meeting agenda (open session) wednesday 21 august 2019 9 ... · meeting agenda (open session)...

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SHARED AGENDA For the Meetings in Common of:

NHS Mansfield and Ashfield CCG Primary Care Commissioning Committee NHS Newark and Sherwood CCG Primary Care Commissioning Committee

NHS Nottingham City CCG Primary Care Commissioning Committee NHS Nottingham North and East CCG Primary Care Commissioning Committee

NHS Nottingham West CCG Primary Care Commissioning Committee NHS Rushcliffe CCG Primary Care Commissioning Committee

Meeting Agenda (Open Session)

Wednesday 21 August 2019 9:00 – 10:45

Boardroom, Standard Court, 1 Park Row, Nottingham, NG1 6GN

Time Item M&A N&S NC NNE NW R Sponsor Reference

9:00 Introductory Items

1. Welcome, introductions and apologies

EdG PCC19/039

2. Confirmation of quoracy EdG PCC19/040

3. Declarations of interest for any item on the agenda

EdG PCC19/041

4. Management of any real or perceived conflicts of interest

EdG PCC19/042

5. Questions from the public EdG PCC19/043

6. Shared minutes from previous meetings in common held on:

17 July 2019

EdG PCC19/044

7. Action log and matters arising from the meetings in common held on:

17 July 2019

EdG PCC19/045

8. Actions arising from the Governing Bodies

EdG PCC19/046

9:10 Committee Business

9. Draft Annual Work Programme EdG PCC19/047

9.15 Contract Management and Applications

10. Millview Surgery – Six Month List Closure Review

SP PCC19/048

11. Orchard Medical Practice – List Closure Request

SP PCC19/049

Chair: Eleri de Gilbert

Enquiries to: ncccg.notts - [email protected]

Agenda

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Time Item M&A N&S NC NNE NW R Sponsor Reference

12. Eastwood Primary Care Centre: update regarding application to withdraw from being a dispensing practice

SP PCC19/050

13. Discretionary Payment Request linked to Boulevard Medical Centre Relocation

SP PCC19/051

10:00 Quality Monitoring

14. Primary Care Quality Exception Report

EM PCC19/052

10:10 Items for discussion

15. Primary Care Hub – MOU & Handbook 2019/20

SP PCC19/053

10:20 Financial Management

16. Finance Report SPo PCC19/054

10:30 Risk Management

17. Risk Report EM PCC19/055

10:40 Closing items

18. Any other business EdG PCC19/056

19. Key messages to escalate to the Governing Bodies

EdG PCC19/057

20. Date of next meetings:

18/09/2019

Committee Room, Civic Centre, Arnold, NG5 6LU

EdG PCC19/058

Confidential Motion:

The Primary Care Commissioning Committees will resolve that representatives of the press and other members of the public be excluded from the remainder of this meeting, having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest (Section 1[2] Public Bodies [Admission to Meetings] Act 1960)

Agenda

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Name Current position (s)

held in the CCGs

Employing or Member CCG Declared

Interest

(Name of the

organisation

and nature of

business)

Nature of Interest

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Inte

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Pe

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o: Action taken to mitigate risk

BEEBE, Shaun Lay Member NHS Mansfield and Ashfield CCG University of Nottingham Senior manager with the University of

Nottingham, the school is in receipt of

NIHR research funding.

-

Present This interest will be kept under review and specific

actions determined as required.

BEEBE, Shaun Lay Member NHS Mansfield and Ashfield CCG Nottingham University Hospitals NHS

Trust

Patient in Ophthalmology -



BURNETT, Danni Associate Director of Nursing and

Outcomes

NHS Mansfield and Ashfield CCG NHS England and Improvement Spouse employed as Senior Delivery

and Improvement Lead

01/07/2018Present

This interest will be kept under review and specific



Outcomes

NHS Mansfield and Ashfield CCG Nottingham and Nottinghamshire

CCGs

Family member employed as Head of

Service Improvement and BCF

01/07/2018Present




Outcomes

NHS Mansfield and Ashfield CCGNHS England and Improvement

Family member employed as Contracts

Manager

01/07/2018Present



BURNETT, DanniAssociate Director of Nursing and

Outcomes

NHS Mansfield and Ashfield CCG Nottingham Emergency Medical

Services (NEMS)Family member employed as Finance

Accountant

01/07/2018

Present

Involvement in commissioning work relevant to this

interest will be kept under review and specific actions

determined as required.


Outcomes

NHS Mansfield and Ashfield CCGAcademic Health Science Network

Family member employed in Project

Team

01/07/2018 Present



BURNETT, DanniAssociate Director of Nursing and

Outcomes

NHS Mansfield and Ashfield CCGCastle Healthcare Practice (Rushcliffe

Practice)

Registered Patient

01/07/2018 Present


practice will be kept under review and specific actions


CAMPBELL, Dr Ian GP Lead NHS Nottingham North and East CCG

Park House Medical Centre (NNE)Senior Partner 21/04/2015 Present Withdraw from a specified activity or relevant parts of

meetings during which relevant are discussed and not to

take part in any related vote.

CAMPBELL, Dr Ian GP Lead NHS Nottingham North and East CCG Bodylibrium (weight loss and lifestyle

business)

Partner 21/04/2015 Present This interest will be kept under review and specific


CAMPBELL, Dr Ian GP Lead NHS Nottingham North and East CCG

Nutracheck/co/uk (weight loss

business)

Medical Advisor 14/07/2016 Present Withdraw from a specified activity or relevant parts of

meetings during which relevant subjects are discussed

and not to take part in any related vote.

CASSIDY, Lucy Practice Liaison Officer Local Medical Committee

Park House Medical Centre (NNE)

Registered Patient 01/09/2016 Present Involvement in commissioning work relevant to this



CAWLEY, Michael Operational Director of Finance NHS Mansfield and Ashfield CCG No relevant interests declared Not applicable - - Not applicable

DADGE, Lucy Chief Commissioning Officer NHS Newark and Sherwood CCG Mid Nottinghamshire and Greater

Nottingham Lift Co (public sector)

Director 01/10/2017 Present This interest will be kept under review and specific

actions determined as required. NOTE LiftCo develop

health and social care buildings

DADGE, Lucy Chief Commissioning Officer NHS Newark and Sherwood CCG Pelham Homes Ltd – Housing provider

subsidiary of Nottinghamshire

Community Housing Association



DADGE, Lucy Chief Commissioning Officer NHS Newark and Sherwood CCG 3Sixty Care Ltd – GP Federation,

Northamptonshire


actions determined as required. NOTE 3Sixty are a

partnership of 28 practices that aims to provide

community based prevention and joined up health and

care treatment

DADGE, Lucy Chief Commissioning Officer NHS Newark and Sherwood CCG First for Wellbeing Community Interest

Company (Health and Wellbeing

Company)


actions determined as required. NOTE First for

Wellbeing are a social enterprise and is based with the

Public Health Team in Northamptonshire County Council

DADGE, Lucy Chief Commissioning Officer NHS Newark and Sherwood CCG Nottingham Schools Trust Chair and Trustee 01/11/2017 Present This interest will be kept under review and specific


DE GILBERT, Eleri Lay Member NHS Mansfield and Ashfield CCG Middleton Lodge Surgery Husband registered patient -



Primary Care Commissioning Committees - Register of Members Declared Interests as at August 2019

Declarations of interest for any item

on the agenda

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DE GILBERT, Eleri Lay Member NHS Mansfield and Ashfield CCG Middleton Lodge Surgery Registered Patient

-

Present Involvement in commissioning work relevant to this



DE GILBERT, Eleri Lay Member NHS Mansfield and Ashfield CCG Middleton Lodge Surgery Son registered patient -



DE GILBERT, Eleri Lay Member NHS Mansfield and Ashfield CCG Nottingham Bench Justice of the Peace -



DE GILBERT, Eleri Lay Member NHS Mansfield and Ashfield CCG Sherwood and Newark Citizens Advice

Bureau

Trustee on the board 01/03/2016 Present This interest will be kept under review and specific


DE GILBERT, Eleri Lay Member NHS Mansfield and Ashfield CCG Major Oak Medical Practice,

Edwinstowe

Son, daughter in law and grandchild

registered patient

-



HEATHCOTE, David Lay Member NHS Mansfield and Ashfield CCG Torkard Hill Medical Centre Registered Patient Present Involvement in commissioning work relevant to this



KENNEDY, Dr Caitriona GP Member NHS Nottingham North and East CCG Trentside GP Practice GP Partner 14/07/2016 PresentTo be excluded from all commissioning decisions

(including procurement activities and contract

management arrangements) in relation to this practice.

KENNEDY, Dr Caitriona GP Member NHS Nottingham North and East CCG County Health Partnerships

Part time Clinical Director for NNE

Locality (maximum of 1 day per week ).

14/07/2016 Present Withdraw from a specified activity or relevant parts of

meetings during which relevant subjects are discussed

and not to take part in any related vote.

KENNEDY, Dr Caitriona GP Member NHS Nottingham North and East CCG Nottingham Emergency Medical

Services (NEMS)

Shareholder 01/04/2013 Present To be excluded from all commissioning decisions


management arrangements) in relation to services

currently provided by NEMS; and

services where it is believed that NEMS could be an

interested bidder.

LUNN, Joe Head of Primary Care - NHS

England and NHS Improvement

Not applicable No relevant interests declared Not applicable- -

Not applicable

MARSHALL, Nigel Clinical Advisor NHS Newark and Sherwood CCG Southwell Medical Practice Registered Patient

-

Present Involvement in commissioning work relevant to this



MARSHALL, Nigel Clinical Advisor NHS Newark and Sherwood CCG Nottinghamshire County Council -

Education: Minster School, Southwell

Wife is SEN Support Worker 2017 Present This interest will be kept under review and specific


MARSHALL, Nigel Clinical Advisor NHS Newark and Sherwood CCG Hillside Medical Supplies Friendship with Director, Mr J Bagguley 01/06/2015 Present This interest will be kept under review and specific


MARSHALL, Nigel Clinical Advisor NHS Newark and Sherwood CCG Chiropractor, Middleton Lodge Friendship with Practice Manager, Mr

Andrew Adams

01/09/2015 Present This interest will be kept under review and specific


MORTON, Andrew Operational Director of Finance NHS Mansfield and Ashfield CCG No relevant interests declared Not applicable 01/07/2019 Present This interest will be kept under review and specific

actions determined as required

MOSS, Elaine Chief Nurse, Director of Quality and

Governance, ICS Nurse.

NHS Mansfield and Ashfield CCG No relevant interests declared Not applicable- -

Not applicable

PICKETT, Sharon Associate Director of Primary Care NHS Nottingham North and East CCG No relevant interests declared Not applicable- -

Not applicable

SULLIVAN, Amanda Accountable Officer NHS Newark and Sherwood CCG No relevant interests declared Not applicable - Present Not applicable

TANGRI, Arun GP, Cluster Lead/ GP Lead NHS Nottingham City CCG Riverlyn Medical Centre (a spoke

practice for academic, clinical

research.)

GP Partner 01/04/2013 Present To be excluded from all commissioning decisions


management arrangements) relating to this practice

TANGRI, Arun GP, Cluster Lead/ GP Lead NHS Nottingham City CCG Nottingham Emergency Medical

Services (NEMS)

Shareholder 01/04/2013 Present To be excluded from all commissioning decisions


management arrangements) in relation to services

currently provided by NEMS; and

services where it is believed that NEMS could be an

interested bidder.

TANGRI, Arun GP, Cluster Lead/ GP Lead NHS Nottingham City CCG Nottingham City GP Alliance Riverlyn Medical Centre is a member 04/05/2016 Present This interest will be kept under review and specific


TANGRI, Arun GP, Cluster Lead/ GP Lead NHS Nottingham City CCG Nottinghamshire Local Medical

Committee



TANGRI, Arun GP, Cluster Lead/ GP Lead NHS Nottingham City CCG Riverlyn Medical Centre Family Member GP 01/04/2013 Present To be excluded from all commissioning decisions


management arrangements) relating to this practice

TRIMBLE, Ian Independent GP Advisor NHS Rushcliffe CCG Occasional consultancy work for other

CCGs

Occasional consultancy work for other

CCGs




on the agenda

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TRIMBLE, Ian Independent GP Advisor NHS Rushcliffe CCG National Advisory Committee for

Resource Allocation

Independent GP Advisor 01/04/2013 Present This interest will be kept under review and specific


WADDINGHAM, Rosa Associate Director of Personalised

Care and Deputy Chief Nurse

NHS Newark and Sherwood CCG No relevant interests declared Not applicable

- -

Not applicable

WOODS, Kerrie NHS England Representative - GP

Contracts

Crown Medical Centre - Newark and

Sherwood

Registered Patient

01/04/2015 Present




WRIGHT, Michael LMC Representative, CEO LMC Practice Support Services Limited -

Nottinghamshire

Support service as for profit subsidiary

of LMC



WRIGHT, Michael LMC Representative, CEO LMC LMC Buying Groups Federation Manager 01/04/2016 Present This interest will be kept under review and specific


WRIGHT, Michael LMC Representative, CEO LMC Nottinghamshire GP Phoenix

Programme

Manager 01/04/2016 Present This interest will be kept under review and specific



on the agenda

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Managing Conflicts of Interest at Meetings

1. A “conflict of interest” is defined as a “set of circumstances by which a reasonable person

would consider that an individual’s ability to apply judgement or act, in the context of

delivering commissioning, or assuring taxpayer funded health and care services is, or could

be, impaired or influenced by another interest they hold”.

2. An individual does not need to exploit their position or obtain an actual benefit, financial or

otherwise, for a conflict of interest to occur. In fact, a perception of wrongdoing, impaired

judgement, or undue influence can be as detrimental as any of them actually occurring. It is

important to manage these perceived conflicts in order to maintain public trust.

3. Conflicts of interest include:

Financial interests: where an individual may get direct financial benefits from the

consequences of a commissioning decision.

Non-financial professional interests: where an individual may obtain a non-financial

professional benefit from the consequences of a commissioning decision, such as

increasing their reputation or status or promoting their professional career.

Non-financial personal interests: where an individual may benefit personally in ways

which are not directly linked to their professional career and do not give rise to a direct

financial benefit.

Indirect interests: where an individual has a close association with an individual who has

a financial interest, a non-financial professional interest or a non-financial personal

interest in a commissioning decision.

The above categories are not exhaustive and each situation must be considered on a case

by case basis.

4. In advance of any meeting of the Committee, consideration will be given as to whether

conflicts of interest are likely to arise in relation to any agenda item and how they should be

managed. This may include steps to be taken prior to the meeting, such as ensuring that

supporting papers for a particular agenda item are not sent to conflicted individuals.

5. At the beginning of each formal meeting, Committee members and co-opted advisors will be

required to declare any interests that relate specifically to a particular issue under

consideration. If the existence of an interest becomes apparent during a meeting, then this

must be declared at the point at which it arises. Any such declaration will be formally

recorded in the minutes for the meeting.

Management of any real or perceived conflicts of interest


6. The Chair of the Committee (or Deputy Chair in their absence, or where the Chair of the

Committee is conflicted) will determine how declared interests should be managed, which is

likely to involve one the following actions:

Requiring the individual to withdraw from the meeting for that part of the discussion if the

conflict could be seen as detrimental to the Committee’s decision-making arrangements.

Allowing the individual to participate in the discussion, but not the decision-making

process.

Allowing full participation in discussion and the decision-making process, as the potential

conflict is not perceived to be material or detrimental to the Committee’s decision-making

arrangements.

Management of any real or perceived conflicts of interest


Nottingham and Nottinghamshire CCGs’ Primary Care Commissioning Committees’ Meetings in public - Guidance for members of the public

1. Introduction

The Nottingham and Nottinghamshire Clinical Commissioning Groups (NHS Nottingham City

CCG, NHS Nottingham North and East CCG, NHS Mansfield and Ashfield CCG, NHS

Newark and Sherwood CCG, NHS Rushcliffe CCG and NHS Nottingham West CCG -

hereafter referred to as “the CCGs”) are committed to openness and transparency, and

conduct as much of their business as possible in sessions that members of the public, and

staff from any organisation, are welcome to attend and observe (subject to available space).

As part of the CCGs’ Primary Care Delegation Agreements, we are also required to hold

these meetings in public.

As part of the alignment of arrangements across the CCGs, meetings of the CCGs’ Primary

Care Commissioning Committees will be held ‘in common’. This will enable the Committees

to discuss common agenda items, whilst retaining the specific accountabilities of each

individual CCG.

The meetings, although held in public, are not a public meeting and as such there is no

opportunity provided for the public to ask questions in that arena other than that offered at

the discretion of the Chair.

2. How do I find out about meetings?

Meeting dates, times and the venue, which can be subject to change, are published on each

of the CCG’s websites:

NHS Nottingham North and East CCG - http://www.nottinghamnortheastccg.nhs.uk/our-

meetings/primary-care-commissioning-commitee/

NHS Rushcliffe CCG - https://www.rushcliffeccg.nhs.uk/your-ccg/primary-care-

commissioning-committee/

NHS Nottingham West CCG - https://www.nottinghamwestccg.nhs.uk/about-us/primary-

care-commissioning-committee/

NHS Nottingham City CCG - https://www.nottinghamcity.nhs.uk/your-ccg/governing-

body/primary-care-commissioning-committee/

NHS Mansfield and Ashfield CCG - https://www.mansfieldandashfieldccg.nhs.uk/about-

us/meetings/primary-care-commissioning-committee/

NHS Newark and Sherwood CCG - https://www.newarkandsherwoodccg.nhs.uk/about-

us/meetings/primary-care-commissioning-committee/

The Agenda and supporting papers are available on website up to five days before the

meeting.

Questions from the public


http://www.nottinghamnortheastccg.nhs.uk/our-meetings/primary-care-commissioning-commitee/

http://www.nottinghamnortheastccg.nhs.uk/our-meetings/primary-care-commissioning-commitee/

https://www.rushcliffeccg.nhs.uk/your-ccg/primary-care-commissioning-committee/

https://www.rushcliffeccg.nhs.uk/your-ccg/primary-care-commissioning-committee/

https://www.nottinghamwestccg.nhs.uk/about-us/primary-care-commissioning-committee/

https://www.nottinghamwestccg.nhs.uk/about-us/primary-care-commissioning-committee/

https://www.nottinghamcity.nhs.uk/your-ccg/governing-body/primary-care-commissioning-committee/

https://www.nottinghamcity.nhs.uk/your-ccg/governing-body/primary-care-commissioning-committee/

https://www.mansfieldandashfieldccg.nhs.uk/about-us/meetings/primary-care-commissioning-committee/

https://www.mansfieldandashfieldccg.nhs.uk/about-us/meetings/primary-care-commissioning-committee/

https://www.newarkandsherwoodccg.nhs.uk/about-us/meetings/primary-care-commissioning-committee/

https://www.newarkandsherwoodccg.nhs.uk/about-us/meetings/primary-care-commissioning-committee/

3. Can members of the public ask questions during the meeting?

To assist in the management of the agenda and meeting, individuals are encouraged to

submit written questions to the Corporate Governance Team at ncccg.notts-

[email protected] at least 48 hours before the meeting. This will greatly assist in

responding to questions where possible at the meeting.

The maximum amount of time for any one individual to raise a question or speak on a topic

is five minutes. It is necessary to impose such a timeframe so as to ensure that those who

wish to speak are given a fair opportunity to do so while also ensuring the meetings in

common runs to time

Where possible, a response will be given to questions at the meeting, however if the matter

is complex or requires the consideration of further information, a written response to

questions will be provided within 10 working days. If the number of questions raised exceeds

the time allocated, questions will be taken on a first come, first served basis and any

remaining questions subsequently addressed in writing

We will not be able to discuss questions if

They relate to individual patient care or the performance of individual staff members.

The question does not relate to an item on the agenda.

The question relates to issues which are the subject of current confidential discussions,

legal action or any other matter not related to the roles and responsibilities of the CCGs

The Chair reserves the right to move the meeting on if they judge that no further progress is

likely to result from further discussion or questioning, or to ensure that the meetings in

common can be conducted on time.

Any questions submitted may be treated as a request under the Freedom of

Information Act and treated accordingly

4. Attendance at meetings.

If you have any particular needs with regards to access or assistance, such as wheelchair

access or an induction loop please contact the Corporate Governance Team at ncccg.notts-

[email protected] and we will do our best to assist you.

Please be aware that you will need to sign-in at the venue reception upon arrival, for fire

safety and security reasons. A member of staff will escort everyone to the meeting room.

Unfortunately, if members of the public arrive after the meeting has already started it may

not be possible for them to join the meeting.

At the end of meeting, all members of the public will also be escorted back to the main

entrance by a member of staff.

Please note that the use of mobile phones or other electronic devices during the meeting will

not be permitted if their use is deemed disruptive to the meeting. This is for the benefit of all

present.



mailto:[email protected]




5. Identifying committee members

The Chair will ask members to introduce themselves at the beginning of each meeting. A

name plate for each member will also be displayed on the table to help you see who is

speaking during the meeting.

6. Discussion at meetings

The members will have been provided with copies of the agenda and papers at the same

time as they are published on the CCGs’ websites and will therefore have had the

opportunity to consider the papers prior to the meeting. The Primary Care Commissioning

Committees will consider the items on the agenda in turn and each paper includes a

summary cover sheet, which makes recommendations for the meeting to consider. For some

items there may be a presentation, whereas for others this may not be necessary. The

members may not actively discuss each item in detail; this does not mean that the item has

not received careful consideration but means that the members have no further questions on

the matter and do not wish to challenge the recommendation(s). A formal vote will not be

taken if there is a general consensus on a suggested course of action.

7. Minutes

A record of the issues discussed and decisions taken at the meeting will be set out in the

minutes, which members will be asked to approve as a correct record at its next meeting.

Please note that the minutes will not be a verbatim record of everything that was discussed

at the meeting.

The minutes are presented to the next meeting for approval and will be added to the CCG’s

website once approved.

8. Public Order

The Chair may at any time require the public or individual members of the public or media to

leave the meeting or may adjourn the meeting to a private location if they consider that those

present are disrupting the proper conduct of the meeting or the business of the Committees.



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Meetings in common of the

NHS Mansfield and Ashfield CCG Primary Care Commissioning Committee

NHS Newark and Sherwood CCG Primary Care Commissioning Committee

NHS Nottingham City CCG Primary Care Commissioning Committee

NHS Nottingham North and East CCG Primary Care Commissioning Committee

NHS Nottingham West CCG Primary Care Commissioning Committee

NHS Rushcliffe CCG Primary Care Commissioning Committee

Public Session

Unratified minutes of the meetings held in common on 17/07/2019, 09.00 – 10.45

Committee Meeting Room, Civic Centre, Arnot Hill Park, Arnold, NG5 6LU Organisation

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Members present:

Eleri de Gilbert Lay Member, Quality and Performance (Chair)

Danni Burnett Associate Director of Nursing and Outcomes (deputising for Rosa Waddingham)

Mick Cawley Operational Director of Finance Lucy Dadge Chief Commissioning Officer

David Heathcote Associate Lay Member, Audit and Governance

Dr Nigel Marshall Independent GP Advisor, Mid-Nottinghamshire

Sharon Pickett Associate Director of Primary Care Commissioning

Dr Ian Trimble Independent GP Advisor, Greater Nottingham

In attendance: Lucy Branson Associate Director of Governance

Helen Brocklebank-Clark

Corporate Governance Officer (minute taker)

Siân Gascoigne Corporate Governance and Assurance Manager (item PCC 19/035 Risk Report)

Shared minutes from previous meetings in common held on 17 July 2019


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Esther Gaskill Head of Quality – Primary Care

Cathy Quinn Deputy Director of Primary Care (item PCCC 19/027 Barnby Gate Surgery)

Kerrie Woods Primary Care Lead (GP Contracts), NHS England

Michael Wright Chief Executive, Local Medical Committee

Apologies: Shaun Beebe Lay Member, Financial Management

Andrew Morton Operational Director of Finance

Amanda Sullivan Accountable Officer

Rosa Waddingham

Associate Director of Nursing and Personalised Care

Cumulative Record of Members Attendance (2019/20)1

Name Possible Actual Name Possible Actual

Eleri de Gilbert 2 2 Mick Cawley 2 2

Shaun Beebe 2 2 Lucy Dadge 2 2

David Heathcote 2 2 Andrew Morton 2 1

Dr Nigel Marshall 2 2 Sharon Pickett 2 2

Dr Ian Trimble 2 2 Amanda Sullivan 2 0

Rosa Waddingham 2 0

1 From commencement of new aligned governance arrangements

ITEM

Introductory Items

PCC 19/020 Welcome and Apologies for Absence

Eleri de Gilbert welcomed everyone to the public meeting in common of the

Primary Care Commissioning Committees of NHS Nottingham City CCG, NHS

Mansfield and Ashfield CCG, NHS Newark and Sherwood CCG, NHS Nottingham

West CCG, NHS Rushcliffe CCG and NHS Nottingham North and East CCG

(hereafter referred to collectively as “the Committees” unless the item being

discussed pertains to an individual CCG (or CCGs)).

Further to the June 2019 meeting the following meeting principles were outlined;

i. Members are encouraged to read the papers and seek points of clarification

in advance of the meetings where possible;

ii. Presenters will assume that members have read all papers and will present

accordingly;

iii. The authors and presenters of papers are to be treated with respect, whilst

accepting that fair and constructive challenge is appropriate;



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ITEM

iv. Respect is to be shown to the different ways of working within each of the

six CCGs during this time of transition;

v. When discussing individual contractors the information provided must be

factual and accurate.

Apologies were noted as above. Mick Cawley explained that he was also fulfilling

the role of deputy for Andrew Morton and would present the finance report on

behalf of both the Nottingham and Nottinghamshire CCGs.

PCC 19/021 Confirmation of Quoracy

It was confirmed that the meeting was quorate.

PCC 19/022 Declaration of interest for any item on the shared agenda

No interests were declared in relation to any item on the agenda. The Chair reminded members of their responsibility to highlight any interests should they transpire as a result of discussions during the meeting.

PCC 19/023 Management of any real or perceived conflicts of interest

As no conflicts of interest had been identified, this item was not necessary for the meeting.

PCC 19/024 Questions from the Public Protocol

There were no questions from the public. Members observed that questions from the public are an important form of engagement. Eleri agreed to contact the Patient and Public Engagement Committee (PPEC) to identify the most effective way to engage with the public and seek questions for the Committees in common.

ACTION: Eleri de Gilbert to contact the Patient and Public Engagement Committee (PPEC) to identify the most effective way to engage with the public and seek questions for the Committees in common.

PCC 19/025 Shared Minutes from previous meetings in common held on 19 June 2019

It was agreed that the minutes were an accurate record of the meeting.

PCC 19/026 Action log and matters arising from the meetings in common held on 19 June 2019

All actions were noted as complete and agreed for closing on the action log.



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ITEM

On reflection, members felt that it would be pertinent to include the Leen View Surgery Boundary Reduction and Parkside Medical Centre Boundary Expansion on the action log, as well as the forward work programme, to ensure the Committees are sighted of the requirement for the items to be re-presented at a future meeting.

ACTION: Helen Brocklebank-Clark to include Leen View Surgery Boundary Reduction and Parkside Medical Centre Boundary Expansion on the action log in advance of the August 2019 meeting.

Contract Management and Applications

PCC 19/027 Contract Management

Kerrie Woods was in attendance to provide a verbal update in relation to this item, supported by a tabled briefing. The following key points were highlighted: (a) The briefing provides the Committees with an overview of contractual changes

undertaken by Nottinghamshire practices between 1 January 2019 – 15 July 2019.

(b) Within the Nottingham City locality there have been four patient list closures; those at the High Green Surgery and Wellspring Surgery have concluded. The practice list closure at the Whyburn Medical Practice was extended for a month, until the end of the contract period. Mapperley Park Medical Practice closed on 21 June 2019.

(c) Within the Mansfield and Ashfield locality the Millview Surgery practice list is currently closed and scheduled to reopen in September 2019.

(d) Boundary change applications for Parkside Medical Practice (expansion) and Leen View Surgery (reduction), within the Nottingham City locality, were presented to the June 2019 Committees for consideration. It was agreed to defer these items to a future Committees meeting to enable further consultation with the provider.

(e) NEMS Platform One Practice Upper Parliament Street branch within the Nottingham City locality closed on the 30 May 2019.

(f) A formal merger application has been received for the Greenfields Medical Practice and the Mayfield Medical Practice both located within Nottingham City.

(g) There are 49 Personal Medical Services (PMS) contracts within Nottinghamshire.

(h) A contractor holding a PMS agreement and providing essential clinical services has the right to transfer onto a General Medical Services (GMS) contract in accordance with Regulation 19 of the PMS Regulations.

(i) Due to the decline in PMS premiums practices will be more financial secure in a GMS contract by 2021.

(j) Orchard Medical Practice and Oakwood Surgery within the Mansfield and Ashfield locality have already transferred onto a GMS contract. Greenfields Medical Practice in the Nottingham City locality will transfer onto a GMS contract on the 30 September 2019.

(k) An update was received in relation to Alternative Provider Medical Services (APMS) contracts; Platform One (Nottingham City) and Southglade Medical Practice (Nottingham City) have had their contracts extended. Kirkby



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ITEM

Community Primary Care Centre (Mansfield and Ashfield) and Balderton Medical Practice (Newark and Sherwood) are under a caretaker contract delivered by Primary Integrated Community Services Ltd (PICS)

(l) Bilborough Medical Centre (Nottingham City) and Whyburn Medical Practice (Nottingham North and East) have transferred from a GMS contract to an APMS contract.

(m) GP services at Strelley Health Centre (Nottingham City) and Mapperley Park Medical Practice (Nottingham City) are now closed.

(n) Clinical services previously delivered at Boulevard Medical Centre have relocated to the Beechdale Medical Practice.

(o) Members will receive a quarterly update on contractual changes.

The following points were made in discussion: (p) Members noted that the update on contractual changes was useful. (q) Sharon invited members to comment on the format of the initial contractual

changes briefing paper and confirmed that specific contractual issues will be presented to the Committees as required.

(r) Members requested that future versions of the contractual changes briefing paper include details on breaches and any further actions required in relation to contract changes.

(s) Members were reminded that all practices have the contractual right to close their patient list; however, the Committees had a recognised responsibility to consider how a patient list closure would impact on patients and neighbouring practices.

(t) It was noted that the reported contractual changes would have a detrimental impact on the overall financial position of the CCGs.

(u) Members observed that it was encouraging to see an increase in partnership contracts; however, there was still a challenge in relation to the number of GPs leaving the profession.

ACTION: Kerrie Woods to amend future versions of the contractual changes briefing paper to include details on breaches and any further actions required in relation to contract changes.

The Committees:

NOTED the verbal update; and

RECEIVED the tabled contractual changes briefing.

PCC 19/028 Practice merger for Greenfields Medical Centre and Mayfield Medical Practice

Sharon Pickett introduced the item and welcomed Kerrie Woods to provide additional detail. The following key points were highlighted: (a) Greenfield Medical Centre and Mayfield Medical Practice are located within the

same building in Hyson Green, within the Nottingham City locality. (b) Both practices have applied to merge from 1 October 2019. (c) NHS Nottingham City Primary Care Commissioning Committee is asked to

approve the merger in principal to enable a consultation and engagement exercise to commence.



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ITEM

(d) Greenfields Medical Centre operates under a PMS agreement and Mayfield Medical Centre is on a GMS contract. Greenfields Medical Centre is in the process of completing a transfer from PMS to GMS as part of the application process. This will take effect from 30 September 2019.

(e) Dr YVS Rao, sole partner of Mayfield Medical practice intends to retire from the partnership from the 2 October 2019. However, it is Dr Rao’s intention to continue to support the merged business.

(f) As part of the application it is proposed that the two patient lists are combined into a single list.

(g) There will be minimal impact on patients as both practices are located in the same building and all existing services will remain intact. The overall amount of clinical sessions offered will remain the same and extended hours will still be offered. The skills of clinical staff will be utilised to offer patients a wider flexibility of appointments.

(h) It is envisaged that good working practices will be shared across the newly merged practice to help eliminate previous quality issues.

The following points were made in discussion: (i) Members noted that Mayfield Medical Practice had received a Care Quality

Commission (CQC) rating of ‘requires improvement’ and were assured that the Practice had an action plan in place and were expected to meet all requirements.

(j) It was observed that the direction of travel in terms of delivering clinical sustainability was to move away from single handed practices.

(k) Members queried whether a procurement exercise should be undertaken and were advised that the merger was a provider led initiative and did not meet the procurement threshold.

(l) It was observed that the aggregate number of General Practitioner’s (GP’s) is decreasing from eight to six. Assurance was received that the same number of clinical sessions would be offered to patients; however, not all of these would be GP sessions.

(m) Patient and stakeholder engagement would be concluded within 28 days; subsequently the Committees will receive an updated merger application for formal approval in September 2019. This will be included on the forward work programme.

ACTION:

Helen Brocklebank-Clark to update the work programme to reflect that the practice

merger for Greenfields Medical Centre and Mayfield Medical Practice will be re-

submitted to the September 2019 Committees in common for final approval.

NHS Nottingham City Primary Care Commissioning Committee:

APPROVED the proposed merger in principal between the two practices

subject to patient and stakeholder engagement being completed.

PCC 19/029 Barnby Gate Surgery – application to close patient list



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ITEM

Kerrie Woods was in attendance to provide a verbal update in relation to this item. The following key points were highlighted: (a) Barnby Gate Surgery has a list size of circa 14,500 patients and is located

within the Newark and Sherwood locality. (b) It has applied to close its list size to new patients for a period of nine months to

respond to increasing workforce pressures and ensure capacity for GPs and staff to continue to carry out patient care in a quality and safe manner.

(c) Three GPs have left the surgery in recent months and there is now one GP per 3,500 patients which is significantly above the national average of one GP per 1,800/2000 patients.

(d) Neighbouring practices are currently providing Extended Hours on behalf of the Barnby Gate Surgery and have been doing so for the past eighteen months.

(e) Neighbouring practices are supportive of the surgery’s proposal to temporarily close its list.

(f) The premises are currently owner occupied on which notional rent is paid however; consideration is being given to commencing a sale and lease back process.

The following points were made in discussion: (g) Members sought to understand the actions surgery staff will take during the

nine months to mitigate the workforce challenges that are being experienced. Confirmation was received that the surgery had requested additional Information Technology equipment, was actively trying to recruit a full time GP and would review the skill mix required to meet the needs of their patient population.

(h) Members commented that it was positive to see that neighbouring practices and the Primary Care Network (PCN) were in support of the temporary list closure.

(i) Lucy Dadge referred to the sale and lease back process and offered to liaise with Lynne Sharp, Associate Director of Estates and source support for colleagues at the Surgery to reach a decision that is mutually beneficial, should this be required.

(j) Confirmation was received that moving forward it was hoped that GPs would be employed at PCN level which would offer increased flexibility to support practices experiencing workforce issues.

(k) Members urged colleagues at Barnby Gate Surgery to use this as an opportunity to exercise their voice and input into the PCN Strategy.

(l) Assurance was received that the CCG locality team was also in support of the proposed temporary list closure.

(m) The Committees recognised the immense pressure the Surgery was under and recognised that approving the temporary list closure would alleviate pressure on the workforce and enable clinical capacity to be increased.

(n) The practice was encouraged to avail themselves of support being offered by the CCG, PCN and Local Medical Committee (LMC) to address their workforce challenges.

ACTION:

Helen Brocklebank-Clark to update the work programme to reflect that the Barnby

Gate Surgery nine month temporary list closure will be reviewed by the Committees

in six months’ time.

NHS Newark and Sherwood Primary Care Commissioning Committee:



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ITEM

CONSIDERED and APPROVED the application from Barnby Gate to close

their practice list of patients for a period of nine months. The list closure will

be reviewed by the Committee in six months’ time.

PCC 19/030 GP Retention Scheme Approvals Process

Sharon Pickett presented this item. The following key points were highlighted: (a) The GP Retention Scheme forms part of the national solution for closing the

current gaps in GP workforce trajectories. (b) The scheme supports GPs to remain in general practice and the practice

employing them by offering financial support in recognition of the fact that this role is different to a ‘regular’ part-time, salaried GP post, offering greater flexibility and educational support.

(c) In April 2019 Nottingham City Clinical Commissioning Group received three applications for the first time since the responsibility for approving the schemes was transferred from NHS England (NHSE) to CCGs. This identified a requirement to establish a formal process for approving applications and monitoring the number of approved applications across the CCGs. The report presented to the Committees provides further information on the application process.

(d) As of 1 July 2019 there are currently twelve GPs participating in the GP Retention Scheme across Nottingham and Nottinghamshire at a maximum cost to the CCGs of £20,000 per annum, per GP.

(e) Given the recognised shortage of GPs there is an expectation that if an application to join the GP Retention Scheme meets the approval criteria when reviewed by Health Education England (HEE), and the NHSE Responsible Officer does not have any concerns relating to fitness to practice then the application should be approved by the CCGs.

(f) Four options are presented to the Committees for consideration; i. Option one - All new applications and renewals are considered for approval

via the Primary Care Commissioning Committees; ii. Option two - All new applications are considered for approval via the

Primary Care Commissioning Committees, with approval of renewals delegated to the Associate Director of Primary Care;

iii. Option three - Approval of new applications and renewals is delegated to the Associate Director of Primary Care within a defined limit either across the Integrated Care System (ICS) area or for each CCG;

iv. Option four - Approval of new applications and renewals is delegated to the Associate Director of Primary Care and the Chief Finance Officer (CFO) with each application being considered on its own merits taking into account local circumstances and affordability.

(g) Option four is the recommended option; however given the challenging financial position support is sought from the Chief Finance Officer (or delegated role) to consider and approve each application on its own merit.

The following points were made in discussion: (h) It was noted that although the CCGs incur a cost by approving the applications

the cost of not approving the applications is considerably greater. (i) Members were keen to understand why the majority of the twelve retention

schemes were in the Nottingham City locality. It was thought this was related to



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ITEM

a close working relationship with the Deanery and promotion of the schemes. (j) Members recognised that the scheme responded to local GP shortages and

supported the adoption of option four. (k) It was noted that the Scheme of Reservation and Delegation would need to be

update accordingly. (l) The role of the CFO in supporting the approval of retention scheme applications

was considered and it was agreed that the CFO would conduct a financial appraisal of the impact and the opportunity cost associated with each application.

(m) It was confirmed that an exercise was underway to review the application form to ensure it adequately outlined the practice need and informed the decision making process; this would include the impact if the application was not approved.

ACTION:

(a) Helen Brocklebank-Clark to update the work programme to reflect that an update on the GP Retention Scheme Approvals will be received by the Committees every six months.

(b) Lucy Branson to update the Scheme of Reservation and Delegation to reflect

that the approval of new GP retention scheme applications and renewals is

delegated to the Associate Director of Primary Care with support from the

Chief Finance Officer.

The Committees:

CONFIRMED its support to the GP Retention Scheme recognising the

valuable contribution this makes to GP recruitment across the area.

DELEGATED the approval of new applications and renewals to the

Associate Director of Primary Care and the CFO with each application being

considered on its own merits taking into account local circumstances and

affordability – option four.

CONFIRMED a frequency of six monthly updates to the Committees in

respect of decisions made.

Quality Monitoring

PCC 19/031 Quality Monitoring – emerging issues (verbal update)

Esther Gaskill was in attendance to provide a verbal update in relation to this item. item. The following key points were highlighted:

(a) The update focused on the closure of GP services at Strelley Health Centre and Boulevard Medical Centre both located within Nottingham City.

(b) Following the closure of GP services at Strelley Health Centre 3,000 patients have re-registered at new practices and 1,600 patients are yet to do so. Work continues to contact and support vulnerable patients to re-register at local practices; and assurance was received that all patients in the three



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ITEM

residential/retirement homes within the area are now registered at alternative practices.

(c) The Patient Experience Team has received minimal enquiries regarding the closure of GP services at Strelley Health Centre.

(d) Neighbouring practices within Primary Care Network (PCN) continue to be engaged, supportive and take on new patients.

(e) The Strelley Health Centre CQC inspection report is due to be published on the 17 July 2019 and colleagues are prepared for media interest should it arise.

(f) The majority of Boulevard Medical Centre patients have re-registered at the Beechdale Medical Practices.

(g) Quality assurance meetings are taking place with colleagues at the Beechdale Medical Group and the Health Overview and Scrutiny Committee are engaging with practice staff, the PCN and other stakeholders on future plans.

(h) Queen’s Bower Surgery within Nottingham City has recently been inspected by the CQC and rated as inadequate. The surgery was found to be in breach of regulation twelve (safe care and treatment) and regulation seventeen (good governance) and has made representations to the CQC which will be considered.

The following points were made in discussion: (i) Members were assured that colleagues within the Quality Team were working

with colleagues at Queen’s Bower Surgery to ensure identified improvements were implemented.

The Committees:

NOTED the verbal update.

PCC 19/032 Primary Care Quality – Monitoring and Assurance Overview (verbal update)

Esther Gaskill was in attendance to provide a verbal update in relation to this item, supported by a presentation. The following key points were highlighted: (a) The paper gives an overview of Quality Monitoring process across the

Nottingham and Nottinghamshire CCGs. (b) The Primary Care Quality Team is part of the CCGs wider quality team and

works across the six CCGs overseeing 132 GP practices. (c) The Quality Team fulfils the role of a critical friend, disseminates learning,

seeks assurance on the quality of services provided, and supports practices in continuous quality improvement.

(d) The Quality Assurance Framework (QAF) is comprised of the Primary Care Quality Group, Quality Dashboard and Escalation of Concerns Process.

(e) The two established Quality Groups and the re-established Mid-Nottinghamshire Quality Group will work across the Integrated Care Partnership (ICP) footprints to monitor the quality of general practice and escalate issues and concerns to the Primary Care Commissioning Committees.

(f) A consultation exercise took place with practice staff, GPs and patient groups prior to the implementation of the dashboard.

(g) The membership of the Primary Care Quality Group has been refined over time and now includes a Community Nurse, GP and a Practice Manager as the perspective of the individuals fulfilling these roles has been identified as adding



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ITEM

value. (h) Practices are encouraged to enact the Duty of Candour and talk to the patient,

or the relative of a patient, affected by an incident. (i) A review of the National GP Survey results is scheduled within the Quality

Team’s workplan and will feed into the work of the Quality Group. (j) Quality support visits are undertaken by the team if an indicator or a group of

indicators on the dashboard identifies a quality concern. (k) The Dashboard is refreshed quarterly. (l) All practices are sighted on the dashboard and performance against a range of

indicators within three quality domains; clinical outcomes, patient experience and patient safety.

(m) A Dashboard Development Group has been established to review whether the dashboard indicators remain fit for purpose.

(n) Benefits of the dashboard include increased engagement between practices and patients as support can be sought from the Patient Participation Group (PPG) to improve performance against some indicators, improved collaborative working, and healthy competition as it is shared across practices.

(o) The dashboard can be used by a practice as part of their CQC presentation and is an early indicator of practices requiring additional support.

(p) The Primary Care Quality Groups will provide the Committees with a single quarterly exception report identifying the areas of quality concern the team are focused on.

(q) Members of the Committees were shown the dashboard via eHealthscope and invited to ask questions.

The following points were made in discussion: (r) Members were interested to understand how the Community Nurse

representative on the Primary Care Quality Group engaged with Community Nurses from the 132 practices. It was explained that the Community Nurses had a communication mechanism that enabled them to share information pertaining to quality issues and patient safety concerns.

(s) It was confirmed that the domains the PCNs report on will align with those in the dashboard.

(t) The LMC routinely promoted the dashboard to practice managers as a useful tool.

(u) It was confirmed that the dashboard will continue to be used as a tool for early identification of quality concerns at practice level.

(v) Clarification was received that the Committees would be notified of any practices identified as consistently failing to meet the quality indicators.

(w) Members recognised that early identification of quality issues does not always result in the avoidance of outcomes such as practice closures.

(x) Members took assurance that the process for monitoring quality within practices is robust and continually reviewed and improved.

ACTION:

Helen Brocklebank-Clark to update the work programme to reflect that the Primary

Care Quality Groups will provide the Committees with a quarterly exception report.

The Committees:



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ITEM

NOTED the Primary Care quality monitoring and assurance processes;

APPROVED the proposal to receive a quarterly exception report from the Primary Care Quality Groups.

Financial Management

PCC 19/033 Finance Report at Month Three

Mick Cawley presented this item on behalf of both the Nottingham and Nottinghamshire CCGs. The following key points were highlighted: (a) The report outlines the financial position of the Primary Care Delegated Budget

for each of the Nottingham and Nottinghamshire CCGs, including a consolidated position.

(b) The consolidated position shows a year to date position of £513k favourable variance.

(c) The combined forecast position of the six CCGs is to remain within budget. (d) There remained a risk to the overall financial position of the CCGs in relation to

the achievement of the £78 million Quality, Improvement, Productivity and Prevention (QIPP) target.

(e) As part of the organisation-wide approach to financial recovery, a review of primary care spend against budgets will be undertaken with the aim of identifying financial opportunities that could be used to mitigate the CCGs risk.

(f) The review will include an exercise to bench-mark primary care spend across CCG footprints.

No further points were raised during discussion.

The Committees:

RECEIVED and NOTED the Finance Report at month three.

PCC 19/034 GP Forward View Funding

Sharon Pickett presented this item. The following key points were highlighted: (a) Historically GP Forward View (GPFV) funding has been awarded at CCG level. (b) In June 2019 funding for four GPFV programmes (Practice resilience, GP

retention, reception and clerical, and online consultation) was allocated to each ICS, rather than to individual CCGs.

(c) The ICS has been required to sign a Memorandum of Understanding (MOU) with NHSE which includes the requirement to establish an ICS and CCGs Primary Care Programme Board which has the remit to approve the funding allocation.

(d) An engagement process has taken place to identify the system-wide priorities for the use of the GPFV funding allocation, outlined as:

i. PCN Organisational Development ii. Group consultations iii. Health Care Assistant Workforce Training iv. Practice Manager Roving Support v. Practice Manager Training vi. Senior Fellowship Programme vii. Fellowship Lite viii. General Practice Fundamentals Programme (Practice Nursing)



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ITEM

ix. Reception and Clerical Staff Training Programme (e) A GPFV Funding Working Group has been established to coordinate and

monitor delivery of the approved schemes.

The following points were made in discussion: (f) It was highlighted by Michael Wright that practice colleagues remain unclear

about where the funding has been allocated and how they can contribute feedback. Confirmation was received that members of the GPFV Funding Working Group and individual task and finish groups were encouraged to seek views from their practice colleagues; however, in some instances this conversation will be ongoing as the projects develop and stakeholder engagement and analysis is required.

(g) Members requested that a communication briefing was circulated to practices to outline the approved schemes and how staff can engage in the process.

ACTION:

(a) Helen Brocklebank-Clark to update the work programme to reflect that an

update on the GP Forward View Funding Allocations will be received by the

Committees every six months.

(b) Sharon Pickett to send a communication briefing to practice staff detailing the

system-wide priorities and schemes that have received GPFV funding

allocation, and confirm how staff can engage in the process.

The Committees:

ACKNOWLEDGED progress on this programme of work to date;

NOTED the use of the GP Forward View funding for 2019/20 as approved by the Nottingham and Nottinghamshire ICS CCG Primary Care Programme Board and in line with the proposals and priority areas detailed in the report;

DETERMINED the future updating requirements to the PCCCs.

Risk Management

PCC 19/035 Risk Report

Siân Gascoigne was in attendance to present this item. The following key points were highlighted: (a) Primary care risks are being systematically captured across the Nottingham

and Nottinghamshire CCGs. (b) Following alignment of the Greater Nottingham and Mid-Nottinghamshire

CCGs risk reports an exercise has taken place to review all risks and remove duplication.

(c) Four duplicated risks are proposed for archiving (RR 055, RR 061, RR 065

and RR 066), although their content is retained within the register. (d) During the course of the Committees, risks were referenced in relation to

primary care workforce and estates, both of which are already included within



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ITEM

the register.

The following points were made in discussion: (e) Members sought clarification on what the term archiving means in relation to

the corporate risk register. It was confirmed that archived risks will be removed from the live register onto an archived register which can still be accessed as a reference tool.

(f) It was highlighted that RR 032 and RR 061 are scored differently although they appear to be the same risk. Assurance was received that an engagement exercise has taken place with risk owners to review the risks, remove duplication, and confirm mitigating actions to ensure they remain accurate. As a result RR 061 will be archived and RR 032 will remain on the live register with a reduced impact score of four. It will remain a major (red) risk, meaning it will continue to be reported to the Governing Bodies as part of their Corporate Risk Report.

(g) Members felt that given the challenging financial environment it would be pertinent to articulate a risk relating to the increased pressure on Primary Care delegated budgets. Assurance was received that initial conversations have taken place in relation to this risk and a risk owner needed to be identified prior to inclusion on the risk register.

(h) Members noted that a risk will need to be articulated in relation to the national GP System of Choice (GPSoC) arrangements which end in December 2019, to be replaced by CCG procured Information Technology systems funded on a capitation basis.

(i) Members observed that financial risk was a recurring theme during the Committees discussions and were assured that an exercise was underway to consider and review all financial risks.

ACTIONS:

Siân Gascoigne to meet with finance colleagues to consider the inclusion of financial risks associated with Primary Care on the Corporate Risk Register.

The Committees:

APPROVED the archiving of risks RR 055, RR 061, RR 065 and RR 066;

COMMENTED on the risks shown within the paper and those at Appendix

A.

Closing Items

PCC 19/036 Any other business

There was no other business to be discussed.

PCC 19/037 Key messages to escalate to the Governing Body

(a) The Committees considered a number of contract management issues, receiving an update from NHSE Primary Care Hub colleagues on contractual changes undertaken by practices since the 1 January 2019.



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ITEM

(b) The approval in principle of a practice merger application for Greenfields Medical Centre and Mayfield Medical Practice, both within Nottingham City, subject to patient and public consultation over the next 28 days.

(c) An application from the Barnby Gate Surgery, Newark, to temporarily close its practice list to new patients for nine months was approved.

(d) Assurance was received that the quality monitoring process in place was robust and routinely reviewed and improved.

(e) The Committees noted the finance report as at month three. (f) The risks related to Primary Care have now been updated following the

alignment of the primary care functions and duplication removed from the register.

PCC 19/038 Date of next meeting

21/08/2019 Boardroom, Standard Court, 1 Park Row, Nottingham, NG1 6GN

Confidential Motion: The Primary Care Commissioning Committees will resolve that representatives of

the press and other members of the public be excluded from the remainder of this

meeting, having regard to the confidential nature of the business to be transacted,

publicity on which would be prejudicial to the public interest (Section 1[2] Public

Bodies [Admission to Meetings] Act 1960)



of 4

Primary Care Commissioning Committees in Common OPEN ACTION LOG from the Primary Care Commissioning Committees on 17 July 2019

MEETING

DATE

CCG AGENDA

REFERENCE

AGENDA ITEM ACTION LEAD DATE TO BE

COMPLETED

COMMENT

ACTIONS OUTSTANDING

No actions outstanding

ACTIONS ONGOING

17/07/2019 All PCC 19/024 Questions from the

Public Protocol

Contact the Patient and Public

Engagement Committees (PPEC)

Chairs to identify the most effective

way to engage with the public and

seek questions for the Committees

in common.

Eleri de Gilbert 21/08/2019 A verbal update will be provided

at the meetings in common.

17/07/2019 All PCC 19/027 Contract

Management

Amend future versions of the

contractual changes briefing paper

to include details on breaches and

any further actions required in

relation to contract changes.

Kerrie Woods 20/11/2019 This amendment will be

reflected in the next version of

that report; to be next received

by the Committees at the

meeting on the 20 November

2019.

17/07/2019 All PCC 19/034 GP Forward View Send a communication briefing to Sharon Pickett 31/08/2019 This item is being progressed

Action log and m

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MEETING

DATE

CCG AGENDA

REFERENCE


COMPLETED

COMMENT

Funding practice staff detailing the system-

wide priorities and schemes that

have received GP Forward View

funding allocation, and confirm how

staff can engage in the process.

with the Communications and

Engagement Team.

ACTIONS COMPLETED

19/06/2019 Nottingham

City CCG

PCC 19/008 Leen View

Boundary

Reduction

To be included on a future agenda

item for consideration and approval.

Helen

Brocklebank-

Clark

21/08/2019 Included on the forward work

programme and scheduled for

the September 2019 meeting.

See agenda item PCC 19/047.


City CCG

PCC 19/009 Parkside Boundary

Expansion

To be included on a future agenda

item for consideration and approval.

Helen

Brocklebank-

Clark






City CCG

PCC 19/028 Practice merger

for Greenfields

Medical Centre

and Mayfield

Medical Practice

Update the work programme to

reflect that the practice merger for

Greenfields Medical Centre and

Mayfield Medical Practice will be re-

submitted to the September 2019

meeting in common for final

approval.

Helen

Brocklebank-

Clark





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MEETING

DATE

CCG AGENDA

REFERENCE


COMPLETED

COMMENT

17/07/2019 Newark and

Sherwood

CCG

PCC 19/029 Barnby Gate

Surgery –

application to

close patient list


reflect that the Barnby Gate Surgery

nine month temporary list closure

will be reviewed by the Committees

in six months’ time.

Helen

Brocklebank-

Clark


programme. See agenda item

PCC 19/047.

17/07/2019 All PCC 19/030 GP Retention

Scheme Approvals

Process

Update the Schemes of

Reservation and Delegation to

reflect that the approval of new GP

retention scheme applications and

renewals is delegated to the

Associate Director of Primary Care

with support from the Chief Finance

Officer.

Lucy Branson 21/08/2019 The Scheme of Reservation

and Delegation has been

amended to reflect this.

17/07/2019 All PCC 19/030 GP Retention

Scheme Approvals

Process


reflect that an update on the GP

Retention Scheme Approvals will be

received by the Committees every

six months.

Helen

Brocklebank-

Clark



PCC 19/047.

17/07/2019 All PCC 19/032 Primary Care

Quality –

Monitoring and

Assurance

Overview (verbal

update)


reflect that the Primary Care Quality

Groups will provide the Committees

with a quarterly exception report.

Helen

Brocklebank-Clark



PCC 19/047.

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MEETING

DATE

CCG AGENDA

REFERENCE


COMPLETED

COMMENT

17/07/2019 All PCC 19/034 GP Forward View

Funding


reflect that an update on the GP

Forward View Funding Allocations

will be received by the Committees

every six months.

Helen

Brocklebank-

Clark



PCC 19/047.

17/07/2019 All PCC 19/035 Risk Report Siân Gascoigne to meet with

finance colleagues to consider the

inclusion of financial risks

associated with Primary Care on

the Corporate Risk Register.

Siân Gascoigne 21/08/2019 Siân Gascoigne met with

colleagues on the 7 August

2019 and the risk report has

been updated accordingly, see

item PCC 19/055.

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Primary Care Commissioning Committees in Common OPEN ACTION LOG from the Governing Bodies on 7 August 2019

MEETING

DATE

CCG AGENDA

REFERENCE


COMPLETED

COMMENT

ACTIONS OUTSTANDING

No actions outstanding

ACTIONS ONGOING

07/08/2019 All GB/19 034 Clinical Chair’s

Report

Members of the Governing

Bodies sought assurance that

GP practice's Business

Continuity Plans addressed

premises inaccessibility.

Eleri de Gilbert 21/08/2019 A verbal discussion to take

place at the Primary Care

Commissioning Committees

on the 21 August 2019.

Actions arising from

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Meeting in Common of NHS Mansfield and Ashfield CCG, NHS Newark and Sherwood CCG, NHS Nottingham City CCG, NHS Nottingham North and East CCG, NHS Nottingham West CCG and NHS Rushcliffe CCG

Meeting Title: Primary Care Commissioning Committees

(Open Session) Date: 21 August 2019

This item relates to:

ALL ☒ M&A ☐ N&S ☐ NC ☐ NNE ☐ NW ☐ R ☐

Paper Title: Draft Annual Work Programme Paper Reference: PCC 19/047

Sponsor:

Presenter:

Sharon Pickett, Associate Director of Primary Care Commissioning

Attachments/ Appendices:

Draft Annual Work Programme

Eleri de Gilbert, Lay Member, Quality and Performance

Summary Purpose:

Approve ☒ Endorse ☐ Review

☐ Receive/Note for:

Assurance

Information

☐

Executive Summary

The attached draft work programme has been updated to incorporate comments received by the Committees and from further discussions that have taken place within the CCGs. It is presented to the Committees for review and approval.

Relevant CCG priorities/objectives:

Compliance with Statutory Duties ☒ Establishment of a Strategic Commissioner ☐

Financial Management ☐ Wider system architecture development (e.g. ICP, PCN development)

☐

Performance Management ☐ Cultural and/or Organisational Development

☐

Strategic Planning ☐ Procurement and/or Contract Management ☐

Conflicts of Interest:

☒ No conflict identified

Completion of Impact Assessments:

Equality / Quality Impact Assessment (EQIA)

Yes ☐ No ☐ N/A ☒ An EQIA is not required for this item.

Data Protection Impact Assessment (DPIA)

Yes ☐ No ☐ N/A ☒ A DPIA is not required for this item.

Risk(s):

No risks have been identified.



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Confidentiality:

☒No

Recommendation(s):

1. REVIEW and APPROVE the draft annual work programme.



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APPENDIX A: Primary Care Commissioning Committees DRAFT Annual Work Programme 2019/20

June Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Notes

Items for assurance/discussion

General Practice Forward View (GP FV)

Funding

Extended Access Mid-Year Review

Scheme allocation

x x Six monthly thereafter.

Primary Care Estates Update x Item deferred from August 2019

Quality/Performance Exception Report x x x x x -

Contract Management Update Report x x x x -

Finance Report x x x x x x x x x x x -

Directed Enhanced Services Meeting date(s) to be determined.

Local Enhanced Services x x Three month update as determined at the July 2019 meeting.

Risk Report x x x x x x x x x x x x

Items for decision (NB. All items for decision cannot be proactively scheduled)

Primary Care Hub Memorandum of Understanding (MoU) and Handbook

x Item deferred from July 2019

Items for information (and discussion where necessary)

Integrated Care System Primary Care Five Year Strategy

x

Primary Care Network Update x x x x x

Primary Care Estates Strategy x

Half yearly Primary Care Hub/CCG performance review outputs

Meeting date to be determined.

Committee business

Terms of Reference x

Annual Work Programme/Forward Work Programme

x (Draft)

x x

(Final) x x x x x x x x x

To be approved at August meeting following development discussions.

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June Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Notes

Committees’ Annual Report x

Forward Planner

Leen View Surgery Boundary Reduction

x Deferred from July 2019

Parkside Medical Centre Boundary x Deferred from July 2019

Practice merger for Greenfields Medical Centre and Mayfield Medical Practice

x

Barnby Gate Surgery – patient list closure review

x

GP Retention Scheme Approvals x Six monthly thereafter.

Brierley Park Expansion x

Discussion on how the PCCCs interface with the ICS architecture and clarification of roles and responsibilities (verbal)

x

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Meeting Title: Primary Care Commissioning Committees (Open Session)

Date: 21 August 2019

This item relates to: ALL☐

M&N ☒ N&S ☐ NC ☐ NNE ☐ NW ☐ R ☐

Paper Title: Millview Surgery – Six Month List Closure Review

Paper Reference: PCC 19/048

Sponsor:

Presenter:

Sharon Pickett, Asscociate Director of Primary Care Commissioning


Appendix 1 -February 2019 List Closure PCCC Application Request

Appendix 2 -January 2019 Original List Closure Application

Appendix 3 –Closure Notice

Joe Lunn, Head of Primary Care, NHS England

Summary Purpose:

Approve ☐ Endorse ☐ Review ☒ Receive/Note for:

∑ Assurance∑ Information

☒

Executive Summary

Item for Mansfield and Ashfield CCG Primary Care Commissioning Committee

Millview Surgery applied to close their list which was agreed by the Mansfield & Ashfield CCG Primary Care Commissioning Committee on 14 February 2019 (See Appendix One). The practice cited increasing patient demand and significant changes to GP numbers as the rationale the request, along with the need to ensure patient safety and continued quality of care.

The list closure was requested for twelve months. The Committee approved the closure for a period of six months commencing on 1 March 2019 and is due to re-open the list on 1 September 2019. The Committee requested that the list closure be reviewed during the closure and this report is provided accordingly.

The position of the practice has not greatly improved; some of the staffing vacancies have now been filledhowever a practice nurse will soon be leaving to go on maternity leave and there is another pending GP resignation. This is combined with an insignificant decrease in the list size which has not alleviated the pressures the practice face.

Millview Surgery – Six Month List Closure Review


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The practice has prepared for a reopening of 1 September 2019 and has worked towards this date; they believe that an extension of three months would help to stabilise their staffing situation further and offer opportunity to decrease the list further. The practice has been informed that the deadline for an extension has passed.

It is noted that the practice is in the same Primary Care Network at Orchard Medical Practice that are applying to close their list for 12 months in a separate agenda item.

Relevant CCG priorities/objectives: (please tick which priorities/objectives your paper relates to)

Compliance with Statutory Duties ☐ Establishment of a Strategic Commissioner

☐


☐

Performance Management ☐ Approval of Practice Mergers ☐

Strategic Planning ☐ Procurement and/or Contract Management ☒

Conflicts of Interest: (please indicate whether there are any conflicts of interest considerations in relation to the paper)


Completion of Impact Assessments: (please indicate whether the following impact assessments have been completed)


Yes ☐

No ☐ N/A☒ An EQIA is not required for this item.


Yes ☐

No ☐ N/A☒ A DPIA is not required for this item.

Risk(s): (please highlight any risks identified within the paper)

Due to the potential overlap in practice areas of Millview Surgery and Orchard Medical Practice, the mostsignificant patient risk to approving the extension is the stability of neighbouring practices considering theproposed list closure of Orchard Medical Practice. The majority of practices in the area have alreadyexperienced list increases over the last six months. Two practice closures within a short distance maynegatively affect neighbouring practices and impact on their stability.

Contractually, any extension would also be outside of the provisions of the General Medical Servicescontract as the practice has not completed an extension application as required by the contract.

Confidentiality: (please indicate whether the information contained within the paper is confidential)

☒No

Recommendation(s):

1. The NHS Mansfield and Ashfield CCG Primary Care Commissioning Committee is asked to RECEIVEthe Millview Surgery six month list closure review.2. CONSIDER the application for a three month list closure extension.

3. DECLINE the list closure extension due to the practice being outside of the contractual timeframe forsuch a request.



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Millview Surgery List Closure Review and list closure extension proposal

Millview Surgery is a practice based in Mansfield town, part of Mansfield and Ashfield CCG. In February 2019 the practice submitted an application to close their list for a period of 12 months. The application was approved but for a reduced period of six months which came into effect from 1 March 2019. The practice is due to open the list from the 1 September 2019.

The practice currently has five GP Partners; Dr Helen Field (Senior Partner), with Dr Simon Maddock, Dr Catherine Mann, Dr Aparna Ravi and Dr Andrew Sommers. Since the list closure there have been no further partnership changes; however, another GP has submitted a proposal to retire from the partnership from 31 October 2019.

The five partners work a total of 27 sessions a week which equates to three whole time equivalent (WTE) where a full time GP is classed as working nine sessions per week.

Following the resignation of Dr Durnin, who left at the time of the previous list closure, the practice isstill in deficit of eight sessions. With a GP due to leave the partnership in October 2019, the practice will then be down a further four sessions leading to a total twelve-session deficit per week from 1 November 2019. This departure will bring the WTE of permanent GPs at the practice down to 2.56.

The GP patient ratio of 1:3,273.44, significantly above the national expected range of 1:1800-2200.Staffing pressures were cited as the most significant reason in the initial application for the list closure. The practice is currently supported by two long term locums working 3 sessions a week and 1 session a week, which brings the GP to Patient ratio down to 1:2,793.33. The locum currently employed for 1 session per week is expecting to relocate in the near future, so it is uncertain how long they will be able to continue to provide cover.

To cover outstanding sessions the practice is using ad-hoc locums from agencies however, this has a significant financial burden for long term use.

In order to alleviate the pressures of the GP shortage, the practice has been actively recruiting for GP positions, nurse positions as well as upskilling their current work force. The details of which can be found below.

∑ A salaried GP has been recruited for 5 sessions per week. This GP will not start until March 2020 as they are a current registrar awaiting full qualification.

∑ A nurse at the practice has completed a prescribing course so can now see a wider variety of patients which will help to manage the GP workload. She is now completing the necessary training to become an advanced nurse practitioner and is expected to be fully qualified in the new year (approx. Jan/Feb).

∑ The HCA team is now fully staffed, at the time of the list closure there was one vacancy.∑ The nursing staff are now at full capacity, at the time of the list closure there were two

vacancies. A newly recruited nurse will be going on maternity leave in January 2020, however the practice is already in the process of planning cover for this.

∑ Members of the reception team have been upskilled to assist with clinical coding to help manage tasks amongst the team more efficiently.

∑ The practice is still seeking a tier 2 sponsorship for an overseas GP to join the team.

Despite the improvements, feedback from patients is still negative around appointment availabilityand access. This feedback has been received by staff and the practice manager. There are concerns this will only get worse with the further session decreases upcoming.



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Patient Reduction

It is felt from the practice that overall the list closure to date has had little impact on the practice.

Between January 2019 and July 2019, the raw list size reduced by 110 patients and the weighted list size reduced by 123.14 patients; a percentage reduction of 1.3%. This decrease has not had a significant reduction on the GP work load and capacity at the practice

In comparison, a another practice located in the same CCG, closed their list for a three-month periodbetween January and April 2018, in this time period the practice reduced their raw list by 39 raw patients and 83.23 weighted patients with a percentage reduction of 0.86%.

There have been no other formal list closures in the Mansfield and Ashfield CCG area. However, in the Nottingham City CCG area a practice of a similar list size to Millview Surgery closed for a six-month period between December 2018 and June 2019. In this time the raw list size reduced by 288 patients; a 2.95% reduction.

Millview Surgery have agreements with a local women’s refuge and care homes whereby patients have still been registered during the list closure. These patients are often complex and require more GP attention.

During a list closure, practices are also still obliged to register immediate family members already registered at the practice if requested.

A list cleansing exercise has already taken place to remove out of boundary patients from the list. Going forward out of area patients will no longer be accepted at the practice for the foreseeable future.

Contractual provisions for list closure

The provisions of the General Medical Services (GMS) contract allow a contractor to submit one application to close its list of patients in any period of twelve months unless there has been a change in the circumstances of the contractor which affects its ability to deliver services under the contract.

Where an application for list closure has been approved the practice, under the terms of the contract, may apply for an extension to the period no later than eight weeks before the date on which the closure period is due to expire.

Millview Surgery list closure was due to re-open on 1 September 2019 and the practice were advised of the eight-week extension notice in the Closure Notice issued to the practice dated 21 February 2019. An application for extension should have been received from the practice by 7 July 2019.

Any approval of the list closure period would be discretionary and outside of the contract terms.

Impact on Neighbouring Practices

There are 6 practices within a 1-mile radius of Millview Surgery.

Name Distance from List size as List Size as List status



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Millview Surgery of 1 Jan 2019

of 1 July 2019

Orchard Medical Practice

0.2 miles 19,730 19,893 Applied for list closure

Churchside Medical Practice

0.2 miles 6,370 6,460 Open

St Peters Medical Practice

0.4 miles 2,773 2,759 Open

Acorn Medical Practice 0.2 miles 3,120 3,207 Open

Roundwood Surgery 0.3 miles 13,183 13,225 Open

Rosemary Street Health Centre

0.4 miles 15,370 15,599 Open

The total CCG population grew by 779 patients between January 2019 and July 2019, therefore it can be anticipated that much of the increase in the above practice list size during this period is due to the list closure in place at Millview Surgery.

Millview Surgery is in Mansfield South Primary Care Network (PCN) along with Churchside Medical Practice, Forest Medical, Roundwood Surgery and The Acorn Medical Practice. The total Primary Care Network (PCN) population is 46,593 (Jan 2019) and Millview Surgery accounts for 18.3% of the total PCN population.

PCN workforce reimbursements are set to help practices within the next year. The practice does not currently have a clinical pharmacist or social prescriber but positions for social prescribers are currently being recruited for by the PCN.

Orchard Medical Practice has applied to close their list for twelve months. Millview Surgery and Orchard Medical practice are two larger practices within a very short distance. The closure of both lists may have a capacity impact on other neighbouring practices.

Stakeholder Comments

The Local Medical Committee is supportive of the extension. The clinical director of Mansfield South PCN has been contacted for comment. At the time of submitting this paper a response has not yet been received. A verbal update will be given to the committee should a response be received.

Options Appraisal with Risks

1. Approve the three month list closure extension, for the practice to reopen on 1 December 2019.

The practice feels this extra time period would allow them to work through the departure of the additional GP and stabilise the staffing dynamics following this.

The practice is a training practice and is currently accepting placements of registrars. However, there will be an induction period associated with this as well as extra support from the existing GPs at the practice to ensure appropriate care is given to patients. The practice feels that by December, the registrars will be more competent in the practice and require less support that what is being given at present.

Staffing pressures were a significant issue cited in the original report as to why the practice



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was in need of the list closure. Since the closure, the GP staffing issue has not improved and by November, this will be worse. Despite this, all nurse and HCA positions are now filled. Existing members of staff have also been upskilled to assist with workload distribution.

By allowing a list closure for the remainder of the summer months, the practice will be able to reopen for winter and may be in a better, more stable position for the pressures which follow.

Overall the list closure has had little impact to date on the list and capacity of the practice and at present feel they are still in a similar position as they were in February.

There is a significant financial pressure on using locums to cover the sessions currently in deficit.

Patient feedback has found that patients are still unhappy with appointment access and availability.

Risks:

The most significant risk to approving the extension is the stability of neighbouring practices considering the proposed list closure of Orchard Medical Practice. The majority of practices in the area have already experienced list increases over the last 6months. Two practice closures within a short distance may negatively affect neighbouring practices and impact on their stability.

Any extension would also be outside of the provisions of the GMS contract as the practice has not completed an extension application as required by the contract.

2. Reject the three month closure extension for the practice to open on 1 September 2019.

Throughout the list closure the practice has prepared themselves to open from 1 September. There have been some improvements in the workforce which have been designed to relieve some of the pressure facing the GPs.

The practice has two long term locums who are offering a total of four sessions per week. Further locums are being used when needed. Although this does have a cost implication. The committee can be assured that the practice does have GPs covering some of the sessions in deficit and a nurse prescriber can now be offered to patients.

Overall the practice feels they are able to reopen the list from 1 September, but there will still be significant pressures to work through in order to maintain a good quality service.

The practice has missed the deadline for extending the list closure in line with the provisions of the contract therefore the approval of such an extension is outside of the contract.

Risks:By rejecting the extension, a risk is placed on the stability of the practice. GP and session shortages are the main cause of pressure on the practice. Patient access and appointment availability is currently limited by the session deficit and this may only get worse as the list reopens and new patients are accepted. The approval of Orchard Medical Practice’s list closure may increase the number of new patients requesting registration as the two practices are in very close proximity.

There is a risk that under the pressures facing the practice, quality indicators may be compromised. Millview surgery is currently rated Good by CQC and was last inspected 2016.

In order to help mitigate these risks, monitoring of the practice could be arranged by the CCG or NHS England in order to provide assurance to the committee regarding appointment



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availability and quality indicators, as well as providing support to the practice.

The committee is asked to consider both options presented in this paper along with the issues noted in the original paper in order to approve an option moving forward.

Further Information

The original application can be found in Appendix 1.

The original paper can be found in Appendix 2.

The closure notice can be found in Appendix 3.



Appendix Two

PRIMARY CARE COMMISSIONING COMMITTEES FOR NHSMANSFIELD AND ASHFIELD CCG AND NHS NEWARK AND

SHERWOOD CCG

TITLE: Millview Surgery - Application to close the practices list of patients to new registrations

DATE OF MEETING: 14 February 2019 PAPER REF:

AUTHOR: Richard Hobbs, Assistant Contract Manager, NHSE

PRESENTER: Julie Kent, Contract Manager, NHSE

PURPOSE OF REPORT:

∑ The committee are asked to consider the application from Millview Surgery to close their practices list of patients to new registrations for a period of 12 months.

∑ The committee are asked to approve or decline the request.

∑ To ensure that rights under the NHS Constitution and GMS Contract arrangements are met for patients accessing the service.

RECOMMENDATION:

® To endorse

˛ To approve

® To receive the recommendation (see details below)

® To discuss

The committee are asked to approve the closure of the practices list of patients to new registrations for 12 months.

EXECUTIVE SUMMARY (OVERVIEW):

The application was initially received by NHS England on 12 December 2018. NHS England and the CCG went to meet with the Practice Manager on 17 December 2018 to discuss the application in more detail. During the meeting it was suggested that the practice consider extending their advertising to other agencies and to consider Locum GPs, ANP and clinical pharmacist.

A revised application was received on 9 January 2019. Millview Surgery has requested that they close their practice list of patients to new registrations for a period of 12 months.

There are two main reasons for the practice requesting a list closure: ß The resignation of Dr Durnin on 1 February 2019 who worked 8 sessions per weekß The difficulty in recruiting a salaried GP

The practice is considering locum help, but is reluctant to recruit a locum as they do not assist with work such as signing prescriptions, looking at letters, reviewing test results and dealing with private medical reports.

REPORT:Millview Surgery operates from a site in Goldsmith Street, Mansfield, NG18 5PF.



ß The premises are owner occupied on which notional rent is paid.

ß The practice is a GP training practice for GP Registrars and Foundation Year 2 Doctors.

ß The practice’s opening hours are Monday to Friday 8.00am to 6.30pm and the practice does not provide DES extended hours. The registered population of Millview Surgery continue to receive access to the CCG commissioned extended access service. This service is provided at Primary Care Network level with all practices within the PCN collaborating to jointly provide the service meeting the national requirements set by NHS England.

Milview Surgery has completed an application to close their practices list of patients to new registrations for 12 months.

The Primary Medical Care Policy and Guidance Manual (PGM) updated in November 2017, provides policies and guidance across to support a consistent approach to primary care commissioning across England. Section 5 on Temporary suspension to patient registration provides the detail on formal list closure requests such as this at Millview Surgery. It describes the issues that should be considered, and the process that should be followed.

Millview Surgery previously had approval from Nottinghamshire County PCT to close their patient list for six months from 14 January 2013 to 14 July 2013.

Workforce:

The practice workforce is as detailed below.

ß With the resignation of Dr Durnin, this leaves 5 partners – Drs Field, Maddock, Mann, Ravi & Sommers. Between them they work 27 sessions per week. Based on 9sessions representing 1 Whole Time Equivalent (WTE); this gives the practice 3 WTE as opposed to 3.89 before Dr Durnin’s resignation. With a list size of 8,550 this gives 2,850 patients per WTE as opposed to 2,198 per WTE before Dr Durnin left. The national average range of 1 WTE GP to the total number of patients is 1,750 to 2,100 patients.

ß Millview Surgery does not have an Advanced Nurse Practitioner (ANP) or a Clinical Pharmacist working in the practice. They have 3 Practice Nurses (2 WTE) and 2 Health Care Assistants (1 WTE) which is their usual capacity; two of the Practice Nurses are from secondary care and need additional support and training to become primary care nurses.

ß Dr Nigel Marshall, the CCG GP Clinical Advisor, met with the practice in January to discuss the clinical workforce situation. One of the senior partners is delaying theirplanned retirement due to the situation with Dr Durnin’s resignation. Other GPs are unable to increase their sessions due to other work commitments. Initially the practice appeared reluctant to explore the options of a salaried GP or a long-term locum; however, these are avenues they are now looking to explore. The practice is to interview a prospective salaried GP on 15 February but it is unclear at this stage how many sessions they may work, and they could not start work until their training finishes in August. They are also looking at Tier 2 Visa applications to be a sponsor of a trainee doctor from overseas.

ß The practice is concerned that if the list remains open, and the list size increases, the remaining GPs will not be able to see patients and deal with the paperwork. This could impact on patient safety and quality of care.

Local practices:

The nearest practices to Millview Surgery are:



Practice Map key Distance from Millview Surgery (miles)

List size (1/1/19)

Nos of GPs

Patient ratio not known

Orchard Medical Practice B 0.2 19,730 9

Churchside Medical Practice C 0.2 6,370 4

Acorn Medical Practice D 0.2 3,120 2

Roundwood Surgery E 0.3 13,183 6

St Peters Medical Practice F 0.4 2,773 1

Rosemary Street Health Centre G 0.4 15,370 6

Sandy Lane Surgery H 0.9 5,973 3

All the above practices have been advised of the application, and invited to send any comments to NHS England. Nottinghamshire LMC has also been made aware.

Sandy Lane Surgery and Churchside Medical Practice have both written in support of the application and stated that they have capacity to take additional patients during any closure of the list at Millview. Acorn Medical Practice wrote to say that they had no objection to the closure until they manage to recruit. Orchard Medical Practice wrote that “Whilst as a practice we would wish to support a neighbouring practice which, for whatever reason, has found such action necessary, we are mindful of the increased pressures this is likely to have on other practices in the locality, all of whom are facing staffing and workload issues……. We would also seek your confirmation that any such decision would set precedent in the event of other practices seeking similar list closure.” Orchard also wanted reassurance that the closure would not have an adverse effect on them in terms of the fair allocation of patients residing in local care homes. The CCG will respond to these concerns, taking into account the comments of the Committee.

Nottinghamshire LMC also wrote to support the application.



Patient list size:Currently, the practice list size is 8,550 at 31 December 2018. The following table outlines the changes in list size over the last four years at Millview Surgery:

Date Raw list sizeAnnual % increase

Weighted list size

Annual % increase

01/01/2019 8,550 1.5% 9016.13 0.7%

01/01/2018 8,423 2.0% 8,953

01/01/2017 8,255 -0.4%

01/01/2016 8,286 2.4%

01/01/2015 8,091

Patient catchment area:The patient catchment area is as follows:



Summary:The practice have stated that they need time to recruit a salaried GP to replace Dr Durnin, and to enable the remaining partners to continue to see existing patient list size safely. To do this they wish to close their patient list for 12 months.

QIPP Assurance and connection

ß There will be an impact on patient choice though at least two neighbouring practices welcome the opportunity to register additional patients

ß List closure may increase the pressure on some other local practicesß During a list closure, the practice can continue to register immediate family member(s)

of registered patientsFinancial Impact and Risks

ß Minimal financial implications

Legal Impact

ß Minimal legal implications albeit limiting patient choice

Risk Implications, Assessment and Mitigations

ß The remaining GPs are concerned that they will not have the capacity to maintain seeing patients and dealing with the paperwork, and this could impact on patient safety and quality of care.

Consultation, Involvement and Engagement



ß The Practice Manager met their PPG in January 2019 to discuss the list closure proposal. The PPG had no objections to this.

Equality Impact

ß Minimal equality implications

Evidence and Research (include where this informs why the paper is presented to Governing Bodies

ß N/A

HOW DOES THIS CONTRIBUTE TO THE OUTCOMES AND OBJECTIVES OF THE CCG:

˛ Quality ˛ Health ®Financial ˛Clinical ˛ Performance (tick as appropriate)

CONFLICTS OF INTEREST:

This is a recommended action to be agreed by the Chair at the beginning of the item.® No conflict identified

® Conflict noted, conflicted party can participate in discussion but not decision (see below) √

® Conflict noted, conflicted party can remain but not participate (see below)

® Conflicted party is excluded from discussion (see below)

Please state rationale for decision

Advice regarding conflicts of interest is available from the Corporate Governance Team, or here:

https://www.england.nhs.uk/wp-content/uploads/2017/06/coi-annex-k.docx

CONFIDENTIALITY:

Is the information in this paper confidential?˛ Yes

® No

If the paper is considered confidential, please tick the relevant box.® Does it contain personal information e.g. regarding a patient, member of staff or another individual?

® Is the CCG in commercial negotiations or about to enter into a procurement exercise and would the information in the report prejudice the CCG's position if made public e.g. by declaring the budget available for a particular contract in advance of a tendering exercise or indicating what the CCG's fall-back position might be in a negotiation situation?

® Does the report include commercial in confidence information about a third party? - this would need to be relatively detailed information which could be argued to give a competitor an advantage if it was made available to them i.e. the total value of a contract awarded to a supplier or the value of a tender could not be considered commercial in confidence but details of how a supplier performs a particular process or the day rate for different grades of consultancy staff might be considered confidential.

® Does the report contain information which has been provided to the CCG in confidence by a third party and is there a risk that the third party could take legal action for a breach of confidence if it was disclosed?



https://www.england.nhs.uk/wp-content/uploads/2017/06/coi-annex-k.docx

® Does the discussion relate to policy development not yet formalised by the organisation and if the discussion were made public would this hamper full and frank discussion and therefore adequate consideration and development of proposal? This is intended for matters that are considered at a Board meeting early in the process to obtain initial thoughts and to give officers a steer in developing the policy. It would not be appropriate to use this argument where the governing body is being asked to approve a policy or initiative as this would be too late to argue that policy development was still on-going.

® Has the document/report been produced by another public body which has chosen not to make the document publicly available and would not wish the CCG to do so?

® Is the document in draft form which will publically available at a future date?

Note: Upon request for the release of a paper deemed confidential, under Section 36 of the Freedom of Information Act 2000, parts or all of the paper will be considered for release by the CCG’s ‘Qualified Person’ based on the circumstances at that time.

Appendix 1 – Millview Surgery’s List Closure Application

Application form Millview list closure.pdf



Dear Dr Field

Re: Closure Notice

Further to Mansfield & Ashfield and Newark & Sherwood’s CCG’s Joint Primary Medical Clinical Commissioning Committee (PMCCC) who met on 14 February 2019, we can confirm that NHS England – North Midlands and the CCGs have approved your application to close your patient list for a period of six months starting on 1 March 2019.

Based upon this closure notice your list of patients will re-open on 1 September 2019.

You must close your list on the date specified above and should you wish to re-open your patient list before the end of this closure notice this must be agreed with NHS England and the CCGs in advance.

While closed you may only accept an application for inclusion onto your practice list from a person who is an immediate family member of an existing registered patient.

If you wish to extend the closure of your patient list a further application must be received no less than eight weeks before this closure notice is due to end. A copy of the extension application form may be requested from NHS England should it be required.

Yours sincerely

Richard HobbsNHS England – North Midlands

Cc: Local Medical Committee.

North Midlands Birch House

Ransom Wood Business ParkSouthwell Road West

MansfieldNotts

NG21 0HJ

Email: [email protected]: 0113 8255472

Dr H FieldMillview Surgery1a Goldsmith StreetMANSFIELDNottinghamshireNG18 5PF

Our Ref: C84106

Date: 21 February 2019

Appendix Three



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This item relates to:

ALL ☐ M&A ☒ N&S ☐ NC ☐ NNE ☐ NW ☐ R ☐

Paper Title: Orchard Medical Practice – List Closure

Request Paper Reference: PCC 19 19/049

Sponsor:

Presenter:



Appendix 1 - Orchard Medical Practice list closure application

Joe Lunn, Head of Primary Care for NHS England

Summary Purpose:



Assurance

Information

☐

Executive Summary

Item for Mansfield and Ashfield CCG Primary Care Commissioning Committee

Orchard Medical Practice is located in Mansfield and Ashfield CCG and is the largest practice in the Mansfield area. The practice has applied to close their list for a period of twelve months

months. The practice has not previously closed their list or submitted an application to do so.

To ensure consistency in line with the Primary Medical Care Policy and Guidance Manual v2 and for this proposal to be considered, supporting information and rational have been provided along with evidence from the practice. The main purpose of the list closure is to ensure continued quality care, sustainability of function and maintaining quality of patient care.


Compliance with Statutory Duties ☐ Establishment of a Strategic Commissioner ☐


☐


☐



Orchard Medical Practice - List Closure Request


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Yes ☐ No ☒ N/A ☐ There would be no impact on patients registered at the practice.


Yes ☐ No ☐ N/A ☒ A DPIA is not required for this decision.

Risk(s):

Risk if the list closure is approved:

Reduced patient choice for prospective patients in the area.

Risk if list closure is not approved:

Potential for continuous increase in patient registrations and resulting pressure on practice staff and

GPs within Orchard Medical Practice

Potential for adverse impact on individual health and wellbeing within the clinical team including

implications for retention

Although there are no issues with the quality of records/record-keeping currently, there may be an

impact in the future should the list size continue to increase.

Confidentiality:

☒No

Recommendation(s):

1. NHS Mansfield and Ashfield CCG Primary Care Commissioning Committee is asked to CONSIDER and APPROVE the formal list closure for twelve months.



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Introduction

Orchard Medical Practice is located in Mansfield and Ashfield CCG and is the largest practice in the

Mansfield area.

Orchard Medical Practice has applied to close their patient list to new patient applications for a period of

twelve months. The practice has cited increasing patient demand and significant changes to GP numbers

as the driving forces behind the request, along with the need to maintain quality of patient care.

The NHS England Primary Medical Care Policy and Guidance Manual (PGM) provides guidance to

commissioners to ensure a consistent approach to Primary Care Commissioning across England; Section

5 “Temporary Suspension to Patient Registration” must be adhered to in this instance and section 5.1

covers formal list closure.

Practice Background and Context

Orchard Medical Practice is a well-established practice in the Mansfield and Ashfield locality, part of the

Mansfield and Ashfield CCG. There are currently nine Partners included on the contract; Dr Dean Temple

(Senior Partner) with Dr Walter Freeman, Dr Judith Jones, Dr Patrick Law, Dr Christopher Macgregor, Dr

Anisa Malik, Dr James Mills, Dr Kathryn West and Dr Helena Wagstaff.

The practice list currently stands at just below 20,000 registered patients. They have confirmed that a

portion of the difficulty they are experiencing relates to patient migration from surrounding practices – 628

new registrations have taken place since January 2019 of which 120 were from neighbouring practices.

Month Weighted Capitations

Raw Capitations

July 2017 19,475.55

19,101

July 2018 19,748.22

19,437

July 2019 20,155.85

19,893

The practice has experienced significant staffing changes which have further contributed towards

pressures in workload; three experienced GPs including the former Lead Partner, have taken early

retirement. Although it has been possible to recruit an experienced GP on a part-time basis, they have

been unsuccessful in recruiting enough GPs to backfill the number of sessions lost, despite their best

efforts.

There are currently 9 partners offering a combined 342 hours per week and a salaried GP working 24

hours per week. The 2 Partners whom left the practice worked 50 hours and the 2 salaried GPs worked 5

days between them.

The practice has stated it is likely that a further two or three current partners will retire within the next two

years. In addition, the practice report that they have 2 vacancies for 2 salaried GPs, 1 Assistant Nurse

Practitioner and 1 Pharmacist. The current GP-patient ratio is 1:1,989.

As of March 2019, the staffing at the practice based on WTE were as follows, for each category:

Total GP WTE – 11.84

Total Nurse WTE – 4.68

Total DPC/HCA WTE – 2.49



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Total Admin WTE – 19.44

Over the last two years, the practice has implemented a number of changes in an attempt to manage

workloads more affectively, including:

Increased use of telephone triage. All incoming calls between 8am and 8.30am requesting GP appointments are screened by the doctors.

Increased use of telephone consultations, where appropriate.

Employment of a Practice Pharmacist to manage a large proportion of prescription queries and medication reviews.

Introduction of short appointments in “one-problem clinics” which are held every morning to increase capacity.

Up-skilling administration staff to ease the burden of reviewing hospital correspondence etc.

Provision of Extended Access as a practice rather than as part of a consortium –the practice state this is an attempt to increase capacity.

Triaging of all visit requests –resulting in a very significant reduction in the number of visits which are undertaken by GPs.

The practice report that they have carefully considered the possibility of employing a Physician’s Associate but at present do not feel they are able to commit to make such an appointment viable. It is hoped that if the List Closure is approved, it will ease some of the pressure that staff are feeling and assist in the retention of their current GPs whom are considering retiring within the next eighteen months to two years. Orchard Medical Practice’s boundary map is shown below:



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Neighbouring Practices

Orchard Medical Practice is within Mansfield North PCN which comprises of eight practices. The PCN has

a population of 58,425 as of 1 January 2019. Mansfield North PCN has two Clinical Directors; one from

Oakwood Surgery and one from Orchard Medical Practice. A map of the Mansfield North PCN is shown

below. The practices are highlighted in green and Orchard Medical Practice is outlined in orange.

Furthermore, there are 6 practices within a 1-mile radius of Orchard Medical Practice as set out below.

Name Distance from Orchard

Medical Practice

List size List status

Mill View Surgery 0.3 miles 8,384 Currently closed list

Churchside Medical Practice 0.4 miles 6,461 Open

St Peters Medical Practice 0.4 miles 2,760 Open

Acorn Medical Practice 0.5 miles 3,205 Open

Roundwood Surgery 0.5 miles 13,215 Open

Rosemary Street Health Centre 0.6 miles 15,601 Open



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Engagement with Stakeholders

The practice has discussed the proposal with their surrounding GP Network on Tuesday 25 June 2019.

This was supported by the Clinical Director of the Network as well as the member practices (Oakwood

Surgery, St Peters Medical Centre, Pleasley Surgery, Riverbank Medical Services, Sandy Lane Surgery,

Meden Medical Services, Bull Farm Primary Care Centre) and the group felt it was a positive move.

Concern was raised about the current migration of patients from other North practices and the destabilising

affect as a result. The CCG have been supportive, but it is felt that the ability to assist any further is limited

due to the staffing level concerns.

Confirmation has also been received that the LMC are in support of this List Closure application.

Risk if the list closure is not approved:

Potential for continuous increase in patient registrations and resulting pressure on practice staff

and GPs.

The practice is having to provide 5-minute duty appointments to match demand which potentially

increases the risk of error.

Although there are no issues with the quality of records/record-keeping currently, there may be an

impact in the future should the list size continue to increase.

Risk if the list closure is approved:

There would be no change of service to current patients.

Reduced patient choice for prospective patients in the area.

Additional information

Orchard Medical Practice is in Mansfield South’s PCN along with Oakwood Surgery, St Peters

Medical Centre, Pleasley Surgery, Riverbank Medical Services, Sandy Lane Surgery, Meden

Medical Services, Bull Farm Primary Care Centre.

The total PCN population is 46,593 (Jan 2019) and Orchard Medical Practice is 42.9% of the total

PCN population.

The practices opening hours are Monday to Friday, 8:00am – 8:00pm and 8:00am – 12 noon on

Saturdays. The practice does participate in Extended Hours DES.

Primary Medical Care Policy and Guidance Manual The following excerpt is taken from the NHS England Primary Medical Care Policy and Guidance Manual: 5 Temporary suspension to patient registration

5.1 Formal List Closure

5.1.1 The GMS and PMS contracts allow for a Practice to request permission from its commissioner to

close its list to new patients (Paragraph 33 of Schedule 3, Part 2 of the NHS (GMS Contracts)

Regulations 2015. This option exists to give practices a degree of workload control over the

management of their services, particularly when there is unusual and sustained demand from

patients or in situations of workforce or recruitment difficulties that affect a practices ability to



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provide services to an acceptable and safe standard.

5.1.2 As the commissioner also has a duty to ensure the availability of primary care services for the

resident population it has certain powers with regard to these requests including agreeing to the

length of the closure and the conditions that would need to exist to trigger a re-opening of the list.

The commissioner will also need to consider the availability of alternative provision for new patients

and any impact on neighbouring practices. Following changes to the formal list closure process in

2012 the commissioner does not have the power to halt practices’ delivery of additional and/or

enhanced services as a means to reduce practice workload thereby keeping the patient list open.

Therefore, list closure no longer carries such financial consequences for the practice as it was once

thought to have and allows practices to continue to deliver holistic care to registered patients.

5.1.3 When a practice does formally close its list, the requirement is to close between three and twelve

months; not less than three months. An approved closure notice must specify what the time period

is.



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This item relates to: ALL ☐ M&A ☐ N&S ☐ NC ☐ NNE ☐ NW ☒ R ☐

Paper Title: Eastwood Primary Care Centre: update regarding application to withdraw from being a dispensing practice.


Sponsor:

Presenter:



Appendix 1: Closure Notice

Appendix 2: Letter from NHS England

Joe Lunn, Head of Primary Care

NHS England

Summary Purpose:

Approve ☐ Endorse ☐ Review ☐ Receive/Note for:


☒

Executive Summary

NHS Nottingham West CCG Primary Care Commissioning Committee is asked to note for information the cessation of dispensing services at Eastwood Primary Care Centre from 20 September 2019.

Background:

Eastwood Primary Care Centre is a dispensing practice based in Eastwood in Nottingham West CCG. The practice was established in April 2018 following a merger between Church Street Medical Practice and Church Walk Surgery. The practice has notified pharmaceutical commissioners that they wish to relinquish their dispensing rights from the 20 September 2019.

Dispensing practices are a feature of rural communities. In England; the majority of patients receiving the GP dispensing service will live in a controlled area (a controlled area or locality is a geographical area, judged to be rural in nature by NHS England as the commissioner of Pharmaceutical Services) and their registered residence will be located more than 1.6km from the nearest pharmacy.

Funding and management of dispensing services:

∑ NHS Business Services Authority (NHSBSA) provide dispensing practices a proportion of the prescription cost in the same way as for a community pharmacy.

∑ NHS England administer a quality scheme for dispensing services (DSQS) which provides adispensing practice £2.58 per dispensed to patient.

∑ Each year NHS England completes a patient list validation to ascertain and review which practice

Eastwood Primary Care Centre: update regarding application to withdraw from being a dispensing practice


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patients can be dispensed to. ∑ Payment for items dispensed by dispensing practices is funded from the correlating CCG budget in

the same way as in a community pharmacy environment.According to Pharmaceutical Regulations, if the single provider/dispensing doctor decides to withdraw from the dispensing doctor list or wishes for a premise to no longer be listed, it must notify the NHS England with at least 3 months’ notice of their intentions (Schedule 6, Regulation 10).

Eastwood Primary Care Centre application

Eastwood Primary Care Centre followed the Regulations and notified NHS England on the 21 June 2019. The case was considered by the NHS England Pharmaceutical Regulations Committee who approved the request. Eastwood Primary Care Centre currently has 283 dispensing patients based in Underwood.

The practice was asked by the Pharmaceutical Regulations Committee to consider how they would plan the transition to ensure this was as smooth as possible and patients were provided with necessary information. Since the approval the practice and dispensing team have:

∑ Developed a communication plan, so all patients affected are aware of the change and medications supplies are not interrupted.

∑ Issued a letter to all patients affected by the change, informing them of the dispensing changes at the practice. The team are also making phone calls to the patients to inform them of the change and ascertain their new nominated pharmacy. The practice will then determine if any actions are needed for the patient.

∑ Identified a list of frail and elderly patients affected and staff are in the process of carrying out home visits to these patients to help establish their preferred pharmacy and medication arrangements and deliveries.

The following Community Pharmacies are within a 1.5-mile radius from the practice:

Pharmacy Distance from the practiceWell Eastwood – Church Walk 0.1 milesBoots 0.2 milesBoots 0.6 milesAsda Stores Ltd 0.9 milesBoots 1.4 miles

There are two pharmacies in very close proximity to the practice therefore patients should not be disadvantaged by the practice no longer dispensing medication. Well Pharmacy and Boots Pharmacies offer a prescription delivery service for patients who may struggle to get to a pharmacy and any distance selling pharmacy (e.g. internet based) offer a national delivery service.

The Primary Care Commissioning Committee is informed of the change to service for patients, the alternative services available and the timeline for change.




☐


☐




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Yes ☐ No ☐ N/A☒ NHS England is the decision maker and would be responsible for completion of an EQIA if required.


Yes ☐ No ☐ N/A☒ NHS England is the decision maker and would be responsible for completion of a DPIA if required.

Risk(s):

None identified.

Confidentiality:

☒No

Recommendation(s):

1. The Primary Care Commissioning Committee of NHS Nottingham West CCG is asked to NOTE for information the cessation of dispensing services at Eastwood Primary Care Centre from 20 September 2019.



18th June 2019 Pharmaceutical Regulations Committee

Dear sir/madam RE: Closure of Practice Dispensary Eastwood Primary Care Centre hereby gives 3 months’ notice of its intention to close its dispensary. We wish its final working day to be Friday 20th September 2019. We understand we have duties regarding how to process this closure. Your guidance in this matter would be most appreciated. Yours faithfully,

Sarah Petter Finance Manager

Correspondence Planned Care Centre

Eastwood Primary Care Centre Church Walk, Eastwood Nottingham NG16 3BH

Prescriptions

Urgent Care Centre Eastwood Primary Care Centre

11b Church Street, Eastwood Nottingham NG16 3BS



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This item relates to: ALL☐

M&N ☐ N&S ☐ NC ☒ NNE ☐ NW ☐ R ☐

Paper Title: Discretionary Payment Request -Boulevard Medical Centre Relocation


Sponsor:

Presenter:



N/A

Julie Kent, Contracts Manager –Primary Care, NHS England

Summary Purpose:



☒

Executive Summary

Item for NHS Nottingham City CCG Primary Care Commissioning Committee

The purpose of this paper is to request a decision on whether the CCG should offer a discretionary payment to those practices who have accepted new patient registrations following the relocation of services for the Boulevard Medical Centre.

On Thursday 27 June 2019 the CQC inspected Boulevard Medical Centre and found a number of concerns. The CQC decided to take action to prevent services being delivered at the Boulevard Medical Centre site on Western Boulevard.

The Primary Care Commissioning Committee approved a contract variation to support the temporary relocation of services from the Boulevard Medical Centre (635 Western Boulevard, Nottingham NG8 5GS) to the premises of Beechdale Medical Practice at 439 Beechdale Road, Nottingham NG8 3LF, with effect from Tuesday 2 July 2019. Both practices are run by the same organisation, The Beechdale Medical Group, and the practices are 0.8 miles apart.

In the five weeks from 1st July 2019 the patient list of Boulevard Medical Centre has reduced by 240. This reduction is down to patient choice as patients have chosen to register at another GP practice rather than receive services from the new location at Beechdale Surgery.

Two options are presented in the paper. The preferred option is to not offer a discretionary payment.


Discretionary Payment Request linked to Boulevard Medical Centre Relocation


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Compliance with Statutory Duties ☐ Establishment of a Strategic Commissioner

☐


☐

Performance Management ☐ Approval of Practice Mergers ☐






Yes ☐

No ☐ N/A☒ An EQIA is not required for this item.


Yes ☐

No ☐ N/A☒ A DPIA is not required for this item.


Risks are referenced against each of the options in the options appraisal.


☒No

Recommendation(s):

1. NHS Nottingham City CCG Primary Care Commissioning Committee is asked to RECEIVE the Boulevard Medical Centre Discretionary Payment Request

2. DECLINE the request for Boulevard Medical Centre Discretionary Payment Request



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Boulevard Medical Centre Discretionary Payment Request

1. Purpose1.1 The purpose of this paper is to request a decision on whether the CCG should offer a

discretionary payment to those practices who have accepted new patient registrations following the relocation of services for the Boulevard Medical Centre.

1.2 The CCG has been requested to consider this by the Local Medical Committee (LMC) and a local GP practice.

2. Background2.1 In June 2019 the Primary Care Commissioning Committee agreed to offer a discretionary

payment to practices that had received more than 50 new patient registrations following the closure and list dispersal of both Mapperley Park Medical Centre and the GP services based in Strelley Health Centre.

2.2 The discretionary payment is equivalent to one quarter of the 2019/20 global sum (£22.47) and is to support practices in responding to the immediate increase in patient registrations where a GP contract has been terminated and patients have been directed to register at another GP practice.

2.3 On Thursday 27 June 2019 the CQC inspected Boulevard Medical Centre and found a number of concerns. The CQC decided to take action to prevent services being delivered at the Boulevard Medical Centre site on Western Boulevard.

2.4 The Primary Care Commissioning Committee approved a contract variation to support the temporary relocation of services from the Boulevard Medical Centre (635 Western Boulevard, Nottingham NG8 5GS) to the premises of Beechdale Medical Practice at 439 Beechdale Road, Nottingham NG8 3LF, with effect from Tuesday 2 July 2019. Both practices are run by the same organisation, The Beechdale Medical Group, and the practices are 0.8 miles apart.

2.5 All patients registered at the Boulevard Medical Centre were written to and advised that the patient list has been temporarily transferred to the Beechdale Surgery site. Patients can continue to exercise their rights around patient choice and choose to register at any other neighbouring practice so long as they reside within their practice boundaries.

3. Discretionary payment request and List size movement

3.1 Melbourne Park Medical Centre has recently contacted the CCG to advise that they have now accepted more than 50 patients from the Boulevard Medical Centre and enquired as to whether the CCG would be offering a discretionary payment for these patient re-registrations.

3.2 The LMC support Melbourne Park Medical Centre with this request. They believe that although Boulevard is not being treated as a list dispersal the same principles should apply



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as the practice is experiencing additional pressures on workload and workforce from registering these patients.

3.3 Table 1 below demonstrates the list sizes for the Boulevard Medical Centre over the past five weeks since the relocation of the services on 2nd July 2019.

Table 1 1st July 2019

17th July 2019 26th July 2019 7th August 2019

Registered list (raw)

1,915 1,775 1,722 1,691

Change from 1st July

-140 -193 -224

3.4 The movement is due to patient choice as patients have not been asked by the commissioner to register at another GP practice.

3.5 Commissioners have approached two further neighbouring practices that are located within 0.7 miles of the Boulevard Medical Centre to understand how many Boulevard patients have re-registered with them. Onc practice advises that they have taken on 23 patients, the other practice advised that they have accepted Boulevard patients however they have not been maintaining a register of these and they have generally seen their list size increase following the Strelley Health Centre closure. They have also accepted patients from other practices run under the Beechdale Medical Group where patients have chosen to move because of patient choice.

3.6 There are 11 practices located within 1 mile of the Boulevard Medical Centre.

3.7 It is difficult at this stage to quantify the financial cost of these discretionary payments as assumptions would need to be made on what proportion of the list may choose to register at another practice and because of the minimum threshold requirement of 50 patients before a practice is eligible to claim.

3.8 Based on the current movement of 244 patients the cost of the discretionary payment could be £5,483.

4. Options appraisal

4.1 Table 2 below outlines the options for this request and the CCG Primary Care Team and NHS England preferred option.

Table 2 Options AppraisalOption 1 No discretionary payment offeredAdvantage ∑ Consistent with current policy of offering discretionary payment only

where a list has been dispersed and patients have been asked to registered at another practice

∑ Reduced financial risk to the CCG on current primary care budgets as a separate budget does not need to be identified to fund these payments

Disadvantage ∑ Practices that are accepting new patients from the Boulevard Medical Centre may continue to experience an increase in workload, on top of pressures they may have already experienced following the nearby closure of the Strelley Health Centre. This could put the practices



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under financial and workload pressures which could impact upon their ability to deliver timely access to good quality primary care services.

Option 2 Offer a discretionary payment of £22.47 (as offered for list dispersals)Advantage ∑ Practices are financially reimbursed for additional workload, allowing

additional administrative and clinical staff to be employed and more appointments to be offered to manage these new patients in a timely manner.

Disadvantage ∑ Financial risk to CCG as no separate budget identified and difficult to estimate financial cost of this due to the list not being dispersed and movement is down to patient choice.

∑ Inconsistent with current policy and sets a new precedent to offer discretionary payments for list sizes changes due to patient choice.

Preferred Option

The CCG Primary Care Team and NHS England Primary Care Hub’s preferred option is Option 1: No discretionary payment offered

5 RecommendationThe Primary Care Commissioning Committee is asked to:

∑ RECEIVE the Boulevard Medical Centre Discretionary Payment Request∑ DECLINE the request for Boulevard Medical Centre Discretionary Payment Request



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This item relates to: ALL ☒ M&A ☐ N&S ☐ NC ☐ NNE ☐ NW ☐ R ☐

Paper Title: Primary Care Quality Exception Report August 2019


Sponsor:

Presenter:

Rosa Waddingham, Associate Director of Nursing and Personalised Care


-

Esther Gaskill, Head of Quality Primary Care

Summary Purpose:



☒

Executive Summary

This paper provides an overview of Primary Care Quality for the Nottingham and Nottinghamshire CCGs.

It includes:

∑ Primary Care Quality Dashboard - An overall summary of the Quarter 1 quality dashboard ratings and actions identified to be taken with practices achieving an overall ‘Red’ rating and identification of actions being taken where an issue has been identified in relation to several practices or group of practices.

∑ Primary Care Quality Groups – An update on progress in establishing a Primary Care Quality Group for each Integrated Care Partnership.

∑ CQC - An overall summary of current CQC ratings and actions being taken to support practices with either an overall rating of ‘Inadequate’ or ‘Requires Improvement’.




☐

Performance Management ☒ Cultural and/or Organisational Development

☐



Primary Care Quality Exception Report


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Yes ☐ No ☐ N/A☒ An EQIA is not required for this item.


Yes ☐ No ☐ N/A☒ A DPIA is not required for this item.

Risk(s):

None identified

Confidentiality:

☒No

Recommendation(s):

1. NOTE the Primary Care Quality Exception Report August 2019



1

Primary Care Quality Exception Report August 2019

1. Primary Care Quality Dashboard

The 2019/20 Q1 dashboard results were available for the Greater Nottingham practices towards the end of July 2019. The majority of practices achieved an overall ‘Green *’ or ‘Green’ rating (62 out of 91). 28 practices achieved an overall ‘Amber’ rating and one practice, RHR Medical Centre(Nottingham City CCG), received an overall ‘Red’ rating. Quality and contractual assurance meetings are in progress with the practice and improvements are being evidenced against an assurance matrix.

Review of the dashboard highlighted that achievement of the cervical screening indicator remains a challenging target for many practices. The CCGs’ Primary Care Quality Team has developed a self-audit tool, which has received approval from Cancer Research UK (CRUK). This enables practices to check that they are implementing all the systems and processes around cervical screening recommended by CRUK as best practice. The tool has been shared with all practices and some specific practices, not achieving the 80% national target, have been asked to return their completed checklist to provide assurance that either actions have been identified to be taken, or that the practice is implementing all recommended elements of the tool.

The 2019/20 Q2 dashboard will ‘go live’ mid-November 2019. This will include a test version for the Mid-Nottinghamshire practices and work is underway to introduce the dashboard to those practices in the meantime.

The second Primary Care Quality Dashboard Development Group was held in July 2019. The group membership consists of GPs, practice nurses, practice managers and primary care colleagues from each of the Greater Nottingham CCGs. Its remit is to review the current dashboard indicators and amend / remove / add new ones to ensure that the dashboard maintains its purpose as a quality improvement tool and usefulness for practices in providing an overarching view of the quality of service and preparedness for CQC inspections / reviews. Several changes to the current indicators were agreed and these will be circulated to practices in September 2019 in preparation for the Q2 dashboard release.

2. Primary Care Quality Groups

Development of a Primary Care Quality Group for each Integrated Care Partnership (including standardised terms of reference, membership, work plan and governance and reporting arrangements)is underway with the first South Nottinghamshire and Nottingham City Primary Care Quality Groups having taken place in July and August respectively. A Mid-Nottinghamshire Primary Care Quality Group has been scheduled to take place in November 2019.

3. Care Quality Commission (CQC)

The table below provides a summary of CQC ratings as of 1 August 2019, and actions being taken to support practices with either an overall rating of ‘Inadequate’ or ‘Requires Improvement’.

Integrated Care Partnership

Practice Current Overall CQC Rating

Actions / Support In Place

Nottingham City

Queen’s Bower Inadequate Quality and contractual assurance meetings in progress and improvements being evidenced against an assurance matrix



2

Nottingham City

Mapperley Park Inadequate Practice closed 30.06.19following GP retirement

Nottingham City

Strelley Surgery Inadequate Practice closed by CQC 07.06.19

Nottingham City

Boulevard Medical Centre

Report awaited Provider prevented from operating at location by CQC, patient list transferred to Beechdale Surgery

Nottingham City

Beechdale Surgery Report Awaited Quality and contractual assurance meetings are in progress and improvements being evidenced against an assurance matrix

Meetings with current partners and potential incoming partners are also taking place and are ongoing to support the new partnership and ensure a sustainable future for the Beechdale Group

Nottingham City

RHR Medical Centre

Requires Improvement

Nottingham City

Mayfields Medical Practice

Requires Improvement Re-inspection anticipated imminently, CCG’s quality team to undertake pre CQC support visit

Nottingham City

Bakersfield Medical Centre

Requires Improvement Support visit undertaken to ensure action plan in place and required improvements implemented. Repeat visit to be undertaken prior to further inspection

Nottingham City

St Alban’s MedicalCentre

Requires Improvement Re-inspection anticipatedimminently, support visit undertaken to ensure required improvements implemented.

The CQC have commenced their Annual Regulatory Reviews (ARR) for ‘Good’ and ‘Outstanding’ Practices. They will continue to inspect at least every 5 years but in between will carry out an ARR. Inspectors will identify any changes by reviewing: the data they hold in CQC Insight (their internal database), information from stakeholders, for example, Healthwatch, or the Clinical Commissioning Group (CCG), information that the practice provides, including through a structured telephone call each year, as part of the provider information collection (PIC).

Before the annual telephone call, the local CQC inspector will contact the practice approximately four weeks beforehand to arrange a mutually convenient time for the call. During the call, they will ask the practice a set of questions, the answers form the PIC and the practice will have had opportunity to prepare their responses.

If the ARR indicates that the quality of care may have improved or deteriorated since the practice’s last rating, CQC may decide to inspect, or ask the practice to clarify any information. If CQC don’t need to



3

take any action, they will tell the practice that they have carried out the review and that no further action is needed at this stage.

The ARR forms part of the CQC’s ongoing monitoring but it cannot change the practice rating, only an inspection can do this.

A communication summarising the ARR process has been issued to all practices and a template for practices to complete in preparation for the call with the CQC has also been shared.

4. Updates

Strelley Surgery

Strelley Surgery closed on Friday 7 June 2019 following concerns identified by the CQC regarding service quality and patient safety. All registered patients at the practice received a letter from NHS Nottingham City Clinical Commissioning Group (CCG) and NHS England informing them of the closure with instructions about how to register at a nearby GP Practice. More than 3200 of 4600 patients have already registered with alternative practices since the closure. This includes the majority of residents in retirement and residential homes.

CCG and NHSE colleagues continue to work with staff at the practice to identify and contact the most vulnerable patients, and are writing to all those who have not yet registered to remind them to do so as soon as possible. The practice is also being supported to make sure that all patient records are processed appropriately.

Boulevard Medical Centre

Patients of Boulevard Medical Centre were transferred to the nearby Beechdale Medical Centre following action taken by the Care Quality Commission (CQC). Approximately 1900 patients are registered with the practice and have been notified of the transfer by letter. Fewer than 100 patients have chosen to register with another practice following closure of the Boulevard building, to date.

NHSE and CCG colleagues are holding regular contractual and quality assurance meetings with the Beechdale Medical Group going forward to ensure all the identified CQC concerns and issues are being addressed and improvements are being made.



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Paper Title: Primary Care Hub – Memorandum of

Understanding and Handbook 2019/20 Paper Reference: PCC 19/053

Sponsor:

Presenter:



Appendix 1 - Primary Care Hub Handbook

Appendix 2 - Memorandum of Understanding

Joe Lunn, Head of Primary Care for NHS England

Summary Purpose:



Assurance

Information

☐

Executive Summary

Since April 2015, all CCGs within the Derbyshire & Nottinghamshire area have been fully delegated to commission primary medical services. The Delegation Agreement entered into between NHS England and CCGs sets out the national terms and conditions on how delegated primary medical care functions are to be exercised. A Memorandum of Understanding and Primary Care Hub Handbook were developed in 2015 to set out the arrangements for Derbyshire & Nottinghamshire CCGs and are refreshed to reflect the 2019/2020 arrangements.

The 2019/2020 Memorandum of Understanding and Primary Care Hub Handbook are attached for the Committee’s approval.




☐


☐


Primary Care Hub - Memorandum of Understanding and Handbook 2019/20


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Yes ☐ No ☐ N/A ☒ An EQIA is not required for this item.


Yes ☐ No ☐ N/A ☒ A DPIA is not required for this item.

Risk(s):

There are no risks identified within these documents.

Confidentiality:

☒No

Recommendation(s):

1. The Committees are asked to APPROVE the Memorandum of Understanding 2019/2020 between the Nottinghamshire CCGs and NHS England Primary Care Hub

2. The Committees are asked to APPROVE the Primary Care Hub Handbook



NHS England and NHS Improvement

Derbyshire & NottinghamshirePrimary Care Hub Handbook



Derbyshire & Nottinghamshire Primary Care Hub Handbook

Version number: 2.0

First published: April 2015

Updated: August 2019

Prepared by: Kerrie Woods, GP Contracts Lead



Contents

Contents..................................................................................................................... 2

1 Executive summary............................................................................................. 3

1.1 Background................................................................................................... 31.2 2019/2020 ..................................................................................................... 31.3 Key points of contact..................................................................................... 4

2 Functions of the Primary Care Hub..................................................................... 6

2.1 Primary Medical Care Policy and Guidance Manual (PGM).......................... 62.2 Functions support in accordance with the NHS England Delegation Agreement .............................................................................................................. 7

3 Arrangements for Financial Management ......................................................... 13

4 Communications ............................................................................................... 14

4.1 Primary Care Hub Key Contacts ................................................................. 144.2 Derbyshire................................................................................................... 154.3 Nottinghamshire .......................................................................................... 16

5 Key programmes of work for 2019/2020 ........................................................... 17



1 Executive summary

1.1 Background

Primary Care co-commissioning is set out in the NHS Five Year Forward View. It gives Clinical Commissioning Groups (CCGs) an opportunity to take on greater responsibility for general practice commissioning. It was introduced to support the development of integrated out-of-hospital services, based around the needs of local people.

Since April 2015, all CCGs within the Derbyshire & Nottinghamshire area have been fully delegated to commission primary medical services and this is agreed through a Memorandum of Understanding.

1.2 2019/2020

CCGs

For 2019/2020 arrangements are refreshed to include plans and arrangements asset out in NHS England’s Long-Term View. This includes that by 2021 it is the intention that Integrated Care Systems (ICSs) will cover the whole of the country having emerged from Sustainability and Transformation Partnerships (STPs) where they are not already formed. The streamlined commissioning arrangements under ICSs will typically involve a single CCG for each ICS area.

As CCGs locally move forward with new arrangements, the Primary Care Hub will endeavour to support and refresh working arrangements to best suit the emerging commissioning structures within the CCGs.

In Derbyshire, the proposal to merge the county’s four CCGs of Erewash, Hardwick, North and Southern Derbyshire into a single organisation with effect from 1 April 2019 has been approved by NHS England. This means that the Primary Care Hub will focus on communications and management of primary medical contracts with the single CCG structure in 2019/20.

In Nottinghamshire an ICS is in place. The six CCGs in Nottinghamshire – Mansfield and Ashfield, Newark and Sherwood, Nottingham City, Nottingham North and East, Nottingham West and Rushcliffe – are proposing to merge to create one Nottingham and Nottinghamshire CCG with effect from 1 April 2020. This means that the Primary Care Hub will focus on communications and management of primary medical contracts either on a single basis or with the areas of Mid NottinghamshireCCGs and Greater Nottingham CCGs in 2019/20.

This will be overseen by the single Associate Director of Primary Care for Nottinghamshire CCGs and by Locality Directors for Mid Nottinghamshire, Nottingham City and South Nottinghamshire.



https://www.england.nhs.uk/ourwork/futurenhs/

NHS England

NHS England and NHS Improvement are currently undertaking a formal consultationunder the Joint Working Programme for the two organisations. The Government has set mandatory cost reduction targets for NHS England and NHS Improvement which they are legally required to meet.

The current consultation is phase 3 of the process and affects all staff in Agenda for Change Bands 2 to 9 or Monitor equivalent, those on medical grades and ESM grades for Greater Manchester.

The collective consultation period is scheduled for 16 July - 29 August 2019 for mostdirectorates (exceptions being the People Directorate, NHSX and Greater Manchester). A synopsis of the key dates is below:

∑ 16 July 2019: Formal collective consultation commences with all affected staff. ∑ 29 August 2019: Formal collective consultation ends for most directorates for

consideration of feedback. ∑ 23 September 2019: Outcomes document shared with all staff. ∑ From October 2019: Implementation process commences with the filling of posts. ∑ End November 2019: Majority of staff will know their position in the new

structure.

As part of the new operating model, NHS England and NHS Improvement have moved from four to seven regions, who support local systems to provide more joined up and sustainable care for patients.

The Derbyshire & Nottinghamshire GP Contracting Team moves into the new Midlands regional team which covers 11 ICSs and STPs and 39 CCGs across Derbyshire, Nottinghamshire, Shropshire, Staffordshire, Birmingham & the Black Country (Dudley,Sandwell, Walsall and Wolverhampton), Solihull, Coventry & Warwickshire, Hereford & Worcestershire, Northamptonshire, Leicestershire & Lincolnshire.

Under the consultation proposal released on 16 July 2019, it is proposed a single GP hub supports the delivery of delegated functions across the Midlands region.

The Midlands region senior management team is made up of:

∑ Midlands Regional Director: Dale Bywater∑ Chief Nurse: Siobhan Heafield∑ Medical Director and Chief Clinical Information Officer: Dr Nigel Sturrock∑ Director of Workforce and OD: Steve Morrison∑ Director of Performance and Improvement: Jeff Worrall∑ Director of Commissioning: Alison Tonge∑ Director of Public Health: Dr Rashmi Shukla

1.3 Key points of contact

The Primary Care Hub will remain hosted by Mid Nottinghamshire CCGs for 2019/20 and Amanda Sullivan, Chief Operating Officer for Nottinghamshire CCGs is the principal contact for strategic matters relating to the Delegation Agreement on behalf of all Derbyshire & Nottinghamshire CCGs.



For the Primary Care Hub, the principal contact for matters relating to the Delegation Agreement will be Joe Lunn, Head of Primary Care for Derbyshire & Nottinghamshire.

The Derbyshire & Nottinghamshire Primary Care Hub form part of the NHS England & NHS Improvement Midlands region where the relevant contact is Trish Thompson as Director of Primary Care.

A full list of contacts is provided at section 4.



2 Functions of the Primary Care Hub

2.1 Primary Medical Care Policy and Guidance Manual (PGM)

NHS England published the first ‘Policy Book’ for Primary Medical Services (Gateway Ref 04171) in 2016, which provided commissioners of GP services with the context, information and tools to commission and manage GP contracts.

The ‘Policy Book’ was superseded in November 2017 by the Primary Medical Care Policy and Guidance Manual (PGM) and subsequently updated in April 2019 and is available online www.england.nhs.uk/publication/primary-medical-care-policy-and-guidance-manual-pgm/

This approach ensures that all commissioners, providers and most importantly patients are treated equitably and that NHS England and CCG’s meet their statutory duties.

During 2019/2020 NHS England is expected to publish alongside the PGM, additional information and supporting materials to assist commissioners and providers in further developing PCNs.

In relation to the PGM, the Primary Care Hub acts as the primary subject matter experts in relation to understanding the policy and process set out and its application to local circumstance.

Each CCG should ensure it is aware of the general duties of NHS England (including addressing health inequalities) and the relevance and application to CCGs in relation to delegated commissioning. These are summarised within the PGM for ease of reference.

The Primary Care Hub will deliver expert knowledge, understanding and application in relation to the PGM particularly for:

1. General Contract Management

1.1. Contracts 1.2. Assurance Framework Contract Review1.3. Managing Patient Lists1.4. GP Patient Registration Standard Operating Principles for Primary Medical

Care1.5. Temporary suspension to patient registration1.6. Special Allocation Scheme (SAS)1.7. Contract Variations1.8. Managing a PMS Contractor’s Right to a GMS Contract1.9. Practice Closedown (Planned / Scheduled)1.10. National Procurement Support Contract1.11. Premises Running Costs and Service Charges



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

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

2. When things go wrong

2.1. Contract Breaches, Sanctions and Terminations2.2. Unplanned / Unscheduled and Unavoidable Practice Closedown2.3. Death of a Contractor (excluding single handers)2.4. Adverse Events (e.g. flood fire)

3. General

3.1. Protocol in respect of locum cover or GP performer payments for parental and sickness leave

2.2 Functions support in accordance with the NHS England Delegation Agreement

Function as described in the Delegation Agreement

Duties of the Primary Care Hub Not within the scope of the Primary Care Hub

Decisions in relation to the commissioning, procurement and management of Primary Medical Services Contracts

∑ Advising on the application of and ensuring compliance with the NHS England Policy & Guidance Manual

∑ Managing the end of time limited contracts

∑ Advising on the procurement options to CCGs including PCCCs

∑ Writing papers for PCCCs on commissioning options and discretionary contract changes

∑ Direct liaison with the contract holder

∑ Supporting contractual elements of the procurement process

∑ Supporting the contractual elements of contract mobilisation and close down

∑ Signposting to NHS England advice and guidance

∑ Ensuring compliance with the national contract monitoring tools (e-Dec)

∑ Undertaking operational contract management

∑ Decision making as described in the terms of reference of the PCCCs

∑ Leading patient and stakeholder engagement

∑ Providing legal support∑ Providing

communications support∑ Proving any other

relevant expert resource (HR, IT etc).

∑ The management of local dispute resolution arrangements





∑ Managing contract variations∑ Liaison with PCSE

Decisions in relation to Enhanced Services;


The management of all nationally specified Directed Enhanced Services including:

∑ Managing participation in schemes to practices, including contractual entry and exit

∑ The management of payment systems for the DES (CQRS, local payment) including payments and reconciliation

∑ The collation of activity information as required by the DES

∑ Receiving and resolving queries and questions from practices

∑ Managing the day to day decisions on Enhanced Service contract management

∑ Providing supporting information for any dispute resolution (local or national)


∑ Providing legal support∑ The management of local

dispute resolution arrangements

Decisions in relation to Local Incentive Schemes (including the design of such schemes);


∑ Providing advice and support in relation to the relationship with core contract











∑ Any other element of Local Incentive Schemes

Decisions in relation to the establishment of new GP practices (including branch surgeries) and closure of GP practices;


∑ Advising on the procurement options to CCGs including PCCCs

∑ Writing papers for PCCCs on commissioning options and discretionary contract changes


∑ Managing the end of time limited contracts

∑ Supporting contractual elements of the procurement process

∑ Supporting the contractual elements of contract mobilisation and close down



∑ Managing contract variations∑ Liaison with PCSE







Decisions about ‘discretionary’ payments;


∑ Advising on the application of Regulations (including SFEs, Section 96, Premises Cost Directions etc)

∑ Writing papers for PCCCs on discretionary payments related to the core contract




∑ Managing general requests for discretionary payment not related to core contract or delegated functions





Decisions about commissioning urgent care (including home visits as required) for out of area registered patients;


∑ The management of payment systems for the DES (CQRS, local payment) including payments and reconciliation

∑ The collation of activity information relating to out of area patients

∑ Receiving and resolving queries and questions from practices

∑ Managing the day to day decisions on Enhanced Service contract management

∑ Providing supporting information for any dispute resolution (local or national)

∑ Direct liaison with the contract holders

∑ Distribution of information to all practices

∑ Managing participation in schemes to practices, including contractual entry and exit







Approval of practice mergers;


∑ Writing papers for PCCCs on practice mergers


∑ Supporting contractual elements of the practice mergers

∑ Supporting the contractual elements of contract merger


∑ Liaison with the NHS England Pharmacy contracting team in relation to dispensing arrangements as necessary











Planning primary medical care services in the area, including carrying out needs assessments;


∑ Management in relation to the commissioning, procurement and management of Primary Medical Services Contractsas described above






Undertaking reviews of primary medical care services in the area;



∑ Management in relation to the commissioning, procurement and management of Primary Medical Services Contractsas described above






Decisions in relation to the management of poorly performing GP practices and including, without limitation, decisions and liaison with the CQC where the CQC has reported non-compliance with standards (but excluding any decisions in relation to the performers list);


∑ Identifying contract breaches and the issuing of contract notices (remedial / breach).

∑ Managing the contractual risks identified by the CQC incooperation and joint working with CCG locality and quality teams.

∑ Liaison with the NHS England Professional Standards team as necessary

∑ Liaison with the CQC as necessary

∑ Writing papers for PCCCs on commissioning optionsincluding contract termination











Management of the Delegated Funds in the Area


∑ Advising on the application of Regulations (including SFEs, Section 96, Premises Cost Directions etc)





Premises Costs Directions Functions


∑ Managing applications and implementation process for ETTF schemes and any subsequent schemes at both local and regional levels on behalf of NHS England

∑ General advice and support on proposals/business cases for premises developments/improvement grants/sale & leaseback

∑ Review practice proposals in detail, including cost-benefit analysis, VFM (revenue consequences)

∑ S106/Planning Applications: support CCGs regarding responses to relevant planning applications, specifying S106 funding requirements

∑ Manage the three-yearly schedule of rent reviews for each GP practice including instructing the DV and notifying practices of outcomes

∑ Managing the process for Business As Usual (BAU) capital, reviewing CCG prioritised schemes in line with PCDs and compliance with legislation

∑ Manage all other premises related issues as appropriate,





∑ Local leadership of proposals/business cases for premises

∑ CCG level prioritisation of applications for funding

∑ Local leadership of S106 funding applicationsincluding communications with the relevant local authorities







including visits to practices as required, in line with the Premises Costs Directions

Co-ordinating a common approach to the commissioning of primary care services with other commissioners in the Area where appropriate


∑ Supporting CCGs with the provision of contractual information as required







Such other ancillary activities that are necessary in order to exercise the Delegated Functions


∑ Supporting CCGs with theprovision of contractual information as required







3 Arrangements for Financial Management

The NHS England Primary Care Finance Team undertake the following functions on behalf of delegated CCGs:

1. Overall management and the reporting of delegated funds – processes for forecasting, monitoring and reporting

2. Review of financial controls and processes for approving payments to practices

3. Review of compliance with coding guidance on a sample basis

4. Provide support on the consideration of ‘discretionary’ payments (e.g. Section 96 funding arrangements)



4 Communications

4.1 Primary Care Hub Key Contacts

Name Job TitleTelephone

NumberEmail Address

Joe Lunn Head of Primary Care 07967 006968 [email protected]

Kerrie Woods

General PracticeContracts Lead

07918 336070 [email protected]

Nottinghamshire and Derbyshire GP Team Generic Email [email protected]

Name Job TitleTelephone

NumberEmail Address

JulieKent

Contracts ManagerNottinghamshire


David Knight

Contracts ManagerDerbyshire


Rachael Preston

Contracts ManagerPremises


Julia Wong

Assistant Contracts Manager


Bryony Higgins

Primary Care Contracts Officer


Georgie Heath

Primary Care Contracts Officer

0113 82533040770 2412557

[email protected]

Naomi Roots

Primary Care Contracts Officer (ETTF)


Kelly TaftPrimary Care

Support Officer0113 82 55366 [email protected]

Lisa-Marie Bell

Business Support Officer 0113 8251854 [email protected]

Emma Cooper

Primary Care Admin Support




Clinical Commissioning Group Key Contacts

4.2 Derbyshire

Executive Leads

Name Role Email PhoneClive Newman

Director of GP Development

[email protected] 07920 283518

Brigid Stacey Chief Nursing Officer


Steve Lloyd Medical Director [email protected] 07966 441874

Operational Leads

Name Role Email PhoneHelen Dean Assistant Director

GP Commissioning and Development


Hannah Belcher

Head of GP Commissioning and Development -Primary Care


Emma Prokopiuk

Head of GP Commissioning & Development -GPFV

[email protected] 07584 800 796

Marie Scouse

Assistant Director of Nursing and Quality: Primary Care




4.3 Nottinghamshire

Executive Leads

Name Role Email PhoneMichelle Tilling

Nottingham City Locality Director

[email protected] 0115 8839545 07919 392554

David Ainsworth

MidNottinghamshireLocality Director

[email protected] 01623 67313507713 706 974

Fiona Callaghan

South NottinghamshireLocality Director

[email protected] 0115 8831891 07515192073

Helen Griffiths

Associate Director of Primary Care Networks


Sharon Pickett

Associate Director of Primary Care

[email protected] 0115 883 189107808 647119

Elaine Moss Chief Nurse and Director of Quality & Governance


Operational Leads

Name Role Email PhoneLynette Daws

Head of Primary Care Nottingham City

[email protected] 0115 883 947507714 598220

Rachael Rees

Head of Primary Care & MCP Development(Nottingham North & East)

[email protected] 0115 883 1716 07920470681

Rachael Harrold

Primary Care Manager(Nottingham West)

[email protected] 0115 883 5246

Jacki Moss Head of Primary Care & MCP Development (Rushcliffe)


Cathy Quinn Deputy Director of Primary Care(Mid Nottinghamshire)


Esther Gaskill

Head of Quality, Primary Care

[email protected] 0115 883184907920 812539



5 Key programmes of work for 2019/2020

The Primary Care Hub has identified the following key programmes of work it will support this year:

1. The implementation of NHS England’s “Investment & Evolution: a five-year framework for GP contract reform to implement The NHS Long Term Plan”

a. Developing the contractual mechanisms to support the introduction of Primary Care Networks

b. Local establishment and management of the Primary Care Network DES

c. Local establishment and management of the Additional Roles Reimbursement Scheme

d. The resolution of the routine afternoon closurese. Management of the new Quality Improvement domain within QOF

2. Management of the time limited contracts that cease within this year includingeither the termination, re-procurement or extension of the following contracts:

a. Special Allocation Scheme for Greater Nottinghamshire (Notspar), scheduled to cease 30/09/2019 and 31/03/2020 (for two contracts)

b. Special Allocation Scheme for Derbyshire (Wilson Street Surgery) scheduled to cease 31/03/2020

c. Kirkby Community Primary Care Centre (KCPCC) scheduled to cease 31/09/2020

d. Balderton Primary Care Centre scheduled to cease 31/09/2020e. Southglade Health Centre scheduled to cease 31/03/2020

3. Preparation for the management of the time limited contracts that cease within the following year including:

a. NEMS Platform One scheduled to cease 31/03/2021b. Bilborough Medical Centre scheduled to cease 31/03/2021c. Grange Farm Medical Centre scheduled to cease 31/09/2021d. Whyburn Medical Practice scheduled to cease 31/05/2021

4. Supporting the intensive contract management of practices during instability and challenging environments and those who have been rated Inadequate by the CQC

5. The managed transition of Nottinghamshire practices in, or scheduled to be in, PMS negative premium by March 2021

6. The management of practice mergers in line with requests



NHS England and NHS Improvement

Derbyshire & NottinghamshireCCGs & Primary Care HubMemorandum ofUnderstanding

For the delegated commissioning of Primary Medical Services



Derbyshire and Nottinghamshire Clinical Commissioning Group (CCG) and Primary Care Hub (PC Hub) Memorandum of Understanding (MOU)

For the delegated commissioning of Primary Medical Services

Version number: 3

First published: 14 May 2015

Updated on: 14 August 2019

Prepared by: Kerrie WoodsGP Contracts Lead, Derbyshire and NottinghamshireNHS England North Midlands



Contents

Contents..................................................................................................................... 2

1.1 Background................................................................................................... 31.2 2019/2020 ..................................................................................................... 3

2 Principles ............................................................................................................ 5

3 Ways of working.................................................................................................. 5

3.1 Local commissioning..................................................................................... 54 Resources........................................................................................................... 6

4.1 Variation in workload..................................................................................... 65 Accountability ...................................................................................................... 7

6 Resolving issues ................................................................................................. 7

7 CCG lead for the Primary Care Hub.................................................................... 7

7.1 Role of CCG Lead......................................................................................... 87.2 Lead CCG accountabilities............................................................................ 8

8 Performance Reporting ....................................................................................... 8

9 Communication and engagement ....................................................................... 9



1 Introduction

1.1 Background

The purpose of this memorandum of understanding is to set out the principles and detailed working arrangements between the Primary Care Hub and CCG commissioners for 2019/20.

In 2015, the local 10 Clinical Commissioning Groups (CCGs) in Derbyshire and Nottinghamshire were successful in their request to take on full delegation of commissioning for Primary Medical Services from 1 April 2015. NHS England hascontinued to commission community pharmacy, dental and optometric services during this period alongside other direct commissioning functions.

In late 2014 all 10 CCGs and the NHS England Derbyshire and Nottinghamshire Area Team (as was) agreed that the existing NHS England Primary care team should support CCGs in the commissioning of Primary Medical Services through a Primary Care Hub arrangement from 2015 and this arrangement has remained in situ. This arrangement was agreed to ensure that both CCGs and NHS England retain access to the established contracting expertise in order to effectively discharge their respective functions.

1.2 2019/2020

CCGs

For 2019/2020 arrangements are refreshed to include plans and arrangements asset out in NHS England’s Long-Term View. This includes that by 2021 it is the intention that Integrated Care Systems (ICSs) will cover the whole of the country having emerged from Sustainability and Transformation Partnerships (STPs) where they are not already formed. The streamlined commissioning arrangements under ICSs will typically involve a single CCG for each ICS area.

As CCGs locally move forward with new arrangements, the Primary Care Hub will endeavour to support and refresh working arrangements to best suit the emerging commissioning structures within the CCGs.

In Derbyshire, the proposal to merge the county’s four CCGs of Erewash, Hardwick, North and Southern Derbyshire into a single organisation with effect from 1 April 2019 has been approved by NHS England. This means that the Primary Care Hub will focus on communications and management of primary medical contracts with the single CCG structure in 2019/20.

In Nottinghamshire an ICS is in place. The six CCGs in Nottinghamshire – Mansfield and Ashfield, Newark and Sherwood, Nottingham City, Nottingham North and East,



Nottingham West and Rushcliffe – are proposing to merge to create one Nottingham and Nottinghamshire CCG with effect from 1 April 2020. This means that the Primary Care Hub will focus on communications and management of primary medical contracts on a single basis or with the areas of Mid Nottinghamshire CCGs and Greater Nottingham CCGs in 2019/20.

This will be overseen by the single Associate Director of Primary Care for Nottinghamshire CCGs and by Locality Directors for Mid Nottinghamshire, Nottingham City and South Nottinghamshire.

NHS England

NHS England and NHS Improvement are currently undertaking a formal consultationunder the Joint Working Programme for the two organisations. The Government has set mandatory cost reduction targets for NHS England and NHS Improvement which they are legally required to meet.

The current consultation is phase 3 of the process and affects all staff in Agenda for Change Bands 2 to 9 or Monitor equivalent, those on medical grades and ESM grades for Greater Manchester.

The collective consultation period is scheduled for 16 July - 29 August 2019 for mostdirectorates (exceptions being the People Directorate, NHSX and Greater Manchester). A synopsis of the key dates is below:

∑ 16 July 2019: Formal collective consultation commences with all affected staff. ∑ 29 August 2019: Formal collective consultation ends for most directorates for

consideration of feedback. ∑ 23 September 2019: Outcomes document shared with all staff. ∑ From October 2019: Implementation process commences with the filling of posts. ∑ End November 2019: Majority of staff will know their position in the new

structure.

As part of the new operating model, NHS England and NHS Improvement have moved from four to seven regions, who support local systems to provide more joined up and sustainable care for patients.

The Derbyshire & Nottinghamshire GP Contracting Team moves into the new Midlands regional team which covers 11 ICSs and STPs and 39 CCGs across Derbyshire, Nottinghamshire, Shropshire, Staffordshire, Birmingham & the Black Country (Dudley, Sandwell, Walsall and Wolverhampton), Solihull, Coventry & Warwickshire, Hereford & Worcestershire, Northamptonshire, Leicestershire & Lincolnshire.

Under the consultation proposal released on 16 July 2019, it is proposed a single GP hub supports the delivery of delegated functions across the Midlands region.

The Midlands region senior management team is made up of:

∑ Midlands Regional Director: Dale Bywater∑ Chief Nurse: Siobhan Heafield∑ Medical Director and Chief Clinical Information Officer: Dr Nigel Sturrock



∑ Director of Workforce and OD: Steve Morrison∑ Director of Performance and Improvement: Jeff Worrall∑ Director of Commissioning: Alison Tonge∑ Director of Public Health: Dr Rashmi Shukla

2 Principles

The following principles support effective fully delegated commissioning of Primary Medical Services during 2019/20:

a) The Primary Care Hub will work to the direction of each CCG or to direction jointly agreed by multiple CCGs where appropriate.

b) The Primary Care Hub will support delegated CCGs as necessary in the NHS England Internal Audit Framework for delegated Clinical Commissioning Groups.

c) Working arrangements have been, and will continue to be, co-designed between the Primary Care Hub and CCG commissioners.

d) Arrangements will aim to make the best use of NHS resources to enhance primary care commissioning to improve quality, outcomes and value.

e) Arrangements will be practical, reduce duplication and minimise additional workload.

f) The aim is to not destabilise the commissioning resources required for CCGs or NHS England to discharge their respective functions effectively.

g) The Primary Care Hub and CCGs will conduct business in an open and transparent way with no surprises.

h) All staff will be treated with respect, dignity and compassion

3 Ways of working

Key interfaces between the Primary Care Hub team and teams within CCGs are included in the Primary Care Hub Handbook.

3.1 Local commissioning

The Primary Care Hub focuses on delivering core contracting activities including maintaining contracts and introducing the nationally agreed contract changes to local contracts. Each CCG have local priorities that require Primary Care Hub support to deliver.

The Head of Primary Care and GP Contracts Lead will work with each CCG to identify these priorities and agree how they can be supported by the Primary Care



Hub in 2019/20. The Primary Care Hub will do everything it can to flexibly support CCGs to deliver fully delegated commissioning.

4 Resources

The Primary Care Hub comprises of the entire NHS England Primary Medical Services (GP) contracting team for Derbyshire & Nottinghamshire and a proportion of the finance team, the Head of Primary Care (HOPC), and the primary care business support. The proportionate resource reflects additional responsibilities for Pharmacy, Optometry and Dentistry commissioning within the team.

The working structure of the NHS England North Midlands Primary Care Hub for Derbyshire and Nottinghamshire is illustrated in the Primary Care Hub Handbook.

The NHS England Delegation Agreement sets out three staffing models under which CCGs may engage NHS England staff to undertake delegated functions. It is understood that the Primary Care Hub arrangement described above is “Model 1 –Assignment”.

4.1 Variation in workload

The workload for primary care commissioning can be variable and unpredictable. In recognition of this the following principles have been drafted:

a) The Primary Care Hub will do everything it can to flexibly support CCGs to deliver their commissioning priorities for primary care whilst also responding to emergent priorities adopting the principle of ‘working to need’.

b) The PC Hub will also aim to provide equitable support to each CCG and will endeavour to effectively balance competing priorities.

c) Where a CCG requires support that exceeds the available resources then the HoPC will initiate a discussion with CCGs about how that can be resourcedincluding:

i. CCG securing additional resource (potentially secured through the PC Hub).

ii. PC Hub securing additional resource (potentially through a CCG).iii. CCG agreeing with other CCGs to focus the PC Hub resource

temporarily on a specific issue.iv. CCG divert internal resource and backfill as necessary.v. Solution may require a combination of the above



5 Accountability

The Primary Care Hub is directly accountable to each CCG for delivery of the Primary Medical Services Commissioning function:

a) Each CCG will have direct access to the Primary Care Hub through a named lead.

b) The HOPC will lead the Primary Care Hub on a day to day basisc) The HOPC and GP Contracts Lead will manage the business interface

with each individual CCG and collective groups of CCGs. d) The HOPC and GP Contracts Lead will work with each CCG to

identify/agree and deliver against specific priorities for 2019/20.e) The HOPC will highlight resource constraints and propose solutions where

there may be a risk to delivering against the MOU and the Primary Care Hub Handbook.

f) The Primary Care Hub will support CCGs in the NHS England Internal Audit Framework for delegated Clinical Commissioning Groups

g) The Primary Care Hub will routinely attend CCG Primary Care Commissioning Committees where identified as a member / invitee of the committee.

h) The Primary Care Hub will provide quarterly reports (position statements) to provide transparency, information and mutual understanding.

i) Primary Care finance is separately managed and accountable to the NHS England Midlands Director of Finance with the Assistant Head of Finance (Primary Care) as the first point of contact for CCG finance teams.

6 Resolving issues

The first line for resolving any concerns relating to support from the Primary Care Hub is between the Head of Primary Care (HoPC) and the CCG Director of Primary Care (Nottinghamshire CCGs) or Director of GP Development (Derby & Derbyshire CCG).If necessary, then any escalated issues will be to the NHS England Director of Primary Care or CCG Accountable Officer for resolution.

7 CCG lead for the Primary Care Hub

It is agreed that NHS Mansfield & Ashfield CCG will be the CCG lead for the Primary Care Hub during 2019/20.



7.1 Role of CCG Lead

It is recommended that Mansfield and Ashfield CCG act as the lead the Primary Care Hub for 2019/20 with the following purposes:

∑ Provide oversight of a Memorandum of Understanding (MOU) between all 7CCGs and the Primary Care Hub for 2019/20.

∑ Ensure that the Primary Care Hub and CCGs deliver against their respective roles and responsibilities as set out in the MOU and agreed working arrangements.

∑ Facilitate development of Primary Care Hub and CCGs in response to common themes, risks, issues arising in year.

∑ Lead the CCG interface with the NHS England Director of Primary Care (or nominated deputy) in relation to future arrangements for the Primary Care Hub team.

∑ Lead the CCG interface with the NHS England Director of Primary Care to resolve any issues that have been unable to be resolved between the HOPC and CCGs.

7.2 Lead CCG accountabilities

The Primary Care Hub HOPC will meet with the Chief Officer of Mansfield and Ashfield CCG indicatively every 6 weeks to share progress, risks and issues to be escalated. This will also provide an opportunity for feedback to inform improvements both within the Primary Care Hub and CCGs.

8 Performance Reporting

The Primary Care Hub will provide a quarterly report summarising performance including activities completed during the previous period. The report will be based to reflect STP footprints and be issued to the designated leads for the CCG geography.

Quarter Performance report1 End July2 End October3 End January4 End April

The report shall be accompanied by information on:

∑ Contracted practices within the geography∑ Contract variations undertaken during the preceding 3 months∑ CQC ratings of practices within the geography



∑ Directed Enhanced Services participation and activity during the preceding 3 months

∑ Premises information – including rent review determinations∑ Procurements

Key themes will be extracted from the information will be included in an overview report – it is for each CCG or group of CCGs to decide if the report needs to receive within its governance structure.

The HOPC will meet quarterly with CCGs or group of CCGs to share the Primary Care Hub activity, risks and issues to support discussions relating to further development.

This report is in addition to regular contract-based reports will be provided to the CCG to support commissioning decisions, quality and financial governance as required as Primary Care Commissioning Committees.

9 Communication and engagement

In order to ensure strong communications between the Primary Care Hub and CCG teams a communications pack has been prepared which is included in the Primary Care Hub Handbook.

The Primary Care Hub will be available to attend CCG Primary Care Commissioning Committees and other forums as appropriate and requested. Wherever possible the HOPC will also attend. Team members will attend to support papers / discussions on request.

Senior team members have been aligned to each CCG as follows: CCG Team memberAll CCGs Joe Lunn (Head of Primary Care – Derbyshire &

Nottinghamshire)Kerrie Woods (GP Contracts Lead – Derbyshire & Nottinghamshire)

Derby & Derbyshire CCG

David Knight (GP Contracts Manager – Derbyshire)

Nottinghamshire CCGs

Julie Kent (GP Contracts Manager – Nottinghamshire)



of 2





Paper Title: Finance Report at month four Paper Reference: PCC 19/054

Sponsor:

Presenter:

Stuart Poynor – Chief Finance Officer Attachments/ Appendices:

Finance Report, Month Four

Mick Cawley, Operational Director of Finance, Mid-Nottinghamshire CCGs

Summary Purpose:

Approve ☐ Endorse ☐ Review ☒ Receive/Note for:


☐

Executive Summary

The paper presents the financial position of each CCG’s Delegated Primary Care budget plus a consolidated position.

The consolidated position shows a year to date position of £630k favourable variance. The combined forecast position of the six CCGs is to remain within budget, with sufficient reserves available to cover all risks that may be incurred during the financial year. Such risks include locum cover, care-taking and list dispersal.

The overall financial position for the CCGs is deteriorating and shows a £0.987 million deterioration from plan to month four. All budgets are subject to increased scrutiny and savings against all areas of spend need to be maximised.



Financial Management ☒ Wider system architecture development (e.g. ICP, PCN development)

☐


☐




Finance Report


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Yes ☐ No ☐ N/A☒ An EQIA is not required for this item.


Yes ☐ No ☐ N/A☒ A DPIA is not required for this item.

Risk(s):

No risks identified

Confidentiality:

☒No

Recommendation(s):

1. NOTE the financial position of the Delegated Primary Care Budget.

Finance Report


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Delegated Co-Commissioning – Month 4 Finance Report – JULY 2019

Nottingham & Nottinghamshire CCG’s

The table below shows the consolidated summary financial position for the Nottingham and Nottinghamshire CCGs at the end of July 2019 (M4)

Year to Date

The consolidated position for all six CCGs is showing an underspend of £698k. This is mainly due to the favourable variance within NHS Mansfield and Ashfield CCG of £630k as well as smaller underspends across the Greater Notts. CCGs. This is offset by an overspend position of £151k within Newark and Sherwood CCG.

Detailed budget line variances are shown by individual CCGs below.

Forecast

Overall, the Co-Commissioning financial position is forecast to remain within budget. However, Newark & Sherwood CCG in isolation has a current forecast overspend position of £732k. The deterioration in this position in comparison to the ytd position is mainly due to increases in Dispensing / Prescribing Drs because of seasonal variation as well as increases in Premises Cost Reimbursement and Quality and Outcomes Framework (QOF) that are expected to increase over the course of the year.

There are also a number of other items that are likely to require investment from reserves throughout the year for each of the CCGs, e.g. Caretaker costs whereas the agreement for the Caretaker requires amounts to be held in Reserves to cover any unforeseen costs and any discretionary payments that have been agreed to be made to practices that have taken on patients when practices have closed.

Overall CCG Financial Position

The financial position reported across all CCGs is challenging, with an adverse year to date position of £0.987million overspend being reported and risk that the year-end Control Total may not be met. In this context, all areas of spend are subject to increased scrutiny with savings required from all areas, including Primary Care, and these will need to be maximised as much as possible.

Co-Commissioning CategoryAnnual Budget

£'000sYTD Budget

£'000sYTD Actual

£'000sYTD Variance

£'000sDispensing/Prescribing Drs 2,339 768 558 -210Enhanced Services 3,891 1,271 1,221 -51General Practice – APMS 5,580 1,909 1,908 -1General Practice – GMS 60,605 19,900 19,868 -32General Practice – PMS 31,502 10,538 10,537 -1General Reserves 3,326 90 0 -90Other GP Services 2,186 789 718 -70Other Premises costs 2,913 971 994 23Premises Cost Reimbursement 15,756 5,243 5,215 -29Primary Care Networks 4,587 1,491 1,326 -165QOF 13,759 4,109 4,036 -73Grand Total 146,443 47,080 46,382 -698

Finance Report


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Mansfield and Ashfield CCG (04E)

The financial position for Mansfield and Ashfield CCG at month four 2019/20 is £630k underspent. Below is the summary position by expenditure category.

Key Variances

Dispensing/Prescribing Drs – Currently below plan however this activity is seasonal and usually increases during the winter period.

Enhanced Services – Minor surgery claims are below plan at this stage however is being equally offset by overperformance in learning disability claims, activity varies throughout the year.

General Practice contracts – Core contract payments are on plan except for GMS. The underspend on the GMS contracts line is a non-recurrent benefit relating to a deduction of OOH that was not collected by PCSE at the point practices switched from PMS to GMS that is being clawed back.

General Reserves – As in previous years Mansfield & Ashfield CCG has a surplus reserve that is phased evenly throughout the year and is the primary driver of the overall surplus position.

Primary Care Network (PCN) – A new category of spend has been introduced this financial year summarised as the PCN which encompasses the PCN payment, Clinical Director, Clinical Pharmacist and Social Prescriber payments. There is a non-recurrent benefit this year due to the guideline to budget being for the year however claims do not start until July 2019 as well as a cap on claims that drives the underspend to the end of the year.

QOF – The underspend relates to 18/19 prior year fall out £35k with the balance relating to lower than planned Aspiration payments.


£'000sYTD Budget

£'000sYTD Actual

£'000sYTD Variance

£'000sDispensing/Prescribing Drs 164 54 21 -33Enhanced Services 1,044 335 338 2General Practice – APMS 1,279 424 424 0General Practice – GMS 14,123 4,486 4,437 -49General Practice – PMS 3,033 1,203 1,203 0General Reserves 1,217 404 0 -404Other GP Services 281 92 80 -11Other Premises costs 58 19 25 6Premises Cost Reimbursement 2,729 905 910 5Primary Care Networks 858 264 166 -97QOF 2,757 639 590 -48Grand Total 27,543 8,824 8,195 -630

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Newark & Sherwood CCG (04H)

The financial position for Newark and Sherwood CCG at month four 2019/20 is £151k overspent. Below is the summary position by expenditure category.

Key Variances

Dispensing/Prescribing Drs – Currently below plan however this activity is seasonal and usually increasesduring the winter period.

Enhanced Services –Learning disability services are overperforming at this stage however is being offset by underperformance on Minor Surgery. Activity varies throughout the year.

General Practice contracts – Core contract payments are largely on plan with the exception of a slight overspend on the GMS contracts relating to changes in list size. As with all contracts this will vary throughout the year.

General Reserves – As in previous years Newark & Sherwood CCG has an unidentified QIPP target that is phased evenly throughout the year and is the primary driver of the overall deficit position as the scheme is still to be determined to achieve the balanced position.

Other GP Services – The key areas of spend in this category relate to CQC reimbursements, Seniority payments and Locum costs. At this stage all areas are performing on plan with a benefit from Locum budget not required year to date.

Primary Care Network (PCN) – A new category of spend has been introduced this financial year summarised as the PCN which encompasses the PCN payment, Clinical Director, Clinical Pharmacist and Social Prescriber payments.

QOF – The underspend relates to 18/19 prior year fall out £17k with the balance relating to lower than planned Aspiration payments.


£'000sYTD Budget

£'000sYTD Actual

£'000sYTD Variance

£'000sDispensing/Prescribing Drs 659 209 163 -46Enhanced Services 632 198 194 -4General Practice – APMS 903 299 299 0General Practice – GMS 12,131 4,024 4,041 17General Practice – PMS 0 0 0 0General Reserves -947 -314 0 314Other GP Services 290 95 75 -20Other Premises costs 104 34 39 5Premises Cost Reimbursement 2,253 747 724 -23Primary Care Networks 596 183 115 -68QOF 1,931 447 423 -24Grand Total 18,551 5,923 6,075 151

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Nottingham City CCG (04K)

The financial position for Nottingham City CCG at month four 2019/20 is £101K underspent. Below is the summary position by expenditure category.

Key Variances

Dispensing/Prescribing Drs – The spend on this code relates to payments made in relation to dispensing practices and the prescribing costs associated with them. This is currently underspending due to the seasonal factor that effects Prescribing in general and spend is expected to increase during the winter months.

Enhanced Services – The majority of this underspend relates to Minor Surgery which had a prior year falloutof £26k.

General Practice Contracts – The budgets within the General Practice contracts have been adjusted to reflect the current list sizes and are all on plan.

General Reserves – There are a number of items that will be required to be funded by Reserves in 19/20;including List Size Adjustments, Locum costs and discretionary payments that will be required to be made to practices that have registered patients from practices that have closed.

Other GP Services – The underspend here relates to Seniority, this is due to Seniority as a whole being eroded over seven years and will fully come to an end in March 2020. As well as rules around only GPs that are currently in receipt of Seniority will be eligible to continue to receive it if they move practices, however, any new GP will not be eligible to receive Seniority payments.

Premises Cost Reimbursement – This is mainly on plan however, there is a continual review of Practice budgets to ensure that they are in line with expected costs.


£'000sYTD Budget

£'000sYTD Actual

£'000sYTD Variance

£'000sDispensing/Prescribing Drs 264 88 32 -56Enhanced Services 1,043 348 321 -27General Practice – APMS 3,315 1,101 1,101 0General Practice – GMS 19,570 6,481 6,481 0General Practice – PMS 10,709 3,507 3,507 0General Reserves 1,632 0 0 0Other GP Services 808 316 300 -16Other Premises costs 2,122 707 709 1Premises Cost Reimbursement 5,793 1,931 1,929 -2Primary Care Networks 1,569 523 523 0QOF 3,890 1,296 1,296 -1Grand Total 50,715 16,299 16,198 -101

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Nottingham North & East CCG (04L)

The financial position for Nottingham North & East CCG at month four 2019/20 is £96k underspent. Below is the summary position by expenditure category.


Enhanced Services – The majority of this underspend relates to Minor Surgery which had a prior year fallout of £15k and this service is also currently underspent by £12k for 19/20.

General Practice Contracts – The budgets within the General Practice contracts have been adjusted to reflect the current list sizes and are all on plan.

General Reserves – Items that will be required to be funded from Reserves include current Locum claims and Caretaker costs where the agreement specifies amounts to be held in Reserves to cover any shortfall in funding.

Other GP Services – This underspent position is mainly around Seniority (£6k), CQC (£5k) and Staff Relief(£6k).


Other Premises Costs – The majority of this underspend relates to a £24k prior year fallout for practice C84026 Stenhouse Medical Centre that has occurred due the current valuation being less than the expected increase.


£'000sYTD Budget

£'000sYTD Actual

£'000sYTD Variance

£'000sDispensing/Prescribing Drs 285 95 74 -21Enhanced Services 410 136 110 -27General Practice – APMS 84 84 83 -2General Practice – GMS 3,957 1,327 1,327 0General Practice – PMS 8,284 2,688 2,688 0General Reserves 1,058 0 0 0Other GP Services 350 133 114 -20Other Premises costs 160 53 29 -24Premises Cost Reimbursement 1,479 493 490 -2Primary Care Networks 646 215 215 0QOF 1,845 615 615 0Grand Total 18,558 5,841 5,745 -96

Finance Report


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Nottingham West CCG (04M)

The financial position for Nottingham West CCG at month four 2019/20 is £10k underspent. Below is the summary position by expenditure category.

Key Variances


Enhanced Services – Learning Disability Health Checks enhanced service is currently overspent by £6k, based on current CQRS claims to date.

Other Premises Costs - Currently overspent by £12k, the main overspend here relates to Giltbrook Surgery where budgets are going to be reviewed following the transfer from Nottingham North & East CCG to ensure that all budgets are in the correct place.



£'000sYTD Budget

£'000sYTD Actual

£'000sYTD Variance

£'000sDispensing/Prescribing Drs 127 42 18 -24Enhanced Services 398 133 139 7General Practice – APMS 0 0 0 0General Practice – GMS 5,521 1,827 1,827 0General Practice – PMS 3,813 1,263 1,262 0General Reserves 708 0 0 0Other GP Services 177 59 58 -1Other Premises costs 230 77 88 12Premises Cost Reimbursement 1,529 510 507 -3Primary Care Networks 393 131 131 0QOF 1,693 564 564 0Grand Total 14,589 4,605 4,595 -10

Finance Report


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Rushcliffe CCG (04N)

The financial position for Rushcliffe CCG at month four 2019/20 is £14k underspent. Below is the summary position by expenditure category.

Key Variances


Other Premises Costs – The majority of this overspend relates to a rent review for C84025 (East Bridgford MC) which had rent arrears of £24k more than was anticipated.

Premises Costs Reimbursements – Clinical Waste currently underspent by £5k, but the costs and accruals are done on a claims basis so tends to fluctuate.


£'000sYTD Budget

£'000sYTD Actual

£'000sYTD Variance

£'000sDispensing/Prescribing Drs 840 280 250 -30Enhanced Services 365 122 120 -2General Practice – APMS 0 0 0 0General Practice – GMS 5,303 1,756 1,756 0General Practice – PMS 5,664 1,878 1,878 0General Reserves -344 0 0 0Other GP Services 280 93 91 -3Other Premises costs 239 80 103 24Premises Cost Reimbursement 1,973 657 654 -3Primary Care Networks 524 175 175 0QOF 1,643 548 548 0Grand Total 16,487 5,588 5,574 -14

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Paper Title: Risk Report Paper Reference: PCC 19/055

Sponsor:

Presenter:

Elaine Moss, Director of Quality and Governance


Risk Report

Risk Register (Extract) -Appendix A

Siân Gascoigne, Corporate Governance and Assurance Manager

Summary Purpose:



☒

Executive Summary

The purpose of this paper is to present the Primary Care Commissioning Committees with risks relating to the Committees’ responsibilities. The paper provides assurance that risks pertaining to each Committee’s responsibilities are being systematically captured across the Nottingham and Nottinghamshire CCGs and that sufficient management actions are in place and being actively progressed.




☐

Performance Management ☐ Cultural and/or Organisational Development ☐






Yes ☐ No ☐ N/A☒ None required for this paper.


Yes ☐ No ☐ N/A☒ None required for this paper.

Risk Report


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Report contains all risks from the CCGs’ corporate risk register which fall under the remit of the Primary Commissioning Committees.


☒No

Recommendation(s):

1. COMMENT on the risks shown within this paper (including the high/red risk) and those at Appendix A;

2. HIGHLIGHT any risks identified during the course of the meeting for inclusion within the Corporate Risk Register.

Risk Report


1

Primary Care Commissioning Committees

Monthly Risk Report

1. Introduction

The purpose of this paper is to present the Primary Care Commissioning Committees

with risks relating to the Committees’ responsibilities. The paper provides assurance

that primary care risks are being systematically captured across the Nottingham and

Nottinghamshire CCGs and those sufficient management actions are in place and

being actively progressed.

2. Risk Profile

There are currently six risks pertaining to the Committees’ responsibilities (as

detailed in Appendix A). The movement

of risks is described in Sections 3 and 4

of this paper.

The table to the right shows the current

risk profile of the six risks.

Since the last meeting, risks have been

reviewed by the Corporate Governance

and Assurance Manager in conjunction

with the Associate Director of Primary

Care, Locality Directors, Associate

Director of Estates and finance

colleagues.

There is one high / red risk in the Committees’ remit as outlined below. It should be

noted that the risk narrative has been slightly amended following discussions at the

August meeting of the Governing Bodies and discussions with the Associate Director

of Primary Care and the Lay Member (Quality and Performance).

Risk

Reference Risk Narrative

Current Risk

Score

RR 032 Reducing workforce capacity and capability within General

Practice may impact the sustainability of some GP Practices.

This risk can be influenced by a number of internal and

Overall Score

16: Red

Risk Matrix

Imp

act

5 - Very High

4 – High 1

1

3 – Medium 1 3

2 – Low

1- Very low

1 -

Rare

2 -

unlik

ely

3 -

Po

ssib

le

4 -

Lik

ely

5 -

Alm

ost

Cert

ain

Likelihood

Risk Report


2

external factors, including GP closures, changes in Practice

boundaries, new housing developments, for example.

This presents a risk that GP Practices may be unable to

deliver core services and transformation requirements, which

in turn, may adversely impact patient experience, patient

outcomes and the quality of services. (Reworded August

2019)

(I4 x L4)

3. Risk Identification

Since the last meeting, discussions have been held with the Associate Director of

Primary Care and the Lay Member (Quality and Performance) in relation to potential

risks associated with the closure of GP Practices.

These, along with a potential risk regarding the loss of financial flexibility due to

national funding adjustments to the primary care budget, have been included in the

Corporate Risk Register, as described below:

Risk Reference

Risk Narrative Current Risk

Score

RR 103

Closure of Practices and/or changes in Practice boundaries,

presents a risk that members of the population may not

register (or re-register) and, thus, may not access primary

care services.

Overall Score 6: Amber

(I3 x L2)

RR 104

Increasing pressure / demand on GP Practices, alongside

capacity and access concerns, presents a potential risk

regarding the quality of primary care services being received.

This, in turn, may result in poor clinical outcomes and/or

patient experience.


(I4 x L2)

RR 089

National funding adjustments within primary care has

resulted in a loss of financial flexibility for the organisation (of

a value £1.4 million). This has also resulted in a cost

pressure of £400k within the primary care budget.

The above presents a potential risk to the delivery of the Mid-

Nottinghamshire CCGs' financial control total.


(I3 x L3)

4. Archiving of Risks

There are no risks being proposed for archiving.

Risk Report


3

5. Amendments to Risk Score

There have been no changes to risk scores since the last meeting of the Committee.

6. Recommendations

The Committees are asked to:

COMMENT on the risks shown within this paper (including the high/red risk) and

those at Appendix A; and

HIGHLIGHT any risks identified during the course of the meeting for inclusion

within the Corporate Risk Register.

Risk Report


Risk Ref Oversight Committee

(as per June 2019

Governance Structure)

Directorate

(as per April 2019

Joint CCG structure)

Relevance to

Statutory CCG

Risk Source /

Previous Risk Ref

(e.g. GN or MNs)

Date Risk

Identified

Risk Description Risk Category Existing Controls Mitigating Actions Mitigating Actions Progress Update: Last Review

Date

(Relevant committee in the

CCGs' governance

structure responsible for

monitoring risks relating to

their delegated duties)

(Risk relevant to all

six statutory CCGs or

specific CCGs, as

noted).

(Previous risk

register ref if

applicable)

(Date risk

originally

identified)

(These risks are by-products of day-to-day business delivery. They arise

from definite events or circumstances and have the potential to impact

negatively on the organisation and its objectives.)

Imp

act

Like

liho

od

Sco

re

(The measures in place to control risks and reduce the likelihood of them

occurring).

(Actions required to manage / mitigate the identified risk. Actions should support achievement of

target risk score and be SMART (e.g. Specific, Measurable, Assignable, Realistic and Time-bound).

Imp

act

Like

liho

od

Sco

re

(To provide detailed updates on progress being made against any

mitigating actions identified. Actions taken should bring risk to level

which can be tolerated by the organisation).

RR022 Primary Care

Commissioning

Committees

Commissioning All 6 CCGs GN068 Jul-19 There is a risk that reductions in unwarranted clinical variations in

primary care may not be achieved across Nottingham and

Nottinghamshire in order to deliver better value for money and better

outcomes for patients.

Commissioning

Lucy

Dad

ge

Loca

lity

Dir

ecto

rs

4 3 12 • Role and remit of the Primary Care Commissioning Committee (and

supporting governance structures - e.g. primary care quality / contracting

teams)

• PCCC assurance reporting requirements (PENDING)

• Activity monitoring via e-Health Scope tool.

• GP Practice Quality Visits programme

Action: To implement and embed PCCC supporting governance and reporting requirements to ensure

appropriate assurance is provided regarding primary care services (e.g. quality of services, delivery of

contract requirements, patient experiences).

3 3 9 August 2019: It was advised that the Locality Directors (and

Deputies) have reviewed the activities in each ICP and will

benchmark to ensure consistency of approach in relation to GP

referrals.

09/08/19

RR023 Primary Care

Commissioning

Committees

Commissioning All 6 CCGs GN070 Jul-19 As practices have seen an increase in charges for non-reimbursable

costs for premises from Property Services and from CHP (Community

Health Partnerships), there is a risk that (for some practices) this may

impact viability of providing primary care services from their current

location.

This may, in turn, may lead to service disruption, inability to invest

and/or risks to patient access to primary care services.

Finance

Lucy

Dad

ge

Lyn

ne

Shar

p

3 3 9 • CCG meetings with NHS Property Services and Community Health

Partnerships (quarterly).

• Engagement with NHS England Primary Care national and local teams

• LMC support to Practices

Action: To continue to work with local GP practices, the LMC and property companies (NHSPS and

CHP) to ensure management plans are in place.

3 3 9 August 2019: It was highlighted by the Associate Director of

Primary Care that some element of this risk is mitigated via lease

agreements in place directly between the GP Practices and

CHP/NHSPS.

Work is also ongoing to support Practices in identifying solutions to

their premises cost issues, with areas of most concern (e.g. largest

debt) being prioritised. Clear advice is being provided from the

CCGs (and LMC) to Practices to pay reimbursable costs and pay

costs not in dispute.

08/08/19

RR032 Primary Care

Commissioning

Committees

Commissioning All 6 CCGs GN089 Jul-19 Reducing workforce capacity and capability within General Practice

may impact the sustainability of some GP Practices. This risk can be

influenced by a number of internal and external factors, including GP

closures, changes in Practice boundaries, housing development, for

example. (Reworded August 2019)

This presents a risk that GP Practices may be unable to deliver core

services and transformation requirements, which in turn, may

adversely impact patient experience, patient outcomes and the quality

of services provided.

Workforce

Lucy

Dad

ge

Shar

on

Pic

kett

4 4 16 • Role and remit of the Primary Care Commissioning Committee (and

supporting governance structures - e.g. primary care quality / contracting

teams)

• PCCC assurance reporting requirements (PENDING)

• Appointment of Associate Director of Primary Care

• Appointment of Associate Director of PCN Development

• Appointment of Locality Directors (and supporting teams)

• Establishment of Primary Care Networks (PCNs) (and/or other

collaboration/federation activities)

• Delivery of the Nottingham and Nottinghamshire ICS Workforce and OD

Plan

• Ensuring the best use of funding via the GP Forward View, targeting

resources to areas of need e.g. GP Resilience Funding, Practice Manager

training and development funding.

• CQC Inspection Rating(s) / Report(s)

Action: Implement and embed PCCC supporting governance and reporting requirements to ensure

appropriate assurance is provided regarding primary care services (e.g. quality of services, delivery of

contract requirements, patient experiences).

Action: To continue to deliver requirements of Primary Care Workforce Strategy.

4 4 16 August 2019: Risk narrative updated following discussions with

Associate Director of Primary Care and Chair of PCCC. It was

confirmed that workforce capacity and capability continues to be

the biggest risk area for Primary Care. Work continues through the

Primary Care Workforce Strategy to manage this risk; examples

included the GP Retention Scheme, training and development

activities/placements, work with the LMC and PCNs.

12/08/19

RR089 Finance and Turnaround

Committee / Primary Care

Commissioning Committee

Commissioning MN CCGs N/A Jul-19 National funding adjustments within primary care has resulted in a loss

of financial flexibility for the organisation (of a value £1.4 million). This

has also resulted in a cost pressure of £400k within the primary care

budget.

The above presents a potential risk to the delivery of the Mid-

Nottinghamshire CCGs' financial control total.

Finance

Stu

art

Po

yno

r

Mic

k C

awle

y /

Shar

on

Pic

kett

4 3 12 • Financial management arrangements (including Associate Director of

Primary Care as nominated Primary Care Budget Holder) to identify

opportunities within Primary Care budgets to match the pressure where its

arisen.

• Financial Recovery Plan (and associated action plan, SRO, Programme

Lead and supporting governance arrangements)

Action: To scrutinise primary care budgets to determine if actions can be taken to offset any increase

in spend.

Action: To ensure appropriate financial management arrangements are in place across (e.g. budget

holder handovers following staff Consultation).

3 3 9 August 2019: Meetings have been held between Associate Director

of Primary Care and relevant finance leads in relation to the

financial position of primary care budgets.

12/08/2019

RR103 Primary Care

Commissioning

Committees

Commissioning All 6 CCGs N/A Aug-19 Closure of Practices and/or changes in Practice boundaries, presents a

risk that members of the population may not register (or re-register)

and, thus, may not access primary care services. (Draft risk)

CommissioningLu

cy D

adge

Shar

on

Pic

kett

3 3 9 • GP Practice List dispersal and transfer arrangements.

• Primary Care Network (PCN) collaborative arrangements / business

continuity arrangements.

• Increased clinical capacity at surrounding GP Practices (via transfer of

workforce from two closed Practices)

• Increased quality and contract review meetings with two remaining GP

Practices(weekly)

• Communication and engagement activities regarding GP closures (social

media, letters, etc.)

Action: To continue communications and engagement activities to support patient registering/re-

registering.

3 2 6 New risk identified. 12/08/2019

RR104 Primary Care

Commissioning

Committees

Commissioning All 6 CCGs N/A Aug-19 Increasing pressure / demand on GP Practices, alongside capacity and

access concerns, presents a potential risk regarding the quality of

primary care services being received. This, in turn, may result in poor

clinical outcomes and/or patient experience. (Draft risk)

Quality

Lucy

Dad

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Ro

sa W

add

ingh

am

4 3 12 • Quality reviews / Quality dashboards / Primary Care Quality monitoring

framework.

• Primary Care Network (PCN) collaborative arrangements / business

continuity arrangements.

• Increased clinical capacity at surrounding GP Practices (via transfer of

workforce from two closed Practices)

• Increased quality and contract review meetings with two remaining GP

Practices(weekly)

Action: To develop partnership arrangements for the future provision of GP services for this group of

Practices.

Action: To develop proactive business continuity and collaborative arrangements across PCNs.

4 2 8 New risk identified. 12/08/2019

Current Risk

Rating

Initial Risk Rating

Corporate Risk Register for Nottingham and Nottinghamshire CCGs (August 2019)

Exe

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meeting agenda (open session) wednesday 21 august 2019 9 ... · meeting agenda (open session)...

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