boardroom, hilldale, wigan road, ormskirk, l39 2jw

NHS WEST LANCASHIRE CLINICAL COMMISSIONING GROUP

PRIMARY CARE COMMISSIONING COMMITTEE

12 September 2017, 1.30 – 3.00 pm

Boardroom, Hilldale, Wigan Road, Ormskirk, L39 2JW

I – Information D-Discussion DR – Decision Required

Item Time Agenda item Paper / Verbal

Action Presenter

1. 1.30 Welcome and apologies

Chair

2. 1.35 Declaration of Interests

Verbal I All

3. 1.40 Minutes from the previous meeting

Paper DR Chair

4 1.50 Update on actions from the previous meeting

Paper D Chair

STRATEGIC ISSUES

5. 2.00 Primary Care Strategy / working in neighbourhoods

Verbal I / D Jan Charnock / Jackie Moran

6. 2.10 Finance update

• Primary care benchmarking by CCG

Paper

I

Matt Greene

7. 2.20

Medicines management update:

• Prescribing hubs

• Care homes

• Community pharmacy

• Prescribing for clinical needs and gluten-free policy

Verbal Verbal Verbal Verbal

I I I I

Nic Baxter

OPERATIONAL ISSUES

8. 2.35 NHS England update Verbal I Sheena Wood

9. 2.45 Primary Care Practice Update Verbal I Jan Charnock

10. 2.50 Practice Visits Update Verbal I Jan Charnock

11. 2.55 Workforce - Enhanced Training Practice - Education for Workforce Transformation

(CPD) Allocation 2017

Verbal Paper Paper

I

Jan Charnock / Jackie Moran /

FOR INFORMATION

12. 3.00 Notes from the Primary Care Group Verbal I Jan Charnock

13. 3.05 Any other business Verbal I Chair

Date and Time of Next Meeting – 14 November 2017, 1.30 – 3.00 pm, Boardroom, Hilldale

Primary Care Commissioning Committee – 11 July 2017 Page 1 of 6

Minutes

Primary Care Commissioning Committee

Venue: Boardroom, Hilldale, Ormskirk

Date & Time: Tuesday 11 July 2017 at 2.00 – 3.30 pm

Attendees: Mr S Gross – Chair Mrs C Heneghan – Chief Nurse Mr P Kingan – Chief Finance Officer Mr M Maguire – Chief Officer

In attendance: Dr J Caine – West Lancashire CCG Chair Miss C Ashcroft – Executive assistant Mrs J Moran – Head of Quality, Performance and Contracting Mrs J Charnock – Primary Care Development Manager Mrs S Wood, Clinical Leadership Manager, NHS England North (Lancashire) Mr M Green – Finance manager Mrs N Baxter – Head of Medicines Optimisation

Apologies: Dr A Robinson – Secondary Care Consultant Mrs A Lumley – Primary Care Nurse Development Lead Mr D Soper – Lay Member

Agenda Item

Summary of Discussion Lead

1. Welcome and apologies for absence Steve Gross introduced himself and welcomed the members of the Primary Care Commissioning Committee to the meeting of the committee. The apologies above were relayed. No members of the public were present.

2. Declaration of interest Steve Gross reminded committee members of their obligation to declare any interest they may have on any issues arising at committee meetings which might conflict with the business of West Lancashire CCG. Declarations declared by governing body members are listed in the CCG’s Register of Interests. The register is available either via the secretary to the governing body or the CCG website at the following link: http://www.westlancashireccg.nhs.uk/wp-content/uploads/Register-of-interests-Governing-Body-and-committee-members-March-2017.pdf John Caine declared a general interest as he is employed as a sessional GP and works in care homes. As John Caine is a non-voting member the chair considered the declaration of interest and deemed this to be significant and not fundamental in terms of item 12. Workforce and 6. West Lancashire enhanced care home scheme respectively. Therefore, John Caine will remain in the meeting and contribute to the discussion but not vote.

3. Minutes from the previous meeting The minutes were approved as a correct record with the following minor amendments: , Item 4. The average cost of multi-disciplinary team is approximately £5.5 £550 thousand and £400 thousand allocated to a LES. Page 4, Item 9. Any other business. Helen Fogg, the new federation manager,

http://www.westlancashireccg.nhs.uk/wp-content/uploads/Register-of-interests-Governing-Body-and-committee-members-March-2017.pdf

http://www.westlancashireccg.nhs.uk/wp-content/uploads/Register-of-interests-Governing-Body-and-committee-members-March-2017.pdf


Agenda Item


will be working closely with Sheena Wood going forward in respect of developing the GP federation.

4. Update on actions from previous meeting The action sheet was updated.

STRATEGIC ISSUES

5. Primary Care Strategy / working in neighbourhoods The primary care strategy is currently being compiled, with two days set aside in July to complete and collate the different workstreams to be all encompassing. The strategy will cover a 5-year period incorporating the 2 years GPFV requirements. Working in neighbourhoods was discussed in respect of involvement and ownership by the membership council. Collaboration is progressing with patients as the priority. Sheena Wood referred to the Manchester model which looks to relax barriers between provider and commissioners. The strategy needs to guide the direction of primary care for years to come and will enable progression of recruitment and training. It will include the enhanced care home scheme and return to the committee in September.

6. Draft options for a West Lancashire enhanced care home scheme The care home model had been given a mandate to continue. Some practices had reservations about the scheme around patient response and the financial impact. These comments will be addressed. It had been agreed to include this scheme is a much wider piece of work about working in neighbourhoods, to highlight the strength of working together. Therefore, the scheme will be revisited in September / October 2017, with training for care homes and input from medicines management services to follow. The practices could join neighbourhood working at different stages, dependent on their readiness in terms of communications and relationships with neighbouring practices. This has been mapped out by Mike Maguire. The options for appointing an executive lead GP for each neighbourhood was discussed with regular meetings required to sustain momentum. Claire Heneghan will be visiting practices to introduce Virgin Care and present clarity of the message to GPs. The neighbourhood working has been successful in other areas, but required a high level of communications input.

7. Finance update Matt Green tabled a finance update. As data demonstrates an early position in the financial year, the focus is on the forecast expected at year end. The forecast variance for the quality achievement element of the QoF is £60,000. Released reserves equate to £72,000. Mike Maguire asked where recent changes in the medical centre have been factored into the current financial position. This will be provided at the next meeting. The overall financial position will be clearer as the year progresses. No future major financial pressure are anticipated at this point. The CCG have access to

MG


Agenda Item


detailed working payments and the data is growing. The contingency value must be safeguarded until closer to year end, when a decision from NHS England is due. Mike Maguire expressed his disappointment at the level of funding provided by NHS England. Sheena Wood confirmed that NHS England are governed at regional level in terms of allocations and will feedback the comments to region. Legacy funding was transferred to CCGs following historical financial decisions, which contributes to the gap in funding for this area. An update will return to the committee in Autumn.

8. Pharmacy update

• Minor ailment scheme On 1 July NHS England ceased hosting the scheme. Before the CCG start to deliver the scheme, changes are required taking into account the pharmacy strategy and the medicine management strategy. There is a need for the service to be tailored to meet the needs of the local population with community pharmacies supporting self-care of patient, in the use of PGDs and medicine use reviews. A pilot scheme is starting in Tarleton to see where pharmacists can help GPs and patients to provide support and forge stronger relationships. NHS England have been informed that the scheme will commence after the scoping exercise. A budget of £35,000 will transfer to the CCG to fund this work. The scheme will return for the committee meeting in September / November.

NB

OPERATIONAL ISSUES

9. NHS England update Sheena Wood provided an update for NHS England, highlighting the following:

• A meeting will be arranged between the CCG and NHS England to discuss the MOU that needs to be signed by the CCG and NHSE. Additional information is required before this document can be signed around procurement and legal advice. Sheena Wood will provide the flow chart for the procurement process.

• Mike Maguire asked how do decisions get made on how to use new money in primary care? There is a need to understand why collaborative decision making is not in place for co-commissioning. Sheena Wood agreed that this detail is not in the memorandum of agreement (MOU), which requires further clarity and to feedback to the committee. Comments are required by the end of August.

• The main discussion in primary care meetings is about the legal work and cost to CCGs.

• Viran Medical Centre went live on Monday 3 July. A sound-proofing issue is being addressed. A fortnightly meeting to discuss a permanent accommodation solution is in place with George Hurst.

• Lathom House practice – an update was provided to the group and Jackie Moran was asked to contact Sarah Bloy for further details.

• Clinical pharmacist in general practice – Notification of the successful applications for Wave Two Phase Two of the Clinical Pharmacists in General Practice were announced on Friday 14 July. Two applications in Lancashire have been approved. Wave two, phase three will now commence and applicants have until the portal closes on the 29 September 2017 to submit their applications.

SW


Agenda Item


The Clinical Pharmacists in the General Practice scheme aims to have ‘’a pharmacist per 30,000 of the population leading to a further 1,500 pharmacists in general practice by 2020’’. The funding will contribute to the costs of recruitment, employment, training and development of clinical pharmacists and the development of employing/participating practices. Applications are received via the portal from providers in Lancashire and South Cumbria and are considered by a local panel consisting of Representatives from NHS England, Health Education England, LPN/LPC (qualified pharmacists) and LMC. To date, 10 applications have been received during wave two and three. All of the bidders have been notified of the outcome from the panel and have been provided with feedback regarding their bids.

• Zero tolerance scheme – PDS Ltd were the successful bidder. There were early issues with the EMIS system, with a temporary solution now in place. Jackie Moran will meet Sheena Wood to discuss this further. The service will be provided on five sites in this area. The referral-in process was felt to be unclear by some GPs and the KPIs, which were sent originally, could be resent. Repatriation of patients to mainstream care is being looked at, for patients who have been removed from several GP practice lists, with support from a multi-disciplinary team approach to manage complex issues. This also requires good communication and information sharing from other bodies. Sheena Wood will visit practices to discuss this group of patients.

• Beacon Primary Care and North Meols Medical Centre merger. John Caine raised his declaration of interest in terms of working with the GP partner of Beacon Primary Care. The Chair deemed that this was not fundamental as John Caine was not a voting member of the committee and would be allowed to take part in the discussion. The committee agreed to the remove of the Practice code from North Meols Medical Centre as part of the merger of the two practices. The merger will result in a leaner approach requiring only one practice visit, one CQC visit and more collaborative IT systems etc. The new model at North Meols has been well received with patient complaints reducing and being replaced with positive feedback about access to services. There had been a high response rate to surveys shared around the area. Patients are welcome to travel to the partner practices for appointments, if they prefer. Triage and Prescription Ordering Direct are being considered.

10. Primary Care Practice update

• Practice issues by exemption This item links with the practice visits. Issues will be collated and common themes identified. Regular communications with the practices will continue and comments will be addressed. Feedback will be provided to GPs and the themes will return to the next meeting.

• Viran Medical Centre update Viran Medical Centre was mobilised on 3 July. The PPG chair has stepped down from the position. Patient feedback is positive eg one patient was pleased to have a consultation with a female GP.


Agenda Item


• Cyber attack The CCG are working with practices on business continuity plans and with practice managers around lessons learnt. Discussions are taking place with the resilience team around the funding of new processes.

The mobilisation plan was managed by the CCG and the lessons learned can feed into the MOU to provide more clarity for the future. Legal advice had been taken too. The CCG is pursuing a long-term solution for the location of the practice, including an engagement and procurement process. The sound proofing issues have been raised with Property Co. services who had stated the portacabin would be sound proof. A license for a radio in waiting room is being pursued. Meetings will be held to clarify and agree the MOU.

11. Quality and Safety by exception

• Assurance Framework The framework demonstrates how the various sectors, including primary care, will feed into the Quality and Safety Committee on a quarterly basis by exception.

12. Workforce

• Primary care tool – an escalation tool will be incorporated into each of the meetings and the committees, to apply consistency across the meetings.

• Wider workforce development work – the CCG have an MOU with the University of Central Lancashire for the Grow Your Own GP programme. This involves supporting children, 6th form college students, those who just missed the grades and doctors from other areas. Work with schools in Skelmersdale is taking place around the aspiration for science. It was suggested that Lucinda McArthur be invited to a future meeting to feedback.

• Practice Nurse Annual Report – the non-medical workforce is key to delivering the 5-year forward view. There is a concern about sustainability and skills to achieve this. The numbers due to leave in retirement were outlined along with the lack of student exposure to primary care. Much work has been done as to how to get student nurses into practices to provide experience and exposure. There is a need to achieve standardisation of contracts for nurses in all practices, as nurses tend to move internally in West Lancashire. The CCG is working closely with Edgehill to offer courses important to practice nurses and a plan around primary care non-medical workforce including repatriating nurses.

• Primary care work tool – shows how practices currently structure appts and how slight changes will affect improve capacity/efficiency, plus show current the shortage in their workforce. The tool will also highlight future workforce requirements that will allow the practice to plan future workforce needs according to demand. A further update will be received on Thursday after the NHSE workforce meeting. Funding is needed to come down to get all Practices on this.


Agenda Item


13. Practice Visits update This item was discussed in item 10.

FOR INFORMATION

14. Notes from the Primary Care Operation Group The notes will be circulated after meeting. All issues from the group meeting had been discussed today.

15. Date and time of the next meeting – The next meeting of the committee will take place on Tuesday 12 September at 1.30 pm, Boardroom, Hilldale.

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West Lancashire CCG Primary Care Commissioning Committee Action sheet

11 July 2017 Action Lead Date required by Action completed

7. Finance update Mike Maguire asked where recent changes in the medical centre have been factored into the current financial position. This will be provided at the next meeting.

Matt Greene 12 September 2017

8. Pharmacy update A budget of £35,000 will transfer to the CCG to fund this work. The scheme will return for the committee meeting in September / November.

Nicola Baxter 12 September 2017

9. NHS England update In terms of the MOU between NHS England and the CCG, Sheena Wood will provide the flow chart for the procurement process.

Sheena Wood 12 September 2017

9 May 2016 Action Lead Date required by Action completed

5. Primary Care The primary care strategy and the operational plan including the next two years planning will return to the next committee meeting in July.

Janet Charnock 12 September 2017

The strategy will be ready in September.

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6. Quality monitoring process in primary care There is a need to be mindful of who will escalate this in the organisation and, once agreed, the tool will go to the Membership Council to inform them that their requirements will change.

Claire Heneghan 11 July 2017

On the agenda

6. Quality monitoring process in primary care Other practices in Lancashire use datix to record internal complaints about practices. Sheena Wood will ask Alison Cole who can discuss practice complaints with the Membership Council.

Sheena Wood 11 July 2017 All GP practices should use Datix.

Issues should be identified with a trigger tool to address before becoming an incident. Alison will feedback to the

quality forum on 12.7.17.

6. Quality monitoring process in primary care A governance framework will return to the next committee meeting.

Janet Charnock / Claire Heneghan

11 July 2017

On the agenda

7. NHS England update The pharmacy scheme has now finished and clinical pharmacists are working in two GP practices in West Lancashire. The demand on the clinical pharmacists time to study during the first few years in practice was raised as an issue. Sheena Wood will feedback this comment.

Sheena Wood 11 July 2017

Sheena Wood will feedback as part of the agenda.

9. Any other business Angela Manning is looking for primary care clinicians with an interest in right care. John Caine will consider this.

John Caine 11 July 2017 John Caine will continue to be involved

in the interim, until this has been discussed with the GP leads and a lead

is identified.

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28 March 2017 Action Lead Date required by Action completed

5. Practice overview (including current issues) A new dashboard is being produced and will develop to ensure current information is recorded. This will return to the next meeting.

Jackie Moran 12 September 2017 The dashboard is close to completion and will be brought to the next meeting. Q3 data will be shared with Membership Council and can be sorted by practice or

neighbourhood. It will be available in hardcopy and on sharepoint for GPs.

6. Financial plan A regular financial update will come to future meetings and the data received will be included in the future CCG integrated business reports.

Paul Jones Ongoing Sheena Wood will enquire if the CCG will be picking up finances from pharmacies. Some funding is ring-fenced for primary care. A summary will be produced for the next meeting.

Primary Care Funding Benchmarking

CCG Comparison

Introduction

This slide deck explores how primary care funding in West

Lancashire compares with funding in other Lancashire,

Cheshire and Merseyside CCGs.

Including WL CCG, 32 CCGs have been reviewed.

All figures reflect 2015/16 – funding per weighted patient.

Summary

Annual Amount shows total spend by all 32 CCGsRank of 1 would reflect highest spend per weighted patient of the 32 CCGsRank of 32 would reflect lowest spend per weighted patient of the 32 CCGs

Description Annual Amount % WL CCG Rank

Global SUM £372,282,753 39% 6

MPIG £5,613,401 1% 28

PMS £204,417,118 21% 29

Premises £74,305,027 8% 32

PCO Administered £17,276,969 2% 16

QOF £92,952,770 10% 22

DES £66,094,371 7% 19

National Enhanced Services £434,944 0% 27

LES £61,633,687 6% 13

Prescribing £41,262,411 4% 19

Other £25,123,132 3% 31

Total £961,396,583 100% 30

Global SUM + MPIG + PMS £582,313,272 61% 31

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Prescribing (Immunisations, Dispensing Fees, Prescribing Fee Payment, Reimbursement of Drugs)


-£2.00

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Other


Report Title Enhanced Training Practice (ETP)

Written by Alison Lumley, Nursing & Clinical Quality Lead

Meeting Primary Care Commissioning Committee

Date 12th September 2017

Purpose of the Paper To outline a proposal for West Lancashire practices to become part of Wigan Enhanced Training Practice and seek approval for the same.

Background Enhanced Training Practices are an initiative, funded by Health Education England, to develop placements for inter-professional healthcare students in Primary Care across the North West. The purpose of these hubs or networks is to enable groups of GP practices to offer inter-professional training to primary care staff, extending the skills base within general practice and develop a workforce which can meet the challenge of new ways of working.

Using a Hub and Spoke model, the ETPs provide exposure and breadth of placement experience, allowing general practice the opportunity to address workforce shortages in primary care. ETPs take the lead role by becoming a 'Hub' working to expand the number of placement providers by recruiting and managing ‘spoke placements’. Advantages of becoming part of ETP model include:

• It promotes careers in primary care, shifting student expectations and providing an opportunity to address the workforce shortage

• It gives existing primary care staff an opportunity to train and develop their own careers, extending the skills based within general practice

• Provides a recruitment opportunity, which primary care did not have in place before

• Due to the needs for an educational audit before placements can take place, it also boosts provider status for CQC

Wigan ETP have approached West Lancashire to become part of their ETP. To date, Wigan have employed 3 newly qualified nurses into primary care.

Summary Whilst West Lancashire has developed placements for pre-registration nurses much more work can be done. This includes:

• Opening more placements

• Developing sign-off mentors which will enable placements to take nurses at the end of their training and also return to nursing students

• Support for practice mentors

• Local mentor updates There is limited capacity in the system to support the above on a wide scale. Becoming part of an ETP would provide this plus a number of additional advantages including:

• Having a targeted and sustained approach for the development and support of practice placements.

• Support for mentors in practice with regular mentor meetings to share best practice and support each other.

• Provision of bespoke local annual mentor updates.

• Delivery of standardised training to students in practice around clinical skills; blood pressure monitoring, pulse, ECG, urinalysis, inhaler technique, screening for COPD.

• Bespoke training for annual health checks including a 'carers review' and the over 75 check. These reviews offer transferable skills to any nursing role as it promotes holistic care.

• Practices will be updated with a newsletter and will be able to contribute to this to help promote best practice.

• Development of mentor packs; student packs and FAQ for managers

• Training to become mentor - course fees funded (limited places) and backfill to enable the practice nurse to be released from practice. Completion of the course requires the placement of a student within practice. Combination of the backfill plus the national placement tariff totals around £2050, this is for a typical 10-week student nurse placement, the actual costing will vary if the placement is of a different duration.

• Management of funding to ensure practices receive accurate payments in a timely manner

Key Points

• National shortage of nurses, so we need to ‘grow our own’.

• Only general practice can train general practitioners

• Becoming part of an ETP provides the support and infrastructure to develop and increase placements at no cost to the CCG.

• ETPs have funding confirmed March 2018 although it is anticipated it will continue beyond this date. Should tfunding not continue, this would result in practices and the CCG reverting to the current position. However, the infrastructure for more robust placements should have been put in place by that time.

Additional Information

https://hee.nhs.uk/hee-your-area/north-west/our-work/attracting-developing-our-workforce/enhanced-training-practices

Actions Required by the Group To make a decision on the above proposal to become part of Wigan ETP.



Report Title Education for Workforce Transformation (CPD) Allocation 2017

Written by Alison Lumley, Nursing & Clinical Quality Lead

Meeting Primary Care Commissioning Committee

Date 12th September 2017

Purpose of the Paper

To advise the group of the a CPD allocation 2017, the requirements of use and the proposal for spend to meet

the specified criteria.

Background

Health Education England are supporting a flexible cash allocation for Education for Workforce Transformation (CPD) for use within this financial year of £5,364.81. This investment is in addition to the commitments that have already been indicated related to Mentorship Support (MSLAP) and Non-Medical prescribing.

There is flexibility in determining and making the best use of the available investment however we must assure the following:

• Planning and governance arrangements are in place for ensuring that this investment is used only for the intended purpose of upskilling of the organisation’s (primary care) workforce.

• Prioritising the use of the investment to meet the training needs of staff to ensure that the organisation can meet clinical imperatives and any expected standards related to safe service delivery.

• Consideration of how the organisation may collaborate with others, within their local health systems, to maximise the value of the investment through sharing funding arrangements.

• Review and utilise the CPD provision available through local Education Providers that best meets identified needs.

Consideration can be given on how we might use some of the investment in being able to research, plan, and support internal and system wide sustainability to be able to meet the ongoing training needs of the workforce.

The CCG will need to submit an impact report at the end of the financial year which fully accounts for how the

investment has been used, actual activity data and an appreciation of the benefits seen for staff and

organisations.

Proposal

Given the relative the limited amount it is recommended that priority for funding is given to the two areas below:

1. A number of registered nurses across the area have commenced advanced practice pathways. This is a clear upskilling of the workforce. It is proposed that these modules are fully supported if the applicant can demonstrate the benefits for both themselves and the practice.

2. Registered nurses new in post will require, as a minimum, immunisation training and cervical cytology training. It is proposed that this is fully funded as completion will clearly provide benefits for both the individual and practice. In addition, healthcare assistants may be identified to undertake immunisation training.

Both of these areas are priorities for practices. Estimated costings are detailed below but applications will need to be managed on an individual basis. This may result in either more or less applications than detailed below.

Estimated Costings:

Modules x 6 £640 per module £3,840

Cervical cytology x 3 £250 per course £750

Immunisation x 3 £200 per course £600

Actions Required by the Group

To agree the above proposal or recommend alternative options.

boardroom, hilldale, wigan road, ormskirk, l39 2jw

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