days in advance of the meeting will receive a NHS Eastbourne, Hailsham and Seaford Clinical Commissioning Group NHS Hastings and Rother Clinical Commissioning Group

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verbal response at the meeting. A written reply will also be sent after the meeting, and the minuted question and response will be appended to the minutes of the meeting. Please send your question, along with a contact telephone number or e-mail address, to: Sally Robson, 36-38 Friars Walk, Lewes, East Sussex, BN7 2PB, or [email protected] If your question includes personal information about you or someone else we may contact you about safeguarding such information. Committee papers: Eastbourne, Hailsham and Seaford Clinical Commissioning Group Committee papers are held on the website and can be accessed through the following web page link: http://www.eastbournehailshamandseafordccg.nhs.uk/ Hastings and Rother Clinical Commissioning Group Committee papers are held on the website and can be accessed through the following web page link: http://www.hastingsandrotherccg.nhs.uk/

NHS Eastbourne, Hailsham and Seaford Clinical Commissioning Group NHS Hastings and Rother Clinical Commissioning Group

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DRAFT minutes of a meeting of the Primary Care Commissioning Committees (PCCCs) of the Eastbourne, Hailsham and Seaford (EHS) and Hastings and Rother (HR) Clinical Commissioning Groups (CCGs) held together on Wednesday 22 February 2017 from 10.30am in the Forest Room, Sussex Exchange, Queensway, St Leonards on Sea, East Sussex, TN38 9AG Present (Voting Members):

Eastbourne, Hailsham and Seaford CCG Frances Hasler, Lay member, Patient and Public Involvement (Chair – and meeting Chair) (FH) Allison Cannon, Chief Nurse (AC) Graham Dodge, Independent member, Secondary Care Doctor (from item 6/17) (GD) Rose Durban, Lay member (RDu) Karen Keane, Independent member, Registered Nurse (KK) John O’Sullivan, Chief Finance Officer (JOS) Julia Rudrum, Lay member, Governance (Vice Chair) (JR) Hastings and Rother CCG Barbara Beaton, Lay member, Patient and Public Involvement (Chair) (BB) Allison Cannon, Chief Nurse (AC) Rajeev Dhar, Independent member, Secondary Care Doctor (RD) Rose Durban, Lay member (RDu) Karen Keane, Independent member, Registered Nurse (KK) John O’Sullivan, Chief Finance Officer (JOS) Alan Rummins, Lay member, Governance (Vice Chair) (AR)

Present (Non-voting members):

Tim Caroe, GP member (TC) Julie Fitzgerald, Executive Director, East Sussex Community Voice (JF) Stephen Ingram, Head of Primary Care, NHS England South East (SJI) Julius Parker, East Sussex Local Medical Committee (JP)

In Attendance

Jessica Britton, Chief Operating Officer (JeB) Nic Hone, Primary Care Co-Commissioning Strategic Manager (NH) Clive Mellor, Head of Governance and Business Planning (CM) Kerry Okines, Governance and Corporate Services Officer (minutes) (KO) Sally Robson, Corporate Services and Business Planning Manager (observing) (SR) Members of the public

Questions from the public were taken prior to the formal opening of the meeting. A record of the discussion is appended to these minutes – please see Appendix A. Item No. 1/17

Item

Action

Welcome and apologies for absence Frances Hasler welcomed those present and noted apologies from:  Ian Harper, Medical Director, East Sussex Local Medical Committee;  Fiona Kellett, Head of Finance and Primary Care Commissioning, EHS and HR CCGs;  Amanda Philpott, Chief Officer, EHS and HR CCGs; and

NHS Eastbourne, Hailsham and Seaford Clinical Commissioning Group NHS Hastings and Rother Clinical Commissioning Group

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 2/17

Susan Rae, GP member, HR CCG.

Declarations of interest Julie Fitzgerald declared that her work for East Sussex County Council (ESCC) was relevant to items 13/17 and 14/17 on the agenda. The Chair assessed that Julie Fitzgerald was not conflicted regarding the current agenda items and no further action was necessary. The Committees noted that there were no new Declarations of interest considered prejudicial to any of the agenda items.

3/17

Minutes of the 14 December 2016 meeting As the HR contingent of the 14 December 2016 meeting was inquorate due to insufficient Independent member representation the HR CCG Committee ratified:  agreement of the 2016/17 Work Plan; and  approval of the update on Primary Care Delegated Commissioning Budgets 2016/17. The minutes of the 14 December 2016 meeting of the PCCCs of EHS and HR CCGs were approved as an accurate record of the meeting.

4/17

Action Log 41/16 i an update on changes to General Medical Services (GMS) contract for 2016/17 Stephen Ingram confirmed that action to establish whether there will be consistency in definitions around data extraction from the access survey to GP services is complete. There are no definitions for the Patient Survey within national definitions which underpin contract. 43/16 ii Managing General Practice Performance and Quality under Delegated Commissioning Responsibilities Policy 2016 Allison Cannon confirmed that action to bring back information on the complaints dashboard from NHS England (NHSE) is in progress. Action: Allison Cannon will ask the Primary Care Commissioning Operational Group (PCCOG) to discuss how we get information from local GP Practices on the complaints dashboard (including data, trends and what they do with it).

AC 26/04/17

All other actions were reported as complete. The Committees received the update on matters arising. 5/17

Committee Chairs’ opening remarks Frances Hasler remarked that there has been a huge change in the way we think locally. We are committed to developing services that are as close to home as possible. We are aware that Primary Care is facing a lot of pressure and the General Practice Five Year Forward View Group is considering how we relieve this. We need to get more radical about transformation and work jointly with our Primary Care colleagues to increase capacity. We also need to set stretching ambitions for beyond April 2017. Barbara Beaton remarked on the importance of involving, designing and planning with our local population and the part GPs play in making Primary Care work more effectively. The Committees noted the Chairs’ opening remarks.

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Section 1 - Governance of the Committees 6/17 Committee Briefing  Partnerships at will John O’Sullivan presented a briefing paper regarding Partnerships at will. The Committees heard that if no current partnership agreement exists for a GP practice there is a risk that it has a ‘Partnership at will’ which is governed by the Partnership Act 1890. GP Practices are being advised to update their partnership agreements in recognition that a Partnership at will is seen as an unstable business relationship because it can be dissolved on notice by any partner. Furthermore if a Partnership at will ends and the resigning partner does not nominate the remaining partners to hold the contract, the GMS contract must end and a new service must be procured. To assess the risk across the two CCGs Partnership agreements will be raised with Practices at their Support Visits. A view on this will be brought back to the Committees later in the year. Julius Parker informed the Committees that the British Medical Association (BMA) and Local Medical Committee (LMC) have advised Practices that they are vulnerable if they do not have a Partnership agreement in place. He further informed the Committees that there is a clause in regulations which allows Commissioners to offer a 12 month GMS contract if a partnership is dissolved; to create sustainability and mitigate immediate risk in the short-term. The Committees noted the paper and the action being undertaken to assess the potential effect of partnerships at will across both CCGs. 7/17

Risk Register Frances Hasler presented the Primary Care Risk Register. The Committees reviewed all of the current risks with a score of 12 (risk numbers PC4, PC10 and PC11) and were given the option to review other current risks by exception. During review Jessica Britton confirmed that as part of our development of the Risk Register we are considering how we map it with our Assurance Framework. The Committees agreed the following actions: 

Action: Jessica Britton will ensure that a link to the Sustainability and Transformation Plan (STP) and Workforce strategy is included under risk PC4.

JeB 26/04/17



Action: Jessica Britton will ensure that the Five Year Forward View Group considers including actions under risk PC11 around being more radical and more engagement around the notion of delivery and impact.

JeB 26/04/17

The Committees:  reviewed the risk register as part of the CCG overarching system of risk management;  noted the updated and new actions and the amendments to risk wording previously requested;  approved the proposal that the PCCOG be directed to review the Primary Care Risk Register at least bi-monthly; and  directed the actions listed above for individual risks. 8/17

Draft work plan 2017/18 Frances Hasler introduced the draft work plan for 2017/18.

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John O’Sullivan raised the link between Primary Care work into wider East Sussex Better Together (ESBT) work. He stated that the plan will change to reflect our priorities over the next year. The Committees approved the draft 2017/18 work plan. Section 2 – Quality, Performance and Delivery 9/17 General Practice Forward View: an update on the implementation of the programme to support sustainability in primary care Nic Hone presented a report highlighting the progress on current initiatives in place to support implementation of the General Practice Forward View (GPFV). She highlighted that funds are allocated sporadically. The next allocation will be used to focus on IT infrastructure. Since the last meeting three practices across EHS and HR have been allocated funding under the GP resilience programme. Their business process and protocol will be assessed by an external organisation and recommendations for improving their resilience will be made by the end of February 2017. Funds already released under the GP Development Programme are being utilised to support releasing time for care, training for reception and clerical staff and supporting online consultations. Engagement around service redesign including workforce skill mix in practices will be undertaken. HR CCG has been identified as a pilot site for NHSE’s ‘GP Career Plus’ initiative. The proposal is designed to support HR in retaining the skills and experience of GPs who would otherwise leave the profession by developing a pool of experienced and skilled GPs who can be utilised across the CCG. It is proposed that the ‘GP pool’ will be operational by 31 May 2017. Work continues with the Community Provider Education Network (CEPN) to ensure the right pathways for education. Interim GPs recruited across both CCGs are continuing to be integrated into Primary Care and have been reported as successful. Utilising the allocation from the GP Development monies Practices have started to receive system training to enable staff to clinically code patient correspondence reducing avoidable administration for GPs. Work on centralised data extraction templates continues to improve manual data submitted by Practices. During discussion it was confirmed that:  There will be a report on the GP Access fund at the next GPFV meeting and it will be put into the workplan.  The baseline requirement of £3 per head is included within the Schedule of Investment which was presented to the Committees at their last meeting. A more detailed budget will be presented to the Governing Bodies at their March 2017 meeting and to the Committees at their April 2017 meeting.  Funding has been used to train Receptionists around workflow and will be used towards the Care Navigator package. Committee members raised the following points for consideration as we go into our planning year: NHS Eastbourne, Hailsham and Seaford Clinical Commissioning Group NHS Hastings and Rother Clinical Commissioning Group

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        

how we know what we expect to happen in the short, medium and long term; importance of localities and how we pull out wisdom from them; being more vocal about the funds available to us; where local control lies for our change; focus on the wider Primary Care issue in addition to GPs; integrated work on social care; assurance work is offset against ESBT principles going forward; setting out apprenticeship pathways; and being clear about what gets reported where.

The Committees noted the progress on the implementation of the GPFV to support sustainability in Primary Care. 10/17

Finance: Primary Care Delegated Commissioning Budget 2016-17 John O’Sullivan presented an update report on Finance and Primary Care Delegated Commissioning Budgets 2016/17 as at Month 9 (M9) (December 2016). The Committees heard that the 2016/17 allocation for Primary Care Delegated Commissioning for EHS CCG is £24.7m and for HR CCG is £26.1m. The Locally Commissioned Services (LCS) budget is just over £5m in both CCGs. The overall forecast position on the delegated co-commissioning budgets is a breakeven position. During discussion it was confirmed that:  The Vulnerable Patient Scheme is subject to review and will be presented to the Committees as part of budget setting for 2017/18.  Notes on variance in LCS will be included in future reports to the Committees.  We have new ways of managing Anti-Coag and are looking at appropriate funding for this.  A few Practices have not undertaken data harmonisation around Dementia. It is anticipated that this will be resolved by the end of the year.  Not all Practices are claiming correctly for the two levels we have in place for Dementia. This will be validated at the end of the year and an education day and monitoring have been put in place around this.  The December 2016 position reflects what practices claimed rather than what they actually did. The Committees noted the M9 year to date and forecast position for Primary Care delegated commissioning budgets and LCS budgets for EHS and HR CCGs. Action: John O’Sullivan will consider money to support additional one off projects and evaluation of them as part of the budget to be presented to the Committees at their April 2017 meeting.

11/17 i ii

JOS 26/04/17

Monitoring Performance and Quality in Primary Care: Q4 2016/17 update Primary Care Performance Dashboard executive summary Allison Cannon presented a paper providing the Committees with updates on the process identified in the managing General Practice Performance and Quality under Delegated Commissioning Responsibilities Policy and the position on the Primary Care Performance Dashboard. She highlighted the following improvement in quality and performance. The Primary Care Commissioning and Quality teams have undertaken all Practice Support Visits. They are planning further visits from April 2017. It is recommended that proposals for monitoring quality differently in light of ESBT

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Alliance arrangements are presented to the Committees at their April 2017 meeting. The Medicines Management team and Practice Nurse team continue their work on the Medicines Optimisation and Care Home project and Nurses for mentors project respectively. During discussion Tim Caroe congratulated Allison Cannon and her team on their work around quality. He reflected on comments made by Eileen Callaghan, Head of Medicines Management/Deputy Director of Quality around pioneering new ways of doing things to improve quality which might save but are not focussed on saving money in the process. Tim Caroe suggested that we allocate funds to create a formal sharing process for expertise from Practices with a Care Quality Commission (CQC) rating of ‘outstanding’. Nic Hone confirmed that Sidley Medical Practice’s patient list is currently open but was previously closed due to partnership changes. We have regular meetings with the Practice around its CQC rating of ‘requires improvement’ and the Practice is utilising interim GP support. John O’Sullivan confirmed that we are in the process of working through contracts renewal. The Committees:  noted the progress made in relation to the Practice Support Visits conducted to date and the proposals for the structure of the visits for 2017/18; and  agreed that individual practices will be given the opportunity to view and comment on the dashboard before it is released into the public domain. 12/17

Primary Care Commissioning Operational Group (PCCOG) update The Committees noted the summary update.

13/17

Engagement and Communication to support implementation of the GP Five Year Forward View: Engagement and Communications Plan April 2017 – March 2018 Jessica Britton presented a report summarising the work undertaken during 2016/17 to involve patients and the wider public in primary care redesign.

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The Committees heard that feedback from all engagement to date has enabled us to identify the following three strategic goals: to co-design primary care services with local people; to co-design meaningful communications and accessible information with local people; and to create an on-gong engagement system. In response to this we are keen to promote a number of key messages that we think will help achieve the goals identified by local people. The key draft messages are as follows:  there are a range of healthcare professionals that can help with certain conditions;  sometimes these professionals will be able to help faster and more effectively;  there are a range of access routes for help with conditions, e.g. online or through telephone appointments, as well as face to face;  understanding conditions and being active in their management can significantly improve health and wellbeing; and  feeding back experience helps us to continuously improve services. The following points were raised during discussion: NHS Eastbourne, Hailsham and Seaford Clinical Commissioning Group NHS Hastings and Rother Clinical Commissioning Group

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  

Consideration needs to be given to the best ways of using localities to capture wider changes in the wholesystem. A further key message is that there are things we can do ourselves to support our health and well-being. We will work closely with local people to test and finalise the key messages.

The Committees:  noted the work undertaken so far; and  approved the proposed framework for the Engagement and Communications Plan that aims to support our local delivery of the GPFV for the period April 2017-March 2019. ii

Implementing the Accessible Information Standard (AIS) – progress report Jessica Britton presented a report outlining the progress made in implementing the AIS within Primary Care. During discussion John O’Sullivan confirmed that Primary Care is obliged to implement the AIS under contract requirements. Stephen Ingram added that if patients feel that requirements are not met they can seek redress from their practice and through the ombudsman if appropriate. If the CCGs feel that requirements are not met they can take contractual actions against Primary Care providers. The Committees noted the progress that has been made in General Practice in implementing the AIS, in particular: the requirements of the AIS; the support the CCGs have put in place for Primary Care as they implement this standard; the progress made; and the proposed action for 2017/18. Action: Jessica Britton will take forward the suggestion that interpretation services are extended to cover Braille and that Federations are encourage to co-ordinate this going forward.

JeB 26/04/17

Section 3 – For information 14/17 Patient Participation Group (PPG) update Julie Fitzgerald updated the Committees that a summary report on outcomes of the programme to ensure every practice has a PPG will be available after 31 May 2017. She stated that PPGs are variable across EHS and HR Practices. During discussion It was suggested that further consideration is given outside of the Committees to the kind of support we might want to commission in this area going forwards. The Committees noted the progress of the project to date. 15/17

Any Other Business There was no further business.

The meeting finished at 12.10pm. The Committees considered and agreed the motion “that representatives of the press and other members of the public be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest”. (Section 1(2) Public Bodies (Admissions to Meetings Act 1960)). Appendix A – Questions from the Public taken prior to the formal opening of the meeting There were no questions from the Public taken prior to the formal opening of the meeting. NHS Eastbourne, Hailsham and Seaford Clinical Commissioning Group NHS Hastings and Rother Clinical Commissioning Group

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Appendix B – Reflections from the Public following the meeting There were no reflections from the Public following the meeting.

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Action Log

Date

Agenda Item 26/10/2016 43-16 ii

Item Title

Initial Action Required

Staff to Action

Managing General Practice Performance and Quality under Delegated Commissioning Responsibilities Policy 2016

Allison Cannon to bring back information on Allison Cannon the complaints dashboard which will be available from November 2016 and provide an update at the next meeting in December 2016.

22/02/2017 4/17

Action Log

22/02/2017 7/17

Risk Register

22/02/2017 7/17

Risk Register

22/02/2017 10/17

Finance: Primary Care Delegated Commissioning Budget 2016-17

Allison Cannon will ask the Primary Care Commissioning Operational Group (PCCOG) to discuss how we get information from local GP Practices on the complaints dashboard (including data, trends and what they do with it). Jessica Britton will ensure that a link to the Sustainability and Transformation Plan (STP) and Workforce strategy is included under risk PC4. Jessica Britton will ensure that the Five Year Forward View Group considers including actions under risk PC11 around being more radical and more engagement around the notion of delivery and impact. John O’Sullivan will consider money to support additional one off projects and evaluation of them as part of the budget to be presented to the Committees at their April 2017 meeting.

22/02/2017 13/17 ii

Implementing the Accessible Information Standard (AIS) – progress report

Action Due

Action Complete update for next In progress meeting and complaints dashboard report at a later date

Allison Cannon

26/04/2017 Complete

Jessica Britton

26/04/2017 complete

Jessica Britton

26/04/2017 complete

John O'Sullivan

26/04/2017 complete

Jessica Britton will take forward the suggestion Jessica Britton that interpretation services are extended to cover Braille and that Federations are encourage to co-ordinate this going forward.

NHS Eastbourne, Hailsham and Seaford Clinical Commissioning Group NHS Hastings and Rother Clinical Commissioning Group

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26/04/2017 complete

Further Actions/Comments Update 01.11.2016: Allison Cannon will update the Committees at the December 2016 meeting. Update 14.12.2016 by Allison Cannon: Further information is yet to be received and the Committees will be updated at the next meeting of the Committees. Update as at 14.02.2017: Allison Cannon will provide an update to Committees about the availability of information at their February 2017 meeting. At the February 2017 meeting Allison Cannon confirmed that action to bring back information on the complaints dashboard from NHS England (NHSE) is in progress. Update as at 13.04.2017: Summary of complaints received from NHSE needs further analysis due to the limited information provided. Allison Cannon will update at the Committees at the June meeting

Translation and Interpreting Contract already includes the translation of text documents to braille via the Royal National Institute of Blind People (RNIB). Discussions will be held with Federations.

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The Primary Care Commissioning Committees of Eastbourne, Hailsham and Seaford CCG and Hastings and Rother CCG meeting together Date of meeting: 26 April 2017

Item Number: 21/17

Title of report: Primary Care Risk Register Recommendation: The Committees are recommended to:  review the attached risk register as part of the CCG overarching system of risk management.  note the updated and new actions and the amendments to risk wording previously requested  approve the proposal that the Primary Care Operational Group be directed to review the Primary Care risk register at least bi-monthly. Executive Summary: The committees previously identified that oversight of CCG risks relating to Primary Care would support them in discharging their duties. As such a risk register has been submitted to each meeting since December 2016. We reviewed other CCG Primary Care risk registers, where possible, and compared these against our own risks. The register continues to be refined in order to test the totality of risk that might impact the delegated commissioning of primary care. Since the last meeting (February 2017) all risks have been reviewed and the following changes have been made (including those actions set at the meeting): 

Risk PC1 (removal of a GP from the performers’ list) – the likelihood score has been increased from 2 to 4 resulting in a new overall score of 12.



Risk PC4 (lack of resilience in Primary Care) – includes links to the Sustainability and Transformation Plan (STP) and Workforce strategy.



PC8 (realisation of expected ESBT benefits) – the likelihood has been increased from 2 to 3 resulting in a new overall score of 9.



PC11 (engagement of the wider membership) - actions around being more radical and more engagement around the notion of delivery and impact have been referred 1

NHS Eastbourne, Hailsham and Seaford Clinical Commissioning Group NHS Hastings and Rother Clinical Commissioning Group

to the Five Year Forward View Group. 

PC12 (Primary Care Team resource) – this new risk has been added under the Workforce and Workload section to reflect the risk from the transfer of additional responsibilities from NHSE from 1 April 2017 with no additional CCG resource.



The 2017/18 actions have been added to the risks.

The existing Primary Care Commissioning Operational Group (PCCOG) maintains operational oversight of risks impacting on the CCGs’ primary care functions and duties. The Quality and Governance and Audit Committees would continue their current remits which include scrutiny across all areas of risk. Committee sponsor: John O’Sullivan Chief Finance Officer Author(s): Fiona Kellett, Head of Finance and Primary Care Commissioning, and Clive Mellor, Head of Date of report: 18/04/17 Governance and Business Planning Review by other committees: All ‘corporate risks’ (those scoring 10 or above on a scale of 1 – lowest to 25 – highest) are individually scrutinised at each bi-monthly meeting of the by the CCG Quality and Governance Committees. All ‘extreme risks’ (scoring 15 or above) risks are submitted to each bi-monthly meeting of the Governing Bodies. Health impact: Individual risks may have health impacts. This will be indicated within the detailed information about the risk. Financial implications: Individual risks may have financial implications. This will be indicated within the detailed information about the risk. Legal or compliance implications: The CCGs are required to have a robust system of risk, the effectiveness of which forms part of its annual governance statement. Link to key objective and/or principal risks: Risk Register details the key risks to the delivery of the delegated Primary Care commissioning functions and duties. Link to East Sussex Better Together (ESBT) programme: A number of risks arise from or may impact upon the ESBT programme. This is detailed within the individual risks. How has the patient and public engagement informed this work: The Primary Care Risk Register is in the public domain and the usual feedback mechanisms, including comment from those attending these meetings or reading the supporting documents. Equality Analysis (EA) Process - outcome: Negative Impact Neutral Impact Positive Impact No Impact Not required for report ☐ ☐ ☐ ☐ ☒ EA Summary: The Risk Management Strategy and Policy have been Equality Assessed and have neutral impact. 2 NHS Eastbourne, Hailsham and Seaford Clinical Commissioning Group NHS Hastings and Rother Clinical Commissioning Group

Privacy Impact Assessment (PIA) – outcome: No personal data used Data processes sufficient ☒ ☐ Actions: Nil

Actions required ☐

3 NHS Eastbourne, Hailsham and Seaford Clinical Commissioning Group NHS Hastings and Rother Clinical Commissioning Group

GP Contracts / Appraisals procedures. Training and Education delivery. General Medical Council (GMC) Registration and Audit processes (NHSE). Procedures to refer GP under-performance to the NHS England.

1) Deliver GP Education, training and development in 2016/17). 2) Complete programme of regular scheduled support visits to practices in 2016/17. 3) Re-prioritise support visits, as required. 4) Support development of robust Federation arrangements. 5) Deliver GP Education, training and development (two Membership Engagement and Learning Events (MELE) per CCG in 2017/18). 6) Complete programme of regular scheduled support visits to practices in 2017/18.

Liklihood

Actions to improve control, ensure delivery of principal objectives, gain assurance

Residual Risk Score (SxL)

Key Controls - systems in place (e.g. strategies, policies and procedures)

Severity

Liklihood

Current Risk Score (SxL)

Severity

Lead

Risk Description and Impact

Owner

Last Updated

No.

Last Reviewed

Original Date

CCG PRIMARY CARE RISK REGISTER – APRIL 2017 Dates actions will be completed

WORKFORCE & WORKLOAD There is a risk that if there were significant individual issues, including GMC or NHS England Performers List Undertakings or Conditions, this might cause the removal of a GP from the Performers' List and result in a gap in the provision of primary medical services. PC1

30/11/2016 31/01/2017 31/01/2017

JOS

PC2

There is a risk that difficulties recruiting substantive GPs, nurses and practice managers may cause member practices to be unable to fulfil their contractual 30/11/2016 31/01/2017 31/01/2017 obligations and result in a gap in the provision of primary medical services.

JOS

There is a risk that increasing overheads and financial pressure on member practices (e.g. increasing cost of medical indemnity insurance, rent increases and financial sustainability of operating branch surgery sites) may cause practices to fail and 30/11/2016 31/01/2017 31/01/2017 JOS result in a gap in the provision of primary medical services.

PC3

FK

FK

3

3

4

3

30/11/2016 31/01/2017 30/11/2016

JOS

East Sussex Better Together (ESBT) workforce strategy and plans. 9 GP Forward View Sustainability Plan. On-going engagement processes between CCG Primary Care Team and Member Practices.

FK

4

2

There is a risk that the current lack of resilience in Primary Care may impede the necessary pace and scale of transformation and result in prevention of full delivery of our ambitions as part of ESBT. PC4

12

FK

4

3

8

Sustainability and Transformation Plan (STP) and Workforce Strategy. ESBT workforce strategy and plans. 12 GP Forward View Sustainability Plan. On-going engagement processes between CCG Primary Care Team and Member Practices.

There is a risk that without additional resources the wider responsibilities transferred from NHSE to the CCGs from 1 April 2017 may take primacy over delivery of our ambitions as part of ESBT. PC12

01/04/2017 New risk

New risk

INFORMATION MANAGEMENT & TECHNOLOGY (IM&T) There is a risk that the use of or age of IT equipment and applications may limit PC5 30/11/2016 31/01/2017 31/01/2017 opportunities for data sharing and result in not all information being available to clinicians, or may result in potential security breaches or losses of data.

PC6

There is a risk that recourse to data entry (rather than data transfer) may limit real time access to information and result in up to date information not be available to 30/11/2016 31/01/2017 30/11/2016 clinicians.

Sustainability and Transformation Plan (STP) and Workforce Strategy. ESBT workforce strategy and plans. JOS

FK

4

3

JOS

GMcG

3

2

JOS

GMcG

3

2

1) Deliver 2016/17 actions within ESBT workforce plans. 2) Deliver 2016/17 actions within GP Forward View Sustainability Plan. 3) Deliver 2017/18 actions within ESBT workforce plans. 4) Deliver 2017/18 actions within GP Forward View Sustainability Plan. 1) In year (2016/17) investment in systems and create processes that enable improvements in practice efficiency. 2) Complete on-going liaison with Practices and Local Medical Committee (LMC). 3) Support development of robust Federation arrangements. 4) In year (2017/18) investment in systems and create processes that enable improvements in practice efficiency. 1) Deliver 2016/17 actions within East Sussex Better Together (ESBT) workforce plans. 2) Deliver actions within GP Forward View Sustainability Plan. 3) Invest in systems and create processes that enable improvements in practice efficiency. 4) Complete on-going liaison with Practices and LMC. 5) Deliver 2017/18 actions within East Sussex Better Together (ESBT) workforce plans. 1) Detailed actions being developed.

12

Training for practice staff 6 IT hardware refresh programme

1) Complete 20% refresh of hardware within 2016/17 year.

Sustainability and Transformation Plan (STP) IM&T Strategy Group. 6 Digital Roadmaps (national and local) for paperless NHS (at point of care) by 2020.

1) Increase NHS electronic discharge systems in NHS providers from 75%. 2) Pursue electronic discharge systems with non-NHS providers.

2

3

4

4

2

2

1

2

1) 30/03/2017 - completed on target 2) 30/03/2017 - completed on target 3) 31/03/2017 - completed on target 4) 31/09/2017 5) 31/03/2018 4 6) 31/03/2018

1) 31/03/2017 - completed on target 2) 31/03/2017 - completed on target 6 3) 31/03/2018 4) 31/03/2018 1) 30/09/2017 2) 30/06/2017 3) 30/09/2017 4 4) 30/09/2018

1) 31/03/2017 - completed on target 2) 31/03/2018 3) 31/03/2017 - completed on target 8 4) 31/03/2017 - completed on target 5) 31/03/2018

1) TBC

4

2

8

3

1

3

1) 31/01/2017 - completed on target

3

1

3

1) 31/12/2018 2) 31/12/2018

PREMISES

PC7

There is a risk that the ESBT Estates Strategy will not sufficiently support the needs of primary care providers which may cause practices to be unable to contribute to ESBT transformation and result in ESBT key objectives not being delivered. 05/07/2106 31/01/2017 30/11/2016 (Primary Care impact from key CCG risk 728).

Regular Premises update procedures to bi-monthly Primary Care Commissioning Committee (PCCC) meetings. PG

WW

3

3

9

1) Submit final Premises and Technologies bid under Estates and Technology Transformation Fund. 2) Update the interim ESBT Strategic Estates Plan. 3) Report with final premises strategy to Governing Body. 4) Complete ESBT Estates Plan and deliver 2016/17 actions within the plan. 5) Deliver 2017/18 actions within the ESBT Estates Plan plan.

3

1

1) 30/06/2016 - completed on target 2) 30/11/2016 - completed on target 3) 30/04/2017 3 4) 31/03/2017 - completed on target 5) 31/03/2018

FINANCE

PC8

There is a risk that the expected benefits of strategic plans (ESBT) are not operationally delivered and may cause a financial deficit within the health economy and also result in reduced levels and quality of care. 10/06/2015 31/01/2017 30/11/2016 (Primary Care impact from key CCG risk 425). PG

JOS

3

3

ESBT Strategic Programme with well established programme governance structure - 150 week plan is monitored weekly and reporting to all Governing Body meetings. 9 Individual organisational annual planning procedures. Local Health Economy oversight of ESBT planning. Active ESBT engagement in shaping STP.

1) Delivery of 2016/17 actions within ESBT plan. 2) Pro-active development of provider landscape sustainability options, eg. Accountable Care Model for East Sussex. 3) Continue delivery of Accountable Care Model for 2017/18 test bed year.

1) 31/03/2017 - completed on target 2) 31/03/2017 - completed on target 3) 31/03/2018 3

2

6

3

2

6 1) 31/03/2017 - completed on target 2) 30/11/2016 - completed on target 3) 31/03/2017 - completed on target 4) 30/06/2017 5 31/03/2018 6) 31/03/2018

QUALITY & SAFETY There is a risk that member practices not meeting the standards of the Care Quality Commission (CQC) and receiving improvement notices may result in patient safety issues or continuity of service issues. PC9

30/11/2016 31/01/2017 30/11/2016

Policy of supporting practice pre-inspection. Training and development offered to Practices to help tham manage CQC requirements. AC

AL

4

2

8

1) Deliver against 2016/17 in-year practice requests for pre-inspection support. 2) Complete a general analysis/follow up of learning from 2016/17 Practice Support visits. 3) Implement 2016/17 quality visits. 4) Further develop mechanisms for sharing learning across practices. 5) Deliver against 2017/18 in-year practice requests for pre-inspection support. 6) Implement 2017/18 quality visits.

Residual Risk Score (SxL)

Actions to improve control, ensure delivery of principal objectives, gain assurance

Liklihood

Key Controls - systems in place (e.g. strategies, policies and procedures)

Severity

Liklihood

Current Risk Score (SxL)

Severity

Lead

Risk Description and Impact

Owner

Last Updated

Last Reviewed

No.

Original Date

CCG PRIMARY CARE RISK REGISTER – APRIL 2017 Dates actions will be completed

REPUTATION/STAKEHOLDERS There is a risk that engagement activities might not be consolidated which may cause public awareness, confidence in ESBT and our ability to achieve community leadership to be undermined and result in a loss of confidence and support of local stakeholders. (Primary Care impact from key CCG risk 426) PC10

23/12/2015 31/01/2017 30/11/2016

JEB

FS

4

3

12

There is a risk that engagement with the wider membership may not be fully delivered which may cause a lack of support and result in the CCG being unable to deliver major service change. (Primary Care impact from key CCG risk 709)

PC11

20/04/2015 31/01/2017 31/01/2017

Key to owners and leads: AC Allison Cannon - Chief Nurse AL Adrian Leah - Quality Manager FK Fiona Kellett - Head of Finance and Primary Care Commissioning FS Fiona Streeter - Deputy Director, Organisational Development and Corporate Affairs GMcG Gerry McGee - Head of Information Management and Technology JEB Jessica Britton - Chief Operating Officer JOS John O'Sullivan - Chief Finance Officer PG Paula Gorvett - ESBT Programme Director WW Wolfgang Weis - Strategic Investment Manager

JEB

FS

4

3

Overarching ESBT Communications strategy and ESBT Communications Plan. Communications and engagement plan developed around 'Accountable Care Organisations'. Prcedure for reporting to and gaining feedback on ESBT from Governing Bodies reporting

1) Deliver briefings for all ESBT stakeholders and Quarterly CCG newsletter within 2016/17. 2) Deliver the ESBT communications and engagement plan and the specific accountable care communications in 2016/17. 3) Deliver monthly briefings for all ESBTstakeholders and Quarterly CCG newsletter within 2017/18. 4) Deliver the ESBT communications and engagement plan and the specific accountable care communications in 2017/18.

Federation agreements. Membership engagement and learning events (MELE). Practice Operational Forum (POF).

1) Deliver locality meetings regarding service change. 2) Receive and analyse results from stakeholder surveys. 3) Develop medium term Primary Care workforce plan. 4) Implement 2016/17 actions in member engagement action plan. 5) Deliver Action Plan to support resilient Primary Care within ESBT. 6) Deliver planned 2016/17 GP Education, training and development and GP Summits. 7) Support development of robust Federation arrangements. 8) Develop long term Primary Care workforce plan. 9) Implement 2017/18 actions in member engagement action plan. 10) Deliver planned 2017/18 GP Education, training and development and GP Summits.

12

Changes since previous submission are in blue italic text.

1) 31/03/2017 - completed on target 2) 31/03/2017 - completed on target 3) 31/03/2018 4) 31/03/2018

4

4

2

2

8

1) 31/03/2017 - completed on target 2) 31/05/2017 3) 28/02/2017 - completed on target 4) 31/03/2017 - completed on target 5) 30/04/2017 6) 31/03/2017 - completed on target 7) 30/09/2017 8 8) 31/12/2017 9) 31/03/2018 10) 31/03/2018

The Primary Care Commissioning Committees of Eastbourne, Hailsham and Seaford CCG and Hastings and Rother CCG meeting together Date of meeting: 26 April 2017

Item Number:

22/17

Title of report: Work plan 2017/18 Recommendation: The Committees are recommended to note the work plan which:  was agreed at the February 2017 meeting of the Committees  ensures appropriate planning for the work of the committees that meets their terms of reference  enables assurance with regard to the delegated responsibility for the commissioning of primary medical services to be provided to the Governing Bodies Summary: As part of the assurance and governance work of the CCGs, a work plan for the Primary Care Commissioning Committees ensures appropriate planning for the work of the committees that meets their terms of reference and enables assurance with regard to the delegated responsibility for the commissioning of primary medical services to be provided to the Governing Bodies. The work plan is agreed annually by the committees (the 2017/18 work plan was agreed on 22 February 2017). The Committees receive an update at each meeting as a standing agenda item, detailing any changes and any variance from the work plan. There have been no changes to the plan since it was agreed in February 2017. Committee Sponsor: John O’Sullivan, Chief Finance Officer. Author(s): Fiona Kellett, Head of Finance and Primary Care Commissioning and Clive Mellor, Head of Date of report: 11/04/17 Governance and Business Planning Review by other committees: The work plan has not been reviewed by any other committees Financial implications: An agreed work plan will assist the CCGs to manage within the delegated budget 1 NHS Eastbourne, Hailsham and Seaford Clinical Commissioning Group NHS Hastings and Rother Clinical Commissioning Group

Legal or compliance implications: An agreed work plan will ensure that the committees meet their statutory obligations Link to key objective and/or principal risks: An agreed work plan is a key element in the assurance and governance of the CCGs. Link to East Sussex Better Together (ESBT) programme: Sustainable primary care is a key platform for the delivery of the ESBT transformation programme How has the patient and public engagement informed this work: External scrutiny of the work plan is undertaken by NHS England, Healthwatch and a representative from the Health and Wellbeing board

Equality Analysis (EA) Process - outcome: Negative Impact Neutral Impact Positive Impact ☐ ☐ ☐ EA Summary: n/a

No Impact Not required for report ☐ ☒

Privacy Impact Assessment (PIA) – outcome: No personal data used Data processes sufficient ☒ ☐ Actions: n/a.

Actions required ☐

2 NHS Eastbourne, Hailsham and Seaford Clinical Commissioning Group NHS Hastings and Rother Clinical Commissioning Group

Plan for PCCC meetings 2017/18 x = month for item to be included (filter to remove blanks for complete agenda) Item Author Standing items Questions from Public

_

Welcome and apologies for absence

_

Declarations of Interests

Clive Mellor

Minutes of the previous meeting

Governance and Corporate Services Officer

Action Log

Governance and Corporate Services Officer

Committee Chairs' opening remarks

Governance and Corporate Services Officer

Section 1- Governance of the Committees Risk register

Fiona Kellett, Head of Finance and Primary Care Commissioning

Workplan review

Fiona Kellett, Head of Finance and Primary Care Commissioning

Terms of Reference of the Committee

Clive Mellor, Head of Governance and Business Planning

Managing General Practice Performance and Quality under Delegated Commissioning Responsibilities Policy 2016

Nicola Hone, Primary Care CoCommissioning Strategic Manager and Allison Cannon Chief Nurse

Committee Annual Report

Clive Mellor, Head of Governance and Business Planning, Committee Chairs

Mid Year Review

Clive Mellor, Head of Governance and Business Planning, Committee Chairs

Committee development review

Clive Mellor, Head of Governance and Business Planning

Managing Conflicts of Interest Policy

Clive Mellor, Head of Governance and Business Planning

PCCC lead(s)

Action

Frequency

April 2017

June 2017

October 2017 December 2017

February 2018

Frances Hasler, Lay member, PPI (Chair) (EHS) / Barbara Beaton, Lay member, PPI, Chair (HR) Frances Hasler, Lay member, PPI (Chair) (EHS) / Barbara Beaton, Lay member, PPI, Chair (HR) Frances Hasler, Lay member, PPI (Chair) (EHS) / Barbara Beaton, Lay member, PPI, Chair (HR) Frances Hasler, Lay member, PPI (Chair) (EHS) / Barbara Beaton, Lay member, PPI, Chair (HR) Frances Hasler, Lay member, PPI (Chair) (EHS) / Barbara Beaton, Lay member, PPI, Chair (HR) Frances Hasler, Lay member, PPI (Chair) (EHS) / Barbara Beaton, Lay member, PPI, Chair (HR)

Answer

All meetings

X

X

X

X

X

Note

All meetings

X

X

X

X

X

Declare/ note

All meetings

X

X

X

X

X

Record to be shared with Chairs only on Boardpad before meeting. Management of Conflicts of Interest.

Approve

All meetings

X

X

X

X

X

Reviewed by all key parties and ready for agreement by the Committees.

Approve

All meetings

X

X

X

X

X

Including all new actions and with as many actions addressed as possible between Committees meeting together.

Note

All meetings

X

X

X

X

X

Front sheet only with standard introduction text.

Frances Hasler, Lay member, PPI (Chair) (EHS) / Barbara Beaton, Lay member, PPI, Chair (HR) Frances Hasler, Lay member, PPI (Chair) (EHS) / Barbara Beaton, Lay member, PPI, Chair (HR)

Note

All meetings

X

X

X

X

X

As requested 26 October 2016, to be reviewed at every PCCC meeting.

Note

All meetings

X

X

X

X

X (nb. Committes to approve the following year's annual work plan)

To include actions and items that give assurance that delegated functions and responsibilities of the Committees are monitored. See Terms of Reference. To be brought to each meeting as a standing item. The work plan for the following year to be approved at the February meeting.

Frances Hasler, Lay member, PPI (Chair) (EHS) / Barbara Beaton, Lay member, PPI, Chair (HR) Allison Cannon, Chief Nurse

Approve

Annual

Ratify

Every 2 years

Frances Hasler, Lay member, PPI (Chair) (EHS) / Barbara Beaton, Lay member, PPI, Chair (HR) Frances Hasler, Lay member, PPI (Chair) (EHS) / Barbara Beaton, Lay member, PPI, Chair (HR) Frances Hasler, Lay member, PPI (Chair) (EHS) / Barbara Beaton, Lay member, PPI, Chair (HR) Jessica Britton, Chief Operating Officer

Approve

X

Notes re. plan (for Governance and Corporate Service Team information)

To be reviewed annually in the June meetings and sent to the GB July meeting for approval. Updated annually or sooner if required. (nb. Next review October 2018)

Went to EHS in October 2015 and HR in April 2016. Agreed to develop a joint policy for adoption, to be ratified by GB in November and reviewed by PCCC every two years.

X

For approval by the PCCC and then sent to GB July meeting.

Approve

Annual

X

For ratification at the January GB. To be completed by December 2016 meeting.

Note

Annual

X

Whilst completing the mid-year review, assessment of Board development needs.

Note

Annual

Stephen Ingram, Head of Primary Care, NHS Stephen Ingram, Head of Primary England South East Care, NHS England South East

Note

All meetings

X

X

X

X

X

Fiona Kellett, Head of Finance and Primary Care Commissioning (progress report and premises) Gerry McGee, Head of IM&T (IM&T) Nic Hone, Head of Primary Care CoCommissioning (Workforce)

Fiona Kellett, Head of Finance and Primary Care Commissioning

Note

All meetings

X

X

X

X

X

Fiona Kellett, Head of Finance and Primary Care Commissioning Nicola Hone, Primary Care CoCommissioning Strategic Manager, Allison Cannon, Chief Nurse

Fiona Kellett, Head of Finance and Primary Care Commissioning Fiona Kellett, Head of Finance and Primary Care Commissioning/Allison Cannon, Chief Nurse

Note

All meetings

X

X

X

X

X

Note

All meetings

X

X

X

X

X

Primary Care Commissioning Operational Group (PCCOG) update Nicola Hone, Primary Care CoCommissioning Strategic Manager

John O'Sullivan, Chief Finance Officer Note

All meetings

X

X

X

X

X

Annual Needs Assessment

Fiona Kellett, Head of Finance and Primary Care Commissioning

Fiona Kellett, Head of Finance and Primary Care Commissioning

Note

Annual

Accessible Information Standard

Fiona Kellett, Head of Finance and Primary Care Commissioning

Fiona Kellett, Head of Finance and Primary Care Commissioning

Review

Public and patient involvement

Jessica Britton, Chief Operating Officer

Note

As required

Accessible Information Standard (AIS)

Jessica Britton, Chief Operating Officer

Frances Hasler, Lay member, PPI (Chair) (EHS) / Barbara Beaton, Lay member, PPI, Chair (HR) Fiona Kellett, Head of Finance and Primary Care Commissioning

Note

Annually

Primary Care Procurements (delegated commissioning)

John O'Sullivan, Chief Finance Officer

John O'Sullivan, Chief Finance Officer Approve/n As required ote

Section 3 - For information Patient Participation Group (PPG) 6 month update

ESCV

Julie Fitzgerald

Primary Care Commissioning Operational Group (PCCOG) Terms of Reference Any Other Business and Future meeting date

Fiona Kellett, Head of Finance and Primary Care Commissioning _

John O'Sullivan, Chief Finance Officer Note

Annual

X

Frances Hasler, Lay member, PPI (Chair) (EHS) / Barbara Beaton, Lay member, PPI, Chair (HR)

All meetings

X

Section 2 - Quality, Performance and Delivery NHS England briefing

General Practice Forward View Progress Report on Sustainability of Primary Care: i. Progress Report ii. Information Management and Technology (IM&T) iii. Workforce iv. Premises Finance Monitoring Performance and Quality in Primary Care

Note

Note

X

To be reviewed annually or sooner if required. First review October 2016.

X

Information update delivered by NHSE for Committees regarding delegated functions. This item is for anything NHSE wish to inform the Committees about and an opportunity for Committees to obtain clarification from NHS England on matters of note and importance that should arise. General Practice Forward View ESBT: Performance report to include areas and work that allign with ESBT strategic intentions. Federations - update To include update and information on the GP Support Framework when available. To note at every meeting. To also include impact on specific areas and variation in provision of health services where appropriate. To include review of primary medical care services. To include impact on reducing inequalities and 4 key practice nurse objectives. To include the Primary Care Performance Dashboard for CCGs. To also inform committees on newly designed services, local incentive schemes, decision making with regard to new GP practices. To note the Annual Needs Assessment which goes to Governing Bodies annually. Note planned Primary Medical Care Services.

X

X

Review of how practices are implementing the Accessible Information Standard (AIS)

X

Review regularly and in consultation with PCCC Chairs.

X

For note annually. Review of how practices are implementing the AIS. Note or approve primary care procurements as and when required. Not applicable at present (October 2016).

6 month update

x

X

X

X

X

X

Public invovlement and consultation; Patient choice. Newly commissioned paper in October 2016. To be delivered, for note, approximately every 6 months. For note annually or sooner if required.

1

The Primary Care Commissioning Committees of Eastbourne, Hailsham and Seaford CCG and Hastings and Rother CCG meeting together Date of meeting: 26 April 2017

Item Number: 29/17

Title of report: Terms of Reference (TOR) of the Hastings and Rother CCG and Eastbourne, Hailsham and Seaford CCG Primary Care Commissioning Committee. Recommendation: The Committee is recommended to approve the… Terms of Reference (TOR) of the Hastings and Rother CCG and Eastbourne, Hailsham and Seaford CCG Primary Care Commissioning Committee. Executive Summary: The ToR for this Committee, based on the NHS England Model TOR and taking into account legal advice received, are attached as Appendix A. Following review in April 2017 no changes have been made to the PCCOG TOR agreed by PCCC in April 2016. The TOR remain appropriate and adequate They have been approved by NHS England and will be submitted to the Governing Body for ratification in May 2017. Committee sponsor: John O’Sullivan, Chief Financial Officer Author(s): Nicola Hone, Primary Care Co-commissioning Strategic Manager

Date of report: 10/04/17

Review by other committees: Reviewed by the CCGs’ Primary Care Commissioning Operational Group Health impact: Decisions made by the Committee will have implications for the provision of primary healthcare. Financial implications: : Decisions made by the Committee will have financial implications. Legal or compliance implications: The Committee operates the delegated duties from NHS England on behalf of the Governing Body

NHS Eastbourne, Hailsham and Seaford Clinical Commissioning Group NHS Hastings and Rother Clinical Commissioning Group

Link to key objective and/or principal risks: All objectives. GPFV, ensuring resilience and stability in Primary Care. Link to East Sussex Better Together (ESBT) programme: Resilience and stability in Primary Care is key to the delivery of Quality Services under the ESBT programme. How has the patient and public engagement informed this work: Representatives from HealthWatch and the Health and Wellbeing Board are invited to attend PCCC and Board meetings, which are held in public. Equality Analysis (EA) Process - outcome: Negative Impact Neutral Impact Positive Impact ☐ ☐ ☐ EA Summary:

No Impact Not required for report ☐ ☒

The delegation of these duties - which will continue to operate under the existing policies - will not impact equality.

Privacy Impact Assessment (PIA) – outcome: No personal data used Data processes sufficient ☒ ☐ Actions: None

Actions required ☐

NHS Eastbourne, Hailsham and Seaford Clinical Commissioning Group NHS Hastings and Rother Clinical Commissioning Group

Appendix A

PRIMARY CARE COMMISSIONING OPERATIONAL GROUP TERMS OF REFERENCE Constitution The Primary Care Commissioning Operational Group (PCCOG) is established as a sub-group of the Primary Care Commissioning Committee (PCCC) of the Eastbourne, Hailsham and Seaford Clinical Commissioning Group (EHS CCG) and Hastings and Rother Clinical Commissioning Group (HR CCG). PCCOG’s role is to ensure the transactional aspects of primary care commissioning are undertaken quickly, efficiently, clearly and in line with national regulation and local strategy. The group will make decisions on an agreed range of areas and will recommend strategic decisions to the PCCC. Membership The membership of the group shall be:  Chief Finance Officer – Chair (Chief Officer to deputise if required)  Head of Finance and Primary Care Commissioning (Vice Chair)  EHS GP Governing Body member (with named deputy)  HR GP Governing Body member (with named deputy)  Finance  Primary Care Development Lead  Quality Team member The following shall be invited to attend meetings:  A representative from NHS England– Primary Care contracts  A representative from NHS England– Performers’ List  A representative from NHS Property Services (for Premises issues) A representative from the East Sussex Local Medical Committee shall be invited to observe. The group may invite other staff as required (e.g. from the Information Management and Technology Team). Practice representatives may also be invited to attend for items that concern them. For some items, the input from the Performers’ List team at NHS England will be very important. For this reason, we will ensure that this team has early sight of the agenda for PCCOG meetings and that “Relevant Input from Performers’ List Team” is a standing item on all agendas. Quorum A quorum shall be the Chair or Vice Chair, the GP members, at least one primary care team member and a finance member. Frequency of Meetings Meetings shall be held monthly. When national timescales demand it and in exceptional/operationally urgent situations a “virtual meeting” may take place, using email or phone conferencing. (This shall not be a reason for inadequate planning.) Alternatively, after taking advice, Chair’s action may be taken. Chair’s action will be ratified at the next full meeting of the group. For example, this may occur when a statutory response time of 28 days applies, as is the case in some procedures.

1

Authority The committee is authorised by the Primary Care Commissioning Committee of Eastbourne, Hailsham and Seaford Clinical Commissioning Group and Hastings and Rother Clinical Commissioning Group to:  Apply the national Primary Care contracting regulations in the context of local strategy and agreed Standard Operating Procedures (SOPS);  Make recommendations to the PCCC;  Seek advice on aspects of its work requiring specialist knowledge (e.g. legal, estates). Duties  To make decisions on the following items, in line with agreed SOPS: o Remedial and breach notices, contract variations, boundary changes, 24 hour retirements, contract mergers, list closures, cold chain events, Serious Incidents, partnerships becoming sole contractors, branch closures/openings, discretionary payments, minor improvement grants, rent reviews, sale and leaseback, initial scrutiny of Project Initiation Documents (PIDs) for premises developments, special patient scheme and other operational issues;  To report to the PCCC on the above issues and decisions made;  To correspond with practices on the above issues, to ensure decisions are made with the fullest possible information and to communicate back to practices clearly and promptly;  To recommend decisions to the PCCC on the following: o Contract final notices and terminations, major investment decisions, PIDs for premises developments; o Year-end sign-off of the Quality and Outcomes Framework (QOF); o Other strategic items, as required.  To improve quality, safety and patient experience of primary care services, as part of the organisation’s overall responsibilities for improving quality across the board. Note Keeping A formal record of meetings will be kept and an action log maintained. Draft notes will be made available within a week of the meeting. Notes will be subject to the Freedom of Information Act. Certain parts of the notes may be redacted, if deemed confidential/not in the public interest. Appeals If a practice considers that the PCCOG has not followed due procedure in its decision, it may appeal against the decision to the PCCC. The PCCC Appeals Process will be used to undertake this. Conduct The PCCOG shall conduct its business in accordance with national guidance and relevant codes of practice, including the Nolan Principles and the CCG Conflicts of Interests policy. Declarations of Interest will be recorded at each meeting and all members will complete a Declaration of Interest, which will be publicly available. If any member or attendee has a conflict of interest in a particular item, appropriate arrangements will be made in line with the CCG Conflicts of Interest Policy to ensure the clinical input needed to the work of the Group is provided. Where the GP members and all available Governing Body GPs are conflicted, a deputising GP may be sought from a neighbouring CCG with the agreement of the chair of the PCCC. Reporting A written summary report of the meeting will be made to the PCCC on a regular basis, along with any recommendations or details of any decisions. (The PCCC will take items under Part 2 of its meeting where necessary.)

2

Review These Terms of Reference will be reviewed annually or sooner if required. Proposed amendments will be submitted by the Chair of the PCCOG for agreement and the PCCC for approval.

Editor Version Approved by Date approved Review date

Fiona Kellet 3.0 PCCOG 26th April 2017 April 2018

3

The Primary Care Commissioning Committees of Eastbourne, Hailsham and Seaford CCG and Hastings and Rother CCG meeting together Date of meeting: 26 April 2017

Item Number:

24/17

Title of report: General Practice Forward View: An update on the implementation of the programme to support sustainability in primary care Recommendation: The Committees are recommended to note the progress on the implementation of the General Practice Forward View to support sustainability in primary care. Executive Summary: The report highlights the progress on current initiatives in place to support implementation of the General Practice Forward View published in April 2016. This includes Community Education Provider Network (CEPN) developments supporting workforce, local initiatives supporting workload management and the successful Estates and Technology Transformation Fund bids and other infrastructure developments. The report also covers the next steps to be taken in respect of Workload, Workforce and Infrastructure to enable sustainable primary care to be maintained and to implement the objectives outlined in the General Practice Forward View. Committee sponsor: John O’Sullivan, Chief Finance Officer Author: Fiona Kellett, Head of Finance and Primary Care Commissioning

Date of report: 10/4/17

Review by other committees: Reviewed by the CCGs’ Primary Care Commissioning Operational Group (PCCOG). Health impact: Improved access to services. Financial implications: Sustainable primary care is critical to ensuring financial balance. Legal or compliance implications: None. Link to key objective and/or principal risks: National priority – Sustainability and Quality of General Practice and delivery of East Sussex Better Together (ESBT).

NHS Eastbourne, Hailsham and Seaford Clinical Commissioning Group NHS Hastings and Rother Clinical Commissioning Group

How has the patient and public engagement informed this work: Patient and public engagement plans are built into each work programme. Equality Analysis (EA) Process - outcome: Negative Impact Neutral Impact Positive Impact ☐ ☐ ☐ EA summary: N/A.

No Impact Not required for report ☐ ☒

Privacy Impact Assessment (PIA) – outcome: No personal data used Data processes sufficient ☒ ☐ Actions: N/A.

NHS Eastbourne, Hailsham and Seaford Clinical Commissioning Group NHS Hastings and Rother Clinical Commissioning Group

Actions required ☐

Update on General Practice Forward View 1

Introduction The General Practice Forward View (GPFV) was published by NHS England (NHSE) in April 2016 and sets out how general practice workload pressures will be addressed. It refers to specific programmes to address investment, workforce, workload, infrastructure and care redesign. Since the last meeting of the Primary Care Commissioning Committees (PCCC) in December 2016, the CCGs have added to all locality agendas a discussion point around collaborative working to support resilience in primary care. With the increasing pressures on primary care it is imperative the practices start to work collaboratively where possible.

2

Investment Bids for funds from the GPFV Budget are considered at the GPFV Steering Group.

3

Federation Development Regular meetings continue to be held between CCG senior officers and federation board members as the federations are key to supporting and strengthening primary care services. Federations are working with practices and the CCGs on the implementation of some GPFV projects including the locum bank and the Primary Care redesign fund.

4

Workforce

4.1

Key developments since last meeting One practice in Eastbourne, Hailsham and Seaford (EHS) has received a diagnostic visit under the GP Resilience part of the GPFV programme. An initial meeting has been held with that practice to discuss the outcome of the visit and an action plan is being worked up to build resilience within the practice and the locality. Funds continue to be used under the GP Development Programme to support releasing time for care, training for reception and clerical staff and supporting online consultations. The Hastings Federation (Integrated Family Health Care Limited) has had its ‘GP Career Plus’ initiative proposal agreed. Further NHSE workshops are planned for April 2017 where mobilisation of the projects will be discussed. One of the GP registrars on their four month placement with the CCGs is interviewing local GPs to ascertain what would encourage GPs to support the GP Career Plus initiative. The CCG primary care Workforce Tutor (PCWT) continues to work with the Health Education Institute and local practices to identify where nursing gaps are and to inform the future education curriculum. This will ensure the delivery of an appropriate nursing workforce is incorporated in workforce plans. Details of the work to date is reported below:

4.2

On-going Work GP recruitment continues to be a priority but also one of the greatest challenges. Latest workforce/skillmix data for EHS and HR CCGs is shown at Appendices A and B. 1

This information is used to support discussions around Primary Care Workforce Redesign. Four practices are being resourced to mentor Physicians Associate (PA) students in primary care. Early review suggests that to work safely and effectively in primary care, PAs would need post qualification training. At the time of writing, 76% of practices have been audited in readiness to host student nurses within EHS CCG and 33% within HR CCG. There are now 68 nurse mentors across both CCGs1 and there are five sign off mentors to host final management placement students and return to practice nurses. From this activity four final placement students have been hosted (two of which have been recruited directly into GP practice from qualifying). Three newly qualified nurses have now been recruited and a further three mentors are signed up to take sign off course. A further final management placement is due to commence in June 2017. The preceptorship framework to support newly qualified registrants during their induction period will be closely monitored from February to April 2017. Three newly qualified nurses are currently being supported by practice through their preceptorship phase whilst awaiting their PIN number from the Nursing and Midwifery Council (NMC) Practice Nurses, Nurse Practitioners, Support Workers, Pharmacists, Paramedics, the newly emerging Physician Associate, Nurse Associate and Care-navigator roles will all require support mechanisms with adequate mentorship made available.2 Two new roles are currently being scoped which include a Care Coordinator and a Care Navigator. A proposal for financial support is with Health Education England for consideration. The objectives below illustrate the essential aims that will be delivered regarding educational improvement and standards of primary care nursing staff: Objective All nurses and healthcare assistants (HCA) are clear about their responsibility and accountability. This will give assurance around patient safety.

Mechanism for achievement: Educate workforce on Duty of Candour and incident reporting; improvement in patient experience will be evidenced within the patient satisfaction survey and promote a workforce fit for 2020;  The Nursing Strategy/Framework (draft) for EHS and HR CCGs is currently under peer review.  Key messages from Objective One continue to be delivered at the Membership

1

Please note: some mentors are due an annual update and all are required to support a minimum of two learners over three years to retain their mentor status. 2 Development and training support for these emerging roles whilst working strategically within the East Sussex Better Together (ESBT) Community Education Provider Network (CEPN) remains a core part of the Lead Practice Nurse remit. 2

Develop nurse mentors, sign off mentors and practice teachers through the support and delivery of academic learning and in-house educational updates.

Develop a competency framework for all non-medical workforce bands 1- 9 by June 2017 Promote continuous professional development (CPD) by improving education capability and capacity in Primary Care for all non-medical workforce this financial year 4.3

Engagement Learning Event (MELE) and conference events. A full round of engagement however will continue as a rolling item; and,  A Sussex wide Nursing conference entitled “Primary Care Conference: valuing roles in General Practice” to be held on 22 June 2017 at the Amex Stadium, Brighton.3 The CCGs have increased the number of nurse mentors by 28; A further 21 nurse mentors within the Continuing Healthcare (CHC) team all of whom have received an annual update have been supported by the CCGs. Build on the band 1- 4 document and support the progression of all appropriate roles within bands 5 - 9 thereby ensuring a balanced and safe skill mix within General Practice. CPD sessions have been planned, and communicated to all non-medical workforce running up to Quarter Four (2016/17). The link for all is embedded in the nurse section of the intranet and event calendar.4

Next Steps The GPFV implementation group agreed to support the Care Navigator training pathway. Further work is being done to ensure the most appropriate training package is commissioned Public relations tools are being used to promote the opportunities in the local area and demonstrate that the area is an attractive place to work. The CCG engagement team have organised a meeting with the CCG’s current social prescribing provider to consider the most effective way of engaging with all stakeholders around the redesign of Primary Care. Work continues on Commissioning of Educational Pharmacists pathways. The ESBT Strategic Workforce Group continue to review the ESBT Workforce Strategy and priorities for 2017/18, including developing an integrated Recruitment and Retention Strategy to address the current and predicted vacancy gap due to continuing workforce supply issues.

5 5.1

Workload Key development since last meeting

3

This will cover national and local perspective alongside developing roles/advanced practice/resilience/frailty/speech from Cuckoo Lane practice showing innovation. 4 27 nurses have enrolled or booked to commence academic modules over the next six months. 3

Following on from positive feedback from practices utilising the interim GPs negotiations are underway with the supplier agency around a reduction on costs to enable the scheme to continue for a further year in HR CCG. Work continues with colleagues on ensuring East Sussex Healthcare NHS Trust (ESHT) undertakes contractual requirements around sharing information, referrals, outpatient prescribing etc. continues. Feedback from the local medical committee (LMC) and local practices says they have seen an improvement but continue to feedback on on-going issues. The CCGs and ESHT continue to work together to ensure improvements remain embedded. 11 practices across the CCGs are receiving training around utilising administration staff to code clinical letters where appropriate. Feedback is positive from practices reporting a reduction in GP administration workload. The programme will be rolled out to all willing practices utilising lessons learnt from the first tranche of training. An advert for GP Fellowship posts has been placed with interviews scheduled for May 2017 and an expectation that successful applicants will be able to take up posts in September 2017. The forum for practice managers has been established in Hastings by the CCG and management of this is being taken over by the federation. 5.2

On-going Work The work on centralised data extraction templates continues. Plans to run the extract for locally commissioned services (LCS) activity at the end of 2016/17 are on track and will allow practices time to gain confidence in the centralised searches with a view to the data extraction being fully centralised by Q3 2017/18. Alongside the activity extraction, audit reports are being built to enable quality outcomes reporting on LCSs.

5.3

Next Steps The service redesign project is progressing and job descriptions have been drafted to enable localities and federations to develop bids around developing the workforce in Primary Care. Practices will be asked to bid against the service redesign fund in the summer of 2017 to provide innovative ways of working through new technology or alternative work processes or workforce skill mix. A template will be circulated to all practices/localities and Federations asking them for their bids on models to support GP Development and Sustainability.

6 6.1

6.2

Infrastructure Key developments since last meeting The CCGs are continuing to progress a number of new build projects including two major projects supported by Estates and Technology Transformation Fund (ETTF) grants awarded (report December 2016); one in Hailsham, East Sussex and one in Ore Valley, Hastings. With those two schemes, due diligence processes are still underway, which run in parallel to the actual build project. With the award of the ETTF grants time pressure for the projects has increased as one of the grant conditions is the completion of the project by March 2019. On-going Work

4

CCG officers continue to meet regularly with representatives from each of the local district and borough councils. This is to ensure primary care plans take account of any planned or anticipated housing growth and the CCGs are kept updated with regard to the timings of any significant developments. Significant new pressures are currently expected through large scale housing developments around Hailsham, Polegate, Stone Cross and north of Bexhill. All practices now have wireless connectivity installed and are on the Sussex COIN network linking all NHS services. All practices in HR are using EMIS Web as their Clinical System. All EHS practices are either currently using EMIS Web or have a migration date before the end of May 2017. All practices in EHS and HR CCGs are now live with the core Summary Care Record (SCR). Furthermore all practices are now able to create, with explicit patient consent, SCRs with additional information which, in addition to the core information includes: significant medical history; reason for medication; anticipatory care information; communication preferences; end of life care information; and immunisations. There are currently nearly 8000 SCRs with additional information we are aiming to reach 10,000 by September 2017. Currently 95% of practices in EHS and 75% practices in HR are now live with the Electronic Prescription Service (EPS). One further practice went live during March 2017. Utilisation rates are continuing to increase with most practices sending over 50% of their scripts electronically. Most of the non-live practices are dispensing practices. An opt-out has been negotiated for these practices until dispensing systems are able to process scripts via EPS. 6.3

Next Steps The CCGs are continuously engaging with ESBT partners to ensure that any primary care estates requirements are considered within the context of the ESBT footprint and all opportunities for collaborative working are fully explored. Expressions of interest have been received from practices interested in piloting a new off-site records storage system and 18 practices are now engaged in the process. Currently 6 practices are already fully operational with the system and plans are in place for the remaining 12 practices to be live by the end of May 2017. The Information Management and Technology (IM&T) Team has been working with practices to ensure that we meet the national target of 10% of patients registered for online services by 31 March 2017. We are providing extra support for practices to ensure patients are encouraged to use these services and action plans have been developed for practices where additional work is required. Currently across both CCGs 14% of the registered population had signed up for online services. The CCGs intend to move practices onto a single domain. This will enable the existing file servers to be remotely hosted and allow greater flexibility for cross site working. The CCGs have bought extra storage capacity in preparation for this work and North East London Commissioning Support Unit (NELCSU) is currently working on a proposal with a view to work starting on this project during summer 2017.

5

Managed Print Service – Practices have been offered alternative solutions to reduce printing costs and an increasing number of practices are working with the CCGs to introduce this scheme. Currently eight practices are using this service. SMS – use of bi-directional messaging – two way SMS messaging platform allows more intelligent communication with patients. This will allow patients to auto cancel appointments and allow practices to offer flu invitations and other services through this method. Over half of the CCGs’ practices already have this functionality switched on and by the end of May 2017 it is expected that all practices will be enabled. Expansion of Wireless Provision – we will look to expand the current wireless networking infrastructure into additional care settings particularly where mobile coverage is poor. In order to support ESBT initiatives we are currently ensuring that East Sussex County Council (ESCC) social workers are enabled to use the WiFi in GP Practices. 7

Recommendation The Committees are recommended to note the progress on the implementation of the General Practice Forward View to support sustainability in primary care.

Fiona Kellett Head of Finance and Primary Care Commissioning 10 April 2017

6

Appendix A

1

Appendix B

2

The Primary Care Commissioning Committees of Eastbourne, Hailsham and Seaford CCG and Hastings and Rother CCG meeting together Date of meeting: 26 April 2017

Item Number:

25/17 i

Title of report: Finance Update: Primary Care Delegated Commissioning Budgets 2016/17 M11 February 2017 Recommendation: The Primary Care Commissioning Committees are asked to note the M11 year to date and forecast position for Primary Care delegated commissioning budgets and Locally Commissioned Services budgets for Eastbourne, Hailsham and Seaford (EHS) and Hastings and Rother (HR) CCGs (set out in Appendix 1 and Appendix 2) Executive Summary:  The 2016/17 allocation for Primary Care Delegated Commissioning for EHS CCG is £24.788m. For the first year of delegated commissioning in HR CCG the allocation is £26.181m. 

In accordance with NHS England business rules the budgets set in each CCG include a 0.5% contingency reserve and a 1% uncommitted reserve.



The Locally Commissioned Services budget for EHS CCG is £5.062m and for HR CCG is £5.142m.  

  

The year to date position and forecast outturn at February 2017 is breakeven for both CCGs’ delegated budgets.

Committee sponsor: John O’Sullivan, Chief Finance Officer Author: Fiona Kellett, Head of Finance and Primary Care Commissioning

Date of report: 10/04/17

Review by other committees: Reviewed by the Primary Care Commissioning Operational Group Health impact: Ensuring a sustainable financial position best enables the CCG to meet the current and future needs of the population. Financial implications: The CCGs have a statutory responsibility to live within their means.

NHS Eastbourne, Hailsham and Seaford Clinical Commissioning Group NHS Hastings and Rother Clinical Commissioning Group

Legal or compliance implications: Compliance with financial objectives and duties. Link to key objective and/or principal risks: Financial balance. How has the patient and public engagement informed this work: Not applicable Equality Analysis (EA) Process - outcome: Negative Impact Neutral Impact Positive Impact ☐ ☐ ☐ EA Summary: Not applicable.

No Impact ☐

Privacy Impact Assessment (PIA) – outcome: No personal data used Data processes sufficient ☒ ☐ Actions: Not applicable.

NHS Eastbourne, Hailsham and Seaford Clinical Commissioning Group NHS Hastings and Rother Clinical Commissioning Group

Not required for report ☒

Actions required ☐

Finance Report: M11 (February) Primary Care Delegated Commissioning Budgets 2016/17 1.

Introduction The Primary Care Committees (PCCC) approved the delegated commissioning budgets and Locally Commissioned Services (LCS) budgets at their meeting together in June 2016. The Month 11 year to date position and forecast outturn for the delegated commissioning budget in each CCG is shown at Appendix 1. The overall forecast position on the delegated co-commissioning budgets is a breakeven position. NHS England (NHSE) has managed a bidding process for practices to apply for grants for minor improvements and a number of practices have been successful. The additional resource was allocated in M10.

2.

NHS England (NHSE) Allocation and financial business rules compliance The 2016/17 allocation for Primary Care Delegated Commissioning for Eastbourne, Hailsham and Seaford (EHS) CCG is £24.788m. For the first year of delegated commissioning in Hastings and Rother (HR) CCG the allocation is £26.181m. Both CCGs continue to meet the NHSE business rules:  Establish a 0.5% contingency reserve – set at £123k for EHS and £129k for HR.  Set aside a 1% uncommitted reserve which must be held as part of wider health system contingency arrangements and which can only be released or utilised with formal approval from NHSE - set at £215k for EHS and £259k for HR. There is no requirement in 2016/17 to deliver a 1% surplus against the Primary Care allocation. The requirement is “statutory breakeven”.

3.

Summary of budgets for 2016/17 Since the start of the year work has continued with NHSE to understand the current commitments against the delegated budget, the financial risks at individual budget area level and the level of any uncommitted reserve. NHSE and the CCGs had agreed a staged handover with NHSE continuing to make payments until June 2016 and the CCGs taking over full responsibility from July 2016. This timetable for detailed handover of information from NHSE has slipped during the year but took place on 20 March 2017. The LCS budget for EHS CCG is £5.062m and for HR CCG is £5.142m. The detail is shown at Appendix 2. With effect from 2016/17 the CCGs have agreed to uplift all LCS prices annually in line with the global sum uplift. In addition, all LCS specifications are being reviewed to ensure they remain in line with current clinical pathways and this will include a review of the pricing for each scheme. The Local Medical Committee (LMC) and CCGs have agreed to review the pricing of four LCSs initially and proposals have been submitted to LMC for further discussion. These are expected to conclude in April 2017.

4.

Position to the end of February 2017 The overall forecast position on the delegated co-commissioning budgets is a breakeven position. 3

The position of LCS against budget is shown at Appendix 2. The year end forecast for EHS for both LCS and Supporting Vulnerable Patients is an overspend of £12k and for HR is an underspend of £734k. An uplift of 1% has been applied to the rates paid for LCS schemes with effect from 1 April 2016; this is in line with the nationally agreed uplift to the Global Sum. 5.

Key Financial Risks The detailed knowledge of the primary care budgets and associated risks currently sits within NHSE, but there is an on-going process to transfer this knowledge to CCG staff. At this stage in the process, the level of financial risk of an overspend against the total budget appears to be small. The budgets where expenditure can change in-year are:  Premises – NHSE is currently conducting a rent review process.  Enhanced services – dependent on activity undertaken.  Other GP services – locum services required throughout the year.  List size adjustments.  Quality Outcomes Framework (QOF) – dependent on the level of achievement by practices. The CCGs continue in discussions with NHSE to assess the risk and to determine whether the 0.5% contingency reserve is sufficient to cover likely pressures.

6.

Recommendation The Primary Care Commissioning Committees are asked to note the M11 year to date and forecast position for Primary Care delegated commissioning budgets and Locally Commissioned Services budgets for EHS and HR CCGs (set out in Appendix 1 and Appendix 2)

Fiona Kellett, Head of Finance and Primary Care Commissioning 10 April 2017

4

Appendix 1

Eastbourne Hailsham and Seaford CCG 2016-17 Primary Care Commisioning Budget Finance Report to Feb 2017

GMS/PMS/APMS

NHSE Budget £000 16,753

YTD Budget

YTD Actual

YTD Adjusting Accrual

Total

YTD Variance

FOT

FOT Variance

£000

£000

£000

£000

£000

£000

£000

15,357

15,140

217

15,357

0

16,753

0 0

Enhanced Service

917

840

519

321

840

1

917

QOF

3,060

2,805

1,979

826

2,805

0

3,060

0

Premises

2,774

2,542

2,005

537

2,542

0

2,774

0

Dispensing

268

246

239

7

246

0

268

0

GP Other

515

472

820

(348)

472

0

515

0

Pensions

0

0

(398)

398

0

0

0

0

Levy

0

0

(15)

15

0

0

0

0

24,287

22,262

20,289

1,973

22,262

0

24,287

0

Contingency

123

113

0

113

113

0

123

0

Reserve

247

226

9

217

226

0

247

0

Surplus Allocation

131

120

0

120

120

0

131

0

501

459

9

450

459

0

501

0

24,788

22,721

20,298

2,423

22,721

0

Allocated Budget

24,788

0

Hastings and Rother CCG 2016-17 Primary Care Commisioning Budget Finance Report to February 2017

NHSE Budget

YTD Budget

YTD Actual

YTD Adjusting Accrual

Total

YTD Variance

FOT

FOT Variance

£000

£000

£000

£000

£000

£000

£000

£000

GMS/PMS/APMS

16,987

15,572

15,159

413

15,572

0

16,987

0

Enhanced Service

1,050

962

623

339

962

0

1,050

0

QOF

2,879

2,639

1,693

946

2,639

0

2,879

0

Premises

2,807

2,573

2,048

525

2,573

0

2,807

0

Dispensing

1,663

1,524

1,052

472

1,524

0

1,663

0

Other

407

372

370

2

372

0

407

0

Pensions

0

0

(367)

367

0

0

0

0

Levy

0

0

(7)

7

0

0

0

0

25,793

23,642

20,570

3,071

23,642

0

25,793

0

129 259 388

107 248 355

0 0 0

107 248 355

107 248 355

0 0 0

129 259 388

0 0 0

26,181

23,997

20,570

3,427

23,997

0

26,181

0

Contingency Reserve

Allocated Budget

 

 

 

 

 

 

 

5

Appendix 2 Locally Commissioned Services Hastings and Rother CCG

H&R Budget H&R Budget H&R Spend H&R Variance To M11 2016/17 To M11 ClaimsTo M11 £000 £000 £000 £000 Anti‐Coag 840 770 666 104 Cardiology Diagnostics 50 46 21 25 COPD 190 174 168 6 CVD (incl ABPM) 240 220 210 10 Dementia 50 46 46 0 Dermatology 700 642 693 (51) Diabetes 600 550 479 71 DVT 40 37 34 3 Microsuction 70 64 85 (21) Minor Injuries 37 34 32 2 Minor Surgery 350 321 296 25 Near Patient Testing 80 73 78 (5) Neonatal Checks 7 6 7 (1) Optometry 30 28 44 (16) Pharmacy JIC 5 5 3 2 Phlebotomy 220 202 204 (2) Wound Care 350 321 322 (1) Medicines Management LCS (funded BCF) 120 110 110 0 Sub total 3,979 3,649 3,498 151 Supporting Vulnerable Patients 1,073 984 424 560 Sub total ‐ 1,073 984 424 560 Total current schemes 5,052 4,633 3,922 711 Tariff uplift 129 (129) Contingency 90 81 4 77 Reporting Total 5,142 4,714 4,055 659 Healthy Hastings Schemes Atrial Fibrillation Lets get Moving Cancer Screening Full Poverty Sub total

5,000 275,000 106,102 12,000 398,102

4,167 229,167 88,418 10,000 331,752

0

4,167 229,167 88,418 10,000 331,752

H&R Y/E Forecast £000 795 24 183 248 50 769 549 35 95 34 322 85 7 49 3 223 356 40 3,867 434 434 4,301 107 4,408

0 25,771 81,781 1,431 108,983

6

Local Enhanced Services Eastbourne, Hailsham and Seaford CCG Anti‐Coag Ambulatory Blood Pressure Monitoring Dementia Dermatology Diabetes DVT Microsuction Minor Injuries Minor Procedures Near Patient Testing Neonatal Checks Optometry Pharmacy JIC Phlebotomy Spirometry Wound Care Sub total Supporting Vulnerable Patients Sub total ‐ Total current schemes Tariff uplift Contingency Reporting Total

EHS Budget EHS Budget EHS Spend EHS Variance To M11 2016/17 To M11 ClaimsTo M11 £ £ £ £ 1,200 1,100 1,119 (19) 60 55 63 (8) 50 46 46 0 675 619 707 (88) 550 504 523 (19) 40 37 33 4 50 46 54 (8) 75 69 55 14 400 367 276 91 85 78 96 (18) 0 1 (1) 40 37 35 2 5 5 2 3 250 229 239 (10) 5 5 7 (2) 400 367 392 (25) 3,885 3,564 3,648 (84) 1,121 934 868 66 1,121 934 868 66 5,006 4,498 4,516 (18) 148 (148) 56 47 8 39 5,062 4,545 4,672 (127)

EHS Y/E Forecast £ 1,240 84 50 772 537 46 59 61 305 104 1 43 6 260 8 435 4,011 947 947 4,958 116 5,074

7

The Primary Care Commissioning Committees of Eastbourne, Hailsham and Seaford CCG and Hastings and Rother CCG meeting together Date of meeting: 26 April 2017

Item Number:

25/17 ii

Title of report: Primary Care Budgets 2017-18 Recommendation: The Primary Care Commissioning Committees are asked to note the draft 2017-18 budgets for delegated co-commissioning, locally commissioned services and the General Practice Forward View programme Executive Summary:  The draft 2017/18 budget reflects the transfer of the Unplanned Admissions Direct Enhanced Services (DES) into General Medical Services (GMS) contracts from April 2017 and was presented to the March 2017 Governing Bodies’ meeting.  The Locally Commissioned Services budgets have been uplifted by 1% in line with the nationally agreed uplift for the global sum.  The GPFV budget for 2017-18 is based on national allocations, increased to £2.5m for each CCG. Committee sponsor: John O’Sullivan, Chief Finance Officer Author: Fiona Kellett, Head of Finance and Primary Care Commissioning

Date of report: 10/04/17

Review by other committees: Reviewed by the Primary Care Commissioning Operational Group Health impact: Ensuring a sustainable financial position best enables the CCG to meet the current and future needs of the population. Financial implications: The CCGs have a statutory responsibility to live within their means. Legal or compliance implications: Compliance with financial objectives and duties. Link to key objective and/or principal risks: Financial balance. How has the patient and public engagement informed this work: Not applicable

NHS Eastbourne, Hailsham and Seaford Clinical Commissioning Group NHS Hastings and Rother Clinical Commissioning Group

Equality Analysis (EA) Process - outcome: Negative Impact Neutral Impact Positive Impact ☐ ☐ ☐ EA Summary: Not applicable.

No Impact ☐

Privacy Impact Assessment (PIA) – outcome: No personal data used Data processes sufficient ☒ ☐ Actions: Not applicable.

NHS Eastbourne, Hailsham and Seaford Clinical Commissioning Group NHS Hastings and Rother Clinical Commissioning Group

Not required for report ☒

Actions required ☐

Primary Care Budgets 2017/18 1.

Introduction The CCGs have been notified of the total 2017-18 budgets for delegated cocommissioning by NHS England (NHSE). The CCGs have set budgets for the locally commissioned services which include a 1% uplift in line with the nationally agreed uplift to the global sum. The General Practice Forward View programme budget for 2017-18 is based on the national allocations for specific projects and a CCG contribution giving a total budget of £2.5m.

2.

Delegated Co-Commissioning Budgets 2017-18 The CCGs have been notified of the total 2017-18 budgets for delegated cocommissioning by NHSE which are £26.685m for Hastings and Rother (HR) CCG and £25.311m for Eastbourne, Hailsham and Seaford (EHS) CCG. Both CCGs are required to establish a 0.5% contingency reserve – set at £133k for HR and £127k for EHS. There is no requirement in 2017-18 to deliver a 1% surplus against the Primary Care allocation. The requirement is “statutory breakeven”. The main change from 2016-17 to 2017-18 is the withdrawal of the Unplanned Admissions Direct Enhanced Services (DES) and the transfer of this budget into the General Medical Services (GMS) contract (See Table 1)

3

Table 1 Delegated Primary Care Budgets H&R CCG

GMS / PMS / APMS Enhanced Services QOF Premises Dispensing Other Contingency (0.5%) Reserve Total Confirmed Allocation from NHSE Delegated Primary Care Budgets EHS CCG

GMS / PMS / APMS Enhanced Services QOF Premises Dispensing Other Contingency (0.5%) Reserve Total Confirmed Allocation from NHSE

3.

As at M11 2017 ‐ 18 Changes Revised £000 £000 £000 16,987 1,050 2,879 2,807 1,663 407 129 259 26,181

505 ‐505

4 242 246

17,492 545 2,879 2,807 1,663 407 133 501 26,427

As at M11 2017 ‐ 18 Changes Revised £000 £000 £000 16,753 917 3,060 2,774 268 515 123 378 24,788

560 ‐560

4 276 280

17,313 357 3,060 2,774 268 515 127 654 25,068

Uplift  @ 1% £000 175 5 29 28 17 4

258

Uplift  @ 1% £000 173 4 31 28 3 5

243

Draft Comments 2017‐18 £000 17,667 Unplanned Admission DES transferred 550 to GMS from Enhanced Services 2,908 2,835 1,680 411 133 501 26,685 26,685 Draft Comments 2017‐18 £000 17,486 Unplanned Admission DES transferred 361 to GMS from Enhanced Services 3,091 2,802 271 520 127 654 25,311 25,311

Locally Commissioned Services Budget 2017-18 Budgets for individual schemes for 2017-18 have been based on outturn for 2016-17 adjusted for known changes in activity and agreed pricing changes. Any balance not allocated to specific schemes is held in reserve to cover any over performance in year or agreed pricing changes following review. An uplift of 1% has been applied to the rates paid for LCS schemes in line with the nationally agreed uplift to the Global Sum. The LCS budget for EHS CCG is £5,113m and for HR CCG £5.193m. The detail is shown in Table 2. All LCS specifications are being reviewed to ensure they remain in line with current clinical pathways and this will include a review of the pricing for each scheme if applicable. The Local Medical Committee (LMC) and CCGs are currently reviewing the pricing of four LCSs initially and when agreed any price changes will be reflected in the relevant budgets, backdated to the start of the year.

4

Table 2

Anti‐Coag Artial Fibrilation Cardiology Diagnostics COPD CVD (incl ABPM) Dermatology Diabetes DVT ENT Minor Injuries Minor Surgery Near Patient Testing Neonatal Checks Optometry Palliative Care Pharmacy JIC Phlebotomy Wound Care Spirometry Dementia Med & Surg BP Monitoring equip Educational Events Diabetes Training (year of Care Over‐ Accrual from 15‐16 Over 75/Vulnerable Patient Scheme Reserve

 16‐17  Adjusted  Spend  Outturn    £000        1,240             ‐             ‐             ‐              84            772            537              46              59              61            305            104                 1              43             ‐                 4            260            435                 4              50             ‐             ‐             ‐             ‐            941            116

TOTAL

       5,062              51        5,113

EHS CCG LOCALLY COMMISSIONED SERVICES

 Growth  @ 1%  £000              12             ‐             ‐             ‐                 1                 8                 5             ‐                 1                 1                 3                 1             ‐             ‐             ‐             ‐                 3                 4             ‐                 1             ‐             ‐             ‐             ‐                 9                 2

 Start  Annual  Budget     17‐18  £000        1,252             ‐             ‐             ‐              85            780            542              46              60              62            308            105                 1              43             ‐                 4            263            439                 4              51             ‐             ‐             ‐             ‐            950            118

5

HR CCG LOCALLY COMMISSIONED SERVICES Anti‐Coag Artial Fibrilation Cardiology Diagnostics COPD CVD (incl ABPM) Dermatology Diabetes DVT ENT Minor Injuries Minor Surgery Near Patient Testing Neonatal Checks Optometry Palliative Care Pharmacy JIC Phlebotomy Wound Care Dementia Med & Surg BP Monitoring equip Medicines Management LCS (funded BCF) Educational Events Diabetes Training (year of Care Over‐ Accrual from 15‐16 Over 75/Vulnerable Patient Scheme Reserve TOTAL

4.

 16‐17  Adjusted  Spend  Outturn    £000            816             ‐              25            168            221            784            581              30              90              34            328              85                 7              49              38                 4            219            388              50              30              41             ‐             ‐             ‐            923            231        5,142

 Growth  @ 1%  £000                8            ‐            ‐                2                2                8                6            ‐                1            ‐                3                1            ‐            ‐            ‐            ‐                2                4                1            ‐            ‐            ‐            ‐            ‐                9                4              51

 Start  Annual  Budget     17‐18  £000            824             ‐              25            170            223            792            587              30              91              34            331              86                 7              49              38                 4            221            392              51              30              41             ‐             ‐             ‐            932            235        5,193

General Practice Forward View Programme 2017-18 The General Practice Forward View programme budget for 2017-18 is based on the national allocations for specific projects and a CCG contribution giving a total budget of £2.5m. The plan for 2017-18 is shown in Table 3 below

6

Table 3 General Practice Forward View  Budget 2017‐18 Funding CCG Funding £3/head National allocations CCG Additional Funding Total  Estates and Technology Transformation Fund Total including ETTF Planned  Spend Workload Workforce / Service redesign Infrastructure (IM&T and premises) Implementation resource Unallocated at 1/4/17 Total Planned Spend

5.

H&R £000

EHS £000

275 101 2,124 2,500 188 2,688

280 103 2,117 2,500 371 2,871

623 695 697 140 533 2,688

622 695 881 140 533 2,871

Risk A handover of detail related to primary care budgets took place between NHSE and CCGS at the end of 2016-17 and the level of financial risk of an overspend against the total budget appears to be small. The budgets where expenditure can change in-year are:  Premises – NHSE manage a rent review process which is being transferred to delegated CCGs for 2017-18.  Enhanced services – dependent on activity undertaken.  Other GP services – locum services required throughout the year, process being transferred to delegated CCGs for 2017-18  List size adjustments.  Quality Outcomes Framework (QOF) – dependent on the level of achievement by practices. The CCGs continue in discussions with NHSE to assess the risk and to determine whether the 0.5% contingency reserve is sufficient to cover likely pressures.

6.

Summary The Primary Care Commissioning Committees are asked to note the draft 2017-18 budgets for delegated co-commissioning, locally commissioned services and the General Practice Forward View programme

Fiona Kellett, Head of Finance and Primary Care Commissioning 10 April 2017

7

The Primary Care Commissioning Committees of Eastbourne, Hailsham and Seaford CCG and Hastings and Rother CCG meeting together Date of meeting: 26 April 2017

Item Number:

26/17

Title of report: Primary Care Performance Dashboard April 2017 Recommendation: The Committees are recommended to note the position. Executive Summary:  A revised primary care dashboard has been produced and includes a range of indicators covering patient experience and quality indicators that are in the public domain. 

The dashboard has been expanded this month to include data on the national priority areas of diabetes and dementia.



For each indicator, practice specific information is presented alongside the national average for each indicator with the exception of dementia as diagnosis rates are not available at individual practice level.

Committee sponsor: John O’Sullivan, Chief Finance Officer Author: Fiona Kellett, Head of Finance and Primary Care Commissioning

Date of report: 10/04/17

Review by other committees: The report has been reviewed by the Primary Care Commissioning Operational Group Health impact: Not applicable Financial implications: Not applicable Legal or compliance implications: Not applicable Link to key objective and/or principal risks: Not applicable Link to East Sussex Better Together (ESBT) programme: Not applicable

NHS Eastbourne, Hailsham and Seaford Clinical Commissioning Group NHS Hastings and Rother Clinical Commissioning Group

How has the patient and public engagement informed this work: Not applicable Equality Analysis (EA) Process - outcome: Negative Impact Neutral Impact Positive Impact ☐ ☐ ☐ EA Summary: Not applicable. Privacy Impact Assessment (PIA) – outcome: No personal data used Data processes sufficient ☒ ☐ Actions: Not applicable.

No Impact Not required for report ☐ ☒

Actions required ☐

NHS Eastbourne, Hailsham and Seaford Clinical Commissioning Group NHS Hastings and Rother Clinical Commissioning Group

Primary Care Performance Dashboard 1.

Introduction The revised Primary Care Performance Dashboard includes information on patient experience and national clinical priorities of diabetes and dementia. With the exception of dementia information is available at practice level on these indicators and can be assessed against national targets and national averages (Appendices 1 and 2). Where practices are outliers this is followed up by the primary care team in conjunction with CCG colleagues as appropriate. Where practices are performing consistently well, the primary care team will discuss how the practices are managing these issues operationally with a view to cascading best practice and ideas to elsewhere within the CCGs.

2.

Patient Experience

2.1.

Practice Care Quality Commission (CQC) rating This shows the scores received by each practice for each of the five domains within the CQC inspection rating and the overall score. In Hastings and Rother (HR) CCG, 2 practices have received an overall rating of 1 (inadequate) 3 practices received a rating of 2 (requires improvement) and 20 practices received a rating of 3 (good). One practice in HR CCG is awaiting inspection. In Eastbourne, Hailsham and Seaford (EHS), two practices have received an overall rating of 2 (requires improvement), 16 practices have received a rating of 3 (good) and 2 practices received a rating of 4 (outstanding). No practices in EHS CCG are awaiting inspection.

2.2.

Friends and Family test The friends and family test shows the average “recommended” percentage from April 2016 to January 2017. Within HR CCG five practices scored 100% and there were eight practices with a nil return. Within EHS CCG three practices scored 100% and there were three practices with a nil return. It is however important to note that there is a very wide range of response rates. In HR this ranged from two returns (Martin’s Oak Surgery) to 690 returns (Cornwallis Plaza) and in EHS the range is between eight returns (Bridgeside) and 444 returns (Eastbourne Station Health Centre). As Practices are contractually obliged to report the results received from this exercise, the primary care team will be liaising with practices that are showing a nil return and this may result in the issue of remedial notices.

2.3.

GP Patient Survey (Annual) The annual GP patient survey incorporates results from 23 questions related to the general practice. We have chosen the “percentage of patients who would describe 3

their overall experience of this surgery as good” as an indicator of their overall experience. Within HR CCG 8 practices rate below the national average and 18 practices rate on or above the national average (85%). Within EHS CCG 2 practices rate below the national average and 18 practices rate on or above the national average. 2.4.

Patient Access (Annual) From the national patient survey, one question has been chosen “Last appointment was convenient” as an indicator of how easy it is to access a suitable appointment and how satisfied patients are with being able to access a suitable appointment. Within HR CCG 6 practices rate below the national average and 20 rate on or above the national average. Within EHS CCG 3 practices rate below the national average and 17rate on or above the national average.

2.5.

NHS Choices score NHS Choices is a web based facility for patients to record their comments and give a star rating to their practice.

3. 3.1.

Quality Diabetes HR achieved 44.1% of patients achieving the three treatment targets. EHS achieved 41.3% of patients achieving the three treatment targets.

3.2.

Dementia The graph on the summary dashboard shows the current dementia diagnosis rate.as at December 2016 for patients over 65 at CCG level. For HR it is 62.2% and for EHS it is 64.2%. The national average is 67.8%. Dementia diagnosis rates are not currently available at GP practice level. This is because low prevalence counts at some practices result in large swings in diagnosis rates following small changes in the number of diagnoses. The publication of the results of the Cognitive Function and Ageing Study II gave confidence intervals around their estimates of dementia prevalence. The majority of GP practices have counts of registered patients too low for their dementia prevalence estimates to have sufficiently tight confidence intervals that their diagnosis rates could be considered meaningfully distinguishable from a norm.

4.

Conclusion The performance data presented is used as an indicator of practice performance, variation between practices and highlights areas where more detailed follow up with a practice may be required. Future reports will be expanded to include data on how practices are performing in national priority areas of Cancer and Learning Disability health checks. This dashboard will continue to be updated. However both the patient survey and the Quality Outcomes Framework (QOF) data are now only updated annually. This 4

information will be used in reviewing practice performance and shared with practices as part of the practice support visits. Performance data will be reviewed regularly at the Primary Care Commissioning Operational Group (PCCOG) monthly meetings. 5.

Recommendation The Committees are recommended to note the position.

Author: Fiona Kellett, Head of Finance and Primary Care Commissioning Date: 10 April 2017

5

Appendix 1

1

2

3

4

5

6

7

Appendix 2

8

9

10

11

12

13

14

The Primary Care Commissioning Committees of Eastbourne, Hailsham and Seaford CCG and Hastings and Rother CCG meeting together Date of meeting: 26 April 2017

Item Number:

27/17

Title of report: Monitoring Performance and Quality in Primary Care –  Quarter 4 2016 - 2017 (January 2017 - March 2017) update

Recommendation: The Committees are recommended to note the progress made in relation to the Practice Support for 2017/18.

Summary:  This paper provides the Primary Care Commissioning Committees (PCCC) with an update on the process identified in the Managing General Practice Performance and Quality under Delegated Commissioning Responsibilities Policy. Quarter 1 2017 - 2018 (April 2017 – June 2017) update  Practices have been prioritised for Practice Support Visits using criteria as detailed in the policy. At the time of this report 2 practices (both CQC rated as requires improvement) have received a support visit utilising a self-assessment template, the information governance toolkit, the practices latest CQC report and details from the practices edeclaration. Any outliers in Quality and Outcome Framework achievement and the Patient Satisfaction Survey are discussed alongside the practices plans for transformation and resilience in Primary Care. 

Practice visits have commenced in April 2017 with practices prioritised using CQC rating and evidence from the practice performance dashboard.



Infection Control Champions training courses were held in February with an additional session in May 2017. A total of 43 practices will have attended the training.



The Infection Control environmental tool was piloted and launched in December 2016.



The Infection Control accreditation programme will be launched in May 2017 to assist practices with CQC compliance.



The CCG has received raw data regarding GP complaints via NHS England. This information will be reviewed and analysed by the CCG Quality team and a further update will be provided in the next iteration of this report.

NHS Eastbourne, Hailsham and Seaford Clinical Commissioning Group NHS Hastings and Rother Clinical Commissioning Group

1

Committee sponsor: John O’Sullivan, Chief Financial Officer Author(s): Nicola Hone, Primary Care CoCommissioning Strategic Manager and Adrian Leah, Quality Manager

Date of report: 10/04/17

Review by other committees: Reviewed by the CCGs ’Primary Care Co-Commissioning Operational Group (PCCOG). Health impact: Improving the quality of primary care is essential for improving the quality and health outcomes for the residents who use these services. Financial implications: Where residents do not achieve optimal health outcomes and quality there are inherent additional costs to the health system. Legal or compliance implications: GP practices are required to comply with the Care Quality Commissions Fundamental Standards of Quality and Safety. Link to key objective and/or principal risks: Improving Quality and Safety and Supporting Practices. Link to East Sussex Better Together (ESBT) programme: The information contained within this report underpins the principles of the ESBT programme to provide high quality and safe patient care to the residents within East Sussex. How has the patient and public engagement informed this work: Sources of patient experience feedback and engagement information features within the Quality Assessment Tool referred to in this report. Equality Analysis (EA) Process - outcome: Negative Impact Neutral Impact Positive Impact ☐ ☐ ☐ Privacy Impact Assessment (PIA) – outcome: No personal data used Data processes sufficient ☒ ☐

No Impact Not required for report ☐ ☒

Actions required ☐

2

NHS Eastbourne, Hailsham and Seaford Clinical Commissioning Group NHS Hastings and Rother Clinical Commissioning Group

Monitoring Performance and Quality in Primary Care – Quarter 1 2017 - 2018 (April 2017 - June 2017) 1.

Introduction

1.1

This paper provides an update following the paper on managing Quality and Performance in Primary Care which was submitted to and approved by Committees at their meeting in October 2016. A record of Care Quality Commission (CQC) and practice visits conducted within each CCG is attached in Appendices one and two.

1.2

Moving forward towards the East Sussex Better Together (ESBT) Alliance model the CCGs Quality and Performance Team will be working closely with the GP Federations to enable improvement in Performance and Quality within Primary Care. Currently there is one federation serving Eastbourne, Hailsham and Seaford (EHS) CCG and three federations serving Hastings and Rother (HR) CCG:

2. 2.1

Progress to date The CCG Practice Support Visit team membership has remained consistent and is as follows:  Primary Care Co-Commissioning representative;  Quality Directorate representative;  GP Board member;  Medicines Management representative;  Finance representative; and  Any other CCG staff member who may wish to discuss specific issues. The format of the meeting has been revised following feedback from:   

The CCG’s practice support team The practices The practice operational forum.

The agenda is split between contractual and quality with, unless specifically requested, the contract team only attending the contractual section and the quality team their section. We will ask for feedback following the first quarter’s visits to ascertain how the new format has been received. 2.2

Practices to receive a support visit are identified using any of the following agreed criteria:  Outliers identified on the CCG Performance Reporting Dashboard;  A CQC visit resulting in improvements required;  A trend of significant events and/or patient complaints;  Practice request; and  Highlighted GP contractual issues.

2.3

At the time of this report two Practice Support visits have been undertaken with practices in EHS and HR CCG with a further three scheduled for the month of April.

1

NHS

3.

Outcomes

3.1

A practice action plan will be agreed with each practice and a report summarising the issues as they arise will be submitted quarterly to the PCCC.

4.

Primary Care Quality Improvement

4.1 Quality Standards 4.1.1 Work to engage GPs in relation to improving the identification, escalation and management of Sepsis continues. The CCG Quality team has ensured that the April/May 2017 Locality meetings where the further engagement will be sought from GPs. Sepsis as a topic area has also been included within the self-assessment documentation for the annual GP contract and quality review. 4.1.2 The CCG Quality team is currently developing a full business case for the introduction of a Primary Care Sepsis Quality standard. 4.1.3 The draft standard has also been forwarded to the Health Education England (Kent, Surrey and Sussex) Sepsis lead as an example of improvement work within East Sussex to support a wider regional piece of work to improve the level of Sepsis prevention and care across the south east of England. 5.

Infection Control

5.1 Infection Control Champions 5.1.1 Infection Control Champions training courses were held in February with an additional session in May 2017. 5.1.2

A total of 43 practices will have attended the training which included management of Legionella within water systems, cleaning and decontamination within practices and reduction of gram negative bacteraemias.

5.2 Infection Control environmental tool 5.2.1 The Infection Control environmental tool was piloted and launched in December 2016. 5.2.2 The audit tool was launched to standardise the audit process across East Sussex and to provide an updated tool that reflect current national guidance. 5.3 Infection Control accreditation programme 5.3.1 The Infection Control accreditation programme will be launched in May 2017. This programme is a voluntary accreditation programme which will assist practices with CQC compliance. 5.3.2 The programme consists of three levels for practices to work towards and a certificate will be awarded once evidence has been assessed by the Lead Quality and Infection Control Nurse. 6.

Medicines Management 2

NHS

6.1 Medicines Optimisation Strategy (2015-18) 6.1.1 A progress report on the implementation of the Year Two of the Medicines Optimisation Strategy (2015-18) was presented to the CCGs Governing Bodies in March. 6.1.2 The report detailed how the strategy aimed at improving quality through patientcentred medication reviews, has in turn released significant financial efficiencies. Both CCGs have greater reductions in prescribing cost growth than the national average whilst demonstrating significant improvements in quality through. 6.1.3 Projects of particular note in 2016/17 include: 

Patient-centred pain management reviews Over 500 patients taking strong opioids have had an individual review with their GP. This project realised £137,000 efficiencies in the Primary Care prescribing budget;



Medicines Optimisation in Care homes service The service is growing on target to be fully staffed and delivering the target of 400 multidisciplinary polypharmacy reviews per month. An average of four recommendations per patient is discussed with the GP to “stop, start or change” medication and 96% of these are accepted. The reviews undertaken during February 2016 realised an average of £130,000 savings in prescribing costs per patient per year whilst reducing the risk of harm from inappropriate polypharmacy.



Oral nutrition reviews A dietitian has personally reviewed over 100 patients prescribed food supplements by their GP. The work has received very positive feedback from both patients and practices and released over £50,000 in savings.

6.2 Prescribing Decision Support Software 6.2.1 The Medicines Management team is currently rolling out a new Prescribing Decision Support Software that aims to improve the safety and quality of prescribing. 6.2.2 The new system (OptimiseRx) has significant advantages over the old system (Scriptswitch) as it fully integrates with EMIS which allows it to tailor its messaging to individual patients. The system has been successfully piloted in six practices and will be rolled out across both CCGs over Quarter One, 2017/18. 7. 7.1

8 8.1

NHS England GP Complaints The CCG has recently received raw data regarding GP complaints via NHS England. This information will be reviewed and analysed by the CCG Quality team and a further update will be provided in the next iteration of this report. Recommendations The Committees are recommended to note the progress made in relation to the …..Practice Support Visits conducted to date 3

NHS

Author(s): Nicola Hone, Primary Care Co-Commissioning Strategic Manager and Adrian Leah, Quality Manager. Report date: 10 April 2017

4

NHS

Appendix One: EHS CCG CQC Status EASTBOURNE, HAILSHAM AND SEAFORD CLINICAL COMMISSIONING GROUP

Practice Name & Address

CQC Visit

Current List Size

CQC Outcome

CQC Report Published

HAILSHAM LOCALITY BRIDGESIDE SURGERY

12.1.2016

6381

Good

25.4.2016

Practice Support Visit

Code, List List Closure Status & Closure or capping Details of any current Previous list closures /capping Clinical in place applied for contractual issues System Yes / No Yes/ No G81012 6 month temp list closure - June Nov 2015 List closure lifted Jan 2017 6 month temp list closure - July 2016 - Jan 2017

HAILSHAM MEDICAL GROUP

15.10.2015

12118

Good

7.4.2017

20.4.17

G81059

QUINTINS SURGERY HERSTMONCEUX HEALTH CENTRE EASTBOURNE LOCALITY

16.9.2016 29.9.2016

8397 4151

Requires Improvement Outstanding

25.10.2016 31.1.2017

26.4.17

G81098 G81634

02.12.2014 Desk top review Nov 2015

11924

Good

10.12.2015

G81050

23.10.2015

5492

Good

14.1.2016

G81027

Yes

DOWNLANDS MEDICAL CENTRE

4.8.2016

10706

Good

1.9.2016

G81004

Yes

EASTBOURNE STATION HEALTH CENTRE

28.7.2016

3511

Good

19.10.2016

Y02816

ENYS ROAD SURGERY GREEN STREET CLINIC

18.08.2015 1.3.2016

8350 10338

Good Good

12.11.2015 17.6.2016

G81056 G81032

GROVE ROAD SURGERY

12.4.2016

7361

Good

22.6.2016

G81002

24.09.2013 21.6.2016 Jan 2014 and 03.07.2014 30.3.2016

6758 15370 6982 11043

Requires Improvement Outstanding good Good

17.3.17 22.8.2016 10.03.17 22.6.2016

SEASIDE MEDICAL CENTRE

16.2.2016

11570

Good

25.5.2016

G81017

SOVEREIGN PRACTICE

26.4.2016

14431

Good

29.6.2016

G81022

STONE CROSS SURGERY

26.1.2016

11927

Good

11.5.2016

G81008

SEAFORD LOCALITY OLD SCHOOL SURGERY SEAFORD MEDICAL PRACTICE

24.2.2016 29.04.2015

10088 17742

Good Good

16.6.2016 25.6.2015

G81099 G81029

ARLINGTON ROAD MEDICAL PRACTICE BOLTON HOUSE SURGERY

HARBOUR MEDICAL PRACTICE LIGHTHOUSE MEDICAL PRACTICE MANOR PARK MEDICAL CENTRE PARK PRACTICE

1

NHS

10.4.17

Yes

March 17 - Applied for list closure Practice applied for list closure Jan 2017 Reached contractual registered list size

Practice has lifted the list cap 1.2.2017.

3 month closure (ends 1 May 2017)

Yes

Y00080 G81003 G81049 G81104 Yes

List closure application decllined Sept 2016 3 month temp list closure - Aug Oct 2015

Appendix Two: HR CCG CQC Status HASTINGS & ROTHER CLINICAL COMMISSIONING GROUP Code, Status & Clinical System

CQC Visit

Current List Size

CQC Outcome

CQC Report Published

17.11.2015 and 12.1.2016

7145 15348

Good Good

17.5.2016 19.4.2016

G81077 G81039

15.12.2015 and 6.9.2016

8950

Good

15.3.2016 and 27.10.2016

G81025

Aug-16

15899

Requires improvement

11.1.2017

No date set 19.8.2016

4084 3580

Awaiting visit Good

G81052 G81085

13.1.2016 & 23.8.16

8190

Good

Not visited yet 7.10.2016 31.3.2016 & 31.10.16

05.01.2016

6246

Good

17.3.2016

G81087

5.4.2016 7.9.2016 5.5.2016

5381 6902 5953

Good Good Good

8.6.2016 20.10.2016 17.6.2016

G81082 G81051 G81057

08.12.2015 & 26.7.16

5202

Requires improvement

1.3.2016 27.7.2016

10129 3271

Good Good

18.2.2016 & 8.11.16 27.4.2016 21.10.2016

Due Oct - Dec 16

8327

Good

PRIORY ROAD SURGERY

08.12.2015 and 6.4.2016 and August 2016

2667

Good

ROEBUCK HOUSE SURGERY

27.10.2015 and 1.3.2016 and August 2016

3844

Special Measures

15.4.2016

6992

Good

Remains in special measures CQC re-visit 1.2.2017 16.6.2016

10.11.2016 03.11.2015 23.02.2016 19.04.16 Dec-16

7625 5818 7017 3626 6795

Good Good Good Good Special Measures

10.1.2017 14.1.2016 27.4.2016 10.6.2016 16.3.17

G81048 G81105 G81074 G81096 G81033

SOUTH SAXON HOUSE SURGERY

2.2.2016

2836

Good

21.4.2016

G81089

WARRIOR SQUARE SURGERY ST LEONARDS LOCALITY/HASTINGS LOCALITY CORNWALLIS Plaza SURGERY SHANKILL SURGERY ESSENDEN ROAD SURGERY LITTLE RIDGE SURGERY *Practice operated by Integrated Care 24 (IC24)

15.6.2016

7373

Good

22.7.2016

G81026

9.2.2016 24.09.2014 Not visited Not visitied

14922

Practice Name & Address

BEXHILL LOCALITY COLLINGTON SURGERY LITTLE COMMON/OLD TOWN PEBSHAM SURGERY SIDLEY MEDICAL PRACTICE RURAL ROTHER LOCALITY FAIRFIELD SURGERY FERRY ROAD HEALTH CENTRE MARTINS OAK SURGERY NORTHIAM & BROAD OAK SURGERIES OLDWOOD SURGERY RYE MEDICAL CENTRE SEDLESCOMBE & WESTFIELD SURGERIES HASTINGS LOCALITY BEACONSFIELD SURGERY HAROLD ROAD SURGERY HASTINGS MEDICAL PRACTICE AND WALK-IN CENTRE* HASTINGS OLD TOWN SURGERY

THE STATION PRACTICE ST LEONARDS LOCALITY CARISBROOKE SURGERY CHURCHWOOD MEDICAL PRACTICE HIGH GLADES MEDICAL CENTRE SEDLESCOMBE HOUSE SURGERY SILVER SPRINGS MEDICAL PRACTICE

3316

10.4.17

List List Closure Closure or capping Details of any current contractual in place applied for issues Yes / No Yes/ No

Yes

Temp list closure 12 months Dec 15

G81023 Boundary change requested and agreed. Ratified at PCCOG October 2016

Boundary change request to be made larger March 2017

G81084 Yes

10.3.2017

G81095

Yes

12.1.2017

G81641

Yes

G81651

Yes

28.4.17

25.4.17 28.10.2014

Change in partnership requested

Recent change in partnerhip requested

G81658

19.5.2016 Requires improvement

Previous List closures / capping

capped list for 3 months April - July 2017

G81041

G81031 Y03051

2

NHS

Practice Support Visit

G81013

Yes

To be re-inspected by CQC at new premises

Temp list closure declined Sept 2016

The Primary Care Commissioning Committees of Eastbourne, Hailsham and Seaford CCG and Hastings and Rother CCG meeting together Date of meeting: 26 April 2017

Item Number:

28/17

Title of report: Primary Care Commissioning Operational Group (PCCOG) summary update – April 2017 Recommendation: The Committees are recommended to note the summary update. Summary 1. The Primary Care Commissioning Committees (PCCC) delegate some operational responsibilities related to the delegated commissioning of primary medical services to PCCOG. These operational responsibilities include contract variations such as list closures and boundary changes; issuing of breach and remedial notices; and undertaking of the practice support visits and day to management of the GP contracts. 2.

PCCOG discusses a number of issues including Quality and Performance, Finance, Workload, Premises and Information Management and Technology (IM&T) that are the subject of other reports to the Committees. Minutes of PCCOG meetings are submitted to Part 2 of this meeting.

3.

This summary report provides an update on key issues and decisions considered by PCCOG.

4. 4.1

Update on key issues and decisions: The Primary Care and Quality Teams continue to support all practices having received “Requires Improvements” CQC rating.

4.2

The second round of practice support visits commenced on 10th April and details of the format of this year’s visits are found in the Managing Performance and Quality paper submitted to this committee.

4.3

Workload and workforce pressures within practices continue to lead to various discussions and options for managing current pressures. Details on specific workforce and workload schemes are covered in the General Practice Forward View (GPFV) update. 1

NHS Eastbourne, Hailsham and Seaford Clinical Commissioning Group NHS Hastings and Rother Clinical Commissioning Group

4.4

Two practices in EHS and one practice in HR have been awarded GP resilience monies to enable them to resource a diagnostic review of the running of the practice. Each practice will initially work with an external company to undertake the diagnostic review and develop an agreed action plan. Action plans will be made available to PCCOG to ensure appropriate solutions are supported. As at the date of this report only one practice has received the diagnostic report and they are working with the Primary Care Team in implementing appropriate actions.

4.5

The ‘GP Career Plus’ initiative being facilitated by the Hastings Federation (Integrated Family Health Care Limited) has had their working proposal agreed. Further NHS England (NHSE) workshops are planned for April where mobilisation of the projects will be discussed. One of the GP registrars on their four month placement with the CCG is interviewing local GPs to ascertain what would encourage GPs to support the GP Career Plus initiative.

4.6

The EHS and HR walk in centre (WIC) contracts are due to expire on 31 March 2018. A proposal was agreed at the Governing Body meeting in March to extend the contracts a further 6 months to enable appropriate models of Primary Care to be developed and procured. Over the next 6 months the Urgent Care re-design team and Primary Care will work closely with all stakeholders to ensure an appropriate, sustainable service is commissioned.

4.7

The Primary Care Team is working closely with practices struggling to recruit GPs to enable appropriate provision of services. Details of the offers to support these practices are referred to in the General Practice Forward View (GPFV) paper submitted to this committee.

4.8

A GP in Hastings has been suspended by the GMC following an in-depth review of the working practice. The patients are being cared for by a partner on the contract and the practice is being supported by the CCG and Local Medical Committee (LMC)

4.9

Discussion is being had in the Primary Care Team as to extra resources required to be able to deliver further responsibilities which have been delegated by NHSE to the CCG as of 1 April 2017.  Allocation of patients  Reimbursement of rent and rates  Management of the Special Patient Scheme for both CCGs

Committee Sponsor: John O’Sullivan, Chief Finance Officer Author(s): Nicola Hone, Primary Care CoCommissioning Strategic Manager

Date of report: 10/04/17

Review by other committees: Reviewed by the CCGs’ Primary Care Commissioning Operational Group Health impact: Ensuring a sustainable primary care estate best enables the CCGs to meet the current and future needs of the population.

2 NHS Eastbourne, Hailsham and Seaford Clinical Commissioning Group NHS Hastings and Rother Clinical Commissioning Group

Financial implications: The CCGs have a statutory duty to maintain financial balance. Legal or compliance implications: Compliance with statutory duties. Link to key objective and/or principal risks: Sustainability of primary care. Link to East Sussex Better Together (ESBT) programme: Ensuring a sustainable primary care estate best enables the CCGs to meet the current and future needs of the population. How has the patient and public engagement informed this work: Contractual issues are addressed following NHS policy and patient and public engagement is undertaken following NHSE guidance. Equality Analysis (EA) Process - outcome: Negative Impact Neutral Impact Positive Impact ☐ ☐ ☐ Privacy Impact Assessment (PIA) – outcome: No personal data used Data processes sufficient ☒ ☐

No Impact Not required for report ☐ ☒ Actions required ☐

3 NHS Eastbourne, Hailsham and Seaford Clinical Commissioning Group NHS Hastings and Rother Clinical Commissioning Group

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A meeting of the Primary Care Commissioning Committees of the

A meeting of the Primary Care Commissioning Committees of the Eastbourne, Hailsham and Seaford (EHS) and Hastings and Rother (HR) Clinical Commissioni...

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