agenda - suttonccg.nhs.uk · forward plan sian hopkinson 10 agenda page 1 of 51. for information 14...

SUTTON CLINICAL COMMISSIONING GROUP

PRIMARY CARE COMMISSIONING COMMITTEE

Wednesday 14 March 2018, 11:00am-1:00pm

Meeting Room 1, Priory Crescent, Cheam, Sutton SM3 8LR

AGENDA (PART 1) Chair: Sally Brearley

Report Author Presented by ENC

WELCOME & INTRODUCTIONS

1. Welcome & Apologies for Absence

Susan

Gibbin

2. Register of Declared Interests

Primary Care Committee members are asked to

declare if their entry upon the Register of Declared

Interests (attached) is not a full, accurate and

current statement of any interests held.

Jane Walker Susan

Gibbin 01

3. Minutes of previous meeting

To approve the minutes of the Sutton Clinical

Commissioning Group Primary Care

Commissioning Committee meeting held on 10

January 2018.

Jane Walker Susan

Gibbin 02

4. Matters Arising

To review any matters arising and the action log

following the meeting held on 10 January 2018.

Jane Walker Susan

Gibbin 03

FOR APPROVAL

5. Terms of Reference

• Primary Care Quality Surveillance Group

04

6. Community Education Providers Network (CEPN) Governance Report

05

FOR DISCUSSION

7. Locum Payments William Cunningham-Davis 05a

8. Primary Care Finance Report Geoff Price 06

9. Primary Care Risk Register Chux

Ebenezer

(NELCSU)

Sian

Hopkinson 07

10. Primary Care Transformation and Estates

update

Lou Naidu 08

FOR NOTE

11. Engagement Scheme Sian Hopkinson Verbal

12. Primary Care Operational Management Group

Report

Carolyn Reynolds 09

13. Forward Plan Sian Hopkinson 10

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FOR INFORMATION

14. Questions from the Public Members of the public can submit questions relating to

the agenda if raised with the Chair 48 hours prior to the

meeting. The Chair will make every effort to ensure

questions are responded to at the meeting however

there may be occasions where time constraints preclude

this. If a question cannot be answered at the meeting, or

a fuller response is required, a written reply will be sent

as soon as possible.

Susan Gibbin

ANY OTHER BUSINESS & CLOSE

15. Any Other Business

16. Meeting Close

17. Date of Next Meeting

The next meeting of the Primary Care

Commissioning Committee in public will take place

on Wednesday 16 May 2018, 1:00-3:00pm, at

Priory Crescent, Cheam, Sutton SM3 8LR

Closure of Part I To resolve that the public now be excluded from the meeting, on the basis that publicity would be prejudicial to the

public interest by reason of the confidential nature of the business to be conducted in the second part of the agenda.

Future meeting dates:

Third Wednesday in the month, 1:00-3:00pm at Priory Crescent:

PRIMARY CARE COMMISSIONING COMMITTEE IN PUBLIC, 1:00-3:00pm

Wednesday 16 May 2018 Wednesday 21 November 2018

Wednesday 18 July 2018 Wednesday 16 January 2019

Wednesday 19 September 2018 Wednesday 20 March 2019

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Register of Interests

NHS Sutton CCG’s Register of Interests are made publicly available at the Governing Body meetings of the CCG and can be found at

http://www.suttonccg.nhs.uk/News-Publications/publications/Key%20publications/DECLARATIONS%20OF%20INTEREST%20-%20January%202016.pdf

The Register is maintained by the Head of Corporate Governance. The Register is constructed in line with the CCG’s Constitution and Conflicts of Interest

Policy which can be found at

http://www.suttonccg.nhs.uk/News-Publications/publications/Key%20publications/GB%20Approved%20SCCG%20Conflicts%20Of%20Interest%20Policy.pdf

The Register contains details of all members of the CCG’s formal committees and the Governing Body itself. The interests of those individuals that are in

attendance only will be captured in the minutes of the meeting concerned.

Name

CoI Form

Completed / Updated

Position Held Declaration of Interest Membership

Date CoI training

Completed/ Received certificate

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Pippa Barber 01.12.17 Governing Body – Independent Nurse

• Director THF Health Limited

• Non-Executive Director at Kent Community NHS Foundation Trust

• Media appearances in previous role within NHS

✓ ✓ ✓ ✓ 1 March 2018

Eleanor Barnard

29.01.18 GP Executive Member - Mental Health Lead

• Salaried GP, Maner Practice ✓

Sarah Blow 25.01.18 Accountable Officer (1 April 18)

• Trust Governor for Greenshaw Learning Trust ✓ ✓ Held by SWL Alliance

Sally Brearley 07.12.16 Lay Member – Patient & Public Engagement and Chair of the Quality Committee

• National Nursing Research Unit, Kings College. London - Visiting fellow

• Member, NHS England Clinical Priorities Advisory Group

• Chair, NHS England London Region Health in the Justice System Patient and Public Voice Group

• Fellow in Patient and Public Involvement, Faculty of Health, Education and Social Care, Kingston University and St George's University of London.

• Member of the South London Health Innovation Network Musculoskeletal Advisory Board

• Patient representative, NHS 11 Futures/Digital Urgent Care Board.

✓ ✓ ✓ ✓

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Reviewed: 12 March 2018 Jane Walker, Head of Corporate Governance

Name

CoI Form

Completed / Updated


Date CoI training


Go

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Annette Brown Healthwatch representative

• No interests to declare. ✓

Dr Robert Calverley

Wallington Locality Lead

• GP partner at Manor Practice (1.11.16)

• Member of Sutton GP Services Ltd

• GP Trainer.

✓

Imran Choudhury (updated

08.03.2018 Director Public Health

• Commissioner of GP services via London Borough of Sutton Public Health budget

✓ ✓

Dr Jonathan Cockbain

GP Board Member Carshalton Locality Lead

• GP Partner – Chesser GP Practice


• Wife employed by Sutton College working as ESOL tutor.

✓ ✓ ✓

Dr Jeffrey Croucher

Clinical Chair • GP Partner at Benhill and Belmont GP Centre

• Benhill and Belmont GP Centre is a Member of the Sutton GP Federation

• Wife is a Consultant Gynaecologist/Infertility services at Epsom and St Helier’s NHS Trust and is Clinical Director for Women’s Health

• Received a research grant from the Health Innovation Network in 2015/2016 for Musculoskeletal clinical services in Sutton

• Project Lead for the Belmont surgery, in developing the new Belmont GP Centre

• GP Trainer and occasionally supervise OOH shifts in SELDOC for GP Trainees.

✓ ✓ ✓ 22 Feb 2018

Dr Chris Elliott Chief Clinical Officer

• No interests to declare. ✓ ✓ ✓ ✓

Dr Simon Elliott

21.09.16 Independent GP Advisor


Susan Gibbin Lay Member - Performance

• Director – Susan Gibbin Consultancy Ltd

• Corporate consultancy support to Carnall Farrar, Strategic Health and Care Consultancy

• Trustee and Board member of the Bourne Education Trust

• Chair of Governors – Downs Way School, Oxted.

✓ ✓ 1 March 2018

Mary Hopper 13.11.17 Director of Quality

• No interests to declare. ✓ ✓

Dr Senthooran Kathirgama Kanthan

Sutton and Cheam Locality Lead

• GP Partner Well Court Surgery


• GP Tutor St George's University of London.

✓

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Name

CoI Form

Completed / Updated


Date CoI training


Go

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Sean Morgan 15.11.17 Director of Performance & Delivery


James Murray 25.01.18 Chief Finance Office (1 April 18)

• Director, MPL

• Associate Director, Prolex Consultancy,

✓ ✓ ✓ Held by SWL Alliance

Dr Dino Pardhanani

GP Board Member

• GP Partner - Mulgrave Road. ✓ ✓ ✓

Geoff Price 31.01.17 Chief Finance Officer

• Daughter working in a nursing post with Epsom and St Helier NHS Trust at Epsom hospital.

✓ ✓ ✓ ✓ ✓

Dr Les Ross Lay Member – Secondary Care Consultant

• No interests to declare. ✓ ✓ ✓ ✓ ✓ ✓ 27 Feb 2018

Paul Sarfaty Lay Member – Governance and Audit, Vice Chair and Chair of the Audit Committee

• Feughside Limited – Director and Shareholder

• Consultancy through Feughside Limited.

• Trustee of St George's Hospital Charity

✓ ✓ ✓ ✓ ✓ ✓ ✓

Dr Roshni Scott

GP Executive Member


• GP Partner - Dr Scott & Partners

• Husband- clinical director planned care Merton CCG (includes MOT).

• Husband to join partnership - Dr Scott & Partners (01.04.17)

• Member Triage Panel Richmond GP Alliance

✓ ✓

Karol Selvey Primary Care Nurse Board Member

• Partner at The Old Court House - Dr Grice & Partners

• Member of Sutton GP Services Ltd.

✓ ✓ ✓

Lucie Waters Managing Director

• No interests to declare. ✓ ✓ ✓ ✓ ✓

David Williams

02.03.18 Chair - Healthwatch (Participating Observer)

• Member of Old Court House Surgery Patient Participation Group

• Vice Chair, Patient Reference Group

• Vice Chair, Sutton Health and Wellbeing Bard

• Chair Healthwatch Sutton

• Appearances on Radio St Helier on behalf of Healthwatch Sutton

• Son is Senior Planning Officer with the London Borough of Sutton.

• Ownership/part ownership in Alexander Grant Management Services

✓

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Name

CoI Form

Completed / Updated


Date CoI training


Go

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Clare Wilson 10.01.17 Deputy Chief Operating Officer (Interim)

• Director/Owner Chamberlain Partners Ltd. ✓

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MINUTES OF THE SUTTON CLINICAL COMMISSIONING GROUP

PRIMARY CARE COMMISSIONING COMMITTEE

Wednesday 10 January 2018, 11:00am – 1:00pm Meeting Room 1, Priory Crescent

Present

Voting Members:

Pippa Barber PB Governing Body Member - Independent Nurse

Sally Brearley SB Chair Primary Care Commissioning Committee, Lay Member Patient & Public Involvement

Dr Simon Elliott SE Independent GP Advisor

Susan Gibbin SG Lay Member, Performance

Dr Clare O’Sullivan COS General Practitioner, Mulgrave Road Surgery

Geoffrey Price GP Chief Finance Officer

Rebecca Lawrence RL Public Health, London Borough of Sutton (LBS)

Paul Sarfaty PS Vice Chair Primary Care Commissioning Committee, Lay Member Governance & Audit

Lucie Waters LW Managing Director

Non-voting Members:

William Cunningham-Davis

WCD Head of Primary Care, NHS England

Dr Rebekah Dowdy RD Sutton Local Medical Committee (LMC)

David Williams DW Healthwatch representative

In Attendance

Lynn Jackson LJ Locality Manager

Lou Naidu LN Primary Care Transformation Project Manager

Sian Hopkinson SH Associate Director of Primary Care

Carolyn Reynolds CR Head of Primary Care Commissioning

Karol Selvey KS Governing Body member, Nurse Practitioner

India Peach IP CEPN Project

Apologies

Ken Collins KC PRG Representative

Ashley Dickenson AD Patient Representative

Dr Prashanth Sathiagnanam

PrS Salaried GP, Sutton

Welcome & Introduction

1. Welcome and Apologies SB welcomed members, both voting and non-voting, to the meeting in public of the Primary Care Commissioning Committee (PCCC). Apologies were noted as detailed above.

2. Register of Declared of Interest The Register of Interest was agreed as a correct and accurate record.

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DW confirmed that he was no longer the Chair of the patient reference group but had been co-opted as a member. The register of declared interests would be amended to reflect this change. RD confirmed that she was a partner at the Cheam Family Practice.

JW

3. Minutes of previous meeting The minutes of the Sutton CCG PCCC meeting held on 1 November 2017 were agreed as an accurate record.

4. Matters Arising Action Log It was noted that the action log would be updated and submitted to the next meeting of the PCCC with a number of items being covered elsewhere on the agenda. Quality Primary Care Indicators It was noted that the first meeting of the Primary Care Clinical Quality Review Group had been held with a report being presented to the next meeting of the PCCC. Extended Access Performance It was noted that a text messaging solution had been ordered which would then be implemented. A meeting had been arranged to look at equity across practices. LN also reported that a direct booking system via 111 was being considered which would be piloted by a number of practices before being rolled out.

SH

For Approval

5. Primary Care Strategy SH introduced the strategy for primary care commissioning in Sutton which the PCCC had seen previously during its development and was now finalised for approval. The strategy had been discussed at all three locality meetings and the London Borough of Sutton Scrutiny Committee who support the direction of travel. The strategy was also presented at the Patient Reference Group. SH confirmed that the implementation plan would be updated regularly and reported back to the PCCC. It was acknowledged that there was a need to ensure changes were in-bedded across whole system to ensure the benefits were achieved. It was suggested that an item for the next seminar of the PCCC should be to discuss implementation areas and priorities. SH agreed to discuss this with SB and SG outside of the meeting. Members of the committee raised the following key points:

SH

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• The need for key performance indicators (KPIs) behind some of the outcomes to understand what had been achieved.

• The need to ensure regular engagement with secondary care especially in relation to the impact on referral patterns.

• The need to engage with the Sutton Health & Care Transformation Board.

• If approved, the Old Court House to be included within the implementation plan regarding premises development.

• The need to ensure better communication between primary and secondary care.

• To ensure Quality Alerts provide good quality feedback and assurance.

LW confirmed that there was some new funding for 18/19 to support the Primary Care Strategy but was a limited amount across SW London. A business case would need to be developed by the Primary Care Team to secure any funding and include three key elements:

• Service components

• Programme costs

• Provider development. RECOMMENDATION The PCCC APPROVED the Primary Care Strategy prior to submission to the Governing Body meeting in March to note for information.

6. Old Court House Development Business Case LN presented the Old Court House development business case which had now been amended following the discussion and queries raised at the recent PCCC seminar. It was noted that the Practice’s preferred option is to reconfigure the

current surgery and expand into the void space to improve patient flow

within the building and create five additional clinical rooms. This

would create sufficient capacity on the site to accommodate all

patients plus expansion space for significant numbers of new patient

registrations, allowing them to close their branch surgery at Robin

Hood Health Centre.

By operating on one site only, the practice would be more efficient and

this would support long term resilience for the practice.

By vacating Robin Hood Health Centre, this would create the

opportunity to reconfigure the space to bring more of the ground floor

into clinical use, and hence provide additional clinical capacity for new

registrations on that site for Dr Seyan’s practice.

The solutions presented in the business case provide increased primary care capacity in Central Sutton which would meet the needs of the growing population.

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The following key points were raised and discussed by members of the PCCC:

• There was a clear strategy in place in inform and engage patients of the proposed changes including patient letters, practice newsletters, newspaper articles , meetings etc.

• Planning permission was currently in place but was time limited before it expired. It was estimated that the construction and build would take approximately nine months.

• It was confirmed that the finance team had been involved and confirmed that the business case aligns with the Primary Care Strategy and Value for Money (VFM).

• It was important for the CCG that practice growth takes place as key component for the Primary Care strategy in Sutton.

• The need to ensure other practices are not disadvantaged and ensure communication is clear in relation to the options for patients.

• It was confirmed that during construction there would be limited disruption to patient services due to the two sites.

RECOMMENDATION The PCCC APPROVED the business case subject to:

• Value For Money recommendation and Valuation by the

District Valuer

• Agreement of Heads of Terms between the landlord and

the tenant

7. Well Court and James O’Riordan Practice Merger Business Case LJ attended the meeting and introduced the Well Court and James O’Riordan Practice Merger Business Case. LJ informed the PCCC that the Well Court Surgery has submitted a

business case to merge with James O’Riordan Medical Centre, which

is a Merton CCG practice, with the merged practice becoming a

Sutton CCG practice. The practices are 0.6 miles apart, on the same

road and the same bus routes.

The business case provided details of the benefits for patients and for

the resilience of the combined practice. The proposal was for all staff

and patients from Well Court Surgery (2290 patients) to move to the

James O’Riordan Medical Centre (6870 patients), which is a relatively

new purpose built health centre with good patient facilities and the

capacity to accommodate the combined list size of approximately

9,000 patients.

LJ stated that it was important to note that because the merged

Practice would be a Sutton CCG Practice, the responsible

commissioner for all the patients would be Sutton CCG with Sutton

CCG meeting the NHS health care costs of these patients.

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There are patient and business benefits anticipated from the merger,

however the transfer of nearly 7,000 patients from Merton CCG to

Sutton CCG cannot be approved without an appropriate transfer of

resources. CCG allocations are not automatically updated for such

transfers.

Key points raised and noted by the PCCC included:

• More work needed to be undertaken regarding the transfer from Merton to Sutton CCG including the totality of the budget to be transferred. A meeting had been arranged to talk through the mechanics.

• It was noted that there may be an issue around community services as Merton and Sutton CCG have different block contracts.

• It was confirmed that the expectation was that the practice would cover the cost of the merger however the CCG would be responsible for the IT costs and possibly some other areas including communications.

• The need to understand the timing of the merger in relation to the PMS contract and the Sutton KPIs.

• The need to ensure the practice is not financial penalised regarding the merger and the move from Merton to Sutton.

. RECOMMENDATION

The PCCC APPROVED IN PRINCIPLE the business case subject

to:

• Due diligence on the full implications of the transfer of

James O’Riordan Medical Centre’s registered patients

from Merton CCG to Sutton CCG

• Agreement with Merton CCG over resource transfer and

commissioning arrangements for the c7000 patients

currently registered at James O’Riordan Medical Centre.

Additionally, the PCCC DELEGATED APPROVAL of the

agreement with Merton CCG over resource transfer and

commissioning arrangements to the Executive Committee

For Discussion

8. Community Education Providers Network (CEPN) Annual Review

2017/18

CR introduced India Peach (IP), CEPN Project Manager, who

attended the PCCC to provide members with an update on work

undertaken by the CEPN since July 2017.

IP introduced the paper which provided an update on the development

and progress of the Sutton Community Education Provider Network

(CEPN). The document outlines three phases of the CEPNs progress

since July 2017, and the planned next steps.

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CEPNs are responsible for the coordination of training and allocation

of CPPD funding for the primary care workforce. Also tasked with

increasing capacity within general practice – developing (piloting) new

roles, coordinating placements etc, workforce planning and reporting

to HEE. CEPNs are funded by and ultimately accountable to HEE.

Three pots of money:

• Operating costs (pay for resources to deliver the work)

• In-direct – money goes straight to the HEIs (specifically identified by HEEsL), and then we commission training via an online portal.

• Direct - cash pot held within the CEPN. We can decide how this is spent – does not have to be with specified HEIs.

Key highlights:

• Re-established the steering group, which meets every six weeks. ToR has been written and signed off.

• Education commissioning framework has been developed, signed off and shared with practices.

• CEPN newsletter developed and circulated every two months. This is also uploaded to GP Teamnet.

• Insight Solutions have been commissioned to deliver ‘Managing Clinical Correspondence’ training using GPFV funding from NHSE. 11 practices signed up so far.

• Final draft is being prepared for the first multi-professional Protected Learning Time event, which will have a Mental Health focus. This is planned for May/June 2018 and a second one will run in October.

• Next steps include developing a 2018/19 Operating Plan, undertaking a training needs analysis across practices, finalising and disseminating details of the PLTs and attending local school fairs to promote career opportunities in Primary Care.

RECOMMENDATION The PCCC NOTED the progress to date.

9. General Practice Nursing 10 Action Points Plan KS introduced a paper which provided an update of activities occurring against the General Practice Nursing 10 point plan. It was noted that the work was being delivered through the Sutton Community Education Provider Network as item 8 above. Members of the PCCC requested regular updates relating to the total spend for CEPN, the course available and attendance rates. RECOMMENDATION The PCCC NOTED the progress to date.

SH

10. Primary Care Finance Report GP presented the M08 finance report.

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This covered the eight months to end November 2017 and full year 201718 forecast. The report included the report on the core GP contract and a number of other primary care budgets as requested by the Committee.

The overall message is that expenditure is in line with budget for both core and other primary care budgets. Year to date and forecast core contract spend is in line with budget (full year £25.6 million). There are some small in year overspends and 1617 brought forward costs but these are offset by in year underspends and the list size increase reserve.

Other primary care services spend is also in line with budgets. These include local contracted services (£1.1 m), GP out of hours (£1.4 m), GPIT (£412k) and GP access (£308k) but there are a number of other budgets per the schedule also in line with budget.

GP also reported that following a bid to the central NHSE ETTF fund, The CCG was confident it would receive funding to support the Hackbridge, South Sutton and Central Sutton estates projects totalling just under £500k. RECOMMENDATION The PCCC noted the update.

11. Primary Care Risk Register The PCCC received the Primary Care Risk Register which highlighted the current risks to the CCG around Primary Care Commissioning. It was noted that there had been no changes since the last report at the November meeting. LW informed the PCCC that it was proposed to review the Board Assurance Framework prior to the next PCCC meeting in March. RECOMMENDATION The PCCC noted the register.

For Ratification

12. Contract Variation – Bishopsford Road Surgery CR presented a paper following a request by the Bishopsford Road

Practice for the following contract change:

• GP partner, Dr Gupta, to leave the partnership

• Dr Anita Somalanka to join the partnership

It was noted that NHS England had made the required checks on Dr

Somalanka.

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CR stressed that due to the timing of meetings, the PCCC had

approved this request at the seminar meeting in December 2017, but

needed to be formally ratified by the Committee in public.

RECOMMENDATION

The PCCC RATIFIED the decision made to approve this contract

variation.

For Note

13. PMS Contract update It was noted that all practices in Sutton returned their signed contract subject to one which had the intention to sign once an issue around IT has been resolved. In relation to the one GMS practice it was felt positive that the contact would be signed.

14. Primary Care Operational Management Group Report The PCCC noted the report for information only.

15. Primary Care Transformation update The PCCC noted the update for information only.

16. Forward Plan It was agreed to include the Primary Care Operational Management Group to the forward plan going forward.

SH

For Information

17. Questions from the public There were no questions from the public.

Any Other Business

18. Any Other Business CAPITA DWC confirmed that the action plan was ongoing with a turnaround

team taking forward all the issues raised. The NHS England Board

were monitoring progress relating to this. It was noted that members

of the PCCC felt that progress had been slow and unacceptable.

Locum claims for sickness leave and maternity leave

DWC agreed to ask NS to produce a briefing paper following the

publication of National Policy Guidance.

WCD/NS

19. Meeting Close

20. Date of Next Meeting The next meeting of the Primary Care Commissioning Committee in public will take place on Wednesday 14 March 2018, 11:00am-1:30pm, at Priory Crescent.

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Updated: 12 March 2018 Jane Walker, Head of Corporate Governance

Sutton CCG Primary Care Commissioning Committee (PCCC) - Matters Arising /Action Points from previous meetings.

Date Item Title and Action Required Lead Comments Status

5 July 2017 9 Quality Primary Care indicators NS/CR Quality to be a standard item on all future meetings of the PCCC.

Updated: 10.01.18 To report back to the March meeting of the PCCC following the first meeting of the Primary Care Clinical Quality Review Group.

1 Nov 2017 12 Quality Review SH Report to go to the Primary Care Clinical

Quality Review Group to consider in more

detail.

Updated: 10.01.18 To be included on the agenda for the Primary Care Clinical Quality Review Group.

10 Jan 2018 2 Register of Declaration of Interest JW To be updated to reflect changes raised by

DW.

Updated: 10.01.18 To be updated once new DoI completed by DW (subsequently received and updated for May meeting).

10 Jan 2018 5 Primary Care Strategy SH Suggested Item for seminar – implementation areas and priorities.

SH to discuss with SB and SG outside of the meeting.

10 Jan 2018 9 General Practice Nursing 10 Action Points Plan

SH PCCC to receive regular updates relating to spend, courses and attendance.

On-going.

10 Jan 2018 16 Forward Plan SH To include the PC operational management group on the forward plan

Complete.

10 Jan 2018 18 Locum claims for sickness and maternity leave

WCD Briefing note to be produced and circulated.

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Updated: 12 March 2018 Jane Walker, Head of Corporate Governance

1 Nov 2017 18 Forward Plan SH Forward Plan to include the Primary Care Operational Management Group going forward.

On agenda.

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Report to the Sutton Clinical Commissioning Group

Primary Care Commissioning Committee

Date of Meeting: 14th March 2018

Agenda No: 5 ENCLOSURE: 04

Title of Document:

Primary Care Quality Surveillance Group – Terms of Reference

Purpose of Report: For Approval

Report Authors: Sian Hopkinson

Associate Director – Primary Care

Lead Director: Clare Wilson

Deputy Managing Director

Executive Summary: Following its first meeting, the Primary Care Quality Surveillance Group proposed a change

of name (from Clinical Quality Review Group) to more accurately reflect its purpose.

The revised terms of reference are attached for the Quality Surveillance Group, incorporating

the changes proposed by the Primary Care Commissioning Committee in November 2017.

Key sections for particular note (paragraph/page), areas of concern etc: Note changes as described in Executive Summary.

Recommendation(s): The Primary Care Commissioning Committee are asked to:

• APPROVE the Terms of Reference for the Primary Care Quality Surveillance Group

Committees which have previously discussed/agreed the report: Draft Terms of Reference for the Primary Care Quality Surveillance Group were discussed by

the Primary Care Commissioning Committee on 1st November 2017, and at the first meeting

of the Primary Care Quality Surveillance Group on 6th December 2017.

Financial Implications:

None

Other Implications:

N/A

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Equality Impact Assessment: The CCG is committed to monitoring the compliance with the Equality duty of the providers

from whom we commission services. This is done through the quality and contracting

process.

Information Privacy Issues: This report is to be published in the public domain.

Communication Plan:

This report is to be published in the public domain.

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V0.3 271217 1

Primary Care Quality Surveillance Group (QSG)

Terms of Reference

1) Introduction The single common definition of quality for the NHS encompasses three dimensions: clinical effectiveness, patient safety and patient experience. Quality should be at the centre of all discussions with providers to achieve the best possible health outcomes for patients. The commissioning of General Practice has been delegated to the CCG by NHS England (NHSE) from 1st April 2016. Core contracts are currently held with individual GP practices in the form of PMS or GMS contracts as well as additional locally contracted services (previously Local Enhanced Services). This responsibility means there needs to be an overarching, unified approach to monitoring, reviewing and improving quality across primary care, to ensure all the services commissioned in primary care are delivered to the same high level. 2) Objectives To monitor nationally and locally set quality standards with regard to Sutton GP Practice contracts. To ensure that appropriate mechanisms are in place to monitor and hold Practices to account for contractual requirements around clinical quality and safety of service. To be the primary commissioner / provider forum for addressing issues that have the potential to negatively affect clinical outcomes for patients and to ensure continuous improvement of services. 3) Scope and Authority The focus of the Primary Care Quality Surveillance Group (QSG) will be the delivery of the GP Practice contracts commissioned under the remit of the CCG. Additional local contracts may feed in to this group but will be managed in a separate forum. Individual clinician performer issues will be managed by NHSE. The Primary Care QSG is not responsible for reviewing services contracted by other commissioners, such as the Local Authority, however matters of concern may be raised with the appropriate commissioners should they arise. Should any aspect of service quality not be achieved, the Primary Care QSG will be responsible for agreeing the actions required to address this. The following items should be regularly reviewed:

• Significant incidents and events

• Performance Reports (NHSE, CCG and PMS KPIs)

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• Quality Dashboard (to include GP Patient Survey, Family and Friends Test, QOF, General Practice Outcome Standards, CQC rating)

• GP Practice Sustainability and Resilience Report

• CQC Reports

• Progress against Transformation Workstreams

• Safeguarding

• Infection control

• Vulnerable practices

• Workforce and training

• Medicines Management

• Risk Register

• Complaints

• Progress against any provider improvement plans

• Alerts from other care providers about GP Services Each meeting will have a theme around one aspect of quality to allow deeper analysis. 4) Duties To receive and analyse information relating to patient safety, clinical effectiveness and patient experience to gain assurance on the quality of care and clinical outcomes for patients. Where commissioners are not assured, Primary Care QSG members will discuss and agree action plans with the Primary Care commissioning team, who will work with the practice to address quality concerns. This will be fed into the Primary Care Commissioning Committee and if there is an immediate quality concern this would be escalated to the Quality Committee. To monitor progress against action plans related to service development or improvement plans. To ensure that feedback from patients is captured and used to shape any developments in Primary Care provision and development. To escalate matters of concern to relevant bodies. 5) Membership

• Chief Clinical Officer (Clinical) Dr Chris Elliott

• Independent GP - Chair (Clinical) Dr Simon Elliott

• Practice Manager Locality Lead On rotation

• Practice Nurse Locality Lead On rotation

• Assistant Director of Quality (Clinical) Anna Cassin

• CCG Governing Body Nurse (Clinical) Pippa Barber

• CCG Lay Member Sally Brearley

• Associate Director of Primary Care Siân Hopkinson

• Head of Primary Care Commissioning Lou Naidu

• SWL Alliance Primary Care Contracts Manager Nóra Simon Invited according to agenda

• Sutton GP Services Ltd (‘The Federation’)

• CQC

• GP Practice Representatives

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• Infection Control

• LMC

• Medicines Management

• NHS England

• Public Health 6) Quorum Meeting will be quorate when 50% of members are present including at least one:

• Clinician

• Primary Care Commissioner

• Quality Team Member

7) Meetings The QSG will meet regularly with a minimum of four meetings per year. 8) Reporting Accountability The Primary Care QSG will be accountable to the Primary Care Commissioning Committee, a sub-committee of the CCG Board. Notes from the meeting will be reported to the PCCC and Quality Committee. Relationships The Primary Care QSG will have a working relationship with:

• Primary Care Operational Management Group

• Quality Committee

• South West London Alliance

• London Quality Surveillance Group 9) Secretariat

• Papers will be circulated one week in advance of the meeting

• Papers should be submitted 10 days in advance of the meeting

• Potential agenda items for discussion should be submitted to the Chair

• The business programme will be updated regularly to reflect items to be discussed 10) Review The terms of reference will be reviewed bi-annually in the first year and then on an annual basis thereafter, or as required.

Version Date Author Amendments

V0.1 26/9/17 Siân Hopkinson First draft

V0.2 27/10/17 Siân Hopkinson For approval by the PCCC

V0.3

27/12/17 Siân Hopkinson Following PCCC comments and first

QSG meeting, including changing

name from CQRG.

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Report to the Sutton Clinical Commissioning Group Primary Care Commissioning Committee

Date of Meeting: 14th March 2018 Agenda No: 6 ENCLOSURE: 05

Title of Document: Community Education Providers Network (CEPN) Governance Report

Purpose of Report: For Approval

Report Authors: Carolyn Reynolds Head of Primary Care Commissioning

Lead Director: Clare Wilson Deputy Managing Director

Executive Summary This paper provides an update to the Primary Care Commissioning Committee on the proposed governance of the CEPN and HEE funding through the Sutton Education and Training Group as requested at the Primary Care Commissioning Committee on 10th January 2018.

Key sections for particular note (paragraph/page), areas of concern etc:

Recommendation(s): The Primary Care Commissioning Committee is asked to:

• APPROVE the proposed governance monitoring of the CEPN and HEE funding streams.

Committees which have previously discussed/agreed the report: Education and Training Steering Group monthly.

Financial Implications: Main CEPN funding streams: HEE (Health Education England), NHS England, discrete project funding and CCG discretionary allocation.

Other Implications:

Equality Impact Assessment: The CCG is committed to monitoring the compliance with the Equality duty of the providers from whom we commission services. This is done through the quality and contracting process.

Information Privacy Issues: N/A

Communication Plan: This report is in the public domain

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Sutton Education & Training Steering Group Terms of Reference February 2018 - Revised

1. Introduction and Background

The Sutton Education & Training Steering Group will work collaboratively with the community education provider network (CEPN) to ensure the primary care workforce is trained and supported to meet the needs of our patients now and in the future. In particular, it will seek opportunities which help increase capacity and capability in primary care. It will do this through education, multi-professional training, student placements and pilot projects. It will focus on delivering immediate training and education opportunities and workforce transformation initiatives which help the development of the future primary care workforce. Funded by Health Education England (HEE) South London, the Sutton CEPN will work collaboratively with other CEPNs, community services and training providers to develop the network to create opportunities for joint working in areas of mutual benefit. 2. Purpose and Objectives

2.1. To deliver the vision and objectives set out in the annual Sutton CEPN Operating

Plan and the Sutton CCG Strategy.

2.2. To review progress against the Sutton CEPN Operating Plan and the Sutton CCG

Strategy.

2.3. To review and manage (direct, indirect and CCG) budgets allocated to workforce

development and transformation activities and to remain within budget.

2.4. With agreement from Sutton CCG; to take delegated responsibility for the

application of workforce development and transformation funding.

2.5. To ensure provision of all necessary performance reporting, particularly to Sutton

CCG and HEE South London.

2.6. To ensure Sutton’s active participation and contribution to workforce development

activities across the Care Homes Vanguard, wider CEPN network and HEE South

London.

2.7. To remain a central point of contact for all Sutton Primary Care workforce

development and education commissioning.

3. Reporting

The Sutton Education & Training Steering Group is accountable to NHS Sutton CCG‘s Executive Management Team and to HEE South London CEPN Delivery Group Board. A bi-monthly report on activity and finances will be presented to the Primary Care Operational Management Group and this report will be noted at the Sutton CCG Executive Management Team. An annual report will be presented to the Primary Care Commissioning Committee.

4. Membership and Chair arrangements

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The Steering Group includes members from both clinical and non-clinical roles within

primary care as well as CCG representation. Membership may also be expanded at times to

reflect specific project work underway, for example community services, HEI’s (Health

Education Institute) and local acute providers as appropriate. Representation should span

different disciplines to encourage views from across the workforce.

Voting members

Name Position Steering Group Role &

Responsibility

Lou Naidu (Chair) Head of Primary Care Commissioning,

Sutton CCG

CCG representative & CEPN

accountable officer

Dr Ravi Seyan GP Education Lead, Sutton CCG GP representative

Karol Selvey Primary Care Nursing Lead, Sutton

CCG

Nursing & HCA representative

Sarah Kavanagh CEPN Lead, Sutton CCG CEPN Lead

Caroline

Pollington

Sutton Vanguard Sutton Vanguard representative

Sarah Taylor Chief Pharmacist, Sutton CCG Pharmacy representative

Cynthia Abankwa Programme Lead GP Federation representative

Simon Elliott Independent GP Advisor GP representative

Non-Voting Members

Name Position Steering Group Role &

Responsibility

Jane Hopping Community Lecturer Practitioner

HEI representative (The Royal

Marsden)

Clare Ridsdill-

Smith

Public Health Borough of Sutton Public Health representative

TBC TBC St. George’s University

5. Quoracy

Quoracy will be achieved with the minimum attendance of the Chair and:

- Nursing & HCA rep

- CEPN Lead

6. Frequency

The group will usually meet every two months.

7. Recommendation

The Primary Care Commissioning Committee is asked to: Approve the proposed governance and note the financial monitoring of the CEPN and HEE funding streams.

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Agenda No: 7 ATTACHMENT: 05a

Title of Document: Update on payments in respect of locum cover for

GP performers on parental or sickness leave

Purpose of Report:

For note and agreement

Report Authors:

William Cunningham-Davis,

Deputy Director of Primary Care, NHSE London

Lead Director:

Clare Wilson, Deputy

Managing Director

Executive Summary:

The paper is to highlight how the 2017-18 National GMS contract changes agreement in relation to providing financial assistance for practices in respect of locum cover impacted on the cost reimbursed for each claim made.

From 2013 until March 2017 the interim London Locum Reimbursement Policy was in place which was then replaced by the Protocol issued by NHS England. With the introduction of the protocol in April 2017 it has meant that previous criteria for assessing claims cannot now be applied so more claims will meet the reduced criteria and the reimbursement for each claim will increase as previous rules for reimbursement are not so stringent. Also, locum reimbursement for covering sickness leave is an entitlement and the commissioners must provide financial assistance to GP practices.

The key changes are: - Pro-rata of payment is no longer allowed

- The remaining GP vs patient ratio criteria for sickness leave cover applications

has been removed

- GP performer’s and Practices insurance claims are not taken into account

- It is no longer a requirement that the GP performer in leave should be in

receipt of their full salary during their sickness or parental leave

- The maximum payable amount per week for sickness leave cover has

increased from £1,131.74 to £1,734.18

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Whilst the number of claims received in 2017-18 are not significantly higher than

previous years the changes above resulted a significant increase of the amount paid

for locum reimbursement.

Commissioners now have limited discretionary powers in relation to locum

reimbursement applications. Discretionary payments can be agreed for parental leave

longer than 26 weeks*, sickness leave longer than 52 weeks, applications relating to

previous financial years and financial support for GPs returning to work on phased

return. The CCG’s PCCC will be required to make decisions in relation to these

cases.

NHS England’s London Region Team have been working with the National team on

clarification of areas in the Protocol this has now been completed. The Team will be

issuing an FAQ to CCG’s for information and to GP practices to clarify the payment

process for locum reimbursement applications.

*there is a discrepancy between the protocol and the statutory entitlements. This is being clarified with NHS

England.


Recommendation(s):

The Committee are asked to

• NOTE these changes and agree to receive requests and to make decisions on

cases when required about discretionary financial support element.

Committees which have previously discussed/agreed the report:


Increased Claims and increase spend on this due to change.

Other Implications:

Equality Impact Assessment:

The CCG is committed to monitoring the compliance with the Equality duty of the

providers from whom we commission services. This is done through the quality and

contracting process.

Information Privacy Issues:

Communication Plan:

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Update on payments in respect of locum cover for GP performers

on parental or sickness leave

Introduction

The paper is to highlight how the 2017-18 GMS contract changes agreement in relation to

providing financial assistance for practices in respect of locum cover impacted on the cost

reimbursed for each claim made.

Background

NHS England and GPC England have agreed a number of changes to the arrangements for

making payments in relation to locum cover for a GP Performer’s absence which is due to

sickness or parental leave. Following the announcement of the 2017-18 GMS contract

changes NHS England issued a protocol in respect of locum cover for GP performer

payments for parental and sickness leave (The Protocol) which was embedded in the NHS

England Primary Care Policy and Guidance1 document published in November 2017. For

ease, reference to the “Protocol” will be used throughout this document. All Locum

reimbursement claims submitted since 01st April 2017 have been processed in accordance

with the principles included in the protocol.

What has changed

With the introduction of the protocol in April 2017 it has meant that previous criteria for

assessing claims cannot now be applied so more claims will meet the reduced criteria and

the reimbursement for each claim will increase as previous rules for reimbursement are not

so stringent.

For instance;

Maternity Claims

The main difference in the arrangements is that payments are not reflective of the GP’s

contractual arrangements e.g. 8 weeks full pay, 14 weeks half pay and 4 weeks SMP.

Previously the reimbursement would have been made by reflecting the 8 weeks full pay and

14 weeks half pay. No reimbursement would have been made for week 23 to 26. Under the

new arrangements the reimbursement is due for the full 26 weeks at the lesser of actual

invoice costs or maximum payable per week.

Sickness Claims

The criteria that considered the remaining patient to GP ratio has been excluded in the new

protocol along with the pro rata to the contractual arrangement for full and half pay across

the weeks of the claim, this means more claims are meeting the criteria set and payments

increased.

For the full comparison of changes please refer to Appendix 1.

For worked up examples of how these changes impacted the payment please refer to

Appendix 2.

1 https://www.england.nhs.uk/publication/primary-medical-care-policy-and-guidance-manual-pgm/

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Sutton CCG Position and summary SWL Wide Expenditure 2016-17 and 2017-18 (estimated)

Actual position

Expenditure Spend by category

Year Summary Annual Budget

Estimated Spend

2017/18 Variance

Paternal Leave

estimated expenditure

2017-18

Sickness estimated

expenditure 2017-18

Total Expenditure

2016/17 Sutton CCG £88,699 £99,616 £10,917

£99,616 £0 £99,616

2017/18 Sutton CCG £88,699 £352,809 £264,110

£208,848 £143,961 £352,809

Change £0 £253,193 £253,193

£109,232 £143,961 £253,193

2016/17 SWL Wide £785,987 £922,835 £136,848

£861,480 £61,356 £922,836

2017/18 SWL Wide £785,987 £1,919,465 £1,133,478

£1,524,932 £394,533 £1,919,465

Change £0 £996,630 £996,630

£663,452 £333,177 £996,629

Number of claims received in 2016–17 and 2017-18

Number of Claims

Year Summary

2017/18 Number Paternal Claims

2017/18 Number Sickness Claims

Total Number of Claims

2016/17 Sutton CCG 7 0 7

2017/18 Sutton CCG 8 7 15

Change 1 7 8

2016/17 SWL Wide 66 6 72

2017/18 SWL Wide 58 27 85

Change -8 21 13

Comparison of average cost per claim

Summary

Paternal Leave

estimated expenditure

2017-18

Sickness estimated expenditure 2017-

18 Total

Expenditure

2017/18 Number Paternal Claims

2017/18 Number Sickness Claims

Total Number

of Claims

Average Cost per Paternal

Claim

Average Cost Per Sickness

Claim

2016-17 NHS Sutton £99,616 £0 £99,616

7 0 7

£14,231 £0

2017-18 NHS Sutton £208,848 £143,961 £352,809

8 7 15

£26,106 £20,566

Change £109,232 £143,961 £253,193

1 7 8

£11,875 £20,566

2016-17 SWL Wide £861,480 £61,356 £922,836

66 6 72

£13,053 £10,226

2017-18 SWL Wide £1,524,932 £394,533 £1,919,465

58 27 85

£26,292 £14,612

Change £663,452 £333,177 £996,629

-8 21 13

£13,239 £4,386

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The tables represent a very raw comparison of the cost per claim in 2017-18 compared to 2016-17. This is only an indicative indicator as not all claims would have been paid in full within any one financial year so a straight division of costs by number of claims would only provide an indicative value. Paternal Claims: This shows that overall the number of paternal claims has slightly increased between the two years for Sutton CCG but that the cost of each claim has increased. This reflects the policy changes where payment will now be made up to week 26 and will not be reduced reflecting the contractual payment to the doctor on leave. If the claim is for the maximum payable for 26 weeks the total reimbursement will be £43,883.80 but average claim costs are presently approximately £26,106. This reflects where actual claims are lower than the maximum value per week due to the number of sessions claimed as the doctor on leave is employed for part time only. Historically reimbursement could have been made up to week 52 reflecting the contractual arrangements of the doctor on leave so prior year’s average costs would of reflected this increased number of weeks claimed. Sickness Claims: Average costs of sickness claims will be variable depending on the length of the sickness claim made. The data implies that the number of claims qualifying for reimbursement has risen between the two years reflecting the change in qualifying criteria. Across SWL the average cost of a claim has increased implying that the number of weeks per claim has increased and reflect where contractual arrangements are no longer taken into consideration. Sutton Practices where a claim has been received in 2016-17 and 2017-18

ODS Number

2017-18 2016-17

Practice Name Paternal Sickness Paternal Sickness

H84019 GP Centre (Dr Jolly) 0 0 1 0

H85023 Bishopfords Road Medical Centre 0 2 0 0

H85025 Wrythe Green Surgery 0 2 0 0

H85032 Carshalton Fields Surgery 0 0 2 0

H85095 Robin hood lane Surgery 0 0 1 0

H85105 Cheam Family Pracitce 1 0 0 0

H85054 GP Centre Dr Muktar 1 0 0 0

H85113 Maldon Road surgery 1 0 0 0

H85018 Mulgrave Road 2 0 0 0

H85030 Old Court House 0 1 0 0

H85022 Park Road Surgery 0 1 0 0

H85115 Shotfield Medical Pracitce 1 0 0 0

H85653 Wallington Family Practice 2 1 2 0

H85693 Green Wryth Surgery 0 0 1 0

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Total Sutton CCG 8 7 7 0

What discretionary powers Commissioners have? Maternity leave: potentially payments for 27 – 52 are discretionary. However, it depends what the GP Performer’s maternity leave entitlement is. By statute they are entitled to up to 52 weeks maternity leave and if the contract of employment states they are entitled to 52 weeks commissioner are required to pay up to 52 weeks. Sickness leave: if a GP performer is off sick longer than 52 weeks it is at the Commissioners discretion to provide further financial assistance. Claims relating previous financial years: a number of claims relating to 2016 – 17 were received after April 2017. These are not normally considered unless exceptional circumstances involved so a number of them will have been rejected. However, practice may wish to appeal the decision and the CCG’s Primary Care Commissioning Committee (PCCC) will be required to make a decision about claims relating to previous years that have been rejected. This would only apply to claims that would have been eligible for locum reimbursement under the London policy. A number of late claims were considered when a practice had provided satisfactory explanation as why they submitted their application for locum reimbursement late but those were not approved due to not meeting the eligibility criteria.

GPs returning on phased return: there is no provision for phased return payments or for non-clinical sessions provided by the GP who is on sick leave. However, each CCGs may agree to provide financial assistance at their discretion.

Governance The South West London Primary Care Team processes locum claims as business as usual. This is agreed by STPs as part of the London Operating Model for Primary Care. When decision is required from Commissioners details of the claim will be shared with the Primary Care Operational Group or relevant and the Primary Care Commissioning Committee will be asked to make a decision. If, any case a dispute arises following the PCCC’s decision it may be referred by the

contractor as a dispute arising out of or in connection with the contractor’s contract (i.e. via a

referral to the FHSAU or, if appropriate, the civil courts).

Status

• A comprehensive FAQ document is being prepared by NHS England London Region. The purpose of the document to clarify how the Protocol applies to practices and Commissioners.

• The FAQ will be shared with all 3 LMCs covering London and with NHS England National Team

• The FAQ will be published in April 2018

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Appendix 1 – What has changed

Comparison table of changes between the London Locum Reimbursement Policy and

the NHS England Protocol

Pre-April 2017 After April 2017 All applications had to be approved prior to claim. Late applications were only processed under exceptional circumstances.

Any applications received after 01st April 2017 and relating to the 2017-18 financial year are to be processed in line with the Protocol.

For sickness leave applications there was eligibility criteria based on the number of remaining GP and registered patient ratio. Based on this criteria a number of applications were rejected before April 2017.

This assessment criteria deemed to be outdated and was removed as part of the GMS contract negotiations. Payment for sickness leave is no longer discretionary but an entitlement. Although, there is no provision for reimbursement for GPs returning on a phased return.

If the practice or the practitioner had an insurance policy and received payment from the Insurance Company in relation to the GP Performer’s sickness or maternity leave the amount was deducted from the reimbursement Commissioners made to the practice.

The NHS England National Team advised that practitioners private and practice insurance should not be taken into account. It has been brought to our attention that some Insurance Firms already advising practices that sickness cover is now paid by NHS England.

The Statement of Financial Entitlements (SFE) sets out the maximum amount of reimbursement for a GP performer providing cover as follows: (either the cost of locum cover of the max available amount whichever is lower) Sickness leave: £1,131.74 per week (after week one) up to 26 weeks and half pay for week 27-52 taking into account any previous episodes of sickness within the last 12 months Maternity leave: £1,131.74 for weeks 1- 2 £1,734.18 thereafter potentially up to 52 weeks depending the terms and conditions of the practitioner’s Contract of Employment or Partnership Agreement Paternity leave: £1,131.74 per week (two weeks)

The Statement of Financial Entitlements (SFE) sets out the maximum amount of reimbursement for a GP performer providing cover as follows: (either the cost of locum cover of the max available amount whichever is lower) Sickness leave: £1,734.18 per week for week 3-28 and half of that thereafter up to 52 weeks taking into account any previous episodes of sickness within the last 12 months. That is potentially £600.00 increase per week. Maternity leave: no changes Paternity leave: no changes

The maximum available weekly amount was paid for a 1.0 WTE practitioner. For part time GP performers parental or sickness leave the payment was pro-rata

Payments cannot be made on a pro-rata basis having regard to the absent performer’s working pattern, and are the lower of actual invoiced costs or maximum amount.

GP Performers should be in receipt of their full salary during their parental or sickness leave. If this criteria was not met the payment was adjusted accordingly or stopped. (Please see examples in the document)

Under the new guidance GP performers salary entitlements have no regards to the payment rates. For instance, if the GP is only entitled to SMP during their maternity leave the practice can claim for reimbursement for the locum cost occurred.

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Appendix 2: Case Study to represent the impact of the revised protocol arrangements

Maternity:

A Doctor is planning to take maternity leave for 52 weeks. They are contracted for 7 clinical

sessions per week and their contract states they are entitled to 8 weeks full pay, 14 weeks

half pay and 4 weeks SMP after which they can take unpaid leave.

Pre-Revised Protocol:

Reimbursement would have been made for 22 weeks. Payment would be made on

reimbursement of the lesser amount of the actual costs incurred or the maximum payable

per week. The first 8 weeks would be at full reimbursement dropping to 50% of the total for

weeks 9 to 22.

Assuming 7 sessions would mean the maximum payable is reached each week the cost of

reimbursement would have been:

Week 1 & 2 = £1131.74 * 2 = £2,263.48 Week 3 to 8 = £1734.18 * 6 = £10,405.08 Week 9 to 22 = £1734.18 * 14 * 50% = £12,139.26 Total reimbursement due = £24,807.82

Post Revised Protocol:

Reimbursement will be made for the full 26 weeks at the maximum per week Week 1 & 2 = £1131.74 * 2 = £2,263.48 Week 3 to 26 = £1734.18 * 24 = £41,620.32 Total Reimbursement due = £43,883.80

Impact of revised policy = £19,075.98

Sickness:

A Doctor is signed off on sickness leave for 52 weeks. They are contracted for 7 clinical

sessions per week and their contract states they are entitled to 3 months full pay and 3

months half pay (26 weeks total)

Pre-Revised Protocol:

Assuming the claim met the requirement pre-revised protocol then the following

reimbursement would have been made (e.g. Number of patients per remaining GP)

Reimbursement would have been made for 26 weeks. Payment would be made on

reimbursement of the lesser amount of the actual costs incurred or the maximum payable

per week. The first 13 weeks would be at full reimbursement dropping to 50% of the total for

weeks 14 to 26.

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Assuming 7 sessions would mean the maximum payable is reached each week the cost of

reimbursement would have been:

Week 1 to 13 = £1131.74 * 13 = £14,712.62 Week 13 to 26 = £1131.74 * 13 * 50% = £7,356.31 Total reimbursement due = £22,068.93

Post Revised Protocol:

Reimbursement will be made for the full 26 weeks at the maximum per week Week 1 & 2 = No reimbursement to be made = £0 Week 3 to 28 = £1734.18 * 26 = £45,088.68 Week 29 to 54 = £1734.18 * 26 * 50% = £22,544.34 Total Reimbursement due = £67,633.02 Impact of revised policy = £45,564.09

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Title of Document:

Primary Care Finance Report Month 10 2017/18.

Purpose of Report:

For Note

Report Author:

Geoff Price, Chief Finance Officer

Lead Director:

Geoff Price

Chief Finance Officer

Executive Summary:

Financial position - 10 Months to 31 January 2018 and full year forecast

Overview:

The financial position for primary care services for the ten months to 31 January and full year

forecast is in line with budget.

There are some relatively small overspend and underspends.

These budgets cover the core GP contract and other primary care budgets such as primary

care developments, locally commissioned services and the out of hours service.

Core 2017/18 Practice budgets:

The expenditure budget was based on contractual commitments and to meet all known and

anticipated costs. The budget includes an allowance for both demographic growth (based on

historic government forecasts for 2017-18 population growth) and a 2% increase for

premises cost.

Whilst there is no specific QIPP target included in budgets, the CCG is expected to benefit

from the continued renegotiation of local authority rateable values being undertaken

nationally.

A breakdown is given in appendix 1.

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Other primary care budgets The financial position on other primary care budgets show expenditure in line with budget. These budgets cover a range of areas including primary care developments, locally commissioned services and the out of hours service. A breakdown is given in appendix 2.

The Committee is asked to note this report

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Annex 5

APPENDIX 1

PRIMARY CARE GP CORE CONTRACT

FINANCIAL POSITION FOR THE 10 MONTHS ENDING 31st JANUARY 2018

YEAR TO DATE (MONTH 10) FORECAST OUTTURN

Budget Total Annual Forecast Forecast

Description To Date Expenditure Variance Budget Expenditure Outturn

£ £ £ £ £ £

PMS

PMS ENHANCED SERVICES 374,441 328,620 (45,821) 449,455 449,455 0

PMS ESSENTIAL AND ADDITIONAL SERVICES 15,092,733 15,101,291 8,558 18,271,548 18,271,548 0

PMS OTHER ADMINISTERED FUNDS (MATERNITY ETC) 255,048 303,769 48,721 306,287 306,287 0

PMS PERSONALLY ADMINISTERED DRUGS 102,022 106,610 4,588 122,540 122,540 0

PMS PREMISES PAYMENT 2,609,386 2,614,517 5,131 3,223,858 3,223,858 0

PMS PRIOR YEAR ACCRUALS 0 151,433 151,433 0 0 0

PMS QUALITY AND OUTCOMES FRAMEWORK (QOF) 1,711,983 1,730,309 18,326 2,054,607 2,054,607 0

PMS SENIORITY 175,534 163,544 (11,990) 210,773 210,773 0

GMS

GMS ENHANCED SERVICES 21,841 22,271 430 26,217 26,217 0

GMS GLOBAL SUM & MPIG 380,825 380,783 (42) 464,397 464,397 0

GMS OTHER ADMINISTERED FUNDS (MATERNITY ETC) 8,481 8,482 1 10,188 10,188 0

GMS PERSONALLY ADMINISTERED DRUGS 3,480 3,633 153 4,176 4,176 0

GMS PREMISES PAYMENT 48,195 48,196 1 61,418 61,418 0

GMS PRIOR YEAR ACCRUALS 0 2,511 2,511 0 0 0

GMS QUALITY AND OUTCOMES FRAMEWORK (QOF) 41,582 41,387 (195) 49,916 49,916 0

GMS SENIORITY 12,050 11,291 (759) 14,462 14,462 0

OTHER

OTHER NON CONTRACTUAL COSTS 256,789 6,855 (249,934) 308,158 308,158 0

LEVIES 0 (0) (0) 0 0 0

TOTAL PRIMARY CARE DELEGATED COMMISSIONING 21,094,390 21,025,500 (68,890) 25,578,000 25,578,000 0

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Annex 4

APPENDIX 2

PRIMARY CARE

FINANCIAL POSITION FOR THE 10 MONTHs ENDING 31st JANUARY 2018 AND FULL YEAR FORECAST

YEAR TO DATE (MONTH 10) FORECAST OUTTURN

Budget Accruals & Total Annual Forecast Forecast

Description To Date Expenditure Commitments Expenditure Variance Budget Expenditure Outturn

£ £ £ £ £ £ £ £

OTHER PRIMARY CARE DEVELOPMENTS

GP - STATUTORY MEDICAL FEES 62,500 57,804 4,696 62,500 0 75,000 75,000 0

GP - TRAINING BUDGET 21,521 -58,536 80,057 21,521 0 25,825 25,825 0

GP - IT SERVICES 515,000 294,192 220,808 515,000 0 618,000 618,000 0

GP DEV RECEPTION & CLERICAL TRAINING 27,500 0 27,500 27,500 0 33,000 33,000 0

IMPROVED GP ACCESS INITIATIVE SCHEME 385,000 267,880 117,120 385,000 0 462,000 462,000 0

HELP YOURSELF TO HEALTH 0 0 0 0 0 0 0 0

"ASK MY GP" ONLINE PATIENT INITIAL DIAGNOSIS 0 10,015 (10,015) 0 0 0 0 0

PATIENT EDUCATION AND INTEGRATED APPROACH 0 2,324 (2,324) 0 0 0 0 0

PRIMARY CARE SUPPORT MODEL 0 -91,780 91,780 0 0 0 0 0

PRACTICE TRANSFORMATION SUPPORT 240,833 88,254 152,579 240,833 0 289,000 289,000 0

PRIMARY CARE DEVELOPMENT 0 -70,941 70,941 0 0 0 0 0

LOCAL COMMISSIONED SCHEMES (PMS)

LCS - NEAR PATIENT TESTING 8,333 1,786 6,547 8,333 0 10,000 10,000 0

LCS - ANTI COAG 250,000 220,488 29,512 250,000 0 300,000 300,000 0

LCS - PHLEBOTOMY 112,500 33,665 78,835 112,500 0 135,000 135,000 0

LCS - PMS INTERMEDIATE CARE 37,500 43,500 (6,000) 37,500 0 45,000 45,000 0

LCS - MINOR DAY SURGERY 179,167 120,873 58,294 179,167 0 215,000 215,000 0

LCS - PMS PHYSIO SUTTON 0 0 0 0 0 0 0 0

LCS - MENORRAGHIA 41,667 21,136 20,531 41,667 0 50,000 50,000 0

LCS - LOW VISION AIDS 29,167 14,120 15,047 29,167 0 35,000 35,000 0

LCS - PALLIATIVE CARE 79,167 84,600 (5,433) 79,167 0 95,000 95,000 0

LCS - CARIOVASCULAR DISEASE 104,167 100,360 3,807 104,167 0 125,000 125,000 0

LCS - DIABETES 0 131 0 131 131 0 131 131

LCS - POST OPERATIVE WOUND CARE 91,667 42,540 49,127 91,667 0 110,000 110,000 0

ADDITIONAL SERVICES / QOF (PMS)

PMS - OUT OF HOURS 1,197,218 1,050,674 146,544 1,197,218 0 1,436,662 1,436,662 0

PMS - OUT OF HOURS - RECHARGES 0 0 0 0 0 0 0 0

TOTAL PRIMARY CARE 3,382,907 2,233,085 1,149,952 3,383,038 131 4,059,487 4,059,618 131

Page 1 Of 1 12/03/2018 13:23

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Title of Document:


Risk Register

Purpose of Report: For Review

Report Authors: Chux Ebenezer,

Corporate Assurance and Risk Manager,

NEL CSU

Lead Director:

Clare Wilson

Deputy Chief Operating Officer

Executive Summary:

This document highlights current risks to the CCG around Primary Care

Commissioning.

The Risk Register shows any gaps in services and sets out the mitigations and

actions to minimise these risks.

The PCCC Risk Register continues to be reviewed in line with the Strategic

Objectives of the CCG.

All Risks have been updated for Feb 2018

Key issues to note are:

The Corporate Assurance and Risk Manager recommends a unitary consensus on

all PCCC Risks scores and target risk score.

This ensures that all internal controls, management assurance and action plans are

commensurate with the risk score.

A Risk Matrix is attached for critical analysis of individual risks scores.

Changes to the Risk Register:

Escalation of risks from the Quality Committee Risk Register to the Board Assurance Framework No risks have been escalated from the Corporate Risk Register.

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De-escalation of risks from the Board Assurance Framework

Code Description Current

Score

Target

Score

Change

Since

Review

Previous

Score

BAF Page

Number

1017 Primary

Care

estates not

fit for

purpose

12 9 16 No 1

1023 Issues with

quality of

provision of

service in

relation to

patient

records

12 4 16 No 1

1024 Gaps in

primary

care

workforce -

both GPs

and nurses

12 8 12 No 2

1033 Vulnerable

Practices

12 2 16 No 2

Recommendation:

The PCC Committee is asked to:

• NOTE the PCCC Risk Register

• AGREE any updates that are to be included in the register going forward

• AGREE they are satisfied that the mitigating actions provide sufficient

assurance that the risks are being well managed


The Risk Register is reviewed at each PCC Committee.

Financial Implications: As per Strategic Objective 3



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contracting process


As per Freedom of Information Act 2000

Communication Plan:

As per Freedom of Information Act 2000

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1

SCCG Primary Care Commissioning Risk Register

Generated on: 06 March 2018

Risk Category Description Commissioning Code Title Description Impa

ct Likelihood

Current Risk Score

Date Reviewed

Internal Controls

Gaps in Control Management Assurance

Actions Due Date

Impact

Likelihood

Target Risk Score

Target Risk Target Date

Risk Owner Ownership Assigned To

Risk Assurance Framework Description

Categories Description

Risk Business Units Icon

Risk Business Units Description

1017 Primary Care estates not fit for purpose

Cause: Significant period of lack of investment in primary care premises Effect: Financial implications of getting estates to standard where fit for purpose Keywords Primary Care Estates Investment Premises Financial Implications

3 4 12 12-Feb-2018

CCG estates strategy agreed and in place

Lack of in house expertise - capacity and capability

CCG Estates Strategy Prioritised as number seven in SWL schemes

Sutton estates strategy being implemented

31-Dec-2018

3 3 9 31-

Dec-

2018

Geoffrey Price Sian

Hopkin

son

No OBJ.

03 -

15/16

SUTTO

N CCG

SCCG

Premises developments have been bid for against the ETTF money in line with the Estates Strategy

Progressing Schemes for South Sutton, Hackbridge and Old Court House

31-Dec-2018

1023 Issues with quality of provision of service in relation to patient records

Significant issues around provision of service from Capita, with records missing or sent to incorrect practices. Results in problems for continuity of care. Keywords Quality Service Patient Records Capita

3 4 12 12-Feb-2018

SCCG reported concerns to NHSE

SCCG is not in control of the contract, so cannot take direct action to address the issues with the provider Complaints at practice level from patients, which cannot be remedied by practices or SCCG Complaints

Issues raised with NHSE as identified - ongoing

31-Dec-2018

4 1 4 31-

Dec-

2018

Clare Wilson Lou

Naidu

No OBJ.

02 -

15/16

SUTTO

N CCG

SCCG

Regular NHSE contract performance monitoring

Update reports to

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2

Code Title Description Impact

Likelihood

Current Risk Score

Date Reviewed

Internal Controls


Actions Due Date

Impact

Likelihood

Target Risk Score







Continuity of Care SCCG PCCC & Operational Management Group

made to PCSE with no responses

1024 Gaps in primary care workforce - both GPs and nurses

Significant number of GPs and nurses are at or approaching retirement age, which may result in primary care staff shortages, impacting the ability to provide services of sufficient capacity Keywords Primary Care Workforce GP's Nurses Retirement Staff shortages Services Capacity

4 3 12 12-Feb-2018

Member of SWL wide workforce initiative

Significant increase in nurse indemnity costs

Implementation of the Workforce Plan as part of the Primary Care Strategy

31-Mar-2019

4 2 8 31-

Mar-

2018

Clare Wilson Lou

Naidu;

Kavana

gh

Sarah

No OBJ.

02 -

15/16

SUTTO

N CCG

SCCG

Monitored and reviewed at Primary Care Operational Group

Use info from SWL collaborative to mitigate gaps

31-Mar-2019

Primary care strategy includes workforce as a priority

Extensive programme of training and retention of Nurses by CEPN and Hesl

1033 Vulnerable practices in Sutton CCG

Vulnerable practices in Sutton CCG Effect: Risk of losing some GPs and the business closing Keywords Vulnerable Practices GP's

4 3 12 12-Feb-2018

Regular visits to the Practices by NHSE and the CCG.

They are independent Contractors and contract could become repudiated with 6months notice. Capacity of CCG Primary Care Team to support vulnerable

Primary Care Quality Surveillance Group and PC Operational Management Group oversight reporting into the PCCC

Ongoing support to Practices by Primary Care Team

30-Sep-2018

1 2 2 30-

Sep-

2018

Clare Wilson Lou

Naidu

No OBJ.

02 -

15/16

SUTTO

N CCG

SCCG

Involvement of the Chief Medical Officer at NHSE AND

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3

Code Title Description Impact

Likelihood

Current Risk Score

Date Reviewed

Internal Controls


Actions Due Date

Impact

Likelihood

Target Risk Score







Chief Clinical Officer at the CCG

Practices

Ongoing Assessments by the GMC.

Risk Category Description Financial Code Title Description Impa

ct Likelihood

Current Risk Score

Date Reviewed

Internal Controls


Actions Due Date

Impact

Likelihood

Target Risk Score







1022 Potential for overspending on Primary Care Commissioning

There is a risk that expenditure will exceed allocation, resulting in the CCG failing to meet financial targets for the year. Keywords Overspend Primary Care Commissioning Risk Expenditure Allocation Financial targets

3 3 9 12-Feb-2018

Plan is in balance - no 2017/18 overspend

CCG does not yet have control over primary care budget setting

Assurance reports from NHSE re financial position Financial Oversight by PCCC

Alignment of CCG and NHSE finance reporting

31-Dec-2018

3 2 6 Clare Wilson Sian

Hopkin

son

No OBJ.

03 -

15/16

SUTTO

N CCG

SCCG

Reserves held in mitigation

Raised issues with NHSE - ongoing

31-Dec-2018

Regular ongoing liaison with NHSE re financial position

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Appendix 1

Risk Matrix

Impact

5. Catastrophic

Moderate (5)

High (10) Very High (15)

Very High (20)

Very High (25)

4. Major Moderate (4)

High (8) High (12) Very High (16)

Very High (20)

3. Moderate Low (3) Moderate (6)

High (9) High (12) Very High (15)

2. Minor Low (2) Moderate

(4) Moderate (6) High (8) High (10)

1. Negligible Low (1) Low (2) Low (3) Moderate (4) Moderate (5)

1. Rare 2. Unlikely 3. Possible 4. Likely 5. Almost Certain

Inherent Likelihood

Inherent Likelihood Details

Name Description

1. Rare Rare to occur within the next five years. ----- (0 -10%)

2. Unlikely Unlikely to happen within the current year, but could occur within the next 1 to 5 years ----- (10 - 40%)

3. Possible

Possibly could happen within the current year, or could occur within the next 6 -12 months ----- (40 - 65%)

4. Likely Likely to happen within the current year, or could occur within the next 6 months ----- (65 -90%)

5. Almost Certain

Almost certain to happen within the current year, or could occur within the next 3 months ----- (90 - 100%)

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Appendix 1

Impact Details

Name Description

1. Negligible

FINANCIAL Theft/loss up to £1000, Compliant unlikely Litigation risk remote, impact on service <£100 -- SERVICE DELIVERY/CORP OBJECTIVES Negligible Effects on service quality or corporate objectives -- SAFETY Negligible e.g. no obvious harm -- REPUTATION No Effects on reputation -- COMPLAINT/LITIGATION Negligible

2. Minor

FINANCIAL Litigation <£50k, Theft/loss between £1k-£5k, Financial impact on service £100-£5k -- SERVICE DELIVERY/CORP OBJECTIVES Service marginally impaired, Some impact on corporate objectives but recoverable -- SAFETY Minor injury or illness requiring

minor intervention -- REPUTATION Temporary reputational damage-- COMPLAINT/LITIGATION Minor breach with no penalty

3. Moderate

FINANCIAL Litigation possible £50k-£500k Theft/loss between £5k-£25k, loss to service

between £5k-£100k --SERVICE DELIVERY Service quality impaired, Achievement of corporate objectives delayed SAFETY Moderate injury requiring medical treatment and/or counselling REPUTATION Specific regional media coverage, Stakeholder expectations are not met. -- COMPLAINT/LITIGATION Legal action or regulatory penalty

4. Major

FINANCIAL Litigation £1M-£20M, Theft /loss £25k-£400k, impact to service £100k-£20M-- SERVICE DELIVERY/CORP OBJECTIVES Significant reduction in service quality, prioritisation of corporate objectives--SAFETY Major injuries / long term incapacity or disability (loss of limb) requiring treatment/counselling-- REPUTATION damage with Key Stakeholders, some national/widespread regional media coverage--COMPLAINT/LITIGATION NHS London ‘supervision’ or legal case or overhaul of procedures, qualification of accounts

5. Catastrophic

FINANCIAL Litigation >£20 million, Theft loss over £500k, Financial impact to service>£25 million ----- SERVICE DELIVERY/CORP OBJECTIVES Complete failure of services. Unable to meet corporate objectives. ----- SAFETY Incident leading to death or major permanent incapacity An event which impacts on a large number of patients ----- REPUTATION Reputational Damage is irrecoverable, Extensive and sustained national media coverage ----- COMPLAINT/LITIGATION Termination of the CCG or criminal prosecution

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Date of Meeting: 14thMarch 2018


Title of Document: Primary Care Transformation and Estates Update

Purpose of Report:

For information

Report Authors:

Lou Naidu

Head of Primary Care Commissioning

Lead Director:

Clare Wilson


Executive Summary:

Attached is a summary tracking progress against the numerous primary care

transformation workstreams.


Note the progress to date across a large number of workstreams.

Recommendation(s):

The Primary Care Commissioning Committee is asked to:

• NOTE progress to date and key milestones


None


Where applicable, funding for each scheme is identified on the dashboard.




contracting process.



Communication Plan:


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v4 updated 22.12.17

GPFV

10 HIAs

Primary Care

Specifications

Provider

Development

Workforce

Development

Technology

& EstatesAccess GPN 10 PAP

Current Key

Milestone

Timescale

for deliveryRAG

Releasing Time for Care

Programme LN ✓ ✓ ✓ ✓

Centrally

funded

Dec 17:Funding for full programme no

longer available. SWL team working to

develop alternative support programme -

further detail awaitied Jan 18

Jan-18 AMBER

Social Prescribing

Social Prescribing projects support and facilitate primary care teams to

link their patients to the wider support services available by using a

simple electronic referral form, embedded within the clinical system.

These services could include:

• Health, wellbeing and healthy lifestyles – such as Health Trainers for

support with healthy eating and exercise

• Community based mental health projects and exercise programmes;

weight management and more

• Befriending services, volunteering and time bank programmes

• Social Welfare, Legal Advice and Money Management groups

• Adult learning and skills development programmes

• Employability & employment programmes

SM ✓ ✓ ✓ ✓ 40

• Reviewing all documentation

• Relationship building with key providers

• Working with GP practice to embed

referral form into EMIS

• Pilot commenced - to run until 31/03/18

Next steps yet to be agreed

Oct-18 AMBER

Patient Education

Build on the work in 2016/17 delivering twelve Patient Education

sessions in community settings which brought together multiple

stakeholders to provide patients with information to support self-care as

well as short educational talks

CLK ✓ ✓ ✓ 14.4

Draft LCS developed to deliver patient

education/activation programme. To go to

LMC for final agreement by 31/3/18

Jun-18 GREEN

Help Yourself to Health

Six week programme for migrant, black and minority ethnic

communities/patients, specifically the Tamil, Urdu and Polish

communities within the Sutton Borough.

It aims to support learning about NHS Services and how to access

them appropriately, to raise the awareness of key health prevention

messages, encourages self-management and self-care of minor

ailments to support participants to take greater control of their general

health and wellbeing.

CLK ✓ ✓ ✓ ✓ 36.5Programme repeated for 2017/18 following

its successMar-18 GREEN

National Diabetes

Prevention Programme (NDPP)

Working with Practices to proactively identify ‘pre-diabetic’ patients,

provide lifestyle advice and referral into the national education

programme

LJ ✓ ✓ ✓ 65On-going support and monitoring via GP

engagement scheme Mar-18 GREEN

MDT Locality Model

At scale (locality) development of a proactive MDT model of enhanced

care for improved management and outcomes for an identified cohort

of complex patients. This model is being developed as a proactive

model of admission prevention.

Aspirational timeline;

• Primary care team leading the work with localities and wider

stakeholders in the development of the model

• Significant engagewith all stakeholders

• Test against models elsewhere in SW London, London and nationally

• Aim to present a business case for investment in the autumn – needs

to be cost effective

• Model to be commissioned from April 2018

✓ ✓ ✓ ✓Not yet

costed

December 17: Establish delivery plan, task

and finish group, cohort identification,

governance structure February

18: Model co-design Mar/Apr 18 -

Practices review risk stratified patient lists

to identify suitable patients

May 18: Frontline multi-stakerholder teams

to develop strawman model for proactive

care June/July

18: Review and refine model, develop

busines case October

18: Roll out across all localities

Oct-18 GREEN

Pharmacists in

General Practice

• Sutton GP Federation has bid for and been successful in securing

funding from NHSE as part of a national programme of work securing

pharmacist input into GP Practices.

• Sutton CCG’s Medicines Optomisation team are currently running a

pilot to April 18 in conjunction with Robin Hood Lane Health Centre to

demonstrate and evaluate the value of practice employed pharmacists

in a wider role within GP practices.

CR RS ✓ ✓ ✓ ✓ 26

Primary Care Strategy Business Case

being deveolped to include programme of

work for deployment locality based

pharmacists to support primary care

01/07/2018 GREEN

Health Champions

Sutton CCG and Sutton Centre for Voluntary Services have developed

a Health Champions project. The project will train and develop 30 local

people to sign post patients and enable access to health services.

The pilot started in June.

CLK ✓ ✓ ✓Traning to commence/Health Champions

active from Jan 18Mar-18 AMBER

Development of Care

Navigators

and Medical Assistants

SWL piloting care navigator and medical assistant roles as part of bid

from HEE.

Care navigators: Provides patients with a first point of contact which

directs them to the most appropriate source of help. Reception staff are

given training and access to a directory of information about services.

Medical Assistants: A member of clerical staff in the practice is given

additional training and relevant protocols in order to support the GP in

clinical administration tasks.

CR RS ✓ ✓ ✓ ✓ 33.6

Medical Assistant and Care Navigator

training courses underway.

New Sutton integrated MDT locality model -

possible care navigation element currently

being explored.

Oct-17 GREEN

Extended Access

(April 2017-March 2019)

Sutton launched its extended access GP service (6:30pm-8:30pm Mon-

Fri and 8am-8pm at weekends) in April 17

The service is provided by Sutton GP Services, a federation of 24 GP

practices in Sutton.

The first hub site is at Wrythe Green Surgery in Carshalton.

The second hub was selected following an agreed selection process

and opened in July 2017 at Old Court House Surgery .

LN ✓ ✓ ✓ 615

Commissioners are working with Sutton

GP services to ensure maximum utilisation

and work is currently underway to enable

referrals to be received from NHS111.

St Helier ED piloting direct booking of

diverted patients into hub services at

weekends.111 direct booking into the

service commences 11/3/18

Oct-17 GREEN

Sutton CCG - Primary Care Workstream Dashboard

Workstream Overview

Overarching Primary Care Programme

Workstream NameCCG

Lead

Clinical

Lead

Progress in DeliveryBudget 17/18

(£000s)

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GPFV

10 HIAs

Primary Care

Specifications

Provider

Development

Workforce

Development

Technology

& EstatesAccess GPN 10 PAP

Current Key

Milestone

Timescale

for deliveryRAG

Workstream Overview

Overarching Primary Care Programme

Workstream NameCCG

Lead

Clinical

Lead

Progress in DeliveryBudget 17/18

(£000s)

iPlato

Sutton CCG offered a fully funded messaging service to all its member

GP practices, which includes the myGP app for patients and two-way

SMS. This is funded for 3 years from a successful joint South West

London ETTF bid.

LJ ✓ ✓ ✓ ✓ ETTF Offered to all practices Jul-17 GREEN

GP TeamNet

Through the 2017/18 Engagement scheme a web based portal has

been procured on behalf of practices (for two years) to facilitate

engagement and effective communication networks, particularly across

clinical groups who may feel distant from existing networks e.g. salaried

GPs

LJ ✓ ✓ ✓ 22.3 Complete Apr-17 GREEN

Skype for Business LJ ✓ ✓ ✓ ETTF Awaiting ETTF approval 18/19 NOT STARTED

Mobile Working

High specification, EMIS enabled and smartcard ready mobile laptop,

to support mobile working in general Practice i.e.home visits, visits to

care homes, working off site.

The three pilot practices Aug 17

• Wrythe Green

• Robin Hood Lane

• Park Road

The plan is to have one device per 4000 patients

Roll out expected – during Q4 2017/18

LJ ✓ ✓ ✓ ETTF

Currently troubleshooting issus raised

through pilot. Working with EMIS to

resolve interoperability issues relating to

surface pro devices.

Jul-18 NOT STARTED

Wifi for GP Practices

Free Wi-Fi for patients will allow them access to health and social care

resources, online tools and services; empowering self-care and helping

them to make informed decisions about their healthcareLJ ✓ ✓ ✓ 91.7

Sutton has joined Merton and Wandsworth

CCGs to jointly procure a Wi-Fi solution for

all practices. Supplier has been selected

and roll out will be completed by end of

March 2018.

Mar-18 GREEN

E-consultationsOnline consultation software for practices to enable electronic

consulations. Funded by GPFV.LJ ✓ ✓ ✓ 50.5

SWL PMO leading to agree a single

solution across SWL CCGs. Alignment of

solution with NHS111 online software has

been agreed as preferred option.

Jun-18 NOT STARTED

Sutton Integrated

Digital Care Record (IDCR)

Sutton IDCR is now sharing information from residents' GP and social

care records with local Urgent Care, Accident and Emergency, GP out-

of-hours and community health services.

CW ✓ ✓ ✓ Tech Fund 2 GREEN

KinesisElectronic secondary care advice for primary care clinicians to better

manage patients without the need for referral to hospitalLJ/SR ✓ ✓ ✓ 65

All Sutton GP Practices have access to

Kinesis Apr-17 GREEN

Docman Upgrade

As a result of a successful ETTF across SW London, we received

funding to migrate practices to Docman Vault which would enable

external use to practice users (extended access hubs, remote users

etc.) to access scanned documents with the clinical system.

LJ ✓ ✓ ✓

Initially

procured

across SWL

through ETTF

bud and

supported

with one off

non-recurrent

funding of

£20K from

Sutton CCG

Further development of Docman 10 moves

the storage of document to the cloud. The

CCG agreed to support the additional

costs required for Docman 10 and this will

be rolled out in 18/19

Apr-18 NOT STARTED

Patient Online

GP practices are required to promote and offer online services to

patients – booking appointments, order repeat prescriptions and

access coded information and BMA and NHS England target of 20 per

cent of all practice patients’ active users by 31 March 2018.

LJ ✓ ✓ ✓ ✓Centrally

Funded

Practices issued with patient tablets and

Wi-Fi access to enable patients to use

apps to access Patient Online services

Mar-18 GREEN

Premises Development:

Central Sutton

Development of Robin Hood Health Centre and adjacent council-owned

land for large scale multi-occupancy health centreLN ✓ ETTF Practices have decided not to relocate Oct-17

SCHEME

TERMINATED

Premises Development: South

Sutton

Relocation of Belmont branch of Benhill and Belmont GP Centre to a

new health centreLN ✓

Capital

privately

funded

With council planning department for

approval - next planning committee

21/3/18

Sep-19 GREEN

Premises Development:

HackbridgeRelocation of Hackbridge Medical Centre a new health centre LN ✓

s106

HoT's agreed. First interior architectural

design meeting held with practiceSep-19 GREEN

Premises Development: Old

Court HouseRefurbishement and exp[nsion of existing premises LN ✓

Capital

privately

funded

Kick off meeting held 6/3/18. project plan

and timelines mappedDec-18 GREEN

Community Education Provider

Network (CEPN)

Clinical and non-clinical training and education programme to support

general practice workforce initiatives, new ways of working and quality

improvement

CR ✓ ✓HESL &

CEPN

Wide range of training courses and

protected learning time delivered

throughout the year. CEPN lead appointed.

Ongoing GREEN

General Practice Nurse 10

Point Action Plan

Action Plan to raise the profile of practice nursing, extend leadership,

increase the number of student nurses, preceptorship, return to

nursing, access to educational programmes, advanced clinical practice,

apprenticeships and improve retention

CR ✓ ✓HESL &

CEPN

Detailed training programme against each

criteria has been developed, some of

which has been completed, is on going

and planned for 2018

Ongoing GREEN

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Title of Document: Report from the Primary Care Operational

Management Group on 22 February 2018

Purpose of Report:

For Note

Report Authors:

Carolyn Reynolds

Head of Primary Care Commissioning

Lead Director:

Clare Wilson


Executive Summary:

The following items were discussed at the Primary Care Operational Management

Group on 22nd February 2018:

• Update on CEPN, GPN 10 point Action plan a CEPN Finances – review of the

report presented to the PCCC in January 2018

• Resilience Update – Action Plans from Faccini House and Wallington Medical

Centre following CQC ratings of ‘Requires Improvement’. Details of the work

by the Primary Care Team to support the action plans and provide patient

engagement expertise to improve patient survey results for Faccini House and

Green Wrythe Surgery.

• Locally Contracted Services - Next Steps – Details of the issues surrounding

the LCSs in preparation for reports to the PCCC and the Executive Committee

in March 2018.

• Contract Issues

- Merger of Well Court and James O’Riordan. The Business Case was

approved by the PCCC in January 2018.

- Discussion of pans for a practice merger, to operate under one PMS

contract but retaining existing partnership arrangements.

- Details of the work that is being done around searches and reporting for the

PMS Contract KPIs to ensure that the reporting is consistent and can be

monitored efficiently.

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• The Sutton GP Engagement Scheme was discussed prior to going to the

Executive on 28th February where it was approved. There are two elements,

as previously, around engagement of the practices in their localities with CCG

priorities and clinical outcomes for prescribing, clinical peer review of referrals,

support for the QIPP diagnostic awareness scheme and the use of a

MacMillan Cancer Care Review Template.

• Risk Register – updates as discussed at the PCCC in March 2018

• Primary Care Strategy Implementation Draft Business Case – as discussed at

the PCCC In January 2018

• GPFV Transformation Update – as discussed at the PCCC in March 2018

• Health Checks as commissioned by Public Health – the contract for this work

has been given to the Sutton GP Services Ltd. A number of practices are

concerned with this decision as they have staff employed to specifically do this

work and the funding will no longer be coming to the practice. The LMC are

involved in these discussions.

• Locum claims for sickness and maternity – change in guidance around the

contractual remuneration from CCGs. A paper outlining these changes will be

presented to the PCCC in March 2018.


Recommendation(s):

The Primary Care Commissioning Committee is asked to:

• NOTE the work that is being undertaken by the Primary Care Operational

Management Group.


N/A


N/A



This report will be in the public domain.

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