agenda part a, in public · venue: cedar room, canalside conference centre, 34-36 brooks lane,...

Working together: NHS Eastern Cheshire Clinical Commissioning Group NHS South Cheshire Clinical Commissioning Group NHS Vale Royal Clinical Commissioning Group NHS West Cheshire Clinical Commissioning Group

NHS Eastern Cheshire CCG, NHS South Cheshire CCG, NHS Vale Royal CCG & NHS West Cheshire CCGs’

Primary Care Commissioning Committee

Venue: Cedar Room, Canalside Conference Centre, 34-36 Brooks Lane, Middlewich CW10 0JG

Chair: Pam Smith

Date/Time: Wednesday 26th February 2020

9.00-11.00

AGENDA – PART A, in public

Item No.

Topic No. Topic Name Lead Purpose

Reports / Verbal / Page

No.

1

1.1 Welcome and Apologies Chair Verbal

1.2 Declarations of Interest Chair Verbal

1.3 Minutes for approval: 5 December 2019 All Approval Attached/3

1.4.1 1.4.2 1.4.3

Action Log: ECCCG Action Log: WCCCG Action Log: CCGs CsiC December 2019

All Approval Attached/9 Attached/10 Attached/11

2

2.1 Primary Care Commissioning Update CL Information Attached/13

2.2 Primary Care Commissioning Risk Register Recommendations CL Agreement Attached/23

3 3.1 Discretionary Spend Mini Review T J-M Information Attached/29

4 4.1 Terms of Reference GC Agreement Attached/41

5 5.1 Finance Update LW Information Attached/49

6 6.1 GP IT Performance Concerns JM Discussion Verbal

7 Any other business All Verbal

Proposed dates for future meetings: DATE TIME LOCATION

Wednesday 22 April 2020 9.00-12.30 TBA

Wednesday 24 June 2020 9.00-12.30 TBA

Wednesday 26 August 2020 9.00-12.30 TBA

Wednesday 21 October 2020 9.00-12.30 TBA

Wednesday 23 December 2020 9.00-12.30 TBA

Wednesday24 February 2021 9.00-12.30 TBA

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Notes of Primary Care Commissioning Committee 1 5th December 2019

Primary Care Commissioning Committees In Common – Part 1

Meeting held on 5th December 2019 Canalside Conference Centre, Middlewich

Present: Gill Boston (Chair) Lay Member, Eastern Cheshire CCG Pam Smith Lay Member NHS West Cheshire Clinical Commissioning

Group Lynda Risk Executive Director, Finance and Contracting Neil Evans Executive Director, Planning and Delivery Paula Wedd Executive Director of Quality and Patient Experience Sheila Hillhouse Nurse Member Representative, NHS West Cheshire CCG &

NHS Eastern Cheshire CCG Annabel Jones GP Network Chair, City, NHS West Cheshire CCG

Steve Pomfret GP Network Chair, Rural, NHS West Cheshire CCG

William Greenwood Chief Executive, LMC

Louise Barry Chief Executive, Healthwatch

Jane Stephens

Lay Member, NHS Eastern Cheshire CCG

Ann Gray

Lay Member, Vale Royal CCG

Diane Noble Lay Member, South Cheshire CCG

Laura Beresford

GP Peer Group Representative – Bollington, Disley and Poynton

Dr Victoria Buckley

GP Peer Group Representative – Congleton and Holmes Chapel

Amanda Best

Service Delivery Manager, NHS South Cheshire and Vale Royal CCGs

Jenny Lawn

GP, Eastern Cheshire CCG

Katie Mills Clinical Quality Manager, Eastern Cheshire CCG

Christopher Leese Associate Director of Primary Care

Mike Clark GP, Eastern Cheshire CCG

Annabel London GP, South Cheshire and Vale Royal CCGs

In Attendance:

Dean Grice Primary Care Commissioning Manager, Eastern Cheshire CCG

Gemma Caprio Head of Governance, NHS West Cheshire CCG

Stuart Aspin

Interim Deputy Head of Primary Care, NHS West Cheshire CCG

Lorraine Weekes-Bailey

Primary Care Accountant, Cheshire CCGs

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Kevin Carberry

IT Project Manager NHS West Cheshire CCG

James Burchell

Estates and Primary Care, NHS South Cheshire and Vale Royal CCGs

Agenda No

Agenda Item Action

1.1 Welcome Introduction and Apologies The Chair welcomed attendees to the Committee Meetings in Common for the four Cheshire CCGs. The committees were noted as quorate with the exception of NHS West Cheshire CCG, which was not quorate due to absence of a Governing Body GP. The Committee agreed to continue with the meeting. Apologies were received from: Dr Andy McAlavey, Dr Jeremy Perkins, Dr Simon Powell, Cllr Laura Jeuda, Lin Elliot.

1.2 Declarations of Interest Annabel Jones declared a conflict of interest as Clinical Director of Chester East PCN. Other declarations were noted as those already recorded.

1.4 Action Logs Eastern Cheshire CCG: Dean Grice provided an update: 1903-4 – agenda item therefore action to be closed. 1903-6 – paper to be presented to February meeting. Remain open. 1905-1 – This action will be picked up by the ICP. 1905-01- action completed. 1907-02 – agenda item therefore action to be closed. 1907-03 – agenda item therefore action to be closed. 1907-03 agenda item therefore action to be closed. All actions can be closed. South Cheshire and Vale Royal CCG: Christopher Leese provided an updated on VR and SC: Action 1 can be closed. The Risk register has been updated and is an agenda item, therefore the action can be closed. Action 3 is being managed by the Ops group and is an ongoing agenda item and can be closed. West Cheshire CCG: Action 1 is ongoing. There is work across Cheshire with GPs to develop a

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single dashboard. The Estates strategy is on the agenda, therefore the action can be closed.

Item 2.1 Primary Care Commissioning Update Christopher Leese presented the paper and advised that the Committee would receive one overarching report on the current primary care operations status within the four Cheshire CCGs. Christopher Leese highlighted:

All CCGs have submitted initial Primary Care Winter Assurance Reports to NHS England;

All CQC actions have been completed; Primary Care Contractual and Performance Dashboards continue

to be updated and monitored; Cheshire East and Cheshire West Places have been tasked to

provide an updated Primary Care Strategy. Katie Mills advised there has been a reduced uptake, so far, in the flu vaccination for ages 2-3years old due to issues with the supply of vaccines. The Committee noted the report.

Item 2.2 Review of Primary Care Risk Register Christopher Leese presented the paper and advised each CCG had their own risk register and suggested a process for review of the current risk registers and a plan to create one overarching risk register. The newly formed Primary Care Operations and Quality Group will review the risks and create a single risk register, with support from the Governance Team. The single risk register will be presented to the Committee in February 2020. Dean Grice advised risk 00121 had been added to the register. This risk related to estates. Three current sites are in need of significant investment and one of the three practices has a fixed five year lease, which is due to expire in May 2024. Jane Stephens observed there is a different approach across the patch and the CCGs need to ensure the local knowledge is retained. The Operational Group has representatives from across the Cheshire CCGs to ensure this. The proposed risk management process will replicate the current Governing Body process and the risk register will be similar to the Governing Body Assurance Framework. The Committee noted the report.

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3.1 Cheshire CCG Terms of Reference Neil Evans presented the proposed terms of reference for the Cheshire CCGs Primary Care Commissioning Committee based upon the national template and feedback from workshop. The Committee agreed that:

Healthwatch – one representative only Add Primary Care strategy to the responsibilities in section 15 Add themes to the roles and responsibilities to simplify reading of

the list Amend Governing Body GPs to general practice representatives

so this is not restricted to only the four people elected to the Governing Body roles. These should be listed under non voting.

In the quoracy include that it is good practice to ensure general practice representatives to attend the meeting to ensure GP voice is captured

Meetings will be bi-monthly with a minimum of six meetings per year

Local Authority representative to be included as invitee to the non voting members. The local authorities can determine who attends on their behalf

Minimum of four voting members for quoracy including at least two executive members and two Governing Body lay members.

ACTION: Terms of reference to be amended and circulated with the draft minutes to the Committee.

4.1 Enhanced Services There is variation across the four Cheshire CCGs for commissioned enhanced services, both for the range of services and the core contracts. In order to establish a baseline of non core contract spend, it is proposed that a review of spending takes place. This would be a two phased approach to examine commissioned areas and to address interim actions. During 2020/21, there will be an in depth review of contracts with a proposal to have a single contract. Neil Evans recognised there are significant differences across the patch and has raised the issue with the LMC. The plan is to make interim changes during the next year and work collaboratively with Primary Care to establish the correct plan for the future. The work will inform a Cheshire plan and agree with Primary Care the implementation period to ensure a consistent model. Pam Smith queried if there should there be lay member representation on the task and finish group. Neil Evans note the national guidance advises the need to involve patient and public representation not necessarily a lay member and would ensure this occurred.

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Lynda Risk emphasised that Primary Care should not be reviewed in isolation and there must be a consideration of community services which support primary care and mental health services. The Committee discussed adopting the principle of co-design for the review and the best practice to encapsulate the corporate memory of all the four CCGs. The Committee agreed the recommendations.

5.1 Extended Access Dean Grice presented an overview of the variation across the three schemes. Further work is needed over the next year. Funding is to move to Primary Care DES in 2021. It is anticipated the PCN DES specification may be different to the current schemes in operation and that it was possible that there may be a reduction in funding. Dean Grice highlighted the assumptions, issues and barriers. In West Cheshire there is already combined extended access and extended hours. Sarah Murray and Kevin Carberry will lead on establishing the baseline in West Cheshire. The CCGs are awaiting national guidance from NHS England and confirmation of the funding arrangements as this may result in a cost pressure for the CCG. The PCNs also need the guidance before engaging with the process. Overall, more work is required to establish the situation of the current providers. Ann Gray noted the CCGs need to demonstrate benefits and outcomes to patients and any evaluation has to include the benefit to the public. The Committee discussed the evaluation process and the value and outcomes of a review. The Committee noted the information and approved the initial plan. Kevin Carberry will liaise with PCN Clinical Directors to scope the issues and coordinate a planned way forward in relation to the West Cheshire scheme. The Committee noted the information presented and requested further information be brought back when a proposal was developed.

6.1 Friends and Family Test The report was provided to the Committee for information and the committee noted the report.

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The Primary Care Operation Group will consider the content at future meetings.

7.1 Finance Report Lorraine Weekes–Bailey presented the finance report, noting the South Cheshire & Vale Royal CCGs plan is based upon expected expenditure and the recurrent funding from NHS England. Eastern Cheshire CCG and West Cheshire CCG have not secured recurrent funding. The Committee queried the rationale for the funding variation from NHS England and noted this is based upon legacy arrangements. ACTION: Lynda Risk is to liaise with NHS England about funding variation. Mike Clark noted the complexity of the different funding schemes and requested we add per capita in the finance report. ACTION: Lorraine Weekes – Bailey to amend future reports to include the cost per capita as an additional field.

LR LW-B

8.1 Any Other Business None received.

Date of Next Meeting TBC – February 2020

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OD

BS

OS C

ECCCG Primary Care Committee

ACTION LOG 5/12/2019

Key:

Overdue

Behind Schedule but deliverable

On Schedule

Completed

Log No

Date Raised

Agenda Item

Number

Action Description

Due by/ Closed date

Action Update Owner

RAG

Update

Required

Status

1903-6 13.3.19 4.1 Flu Vaccination Campaign - Circulate achievements and learning

from the flu vaccination campaign to Primary Care and bring an

update back to PCC once data is published.

Feb 2020

08.05.19 - to be taken to Sep19 PCC meeting.

10.07.19 - to be taken to Oct19 PCC meeting.

27.09.19 - superseded by start of 2019-20 seasonal flu campaign. Revised

paper/presentation, showing this years performance along with last years performance,

to be taken to a future PCC meeting - January or February recommended.

5.12.19 Update at next meeting, Full presentation in April

KM

OS

Open

Agenda Item A1.4.1 9 of 58

Primary Care Commissioning Committee Action Log 1 NHS West Cheshire Clinical Commissioning Group 5th December 2019

PRIMARY CARE COMMISSIONING COMMITTEE

Action List Part 1– December 2019

Agenda Item

Action Action By

Due Date Status

Meeting Held on 15th November 2018

2018-068 Primary Care Quality and Performance Report Bring the completed quarter three Primary Care Incidents Template to the January

meeting.

Ask the Primary Care Quality Group to look into the issue of the dashboard data being over 12 months old.

This work is ongoing with the Clinical Lead for Primary Care as well as the BI Team

Include trend data in future reports. Bring update to May meeting following discussions on the dashboard at the Primary Care Operational Group. Further information is required in order to establish the level of detail required. Item has been referred to the GP Quality sub group.

LJ

December

2019

Meeting Held on 16th May 2019

2019-32 Primary Care Estates Report Bring the Terms of Reference for the Estates Steering Group to the July meeting. JB December

2019 It has been agreed that because it is

intended to create a Cheshire-wide Primary Care Estates Steering Group in due course it would make sense to

wait until then to revise the existing Terms of

Reference

On Agenda/Complete On-going

Overdue For future meeting

Agenda Item A1.4.2 PCC 26.2.20

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Action

Log No.

Original

Meeting

Date

Description Action Requirements from the Meetings By Whom By When Comments/ Updates Outside of the Meetings Status

A1 5.12.19 PCC Terms of

Reference

Terms of Reference to be amended and circulated with the draft Minutes to

the Committee

GC Completed

A2 5.12.19 Finance Report Finance Report - LR to liaise with NHSE about funding variation LR Ongoing

A3 5.12.19 Finance Report Finance Report - LW-B to amend future reports to include the cost per

capita as an additional field

LW-B Ongoing

Updated: 19/Feb/2020

NHS Eastern Cheshire, NHS South Cheshire, NHS Vale Royal & NHS West Cheshire CCGs Primary Care Commissioning Meeting Part A Action Log

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Paper to be considered by: (please tick those that are applicable for the meeting date)

NHS Eastern Cheshire CCG ☒ NHS Vale Royal CCG ☒ NHS South Cheshire CCG ☒ NHS West Cheshire CCG ☒


PRIMARY CARE COMMISSIONING COMMITTEE MEETING Part A Agenda Item A2.1

Title

Primary Care Commissioning – Update (Part A)

Author Contributors

Chris Leese Associate Director of Primary Care Cheshire CCGs

Sarah Murray Head of Primary Care Development (West) Amanda Best Head of Primary Care Development (East) Dean Grice Head of Primary Care (Cheshire CCGs’)

Date submitted 19th February 2020

Purpose To update the Primary Care Commissioning Committee on key areas by exception in respect of Primary Care Commissioning.

Reason for consideration by Primary Care Committee

The Primary Care Commissioning Committee is asked to review the report which contains key information in respect of the work of the Primary Care Operations and Quality Group and areas for noting.

Key Implications– please indicate Strategic

Consultation & Engagement ☐

Financial Resources (other than finance) ☐

Procurement ☐ Decommissioning ☐

Equality ☐ Quality & Patient Experience

Safeguarding ☐ Governance & Assurance

Legal / Regulatory Staff / Workforce

Other – please state Outcome Required:

Approve ☐ Ratify ☐ Decide ☐ Endorse ☐ For information

Recommendation(s) The Primary Care Commissioning Committee is asked to note for information the content of the Primary Care Commissioning report

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Primary Care Committee 26 February 2020 Agenda Item A2.1

Page 2 of 9

Report/Paper Reviewed by (Committee/Team/Director)

Neil Evans Executive Director of Planning and Delivery

Appendices

Appendix A

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Page 3 of 9

NHS Eastern Cheshire CCG

NHS South Cheshire CCG

NHS Vale Royal CCG

NHS West Cheshire CCG

Primary Care Commissioning Update

Date: 26th February 2020 Report to: Primary Care Commissioning Committee

1 Primary Care Delegated / Strategic Commissioning 1.1 Update to the GP Contract 2020/21- 2023/24

NHS England have released information in relation General Practice contract changes to further support the existing five year GP Contract agreement from 2019. The link to the full document is given here ; https://www.england.nhs.uk/wp-content/uploads/2020/02/update-to-the-gp-contract-agreement-2021-2324.pdf In summary, the changes are as follows ;

- Major enhancements to the additional roles reimbursement scheme to help secure the target of 26,000 additional staff, including an expansion of roles, backed by a bottom up planning process and clinical commissioning group support

- A raft of measures to aid GP training recruitment and retention to help deliver the target of 6000 extra doctors working in primary care, including a new to partnership payment, fellowships in general practice for GP trainees and newly qualified nurses.

- A renewed focus on improving access including a GP access improvement programme which will seek to cut the longest waits for routine appointments and improve patient satisfaction.

- Further reforms to asthma, chronic obstructive pulmonary disease (COPD) and heart failure Quality and Outcomes Framework (QOF) domains, and a new indicator to support diabetes prevention

- An overhaul of vaccination and immunisation payments to increase vaccination coverage - A new universal post-natal check at 6-8 weeks for new mothers - In relation to the Primary Care Network (PCN) Directed Enhanced Service, introduction of revised

structured medications review, care homes (and corresponding requirements for providers of community services will be included in the NHS Standard Contract to be published soon) and early cancer diagnosis national service specifications, with an additional care home payment of £120 per bed

- Introduction of the new Investment and Impact Fund in 2020/21 with incentives in year one to increase uptake of learning disability health checks, seasonal flu jabs, social prescribing referrals, and improve specific aspects of prescribing

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https://www.england.nhs.uk/wp-content/uploads/2020/02/update-to-the-gp-contract-agreement-2021-2324.pdf

https://www.england.nhs.uk/wp-content/uploads/2020/02/update-to-the-gp-contract-agreement-2021-2324.pdf


Page 4 of 9

Further detailed implementation and technical guidance is expected in due course, with some areas being introduced at different points during 2020/2021. The Primary Care Operations and Quality Group will oversee the introduction of this, as it becomes core work during the next 12 months. Financial implications are currently being worked through.

It is noted that the introduction of the new service specifications issued under the Primary Care Network Directed Enhanced Service have implications for the current review of discretionary spend, as does the new Investment and Impact Fund. It is also noted that there will need to be significant support to Primary Care Networks from CCG staff to ensure that implementation by the required date is achieved.

1.2 Internal Audit – Primary Care – Contract Oversight and Management Functions

Mersey Internal Audit agency recently undertook a review of the above functions of the 4 existing Cheshire CCGs. Eastern Cheshire CCG, South Cheshire CCG and Vale Royal CCGs received full assurance. West Cheshire CCG received substantial assurance level with a minor action point in respect of contractual follow ups, which has been addressed adopting the process already in place for the other Cheshire CCGs. Once the reports have been signed off through Governance processes during January and February, they will be presented to the Primary Care Committee by Mersey Internal Audit.

1.3 Roll out of GP Connect

The CCG is working to put in place an IT solution to enable GP Practices to meet their 2019/20 contracting obligations of allowing NHS 111 access to direct booking of GP appointments (one appointment per 3000 patients in practice list per day). The CCG is currently seeking assurances from NHS Digital on the solution to be implemented and will then look to work with the GP practices and NHS 111 to facilitate the implementation and rollout, ideally by the end of March 2020. A more manual contingency plan has been formed for the scenario of the IT solution not being available by 01 April 2020.

1.4 CQC (Care Quality Commission) status update

The following GP practices have recently been inspected by CQC:

- Broken Cross Surgery, Macclesfield – 03/02/2020 – Overall rating of Good - Watling Street Medical Centre, Northwich – 11/02/2020 – Overall rating of Good

As requested at the last Primary Care Committee, the outcomes for CQC (Care Quality Commission) in respect of Primary Care is given below in table form. The Primary Care is currently pulling together a more detailed summary spreadsheet which will be available on request. Eastern Cheshire:

Practice name GP_PRACTICE_CODE POSTCODE Inspection date Date of report Inspection Rating

Alderley Edge N810933 SK9 7AP 26/09/2017 09/11/2017 Good

Chelford Surgery N81069 SK11 9BS 31/05/2016 28/07/2016 Good

David Lewis Centre Y05750 SK9 7UD 09/01/2019 04/02/2019 Good

Handforth Health Centre

N81070 SK9 3HL 14/09/2016 11/11/2016 Good

Kenmore Medical Centre

N81002 SK9 1PA 19/07/2016 15/08/2016 Good

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Wilmslow Medical Centre

N81086 SK9 5HX 23/02/2016 03/05/2016 Good

Lawton House Surgery

N81052 CW12 1QG 10/02/2017 20/03/2017 Good

Meadowside Medical Centre

N81118 CW12 2DY 09/01/2019 27/02/2019 Requires Improvement

Readesmoor Medical Centre

N81027 CW12 1JP 10/06/2016 18/08/2016 Good

Holmes Chapel Health Centre

N81077 CW4 7BB 18/05/2016 17/08/2016 Good

Annandale Medical Centre

N81049 WA16 8HR 04/05/2016 18/07/2016 Good

Manchester Road Medical Centre

N81042 WA16 0LY 07/05/2019 07/05/2019 Good

Toft Road Surgery N81026 WA16 9DX 07/03/2019 01/05/2019 Requires Improvement

Broken Cross Surgery

N81632 SK11 6JL 13/01/2020 03/02/2020 Good

Cumberland House Surgery

N81062 SK11 6JL 08/09/2016 08/09/2016 Good

High Street Surgery N81013 SK11 6JL 21/01/2020 (ARR) 18/06/2018 Good

Park Green Surgery N81088 SK11 6JL 20/05/2016 07/02/2017 Good

Park Lane Surgery N81085 SK11 6JL 18/12/2017 09/02/2018 Good

South Park Surgery N81029 SK11 6JL 15/11/2019 15/11/2019 Good

Middlewood (Formally Bollington

Medical Centre, School Lane

Surgery, McIllvride Practice, Priorslegh

Medical Centre)

N81022 SK10 5JH 21/06/2018 21/06/2018 Good

South Cheshire: Practice name GP_PRACTICE_CODE POSTCODE Inspection date Date of report Inspection Rating

Audlem N81001 CW3 0AH 19/12/2018 21/01/2019 Good

Cedars N81008 ST7 2LU 23 May 2019 (ARR) 23/05/2019 Good

Nantwich N81010 CW5 5NX 16 May 2018 04/07/2018 Good

Millcroft N81016 CW1 3AW 27 March 2019 22/5/2019 Good

Ashfields N81032 CW11 1EQ 30 Aug 2019 (ARR) 30/08/2019 Good

The Oaklands N81039 CW10 9BE 11 July 2017 28/08/2017 Good

Haslington N81043 CW1 5QY 02 Nov 2019 (ARR) 02/11/2019 Good

Hungerford N81044 CW1 5HA 03 Oct 2019 (ARR) 03/10/2019 Good

Kiltearn N81047 CW5 5NX 20 June 2017 20/06/2017 Good

Earnswood N81053 CW1 3AW 27 June 2017 08/08/2017 Good

Grosvenor N81068 CW1 3HB 03 March 2017 02/03/2017 Good

Greenmoss N81071 ST7 3BT 20 Sept 2019 (ARR) 20/09/2019 Good

Rope Green N81084 CW2 5DA 4 May 2019 (ARR) 04/05/2019 Good

Tudor N81090 CW5 5NX 27 Sep 2019 (ARR) 27/09/2019 Good

Merepark N81111 ST7 2LU 19 Oct 2019 (ARR) 18/10/2019 Good

Wrenbury N81614 CW5 8EW 3 July 2019 (ARR) 03/07/2019 Good

Watersedge N81642 CW10 9BH 04 Oct 2017 07/1/2018 Requires Improvement

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Vale Royal: Practice name GP_PRACTICE_CODE POSTCODE Inspection date Date of report Inspection Rating

Swanlow N81024 CW7 1AT 14 Feb 2019 14/03/2019 Good

Firdale N81025 CW8 4AZ 12 March 2019 16/05/2019 Good

High Street N81040 CW7 1AT 12 April 2019 (ARR) 12/04/2019 Good

Weaverham N81051 CW8 3EU 17 Dec 2018 1/02/2019 Good

Watling Street N81055 CW9 5EX 6 Feb 2019 11/02/2020 Good

Witton Street N81061 CW9 5QU 19 March 2019 25/04/2019 Good

Oakwood N81067 CW8 4LF 10 Oct 2018 10/11/2018 Good

Launceston Close N81074 CW7 1LY 3 April 2019 (ARR) 25/05/2019 Good

Danebridge N81087 CW9 5HR 19 Feb 2019 22/05/2019 Requires Improvement

Middlewich Rd N81113 CW9 7DB 18 June 2019 (ARR) 24/08/2019 Good

Willow Wood N81123 CW7 3GY 9 June 2015 13/08/2015 Good

Weaver Vale N81127 CW7 1AT 4 April 2019 (ARR) 4/04/2019 Good

West Cheshire: Practice name GP_PRACTICE_CODE POSTCODE Inspection date Date of report Inspection Rating

Old Hall N81117 CH65 9AD June 2019 Inspection & 31 31

Aug 2019 ARR 31/08/2019 Good

The Elms Medical Centre

N81079 CH1 4DS 12 January 2016 & 12 April

ARR 12/04/2019 Good

Northgate Medical Centre

N81080 CH1 4DS 17 January 2016 & 12 April

2019 (ARR) 12/04/2019 Good

St Werburghs Practice

N81655 CH1 3EQ 8 February 2017 & 25 May

2019 (ARR) 25/05/2019 Good

Handbridge Medical Centre

N81101 CH4 7JS 2 February 2016 & 12 June

2019 (ARR) 12/06/2019 Good

York Road Group Practice

N81063 CH65 0DB 6 October 2015 & 24 May

2019 (ARR) 24/05/2019 Good

Tarporley (Campbell)

N81018 CW6 0BE 20 January 2017 & 16 July

2019 (ARR) 16 July 2019 Good

Malpas Surgery N81038 SY14 8PS 10 May 2016 & 16 July 2019

(ARR) 16 July 2019 Good

Lache Health Centre N81115 CH4 8HX 20 July 2016 & 19 July 2019


Neston Surgery N81060 CH64 4BN 5 July 2016 & 16 July 2019


Boughton Health Centre

N81034 CH2 3DP 18 October 2016 & 10 Aug

2019 10 Aug 2019 Good

Upton Village Surgery

N81100 CH2 3HD 14 February 2017 & 10

August 2019 (ARR) 10 Aug 2019 Good

Helsby Health Centre

N81005 WA6 0BW 28 February 2017 27 March

2017 Good

Tarpoley (Adey) N81031 CW6 0BE 25 May 2017 & 25 September

2019 (ARR) 25 September

2019 Good

Tattenhall Village Surgery

N81624 CH3 6QD 4 July 2017 & 6 September


2019 Good

City Walls & Saughall MC

NN81082 CH1 2NR 12 July 2017 & 5 September


2019 Good

The Knoll N81030 WA6 6RX 27 August 2017 5 October

2017 Good

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Garden Lane N81081 CH1 4EN 25 July 2017 & 18 October

2019 (ARR) 18 October

2019 Good

Western Avenue N81626 CH1 5PA 18 July 2017 & 18 October


2019 Good

Willaston Surgery Y04664 CH64 2TN 21 August 2018 & 15

November 2019 (ARR) 15 November

2019 Good

York Road Surgery N81063 CH65 0DB 6 October 2015 & 24 May

2019 (ARR) 24 May 2019 Good

Hope Farm Surgery N81092 CH66 2WW 1 March 2017 & 10 August

2019 (ARR) 10 August

2019 Good

Fountains Medical Centre

N81102 CH1 4DS 10 July 2018 & 20 December

2019 (ARR) 20 December

2019 Good

Kelsall Medical Centre

N81120 CW6 0QG 7 June 2017 - Practice re-

registered 27 Jan 2019 & not yet re-inspected

18 July 2017 Good

Westminster Surgery

N81607 CH65 2ER 20 May 2019 & 22 January

2020 (ARR) 22 Jan 2020 Good

Whitby Group Practice Green

N81023 CH65 6TG 13 November 2018 7 December

2018 Good

Whitby Group Practice Black

N81091 CH65 6TG 11 December 2018 2 January

2019 Good

Whitby Group Practice Red

N81093 CH65 6TG 27 November 2018 28 December

2018 Good

Bunbury Medical Centre

N81006 CW6 9PE 4 April 2017 & 18 October


2019 Good

Great Sutton Red N81094 CH66 3PB 7 March 2017 & 4 July 2019


Great Sutton Green N81050 CH66 3PB 21 March 2017 & 21 June

2019 (ARR) 21 June 2019 Good

Great Sutton Blue N91095 CH66 3PB 14 March 2017 & 5 July 2019


Handbridge Medical Centre

N81101 CH4 7JS 2 February 2016 & 12 June

2019 (ARR) 12 June 2019 Good

1.5 Update from Primary Care Operations and Quality Group

The newly formed single Cheshire CCG Primary Care Operations and Quality Group (PCOQ) has commenced monthly meetings, replacing previous arrangements in all the CCGs in respect of primary care operations and quality. A further meeting of the West Cheshire Primary Care Quality Group is meeting in March, pending new arrangements being finalised. It is noted that primary care quality issues will also be discussed within the overall quality structure at other meetings, in addition to this. A Terms Of Reference will be developed in due course for this group, this will form part of the next update from the group to the Committee. At the January meeting the following items were included for discussion and agreement/escalation ;

The monthly ‘issues log’ of all ongoing contractual and quality issues across the CCGs – items by exception are escalated to the Committee for further information.

The risk log proposal, included as a separate item for this Committee to consider A focused overview of APMS (Alternative Provider Medical Services) Contracts across Cheshire,

which are contracts for primary care not commissioned through GMS (General Medical Services) or PMS (Personal Medical Services) contracts, was presented.

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The Draft Service(s) Specification for Primary Care Networks (1.1 above) was considered and preparatory work in relation to this was agreed, pending the final specification and guidance being released.

A recommendation in respect of Information Governance in General Practice was discussed and agreed – this item is included as a separate paper, for the committee to agree.

Quality Update – specific updates were received in relation to ; o Flu uptake – data in terms of flu uptake across various areas was discussed, including

outlier information. It was agreed that data would be sent to Practices to assist with future planning, via the quality team.

o Annual Complaints report for the 4 CCGs, including incident reporting An update on the ongoing work in respect of Primary Care ‘non-core’ (discretionary) spend, this

item is also included in a separate paper to the committee.

1.6 Danebridge Medical Practice (Northwich) – Sandiway branch surgery

A period of consultation was launched by Danebridge Medical Practice in December 2019 to gather the views of registered patients on the proposed closure of Sandiway Surgery (a branch surgery of Danebridge Medical Practice).

Patients registered with Danebridge Medical Practice (including Kingsmead and Sandiway Surgery) were invited via letter to share their views on the proposed closure of the Sandiway branch surgery during the consultation period that ran to Monday 27th January 2020, with further engagement carried out by the practice. Patients were encouraged to respond via an online survey but comments received via other means (e.g. letters direct to the Practice/CCG) will also be incorporated into the considerations of the consultation responses. Practice staff also attended local meetings as well as ‘drop’ in sessions for patients. Patients who are members of the PPG (Patient Participation Group) have also been working with the Practice in this respect. The list size of Danebridge Medical Practice is 25,022 patient (as at 1.1.20).

Informed by the outcome and products of the consultation, a branch surgery closure application to the CCG may subsequently be made by Danebridge Medical Practice which would then be heard by the Primary Care Commissioning Committee (PCCC) of NHS Cheshire CCG for decision.

Ahead of the PCCC considering any branch surgery closure application, if Danebridge Medical Practice choose to proceed, the Practice and the CCG will consult with the Health Overview And Scrutiny Committee (OSC) of Cheshire West and Chester Council and the Cheshire Local Medical Committee (LMC). The consideration and views of the OSC and the LMC will also inform the deliberations and decision of the PCCC. Staff from the CCG’s Primary Care Contracting and Communications & Engagement Teams have been and will continue to provide advice and support to Danebridge Medical Practice throughout the consultation process.

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Page 9 of 9

2 Primary Care Development Update 2.1 Cheshire West Place

- No update available for this meeting.

2.2 Cheshire East Place

- All Cheshire East PCNs continue to make good progress against delivering requirements with the DES. PCNs are developing plans that align to the Cheshire East Integrated Care Partnership (ICP) strategic priorities, namely, Respiratory disease, Cardiovascular Health and Mental Health and wellbeing including social prescribing. Work is ongoing to firm up the details of these areas as well as ensuring alignment of priorities with Local authority and other provider partners.

- In addition, local projects to support local population health needs continue to progress. In February the Crewe Care Community successfully launched their Lyndsey Leg Club. This is a multi disciplinary services that supports local patients in a community based setting with lower leg conditions. The club is run by volunteers from the Crewe community and is provided for by district and practice nursing teams. The aim being in increase the healing rate for lower leg conditions and reduce the social isolation that many people experience.

- Across South Cheshire all 4 PCNs have social prescribing link workers in post who are working in partnership with the practices to support and sign post patients appropriately through alternative services. A further 2 SPLWs are in post or being recruited to across Eastern Cheshire PCNs.

- PCNs are now in the planning phase for additional workforce roles for the second year of the DES. The outcomes of these conversations will be dependent on the publication of the final DES specifications for 2020/21.

- The CCG has secured a package of PCN Development support from the Advancing Quality Alliance (AQuA) for practices and PCNs across the Cheshire East ICP footprint. This offer includes facilitated staff engagement support, relationship building, leadership coaching and developing PCN culture. This offer has now been taken up by a number of PCNs and runs until April 2020. Other PCNs have accessed support via Primary Care Commissioning (PCC) or Primary Care Direct.

- PPG Quick Start Programme - GP Practices across the Eastern Cheshire CCG foot print have completed wave 9 Productive GP Practice Quick Start programme, which forms part of NHS Englands “Time to Care” package of support to GP practices. The benefits for practices in undertaking the programme are releasing time; creating headspace; build capacity and confidence to address current and future pressures; introduce tools and techniques which can be put into practice again and again. Practices carried out either practice or PCN based projects looking at appropriate appointments, frequent attenders, clear job standards and efficient processes. As a result of the 3 month programme, changes have been made in practice.

3 Primary Care Team - Cheshire 3.1 The Primary Care Teams across the four Cheshire CCGs have been working in an aligned way

throughout the second half of 2018-19 and into 2019-20. Staff formerly all working as members of the 4 CCGs Primary Care Team(s) were either aligned to the (single) Cheshire CCG or to the primary care development functions of Cheshire West or Cheshire East Integrated Care Partnership (ICP).

3.2 CCG Primary Care Team staff aligned to the CCG functions, has been confirmed in post and have

commenced working in their new roles. CCG Primary Care Development staff remain aligned to the ICP,

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PRIMARY CARE COMMISSIONING COMMITTEE MEETING Part A 26

th February 2020 Agenda Item A2.2

Title

Primary Care Risk Register

Author Contributors

Christopher Leese Associate Director Of Primary Care

Date submitted

Purpose To present to the Primary Care Committee a series of recommendations in relation to the Primary Care Risk Register


The Primary Care Operations and Quality Group have recently reviewed the Primary Care Risk Registers of the Cheshire CCGs and have recommended revisions that will form a single Primary Care risk register for Cheshire CCG from 1st April 2020.

Key Implications– please indicate Strategic ☐

Consultation & Engagement ☐

Financial ☐ Resources (other than finance) ☐




Legal / Regulatory Staff / Workforce ☐


Approve Ratify ☐ Decide ☐ Endorse ☐ For information ☐

Recommendation(s) The Primary Care Committee is asked to: Agree the recommendations from the Primary Care Operations and Quality Group which will

then be transferred over into a single risk register for Primary Care for Cheshire


Primary Care Operations And Quality Group Neil Evans Executive Director Of Planning and Delivery

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Primary Care Committee 26.2.20

Agenda Item 2.2

Page 2 of 6

Appendices

Appendix A Summary of Risk Register Review

Primary Care Committee

Primary Care Decisions ‘Cheshire Wide’ Report

Date: 26th February 2020 CCG Representatives: Christopher Leese Report to: Primary Care Committee

Proposal in respect of single Cheshire Primary Care Risk Register

1. Background

1.1 Eastern Cheshire CCG, West Cheshire CCG and Vale Royal/South Cheshire CCG each

maintained a risk register in respect of Primary Care 1.2 At the Committee meeting held in December, the Primary Care Committee in Common

requested that the Primary Care Operations and Quality Group (PCOQ) reviewed the risks on each of the risk registers and recommended a revised register to be transferred over to the single Cheshire CCG on 1st April 2020.

1.3 A summary of the discussions is given within this paper with recommendations, with a

summary contained in Appendix A.

2. Proposal 2.1 The Primary Care Committee is asked approve the following recommendations ;

2.1.1. Risk 001 in respect of Knutsford Primary Care Estates remain on the register

at the current level. 2.1.2. Risk 002 in relation to the Primary Care Delegated Budget and potential

challenges in managing this, remain on the register at the current level and is amended generically to reflect the picture across Cheshire.

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2.1.3 Risk 003 in relation to Primary Care Support England which reflected previous challenges and service issues with the provider historically remain on the register at the current level of 12. The CCG Primary Care Team will work with practices to ascertain if any ongoing issues, before recommending any changes.

2.1.4 Risk 004 in relation to routine practice visits not taking place on a rolling

annual programme, it is recommended that this risk be maintained at the current level, and issues of capacity and planning for this be discussed further at the Operations and Quality group.

2.1.5 Risk 005 in relation to ongoing stability and resilience of Primary Care, it was

felt this should remain on the risk register and reflect within it specific concerns in relation to recruitment and retention and the impact of any new contract changes. It was noted that this risk was also currently on the governing body risk register of South Cheshire and Vale Royal CCG.

. 3. Recommendations 3.1 It is recommended that the Primary Care Committee approve the recommendations above

noting that the final risk register in the format agreed will return to the committee at each meeting for agreement, with the Primary Care Operations and Quality group discussing between each meeting. This is to be undertaken noting that new risks may be added to this in due course.

4 Access to further information 4.1 For further information relating to this report contact:

Name Christopher Leese Designation Associate Director – Primary Care

NHS Eastern Cheshire Clinical Commissioning Group NHS South Cheshire Clinical Commissioning Group NHS Vale Royal Clinical Commissioning Group NHS West Cheshire Clinical Commissioning Group

Telephone

Email [email protected]

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Agenda Item 2.2

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Appendix A

Risk ID: 0001 Title: Knutsford Primary Care Estates Needs Description (taken from previous risk register):

For a number of years we have looked to build a new GP Health Centre in Knutsford which could house the three existing GP practices. The three current sites are in need of a significant amount of estates development in order to meet current and future requirements. Space utilisation analysis across all three Knutsford GP practices has demonstrated that with regards to adequately providing primary care services to the existing patient population the three GP practices currently have a significant shortfall. Additional growth in patient numbers (estimated to be around 2000 additional patients over the next 10 years based on organic growth and known planning applications) will add further pressures to the three GP practices, with an increase in clinical and non-clinical staff required in order to meet these future patient needs. As part of the CCG ETTF submissions in June 2016 it was agreed that plans should be progressed to build a new GP Health Centre in Knutsford which could house the three existing GP practices and provide the expansion space needed. This was originally put forward as an ETTF funding bid. It now does not look likely that ETTF funding will be available to fully fund the progression of this project. The CCG is working with the three Knutsford GP practices to look at options to allow the project to continue. One of the three GP practices (Annandale) has a fixed five year lease that will end in May 2024. Once the lease is ended, it is understood that the landlords plans to redevelop the site and so Annandale will need to find new premises. There is a risk that if the new combined GP Health Centre is not built and operational within the next five years then Annandale will lose its premises. This risks the practice population having reduced access to primary care services; due to limited additional capacity in neighbouring GP practices this could lead to some patients being unable to adequately access primary care services for an extended period of time. Should the GP practice be unable to fulfil its contract and the CCG not have a clear plan in place to mitigate this risk there would be reputational damage across all

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stakeholder groups. Current Risk Score:

12

Status: Risk to be reviewed, assessed and rated at Primary Care Committee. CCG Estates Group and Primary Care Team to lead on progressing the primary are development.

Recommendation to the Committee

Risk to be transferred over to the Cheshire CCG risk register at current level

Risk ID: 0002 Title: Primary Care Commissioning, Financial Description: CCG Financial Challenges in relation Budget Allocations for

2019/20 Current Risk Score:

16

Status: Managed at the Primary Care Operational Meeting and Primary Care Committee * Regular reporting mechanisms and escalation process in place * Regular Financial internal meetings and forecasts * Monthly reports from Finance



Risk ID: 0003 Title: Primary Care Support England Description: Primary Care Support Services England (PCSE) - issues in

relation to PCSE and concern regarding any onward effects to Practices across both CCGs.

Current Risk Score:

12

Status: * CCG Primary Care Team are supporting practices as far as possible with escalating issues direct to Capita (new supplier) * Standing item for discussion at Delegated commissioning task and finish group / Primary Care Operations Group * Log issue escalated direct to NHSE who attend face to face meetings with Capita * BMA/GPC have written direct to NHS England to raise practices' concerns. * July 2016 NHSE are having regular meetings with Capita * The LMC and GPC continue to support practices in escalating their issues as do the two CCGs.

Recommendation Risk to be transferred over to the Cheshire CCG risk register at

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to the Committee current level

Risk ID: 0004 Title: Rolling annual visits to Practices Description: * The Committee has received and commented on the suggested

framework for Annual Contractual and Quality Visits - The Committee agreed to (1) a rolling programme of planned contract and performance visits over a 3 year period, (2) Responsive visits outside the cycle as required e.g. contractual, quality and soft intelligence or (3) A triggered visit e.g. CQC Requires Improvement - the latter 2 are already in place * Almost all Practices have received CQC visits providing a benchmark

Current Risk Score:

9

Status: * Framework was approved by the committee before being implemented. *The Operational Group with Quality will work up the detail outside of the Committee * Discussion regarding Staffing within Quality in relation to Primary Care



Risk ID: 0005 Title: Resilience and Stability of General Practice Description: Overall risk describing various scenarios and pressures on

General Practice Current Risk Score:

12

Status: *CCG has an interim provider policy.*NHS England policy book has revised section on this issue.* Regular discussions at the Primary Care Operations Group to ensure aware of all Practice issues. *CCG has undertaken scenario plannning in this respect. *Primary Care Performance Dashboard, ongoing Execc buddy visits to ensure aware of issues in advance where possible.*Engagement and dialogue with LMC to support Practices with resilience issues * Resilience section of GP Charter 19.20 * Support Practices in respect of applications for the GP Resilience Fund, when released



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PRIMARY CARE COMMISSIONING COMMITTEE Part A 26

TH February 2020 Agenda Item: A3.1

Title Update on the Primary Care Discretionary expenditure and commissioned schemes review.

Author Contributors

Tanya Jefcoate-Malam Deputy Head of Primary Care

Various including Primary Care Team, Primary Care Finance, Commissioning and Clinical Support

Date submitted 12th February, 2020

Purpose The Primary Care Commissioning Committee has been asked to discuss and review the update report relating to the discretionary Primary Care spend across the 4 Cheshire CCGs. This paper gives an update on the work completed to date relating to the initial review, risks and next steps and is for information only. A report detailing recommendations for the financial year 2020/21 will be circulated for virtual decision by the committee in March 2020.

Reason for consideration by Primary Care Commissioning Committee:

The full review will support development of a single consistent commissioning offer to all

patients within Cheshire in respect of Primary Care services. This should lead to: o Value for money in respect of services commissioned o Supporting the delivery of high quality outcome based Primary Care services o Helping with the stability and resilience of General Practice o Enabling equality of access to Primary Care services.


Consultation & Engagement

Financial Resources (other than finance)




Legal / Regulatory ☐ Staff / Workforce

Other – please state

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Primary Care Commissioning Committee 26th February, 2020

Agenda Item: 3.1

Page 2 of 12

Outcome Required:

Approve ☐ Ratify ☐ Decide ☐ Endorse For information

Recommendation(s) It is recommended that the Primary Care Commissioning Committee:

(a) Review and discuss progress of the initial review to date, including barriers, issues and risks identified,

(b) Note and endorse the time-frames for the comprehensive review as approved by the Primary Care Commissioning Committee in December 2019.


Chris Leese, Associate Director of Primary Care and Neil Evans, Executive Director of Planning and Delivery.

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Agenda Item: 3.1

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Primary Care Commissioning Committee

Update on the Primary Care discretionary expenditure and commissioned schemes review.

Date: 26th February, 2020 CCG Representatives: Tanya Jefcoate-Malam Report to: Primary Care Commissioning Committee

Review of discretionary Primary Care spend – Cheshire CCGs Update 1. Background

1.1 In December 2019, the Primary Care Commissioning Committee across Cheshire was

presented with a paper requesting that work now took place to review the Discretionary Spends funding in Primary Care. The Committee was asked to approve a two stage process:

An initial review of existing schemes to, where possible, roll-over all current CCG

specifications in their existing form in order to provide a period of stability. It is noted that minor tweaks to these specifications may need to take place and a further review once the Primary Care Network Directive Enhanced Service (DES) and Specifications are released later in 2020,

And a more comprehensive review to understand which schemes provide best practice, have demonstrable improvements in patient outcomes or support Primary Care resilience and finance roll-out a standardised Primary Care enhanced offer to patients across Cheshire.

1.2 Within the paper described, work had taken place between Primary Care and Primary Care finance to understand what schemes are currently commissioned at what contractual value.

1.3 Work has now taken place to obtain copies of all specifications detailed within this report, and

the initial review to determine what can be rolled-over in its current form and what requires minor or major amendment is well under way.

2. Progress to date 2.1 The project lead for this work met with the Primary Care Leads across the four Cheshire

CCGs pre-Christmas to set out the “ask” of identifying all relevant specifications in order to complete the initial review. In early January, commissioning leads with clinical support for each specification were identified. Following these roles being filled, the initial review has commenced and is now in its final stages of completion.

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Agenda Item: 3.1

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2.2 A brief summary of progress for the initial review is detailed within the short table below,

however an in-depth understanding of scheme detail, project lead, finance involved, risks and status can be gleaned from the detailed table within the appendix. For ease of reference, a summary financial table has also been included for information purposes only.

CCG Scheme Status Issues

We

st

Minor Injuries, Medicines Management, Minor Surgery, Vasectomies, DMARD, Anticoagulation, Diabetes, Adoption / Fostering & Extended Access

Managerial and Clinical Review complete – roll-over

N/A – roll-over and await comprehensive review

Primary Care CQUIN Managerial review complete – Clinical review pending

Complexity of language and format has led to disengagement Content unchanged in the main but language and format simplified

Mental Health LES (Local Enhanced Service)

Awaiting feedback

Specification not current and in need of review. It is likely that this LES will be used as a mechanism to support Practices over Serious Mental Illness (SMI) health checks

Phlebotomy / Discretionary Spends Ongoing Previous decision pending adoption. Contract notice to be given

Health Inequalities LES Ongoing New LES in 2019/20 commissioned to deal with historic issues with one PMS contract and one APMS contract. An immediate review to be undertaken and meeting with relevant stakeholders pending

SC

& V

R

Counselling LES, Adoption / Fostering, Practice PCG Staff Monies, Weaver Lodge and Wound Care

Managerial and Clinical Review complete – roll-over


Primary Care Charter Ongoing Project Lead currently liaising with managerial and clinical lead in each Indicator area. Review should lead to minor changes only

GP Alliance Funding Managerial and Clinical Review complete – roll-over


Prescribing Incentive Scheme Ongoing Medicines Management Team has

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Agenda Item: 3.1

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identified the need to review this scheme and re-write taking into account learning across Cheshire. This work will sit outside this review

Anticoagulation, Dermatology, GP Care Homes, Minor Surgery, Near Patient Testing and Vasectomy

Ongoing Currently receiving clinical review. Will need to consider impact of PCN DES as released

ECG, Paediatric Bloods and Peer Review

Awaiting Feedback

Awaiting feedback from initial managerial review

Ea

st

Ear Suction, Gynaecology, Insulin Initiation, GP Care Homes, Minor Surgery, Therapeutic Injections, Phlebotomy, Vasectomy, and Echo LES and Adoption / Fostering, Style Babies contract

Ongoing Managerial review complete requiring minor amendments only. Clinical review to be completed. Potential impact from PCN DES

Primary Care Contract – Caring Together

Ongoing Managerial review complete requiring minor amendments only. Clinical review to be completed. Potential impact from PCN DES and are considering strengthening of SMI Health-Check requirements

Prescribing Incentive Scheme Ongoing Medicines Management Team has identified the need to review this scheme and re-write taking into account learning across Cheshire. This work will sit outside this review

Clinical Commissioning Group

East Cheshire South Cheshire Vale Royal West Cheshire

Caring Together Contract / Charter / CQUIN

£3,594,172 £518,046 £302,419 £3,442,414

Other Discretionary Spends (e.g. Prescribing Incentive Scheme / GP Alliance)

£832,252 £959,345 £560,035 £0

Secondary Care Services in Primary Care

£702,307 £1,294,646 £862,493 £1,718,516

Total £5,131,731 £2,772,037 £1,724,947 £5,160,930 £ per head £24.63 £14.45 £15.40 £19.41

2.3 Whilst this mini-review has taken place, engagement with the Local Medical Committee (LMC)

has commenced, with a communication email summarising this work being sent to the LMC, and also their feedback gained on communications to go out to all Practices across Cheshire.

2.4 Agreed communications detailing this initial review and the intentions of the CCG via the

comprehensive review has now been shared with all Practices via partners and Practice

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Managers. Initial engagement work has commenced with discussions taking place at Practice Managers meetings and membership. In addition, a meeting is currently being arranged with the LMC to support this work further.

3. Issues Identified 3.1 Although the initial review has so far progressed without any significant challenge, a number

of key issues have been identified that require further thought and planning:

3.1.1 Wound Care: Due to Primary Care feedback around increased demand on Practices in South Cheshire and Vale Royal CCGs for the delivery of wound care and a risk to resilience caused by a lack of funding, a new one year transitional commissioning solution is in the process of implementation. This is intended to be a collaborative commissioning arrangement between the GP Alliance and Practices. This is currently experiencing some commissioning barriers and is being managed by the Strategy and Partnerships commissioning team.

3.1.2 Serious Mental Illness Health Checks: There is now a requirement to ensure

that all 6 SMI indicators are completed in a health check for those patients on relevant registers to a target of at least 60%. As this work is a priority for the CCG in order to achieve parity of esteem, and will additionally require further input from Practices, a plan is currently being drafted to understand how this extra work can be financed. Additional one year non-recurrent funding has been identified to support Practices in South Cheshire and Vale Royal, and other recycled schemes (via the Mental Health LES in West Cheshire and the Caring Together Contract in East Cheshire) have been identified.

3.1.3 Cost Pressures: Initial conversations around the discretionary spends review

have taken place with the LMC at county wide meetings and via email. A further meeting is currently being arranged. However, the LMC representatives have raised concerns around the requirements of an inflationary uplift to the LES contracts. Initial conversations with CCG finance have taken place and it is understood that the CCG is required to apply a 4% increase to all locally commissioned Primary Care budgets. It is currently unclear whether this increase applies to existing planned rises in e.g. population size or whether this is required to be a new increase applied to the overall budget.

4. Next Steps 4.1 Following the completion of the initial review, approval of the schemes to be rolled-over will

need to take place at a virtual Commissioning Committee in March 2020. Once these schemes have been moved into their correct contracting format and launched, work will then take place to establish Task and Finish Groups for the comprehensive review in 2020/21.

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4.2 Membership of the oversight Task and Finish Group has previously been agreed at Primary Care Commissioning Committee, however it is likely that smaller more specialised groups will need to be established to review specific areas e.g. relating to Primary Care Networks, Care Homes, Long Term Conditions etc. also taking into account the release of the Primary Care Network DES.

4.3 Amended timescales from those specified at the Primary Care Commissioning Committee can

be seen within the table below: Date

Action Governance Outcome

December 2019 Agreement from PCCC (Primary Care Commissioning Committee) to proceed Mini-review of schemes commences

PCC (Primary Care Committee) Primary Care Operations Group

Mini Review process agreed and in place Approval granted

January 2019 Mini- review ongoing Primary Care Operations Group

Project documents to specify scope and agree project lead / timescales Complete

February 2019 Mini- review reports Task and Finish Group established and agree 12 month plan with stakeholder engagement and review points Membership/Practice Communications regarding mini-review

Task and Finish Group Primary Care Operations Group Update to Primary Care Committee

TAF Group Project Plan Mini Review Report Complete Communications with Membership/General Practice re existing schemes complete

March Existing Schemes consultation finishes and contracting arrangements agreed Task and Finish Group meets

Task and Finish Group Virtual Primary Care Commissioning Committee

Sign up to existing schemes incorporating mini review outcomes

April – December 2020 Task and Finish Group plan implementation including stakeholder engagement and design elements progresses with defined

Task and Finish Group Primary Care Operations Group

Actions identified in the Task and Finish Group plan Amendments to current

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reporting and timescales Amendments to be made to existing schemes based on PCN DES specifications once released

Update to Primary Care Commissioning Committee

schemes to be completed

December 2020 Task and Finish Group final report and recommendations to the Primary Care Commissioning Committee

Task and Finish Group Primary Care Operations Group Report to Primary Care Commissioning Committee for agreement

Final report and recommendations in respect of non-core spend Agreement as to implementation period/transitional arrangements a further 12/24 months, in conjunction with ICP

4.4 The risks to the above timeline will be captured and managed through the Task and Finish

Group, but in summary the key risks are:

Resourcing – delivering to the timescales above will require dedicated staff time including overall ‘Project Management’

ICP development – maturity of the ICP and its ability to take on the revised contracting arrangements

General Practice – resilience and stability – the work timescales need to take into account the current issues in General Practice, the pace should reflect the immediate challenges being faced

Consensus – the ability to reach a broad agreement given the many priorities and challenges across the system

Finance/Value for money Practice sign up/adjustment to a ‘single Cheshire approach’.

5. Recommendations 5.1 It is recommended that the Primary Care Commissioning Committee:

(a) Review and discuss progress of the mini-review to date, including barriers, issues and risks identified,

(b) Note and endorse the time-frames for the comprehensive review as approved by the Primary Care Commissioning Committee in December 2019.

6. Access to further information 6.1 For further information relating to this report contact:

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Name Tanya Jefcoate-Malam Designation Deputy Head of Primary Care

Telephone 01244 385264


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7. Appendices

Detailed Mini-Review Table

CCG Scheme Name Contact DetailFunding

(annual)Elements to roll-over

Elements to be significantly changed or

discontinued

Financial

implications

Clinical

implications

Contractual

implicationsStatus

Primary Care CQUIN Tanya Jefcoate-Malam

Multi-aspect contract incorporating CQUIN, over 75s

funding, £1.50 per head and uplift, Nursing Homes,

Residential Homes and Intermediate care, ECGs, Diabetes,

Spirometry, Dressings and Health Checks

£3,442,414

Entire CQUIN contract to roll-over with

minor amendments as follows:

Chapter 1 Frailty / Care Homes - to roll

over with consideration to new DES.

2019/20 spec and reference to 111

direct booking removed

Chapter 2 LTCs

- to roll over with minor amendments

to wording and removal of Starting

Well. Also requirement for quarterly

not monthly reports

Chapter 3 Dressings

- to roll over as is

Chapter 4 Health Checks

- to roll over as is

Appendices

- to roll over with "Support and

Escalation Process" removed

N/A

Potential risk as to

whether PMS

funding is received

on recurrent basis

to fund dressings

service - if not cost

pressure

N/A

Major overlaps

with PCN DES for

care homes and

risk stratification

Complete at

present

Minor Injuries LES Helen Thorniley-JonesLES supporting Practices to carry out procedures that would

often require attendance at A&E in rural settingsTBC Roll-over in its entirety N/A N/A N/A

Currently offered

to all localities in

West other than

Chester

Complete at

present

Medicines Management LES Barbara PerryLES to support Practice employment of Medicines

Managers for projects such as "What a Waste"TBC Roll-over in its entirety N/A N/A N/A N/A

Complete at

present

Minor Surgery LES Amanda Ridge Alternative commissioning and enhancement on DES £118,000 Roll-over in its entirety N/A NHSE DES funding N/A N/AComplete at

present

Vasectomy LES Amanda Ridge Vasectomy within the community offered by one Practice £2,457 TBC TBC N/A N/A

Consider in line

with Planned Care

review

Complete at

present

DMARD LES Andrew Horton Near patient testing for Rheumatology £253,000 Roll-over in its entirety N/A N/A N/A N/AComplete at

present

Anticoagulation LES Adele GrahamTo support Practices in the prescribing and review of

patients on anti-coagulation£168,000 Roll-over in its entirety N/A N/A

To consider in

future addition of

DOACs

N/AComplete at

present

Diabetes LES Adele Graham To support Practices in initiation of insulin £297,936 Roll-over in its entirety N/A N/A N/A N/AComplete at

present

Mental Health LES Emma LeighTo support Practices in achieving parity of esteem for

patients with a mental health condition£130,000

Awaiting

feedback

Phlebotomy / Discretionary Spends Lorraine Weekes Locally agreed funding for phlebotomy and staff to support £12,000Awaiting

feedback

Health Inequalities LES Tanya Jefcoate-MalamNew LES commissioned 2019/20 to support Practices within

deprived communitiesTBC

Awaiting

feedback

Adoption / Fostering Finance Funding for assessments £6,600 Roll-over in its entirety N/A N/A N/A N/AComplete at

present

Extended AccessKevin Carberry / Dean

Grice

Funding for extended access scheme including the

following elements:

- Extended hours provided by CWP

- Extended hours provided by GP Practices

- Physio / WBC

- Individual patient MH package

TBC Roll-over in its entirety N/AComplete at

present

We

st

Ch

esh

ire

Awaiting feeddback from review

TBC - currently being reviewed based on previous PCCC decision

TBC - consideration as to whether this LES is discontinued and funding paid instead via a CCG delegation discretionary spends agreement

Although can be rolled-over as is for now, implications of

PCN DES means extended hours passes to GPs from

31/03/21. Future commissioning arrangements around

extended hours to be decided. Individual patient MH

package to fall either under delegated discretionary spends

or personalised care package

We

st

- O

the

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Primary Care CharterAmanda Best / Tanya

Jefcoate-Malam

Funding to support Practices in improving quality and

engaging with the CCG and population priorities:

- pre-qualifying criteria to standardise Primary Care

- Domain 1 - Primary Care IT, quality and frailty

- Domain 2 - LTCs and Mental Health

- Domain 3 - ACS Conditions

- Domain 4 - PCN development

SC £518,046

VR £302,419N/A

Although scheme is to roll-over are

changes to be made including

- Domain 1 - strengthening of data

sharing requirements and small sections

to be removed due to contract

- Domain 2 - to be reviewed meeting

arranged

- Domain 3 - Diabetes and MH sections to

be strengthened

- Domain 4 - ACS condition areas to be

strengthened

- Domain 5 - PCN section to be removed

due to DES

N/A N/A

Potential need to

re-negotiate and

seek approval for

amended spec is

considered

"material"

Ongoing

GP Alliance Funding Amanda Best Funding to support GP Federation and work within CharterSC £191,869

VR £112,007Roll-over in its entirety

Roll-over in its entirety. There maybe

slight tweaks and amendments.

Feedback to follow

N/A N/A N/A Ongoing

Prescribing Incentive Scheme Mark Dickenson Funding to support Practices in improving prescribingSC £767,476

VR £448,028N/A

Currently being reviewed by Medicines

Management team to align to West

Cheshire scheme

N/A N/A

If scheme is re-

written,

negotiation and

approvals will be

needed

Ongoing

ECG LES Steve Evans Funding for ECGs in Primary CareSC £12,933

VR £7,274

Awaiting

feedback

Anticoagulation LES Mark DickensonTo support Practices in the prescribing and review of

patients on anti-coagulation

SC £37,000

VR £15,555Roll-over in its entirety Roll-over in its entirety N/A

To be reviewed by

MDN/A Ongoing

Counselling LES Chris LeeseFunding to support Primary Care counselling service -

invoiced per activity

SC £27,000

VR £40,612Roll-over in its entirety Roll-over in its entirety N/A N/A N.A

Complete at

present

Dermatology LES (SC only) Chris Leese Funding to support Primary Care dermatology service SC £20,000 Roll-over in its entirety Roll-over in its entirety N/ATo be reviewed by

ALN/A Ongoing

GP Care Homes LES Chris LeeseFunding to support the provision of Primary Care as an

enhanced service in care homes

SC £269,000


To be reviewed by

ALN/A Ongoing

Minor Surgery LES Chris Leese Funding to support Primary Care minor surgery serviceSC £18,000


To be reviewed by

ALN/A Ongoing

Near Patient Testing LES Mark Dickenson Funding to support Primary Care Near Patient TestingSC £129,000


To be reviewed by

MDN/A Ongoing

Paediatric Bloods (VR only) Steve Evans Funding to support Paediatric Phlebotomy in Primary Care VR £3,000Awaiting

feedback

Vasectomy LES Chris Leese Vasectomy within the community offered by PracticesSC £75,000


To be reviewed by

ALN/A Ongoing

Adoption / Fostering Finance Funding for assessmentsSC £10,000

VR £4,000Roll-over in its entirety N/A N/A N/A N/A

Complete at

present

Practice Staff PCG Monies Amanda Best Individual funding agreements with Practices for staffSC £601,000

VR £302,751Roll-over in its entirety Roll-over in its entirety N/A N/A

Will need PMS

style review and

potentially

appropriate

transition

Complete at

present

Weaver Lodge Chris LeeseIndividual funding agreemement for the support of one

homeVR £15,000 Roll-over in its entirety Roll-over in its entirety N/A N/A

Will need to be

considered as part

of the wider

review including

the PCN DES

Complete at

present

Wound Care John Grant Funding to support Primary Care in delivering wound careSC £26,862

VR £15,861

Complete at

present

Peer Review Jamaila TausifFunding to support GP and Federation to carry out peer

review of activity

SC £68,851

VR £38,729

Awaiting

feedback

So

uth

Ch

esh

ire

& V

ale

Ro

ya

lS

ou

th

/V

R -

Oth

er

TBC - awaiting feedback from managerial lead


This contract has recently been reviewed and rolled-out via a new model for 2020/21 as a transitional year only using a joint Primary Care and

community model


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Agenda Item: 3.1

Page 12 of 12

Primary Care Contract Dean Grice

Primary Care incentive scheme to support improved

Primary Care quality and working towards standardisation:

- Indicator 1 - Standardisation of Primary Care

- Indicator 2a - preventative care

- Indicator 2b - LTC care

- Indicator 2c - onward referral

- Indicator 2d - investigations

- Indicator 3 - Community Co-Ordinators

£3,594,172 N/ATo be reviewed by

MC / KMN/A Ongoing

Ear Suction LES Dean Grice LES to support the delivery of Ear Suction in Primary Care £49,091 Roll-over in its entirety Roll-over in its entirety N/ATo be reviewed by

MCN/A Ongoing

Gynaecology LES Dean GriceLES to support the delivery of Gynaecology services in

Primary Care£9,430 Roll-over in its entirety Roll-over in its entirety N/A

To be reviewed by

MCN/A Ongoing

Insulin Initiation LES Dean Grice LES to support the initiation of insulin in Primary Care £4,086 Roll-over in its entirety Roll-over in its entirety N/ATo be reviewed by

KMN/A Ongoing

GP Care Homes LES Dean GriceFunding to support the provision of Primary Care as an

enhanced service in care homes£412,200 N/A

To be reviewed by

MC

Will need to be

considered as part

of the wider

review including

the PCN DES

Ongoing

Interpractice Minor Surgery LES Dean Grice Funding to support Primary Care minor surgery service £8,910 Roll-over in its entirety Roll-over in its entirety N/ATo be reviewed by

MCN/A Ongoing

LES Interpractice Therapeutic Injections Dean GriceFunding to support Primary Care Therapeutic Injections

serviceTBC Roll-over in its entirety Roll-over in its entirety N/A

To be reviewed by

MCN/A Ongoing

Phlebotomy Support LES Dean Grice Funding to support Primary Care phlebotomy service £177,812 Roll-over in its entirety Roll-over in its entirety N/ATo be reviewed by

MCN/A Ongoing

Vasectomy LES Dean Grice Vasectomy within the community offered by Practices £40,778 Roll-over in its entirety Roll-over in its entirety N/ATo be reviewed by

MCN/A Ongoing

Echocardiography LES Dean GriceEchocardiography within the community offered by one GP

practiceTBC Roll-over in its entirety Roll-over in its entirety N/A

To be reviewed by

MCN/A Ongoing

Prescribing Incentive Scheme Mark Dickenson Funding to support Practices in improving prescribing £835,252 N/A

Currently being reviewed by Medicines

Management team to align to West

Cheshire scheme

N/A N/A

If scheme is re-

written,

negotiation and

approvals will be

needed

Ongoing

Styal Babies Sally LarvinFunding for a Primary Care contract to provide health care

to babies born in prison£12,000

Complete at

present

Adoption / Fostering Finance Funding for assessments TBC Roll-over in its entirety N/A N/A N/A N/AComplete at

present

Roll-over in its entirety pending impact of PCN DES service specification

Roll over as is

Ea

st -

Oth

er

Ea

st C

he

sh

ire

Roll-over for a further year.

Minor tweaks to be applied re:

- minor removals / additions

- potential duplication with 2020-21 GMS Contract.

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DRAFT JAN 2020…to be approved by Memberships and NHSE/I PCC 26.2.20 Agenda Item A4.1

Primary (General Practice) Care Commissioning Committee

1. Introduction The Primary (General Practice) Care Commissioning Committee (‘the Committee’) is established in accordance with the NHS Cheshire CCG Constitution, Prime Financial Policies and Scheme of Delegation. These terms of reference define the membership, remit, responsibilities and reporting arrangements of the Committee which meet the requirements of the Constitution of the CCG and Managing Conflicts of Interest: Statutory Guidance for CCGs. The accountability and decision making of the Committee has been delegated to the Committee by the Clinical Commissioning Group and NHS England. 2. Statutory Framework Simon Stevens, the Chief Executive of NHS England, announced on 1 May 2014 that NHS England was inviting CCGs to expand their role in primary care commissioning and to submit expressions of interest setting out the CCG’s preference for how it would like to exercise expanded Primary Medical Care commissioning functions. One option available was that NHS England would delegate the exercise of certain specified primary care commissioning functions to a CCG. In accordance with its statutory powers under section 13Z of the National Health Service Act 2006 (as amended), NHS England has delegated the exercise of the functions specified in Schedule 2 of the respective delegation agreements to these Terms of Reference to NHS Cheshire CCG. The CCG has established the NHS Cheshire CCG Primary Care Commissioning Committee. The Committee will function as a corporate decision-making body for the management of the delegated functions and the exercise of the delegated powers. In accordance with its statutory powers under section 13Z of the National Health Service Act 2006 (as amended), NHS England has delegated the exercise of the functions specified in Schedule 2 to these Terms of Reference to NHS Cheshire CCG. Arrangements made under section 13Z may be on such terms and conditions (including terms as to payment) as may be agreed between NHS England and the CCG. Arrangements made under section 13Z do not affect the liability of NHS England for the exercise of any of its functions. However, the CCG acknowledges that in exercising its functions (including those delegated to it), it must comply with the statutory duties set out in Chapter A2 of the NHS Act and including: a) Management of conflicts of interest (section 14O); b) Duty to promote the NHS Constitution (section 14P); c) Duty to exercise its functions effectively, efficiently and economically (section

14Q);

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d) Duty as to improvement in quality of services (section 14R); e) Duty in relation to quality of primary medical services (section 14S); f) Duties as to reducing inequalities (section 14T); g) Duty to promote the involvement of each patient (section 14U); h) Duty as to patient choice (section 14V); i) Duty as to promoting integration (section 14Z1); j) Public involvement and consultation (section 14Z2). The CCG will also need to specifically, in respect of the delegated functions from NHS England, exercise those set out below: Duty to have regard to impact on services in certain areas (section 13O); Duty as respects variation in provision of health services (section 13P). The Committee is established as a Committee of the CCG in accordance with Schedule 1A of the “NHS Act”. The members acknowledge that the Committee is subject to any directions made by NHS England or by the Secretary of State. 3. Role of the Committee The Committee has been established in accordance with the above statutory provisions to enable the members to collectively consider the strategy, planning and procurement of primary care services in Cheshire, under delegated authority from NHS England. In performing its role, the Committee will exercise its management of the functions in accordance with the agreement entered into between NHS England and NHS Cheshire CCG which will sit alongside the delegation and terms of reference. The functions of the Committee are undertaken in the context of a desire to promote increased co-commissioning to increase quality, efficiency, productivity and value for money and to remove administrative barriers. The role of the Committee shall be to carry out the functions relating to the commissioning of primary medical services under section 83 of the NHS Act except those relating to the Reserved Functions of NHS England. This includes but is not limited to the following activities: GMS, PMS and APMS contracts (including the design of PMS and APMS

contracts, monitoring of contracts, taking contractual action such as issuing branch/remedial notices, and removing a contract;

Newly designed enhanced services (“Local Enhanced Services” and “Directed Enhanced

Design of local incentive schemes as an alternative to the Quality Outcomes Framework (QOF);

Decision making on whether to establish new GP practices in an area; Approving practice mergers; Making decisions on ‘discretionary’ payment (e.g., returner/retainer schemes).

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The decisions of the Committee shall be binding on the CCG and NHS England. Decisions will be published by the CCG. The Committee will also carry out the following activities: a) To plan, including needs assessment, primary [medical] care services in Cheshire; b) To undertake reviews of primary [medical] care services in Cheshire; c) To co-ordinate a common approach to the commissioning of primary care services

generally; d) To manage the budget for commissioning of primary [medical] care services in

Cheshire.

3. Geographical Coverage The Committee will comprise the Cheshire CCG area. 4. Membership The Committee shall consist of the following membership Independent Lay Governing Body Members (x2) Independent Clinical Governing Body Member (x1) Chief Officer or nominated deputy Executive Director of Finance & Contracts (Chief Finance Officer), or nominated

deputy Executive Director of Strategy & Partnerships, or nominated deputy Executive Director of Planning & Delivery or nominated deputy Executive Director of Quality & Patient Experience or nominated deputy Executive Clinical Director or nominated deputy. Members of the Committee will be listed in the CCG annual report and accounts Committee members may appoint a deputy to represent them at meetings of the Committee. Committee members should inform the Committee Chair at least 48 hours ahead of the meeting of their intention to nominate a deputy to attend/act on their behalf. They should provide assurance that any such deputy is suitably briefed and suitably qualified, and that the individual fulfils the requirements of the role and is not disqualified by whichever schedules of the regulations that may apply. Alternatively, where appropriate members’ views may be sought by email and reported verbally at the Committee meeting. The Committee may determine which other individuals from within and outside of the CCG to invite to attend Committee meetings. Regular attendees do not have any authority to cast a vote. Key regular attendees with a standing invite to attend Committee meetings will be: x4 General Practice Representatives Associate Director of Primary Care CCG Practice Manager Representative Local Medical Committee Representative Healthwatch Cheshire Representative NHS England

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A standing invitation will be open to the following observers to attend and participate in the meeting: Cheshire East Local Authority Health and Wellbeing Board Representative Cheshire West and Chester Local Authority Health and Wellbeing Board

Representative Cheshire East Local Authority Public Health Representative Cheshire West and Chester Local Authority Public Health Representative. These individuals in attendance do not have any authority to cast a vote in any of the decisions undertaken by the Committee. 4. Chair Arrangements The role of Chair of the Committee will be one of the CCGs Independent Lay Governing Body Members for Engagement and Involvement. The other CCG Independent Lay Member present on the Committee will serve as the Vice Chair. The Chair and Vice Chair of the Committee must be undertaken by an individual in the role of an Independent Lay Member on the Governing Body who is not the CCGs Governance, Audit and Risk Committee Chair or Conflicts of Interest Guardian. 5. Meetings and Voting The Committee will operate in accordance with the CCG’s Standing Orders. The Secretary to the Committee will be responsible for giving notice of meetings. This will be accompanied by an agenda and supporting papers and sent to each member representative no later than seven days before the date of the meeting. When the Chair of the Committee deems it necessary in light of the urgent circumstances to call a meeting at short notice, the notice period shall be such as s/he shall specify. Each voting member of the Committee shall have one vote. The Committee shall reach decisions by a simple majority of members present, but with the Chair having a second and deciding vote, if necessary. However, the aim of the Committee will be to achieve decision-making by consensus wherever possible. 7. Quorum A quorum necessary for the Committee to undertake its business shall be at least four voting members of the Committee, comprising: Chair (or Vice Chair) One other Independent Governing Body Member Two Directors from the CCGs Executive Team. Although not voting members of the Committee, to facilitate the involvement of General Practice Representation in the discussions of the Committee, if no General Practice Representatives are available to attend a meeting the Chair may consider the rescheduling of the meeting. Where a meeting is not quorate, owing to the absence of certain members, the meeting may be deferred until such time as a quorum can be convened. Where there is a need for urgent decision-making between meetings, this will be undertaken by

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email or through an extraordinary meeting if required. This will be on an exceptional basis and all decisions will be brought to the next Committee meeting for ratification. Where a quorum cannot be convened from the membership of the meeting, owing to the arrangements for managing conflicts of interest or potential conflicts of interests, the Chair of the meeting shall consult with the CCG Accountable Officer of Chief Finance Officer on the action to be taken. There should be due consideration given by the Chair of the Committee of Clinical Representation at the meeting amongst the members. 8. Frequency of meetings The Committee shall be convened on a bi-monthly basis with a minimum of six meetings per year. Meetings of the Primary (General Medical) Care Commissioning Committee meetings will be held in public unless the CCG considers that it is not in the public’s interest to permit members of the public to attend a meeting or part of a meeting. Members of the public and press will be able to attend all Primary (General Medical) Care Commissioning Committee meetings held in public with the exception of in those circumstances it is deemed necessary to prevent disruption or where publicity on a matter would be prejudicial to the public interest. On the rare occasion where press or public are excluded, members of the Primary (General Medical) Care Commissioning Committee, and employees in attendance will be required not to disclose confidential contents of papers or minutes, or content of any discussion at the meeting on these topics outside the CCG without the express permission of the Committee. Members of the Committee have a collective responsibility for the operation of the Committee. They will participate in discussion, review evidence and provide objective expert input to the best of their knowledge and ability, and endeavour to reach a collective view. The Committee may delegate tasks to such individuals, sub-committees or individual members as it shall see fit, provided that any such delegations are consistent with the parties’ relevant governance arrangements, are recorded in a scheme of delegation, are governed by terms of reference as appropriate and reflect appropriate arrangements for the management of conflicts of interest. The Committee may call additional experts to attend meetings on an ad hoc basis to inform discussions. Members of the Committee, including the non-voting members and attendees, shall respect confidentiality requirements as set out in the CCG’s Constitution. The Committee will present its minutes to the Governing Body of NHS Cheshire CCG at the next appropriate meeting for information, including the minutes of any sub-committees to which responsibilities are delegated under paragraph 31 above.

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The Committee will also comply with any reporting requirements set out in its Constitution. These Terms of Reference will be reviewed from time to time, reflecting experience of the Committee in fulfilling its functions. NHS England may also issue revised model terms of reference from time to time. 9. Accountability of the Committee The Committee is accountable to the CCG membership and to NHS England. The decision-making scope of the Committee is outlined within the NHS Cheshire CCG Constitution and specifically the Scheme of Reservation and Delegation. The minutes of the Committee will be formally recorded and presented to the Governing Body at the earliest practicable meeting. The Committee is responsible for both overseeing the management of primary care delegated budgets and ensuring decisions made do not exceed the primary care delegated budget. The Committee will ensure that patient/public consultation is considered and undertaken when appropriate to aid decision making. 10. Procurement of Agreed Services The Committee will ensure that Procurement, Patient Choice and Competition (No.2) Regulations 2013 are followed. No contracts for NHS healthcare services will be awarded where conflicts or potential conflicts of interest affect or appear to affect the integrity of the award. 11. Decisions The Committee will make decisions within the bounds of their remit. The decisions of the Committee shall be binding on NHS England and the respective CCG. The Committee will produce an executive summary report which will be presented to NHS England’s regional team and the Governing Body of NHS Cheshire CCG Bi-monthly for information. 14. REVIEW OF PERFORMANCE These Terms of Reference were approved on 01 April 2020 The Committee shall undertake an annual review of its performance and effectiveness to ensure it has discharged its functions as intended. Any changes to the Terms of Reference resulting from any such review will need to be approved by the CCG Governing Body. A review log of all Committee Terms of Reference is held within the CCG Corporate Governance Handbook.

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15. SCHEDULE ONE – DELEGATED FUNCTIONS **NOTE TO ADD ONCE RECEIVED FROM NHSE

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PRIMARY CARE COMMISSIONING COMMITTEE MEETING Part A 26

TH February 2020 Agenda Item A5.1

Title Primary Care Financial Report as at Month 10

Author Contributors

Lorraine Weekes-Bailey Primary Care Accountant

Date submitted 18th February 2020

Purpose To provide the Primary Care Commissioning Committee with a summarised overview for the four Cheshire CCGs on their financial performance, for the period ending 31st January 2020 and to provide an update on the projected outturn for the current financial year. The paper also outlines the NHS England and NHS Improvement GP Contract that has now been agreed with the BMA for 2020/21.


The Primary Care Commissioning Committee is responsible for the monitoring and delivery of its services within the available resources. This report outlines for the Primary Care Committee:

Current financial performance and level of associated risks. Provides clarity to General Practice in respect of process and application Supports stability and resilience of General Practice Clarity and expedience for CCG Officers


Consultation & Engagement

Financial Resources (other than finance)




Legal / Regulatory ☐ Staff / Workforce

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Primary Care Committee 26TH February 2020 Agenda Item 5.1


Approve ☐ Ratify ☐ Decide ☐ Endorse ☐ For information

Recommendation(s) The Primary Care Commissioning Committee is asked to note the following: • Forecast expenditure outturn of all four CCGs Primary Care against their allocations. • Year to date position of all four CCGs Primary Care budgets as at Month 10.


Andrew Whittingham- Associate Director of Finance & Contracting

Primary Care Committee

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Date: 26th February 2020 CCG Representatives: Lorraine Weekes- Bailey Report to: Primary Care Committee 1. Purpose of the paper

1.1 The purpose of the paper is to update the Primary Care Committee on the financial position

of the Primary Care budget for Month 10, period ending 31st January 2020, and the projected outturn for the year, for all four of the Cheshire CCGs.

2. Financial Position

2.1 As at the 31st January 2020, the overall Primary Care financial position for the four Cheshire

CCGs is currently forecast to underspent by £1.31m by the end of the financial year. The summarised financial position for 2019/20 is outlined in Table 2a.

Table 2a

2.2 West Cheshire CCG currently shows an overspend within Primary Care. In 2018/19 NHS

England provided West Cheshire CCG £0.45m on a non-recurrent basis to recognise the pressures in the Primary Care delegated budget. This was provided as part of the ongoing discussions to fully understand the impact of the CCG taking on delegated responsibility.

As mentioned above, this was provided on a non-recurrent basis from NHS England and this has not been re-provided in 2019/20. As a result of failing to secure this resource the current position shows a £0.72m overspend in the delegated primary care budget this financial year.

NHS South Cheshire CCG and NHS Vale Royal CCG also received funding from NHS England in 2018/19. However, the CCGs were able to have positive conversations with NHS England with regards to the primary care financial pressures.

Cheshire Clinical Commissioning Groups Variance to BudgetAdditional Funding

Received 2019/20FOT 2019/20

NHS Eastern Cheshire CCG (1,100,000) 1,100,000 0NHS South Cheshire CCG 391,859 640,000 1,031,859NHS Vale Royal CCG 72,665 360,000 432,665NHS West Cheshire CCG (150,879) 0 (150,789)

(786,355) 2,100,000 1,313,735

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This resulted with NHS England committing to recurrent additional funding of £0.64m for NHS South Cheshire CCG and £0.36m for NHS Vale Royal CCG. This will now allow the CCGs to move some of the original planned budget allocated to primary care to other areas, bringing primary care to a more sustainable financial position and improving the overall financial position.

NHS Eastern Cheshire CCG received funding from NHS England for 2019/20 of £1.1m, however this money is non recurrent so remains a risk for 2020/21.

2.3 Below in Table 2b and 2c is a summarised financial position for each of the individual CCG’s and their delegated financial position.

Table 2B

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Table 2C

Cheshire Clinical Commissioning GroupsNHS EASTERN

CHESHIRE CCG

NHS SOUTH

CHESHIRE CCG

NHS VALE

ROYAL CCG

NHS WEST

CHESHIRE CCG

Weighted Population (April 2019) 208,358 191,869 112,007 279,148

General Practice - GMS 18,239,373 11,046,212 8,914,143 20,676,621General Practice - PMS 0 5,447,442 742,752 2,843,153Other List Based Services 0 0 0 0Premises Reimbursements 3,238,435 4,124,891 1,772,737 4,150,690NHS Property Services 0 0 0 0Other Premises 0 118,000 77,000 105,000Enhanced Services 1,690,077 1,286,370 657,157 1,844,476QOF 3,013,025 2,551,043 1,492,745 3,682,566Other - GP Services 1,195,089 1,046,337 506,312 4,314,085DELEGATED PRIMARY CARE TOTAL 27,375,999 25,620,295 14,162,846 37,616,591

Cheshire Clinical Commissioning GroupsNHS EASTERN

CHESHIRE CCG

NHS SOUTH

CHESHIRE CCG

NHS VALE

ROYAL CCG

NHS WEST

CHESHIRE CCG

Primary Care Charter/CQUIN/Caring Together 3,594,172 716,925 415,526 4,094,000GP Care Homes Scheme 412,200 227,350 275,000 0Practice Staff 0 598,772 299,521 0Primary Care Networks DES 314,124 282,060 162,108 372,288Primary Care Other 290,106 (83,975) 151,957 1,659,000Primary Care Access Fund 1,191,000 1,127,000 689,000 1,908,000GP Forward View 97,000 42,500 21,000 0Primary Care IT 537,000 540,214 127,377 768,000LOCALCCG PRIMARY CARE TOTAL 6,435,602 3,450,846 2,141,489 8,801,288

Combined Budget Delegated & Local Primary Care 33,811,601 30,103,000 16,737,000 46,267,000

Combined SPEND Delegated & Local Primary Care 33,811,601 29,071,141 16,304,335 46,417,879

Variance 0 1,031,859 432,665 (150,879)

Primary Care 2019/20 Month 10

Local Primary Care 2019/20

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Annual

BudgetForecast Variance

£ £ £

General Practice - GMS 18,239,373 18,239,373 - General Practice - PMS - - - Other List Based Services - - - Premises Reimbursements 3,238,435 3,238,435 - NHS Property Services - - - Other Premises - - - Enhanced Services 1,690,077 1,690,077 - QOF 3,013,025 3,013,025 - Other - GP Services 1,195,089 1,195,089 - DELEGATED PRIMARY CARE TOTAL 27,375,998 27,375,998 -

NHS Eastern Cheshire CCG Forecast Outturn

Delegated Primary Care

Annual


£ £ £

General Practice - GMS 11,095,000 11,046,212 48,788 General Practice - PMS 5,597,000 5,447,442 149,558 Other List Based Services - - - Premises Reimbursements 3,968,000 4,124,891 (156,891) NHS Property Services - - - Other Premises 164,000 118,000 46,000 Enhanced Services 1,160,000 1,286,370 (126,370) QOF 2,659,000 2,551,043 107,957 Other - GP Services 402,000 1,046,337 (644,337) DELEGATED PRIMARY CARE TOTAL 25,045,000 25,620,295 (575,295)

NHS South Cheshire CCG Forecast Outturn


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3. GP Contract 2020/21 update on the Financial Changes

3.1 Enhancing the Additional Roles Reimbursement Scheme More roles are now added to the Scheme from April 2020, at the request of Primary Care Network (PCN) Clinical Directors. PCNs can now choose to recruit from the following roles within the Scheme, in addition to those previously agreed:

Pharmacy technicians Health and well-being coaches and care coordinators

Annual


£ £ £

General Practice - GMS 8,931,000 8,914,143 16,857 General Practice - PMS 749,000 742,752 6,248 Other List Based Services - - - Premises Reimbursements 1,752,000 1,772,737 (20,737) NHS Property Services - - - Other Premises 100,000 77,000 23,000 Enhanced Services 679,000 657,157 21,843 QOF 1,549,000 1,492,745 56,255 Other - GP Services 140,000 506,312 (366,312) DELEGATED PRIMARY CARE TOTAL 13,900,000 14,162,847 (262,847)


NHS Vale Royal CCG Forecast Outturn

Annual


£ £ £

General Practice - GMS 20,664,935 20,676,621 (11,686) General Practice - PMS 2,630,081 2,579,513 50,568 General Practice - APMS 291,614 263,640 27,974 Other List Based Services - - - Premises Reimbursements 4,102,299 4,150,690 (48,392) NHS Property Services 115,000 105,000 10,000 Other Premises - - - Enhanced Services 1,623,568 1,844,476 (220,908) QOF 3,636,912 3,682,566 (45,654) Other - GP Services 3,828,592 4,314,085 (485,493) DELEGATED PRIMARY CARE TOTAL 36,893,000 37,616,591 (723,591)

Forecast Outturn


NHS West Cheshire CCG

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Occupational therapists Dietitians Podiatrists Occupational Therapists

3.2 Financial Changes to the Contract

The new value of a QOF point will be £194.83. Reimbursement now increases from the current 70% to 100% for all roles. The new value of Global Sum from 1st April will be £93.46 Extra investment will fund new GP training recruitment and retention measures with

£20,000 plus training support for every new partner. Payment arrangements for vaccinations and immunisations to be reformed.

Table 3, shows a summary of the Contractual financial entitlements

Table 3

4. Access to further information 4.1 For further information relating to this report contact:

Name Lorraine Weekes-Bailey Designation Primary Care Accountant

NHS Eastern Cheshire Clinical Commissioning Group NHS South Cheshire Clinical Commissioning Group NHS Vale Royal Clinical Commissioning Group NHS West Cheshire Clinical Commissioning Group

Telephone 07584 886567


Financial Changes 2019/20 2020/21 £ %

Value of Qof Point £187.74 £194.83 £7.09 3.8%

Global Sum price per weighted patient £89.88 £93.46 £3.58 4.0%

Out of Hours Adjustment % 4.82% 4.77%

Out of Hours Adjustment (£ amount) £4.33 £4.46 £0.13 2.9%

Additional Roles Reimbursement 70% 100% 30%

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mailto:[email protected]


5. Notes for the reader

5.1 Types of reported spend- Delegated Primary Care

• General Practice GMS- This contains General Practice- contractual global sum and MPIG (Minimum Practice Income Guarantee) payments.

• General Practice PMS- This contains General Practice PMS contractual payments and any list size adjustments.

• Premises Reimbursements- This includes budgets for rent, rates, water and service charges. Premises budgets are also allocated on a contractual basis and have very little scope for local influence.

• Other Premises- This contains budgets for Clinical waste and pathology collections. • Enhanced Services- This includes budgeted spend on the basis of historic achievement

for the ad-hoc smaller payments or recognising the potential full achievement for those which are list size/patient driven for the practices that have signed up to the particular services, e.g. extended hours. Payment is based upon achievement so variances against budget can occur.

• Quality Outcomes Framework (QOF) - This budget/spend is aspiration payments that are based upon 70% of the previous year’s achievement adjusted for year on year points and price changes. Budgets are set in line with this and pro rata to reflect final forecast achievement. As payment is based upon actual achievement this means that the CCG may have a financial risk or benefit depending on future practice achievement.

• Other – GP Services- This include budgets and payments for seniority, dispensing & prescribing professional fees and locum allowances such as for maternity, paternity and adoption cover. Budgets for the locum allowances are not allocated at practice level at the start of the year as claims can be difficult to forecast. Translation costs, CQC payments, PMS deduction and PMS Re-investment

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6. Types of reported spend- Local CCG Primary Care

6.1 Charter Phase 1- This includes budget and payment by cost per head for £2.70 Core Charter funding, £1.50 Transformational support, £0.14 suture and clip removal, £1.00 GP Alliance funding.

• GP Care Homes Scheme- Funding for the local GP Care homes scheme.

• Practice Staff- Historic funding awarded to practices

• Primary Care Other- This includes budget and costs for anti-coagulation and near-patient testing, counselling services, fostering and adoption medical fees, minor surgery, carpal tunnel, vasectomies, dermatology and Weaver Lodge.

• Primary Care Access Fund (PCAF)-Budget and costs for the improving access programme.

• GP Forward View- Budget and cost for development of Reception & Clerical training and Care Navigation

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agenda part a, in public · venue: cedar room, canalside conference centre, 34-36 brooks lane,...

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