meeting agenda ( public session) primary care ...€¦ · primary care network participation...

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Meeting Agenda (Public Session)

Primary Care Commissioning Committee Wednesday 20 May 2020 9:00-10:45

MS Teams Meeting

Time Item Presenter Reference

09:00 Introductory Items

1. Welcome, Introductions and apologies Eleri de Gilbert PCC/20/068

2. Confirmation of quoracy Eleri de Gilbert PCC/20/069

3. Declarations of interest for any item on the agenda Eleri de Gilbert PCC/20/070

4. Management of any real or perceived conflicts of interest

Eleri de Gilbert PCC/20/071

5. Questions from the public Eleri de Gilbert PCC/20/072

6. Minutes from the meeting held on 22 April 2020 Eleri de Gilbert PCC/20/073

7. Consolidated action log from the predecessor CCGs’ Primary Care Commissioning Committee meetings


8. Actions arising from the Governing Body Eleri de Gilbert PCC/20/075

09:15 Covid-19 Update

9. Primary Care Response to the Covid-19 Pandemic - Update

Lucy Dadge PCC/20/076 - Verbal

10. Overview of GP Practice Additional Expenses in Relation to COVID-19

Lynette Daws PCC/20/077

09:35 Items for Approval

11. Objective Decision Making Criteria Joe Lunn PCC/20/078

12. Additional First Contact Physiotherapists – Mid-Nottinghamshire Primary Care Networks

David Ainsworth PCC/20/079

09:55 Items for Assurance

13. Primary Care Network Participation 2020-2021 Helen Griffiths PCC/20/080

14. Internal Audit Report: Delegated Primary Medical Care Functions

Joe Lunn PCC/20/081

15. Local Enhanced Services Update Joe Lunn PCC/20/082 - Verbal

16. Primary Care Quality Report Esther Gaskill PCC/20/083

10:30 Risk Management

17. Risk Report

Siân Gascoigne PCC/20/084

Chair: Eleri de Gilbert

Enquiries to: ncccg.notts - [email protected]

Agenda

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10:40 Closing Items

18. Any other business

Clinical Director Arrangements


19. Risks identified during the course of the meeting Eleri de Gilbert PCC/20/085

20. Key messages to escalate to the Governing Body Eleri de Gilbert PCC/20/086

21. Date of next meeting:

17/06/2020

MS Teams Meeting


Confidential Motion: The Primary Care Commissioning Committee 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

2 of 193 09:00 - 10:45 via MS Teams-20/05/20

Name Current position (s)

held in the CCGs

Declared

Interest

(Name of the

organisation

and nature of

business)

Nature of Interest

Fin

an

cia

l In

tere

st

No

n-f

ina

nc

ial

Pro

fes

sio

na

l In

tere

sts

No

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ial

Pe

rso

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sts

Ind

ire

ct

Inte

res

t

Da

te F

rom

:

Da

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o:

Action taken to mitigate risk

AINSWORTH, David Locality Director Mid-Notts Erewash Borough Council Lay Member of the

Remuneration Committee

01/01/2019 Present This interest will be kept under review

and specific actions determined as

required.

AINSWORTH, David Locality Director Mid-Notts Consultancy Ad hoc nurse consultancy to

provider organisations



required.

BEEBE, Shaun Non-Executive Director Eastwood Primary Care Centre Family members are registered

patients

-

01/03/2020 Interest expired - no action required

BEEBE, Shaun Non-Executive Director University of Nottingham Senior manager with the

University of Nottingham

-

Present This interest will be kept under review


required.

BEEBE, Shaun Non-Executive Director Nottingham University Hospitals

NHS Trust

Patient in Ophthalmology

-



required.

BURNETT, Danni Deputy Chief Nurse NHS England and Improvement Spouse employed as Senior

Delivery and Improvement Lead



required.

BURNETT, Danni Deputy Chief Nurse Nottingham and Nottinghamshire

CCGs

Family member employed as

Head of Service Improvement

and BCF



required.

BURNETT, Danni Deputy Chief Nurse NHS England and Improvement Family member employed as

Contracts Manager



required.

BURNETT, Danni Deputy Chief Nurse NEMS Community Benefit Services

Ltd

Family member employed as

Finance Accountant



required.

Register of Declared Interests

• As required by section 14O of the NHS Act 2006 (as amended), the CCG has made arrangements to manage conflicts and potential conflicts of interest to ensure

that decisions made by the CCG will be taken and seen to be taken without being unduly influenced by external or private interests.

• This document is extracted, for the purposes of this meeting, from the CCG’s full Register of Declared Interests (which is publically available on the CCG’s website).

This document was extracted on 1 May 2020 but has been checked against the full register prior to the meeting to ensure accuracy .

• The register is reviewed in advance of the meeting to ensure the consideration of any known interests in relation to the meeting agenda. Where necessary

(for example, where there is a direct financial interest), members may be fully excluded from participating in an item and this will include them not receiving

the paper(s) in advance of the meeting.

• Members and attendees are reminded that they can raise an interest at the beginning of, or during discussion of, an item if they realise that they do have a (potential) interest

that hasn’t already been declared.

• Expired interests (as greyed out on the register) will remain on the register for six months following the date of expiry.

Declarations of interest for any item

on the agenda

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held in the CCGs

Declared

Interest

(Name of the

organisation

and nature of

business)

Nature of Interest

Fin

an

cia

l In

tere

st

No

n-f

ina

nc

ial

Pro

fes

sio

na

l In

tere

sts

No

n-f

ina

nc

ial

Pe

rso

na

l In

tere

sts

Ind

ire

ct

Inte

res

t

Da

te F

rom

:

Da

te T

o:


BURNETT, Danni Deputy Chief Nurse Academic Health Science Network Family member employed in

Project Team



required.

BURNETT, Danni Deputy Chief Nurse Castle Healthcare Practice Registered Patient 01/07/2018 Present This interest will be kept under review


required - as a general guide, the

individual should be able to participate in

discussions relating to this practice but

be excluded from decision-making.

CALLAGHAN, Fiona Locality Director - South

Nottinghamshire

No relevant interests declared Not applicable- -

Not applicable

CAWLEY, Michael Operational Director of

Finance

Castle Healthcare Practice Registered Patient

-







DADGE, Lucy Chief Commissioning Officer Mid Nottinghamshire and Greater

Nottingham Lift Co (public sector)

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


required.

DADGE, Lucy Chief Commissioning Officer Pelham Homes Ltd – Housing

provider subsidiary of

Nottinghamshire Community

Housing Association



required.

DADGE, Lucy Chief Commissioning Officer 3Sixty Care Ltd – GP Federation,

Northamptonshire

Chair 01/01/2017 Present This interest will be kept under review


required.

DADGE, Lucy Chief Commissioning Officer First for Wellbeing Community

Interest Company (Health and

Wellbeing Company)



required.

DADGE, Lucy Chief Commissioning Officer Valley Road Surgery Registered Patient 19/06/1905 Present This interest will be kept under review






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


required.

DAWS, Lynette Head of Primary Care Rivergreen Medical Centre Family members are registered

patients

-








on the agenda

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held in the CCGs

Declared

Interest

(Name of the

organisation

and nature of

business)

Nature of Interest

Fin

an

cia

l In

tere

st

No

n-f

ina

nc

ial

Pro

fes

sio

na

l In

tere

sts

No

n-f

ina

nc

ial

Pe

rso

na

l In

tere

sts

Ind

ire

ct

Inte

res

t

Da

te F

rom

:

Da

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o:


DE GILBERT, Eleri Non-Executive Director Middleton Lodge Surgery Individual and spouse registered

patients at this practice

-







DE GILBERT, Eleri Non-Executive Director Rise Park Practice Son and Daughter in Law

registered patients



required.

DE GILBERT, Eleri Non-Executive Director Nottingham Bench Justice of the Peace

-



required.

DE GILBERT, Eleri Non-Executive Director Sherwood and Newark Citizens

Advice Bureau

Trustee on the board 01/03/2016 07/02/2020 Interest expired - no action required

DE GILBERT, Eleri Non-Executive Director Major Oak Medical Practice,

Edwinstowe

Son, daughter in law and

grandchild registered patients

-



required.

GASKILL, Esther Head of Quality Intelligence Mapperley and Victoria Practice Registered Patient

-







GRIFFITHS, Helen Associate Director of Primary

Care Networks

Musters Medical Practice Registered Patient 01/04/2013 Present This interest will be kept under review







Care Networks

Castle Healthcare Practice

(Rushcliffe Practice)

Spouse is GP Partner 01/10/2015 Present To be excluded from all commissioning

decisions (including procurement

activities and contract management

arrangements) relating to services that

are currently, or could be, provided by

this practice


Care Networks

Embankment Primary Care Centre Spouse is Director 01/10/2015 Present This interest will be kept under review


required.


Care Networks

NEMS Healthcare Ltd Spouse is shareholder 01/04/2013 Present This interest will be kept under review


required.


Care Networks

Partners Health LLP Spouse is a member 01/10/2015 Present This interest will be kept under review


required.


on the agenda

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held in the CCGs

Declared

Interest

(Name of the

organisation

and nature of

business)

Nature of Interest

Fin

an

cia

l In

tere

st

No

n-f

ina

nc

ial

Pro

fes

sio

na

l In

tere

sts

No

n-f

ina

nc

ial

Pe

rso

na

l In

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sts

Ind

ire

ct

Inte

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t

Da

te F

rom

:

Da

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o:



Care Networks

Principia Multi-specialty Community

Provider

Spouse is a member 01/10/2015 Present This interest will be kept under review


required.


Care Networks

Nottingham Forest Football Club Spouse is a Doctor for club 01/04/2013 Present This interest will be kept under review


required.

LUNN, Joe Interim Associate Director of

Primary Care

Kirkby Community Primary Care

Centre

Registered Patient

-







SIMMONDS, Joanne Head of Corporate

Governance

Elmswood Surgery Registered Patient

-



required.

STRATTON, Dr Richard Governing Body GP

Representative

Belvoir Health Group GP Partner 01/08/2012 Present To be excluded from all commissioning



arrangements) relating to services that

are currently, or could be, provided by

GP Practices.

STRATTON, Dr Richard Governing Body GP

Representative

PartnersHealth LLP GP member 01/11/2015 Present To be excluded from all commissioning



arrangements) in relation to services

currently provided by Partners Health

LLP; and Services where it is believed

that Partners Health LLP could be an

interested bidder.

SUNDERLAND, Sue Non-Executive Director Joint Audit Risk Assurance

Committee, Police and Crime

Commissioner (JARAC) for

Derbyshire / Derbyshire

Constabulary



required.

SUNDERLAND, Sue Non-Executive Director NHS Bassetlaw CCG Governing Body Lay Member 16/12/2015 Present This interest will be kept under review


required.

SUNDERLAND, Sue Non-Executive Director Inclusion Healthcare Social

Enterprise CIC (Leicester City)

Non-Executive Director 16/12/2015 Present This interest will be kept under review


required.

TILLING, Michelle Locality Director - City No relevant interests declared Not applicable

- -

Not applicable


on the agenda

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held in the CCGs

Declared

Interest

(Name of the

organisation

and nature of

business)

Nature of Interest

Fin

an

cia

l In

tere

st

No

n-f

ina

nc

ial

Pro

fes

sio

na

l In

tere

sts

No

n-f

ina

nc

ial

Pe

rso

na

l In

tere

sts

Ind

ire

ct

Inte

res

t

Da

te F

rom

:

Da

te T

o:


TRIMBLE, Dr Ian Independent GP Advisor Occasional consultancy work for

other CCGs

Occasional consultancy work for

other CCGs



required.

TRIMBLE, Dr Ian Independent GP Advisor Unity Surgery, Mapperley Registered Patient

-







TRIMBLE, Dr Ian Independent GP Advisor National Advisory Committee for

Resource Allocation

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






WADDINGHAM, Rosa Chief Nurse No relevant interests declared Not applicable - - Not applicable

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

Nottinghamshire

Support service as for profit

subsidiary of LMC



required.

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


required.

WRIGHT, Michael LMC Representative, CEO GP-S coaching and mentoring Support service as for profit

subsidiary of LMC



required.

WRIGHT, Michael LMC Representative, CEO Nottinghamshire GP Phoenix

Programme

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


required.

WRIGHT, Michael LMC Representative, CEO Castle Healthcare Practice Registered Patient 30/09/2016 Present This interest will be kept under review


required.


on the agenda

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held in the CCGs

Declared

Interest

(Name of the

organisation

and nature of

business)

Nature of Interest

Fin

an

cia

l In

tere

st

No

n-f

ina

nc

ial

Pro

fes

sio

na

l In

tere

sts

No

n-f

ina

nc

ial

Pe

rso

na

l In

tere

sts

Ind

ire

ct

Inte

res

t

Da

te F

rom

:

Da

te T

o:


WRIGHT, Michael LMC Representative, CEO Notspar and Trent Valley Surgery

Special Allocation Schemes (violent

patient schemes)



required.


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

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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

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NHS Nottingham and Nottinghamshire Clinical Commissioning Group

Extra Ordinary Primary Care Commissioning Committee

unratified minutes of the meeting held on

23/04/2020, 9.00-9.30

Teleconference

(public session)

Members present:

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

Shaun Beebe Lay Member, Financial Management

Michael Cawley Operational Director of Finance

Lucy Dadge Chief Commissioning Officer

Helen Griffiths Associate Director of Primary Care Networks

Dr Richard Stratton GP Representative

Sue Sunderland Lay Member – Audit and Governance

Dr Ian Trimble Independent GP Advisor

In attendance:

Lucy Cassidy Nottinghamshire Local Medical Committee

Lynette Daws Head of Primary Care

Sue Wass Corporate Governance Officer (minutes)

Michael Wright Nottinghamshire Local Medical Committee

Apologies:

Joe Lunn Interim Associate Director of Primary Care

Rosa Waddingham

Chief Nurse

Cumulative Record of Members’ Attendance (2020/21)

Name Possible Actual Name Possible Actual

Shaun Beebe 1 1 Joe Lunn 1 0

Michael Cawley 1 1 Dr Richard Stratton 1 1

Lucy Dadge 1 1 Sue Sunderland 1 1

Eleri de Gilbert 1 1 Dr Ian Trimble 1 1

Helen Griffiths 1 1 Rosa Waddingham 1 0

Minutes from the meeting held on 22 April 2020

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Introductory Items

PCC 20 052 Welcome and Apologies

Eleri de Gilbert welcomed everyone to the public session of the meeting of the Primary

Care Commissioning Committee.

Apologies were noted as above.

PCC 20 053 Confirmation of Quoracy

The meeting was declared quorate

PCC 20 054 Declaration of interest for any item on the shared agenda

Prior to the meeting it was identified that Dr Richard Stratton as a provider of GP

Services, was conflicted for item PCC 20 060.

PCC 20 055 Management of any real or perceived conflicts of interest

The potential conflicts of interest were discussed. It was agreed he would participate in

the discussion but not the decision for item PCC 20 060.

PCC 20 056 Questions from the public

No questions had been received.

PCC 20 057 Shared minutes from the predecessor CCGs’ meetings held in common held on:

25 March 2020

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

PCC 20 058 Action log and matters arising from the from the predecessor CCGs’ meetings

held in common on:25 March 2020

Actions PCC 19 115 and PCC 20 024, 026, and 046 were noted as outstanding due to

the need to prioritise workload during the Covid-19 pandemic and would be brought to

the May meeting or added to the Committee’s work programme as appropriate.

The Chair reminded members that the objective decision making criteria (action PCC 20

048) had been circulated to members ahead of the May meeting in order for them to

provide input ahead of the final paper being produced for the May meeting. Members

were encouraged to send comments via the secretariat.

PCC 20 059 Actions arising from the Governing Body

There were no actions outstanding.

For Approval

PCC 20 0060 Primary Care Transformation Monies 2020/2021 - Proposal for Allocation of

Funding

Helen Griffiths introduced the item, highlighting the following points:

a) The report summarised progress over the last year on the use of primary care

transformation funds over a number of areas, including improving access, Primary


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Care Network (PCN) development and workforce training.

b) The report also detailed discussion, which had been undertaken with primary care

clinical leads during February, to determine the principles for the future allocation of

primary care transformation funds. There had been agreement that the money would

be best used if considered collectively as a ‘single pot’ of transformation funds.

There was also a general consensus and recognition that the money needed to be

split in different ways to best support the system; this included at an individual GP

practice level, as well as a PCN level, and where indicated at an ICP and ICS level,

to support creating a ‘Network of Networks’.

c) A key priority was to support the Clinical Directors with an uplift in their time to

0.4WTE to support the setup of PCNs. Due to the outbreak of the Covid-19

pandemic this action was not resolved and the current increased payment finished

on 31 March.

d) Although the uplift would take up to 60% of the PCN Support Fund for 2020/21,

there was support from the PCNs for this proposal

e) It was noted that the remaining primary care transformation funds, which were still to

be determined and allocated, would be discussed and determined later in the

financial year, when colleagues would have time to give a more considered

response to the best use of the funds to support the future emerging model of

general practice, post Covid-19.

f) The report requested approval of the uplift for PCN Clinical Directors.

The following points were made in discussion:

g) Lucy Dadge asked members to note the instrumental role that the PCN Directors

and the PCNs had taken during the response to the Covid-19 pandemic and for the

need to continue to build on the rapid progress made in establishing and

operationalising the PCNs.

h) Members discussed whether it was appropriate to use 60% of the funds for the uplift

in Clinical Director hours. It was noted that there was a reasonable underspend

from 2019/20 that could be used on other transformation activity. The need to

continue to build on the transformational activities that had been implemented as a

result of the response to the pandemic was emphasised. It was noted that the PCN

Clinical Directors required the extra capacity to ensure the positive changes were

embedded across the PCN areas.

i) Members noted the need to ensure that there was no duplication in funding claims

between the transformation funds and Covid-19 claims, which was acknowledged.

j) Members queried whether this expenditure was appropriate from the transformation

funds and it was noted that there was a wide criteria, which included demonstrating

PCN development across the maturity matrix; however this would be checked again,

whilst also considering if some of the additional activity should be appropriately

charged to the Covid 19 response.

k) Members acknowledged the pivotal role of the Clinical Directors in leading

transformational change within primary care and gave in principle approval to the

uplift in Clinical Director time, subject to confirmation of the fund to be used.

The Primary Care Commissioning Committee:

APPROVED the funding for PCN Clinical Directors to uplift their time to support

PCN delivery and development to 0.4 WTE for full year effect until 31st March 2021.


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To Note

PCC 20 061 Primary Care Response to the Covid-19 pandemic - Update

Lucy Dadge gave a verbal update, highlighting the following points:

a) Primary care had had to adjust to changing demand and unknown challenges

rapidly. It had been a major exercise to establish the Clinical Management Centres;

however they had proved to be flexible and resilient structures.

b) The establishment of Opel reporting had given a clear understanding of the position

of individual practices on a daily basis, enabling support and resource to be shared.

The use of Teamnet to disseminate timely and consistent messages was also noted

as invaluable.

c) These innovations would not have been evident without the Primary Care Networks.


d) Members noted the pivotal leadership of the PCN Clinical Directors in driving the

response and noted the support given by the Local Medical Committee.

e) Members thanked staff working in primary care - the CCG; PCNs; and practices for

their hard work during this time, ensuring resilience in local primary care services

and demonstrating cooperation and innovation / transformation at pace

f) In response to a query from members around additional support being given to the

vulnerable, it was reported that the Humanitarian cell was addressing this.


NOTED the Primary Care Response to the Covid-19 pandemic – Update

PCC 20 062 Overview of GP Practice Additional Expenses in Relation to COVID-19

Lynette Daws introduced the item, highlighting the following points:

a) Since the Covid-19 outbreak, additional pressures and costs had been placed on

General Practice in order for them to respond to the needs of patients whilst

maintaining a safe environment for their staff. A process had been established for

General Practice to claim for these additional expenses and in turn the CCG would

re-claim expenditure from NHS England.

b) All claims necessitated associated evidence and had to be additional to the

Practice’s regular outgoings. The CCG was auditing the claims prior to payment

and the report gave an overview of the number of claims to date.


c) Members queried the assurance process and it was noted there was a three tier

process.

d) Members queried why, compared to the total sum of claims submitted, the sum for

the payment of claims was relatively low. It was noted that many claims had been

returned because of lack of evidence. As this was a new process, it required some


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time to embed and it was anticipated the payment figure would rise as supporting

evidence was forthcoming.


NOTED the Overview of GP Practice Additional Expenses in Relation to COVID-19

Risk Management

PCC 20 063 Risk Report

Sian Gascoigne introduced the item, highlighting the following points:

a) There were currently five risks relating the Committees responsibilities. All had been

reviewed and it was proposed to archive risk 089, relating to last year’s financial

reporting position. No other amendments were recommended.

b) A full review of the Corporate Risk Register was currently on-going to ensure that

the ‘live’ risks recorded continued to be relevant to the single CCG and that the

controls and mitigating actions listed were up to date and accurate.

c) A further exercise was being undertaken to determine whether any risks listed need

to be marked as ‘inactive’ during the current Covid-19 incident response period.

d) The major operational risk for the CCG relating to Covid-19 was also being

examined to ascertain whether it should be broken down into component parts and

an update would be made to the next Committee.


APPROVED the archiving of risk RR 089

Closing Items

PCC 20 064 Any other business

There was no other business.

PCC/20/065

Risk identified during the course of the meeting

No new risks were identified.

PCC/20/066

Key messages to escalate to the Governing Body

Approval of the funding for PCN Clinical Directors to uplift their time to support PCN

delivery and development to 0.4 WTE for full year effect until 31st March 2021.

PCC/20/067 Date of next meeting:

20/05/2020

Teleconference


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Primary Care Commissioning Committee Consolidated open action log from the predecessor CCGs’ Primary Care Commissioning Committee meetings

MEETING

DATE

CCG AGENDA

REFERENCE

AGENDA ITEM ACTION LEAD DATE TO BE

COMPLETED

COMMENT

ACTIONS OUTSTANDING

No actions outstanding

ACTIONS ONGOING/NOT YET DUE

20/11/2019 Nottingham

City

PCC 19/115 Welbeck Surgery

Patient List

Closure

To bring an outline PCN/CCG

plan, with proposed timescales

(supported by the affected

practices) to the Committees

demonstrating that work was in

progress to alleviate pressure on

neighbouring practices caused by

recent practice closures.

Lynette Daws To be

confirmed

The need for the paper has

been superseded by the

Covid 19 response. All

PCNs are working together

to support capacity

pressures within the system,

in addition to new measures

implemented to manage

patient flow, for example,

Clinical Management

Centres. Action proposed

for closing.

19/02/2020 All PCC 20/026 Primary Care A report to be produced detailing Esther To be Verbal update to be given at

Action log and m

atters arising from the from

the meeting held on 22 A

pril 2020

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MEETING

DATE

CCG AGENDA

REFERENCE


COMPLETED

COMMENT

Quality Group’s

Terms of

Reference and

Quality Reporting

how ‘lessons learnt’ have informed

the CCGs' quality monitoring

systems and processes.

Gaskill/Rosa

Waddingham

confirmed the meeting.

21/08/2019 Mansfield

and

Ashfield

CCG

PCC 19/048 Millview Surgery –

Six Month List

Closure Review

Michael Wright to share with Lucy

Dadge a set of objective criteria

the Committees could use when

considering patient list closure

applications. This will be reviewed

and updated for approval at the

September 2019 meeting.

Lucy Dadge To be

confirmed

The Objective Decision

Making Criteria is included

on the May 2020 agenda for

approval.

19/02/2020 All PCC 20/024 Contract

Management

Update Report

It was agreed that an item to

discuss the local recruitment of GP

Partners and issues around the

GP estate would be scheduled on

the forward programme

Andrea

Brown/Lynne

Sharp

To be

confirmed

This has been scheduled on

the forward work

programme for June 2020

25/03/2020 All PCC 20/046 Action from

Previous Meetings

To circulate the draft objective

decision making criteria for list

closure applications to the

Committees for comment.

Sue Wass To be

confirmed

Draft criteria circulated on

12 April 2020

Action log and m



pril 2020

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MEETING

DATE

CCG AGENDA

REFERENCE


COMPLETED

COMMENT

25/03/2020 Nottingham

City

PCC 20/048 Leen View

Surgery:

Boundary

Reduction

To add to the Committee’s

workplan an update on the PCN

DES for care homes in July

Sue Wass To be

confirmed

The forward work

progamme has been

updated.

Action log and m



pril 2020

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Primary Care Commissioning Committee OPEN ACTION LOG from the Governing Body on 6 May 2020

MEETING

DATE

CCG AGENDA

REFERENCE


COMPLETED

COMMENT

ACTIONS OUTSTANDING

No actions outstanding

ACTIONS ONGOING/NOT DUE

No actions ongoing/not due

Actions arising from

the Governing B

ody

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Meeting Title: Primary Care Commissioning

Committees (Open Session) Date: 20 May 2020

Paper Title: Overview of GP Practice Additional

Expenses in Relation to COVID-19. Paper Reference: PCC 20 077

Sponsor:

Presenter:

Joe Lunn, Associate Director of Primary Care

Attachments/ Appendices:

-

Lynette Daws, Head of Primary Care

Summary Purpose:

Approve ☐ Endorse ☐ Review

☐ Receive/Note for:

Assurance

Information

☒

Executive Summary

This paper is in line with delegated function 3; Management of the delegated funds.

On 3 April 2020, information was distributed to practices informing them of a process to claim back additional expenses incurred directly due to COVID-19 pressures. This paper provides an overview of the cost for April, specifically the cost of Bank Holiday Staffing, the process undertaken and summary of spend areas.

This is a further update to the paper which was presented to the committee meeting held on 22 April 2020 which detailed the cost of claims submitting in March.

Relevant CCG priorities/objectives:

Compliance with Statutory Duties ☐

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

☐

Performance Management ☐ Approval of Practice Mergers ☐

Strategic Planning ☐ Procurement and/or Contract Management ☐

Conflicts of Interest:

☒ No conflict identified

☐ Conflict noted, conflicted party can participate in discussion and decision

☐ Conflict noted, conflicted party can participate in discussion, but not decision

☐ Conflict noted, conflicted party can remain, but not participate in discussion or decision

☐ Conflict noted, conflicted party to be excluded from meeting

Completion of Impact Assessments:

Equality / Quality Impact Assessment (EQIA)

Yes ☐ No ☐ N/A ☒ Not applicable to this item

Data Protection Impact Assessment (DPIA)


Overview of GP Practice Additional Expenses in Relation to COVID-19

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Risk(s):

None identified

Confidentiality:

☒No

☐Yes (please indicate why it is confidential by ticking the relevant box below)

Recommendations for the Committee

1. NOTE the information for assurance purposes.

GP Practice Additional Expenses due to Covid-19 Pressures

Since the COVID-19 outbreak, additional pressures and costs have been placed on General Practice in order for them to respond to the needs of patients whilst maintaining a safe environment for their staff and patients. On the 3 April 2020, a message was distributed to practices via TeamNet, outlining a process for which practices could claim back additional expenses from the CCG in relation to costs incurred due to COVID-19. Practice managers were also emailed on the 6th April to ensure the message was received by all.

Practices can claim for additional expense incurred due to COVID-19 pressures such as; staff overtime costs, locum support for ill or self-isolating GPs, additional PPE or additional cleaning items. However, in order to be accepted under the reimbursement arrangement, the costs have to be additional to the practice’s regular orders and outgoings and items must be appropriate and necessary in dealing with the COVID-19 outbreak.

The CCG is currently supporting additional costs as a result of COVID-19 at risk. The CCG will seek to reclaim expenditure from NHS England but need to be able to evidence and demonstrate to NHS England that all costs are appropriate and will satisfy their processes.

Overview of Claims Submitted in April

Practices were asked to submit their April expenses by 8 May 2020 in order to receive timely payment, only claims which related to the month of March and April would be accepted for this submission and practices had to submit backing rationale and evidence of the spend with their claim. Claims originally submitted in March where payment was withheld, were processed again for payment where the extra required information had been received.

Summary of April Claims:

108 practices submitted claims

The total cost of the claims submitted was £717,951.54.

From this total: £465,798.89 has been approved for payment in May. (The above figures are inclusive of claims for bank holiday staffing; further information on the cost of bank holiday is included within this paper.)

From the total of approved claims, £68,804.05 relates to March claims. These were claims originally withheld from payment and the further evidence and information required for payment has now been supplied. The figure also includes a small amount of late claim submission claims. The total sum of paid March claims now stands at: £142,151.05.

Claims were withheld from payment due to the following reasons: o No backing evidence of spend was provided o Practices did not submit forms correctly o Practices did not provide appropriate rationale for the claim o The CCG are awaiting further supporting evidence to allow a review of clinical need for appropriate


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medical equipment to be undertaken o Following clinical review the item may or may not be deemed as appropriate or necessary in relation

to COVID-19

Bank Holiday Staffing Costs

The Easter Bank Holiday 10 and 13 April 2020 have been deemed “normal working days” by NHS England in order to help manage the demand on services over the weekend in the response to dealing with COVID-19. GP practices open on Good Friday or Easter Monday can seek reimbursement for additional staffing costs incurred on these days, in line with the respective national rates set for reimbursement set out below: • Sessional GPs: up to a maximum of £250 a session or £500 per day;

• Overtime for salaried GPs in line with the individual’s contractual arrangements;

• Additional capacity from GP Partners to recognise up to two additional sessions on each of Good Friday and Easter Monday at a rate of £289 per session plus applicable employer National Insurance and pension costs;

• Overtime for non-GP practice staff in line with the individual’s contractual arrangements.

As with the above claims, the CCG will look to reclaim the expenditure from NHS England. The cost of this so far is detailed below:

Of the total sum of claims submitted £424,370.47 related to the cost of staffing for the Easter Bank Holiday. Claims were checked to ensure they were in line with the guidance stated by NHS England.

£256,852,86 worth of claims has been approved for payment.

The remaining £167,517.61 has been withheld from payment, awaiting further evidence. Suitable evidence includes; staff rotas, timesheets, invoices or overtime sheets which demonstrate the costs incurred to the practice.

Total Spend Breakdown of claims paid in April

A breakdown of the spend in each claim category is listed below:

Area of Spend Cost

Cleaning Resources £9,436.50

Equipment Costs £20,792.39

Estates Costs £2,466.73

PPE £30,723.52

Postage Costs £2,541.20

Printing/Stationary £1,058.01

Scrubs £2,283.31

Telephony Charges £2,824.56

Admin Staffing (Including Practice Manger Time) £104,973.56

GP Partner and Salaried Staffing £130,564.44

Nursing Staff Costs £33,847.36

GP Locum Costs £71,389.79

Cleaning Staff (Additional Expense) £2,757.29

COVID Expenses - Other £50,140.23

(N.B this table is based on the categorisation of items by individual practices).


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Future submission and payment dates are as follows:

May 2020 Claim - Submit by 12th Jun - Paid by 26th Jun

Summary

The total amount approved for payment for April 2020 COVID-19 expenses is £465,798.89.

£256,852,86 of this figure is due to staffing claims from the 2 Bank Holiday days over the Easter period.

Due to receipt of additional information, evidence and new claims, a further £68,804.05 of the total approved figure comes from claims dated in March.

On-going contact is taking place with practices where deductions from their original claims were made. If practices are able to provide further information and evidence, deeming the claim payable, they will be considered for future payment in June 2020.

The maximum payable for this month’s claims would be £717,951.54.


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Primary Care Workforce Scoring Matrix for List Closures – May 20 Page 1 of 5

`

Meeting Title: Primary Care Commissioning Committees (Open Session)

Date: 20 May 2020

Paper Title: Objective Decision Making - Workforce Scoring Matrix for List Closures

Paper Reference: PCC 20 078

Sponsor:

Presenter:




Summary Purpose:

Approve ☒ Endorse ☐ Review ☐ Receive/Note for:

∑ Assurance∑ Information

☐

Executive Summary

Arrangements for Discharging Delegated Functions

Delegated function 4 – Decisions in relation to the commissioning, procurement and management of primary medical services contracts.

NHS England & Improvement Primary Medical Care Policy and Guidance Manual (PGM) covers List Closures under Section 5 – Formal Closure and ‘Informal’ or ‘Temporary’ List closure .

A paper was presented to the confidential Primary Care Commissioning Committees (PCCCs) of the 6 former CCGs at the meeting on 18 December 2019, this paper included references to existing criteria such as NHS England Policy Guidance Manual (PGM), a previous paper by the Local Medical Committee (LMC) and analysis of previous list closure applications approved by the committee.

The paper started to set out options for suggested ways forward, including key questions for the committee to consider when faced with list closure requests. These included narrative, objective and subjective evidence for the following areas:1. Workload Pressure 2. Consequence of closure3. Process4. Purpose of list closure

The PCCCs were supportive of the approach and agreed that the questions should offer consistency and transparency of decision making, whilst providing a level of flexibility.

The PCCCs of the 6 former CCGs requested the development of a set of criteria to ensure this transparency and consistency in approach and that when agreed the criteria be tested against previous list closure applications. The 6 former CCGs acted in accordance with NHSE guidance (PGM) but as the guidance is vague and doesn’t aid consistency the Nottingham & Nottinghamshire CCG going forward wants to ensure that applications for list size closures are managed in a consistent manner.

The purpose of this paper is to introduce and seek approval from the Primary Care Commissioning Committee (PCCC) the use of a Workforce Scoring Matrix Template; this will enable the Primary Care

Objective Decision Making Criteria

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Commissioning Team to capture required information consistently in support of applications for list closures.

Also to agree the Primary Care Commissioning Teams proposal of communicating the importance of the National General Practice Workforce Data collection to practices; explaining that the data will be used toevidence workforce challenges on receipt of list closure applications.


Compliance with Statutory Duties ☒

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

☐

Performance Management ☐ Approval of Practice Mergers ☐

Strategic Planning ☐ Procurement and/or Contract Management ☒









Yes ☐

No ☐ N/A☒

Not applicable to this item


Yes ☐

No ☐ N/A☒

Not applicable to this item

Risk(s):

There are no risks identified.

Confidentiality:

☒No


Recommendation(s):

The Committees are asked to:

1. APPROVE the use of the Workforce Scoring Matrix Template which is used to capture all information required in support of decisions relating to list closure applications.

2. AGREE to communicate the importance of submitting accurate National General Practice Workforce Data collections with GP practices in Nottingham and Nottinghamshire.


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Workforce Scoring Matrix for List Closures

Introduction

The NHS England & Improvement Primary Medical Care Policy and Guidance Manual (PGM) covers List Closures under Section 5 – Formal Closure and ‘Informal’ or ‘Temporary’ List closure .

Formal Closure - 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 or 5.2 ‘Informal’ or ‘Temporary’ List closure - While the GMS and PMS contracts do not allow for a ‘temporary’ or ‘informal’ list closure they do allow for a practice to refuse individual patient applications for inclusion in a contractors list of patients providing there are reasonable non-discriminatory grounds to do so (paragraph 21 of Part 2 of Schedule 3).

The PCCCs of the 6 former CCGs requested the development of a set of criteria to ensure transparency and a consistency in decision making. The PCCCs asked that the criteria for consideration be tested against previous list closure application and supported the option for the Primary Care Commissioning Team to develop a local Workforce Data Tool to be used to support the objective decision making criteria,for each list closure application received.

The Primary Care Commissioning Team initially explored the option to request bi-annual workforce data from all practices in Nottingham and Nottinghamshire, to create a local Workforce Data Tool. The workforce data required is to support the collation of relevant information to support each list closure request; examples of information needed are sessions or hours worked per week, per staff type and understand vacancy levels within each practice.

In response to an early draft of these options, the Local Medical Committee (LMC) suggested that where possible duplication in effort for general practice should be avoided. As general practice already submit quarterly workforce data via the National Workforce Reporting System (NWRS), requesting bi-annual workforce data in addition to this would create duplication of effort and reporting methods.

In light of this, the Primary Care Commissioning Team extracted the national data available via NWRS to ascertain if the content can be used to form a localised version of the workforce information. This data when extracted has also been cross-referenced and tested against workforce information that one of the former Rushcliffe CCG previously collated to support similar requests for lost size closures; this was collated on behalf of their Rushcliffe CCG member practices.

A comparison between the existing workforce data tools is detailed below;

1. National Workforce Reporting System (NWRS)Practices record details of their current workforce in the National Workforce Reporting System (NWRS), from which data is extracted on a quarterly basis and available on the NHS Digital website. This General Practice Workforce Data shows headcount numbers of GPs, Nurses, Admin/ Non-clinical staff working in General Practice. The data captured shows a comparison to the previous quarter and drills down practice-by-practice.

The most recent General Practice Workforce Data published on the NHS Digital website is dated 31st

December 2019 and consists of data between the periods of 1st October to 31st December 2019. The table below gives an overview of the workforce numbers across Nottingham and Nottinghamshire.

GPs Headcount Nurses Headcount Admin/ Non-clinical HeadcountPartners 416 Advanced Nurse

Practitioners85 Managers 220

Salaried 193 Nurse Specialists 6 Management Partners 4Retainers 7 Extended Role Practice

Nurse15 Medical Secretaries 209

Registrars 171 Practice Nurse 357 Receptionists 1,008Locums 126 Trainee Nurse 2 Estates and Ancillary 43TOTAL 913 Nursing Partners 1 Apprentices 28


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Nurse Dispensers 0 Other Admin/ Non-clinical 275TOTAL 466 TOTAL 1,787

The Primary Care Commissioning Team evaluated the data and found some inaccuracies with the headcount numbers reported by practices. For example, Practice A recruited GPs and other clinical staff since the list closure commenced in August 2019. The practice reported no workforce changes on the NWRS between the quarter submissions ending September and December 2019. The reason for thiscould be that a GP left prior to the December 2019 submission deadline which therefore wouldn’t show a change in headcount between quarters. As part of the planned process going forward, the Primary Care Commissioning Team would liaise with the practice requesting the list closure to ensure that the information help on NWRS remained an accurate reflection of practice staffing levels

Overall following the initial review of the above data collection, the data was felt to be sufficiently accurate for comparative purposes when considering a list closure. However, to try and improve the quality of the data, practices will be asked to review their own most recent return. The Primary Care Commissioning Team will write once to all Nottingham and Nottinghamshire GP practices at the start of this process providing them with their own extracted workforce figures, and asking that they confirm the data is correct.This should encourage practices to submit accurate returns and will also confirm that the Primary Care Commissioning Team will be using the information for comparative purposes when reviewing list closure applications.

The next return of the General Practice Workforce Data will be published the 28th May 2020 and will consist of data between the periods of 1st January to 31st March 2020. The Primary Care Commissioning Team will download the General Practice Workforce Data each time it’s published on the NHS Digital website so the data is used to populate a local data tool.

2. Rushcliffe CCG Workforce Data CollectionFor the former Rushcliffe CCG, the commissioning team collated workforce data on a quarterly basis from all Rushcliffe CCG practices, usually on the first working day of every quarter. This data was used to map the general practice workforce across Rushcliffe CCG, utilised to establish practices that have impending retirements to consider. The workforce data collated by Rushcliffe CCG colleagues, not only referenced the headcount numbers but also some ‘objective’ measures as referenced in the Objective Decision Making Criteria paper, used to cross-examine list closure applications.

See below list for an example of the ‘objective measures captured from the Rushcliffe CCG workforce data tool;

a) Employment Statusb) Change in employment c) Total number of sessions worked per week (GPs)d) Total number of hours worked per week (Nurses and Admin/ Non-clincial)e) Resignations received and date of last working dayf) Details of current vacancies

3. Workforce Scoring Matrix Template (See Appendix 1 for template representation)In order to effectively evaluate applications for list closures going forward and to ensure consistent utilisation of the objective scoring matrix, the Primary Care Commissioning Team will develop a Workforce Scoring Matrix Template that will be sent to practices on receipt of a list closure application. This process for sending the Workforce Scoring Matrix will avoid all Nottingham and Nottinghamshire practices submitting duplicate quarterly workforce returns as initially explored.

The Workforce Scoring Matrix will include the headcount numbers from the national General Practice Workforce Data, the practice list size and the GP/ Patient ratio based on the workforce submission. The Workforce Scoring Matrix will also include elements of the former Rushcliffe CCG workforce data tool, particularly the total number of sessions or hours clinicians work per week; this is required in order to calculate the Whole Time Equivalence (WTE).

The Workforce Scoring Matrix will provide the evidence required, identifying the workload pressures and how this compares to other local practices to justify closing the list.


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Conclusion

In conclusion, the National Workforce Reporting System and the Workforce Scoring Matrix Template will provide the necessary information and evidence that is required as part of the objective decision making criteria in support of list closure applications.

Recommendation

The PCCC approves the request to implement a Workforce Scoring Matrix Template and to communicate the importance of submitting accurate information on the National General Practice Workforce Data collection; to explain that the data will be used to evidence workforce challenges within practices on receipt of list closure applications.

The process will also allow the Primary Care Commissioning Team to do a retrospective look back at List Size Closures approved by the 6 former CCGs to test the consistency of outcome of decisions made when using this approach. Findings of this will be shared with the committee at the June meeting to ensure the process aids decisions that transparent and consistent going forward.

Serena BroughtonPrimary Care Commissioning Officer – Nottingham CityNottingham and Nottinghamshire CCGs


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Workforce Scoring Matrix Template – May 2020

APPENDIX ONE:

Workforce Scoring Matrix TemplateObjective Measures to support list closure request

Blue sections are populated from the national General Practice Workforce Data. Yellow sections are completed from the GP practice.

Practice CodePractice Name Raw List SizeWeighted List Size

HeadcountIs the headcount correct (Yes/ No)? If no, please explain why?

Total number of sessions/ hours worked per week

Contractual sessions/ hours per full-time staff i.e. 10 sessions for GP, 37.5 hours for admin

1. All Qualified Permanent GPs (excludes registrars and locums)

2. Advanced Nurse Practitioners

3. Practice Nurse

4. All Admin/ Non-clinical staff (includes Practice Manager)

5. Are there any resignations pending? If yes, what is the last working day and are there any planned future appointments?

Objective D

ecision Making C

riteria

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Meeting Title: Primary Care Commissioning Committee (Open Session)

Date: 20 May 2020

Paper Title: Additional First Contact Physiotherapists – Mid Nottinghamshire PCNs


Sponsor:

Presenter:

Lucy Dadge – Chief Commissioning Officer


Network Contract Directed Enhanced Service, Contract specification 2020/21 - PCN Requirements and Entitlements, March 2020

David Ainsworth – Locality Director, Mid Nottinghamshire

Purpose: Approve ☒ Endorse ☐ Review ☐ Receive/Note for:


☐

Executive Summary

Under the Primary Care Network (PCN) Contract Directed Enhanced Service (DES), funding is made available to PCNs through the Additional Roles Reimbursement Scheme (ARRS) to recruit additional staff members across a range of specific roles. One of these roles is First Contact Physiotherapists (FCPs).FCPs are physiotherapists with enhanced skills who are able to see patients with musculoskeletal (MSK)issues directly without needing referral from their GP.

In previous iterations of the ARRS document there have been no limitations placed on the number of FCPs a PCN is eligible to be reimbursed for from April 2020 onwards, within the limitations of the individual PCN’sARRS budget.

Mid Nottinghamshire PCNs reviewed their workforce needs and identified that two FCPs per PCN would be optimal. This decision was made due to high MSK demand and wide geographical spread meaning that either one FCP would spend a large portion of their time travelling between practices or patients would need to travel additional distance to see the FCP with limited public transport options. A recruitment process took place with a view to all FCPs being in post by July.

A new version of the PCN DES was released in March 2020 (after the recruitment process began) which placed a limitation on the number of FCPs a PCN is eligible to employ within the year 2020/21. The document states that a PCN may be reimbursed for “one WTE per PCN where the PCN’s Patients number 99,999 or less” (ref. section 6.3.3, Table 1, page 34 - Appendix 1). The document also states that “the commissioner may waive any limits in Table 1 where this is agreed by the PCN, the commissioner, and the relevant Integrated Care System” (ref. section 6.3.4, page 35, Appendix 1).

Mid Notts First Contact Practitioners

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Mid Nottinghamshire PCNs would like to request that this waiver is applied to allow them to continue their plans to recruit up to two FCPs each in the year 2020/21. There is no financial implication to the CCG of approving the additional numbers as funding for additional roles is provided to PCNs through the national ARRS. Approval is merely required to deviate from updated guidance.

Full workforce plans are due to be submitted by PCNs in August 2020 however it has been confirmed with each PCN that this number of FCPs will fall within their current ARRS budgets, including staff who have already been employed. From 2021 onwards there are no limitations placed on the number eligible to be reimbursed under the scheme. Job offers have already been made to six FCPs with a number of additional suitable candidates identified who have been made provisional offers pending this approval.

Mid Nottinghamshire PCNs are committed to working closely with the existing ICP MSK Service and are integrating their FCPs with the service to ensure consistency and efficiency across the pathway. This will include shared policies and procedures, clinical pathways, patient materials, training and service development across primary and secondary care. This integrated working has attracted three physiotherapists from outside of the Nottinghamshire area to the roles, building local workforce and creating an appealing career pathway to aid local retention of junior physiotherapists.

The ICP MSK Lead is fully involved and supportive of the additional number of FCPs. An induction programme is being planned to start in July and it would be ideal to have all FCPs in post to take part in thissingle induction.


Compliance with Statutory Duties ☐ Wider system architecture development (e.g. ICP, PCN development)

☒

Financial Management ☐ Cultural and/or Organisational Development

☐

Performance Management ☐ Procurement and/or Contract Management ☐

Strategic Planning ☐





Yes ☐ No ☐ N/A☒ Not applicable for this item.


Yes ☐ No ☐ N/A☒ Not applicable for this item.

Risk(s):

No risks identified.

Confidentiality:

☒No

Recommendation(s):

1. APPROVE the increase in the number of FCPs eligible to be refunded to a PCN under the Additional


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Roles Reimbursement Scheme for 2020/21 from one FCP to two for Mid Nottinghamshire PCNs.


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NHS England and NHS Improvement

Network Contract Directed Enhanced Service

Contract specification 2020/21 - PCN Requirements and Entitlements March 2020


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Network Contract Directed Enhanced Service

Contract Specification 2020/21 – PCN Requirements and

Entitlements

Publishing approval number: 001681

Version number: 1

First published: 31 March 2020

Prepared by: Primary Care Strategy and NHS Contracts Group

This information can be made available in alternative formats, such as easy read or large print, and may be available in alternative languages, upon request. Please contact the Primary Care Strategy and NHS Contracts Group at [email protected]. Equalities and health inequalities statement "Promoting equality and addressing health inequalities are at the heart of NHS England’s values. Throughout the development of the policies and processes cited in this document, we have:

• given due regard to the need to eliminate discrimination, harassment and victimisation, to advance equality of opportunity, and to foster good relations between people who share a relevant protected characteristic (as cited under the Equality Act 2010) and those who do not share it;

• given regard to the need to reduce inequalities between patients in access to, and outcomes from, healthcare services and in securing that services are provided in an integrated way where this might reduce health inequalities.”


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mailto:[email protected]

Contents

Network Contract Directed Enhanced Service .............................................................1

Contract Specification 2020/21 – PCN Requirements and Entitlements......................1

1. Introduction .........................................................................................................3

2. Commonly used terms ........................................................................................3

3. Relationship between the Network Contract DES and the primary medical services contract .................................................................................................5

4. Eligibility for and participation in the Network Contract DES ...............................5

5. PCN Organisational Requirements ................................................................... 16

6. Additional Roles Reimbursement Scheme ........................................................ 31

7. Service Requirements ....................................................................................... 39

8. Contract management ....................................................................................... 48

9. Network financial entitlements ........................................................................... 50

10. Monitoring ......................................................................................................... 63

Annex A - Network Contract DES Participation Form ................................................ 66

Annex B - Additional Roles Reimbursement Scheme - Minimum Role Requirements67

B.1. Clinical Pharmacist ............................................................................................ 67

B.2. Pharmacy Technicians ...................................................................................... 68

B.3. Social Prescribing Link Workers ........................................................................ 70

B.4. Health and Wellbeing Coach ............................................................................. 73

B.5. Care Coordinator ............................................................................................... 76

B.6. Physician Associates ......................................................................................... 78

B.7. First Contact Physiotherapists ........................................................................... 79

B.8. Dieticians ........................................................................................................... 81

B.9. Podiatrists ......................................................................................................... 83

B.10. Occupational Therapists .................................................................................. 84

Please be aware that all aspects of this service specification outline the requirements for this programme. As such, commissioners and practices should ensure they have read and understood all sections of this document as part of the implementation of this programme. Practices are advised that to ensure they receive payment, particular attention should be paid to the payment and validation terms. Practices will need to ensure they understand and use the designated clinical codes as required to ensure payment.


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1. Introduction

1.1. The Network Contract Directed Enhanced Service (the “Network Contract

DES”) was first introduced in the Directed Enhanced Services Directions 20191.

1.2. The Network Contract DES placed obligations on practices and commissioners

and granted various entitlements to practices with effect from 1 July 2019.

1.3. An objective of the Network Contract DES in 2019 was for primary medical

services contractors to establish and develop Primary Care Networks (“PCNs”).

1.4. The Network Contract DES forms part of a long-term, larger package of general

practice contract reform originally set out in Investment and Evolution: A five-

year framework for GP contract reform to implement the NHS Long Term Plan

and subsequent updates.

1.5. It is intended that there will be a Network Contract DES each financial year until

at least 31 March 2024 with the requirements of the Network Contract DES

evolving over time.

1.6. This document sets out:

1.6.1. how commissioners must offer to primary medical services contractors the

opportunity to participate in the Network Contract DES;

1.6.2. the eligibility requirements and process for primary medical services contractors

to participate in the Network Contract DES; and

1.6.3. in relation to the Network Contract DES, the rights and obligations of:

a. primary medical services contractors that participate;

b. the PCNs of which they are members; and

c. commissioners,

for the financial year from 1 April 2020 to 31 March 2021.

1.7. This document has been agreed by NHS England and the British Medical

Association’s (BMA) General Practitioners Committee England (GPCE).

2. Commonly used terms

2.1. This document is referred to as the “Network Contract DES Specification”.

2.2. In this Network Contract DES Specification:

1 The Network Contract DES Directions can be found at

https://www.gov.uk/government/publications/nhs-primary-medical-services-directions-2013


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https://www.england.nhs.uk/wp-content/uploads/2019/01/gp-contract-2019.pdf

https://www.england.nhs.uk/wp-content/uploads/2019/01/gp-contract-2019.pdf

https://www.gov.uk/government/publications/nhs-primary-medical-services-directions-2013

2.2.1. the “Network Contract DES” refers to the Network Contract DES for the

financial year commencing 1 April 2020 and ending on 31 March 2021 unless

expressly stated otherwise;

2.2.2. a “practice” refers to a primary medical services contractor;

2.2.3. a “New Practice” refers to a practice that is newly formed following the taking

effect of a new primary medical services contract;

2.2.4. the “commissioner” refers to the organisation with responsibility for contract

managing a practice and this will be either NHS England or a clinical

commissioning group (“CCG”) where the latter carries out contract

management of primary medical services contracts under delegated

arrangements with NHS England;

2.2.5. the “Network Agreement” refers to the agreement entered into by practices

(and potentially other organisations) that are members of a PCN and which

incorporates the provisions that are required to be included in a network

agreement2 in accordance with section 5.1.2.d;

2.2.6. a “Core Network Practice” of a PCN has the same meaning as in a PCN’s

Network Agreement and refers to the practices that are members of a PCN

who are responsible for delivering the requirements of the Network Contract

DES in relation to that PCN;

2.2.7. an “Previously Approved PCN” refers to a PCN that was approved in the

period commencing 1 July 2019 and ending on 31 March 2020;

2.2.8. the “Nominated Payee” refers to a practice or organisation (which must hold a

primary medical services contract) that receives payment of the applicable

financial entitlement set out in this Network Contract DES Specification;

2.2.9. the “Network Area” refers to the area of a PCN as described in section 5.1.3;

2.2.10. a “list of patients” refers to the registered list of patients in respect of a

practice that is maintained by NHS England and NHS Improvement in

accordance with that practice’s primary medical services contract;

2.2.11. the “PCN’s Patients” refers collectively to the persons on a PCN’s Core

Network Practices’ lists of patients;

2.2.12. the “practice list size” refers to the number of persons on the list of patients

of the practice;

2 The Network Agreement and Schedule can be found at

https://www.england.nhs.uk/publication/network-contract-directed-enhanced-service-network-agreement/


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2.2.13. the “PCN list size” refers to the number of PCN Patients, which is the sum of

all practice list sizes of the Core Network Practices of the PCN;

3. Relationship between the Network Contract DES and

the primary medical services contract

3.1.1. Where this Network Contract DES Specification sets out a requirement or

obligation of a PCN, each Core Network Practice of a PCN is responsible for

ensuring the requirement or obligation is carried out on behalf of that PCN.

3.1.2. A practice participating in the Network Contract DES must enter into a

variation of its primary medical services contract to incorporate the provisions

of this Network Contract DES Specification.

3.1.3. The provisions of this Network Contract DES Specification therefore become

part of the practice’s primary medical services contract.

3.1.4. Where a practice chooses not to participate in the Network Contract DES, this

will not impact on the continuation of primary medical services under its

primary medical services contract.

4. Eligibility for and participation in the Network Contract

DES

4.1. Context

4.1.1. A practice wishing to participate in the Network Contract DES for the period

from 1 April 2020 to 31 March 2021 must follow the participation process set

out in this section 4.

4.1.2. A practice participating in this Network Contract DES acknowledges that it will

automatically participate in subsequent years’ Network Contract DES unless

the practice follows the opt-out process set out in section 4.13 of this Network

Contract DES Specification.

4.1.3. A commissioner must ensure that any patients of a practice that is not

participating in the Network Contract DES are covered by a PCN (for example

through commissioning a local incentive scheme). Further information on

commissioning PCN services for patients of non-participating practices is

available in the Network Contract DES Guidance.


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4.2. Eligibility

4.2.1. A practice must satisfy each eligibility criteria below to be eligible to participate

in the Network Contract DES:

a. the practice must hold a primary medical services contract;

b. the practice has a registered list of patients which means that persons are

recorded in the registration system approved by NHS England as being

registered with the practice; and

c. the practice’s primary medical services contract must require the practice

to offer in-hours (essential services) primary medical services.

4.3. Participation

4.3.1. By 1 April 2020 the commissioner must indicate to each practice the method

the practice must use to provide the information necessary for that practice to

participate in the Network Contract DES. The information must be provided by

using the form set out at Annex A of this Network Contract DES Specification.

4.3.2. Where a practice wishes to participate in the Network Contract DES, one of

the situations below will apply. The practice must identify the relevant situation

and act in accordance with the appropriate section:

a. If the practice is a Core Network Practice under the Network Agreement of

a Previously Approved PCN and there have been no changes to the

following information:

i. identity of the Core Network Practices,

ii. the Nominated Payee,

iii. the Clinical Director;

iv. Network Area,

the practice must act in accordance with section 4.4;

b. If the practice is a Core Network Practice under the Network Agreement of

a Previously Approved PCN and there have been changes to the

information listed in sections a.i to a.iv above, the practice must act in

accordance with section 4.5;

c. If the practice has not previously participated in a Network Contract DES

but wishes to be a Core Network Practice of a Previously Approved PCN,

the practice must act in accordance with section 4.6;

d. If the practice is a New Practice and wishes to be a Core Network Practice

of a Previously Approved PCN, the practice must act in accordance with

section 4.7;


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e. If the practice is either a New Practice or an existing practice and wishes

to be a Core Network Practice of a newly proposed PCN, the practice

must act in accordance with section 4.8; or

f. If the practice cannot identify a Previously Approved PCN or a newly

proposed PCN that is willing to allow the practice to be a Core Network

Practice under its Network Agreement, the practice must act in

accordance with section 4.9.

4.4. Previously Approved PCNs with no change

4.4.1. Where this section applies, the practice must notify the commissioner of no

change on or before 31 May 2020. Where the PCN wants to ensure there is

no interruption to payments made to the PCN as the PCN transitions to this

new Network Contract DES Specification, the Core Network Practices of that

PCN must have completed the process for participating in the Network

Contract DES prior to the next local payment deadline. Commissioners should

liaise with Core Network Practices to confirm timescales.

4.4.2. On receipt of the notification, the commissioner will consider all information

received including the extent to which the Previously Approved PCN meets the

criteria for a PCN set out in section 5.1.2 and, as soon as practicable and in

any event within one month of receipt of the notification, notify the practice

whether its participation in the Network Contract DES is confirmed.

4.4.3. Where the commissioner notifies a practice that its participation in the Network

Contract DES:

a. is not confirmed, section 4.10 applies;

b. is confirmed, section 4.11 applies.

4.5. Previously Approved PCNs with change

4.5.1. Where this section applies, the practice must notify the commissioner of the

relevant change on or before 31 May 2020. Where the PCN wants to ensure

there is no interruption to payments made to the PCN as the PCN transitions

to this new Network Contract DES Specification, the Core Network Practices

of that PCN must have completed the process for participating in the Network

Contract DES prior to the next local payment deadline. Core Network

Practices should liaise with the commissioner to confirm timescales.

4.5.2. The practice must include in the notification:

a. the change that has occurred;

b. the reasons for the change.


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4.5.3. The practice must promptly provide to the commissioner any information the

commissioner requests in relation to the change.

4.5.4. Where the commissioner is satisfied that it has all required and necessary

information, the commissioner will consider all information received including

the extent to which the Previously Approved PCN meets the criteria for a PCN

set out in section 5.1.2 and, as soon as practicable and in any event within

one month of receipt of the notification, notify the practice whether its

participation in the Network Contract DES is confirmed.

4.5.5. Where the commissioner consents to a change in the details of the Previously

Approved PCN, the commissioner must complete the PCN ODS Change

Instruction Notice3, to indicate any changes to a PCN’s membership and/or

Nominated Payee. The commissioner must submit the notice by the last

working day on or before the 14th day of the month for the change to take

effect by the end of that month. The commissioner must ensure that the latest

it submits the notice by 12 June 2020.


Contract DES:



4.6. Previously non-participating practice joining a Previously Approved

PCN

4.6.1. Where this section applies, the practice must provide the following information

to the commissioner on or before 31 May 2020:

a. confirmation that the practice has signed an updated version of the PCN’s

Network Agreement;

b. confirmation that the practice is listed as a Core Network Practice in the

PCN’s Network Agreement;

c. confirmation that the practice agrees that payments under the Network

Contract DES are made to the PCN’s Nominated Payee;

d. confirmation that the practice will have in place patient record sharing

arrangements (as clinically required) and data sharing arrangements of the

PCN, in line with data protection legislation and patient opt-out

preferences, prior to the start of any service delivery under the Network

Contract DES.

3 The PCN ODS Change Instruction Notice is available here.


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https://digital.nhs.uk/services/organisation-data-service/services-provided-by-the-organisation-data-service/organisation-data-service-forms#primary-care-networks

4.6.2. Where the commissioner is satisfied that it has all relevant and necessary



set out in section 5.1.2 and, as soon as practicable and in any event within

one month of receipt of the notification, notify the practice whether its

participation in the Network Contract DES is confirmed.

4.6.3. Where, as a result of the commissioner’s decision, there is a change in the

details of the Previously Approved PCN, the commissioner must complete the

PCN ODS Change Instruction Notice4, to indicate any changes to a PCN’s

membership and/or Nominated Payee. The commissioner must submit the

notice by the last working day on or before the 14th day of the month for the

change to take effect by the end of that month. The commissioner must

ensure that the latest it submits the notice is by 12 June 2020.


Contract DES:



4.7. New Practice joining a Previously Approved PCN

4.7.1. Where this section applies, the New Practice must provide the information set

out in sections 4.6.1.a to 4.6.1.d to the commissioner.

4.7.2. A New Practice may provide the information to the commissioner at any time

during the financial year.




set out in section 5.1.2 and, as soon as practicable, notify the practice whether

its participation in the Network Contract DES is confirmed.


details of the Previously Approved PCN, the commissioner must complete the

PCN ODS Change Instruction Notice5, to indicate any changes to a PCN’s

membership and/or Nominated Payee. The commissioner must submit the

notice by the last working day on or before the 14th day of a month for the

change to take effect by the end of that month.

4 The PCN ODS Change Instruction Notice is available here. 5 The PCN ODS Change Instruction Notice is available here.


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Contract DES:



4.8. New Practice or existing practice forms a new PCN

4.8.1. Where this section applies, the practice must provide the following information

to the commissioner on or before 31 May 2020:

a. the names and ODS codes6 of the proposed PCN’s Core Network

Practices7;

b. the number of the PCN’s Patients as at 1 January 20208;

c. a map clearly marking the geographical area covered by the Network Area

of the proposed PCN;

d. an initial Network Agreement – this requires completion of the proposed

Core Network Practices’ details in the front end of the Network Agreement

and in Schedule 1, details of the Network Area, the Clinical Director and

Nominated Payee (additional information in Schedule 1 relating to PCN

meetings and decision-making may also be submitted but it is recognised

that this may not have been fully agreed at the point of submission to the

commissioner);

e. the Nominated Payee9 and details of the relevant bank account that will

receive funding on behalf of the PCN; and

f. the identity of the accountable Clinical Director.

4.8.2. The information must be provided by using the form set out at Annex A of this

Network Contract DES Specification.

4.8.3. The practice must promptly provide to the commissioner any further

information the commissioner requests in relation to the proposed PCN.

4.8.4. Where the commissioner is satisfied that it has all required and necessary


the extent to which the proposed PCN meets the criteria for a PCN set out in

section 5.1.2 and, as soon as practicable and in any event within one month of

6 https://digital.nhs.uk/services/organisation-data-service 7 This may be a single super practice. 8 This can be obtained by aggregating the number of persons on the lists of patients for all Core

Network Practices as recorded in the registration system approved by NHS England. 9 Payment nomination would only apply where there is more than one primary medical care contractor in

the PCN.


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https://digital.nhs.uk/services/organisation-data-service

receipt of the notification, notify the practice whether its participation in the

Network Contract DES is confirmed and whether the proposed PCN is

approved.

4.8.5. Where the commissioner approves the PCN, the commissioner must complete

the PCN ODS Change Instruction Notice10 to indicate the details of the PCN.

The commissioners must submit the notice by the last working day on or

before the 14th day of the month for the change to take effect by the end of

that month. The commissioner must ensure that the latest it submits the notice

by 12 June 2020. The commissioner must also indicate to the PCN and its

Core Network Practices when they are required to commence delivery of the

Network Contract DES and the date payments will be made, taking into

account local payment arrangements.


Contract DES:



4.9. PCNs unwilling to accept a practice

4.9.1. Where this section applies, the practice must notify the commissioner by 31

May 2020 that no Previously Approved PCN or proposed PCN is willing to

enable the practice to be a Core Network Practice of the PCN.

4.9.2. On receipt of the notification, the commissioner will liaise with the relevant

LMC to facilitate discussions between the practice wishing to sign-up to the

Network Contract DES and the appropriate PCN(s) taking all reasonable steps

to reach agreement on the terms for the inclusion of the practice in a PCN.

4.9.3. Where the commissioner determines that there is no agreement on the terms

for the inclusion of the practice in a PCN, the commissioner may require a

PCN to include the practice as a Core Network Practice of that PCN.

4.9.4. Where the commissioner is minded to require a PCN to include the practice as

a Core Network Practice of that PCN, the commissioner must engage with the

relevant LMC and, when making its determination, have regards to the views

of the LMC. The commissioner acknowledges that the Core Network Practices

of the PCN may already have submitted information and had their participation

in the Network Contract DES confirmed at the point the commissioner is

minded to require the PCN to include the practice as a Core Network Practice.

If the commissioner requires a PCN to include the practice, the commissioner



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will consider this a change to the details of the PCN and consider any

consequences of inclusion on the PCN and its Core Network Practices.

4.9.5. Where the commissioner requires a PCN to include the practice as a Core

Network Practice of that PCN pursuant to section 4.9.3:

a. the commissioner must inform that PCN on or before 30 June 2020;

b. the commissioner must inform any other PCN with whom the

commissioner has been liaising with pursuant to section 4.9.2 of its

determination; and

c. each practice in the PCN to which the practice has been allocated will, as

soon as practicable, and in any event within 30 days, after the

commissioner informs them of its decision, take the necessary steps to

enable the practice to become a Core Network Practice of the PCN

including, but not limited, to varying the Network Agreement to include the

practice.

4.9.6. As soon as practicable after the PCN has taken the necessary steps pursuant

to section 4.9.5.c, the practice joining the PCN must provide the following

information to the commissioner:

a. confirmation that the practice has signed an updated version of the PCN’s

Network Agreement;

b. confirmation that the practice is listed as a Core Network Practice in the

PCN’s Network Agreement;

c. confirmation that the practice agrees that payments under the Network

Contract DES are made to the PCN’s Nominated Payee;

d. confirmation that the practice will have in place patient record sharing

arrangements (as clinically required) and data sharing arrangements of the

PCN, in line with data protection legislation and patient opt-out

preferences11, prior to the start of any service delivery under the Network

Contract DES.


information, the commissioner will as soon as practicable but in any event

within five working days, taking into account the information that has been

provided and the fact that the commissioner has required the PCN to include

11 https://digital.nhs.uk/about-nhs-digital/our-work/keeping-patient-data-safe/how-we-look-after-your-

health-and-care-information/your-information-choices/opting-out-of-sharing-your-confidential-patient-information


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https://digital.nhs.uk/about-nhs-digital/our-work/keeping-patient-data-safe/how-we-look-after-your-health-and-care-information/your-information-choices/opting-out-of-sharing-your-confidential-patient-information



the practice in the PCN, notify the practice whether its participation in the

Network Contract DES is confirmed.


details of the PCN, the commissioner must complete the PCN ODS Change

Instruction Notice12. The commissioner must submit the notice by the last

working day on or before the 14th day of the month for the change to take

effect by the end of that month.


Contract DES:



4.10. Participation not confirmed


Contract DES is not confirmed:

a. the commissioner will explain to the practice the reasons for its decision;

b. the commissioner, the practice and the relevant PCN if applicable must

make every reasonable effort to communicate and co-operate with each

other, and with the local LMC if relevant, with a view to enabling the

commissioner to confirm the practice’s participation in the Network

Contract DES as soon as practicable;

c. if no agreement is reached after a reasonable timescale, the commissioner

or the practice may refer the matter to the local NHS England team.

4.10.2. Where a local LMC is involved in the matter, the commissioner must work with

the local LMC to support PCN development, addressing where appropriate

issues that arise and seeking to maintain 100 per cent geographical coverage

of PCNs.

4.10.3. If the commissioner notifies the practice that its participation in the Network

Contract DES is confirmed, section 4.11 applies;

4.11. Confirmation of participation

4.11.1. Where a commissioner has confirmed a practice’s participation in the Network

Contract DES, the practice must, as soon as practicable:



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a. enter into a written variation of its primary medical services contract with

the commissioner that incorporates the provisions of this Network Contract

DES Specification;

b. if the practice has been provided with access to the Calculating Quality

Reporting Service (“CQRS”), indicate via CQRS that it is participating in

the Network Contract DES; and

c. ensure the PCN’s Network Agreement reflects the arrangements for

delivery of the Network Contract DES.

4.12. Auto-enrolment in the subsequent Network Contract DES or in-year

variation

4.12.1. A practice participating in this Network Contract DES acknowledges that it will

automatically participate in:

a. the subsequent Network Contract DES (which means the Network

Contract DES commencing on 1 April 2021); and

b. any variation to the Network Contract DES Specification that is to take

effect prior to 31 March 2021,

unless it chooses not to continue to participate in the Network Contract DES in

accordance with section 4.13.

4.12.2. The PCN acknowledges that to automatically participate in the subsequent

Network Contract DES and the associated specification or the varied Network

Contract DES Specification (as relevant), this particular Network Contract DES

Specification must end on either 31 March 2021 or, where the Network

Contract DES Specification has been varied, the date determined in

accordance with section 4.13, to be replaced with the new specification.

Subject to section 4.12.3 therefore, where a practice participates in the

Network Contract DES, the practice and the commissioner agree that

immediately after the 31 March 2021 or the date determined in accordance

with section 4.13, as relevant, provided that the practice’s participation has not

ceased at an earlier date:

a. this Network Contract DES Specification will cease to have effect; and

b. the practice’s primary medical services contract will be deemed to have

been varied to remove the incorporation of this Network Contract DES

Specification.

4.12.3. Unless expressly stated otherwise or by necessary implication, no term of this

Network Contract DES Specification shall survive beyond 31 March 2021 or

earlier termination (as relevant).


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4.13. Opting out of auto-enrolment in the subsequent Network Contract

DES and opting out of the Network Contract DES where there is an

in-year variation

4.13.1. A Core Network Practice of a PCN may choose not to participate in:

a. the subsequent Network Contract DES (which means the Network

Contract DES commencing on 1 April 2021); or

b. the Network Contract DES where there is any variation to the Network

Contract DES Specification that is to take effect prior to 31 March 2021,

in which case that Core Network Practice must notify the commissioner within

one calendar month of the publication by NHS England and NHS Improvement

of the specification for the subsequent Network Contract DES or the varied

Network Contract DES Specification (as relevant).

4.13.2. The PCN, of which the practice providing notice under section 4.13.1 was a

Core Network Practice, must act in accordance with any provisions set out in

the specification for the subsequent Network Contract DES or the varied

Network Contract DES Specification that relate to changes to the PCN.

4.13.3. For the avoidance of doubt, a practice choosing not to participate in the

subsequent Network Contract DES or any variation is required to act in

accordance with this Network Contract DES Specification until 31 March 2021

unless section 4.14 applies.

4.14. Ending participation in this Network Contract DES

4.14.1. A practice participating in the Network Contract DES acknowledges that it will

participate in the Network Contract DES until 31 March 2021 unless:

a. the practice chooses to end its participation in this Network Contract DES

by notifying the commissioner prior to 31 May 2020, in which case section

4.14.2 applies;

b. the practice provides notice under section 4.13.1 that it no longer wishes

to participate in the Network Contract DES where there is any variation to

the Network Contract DES Specification that is to take effect prior to the 31

March 2021, in which case section 4.14.2 applies; or

c. any of the following events occur:

i. expiry or termination of the Core Network Practice’s primary medical

services contract, in which case section 5.13 applies;

ii. there has been an irreparable breakdown in relationship or an

expulsion, in which case section 5.14 applies;


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iii. the commissioner consents to a merger or split of the Core Network

Practice, in which case section 5.15 applies; or

iv. the commissioner determines that the Core Network Practices’

participation in the Network Contract DES should cease in accordance

with section 8.

4.14.2. Where a practice notifies the commissioner:

a. prior to 31 May 2020 that it chooses to cease its participation in the

Network Contract DES; or

b. that it no longer wishes to participate in the Network Contract DES where

there is any variation to the Network Contract DES Specification that is to

take effect prior to 31 March 2021,

the same process applies as where there is a change in the Core Network

Practice members due to expiry or termination of a Core Network Practice’s

primary medical services contract (and the applicable sections are sections

5.13.1.b to 5.13.4.c).

5. PCN Organisational Requirements

5.1. Definition and criteria for a PCN

5.1.1. A PCN can be broadly defined as a practice or practices (and possibly other

providers13) serving an identified Network Area with a minimum population of

30,000 people.

5.1.2. The criteria for a PCN is:

a. that the PCN has an identified Network Area that complies with the

requirements set out in section 5.1.3;

b. that the PCN list size as at 1 January 2020 is between 30,000 and 50,000

except that:

i. in exceptional circumstances, a commissioner may waive the 30,000

minimum PCN list size requirement where a PCN serves a natural

community which has a low population density across a large rural and

remote area; and

ii. a commissioner may waive the 50,000 maximum PCN list size

requirement where it is satisfied that it is appropriate to do so. In such

13 Examples of other providers - community (including community pharmacy, dentistry, optometry),

voluntary, secondary care providers, social care - and GP providers who are not participating in the Network Contract DES.


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circumstances, the commissioner may require the Core Network

Practices of the PCN to organise the PCN operationally into smaller

neighbourhood teams that cover population sizes between 30,000 to

50,000 and the Core Network Practices will comply with such

requirement. For the avoidance of doubt, the PCN will still be required

to have one Nominated Payee.

iii. that there is more than one Core Network Practice in the PCN except

that there may only be one Core Network Practice if the commissioner

is satisfied that this is appropriate having regard to all relevant factors.

Where a PCN has only one Core Network Practice, the PCN must

work with other providers as set out in section 5.7.1 to achieve the

optimal benefits of PCN working.

c. that the PCN has a Nominated Payee which must hold a primary medical

services contract;

d. that the PCN has in place a Network Agreement signed by all PCNs

members, that incorporates the mandatory provisions set out in the

national template network agreement1415.

e. that the PCN has at all times an accountable Clinical Director;

f. that the PCN has in place appropriate arrangements for patient record

sharing in line with data protection legislation honouring patient opt-out

preferences1617.

5.1.3. The Network Area must:

a. satisfy the commissioner that the Network Area is sustainable for the

future, taking account of how services are delivered by wider members of

the PCN beyond the practices and with a view to the evolution of PCNs;

b. align with a footprint which would best support delivery of services to

patients in the context of the relevant Integrated Care System (ICS) or

Sustainability and Transformation Partnership (STP) strategy;

c. cover a boundary that makes sense to:

14 Where PCNs decide to seek advice related to the Network Agreement, these costs will not be

covered under the Network Contract DES nor by commissioners at a local level. 15 The Network Agreement template has been agreed between NHS England and GPC. The Network

Agreement template can be found at https://www.england.nhs.uk/publication/network-contract-directed-enhanced-service-network-agreement/

16 https://digital.nhs.uk/about-nhs-digital/our-work/keeping-patient-data-safe/how-we-look-after-your-health-and-care-information/your-information-choices/opting-out-of-sharing-your-confidential-patient-information

17 A template data controller/data processer agreement and a template data controller/data controller agreement can be found at https://www.england.nhs.uk/publication/network-contract-directed-enhanced-service-data-templates/


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https://www.england.nhs.uk/publication/network-contract-directed-enhanced-service-data-templates/


i. the Core Network Practices of the PCN;

ii. other community-based providers which configure their teams

accordingly; and

iii. the local community;

d. cover a geographically contiguous area;

e. not cross CCG, STP or ICS boundaries except where:

i. a Core Network Practice’s boundary or branch surgery crosses the

relevant boundaries; or

ii. the Core Network Practices are situated in different CCGs.

5.1.4. Where a practice has one or more branch surgeries in different PCNs, the

practice must ensure that it will be a Core Network Practice of only one PCN

and a non-core member of the other PCN(s) within which the relevant branch

surgeries are situated. The practice acknowledges that its list of patients will

be associated with the PCN of which the practice is a Core Network Practice.

5.1.5. Where a PCN’s Core Network Practices are situated within different CCG

areas, the relevant commissioners must agree which commissioner will be the

‘lead’ for the PCN and identified as such within the PCN ODS reference data

and subsequently within the relevant GP IT systems for payment processing.

The identified lead commissioner will make payments to the relevant

Nominated Payee in relation to the Network Contract DES. The lead

commissioner and any other relevant commissioner must reconcile any

funding allocation discrepancies between themselves and not via national GP

payment systems.

5.2. General PCN organisational requirements

5.2.1. A PCN must ensure it remains compliant with the criteria of a PCN set out in

section 5.1.2 at all times.

5.2.2. A PCN must ensure its Network Agreement reflects the requirements of this


5.2.3. Where required by data protection legislation, a PCN must ensure each

member of the PCN has in place appropriate data sharing arrangements and,

if required, data processor arrangements18, that are compliant with data

protection legislation to:

18 Optional data sharing agreement and data processing agreement can be found at



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a. support the delivery of extended hours access service requirement from 1

April 2020; and

b. support the delivery of all other service requirements set out in this

Network Contract DES prior to the provision of these services to patients.

5.2.4. A Previously Approved PCN must ensure that there is no interruption in

provision of services in the transition from the previous year’s Network

Contract DES to this Network Contract DES. For the avoidance of doubt, this

requires a Previously Approved PCN to:

a. provide the Extended Hours Access service under this Network Contract

DES Specification from 1 April 2020; and

b. to take such steps as are necessary to provide the service requirements

under this Network Contract DES Specification other than the Extended

Hours Access service in the timescales set out in this Network Contract

DES Specification.

5.2.5. The PCN acknowledges that confirmation of the Core Network Practices’

participation in this Network Contract DES may not be received until after 1

April 2020. The PCN acknowledges that it must act in accordance with section

5.2.4 but the PCN acknowledges that section 9 sets out backdating of certain

elements of the financial entitlements.

5.2.6. A commissioner and a PCN must not vary this Network Contract DES

Specification. For the avoidance of doubt, the commissioner must not increase

or reduce the requirements of the financial entitlements set out in this Network


5.2.7. Where a commissioner commissions local services from the PCN that are

supplemental to the Network Contract DES (referred to in this Network

Contract DES Specification as “Supplementary Network Services”)19, the

arrangements for such local Supplementary Network Services must not be

included in a varied version of this Network Contract DES Specification and

should instead be contained in a separate local incentive scheme.

5.3. PCN Clinical Director

5.3.1. A PCN must have in place a Clinical Director who:

a. is accountable to the PCN members;

19 Supplementary Network Services would be services commissioned locally, under separate

arrangements and with additional resource, building on the foundation of the Network Contract DES. Further information regarding commissioning local services can be found in the Network Contract DES Guidance.


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b. provides leadership for the PCN’s strategic plans, working with PCN

members to improve the quality and effectiveness of its delivery of the

Network Contract DES;

c. is a direct and integral component of the overall Network Contract DES;

d. is a practicing clinician from within the PCN’s Core Network Practices;

e. is able to undertake the responsibilities of the role and represent the

PCN’s collective interests;

f. works collaboratively with Clinical Directors from other PCNs within the

ICS/STP area, playing a critical role in shaping and supporting their

ICS/STP, helping to ensure full engagement of primary care in developing

and implementing local system plans;

5.3.2. A PCN must ensure its Clinical Director has overall responsibility for the

following key requirements20:

a. strategic and clinical leadership for the PCN, developing and implementing

strategic plans, leading and supporting quality improvement and

performance across Core Network Practices (including professional

leadership of the Quality and Outcomes Framework Quality Improvement

activity across the PCN). The Clinical Director is not solely responsible for

the operational delivery of services - this is a collective responsibility of the

PCN;

b. strategic leadership for workforce development, through assessment of

clinical skill-mix and development of a PCN workforce strategy;

c. completing the workforce planning template and agree, on behalf of the

PCN, the estimate as referred to in section 6.5;

d. supporting PCN implementation of agreed service changes and pathways

and work closely with Core Network Practices and the commissioner and

other PCNs to develop, support and deliver local improvement

programmes aligned to national priorities;

e. developing local initiatives that enable delivery of the PCN’s agenda,

working with commissioners and other networks to reflect local needs and

ensuring initiatives are coordinated;

f. developing relationships and work closely with other Clinical Directors,

clinical leaders of other primary care, health and social care providers,

local commissioners and LMCs;

20 This section sets out the high-level minimum responsibilities of the Clinical Director. The detailed

requirements will vary according to the characteristics of the PCN, including its maturity and local context and should be set out in the PCN’s Network Agreement.


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g. facilitating participation by practices that are members of the PCN in

research studies and act as a link between the PCN and local primary care

research networks and research institutions; and

h. representing the PCN at CCG-level clinical meetings and the ICS/STP,

contributing to the strategy and wider work of the ICS/STP.

5.3.3. A PCN must manage any conflicts of interest. A PCN must ensure that its

Clinical Director takes a lead role in developing the PCN’s conflict of interest

arrangements, taking account of what is in the best interests of the PCN and

its patients.

5.3.4. A PCN’s appointment of a Clinical Director must follow a selection process

either via appointment, election or both details of which must be included in

Schedule 1 of the Network Agreement.

5.4. Data and analytics

5.4.1. A PCN must share non-clinical data between its members in certain

circumstances. The data to be shared is the data required to:

a. support understanding and analysis of the population’s needs;

b. support service delivery in line with local commissioner objectives; and

c. support compliance with the requirements of this Network Contract DES

specification.

5.4.2. A PCN must determine appropriate timeframes for sharing of this data.

5.4.3. Where the functionality is available, a PCN should ensure that clinical data

sharing for service delivery uses read/write access, so that a GP from any

practice can refer, order tests and prescribe electronically and maintain a

contemporaneous record for every patient.

5.4.4. A PCN must:

a. benchmark and identify opportunities for improvement;

b. identify variation in access, service delivery or gaps in population groups

with highest needs; and

c. review capacity and demand management across the PCN, including

sharing appointment data for the PCN to action (this could be achieved

through using the GP workload tool or other similar tools), and the PCN


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must monitor, share and aggregate relevant data21 across the Core

Network Practices to enable it to carry out these requirements.

5.4.5. A commissioner and the wider system may support PCNs in the analysis of

data.

5.4.6. Core Network Practices of a PCN must use the relevant SNOMED codes to

support data collections for the indicators related to the Network Contract DES

some of which will be included in the Network Dashboard22.

5.5. Patient engagement

5.5.1. A PCN must act in accordance with the requirements relating to patient

engagement under the PCN’s Core Network Practice’s primary medical

services contracts by:

a. engaging, liaising and communicating with the PCN’s Patients in the most

appropriate way;

b. informing and/or involving them in developing new services and changes

related to service delivery; and

c. engaging with a range of communities, including ‘seldom heard’ groups.

5.5.2. A PCN must provide reasonable support and assistance to the commissioner

in the performance of its duties23 to engage patients in the provision of and/or

reconfiguration of services where applicable to the PCN’s Patients.

5.6. Sub-contracting arrangements

5.6.1. Where a PCN (or any one or more of its members which are practices) is

considering sub-contracting arrangements related to the provision of services

under the Network Contract DES, the PCN must have due regard to the

requirements set out in the statutory regulations or directions that underpin

each Core Network Practices’ primary medical services contracts in relation to

sub-contracting, which will also apply to any arrangements to sub-contract

services under the Network Contract DES.

5.6.2. A PCN acknowledges that its members that are practices may be required

under their primary medical services contract to notify the commissioner, in

writing, of their intention to sub-contract as soon as reasonably practicable and

21 Data sources include workload data, population data, appointment data, cost data, outcome data and

patient experience data (e.g. friends and family test, GP patient survey). 22 The Network Dashboard will be introduced during 2020/21. It will include key PCN metrics to support

population health management, including prevention, urgent and anticipatory care, prescribing and hospital use.

23 Section 14Z2 of the 2006 NHS Act.


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before the date on which the sub-contracting arrangement is intended to

begin.

5.6.3. A PCN (and its members that are practices) must make available on request

from the commissioner any information relating to sub-contracting

arrangements and reporting information relating to either the delivery of

network services or the engagement of PCN staff, for which reimbursement is

being claimed under the Network Contract DES.

5.6.4. Notwithstanding any provision to the contrary of a PCN Core Network

Practices’ primary medical services contract, a Core Network Practice may

sub-contract any of its rights or duties under the Network Contract DES in

relation to non-clinical matters provided that the Core Network Practice obtains

prior written approval from the commissioner (such approval to not be

unreasonably withheld or delayed).

5.6.5. Where a Core Network Practice of a PCN has sub-contracted a non-clinical

matter that relates to the Network Contract DES, the sub-contract may allow

the sub-contractor to sub-contract the non-clinical matter provided that the

Core Network Practice obtains prior written approval from the commissioner

(and such approval will not be unreasonably withheld or delayed).

5.7. Collaboration with non-GP providers

5.7.1. A PCN must agree with local community services providers, mental health

providers and community pharmacy providers how they will work together.

5.7.2. A PCN must ensure that compliance with this requirement is evidenced

through setting out in Schedule 7 of the Network Agreement:

a. the specifics of how, where required by this Network Contract DES

Specification or otherwise deemed appropriate, the service requirements

will be delivered through integrated working arrangements between the

PCN and other providers; and

b. how providers will work together, including agreed communication

channels, agreed representatives, and how any joint decisions will be

taken.

5.7.3. A PCN must detail the arrangements with its local community services

provider(s) in Schedule 7 of the Network Agreement by 30 September 2020.

The commissioner will use reasonable endeavours to facilitate the agreement

of arrangements between the local community services provider(s) and the

PCN.


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5.7.4. A PCN must detail its arrangements with community mental health providers,

and community pharmacy (via the community pharmacy nominated Pharmacy

PCN Lead) in Schedule 7 of the Network Agreement by 31 March 2021.

5.8. Changes to a PCN

5.8.1. A PCN acknowledges that:

a. it was approved; and

b. its Core Network Practices’ participation in the Network Contract DES was

confirmed,

on the basis of the information provided to the commissioner.

5.8.2. Where a PCN is minded to change that information, it must act in accordance

with the appropriate section of this Network Contract DES Specification.

5.9. Clinical Director change

5.9.1. Where a PCN wishes to change the identity of its clinical director, it is required

to notify the commissioner of the identity of the new clinical director as soon as

reasonably practicable following the change.

5.10. Nominated Payee change

5.10.1. A PCN must obtain the prior written consent of the commissioner to any

change in the identity of its Nominated Payee.

5.10.2. The PCN must provide to the commissioner the identity of the organisation of

the proposed Nominated Payee and provide such information as required by

the commissioner to enable the commissioner to determine whether the

proposed Nominated Payee meets the requirement of section 5.1.2.c.

5.10.3. Where the commissioner is satisfied that the proposed Nominated Payee

meets the requirement of section 5.1.2.c:

a. it shall provide its written consent to the PCN; and

b. complete the PCN ODS Change Instruction Notice24.

5.10.4. The commissioner must also ensure this information aligns to the information

contained within the relevant GP payment systems.

5.10.5. The change will take effect on the first day of the month following the month in

which the commissioner gave consent and completed the PCN ODS Change

24 The PCN ODS Change Instruction Notice is available here. The commissioner must submit the notice

by the end of the last working day on or before the 14th day the month for the change to take effect by the end of that month.


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Instruction Notice provided that the commissioner submitted the notice by the

last working day on or before the 14th day of that month. If submission was

later in the month, the change will take effect on the first day of the month

following the subsequent month.

5.11. Change in non-Core Network Practice members

5.11.1. Where a PCN changes its non-Core Network Practices members it is not

required to notify the commissioner or obtain the commissioner’s prior written

consent, but it is required to ensure that its Network Agreement reflects the

change of members.

5.12. Change in Core Network Practice members

5.12.1. A PCN acknowledges that a practice participating in the Network Contract

DES cannot end its participation in the Network Contract DES except as set

out in section 4.14. The process for changing Core Network Practice members

is separate from the process of a practice ending its participation in the

Network Contract DES but there may be situations in which a change is a

result of a practice ending its participation.

5.12.2. Once a PCN has been approved in line with the process set out in this

Network Contract DES Specification, changes to Core Network Practices of

the PCN will only be allowed in the exceptional circumstances set out in

sections 5.13 to 5.16.

5.12.3. Where a PCN requests consent for a change to its Core Network Practices

members due to one of the exceptional circumstances set out in sections 5.13

to 5.16, the PCN will act in accordance with the process set out in the relevant

section. A PCN must obtain the prior written consent of the commissioner to

any changes of its Core Network Practice members.

5.12.4. A commissioner must, as part of its consideration of the proposed change,

ensure that the PCN will at all times satisfy the criteria of a PCN set out in

section 5.1.

5.12.5. A PCN seeking to change its Core Network Practices members must provide

to the commissioner details of its view of the impact (if any) of the change on

the PCN’s baseline for the Additional Roles Reimbursement Sum25. As part of

its consideration of the proposed change, the commissioner will seek to agree

with the PCN the change (if any) to the PCN’s baseline for the Additional

Roles Reimbursement Sum.

25 Refer to section 6.2 for details of baselines.


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5.12.6. A PCN must promptly provide any information required by the commissioner in

relation to the change in Core Network Practice membership.

5.12.7. The commissioner will record a PCN’s Core Network Practices members via

NHS Digital’s Organisation Data Service (ODS). Where the commissioner

consents to a change, the commissioner must, before the end of the month in

which it gives consent, complete the PCN ODS Change Instruction Notice26.

The commissioner must submit the notice by the last working day on or before

the 14th day of the month for the change to take effect by the end of that

month. The commissioner must also ensure this information aligns to the

information contained within the relevant GP payment systems.

5.12.8. The change will take effect on the first day of the month following the month in

which the commissioner gives consent and completes the PCN ODS Change

Instruction Notice27 provided that the commissioner submits the notice by the

last working day on or before the 14th day of that month. If submission was

later in the month, the change will take effect on the first day of the month

following the subsequent month.

5.12.9. The PCN must ensure the Network Agreement is updated as soon as

reasonably practicable following the change taking effect.

5.13. Change in Core Network Practice membership due to contract

expiry/termination

5.13.1. Where the primary medical services contract of a Core Network Practice of a

PCN expires or terminates for any reason prior to 31 March 2021, then that

Core Network Practice’s participation in the Network Contract DES will cease

from the date of expiry/termination. In such circumstances:

a. the Core Network Practices of a PCN must, as soon as they are aware of

the possibility of a practice no longer being a Core Network Practice of the

PCN, notify the commissioner.

b. The commissioner will consider the matter, including holding discussions

with all practices within the PCN.

c. The commissioner will consider the consequences of the practice no

longer being a Core Network Practice of the PCN. This will include:

i. the likely consequences for the registered patients of the practice

when that GP practice is no longer a Core Network Practice of the

PCN – i.e. whether a new primary medical services contract will be



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entered into which takes over the former practice’s list of patients,

whether the list of patients of the previous practice are dispersed

between existing practices in the area or any other likely

consequences;

ii. the impact of any consequences on the financial entitlements set out

in this Network Contract DES Specification including consideration of

the fact that for payments based on practice list size or PCN list size,

the consequence of a practice no longer being a Core Network

Practice of a PCN could result in a reduction in the level of payments

made to a PCN; and

iii. any other relevant matters.

5.13.2. The commissioner will, depending on the likely consequences and following

any discussion with the LMC, determine the outcome of such matters including

any changes to the information of the PCN such as changes to the Network

Area and/or level of payments due to the PCN under this Network Contract

DES specification.

5.13.3. The commissioner may, depending on the likely consequences and at its

discretion, determine that where there is a significant influx of new patients

registering with a Core Network Practice of a PCN, it is appropriate for

payments that are based on practice list size or PCN list size to be based on

practice list size or PCN list size as at a date that is more recent than 1

January 2020.

5.13.4. From the date of the expiry or termination of the relevant practice’s primary

medical services contract:

a. the practice will no longer participate in the Network Contract DES;

b. the practice will no longer be considered a Core Network Practice of the

PCN;

c. the PCN must remove that practice from the Network Agreement with

effect from that date; and

d. the commissioner must complete and submit the PCN ODS Change

Instruction Notice28.



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5.14. Change in Core Network Practice membership due to an irreparable

breakdown in relationships or expulsion

5.14.1. Where there is an irreparable breakdown in relationships in respect of a Core

Network Practice within a PCN such that the other members of the PCN are

minded to expel the Core Network Practice from the PCN, the PCN must first

notify the commissioner.

5.14.2. The commissioner will consider the matter, including holding discussions with

all practices within the PCN.

5.14.3. The commissioner will consider the consequences of the practice being

expelled from the PCN. This will include:

a. the likely consequences for the registered patients of the practice of that

practice being expelled the PCN, i.e. whether that practice can join

another PCN;

b. the impact of any consequences on the financial entitlements of the

Network Contract DES of the PCN which the practice would be expelled

from and that of any PCN the practice may seek to join. It is acknowledged

that for payments based on practice list size or PCN list size, the

consequence of a practice being expelled from a PCN is likely to be a

reduction in the level of payments made to a PCN;

c. the viability of the PCN including reference to the criteria of a PCN set out

in section 5.1.2; and

d. any other relevant matters.

5.14.4. The commissioner will, having regard to the likely consequences and any

discussion with the LMC, determine the outcome of such matters including

whether it consents to any changes to the information of any affected PCN

including but not limited to changes to the Core Network Practices, Network

Area, Nominated Payee and/or level of payments.

5.14.5. Where, following the process set out in this Network Contract DES

Specification, a Core Network Practice is expelled from a PCN, then, from the

date the practice leaves the PCN:

a. the practice will no longer be considered a Core Network Practice of the

PCN;

b. the PCN must remove that practice from the Network Agreement with

effect from that date; and


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c. the commissioner must complete and submit the PCN ODS Change

Instruction Notice29.

5.15. Change in Core Network Practice membership due to merger/split

5.15.1. Where:

a. two or more Core Network Practices intend to merge and the resulting

single practice intends to be a Core Network Practice of the same PCN; or

b. two or more practices intend to be formed from the split of a single Core

Network Practice and the resulting practices intend to be Core Network

Practices of the same PCN,

the PCN acknowledges that the prior written consent of the commissioner is

required for both the merger/split and any resulting changes to the information

of the PCN.

5.15.2. The commissioner will consider the application for merger or split and, as part

of that consideration, will consider the consequences (if any) on the practice’s

or practices’ membership of the PCN.

5.15.3. The commissioner may require any New Practice formed from a merger/split

to provide the information set out in sections 4.6.1.a to 4.6.1.d before

indicating to the New Practice whether its participation in the Network Contract

DES is confirmed.

5.15.4. Where the commissioner consents to the type of change set out in section

5.15.1 the commissioner acknowledges that, for the purposes of this Network

Contract DES, payments due under the Network Contract DES will continue to

be made in accordance with this Network Contract DES Specification.

5.15.5. Where the commissioner consents to the type of change set out in section

5.15.1, the commissioner must, before the end of the month in which it gives

consent, complete the PCN ODS Change Instruction Notice30. The

commissioner must submit the notice by the last working day on or before the

14th day of the month for the change to take effect by the end of that month.

The commissioner must also ensure this information aligns to the information

contained within the relevant GP payment systems.

5.15.6. Where:

a. two or more Core Network Practices of a PCN intend to merge and the

resulting single practice does not intend to be a Core Network Practice of

the same PCN; or



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b. two or more practices intend to be formed from the split of a single Core

Network Practice and either one or both of the resulting practices do not

intend to be Core Network Practices of the same PCN,

the PCN and the practices acknowledge that the prior written consent of the

commissioner is required for both the merger/split and any resulting changes

to the information of the PCN and any other related PCN.

5.15.7. The commissioner will consider the application for merger or split and, as part

of that consideration, will consider the consequences on the practice’s or

practices’ membership of the PCN or other PCNs.

5.15.8. The commissioner’s consideration of the consequences of any merger/split on

PCN membership will include:

a. the likely consequences for the registered patients of the practice(s);

b. the impact of any consequences on a PCN’s financial entitlements due

under this Network Contract DES Specification given that the

consequence of a practice leaving a PCN is likely to be a reduction in the

level of payments made to the PCN;

c. whether, if consent for the change was provided, any relevant PCN would

satisfy the criteria for a PCN set out in section 5.1.2; and

d. any other relevant matters.

5.15.9. Where a Core Network Practice is subject to a split or a merger and:

a. the application of sections 5.15.1 to 5.15.8 in respect of splits or mergers

would, in the reasonable opinion of the commissioner, lead to an

inequitable result; or

b. the circumstances of the split or merger are such that sections 5.15.1 to

5.15.8 cannot be applied,

the commissioner will consider the resulting effect on the PCN as part of its

consideration of the application for merger/split and make a determination on

both matters.

5.15.10. Where the commissioner consents to any changes to the details of a PCN as

a result of sections 5.15.8 or 5.15.9, the commissioner must complete the

PCN ODS Change Instruction Notice31. The commissioner must submit the

notice by the last working day on or before the 14th day of the month for the

change to take effect by the end of that month. The commissioner must also

ensure this information aligns to the information contained within the relevant

GP payment systems.



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5.16. Change in Core Network Practice membership due to New Practice

joining

5.16.1. Where a New Practice wishes to join a Previously Approved PCN, section 4.7

applies.

5.16.2. Where a commissioner has confirmed the New Practice’s participation in the

Network Contract DES, the PCN must ensure that its Network Agreement

reflects the arrangements for delivery of the Network Contract DES.

6. Additional Roles Reimbursement Scheme

6.1. General

6.1.1. A PCN is entitled to funding as part of the Network Contract DES to support

the recruitment of new additional staff to deliver health services.

6.1.2. The new additional staff recruited by a PCN are referred to in this Network

Contract DES Specification as “Additional Roles” and this element of the

Network Contract DES is referred to as the “Additional Roles

Reimbursement Scheme”.

6.2. Principle of additionality

6.2.1. To receive the associated funding, a PCN must show that the staff delivering

health services for whom funding is requested, i.e. the Additional Roles,

comply with the principle of “additionality”. Sections 6.2.2 to 6.2.11 below set

out how additionality is measured.

6.2.2. Additionality will be measured on a baseline of staff supporting a GP practice

as taken at 31 March 2019 against six of the reimbursable staff roles – clinical

pharmacists, social prescribing link workers, first contact physiotherapists,

physician associates, pharmacy technicians and paramedics. Two baselines

were established32 during 2019 as follows:

a. A PCN baseline declared by the Core Network Practices of the PCN and

agreed with the commissioner. It is comprised of the actual whole time

equivalent (WTE) staff across these six reimbursable roles and funded by

general practice as at 31 March 2019. The PCN baseline will be fixed until

31 March 2024.

32 See Network Contract DES: Additional Roles Reimbursement Scheme Guidance 2019/20 for further

information.


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b. A Clinical Commissioning Group (CCG) baseline declared by the CCG. It

is comprised of the whole time equivalent (WTE) patient facing or first

contact time of staff across the six reimbursable roles deployed to support

general practice or primary medical care services - either in a specific

practice or in the wider community - funded33 by the CCG as at 31 March

2019 (regardless of whether funded due to direct CCG employment or

through a contract). Any administration, travel, triage or other time directly

related to patient care is included in the WTE. The commissioner is

required to maintain funding for these baseline posts and will be subject to

audit to ensure the funding is maintained.

6.2.3. Subject to section 6.2.4 below, a PCN’s Core Network Practices are required

to maintain the declared PCN baseline in order to meet the additionality rules

under the Network Contract DES Additional Roles Reimbursement Scheme. In

the event the PCN baseline reduces (meaning a vacancy arises in a Core

Network Practices’ baseline WTE) during the period 1 April 2020 to 31 March

2024, then the PCN will be subject to an equivalent WTE reduction in

workforce funding under the Network Contract DES Additional Roles

Reimbursement Scheme. The equivalent WTE reduction will be applicable

from three months after the date at which the vacancy arose, resulting in a

PCN baseline reduction, subject to the post not having been filled within this

period and in accordance with section 9.

6.2.4. With the agreement of the commissioner, which will not be unreasonably

withheld, a PCN will be able to substitute between clinical pharmacists, first

contact physiotherapists and physician associates within the PCN baseline.

Where agreement to a substitution has taken place, the PCN will not be

subject to an equivalent WTE reduction in workforce funding under the

Network Contract DES Additional Roles Reimbursement Scheme.

6.2.5. A PCN is required to demonstrate that claims being made are for new

additional staff roles beyond this baseline (including in future years,

replacement as a result of staff turnover). The commissioner must be assured

that claims meet the additionality principles above.

6.2.6. A PCN baseline will not be established for health and wellbeing coaches, care

coordinators, dieticians, podiatrists or occupational therapists. While the PCN

baseline will not include these five roles, the additionality principles will still

apply as per the additionality principles above. For the avoidance of doubt, this

means that a PCN acknowledges that where it claims reimbursement in

respect of these five roles, the PCN is confirming that:

33 The six reimbursable roles funded include those directly employed by the CCG.


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a. the reimbursement is for additional staff engaged or employed since 31

March 2019; and

b. the reimbursement is not being used to subsidise practice-funded roles

that existed as at 31 March 2019.

6.2.7. A failure to submit information or the provision of inaccurate workforce

information is a breach of the Network Contract DES Specification and may

result in commissioners withholding reimbursement pending further enquires

in accordance with section 9.10. reimbursement claims will be subject to

validation and any suspicion that deliberate attempts have been made to

subvert the additionality principles will result in a referral for investigation as

potential fraud.

6.2.8. Staff employed or engaged via a sub-contract within the reimbursable roles

after 31 March 2019 (i.e. above the baseline set) will be eligible for

reimbursement under the Network Contract DES, if those staff are employed

or engaged to deliver services across the PCN and if the PCN meets the

requirements set out in this Network Contract DES specification.

6.2.9. Clinical pharmacists previously employed via the national Clinical Pharmacist

in General Practice Scheme or those clinical pharmacists or pharmacy

technicians employed via the Medicines Optimisation in Care Homes Scheme

(“MOCH”)34 transferred to become PCN staff will be exempt from the

additionality principles.

a. For this exception to apply to clinical pharmacists previously employed via

the national Clinical Pharmacist in General Practice Scheme the employee

must have been in post on 31 March 2019 and been transferred to

become PCN staff by 31 March 2020 in line with the requirements set out

in this Network Contract DES Specification35.

6.2.10. For all clinical pharmacists and pharmacy technicians employed under the

MOCH Scheme, transfer must take place by no later than 31 March 2021

under the relevant requirements for clinical pharmacists or pharmacy

technicians within this Network Contract DES Specification. PCNs will be

required to support any pharmacists who transfer from the MOCH Scheme

prior to 31 March 2021 to complete their training. Where the transfer is agreed

before 31 March 2021 then PCNs will be expected to make operational use of

the pharmacist’s experience in relation to Care Homes as outlined in the

Network Contract DES Guidance. Any MOCH pharmacy technicians

transferred will count towards a PCN’s eligible limit as outlined in Table 1 in

34 This will include some pharmacy technicians currently funded by CCGs. 35 Full details on the transfer arrangements for clinical pharmacists is available in the 2019/20 Network

Contract DES Guidance.


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https://www.england.nhs.uk/gp/gpfv/workforce/building-the-general-practice-workforce/cp-gp/

https://www.england.nhs.uk/gp/gpfv/workforce/building-the-general-practice-workforce/cp-gp/

https://www.england.nhs.uk/primary-care/pharmacy/medicines-optimisation-in-care-homes/

https://www.england.nhs.uk/gp/gpfv/investment/gp-contract/

https://www.england.nhs.uk/gp/gpfv/investment/gp-contract/

section 6.3.3. Where MOCH pharmacists do not transfer before 31 March

2021, the commissioner is required to align the work objectives of the CCG

commissioned MOCH team to that of the Enhanced Health in Care Homes

service requirements outlined in this Network Contract DES Specification.

6.2.11. The Additional Roles may be employed by a member of the PCN, or another

body (e.g. GP Federation, voluntary sector provider, Local Authority or Trust).

If the PCN chooses to commission the health services provided by the

Additional Roles from another body, outside of the PCN, which therefore

employs the staff, this does not change the general position that the PCN and

its Core Network Practices are responsible for ensuring that the requirements

of the Network Contract DES are delivered. The employer remains responsible

for all costs (including taxes and where applicable VAT) and liabilities relating

to the employment of staff or sub-contracting of services. A PCN should set

out within the Network Agreement if and how any costs and liabilities will be

shared.

6.3. Additional Roles Reimbursement Sum

6.3.1. A PCN must act in accordance with the requirements set out in this section 6

in respect of the Additional Roles and the arrangements in section 9 to receive

reimbursement for employing or engaging the Additional Roles from within a

maximum allocated sum. This sum is referred to in this Network Contract DES

Specification as the “Additional Roles Reimbursement Sum”.

6.3.2. From within the allocated Additional Roles Reimbursement Sum, a PCN may

claim reimbursement for staff across ten eligible roles in accordance with the

terms set out in this section 6.3, section 9 and Table 1.

6.3.3. A PCN may employ or engage any one or more of the roles set out in Table 1

below subject to any limits on the number of any specific role.

Table 1: Workforce roles eligible for reimbursement under the Network

Contract DES with applicable limits

Roles Limit on number eligible for reimbursement

Clinical Pharmacists No limit

Pharmacy Technicians One individual pharmacy technician per PCN

where the PCN’s Patients number 99,999 or

less.


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Roles Limit on number eligible for reimbursement

Two individual pharmacy technicians per PCN

where the PCN’s Patients number 100,000 or

over.

Social Prescribing Link

Workers

No limit

Health and Wellbeing

Coaches

No limit

Care Co-ordinators No limit

Physician Associates No limit

First Contact

Physiotherapists

One WTE per PCN where the PCN’s Patients

number 99,999 or less.

Two WTE per PCN where the PCN’s Patients

number 100,000 or over.

Dieticians No limit

Podiatrists No limit

Occupational Therapists No limit

6.3.4. The commissioner may waive any limits in Table 1 where this is agreed by the

PCN, the commissioner, and the relevant Integrated Care System (ICS).

6.4. Additional Role requirements

6.4.1. To ensure satisfactory provision of health services, a PCN must comply with

the following requirements in relation to any Additional Roles:

a. Additional Roles employed or engaged via a sub-contract must:

i. be embedded within the PCN’s Core Network Practices and be fully

integrated within the multi-disciplinary team delivering healthcare

services to patients;

ii. have access to other healthcare professionals, electronic ‘live’ and

paper-based record systems of the PCN’s Core Network Practices, as

well as access to admin/office support and training and development

as appropriate; and


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iii. have access to appropriate clinical supervision and administrative

support.

b. Liaising with any employing organisation if relevant, the PCN must

consider the appropriateness of, and if considered appropriate, the PCN

must carry out, a review and appraisal process for Additional Roles

whether they are employed directly by the PCN or a PCN member or

engaged via a sub-contract.

c. The PCN must ensure that Additional Roles comply with the minimum role

requirements set out in Annex B of this Network Contract DES

Specification to be eligible for the Additional Roles Reimbursement Sum. A

PCN may build upon the requirements set out in Annex B of this Network

Contract DES Specification in relation to any Additional Role job

description.

d. The PCN must ensure the PCN’s approach to deploying the Additional

Roles is set out in the Network Agreement.

6.4.2. A PCN must inform the commissioner as soon as reasonably practicable

where any change to its Additional Roles arrangements will have an impact on

the payments being claimed (for example changes in WTE or new starters).

6.4.3. A PCN must record information on its Additional Roles, whether those

Additional Roles are employed by the PCN itself or by another body, in the

National Workforce Reporting Service (“NWRS”) in line with the existing or

updated requirements for general practice staff.

6.4.4. The commissioner must complete and return the six-monthly workforce report

to [email protected].

6.5. PCN Additional Roles planning and redistribution of Additional Roles

Reimbursement Scheme funding

6.5.1. A PCN must complete and return to the commissioner a workforce plan, using

the agreed national workforce planning template38, providing details of its

recruitment plans for 2020/21 by 31 August 2020 and indicative intentions

through to 2023/24 by 31 October 2020.

36 Further information is available in the Network Contract DES Guidance. 37 Further information is available in the Network Contract DES Guidance. 38 The workforce planning template is available at https://www.england.nhs.uk/publication/pcn-

workforce-planning-template-2020-21/


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https://www.england.nhs.uk/publication/pcn-workforce-planning-template-2020-21/

https://www.england.nhs.uk/publication/pcn-workforce-planning-template-2020-21/

6.5.2. The commissioner must explore, and must endeavour to procure that the local

ICS explores, different ways of supporting the PCN to implement the

workforce plan through:

a. offering CCG or ICS staff support to the PCN to help with coordinating and

undertaking recruitment exercises;

b. offering collective or batch recruitment across PCNs;

c. brokering arrangements to support full-time direct employment of staff by

community partners, or to support rotational working across acute and

community providers; and

d. ensuring the NHS workforce plans for the local system are helpful in

supporting PCN’s workforce plan.

6.5.3. The commissioner must:

a. have shared with the PCN and relevant LMCs; and

b. have agreed with the PCN,

by 30 September 2020 an estimation of the amount of financial entitlements in

relation to the PCN under the Additional Roles Reimbursement Scheme that

the PCN is unlikely to claim by 31 March 2021. This amount is referred to in

this Network Contract DES Specification as the “Unclaimed Funding”.

6.5.4. The commissioner must base its estimate of the Unclaimed Funding on the

PCN’s workforce planning information that is returned to the commissioner by

the 31 August 2020.

6.5.5. Where the PCN agrees the estimate, the PCN acknowledges that the PCN will

no longer have the right to claim the Unclaimed Funding and the

commissioner may give other PCNs within the commissioner’s boundary the

opportunity to bid for the Unclaimed Funding.

6.5.6. Where a commissioner provides the opportunity to PCNs within the

commissioner’s boundary to bid for any PCN’s Unclaimed Funding, the

commissioner will indicate when and how PCNs may bid.

6.5.7. A PCN acknowledges that if it bids for Unclaimed Funding and is successful,

the Unclaimed Funding allocated to the PCN must be used for the purpose of

recruiting further Additional Roles in accordance with this Network Contract

DES Specification. The PCN and the commissioner acknowledge that any

payment of the Unclaimed Funding to the PCN is in addition to the PCN’s

allocated Additional Roles Reimbursement Sum.

6.5.8. Where there are one or more bids for the Unclaimed Funding, the

commissioner will assess the bids in accordance with the following criteria:


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a. evidence that a bidding PCN has a recruitment process ready to begin for

the Additional Roles to which the Unclaimed Funding relates;

b. evidence that a bidding PCN has the resources and capability to

undertake further recruitment; and

c. whether a bidding PCN is a PCN which:

i. had previously indicated in the workforce planning information that it

was unlikely to claim its full financial entitlement but considers it is now

in a position to recruit; and

ii. evidences that it is able to meet sections 6.5.8.a and 6.5.8.b

d. whether a bidding PCN currently has staff on paid leave e.g. parental

leave or sickness leave;

e. evidence that a PCN is in an area of higher deprivation39; and

f. any other factor that the commissioner, acting reasonably, considers is

relevant to its decision.

6.5.9. A bidding PCN acknowledges that:

a. the above criteria are in descending order of preference. For the

avoidance of doubt, this means that bids satisfying criteria at the top of the

list will be preferred over bids that only satisfy criteria further down the list;

and

b. the commissioner will give preference to a bid which satisfies the criteria in

section 6.5.8.c. over all other bids.

6.5.10. The commissioner will notify each PCN of the outcome of its consideration and

indicate to any successful bidding PCN the level of funding allocated to the

successful bidding PCN.

6.5.11. Notwithstanding that any payments of Unclaimed Funding are not part of the

PCN’s allocated Additional Roles Reimbursement Sum and is in addition to

the PCN’s allocated Additional Roles Reimbursement Sum, payment of the

Unclaimed Funding will be made on the same basis as payments of the PCN’s

Additional Roles Reimbursement Sum.

6.5.12. A successful bidding PCN acknowledges that any additional funding allocated

to the PCN only relates to the period from the date the PCN was notified that it

was successful to 31 March 2021 and that there is no right for the PCN to

39 Defined by the Indices of Deprivation (IoD), based on seven different domains or facets of deprivation

– (1) income deprivation, (2) employment deprivation, (3) education, skills and training deprivation, (4) health deprivation and disability, (5) crime, (6) barriers to housing and services and (7) living environment deprivation. See https://www.gov.uk/government/collections/english-indices-of-deprivation and https://www.gov.uk/government/statistics/english-indices-of-deprivation-2019


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https://www.gov.uk/government/collections/english-indices-of-deprivation

https://www.gov.uk/government/collections/english-indices-of-deprivation

https://www.gov.uk/government/statistics/english-indices-of-deprivation-2019

require a commissioner to continue paying the additional funding after 31

March 2021.

6.5.13. The commissioner will be responsible for monitoring any Additional Roles

Reimbursement Scheme funding redistribution. Where there are repeated

occurrences of redistribution from and/or to particular PCNs, the commissioner

will be responsible for reviewing this in conjunction with the relevant PCNs

and, where appropriate, the LMC and ICS, and take appropriate supportive

actions.

7. Service Requirements

7.1. Extended Hours Access

7.1.1. A PCN must provide extended hours access in the form of additional clinical

appointments in accordance with this Network Contract DES Specification

regardless of whether any practices within the PCN are providing any CCG

commissioned extended access services in 2020/21 (which are referred to in

this Network Contract DES Specification as “CCG Extended Access

Services”).

7.1.2. Where a commissioner is not satisfied that a PCN is delivering extended hours

access in accordance with the requirements of this Network Contract DES

specification then the commissioner may take action as set out in section 8. If

a commissioner determines to withhold payment40, the amount withheld will

be an appropriate proportion of the extended hours access payment and the

Core PCN funding payment.

7.1.3. To provide extended hours access, a PCN must provide additional clinical

appointments that satisfy all the requirements set out below:

a. are available to all registered patients within the PCN:

b. may be for emergency, same day or pre-booked appointments;

c. are with a healthcare professional or another person employed or

engaged by the PCN to assist that healthcare professional in the provision

of health services;

d. are held at times outside of the hours that the PCN Core Network

Practices’ primary medical services contracts41 require appointments to be

40 Payment withheld in this context would be an appropriate proportion of the payments in relation to

both extended hours access and Core PCN funding payments. 41 For practices with PMS and APMS arrangements, the additional clinical appointments provided in

accordance with this Extended Hours Access requirement do not apply to any hours covered by core


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provided otherwise than under the Network Contract DES. For the

avoidance of doubt, if a Core Network Practice was required under a

General Medical Services (“GMS”) contract to provide core services at its

premises until 6:30pm, the additional clinical appointments under this

Extended Hours Access requirement could be provided after 6:30pm. If,

however, another Core Network Practice in the PCN provided core

services at its premises until 8pm, then:

i. any additional clinical appointments provided after 6:30pm but before

8pm must not be provided at the later closing practice’s premises (as

these would not be additional hours appointments) but could be

provided at the other practice’s premises; and

ii. a proportion of the additional clinical appointments must be provided

after 8pm;

e. are demonstrably in addition to any appointments provided by the PCN’s

practices under the CCG Extended Access Services;

f. are held at times having taken into account the PCN’s patient’s expressed

preferences, based on available data at practice or PCN level and

evidenced by patient engagement;

g. equate to a minimum of 30 minutes per 1,000 registered patients per

week, calculated using the following formula:

additional minutes* = the PCN list size** ÷ 1000 × 30

*convert to hours and minutes and round, either up or down, to the

nearest quarter hour

**this is the total number of person on the lists of patients of all Core

Network Practices of the PCN as at 1 January 2020

h. are provided in continuous periods of at least 30 minutes;

i. are provided on the same days and times each week with sickness and

leave of those who usually provide such appointments covered by the

PCN; and

j. may be provided face to face, by telephone, by video or by online

consultation provided that the PCN ensures a reasonable number of

hours set out in the practice’s primary medical services contracts. A PCN will be required to take consideration of this when agreeing the Extended Hours Access offer to the PCN Contractor Registered Population. For practices with GMS arrangements, core hours are from 08:00 to 18:30.


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appointments are available for face-to-face consultations where

appropriate.

7.1.4. A PCN must set out how the extended hours access appointments will be

delivered in the Network Agreement.

7.1.5. A PCN must ensure that all practices in the PCN member actively engage in

planning of the provision of the extended hours access requirements and

acknowledges that nothing in this Network Contract DES Specification require

an individual clinician or practice within the PCN to deliver a particular share of

the appointments. The exact number of extended hours access appointments

delivered from each member practice premises will be for the PCN to

determine subject to complying with the minimum additional minutes set out in

section 7.1.3.g.

7.1.6. A PCN’s Core Network Practices must ensure that their registered patients are

aware of the availability of extended hours access appointments, including any

change to published availability, through promotion and publication of the days

and times of these appointment through multiple routes. This may include the

NHS Choices website, the practice leaflet, the practice website, on a waiting

room poster, by writing to patients and active offers by staff booking

appointments.

7.1.7. Where a PCN cancels any extended hours access appointments or where

appointments cannot be offered on the usual days and times (for example, but

not limited to, due to a bank holiday falling on the usual day), the PCN must

make up the cancelled time by offering additional appointments within a two-

week period. For the avoidance of doubt, any rescheduled appointments

offered in a subsequent week are in addition to the minimum minutes that

must be offered for that week as set out in section 7.1.3.g. The PCN must

ensure that all patients within the PCN are notified of the cancelled and

rescheduled appointments.

7.1.8. A commissioner must publicise information to help patients to identify which

practices are offering appointments at given times.

7.1.9. Core Network Practices of a PCN must inform patients of any changes to the

days and time at which extended hours access appointments are offered,

providing reasonable notice to patients.

7.1.10. If any Core Network Practice of a PCN is providing out of hours services to its

own list of patients, the PCN must, as part of the Extended Hours Access

service provision offer routine extended hours access appointments in addition

to the out of hours service.

7.1.11. A PCN must ensure that:


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a. no Core Network Practice of the PCN will be closed for half a day on a

weekly basis, except where a Core Network Practice has prior written

approval from the commissioner; and

b. the PCN’s Patients are able to access essential services, which meet the

reasonable needs of patients during core hours, from their own practice or

from any sub-contractor.

7.1.12. For the avoidance of doubt, unless a practice has prior written approval from

the commissioner, all PCN Core Network Practices will not close for half a day

on a weekly basis.

7.1.13. The term “prior written approval” in section 7.1.11.a means an explicit

agreement between the practice and the commissioner that specifically

includes written approval to close for half a day on a weekly basis for the

purposes of the Network Contract DES Specification. The agreement must

take the form of either:

a. a new agreement which expressly states that:

i. it is pursuant to the Network Contract DES Specification; and

ii. it will expire no later than 31 March 2021; or

b. an existing agreement with the commissioner to close for half a day on a

weekly basis, which, instead of referring to the Network Contract DES,

explicitly references the GP Extended Hours Access Scheme Directed

Enhanced Service which came to an end on 30 June 2019. For the

purposes of the Network Contract DES, existing agreements will be

considered to expire no later than 31 March 2021.

7.1.14. Where a Core Network Practice does not have prior written approval to close

for half a day on a weekly basis, a Core Network Practice that previously

closed for half a day on a weekly basis will need to either:

a. be open for that half a day in the same way that it is open on other days of

the week, or

b. have in place appropriate sub-contracting arrangements for the time the

practice is closed - in line with Schedule 3, Part 5 para 44 (10) and (11) of

the GMS Regulations42 or Schedule 2, Part 5 para 43 (5) and (6) of the

PMS Regulations43, as applicable - so that patients continue to have

43 National Health Service (Personal Medical Services Agreements) Regulations 2015


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access to essential services which meet their reasonable44 needs during

core hours.

7.2. Structured Medication Review and Medicines Optimisation

7.2.1. From the 1 October 2020, a PCN is required to:

a. use appropriate tools to identify and prioritise the PCN’s Patients who

would benefit from a structured medication review (referred to in this

Network Contract DES Specification as a “SMR”), which must include

patients:

i. in care homes45;

ii. with complex and problematic polypharmacy, specifically those on 10

or more medications;

iii. on medicines commonly associated with medication errors46;

iv. with severe frailty47, who are particularly isolated or housebound

patients, or who have had recent hospital admissions and/or falls; and

v. using potentially addictive pain management medication;

b. offer and deliver a volume of SMRs determined and limited by the PCN’s

clinical pharmacist capacity, and the PCN must demonstrate reasonable

ongoing efforts to maximise that capacity;

c. ensure invitations for SMRs provided to patients explain the benefits of,

and what to expect from SMRs;

d. ensure that only appropriately trained clinicians working within their sphere

of competence undertake SMRs. The PCN must also ensure that these

professionals undertaking SMRs have a prescribing qualification and

44 NHS England’s guidance is that it includes for example: the ability to book and cancel appointments,

collect prescriptions, access urgent appointments/advice as clinically necessary, the ability to attend a pre-bookable appointment.

45 Patients in a ‘care home’ are those resident in services registered by CQC as care home services with nursing (CHN) and care home services without nursing (CHS).

46 See NHS Business Services Authority (2019) Medication Safety Indicators Specification: https://www.nhsbsa.nhs.uk/sites/default/files/2019-08/Medication%20Safety%20-%20Indicators%20Specification%20%28Aug19%29.pdf This document sets out 20 indicators that have been developed to help reduce medications errors and promote safer use of medicines. The ‘denominator’ section for each of the indicators lists medicines commonly associated with prescribing errors, which PCNs should use to help identify individuals to invite for a SMR.

47 Based on the validation of the eFI, on average around 3 per cent of over 65s will be identified as potentially living with severe frailty. However, in some practices this number may be significantly higher. Severe frailty is defined as a person having an eFI score of >0.36. https://www.england.nhs.uk/ourwork/clinical-policy/older-people/frailty/efi/


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https://www.nhsbsa.nhs.uk/sites/default/files/2019-08/Medication%20Safety%20-%20Indicators%20Specification%20%28Aug19%29.pdf

https://www.nhsbsa.nhs.uk/sites/default/files/2019-08/Medication%20Safety%20-%20Indicators%20Specification%20%28Aug19%29.pdf

https://www.england.nhs.uk/ourwork/clinical-policy/older-people/frailty/efi/

advanced assessment and history taking skills, or be enrolled in a current

training pathway to develop this qualification and skills;

e. clearly record all SMRs within GP IT systems;

f. actively work with its CCG in order to optimise the quality of local

prescribing of:

i. antimicrobial medicines;

ii. medicines which can cause dependency;

iii. metered dose inhalers, where a lower carbon device may be

appropriate; and

iv. nationally identified medicines of low priority;48

g. work with community pharmacies to connect patients appropriately to the

New Medicines Service which supports adherence to newly prescribed

medicines; and

h. in complying with this section 7.2, have due regard to NHS England and

NHS Improvement guidance on Structured Medication Reviews and

Medicines Optimisation.

7.3. Enhanced Health in Care Homes

7.3.1. By 31 July 2020, a PCN is required to:

a. have agreed with the commissioner the care homes for which the PCN will

have responsibility (referred to as the “PCN’s Aligned Care Homes” in

this Network Contract DES Specification). The commissioner will hold

ongoing responsibility for ensuring that care homes within their

geographical area are aligned to a single PCN and may, acting

reasonably, allocate a care home to a PCN if agreement cannot be

reached. Where the commissioner allocates a care home to a PCN, that

PCN must deliver the Enhanced Health in Care Homes service

requirements in respect of that care home in accordance with this Network

Contract DES Specification;

b. have in place with local partners (including community services providers)

a simple plan about how the Enhanced Health in Care Homes service

requirements set out in this Network Contract DES Specification will

operate;

48 See the Recommendation (section 5, pp.14-39) of ‘Items which should not routinely be prescribed in

primary care’ https://www.england.nhs.uk/wp-content/uploads/2019/08/items-which-should-not-routinely-be-prescribed-in-primary-care-v2.1.pdf


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https://www.england.nhs.uk/wp-content/uploads/2019/08/items-which-should-not-routinely-be-prescribed-in-primary-care-v2.1.pdf

https://www.england.nhs.uk/wp-content/uploads/2019/08/items-which-should-not-routinely-be-prescribed-in-primary-care-v2.1.pdf

c. support people entering, or already resident in the PCN’s Aligned Care

Home, to register with a practice in the aligned PCN if this is not already

the case; and

d. ensure a lead GP (or GPs) with responsibility for these Enhanced Health

in Care Homes service requirements is agreed for each of the PCN’s

Aligned Care Homes.

7.3.2. By 30 September 2020, a PCN must:

a. work with community service providers (whose contracts will describe their

responsibility in this respect) and other relevant partners to establish and

coordinate a multidisciplinary team (“MDT”) to deliver these Enhanced

Health in Care Homes service requirements; and

b. have established arrangements for the MDT to enable the development of

personalised care and support plans with people living in the PCN’s

Aligned Care Homes.

7.3.3. As soon as is practicable, and by no later than 31 March 2021, a PCN must

establish protocols between the care home and with system partners for

information sharing, shared care planning, use of shared care records, and

clear clinical governance.

7.3.4. From 1 October 2020, a PCN must:

a. deliver a weekly ‘home round’ for the PCN’s Patients who are living in the

PCN’s Aligned Care Home(s). In providing the weekly home round a PCN:

i. must prioritise residents for review according to need based on MDT

clinical judgement and care home advice (a PCN is not required to

deliver a weekly review for all residents);

ii. must have consistency of staff in the MDT, save in exceptional

circumstances;

iii. must include appropriate and consistent medical input from a GP or

geriatrician, with the frequency and form of this input determined on

the basis of clinical judgement; and

iv. may use digital technology to support the weekly home round and

facilitate the medical input;

b. using the MDT arrangements referred to in section 7.3.2 develop and

refresh as required a personalised care and support plan with the PCN’s

Patients who are resident in the PCN’s Aligned Care Home(s). A PCN

must:


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i. aim for the plan to be developed and agreed with each new patient

within seven working days of admission to the home and within seven

working days of readmission following a hospital episode (unless there

is good reason for a different timescale);

ii. develop plans with the patient and/or their carer;

iii. base plans on the principles and domains of a Comprehensive

Geriatric Assessment49 including assessment of the physical,

psychological, functional, social and environmental needs of the

patient including end of life care needs where appropriate;

iv. draw, where practicable, on existing assessments that have taken

place outside of the home and reflecting their goals; and

v. make all reasonable efforts to support delivery of the plan;

c. identify and/or engage in locally organised shared learning opportunities

as appropriate and as capacity allows; and

d. support with a patient’s discharge from hospital and transfers of care

between settings, including giving due regard to NICE Guideline 2750.

7.3.5. For the purposes of this section 7.3, a ‘care home’ is defined as a CQC-

registered care home service, with or without nursing.51

7.4. Early Cancer Diagnosis

7.4.1. From 1 October 2020, a PCN is required to:

a. review referral practice for suspected cancers, including recurrent cancers.

To fulfil this requirement, a PCN must:

i. review the quality of the PCN’s Core Network Practices’ referrals for

suspected cancer, against the recommendations of NICE Guideline

1252 and make use of:

a. clinical decision support tools;

b. practice-level data to explore local patterns in presentation and

diagnosis of cancer; and

49 https://www.bgs.org.uk/sites/default/files/content/resources/files/2019-03-12/CGA%20Toolkit%20for%20Primary%20Care%20Practitioners_0.pdf 50 https://www.nice.org.uk/guidance/ng27 51 See https://www.cqc.org.uk/guidance-providers/regulations-enforcement/service-types for further

information on the definition of care home services for this purpose. A monthly directory of registered care home services that meet these categories is available at https://www.cqc.org.uk/about-us/transparency/using-cqc-data

52 https://www.nice.org.uk/guidance/ng12


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https://www.bgs.org.uk/sites/default/files/content/resources/files/2019-03-12/CGA%20Toolkit%20for%20Primary%20Care%20Practitioners_0.pdf

https://www.bgs.org.uk/sites/default/files/content/resources/files/2019-03-12/CGA%20Toolkit%20for%20Primary%20Care%20Practitioners_0.pdf

https://www.nice.org.uk/guidance/ng27

https://www.cqc.org.uk/guidance-providers/regulations-enforcement/service-types

https://www.cqc.org.uk/about-us/transparency/using-cqc-data

https://www.cqc.org.uk/about-us/transparency/using-cqc-data

https://www.nice.org.uk/guidance/ng12

c. where available the Rapid Diagnostic Centre pathway for people

with serious but non-specific symptoms53;

ii. build on current practice to ensure a consistent approach to monitoring

patients who have been referred urgently with suspected cancer or for

further investigations to exclude the possibility of cancer (‘safety

netting’), in line with NICE Guideline 12; and

iii. ensure that all patients are signposted to or receive information on

their referral including why they are being referred, the importance of

attending appointments and where they can access further support;

b. contribute to improving local uptake of National Cancer Screening

Programmes. To fulfil this requirement, a PCN must:

i. work with local system partners – including the Public Health

Commissioning team and Cancer Alliance – to agree the PCN’s

contribution to local efforts to improve uptake which should build on

any existing actions across the PCN’s Core Network Practices and

must include at least one specific action to engage with a group with

low-participation locally; and

ii. provide the contribution agreed pursuant to section 7.4.1.b.i within

timescales agreed with local system partners; and

c. establish a community of practice between practice-level clinical staff to

support delivery of the requirements set out in sections 7.4.1.a to 7.4.1.b.

A PCN must, through the community of practice:

i. conduct peer to peer learning events that look at data and trends in

diagnosis across the PCN, including cases where patients presented

repeatedly before referral and late diagnoses; and

ii. engage with local system partners, including Patient Participation

Groups, secondary care, the relevant Cancer Alliance, and Public

Health Commissioning teams.

7.5. Social Prescribing Service

7.5.1. A PCN must provide the PCN’s Patients with access to a social prescribing

service.

7.5.2. To comply with this, a PCN may:

53 Further detail on the RDC vision and strategy is available here: https://www.england.nhs.uk/wp-

content/uploads/2019/07/rdc-vision-and-1920-implementation-specification.pdf. Assessment pathways for specific cancers are published here: https://www.england.nhs.uk/publication/rapid-cancer-diagnostic-and-assessment-pathways/


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https://www.england.nhs.uk/wp-content/uploads/2019/07/rdc-vision-and-1920-implementation-specification.pdf

https://www.england.nhs.uk/wp-content/uploads/2019/07/rdc-vision-and-1920-implementation-specification.pdf

https://www.england.nhs.uk/publication/rapid-cancer-diagnostic-and-assessment-pathways/

a. directly employ Social Prescribing Link Workers; or

b. sub-contract provision of the service to another provider.

in accordance with this Network Contract DES Specification.

7.5.3. Where a PCN directly employs Social Prescribing Link Workers to provide the

service, the PCN will be considered to have provided the service where the

PCN’s Social Prescribing Link Workers comply with the provisions of

paragraph 3 of Annex B of this Network Contract DES Specification.

7.5.4. Where a PCN sub-contracts provision of the service to another provider, the

PCN will be considered to have provided the service where the persons

employed or engaged by the sub-contracted provider to deliver the service

comply with the provisions of paragraph 3 of Annex B of this Network Contract

DES Specification. Where this applies, references to the Social Prescribing

Link Worker or Workers in paragraph 3 of Annex B are to be read as

references to the persons employed or engaged by the sub-contracted

provider to deliver the service.

8. Contract management

8.1. General

8.1.1. Section 3 of this Network Contract DES Specification states that each Core

Network Practice of a PCN is responsible for ensuring that a requirement or

obligation of a PCN as set out in this Network Contract DES Specification is

carried out on behalf of that PCN.

8.1.2. A PCN acknowledges that, where a requirement or obligation of a PCN is not

carried out, each Core Network Contract will be in breach of this Network


8.1.3. A PCN further acknowledges that as the provisions of this Network Contract

DES Specification are part of a Core Network Practice’s primary medical

services contract, the commissioner is able to take any action set out in the

relevant primary medical services contracts in relation to a breach of this


8.1.4. Where a breach of this Network Contract DES Specification occurs, a

commissioner may require a PCN to work with the commissioner to compile

and agree a collaborative action plan setting out actions to address non-

delivery and timescales for those actions. The commissioner and the PCN will

make all reasonable efforts to agree the action plan.

8.1.5. It is not expected that commissioners will need to resort to contract

management processes such as issuing of breach or remedial notices due to


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the support options available across the system and the action plan

development process as described in section 8.1.4.

8.1.6. The commissioner acknowledges that the action plan is intended to be a first

step towards remedying the breach. If:

a. the commissioner, acting reasonably, determines that an action plan is not

appropriate;

b. an action plan cannot be agreed within a reasonable timescale; or

c. a breach is not remedied by an action plan,

the commissioner may take any appropriate action set out in the Core Network

Practice’s primary medical services contracts in relation to the breach. This

may include issue of a breach or remedial notice, withholding of payments or

termination.

8.1.7. A PCN (and each Core Network Practice in the PCN) acknowledge that:

a. the legislation underpinning GMS and PMS arrangements include

references to “Contract Sanctions” and “Agreement Sanctions”

respectively which enable the commissioner, in certain circumstances, to

terminate certain obligations under the primary medical services contracts;

and

b. in the unlikely event that a breach cannot be resolved by the application of

the provisions of this Network Contract DES Specification and the contract

management provisions of the primary medical services contract, the

commissioner is able to rely on the Contract Sanctions or Agreement

Sanctions, as relevant, to terminate a Core Network Practice’s

participation in the Network Contract DES while the rest of the obligations

in the primary medical services contract are not terminated;

c. if the commissioner is minded to terminate Core Network Practices’

participation in the Network Contract DES, it must act in accordance with

section 5.13 as if references to the Core Network Practice’s primary

medical services contract terminating are references to the Core Network

Practice’s participation in the Network Contract DES terminating; and

d. where a PCN’s members include a Core Network Practice which holds an

APMS contract, the commissioner must consider if there are

corresponding rights in the APMS contract for the commissioner to

partially terminate the APMS contract to terminate only the provisions

relating to the Network Contract DES. The commissioner acknowledges

that if such rights are not included, the need to deal with all PCN Core

Network Practices in a similar way may mean that the commissioner is not


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be able to terminate the PCN’s Core Network Practices’ participation in the

Network Contract DES.

9. Network financial entitlements

9.1. General

9.1.1. A practice participating in the Network Contract DES acknowledges that

payments made under the Network Contract DES are dependent on the Core

Network Practices of a PCN working together to deliver the requirements of

this Network Contract DES.

9.1.2. A PCN acknowledges that confirmation of participation in the Network

Contract DES may not occur until June 2020 but that this Network Contract

DES Specification sets out certain elements of the Network financial

entitlements that will, provided any required criteria or conditions are satisfied,

be backdated to April 2020. Any such backdating is set out in the relevant

sections of this section 9.

9.1.3. Where information relating to a new proposed PCN is submitted to the

commissioner between 1 April 2020 and 31 March 2021, the commissioner

will, where a PCN is approved, indicate when payments of the financial

entitlements will be made.

9.1.4. Where the financial entitlements refers to a payment being based on practice

list size or PCN list size, the relevant figure will be taken from the registration

system (approved by NHS England) as at 1 January 2020 or a later date if the

commissioner, in its absolute discretion, considers that a PCN has

satisfactorily evidenced that there has been a large fluctuation in its Core

Network Practice’s lists of patients such that the figure derived from the later

date is more appropriate.

9.1.5. The commissioner must ensure that payments due to a PCN set out in this

Network Contract DES are made into the bank account of the Nominated

Payee. For the avoidance of doubt, the Network Participation Payment is not a

payment due to a PCN as it is payable directly to a Core Network Practice.

The PCN must inform the commissioner of the relevant payment details of its

Nominated Payee. The PCN will include in the Network Agreement the details

of arrangements with the Nominated Payee and may indicate the basis on

which the Nominated Payee receives the payments on behalf of the other

practices, e.g. as an agent or trustee.

9.1.6. A PCN and its commissioner acknowledge that:


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a. payments made in accordance with this Network Contract DES

Specification are not payments for specific services and instead are made

in consideration of the PCN delivering the requirements of this Network

Contract DES Specification; and

b. the calculation of the payments in accordance with this Network Contract

DES Specification are split into separate elements which are listed in more

detail in sections 9.3 to 9.10.

9.1.7. Where an ODS Change Instruction Notice needs to be submitted prior to a

payment being made, the payment will be made by the end of the month in

which the notice was submitted provided the notice was submitted before the

end of the last working day on or before the 14th day of that month. If

submitted after the end of the last working day on or before the 14th day of the

month, payment will be made at the end of the following month. The exact

date of payment is subject to local payment arrangements.

9.1.8. If a practice is allocated to a PCN in accordance with section 4.9, an

adjustment will be made to reflect that practice’s patient list in the calculation

of a payment due to the PCN. The adjustment will only apply to payments that

are made once the ODS Change Instruction Notice has been submitted in

accordance with the timescales in section 9.1.7, which, for the avoidance of

doubt, will only occur after the commissioner has confirmed the practice’s

participation in the Network Contract DES in accordance with section 4.9.7.

9.1.9. The adjustment referred to in section 9.1.8 which is to be made to reflect the

practice’s patient list in the calculation of a payment due to the PCN is as

follows:

a. The relevant payment will be recalculated with the relevant measure of the

practice’s patient list included;

b. The amount recalculated will be divided into 12 (or six for the PCN Support

Payment) equal monthly instalments; and

c. Each monthly payment to the PCN, made after the ODS Change

Instruction Notice has been submitted in accordance with the timescales in

section 9.1.7, will be an amount equal to the recalculated monthly

instalment; and

d. For the avoidance of doubt, there will be no adjustment to the previous

monthly payments that have already been paid to the PCN.

9.2. Administrative provisions relating to payment

9.2.1. Payments under the Network Contract DES are to be treated for accounting

and superannuation purposes as gross income of the PCN’s Core Network


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Practices, in the financial year. Where payments are made to the Nominated

Payee, how the income is apportioned for accounting and superannuation

purposes will depend on the arrangements for the distribution of payments

between the Core Network Practices, as set out in the Network Agreement.

Core Network Practices are responsible for ensuring that their arrangements

are appropriate.

9.2.2. Payments made in accordance with this Network Contract DES Specification

may be changed when there is any change to a PCN, including, but not limited

to, where there is a change to the Core Network Practices members.

9.2.3. A PCN (and its Core Network Practices) is required to adhere to current

financial probity standards that are in place across the NHS, ensuring that the

deployment of resources would stand up to wider scrutiny as an efficient and

effective use of NHS funding.

9.2.4. The commissioner will be responsible for post payment verification. This may

include auditing claims of the PCN (and a Core Network Practice in relation to

the Network Participation Payment) to ensure that they meet the requirements

of the Network Contract DES. Where required, PCNs and/or a Core Network

Practice as relevant will provide to the commissioner in a timely manner all

relevant information and assistance to support assessment of compliance with

the requirements of this service and expenditure against the Network Contract

DES.

9.2.5. Payments pursuant to the Network Contract DES, or any part thereof, are only

payable if a PCN or a Core Network Practice if relevant satisfies the following

conditions:

a. the PCN or Core Network Practice as relevant makes available to the

commissioner any information under the Network Contract DES, which the

commissioner requests and the PCN or Core Network Practice as relevant

either has or could be reasonably expected to obtain;

b. the PCN or Core Network Practice as relevant makes any returns required

of it (whether computerised or otherwise) to the payment system or CQRS

and does so promptly and fully; and

c. all information supplied pursuant to or in accordance with this section 9

must be accurate.

9.2.6. If a commissioner makes a payment under the Network Contract DES and:

a. the recipient was not entitled to receive all or part thereof, whether

because it did not meet the conditions for the payment or because the

payment was calculated incorrectly (including where a payment on

account overestimates the amount that is to fall due); or


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b. the commissioner was entitled to withhold all or part of the payment

because of a breach of a condition attached to the payment, but is unable

to do so because the money has already been paid,

then the commissioner is entitled to repayment of all or part of the money paid.

The commissioner may, in this circumstance, recover the money paid by

deducting an equivalent amount from any payment payable to the PCN (or if

the payment relates to payments of the Network Participation, from any

payment to the relevant Core Network Practice), and where no such deduction

can be made, it is a condition of the payments made under the Network

Contract DES that the PCN54 or relevant Core Network Practice as relevant

must pay to the commissioner that equivalent amount.

9.2.7. Where the commissioner is entitled under the Network Contract DES to

withhold all or part of a payment because of a breach of a payment condition

and the commissioner does so or recovers the money by deducting an

equivalent amount from another payment in accordance with this section 9, it

may, where it sees fit to do so, reimburse the PCN or relevant Core Network

Practice as relevant the amount withheld or recovered, if the breach is cured.

9.3. Network Participation Payment

9.3.1. Each practice that:

a. is eligible to participate in this Network Contract DES;

b. has submitted information for confirmation of participation in accordance

with section 4;

c. has been confirmed as participating in the Network Contract DES as a

Core Network Practice of a PCN; and

d. commits to being active members of their PCN as it evolves over the

coming years,

will be eligible for a Network Participation Payment (“NPP”) with effect from 1

April 2020 to support practice engagement.

9.3.2. For the avoidance of doubt:

a. the NPP payment is only made in respect of a PCN of which the practice is

a Core Network Practice; and

54 The PCN must agree how it would deal with such a circumstance so as not to disadvantage the

Nominated Payee. Where required, the commissioner may consider withholding the SFE payment in accordance with the provisions of the SFE.


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b. the NPP payment is paid directly to a Core Network Practice and not the

PCN’s Nominated Payee.

9.3.3. For practices to whom the SFE applies, the NPP will be paid in accordance

with the SFE and is not a financial entitlement pursuant to this Network


9.3.4. For practices to whom the SFE does not apply, it is a requirement of this

Network Contract DES that the commissioner ensures that a payment is made

in respect of those practices that equates to the NPP that would have been

made to the practice if the SFE applied to that practice.

9.3.5. The NPP for the period 1 April 2020 to 31 March 2021 is calculated as £1.761

multiplied by the practice’s “weighted patient population” where weighted

patient population means the practice’s Contractor Registered Population (as

calculated in accordance with the SFE regardless of whether the SFE applies

to that practice) as at 1 January 2020 and as adjusted by the Global Sum

Allocation Formula set out in Part 1 of Annex B of the SFE.

9.3.6. Subject to sections 9.3.7 and 9.3.8, the amount calculated as the NPP is

payable in 12 equal monthly instalments and the commissioner must arrange

for the relevant payment to be made to a Core Network Practice no later than

the last day of the month following the month in which the payment applied

and taking into account local payment arrangements.

9.3.7. The commissioner will make the first payment of the relevant NPP amount to a

Core Network Practice of a Previously Approved PCN no later than the end of

the month following the month in which the participation of all Core Network

Practices of that PCN has been confirmed subject to section 9.1.7 and local

payment arrangements. Where the first payment is paid after April 2020, the

first payment will include payment of instalments backdated to April 2020.

9.3.8. Where a new proposed PCN is approved after 1 April 2020, the Core Network

Practices of that PCN acknowledges that the NPP will be calculated as set out

in section 9.3.4 and split into 12 monthly instalments but the PCN’s Core

Network Practices will only be entitled to receive the monthly instalments for

the months they deliver the service requirements of the Network Contract

DES. As indicated in section 4.8 the commissioner will, when the PCN is

approved, indicate to the PCN the relevant service delivery commencement

date and payment dates.

9.3.9. A Core Network Practice will no longer be eligible to receive the NPP if under

exceptional circumstances it leaves the PCN after 31 May 2020. The change

will take effect from the month following the month in which the Core Network

Practice leaves the PCN.


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9.4. Clinical Director Payment

9.4.1. A PCN is entitled to a population-based payment to facilitate the delivery of the

requirements of the Clinical Director role.

9.4.2. The clinical director payment for the period 1 April 2020 to 31 March 2021 is

calculated using a baseline equivalent of 0.25 WTE (1 WTE is £139,469 in

2020/21) per 50,000 PCN Patients (as at 1 January 2020)55. This equates to a

payment of £0.72256 per registered patient per annum (which equates to

£0.060 per patient per month).

9.4.3. Subject to sections 9.4.4 and 9.4.5, the amount calculated as the clinical

director payment is payable in 12 equal monthly instalments and the

commissioner must arrange for payment to be made no later than the last day

of the month in which the payment applies and taking into account local

payment arrangements.

9.4.4. The commissioner will make the first payment of the relevant clinical director

payment amount to a Previously Approved PCN no later than the end of the

month in which the participation of all Core Network Practices of that PCN has

been confirmed subject to section 9.1.7 and local payment arrangements.

Where the first payment is paid after April 2020, the first payment will include

payment of instalments backdated to April 2020.

9.4.5. Where a new proposed PCN is approved after 1 April 2020, the PCN

acknowledges that the clinical director payment will be calculated as set out in

section 9.4.2 and split into 12 monthly instalments but the PCN will only be

entitled to receive the monthly instalments for the months it delivers the

service requirements of the Network Contract DES. As indicated in section 4.8

the commissioner will indicate to the PCN the relevant service delivery

commencement date and payment dates when the PCN is approved.

9.5. Core PCN funding

9.5.1. A PCN is entitled to a payment of Core PCN Funding for use by the PCN as it

sees fit.

9.5.2. The Core PCN Funding for the period 1 April 2020 to 31 March 2021 is

calculated as £1.50 multiplied by the PCN list size (equating to £0.125 per

patient per month).

55 https://digital.nhs.uk/services/organisation-data-service 56 The additional 6 per cent employer’s superannuation will be met centrally.


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https://digital.nhs.uk/services/organisation-data-service

9.5.3. Subject to sections 9.5.4 and 9.5.5, the amount calculated as the Core PCN

Funding is payable in 12 equal monthly instalments and the commissioner

must arrange for payment to be made no later than the last day of the month

in which the payment applies and taking into account local payment

arrangements.

9.5.4. The commissioner will make the first payment of the relevant Core PCN

Funding amount to an Approved PCN no later than the end of the month in

which the participation of all Core Network Practices of that PCN has been

confirmed subject to section 9.1.7 and local payment arrangements. Where

the first payment is paid after April 2020, the first payment will include payment

of instalments backdated to April 2020.


acknowledges that the Core PCN Funding will be calculated as set out in

section 9.5.2 and split into 12 monthly instalments but the PCN will only be





9.5.6. The Commissioner must provide the Core PCN Funding from its CCG core

allocations57 as per the NHS Operational Planning and Contracting Guidance

2020/2158.

9.6. Extended hours access payment

9.6.1. A PCN is entitled to a payment to facilitate the delivery of the requirements of

the Extended Hours Access service requirement.

9.6.2. The extended hours access payment for the period 1 April 2020 to 31 March

2021 is calculated as £1.45 multiplied by the PCN list size (equating to £0.121

per patient per month).

9.6.3. Subject to sections 9.6.4 and 9.6.5, the amount calculated as the extended

hours access payment is payable in 12 equal monthly instalments and the




9.6.4. The commissioner will make the first payment of the relevant extended hours

access payment amount to an Approved PCN no later than the end of the

month in which the participation of all Core Network Practices of that PCN has

57 Rather than specific primary medical care allocations. 58 https://www.england.nhs.uk/publication/nhs-operational-planning-and-contracting-guidance-2020-21/


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https://www.england.nhs.uk/operational-planning-and-contracting/

https://www.england.nhs.uk/operational-planning-and-contracting/

https://www.england.nhs.uk/publication/nhs-operational-planning-and-contracting-guidance-2020-21/

been confirmed subject to section 9.1.7 and local payment arrangements.

Where the first payment is paid after April 2020, the first payment will include

payment of instalments backdated to April 2020.


acknowledges that the extended hours access payment will be calculated as

set out in section 9.6.2 and split into 12 monthly instalments but the PCN will

only be entitled to receive the monthly instalments for the months it delivers

the service requirements of the Network Contract DES. As indicated in section

4.8 the commissioner will indicate to the PCN the relevant service delivery


9.7. Care home premium

9.7.1. A PCN is entitled to a payment to facilitate delivery of services to patients in

care homes.

9.7.2. The payment is calculated on the basis of £60 per bed for the period 1 August

2020 to 31 March 2021. The number of beds will be based on Care Quality

Commission (CQC) data on beds within services that are registered as care

home services with nursing (CHN) and care home services without nursing

(CHS) in England59.

9.7.3. The commissioner must arrange for payment to be made to the PCN on a

monthly basis from 1 August 2020 at a rate of £7.50 per bed per month for the

period 1 August 2020 to 31 March 2021 based on the number of relevant beds

in the PCN’s Aligned Care Homes.

9.7.4. Subject to sections 9.7.5 to 9.7.7 the amount calculated as the care home

premium payment is payable in eight equal monthly instalments and the




9.7.5. Where a new proposed PCN is approved after 1 August 2020, the PCN

acknowledges that the care home premium payment will be calculated as set

out in section 9.7.3 and split into eight monthly instalments but the PCN will

only be entitled to receive the monthly instalments for the months it delivers

the service requirements60 of the Network Contract DES. As indicated in

59 See https://www.cqc.org.uk/guidance-providers/regulations-enforcement/service-types for further

information on the definition of care home services for this purpose. 60 Monthly payments will be paid in full regardless of whether the new proposed PCN was established

mid-month.


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https://www.cqc.org.uk/guidance-providers/regulations-enforcement/service-types

section 4.8 the commissioner will indicate to the PCN the relevant service

delivery commencement date and payment dates when the PCN is approved.

9.7.6. The commissioner must ensure that the number of beds on which payment is

based is updated on a monthly basis in line with the CQC Care Directory61.

9.7.7. Payment will only be made where the commissioner is satisfied that the PCN

or its Core Network Practices have comprehensively coded care home

residents using appropriate clinical codes as follows and as set out in section

10:

a. 160734000 – Lives in a nursing home; and

b. 394923006 – Live in a residential home.

9.8. PCN Support Payment

9.8.1. A PCN is entitled to the PCN Support Payment for the period 1 April 2020 to

30 September 2020. This payment is calculated as £0.27 multiplied by the

PCNs “weighted patient population” where weighted patient population

means the PCN’s Core Network Practice’s Contractor Registered Population

(as calculated in accordance with the SFE regardless of whether the SFE

applies to that practice) as at 1 January 2020 and as adjusted by the Global

Sum Allocation Formula set out in Part 1 of Annex B of the SFE. This equates

to £0.045 per weighted patient per month.

9.8.2. Subject to sections 9.8.3 and 9.8.4, the amount calculated as the PCN

Support Payment is payable in six equal monthly instalments and the




9.8.3. The commissioner will make the first payment of the relevant PCN Support

Payment amount to an Approved PCN no later than the end of the month in

which the participation of all Core Network Practices of that PCN has been

confirmed subject to section 9.1.7 and local payment arrangements. Where

the first payment is paid after April 2020, the first payment will include payment

of instalments backdated to April 2020.


acknowledges that the PCN Support Payment will be calculated as set out in

section 9.8.1 and split into six monthly instalments but the PCN will only be



61 See https://www.cqc.org.uk/guidance-providers/regulations-enforcement/service-types for further

information on the definition of care home services for this purpose.


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https://protect-eu.mimecast.com/s/AhPCCy8yKumgLjytQEbKz?domain=cqc.org.uk



9.9. Additional funding from October 2020

9.9.1. A PCN and the commissioner acknowledge that:

a. additional funding will be made available to practices in the six months

prior to 31 March 2021;

b. to receive the funding, a PCN may be required to carry out certain actions

or activities;

c. NHS England and NHS Improvement will publish in a separate document

prior to 1 October 2020 details of the level of funding, how to claim the

funding and any actions or activities required to be eligible for the funding

which will be agreed with the BMA’s GPCE;

d. Where a PCN is required to carry out certain actions or activities to receive

the funding and a PCN carries out those actions or activities, then the

terms of the document published by NHS England and Improvement

relating to those actions or activity and associated arrangements for

funding will apply for the period specified in that document;

e. Where a PCN does not carry out those actions or activities then the PCN

will not be entitled to the funding and the terms of the document published

by NHS England and NHS Improvement will not apply; and

f. The existing provisions of this Network Contract DES Specification will not

change as a result of the additional funding and therefore section 4.13.1.b

will not apply in respect of the additional funding.

9.10. Workforce

9.10.1. Subject to sections 9.10.4 to 9.10.8, a PCN is entitled to claim 100 per cent

reimbursement of the aggregate WTE actual62 salary (including employer on-

costs63) up to the maximum amount per role as outlined in Table 2 and within

that PCN’s overall Additional Roles Reimbursement Sum, for the delivery of

health services.

9.10.2. A PCN’s Additional Roles Reimbursement Sum equates to £7.131 per PCN

weighted list size as at 1 January 2020. The explanation of PCN’s weighted

62 If relevant the percentage will be appropriately apportioned to PCN related activity. 63 This does not include the additional 6 per cent employer contributions.


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list size and the calculation used to determine a PCN’s Additional Roles

Reimbursement Sum is set out in the Network Contract DES Guidance.

9.10.3. A PCN must use the mandatory claim form64, or subsequent electronic

replacement, to submit the monthly workforce claim.

9.10.4. The following conditions apply to any claim made pursuant to section 9.10.1:

a. The commissioner will arrange for payment to be made on a monthly basis

in arrears following the start of employment of the relevant Additional Role

or engagement via a service sub-contract. The commissioner will only

make payments following the start of the employment or engagement.

b. The Nominated Payee must in accordance with local payment

arrangements submit a claim for the reimbursement of the cost relating to

the previous month.

c. The commissioner must make payments no later than the last day of the

month following the month to which the payment relates and taking into

account local payment arrangements (for example, a payment relating to

April 2020 is to be made on or by the end May 2020).

d. The claim must relate to reimbursement of costs referred to in section

9.10.1 from within the ten roles covered by the Additional Roles

Reimbursement Scheme in accordance with section 6.

e. A PCN must demonstrate that claims being made are for additional staff

roles beyond the baseline (including in future years, replacement as a

result of staff turnover) as set out in this Network Contract DES

Specification. The commissioner will be required to ensure the claims

meet the ‘additionality rules’ set out in section 6.

f. A PCN (and Core Network Practices) not adhering to the additionality rules

and principles will not be eligible for workforce reimbursement under this

Network Contract DES Specification and could be subject to the recovery

of funds and referral for investigation of fraud.

g. The commissioner will carry out audit appropriately and a PCN must co-

operate fully in providing the relevant information. Failure by a PCN to

provide the requested information will enable the commissioner to withhold

or reclaim reimbursements.

h. A PCN must ensure that clinical pharmacists and pharmacy technicians,

reimbursed under the national Medicines Optimisation in Care Homes

64 The claim form available at https://www.england.nhs.uk/publication/des-additional-roles-

reimbursement-scheme-claim-form-2020-21/. Further information regarding the electronic replacement is available in the Network Contract DES Guidance 2020/21.


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https://www.england.nhs.uk/publication/des-additional-roles-reimbursement-scheme-claim-form-2020-21/

https://www.england.nhs.uk/publication/des-additional-roles-reimbursement-scheme-claim-form-2020-21/


Scheme and that have been transferred65 so that they receive funding

under the Network Contract DES, meet the terms set out in this Network

Contract DES Specification. The PCN must ensure that the clinical

pharmacist or pharmacy technician work across the PCN and carry out the

relevant duties pursuant to section 6 in the delivery of health services.

i. The commissioner will make any payments due under this section 9.10 to

the Nominated Payee.

9.10.5. For the purposes of this section 9.10, “WTE” is defined as 37.5 hours in line

with Agenda for Change (AfC) terms, but this may vary for non-AfC posts.

Where AfC does not apply, a PCN should calculate the relevant WTE

according to the normal full-time hours for that role in the employing

organisation with reimbursement being made on a pro-rata basis accordingly.

9.10.6. If the workforce delivering the health services is employed by a non-PCN

body, the contribution will be the relevant percentage of the actual WTE

equivalent salary and employer on-costs costs, that have been appropriately

apportioned to PCN-related activity.

9.10.7. In addition to the reimbursement of 100 per cent of actual WTE equivalent

salary and employer on costs (pension and national insurance contributions),

where a PCN does not employ a Social Prescriber Link Worker and sub-

contracts the delivery of the social prescribing service, a PCN may claim a

contribution towards additional costs charged by the sub-contracted provider

for the provision of the social prescribing service. A PCN may claim a

contribution of up to £200 per month (£2,400 per year) for each whole WTE

that the sub-contracted provider has appropriately apportioned to PCN-related

activity provided that:

a. a claim for the contribution towards additional costs charged by the sub-

contracted provider must not exceed £200 in respect of any month; and

b. the total annual amount claimed by the PCN in respect of the social

prescribing element in respect of each WTE does not exceed the

maximum reimbursable amount set out in Table 2. For the avoidance of

doubt, the contribution towards additional costs charged by the sub-

contracted provider is included when considering whether the total annual

amount is within the maximum reimbursable amount.

65 Information regarding the transition arrangements is available in the Network Contract DES guidance.


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Table 2: Maximum reimbursement amounts per role for 2020/21

Role

AfC band

Annual maximum reimbursable amount per role66

£

Clinical pharmacist 7-8a 55,670

Pharmacy technician 5 35,389

Social prescribing link worker Up to 5 35,389

Health and wellbeing coach Up to 5 35,389

Care coordinator 4 29,135

Physician associate 7 53,724

First contact physiotherapist 7-8a 55,670

Dietician 7 53,724

Podiatrist 7 53,724

Occupational therapist 7 53,724

9.10.8. A PCN will only be eligible for payment where all of the following requirements

have been met:

a. For workforce related claims, the PCN has met the requirements as set

out in section 6 for the relevant roles against which payment is being

claimed.

66 The maximum reimbursable amount is the sum of (a) the weighted average salary for the specified

AfC band plus (b) associated employer on-costs. These amounts do not include any recruitment and reimbursement premiums that PCNs may choose to offer. If applicable, the on-costs will be revised to take account of any pending change in employer pension contributions. The maximum reimbursement amount in subsequent years will be confirmed in line with applicable AfC rates.


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b. The employing organisation (whether this is a PCN member or a third

party) continues to employ the individual(s) for whom payments are being

claimed and the PCN continues to have access to those individual(s);

c. The PCN makes available to commissioners any information under the

Network Contract DES, which the commissioner needs and the PCN either

has or can be reasonably expected to obtain in order to establish that the

PCN has fulfilled the requirements of the Network Contract DES

Specification;

d. The PCN makes any returns required of it and does so promptly and fully;

and

e. All information supplied pursuant to or in accordance with this Network

Contract DES Specification is complete and accurate.

10. Monitoring

10.1. The commissioner will monitor services and calculate payments under the

Network Contract DES using CQRS and/or NHAIS or any subsequent

replacement system.

10.2. A PCN’s Core Network Practices will be required to manually input data into

CQRS, until General Practice Extraction Service (“GPES”) (or any

subsequent replacement system) is available to conduct electronic data

collections. The data input67 will be in relation to both management and

payment counts.

10.3. Details as to when automated collections will be available to support this

Network Contract DES will be communicated via NHS Digital68.

10.4. A PCN’s Core Network Practices will be required to use the relevant

SNOMED codes, as published in the supporting Business Rules on the NHS

Digital website (http://www.hscic.gov.uk/qofesextractspecs) to record:

Activity to be coded Code type69

Available from70

Patient Activation Measure (PAM) completed Existing Apr 2020

67 For information on how to manually enter data into CQRS, see NHS Digital’s website 68 https://digital.nhs.uk/search/publicationStatus/false?area=data&sort=date 69 Those codes indicated as being ‘new’ have either been requested or are being requested and will be

available in clinical systems in due course. 70 Proposed availability but may be subject to change.


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http://www.hscic.gov.uk/qofesextractspecs

https://digital.nhs.uk/search/publicationStatus/false?area=data&sort=date

Patients whose care has been discussed as part of shared decision-making

Existing Apr 2020

Workforce

Referrals to social prescribing services (carried over from 2019/20).

Existing Oct 2019

Patients who have declined a referral to a social prescribing service (carried over from 2019/20).

Existing Oct 2019

Medication reviews by clinical pharmacists (carried over from 2019/20).

Existing Oct 2019

Consultations by clinical pharmacists (carried over from 2019/20).

Existing Oct 2019

Care home visits by a clinical pharmacist (carried over from 2019/20).

Existing Oct 2019

Consultations by a First Contact Physiotherapist. New Oct 2020

Consultations by a Physician Associate New Oct2020

Consultations by a Health and Wellbeing Coach New Apr 2021

Consultations by a Care Coordinator New Apr 2021

Consultations by a Dietician Existing Apr 2020

Consultations by an Occupational Therapist Existing Apr 2020

Consultations by a Podiatrist Existing Apr 2020

Consultations by a Pharmacy Technician Existing Apr 2020

Structured Medication Reviews

Delivery of structured medication reviews. New Oct 2020

Enhanced Health in Care Homes

Patients living in a residential home or nursing home Existing Apr 2020

Patients living temporarily in a residential home or nursing home.

New Oct 2020

Delivery of personalised care and support plans New Oct 2020

Reviews of personalised care and support plans New Oct 2020


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Falls risk assessments for patients recorded as living in a residential home or nursing home

Existing Apr 2020

Patients with acute confusion recorded as living in a residential home or nursing home

Existing Apr 2020

Delirium assessments for patients experiencing acute confusion, who are recorded as living in a residential home or nursing home

Existing Apr 2020

Psychosocial assessments for patients recorded as living in a residential or nursing home

Existing Apr 2020

Supporting Early Cancer Diagnosis

Patients placed on an urgent referral pathway for suspected cancer

Existing Apr 2020

Delivery of safety netting for patients on urgent referral pathway for suspected cancer

New Oct 2020

Investment and Impact Fund (IIF)

Patients on the learning disability register Existing Apr 2020

Learning disability annual health checks for patients on the learning disability register

Existing Apr 2020

Seasonal flu vaccinations for patients aged 65+ Existing Apr 2020

Patients referred to social prescribing Existing Apr 2020

10.5. A PCN’s Core Network Practices must ensure the coding of care home

residence is accurately recorded on a continuous basis.

10.6. The SNOMED codes outlined in section 10.4 will be used as the basis for the

GPES data collection, which will allow CQRS to calculate aggregated

numbers to support the management information counts. Core Network

Practices must use the relevant codes, outlined above, within their clinical

systems as only those included in this document and the supporting

Business Rules will be acceptable to allow CQRS calculations. A PCN’s Core

Network Practices will therefore need to ensure that they use the relevant

codes and if necessary, re-code patients.


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Annex A - Network Contract DES Participation Form

The Network Contract DES Participation Form is available at https://www.england.nhs.uk/publication/des-participation-form-2020-21/.


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https://www.england.nhs.uk/publication/des-participation-form-2020-21/

Annex B - Additional Roles Reimbursement Scheme -

Minimum Role Requirements

B.1. Clinical Pharmacist

B1.1. Where a PCN employs or engages a Clinical Pharmacist under the Additional

Roles Reimbursement Scheme, the PCN must ensure that the Clinical

Pharmacist is enrolled in, or has qualified from, an approved 18-month training

pathway or equivalent that equips the Clinical Pharmacist to:

a. be able to practice and prescribe safely and effectively in a primary care

setting (for example, the CPPE Clinical Pharmacist training pathways71,72);

and

b. deliver the key responsibilities outlined in section B1.2.

B1.2. Where a PCN employs or engages one or more Clinical Pharmacists under

the Additional Roles Reimbursement Scheme, the PCN must ensure that each

Clinical Pharmacist has the following key responsibilities in relation to

delivering health services:

a. work as part of a multi-disciplinary team in a patient facing role to clinically

assess and treat patients using their expert knowledge of medicines for

specific disease areas;

b. be a prescriber, or completing training to become prescribers, and work

with and alongside the general practice team;

c. be responsible for the care management of patients with chronic diseases

and undertake clinical medication reviews to proactively manage people

with complex polypharmacy, especially the elderly, people in care homes,

those with multiple co-morbidities (in particular frailty, COPD and asthma)

and people with learning disabilities or autism (through STOMP – Stop

Over Medication Programme);

d. provide specialist expertise in the use of medicines whilst helping to

address both the public health and social care needs of patients at the

PCN’s practice(s) and to help in tackling inequalities;

e. provide leadership on person-centred medicines optimisation (including

ensuring prescribers in the practice conserve antibiotics in line with local

antimicrobial stewardship guidance) and quality improvement, whilst

71 https://www.cppe.ac.uk/career/clinical-pharmacists-in-general-practice-education#navTop 72 https://www.cppe.ac.uk/wizard/files/general-practice/clinical-pharmacists-in-general-practice-

education-brochure.pdf


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https://www.cppe.ac.uk/career/clinical-pharmacists-in-general-practice-education#navTop

https://www.cppe.ac.uk/wizard/files/general-practice/clinical-pharmacists-in-general-practice-education-brochure.pdf

https://www.cppe.ac.uk/wizard/files/general-practice/clinical-pharmacists-in-general-practice-education-brochure.pdf

contributing to the quality and outcomes framework and enhanced

services;

f. through structured medication reviews, support patients to take their

medications to get the best from them, reduce waste and promote self-

care;

g. have a leadership role in supporting further integration of general practice

with the wider healthcare teams (including community and hospital

pharmacy) to help improve patient outcomes, ensure better access to

healthcare and help manage general practice workload;

h. develop relationships and work closely with other pharmacy professionals

across PCNs and the wider health and social care system;

i. take a central role in the clinical aspects of shared care protocols, clinical

research with medicines, liaison with specialist pharmacists (including

mental health and reduction of inappropriate antipsychotic use in people

with learning difficulties), liaison with community pharmacists and

anticoagulation; and

j. be part of a professional clinical network and have access to appropriate

clinical supervision. Appropriate clinical supervision means:

i. each clinical pharmacist must receive a minimum of one supervision

session per month by a senior clinical pharmacist73;

ii. the senior clinical pharmacist must receive a minimum of one

supervision session every three months by a GP clinical supervisor;

iii. each clinical pharmacist will have access to an assigned GP clinical

supervisor for support and development; and

iv. a ratio of one senior clinical pharmacist to no more than five junior

clinical pharmacists, with appropriate peer support and supervision in

place.

B.2. Pharmacy Technicians

B2.1. Where a PCN employs or engages a Pharmacy Technician under the

Additional Roles Reimbursement Scheme, the PCN must ensure that the

Pharmacy Technician:

a. is registered with the General Pharmaceutical Council (GPhC);

73 This does not need to be a senior clinical pharmacist within the PCN but could be part of a wider local

network, including from secondary care or another PCN.


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b. meets the specific qualification and training requirements as specified by

the GPhC criteria74 to register as a Pharmacy Technician;

c. enrolled in, undertaking or qualified from, an approved training pathway.

For example, the Primary Care Pharmacy Educational Pathway (PCPEP)

or Medicines Optimisation in Care Homes (MOCH); and

d. is working under appropriate clinical supervision to ensure safe, effective

and efficient use of medicines

in order to deliver the key responsibilities outlined in section B2.2.

B2.2. Where a PCN employs or engages one or more Pharmacy Technicians under


Pharmacy Technician has the following key clinical, and technical and

administrative responsibilities, in delivering health services:

B2.2.1. Clinical responsibilities of the Pharmacy Technician:

a. undertake patient facing and patient supporting roles to ensure effective

medicines use, through shared-decision making conversations with

patients;

b. carry out medicines optimisation tasks including effective medicine

administration (e.g. checking inhaler technique), supporting medication

reviews, and medicines reconciliation. Where required, utilise consultation

skills to work in partnership with patients to ensure they use their

medicines effectively;

c. support, as determined by the PCN, medication reviews and medicines

reconciliation for new care home patients and synchronising medicines for

patient transfers between care settings and linking with local community

pharmacists.

d. provide specialist expertise, where competent, to address both the public

health and social care needs of patients, including lifestyle advice, service

information, and help in tackling local health inequalities;

e. take a central role in the clinical aspects of shared care protocols and

liaising with specialist pharmacists for more complex patients;

f. support initiatives for antimicrobial stewardship to reduce inappropriate

antibiotic prescribing;

74 The training requirements for Pharmacy Technicians are currently in transition and further information

is available on the General Pharmaceutical Council (GPhC) website. This information will provide the specific criteria to register as a pharmacy technician – see https://www.pharmacyregulation.org/i-am-pharmacy-technician


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https://www.pharmacyregulation.org/i-am-pharmacy-technician

https://www.pharmacyregulation.org/i-am-pharmacy-technician

g. assist in the delivery of medicines optimisation and management incentive

schemes and patient safety audits;

h. support the implementation of national prescribing policies and guidance

within GP practices, care homes and other primary care settings. This will

be achieved through undertaking clinical audits (e.g. use of antibiotics),

supporting quality improvement measures and contributing to the Quality

and Outcomes Framework and enhanced services;

B2.2.2. Technical and Administrative responsibilities of the Pharmacy Technician:

a. work with the PCN multi-disciplinary team to ensure efficient medicines

optimisation, including implementing efficient ordering and return

processes, and reducing wastage;

b. supervise practice reception teams in sorting and streaming general

prescription requests, so as to allow GPs and clinical pharmacists to

review the more clinically complex requests;

c. provide leadership for medicines optimisation systems across PCNs,

supporting practices with a range of services to get the best value from

medicines by encouraging and implementing Electronic Prescriptions, safe

repeat prescribing systems, and timely monitoring and management of

high-risk medicines;

d. provide training and support on the legal, safe and secure handling of

medicines, including the implementation of the Electronic Prescription

Service (EPS); and

e. develop relationships with other pharmacy technicians, pharmacists and

members of the multi-disciplinary team to support integration of the

pharmacy team across health and social care including primary care,

community pharmacy, secondary care, and mental health.

B.3. Social Prescribing Link Workers

B3.1. A PCN must provide to the PCN’s patients access to a social prescribing

service. To comply with this, a PCN may:

a. directly employ Social Prescribing Link Workers; or

b. sub-contract provision of the service to another provider

in accordance with this Network Contract DES Specification.

B3.2. Where a PCN employs or engages a Social Prescribing Link Worker under the


Social Prescribing Link Worker:


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a. has completed the NHS England and NHS Improvement online learning

programme75

b. is enrolled in, undertaking or qualified from appropriate training as set out

by the Personalised Care Institute76; and

c. attends the peer support networks run by NHS England and NHS

Improvement at ICS and/or STP level;


B3.3. Where a PCN employs or engages one or more Social Prescribing Link

Workers under the Additional Roles Reimbursement Scheme or sub-contracts

provision of the social prescribing service to another provider, the PCN must

ensure that each Social Prescribing Link Worker providing the service has the

following key responsibilities in delivering the service to patients:

a. as members of the PCN’s team of health professionals, take referrals from

the PCN’s Core Network Practices and from a wide range of agencies77 to

support the health and wellbeing of patients;

b. assess how far a patient’s health and wellbeing needs can be met by

services and other opportunities available in the community;

c. co-produce a simple personalised care and support plan to address the

patient’s health and wellbeing needs by introducing or reconnecting

people to community groups and statutory services, including weight

management support and signposting where appropriate and it matters to

the person;

d. evaluate how far the actions in the care and support plan are meeting the

patient’s health and wellbeing needs78;

e. provide personalised support to patients, their families and carers to take

control of their health and wellbeing, live independently, improve their

health outcomes and maintain a healthy lifestyle;

f. develop trusting relationships by giving people time and focus on ‘what

matters to them’;

75 https://www.e-lfh.org.uk/programmes/social-prescribing/ 76 https://www.england.nhs.uk/personalisedcare/supporting-health-and-care-staff-to-deliver-

personalised-care/personalised-care-institute/ 77 These agencies include but are not limited to: the PCN’s members, pharmacies, multi-disciplinary

teams, hospital discharge teams, allied health professionals, fire service, police, job centres, social care services, housing associations and voluntary, community and social enterprise (VCSE) organisations.

78 Including considering if the persons needs are met (for example, reasonable adjustments, interpreter etc).


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https://www.e-lfh.org.uk/programmes/social-prescribing/

https://www.england.nhs.uk/personalisedcare/supporting-health-and-care-staff-to-deliver-personalised-care/personalised-care-institute/

g. take a holistic approach, based on the patient’s priorities and the wider

determinants of health;

h. explore and support access to a personal health budget where

appropriate;

i. manage and prioritise their own caseload, in accordance with the health

and wellbeing needs of their population; and

j. where required and as appropriate, refer patients back to other health

professionals within the PCN.

B3.4. A PCN’s Core Network Practices must identify a first point of contact for

general advice and support and (if different) a GP to provide supervision for

the Social Prescribing Link Worker(s). This could be provided by one or more

named individuals within the PCN.

B3.5. A PCN will ensure the Social Prescribing Link Worker(s) can discuss patient

related concerns and be supported to follow appropriate safeguarding

procedures (e.g. abuse, domestic violence and support with mental health)

with a relevant GP.

B3.6. A PCN must ensure referrals to the Social Prescribing Link Worker(s) are

recorded within GP clinical systems using the new national SNOMED codes

(see section 6.4.1 and 10).

B3.7. Where a PCN employs or engages one or more Social Prescribing Link

Workers under the Additional Roles Reimbursement Scheme or sub-contracts

provision of the social prescribing service to another provider, the PCN must

ensure that each Social Prescribing Link Worker has the following key wider

responsibilities:

a. draw on and increase the strength and capacity of local communities,

enabling local Voluntary, Community and Social Enterprise (VCSE)

organisations and community groups to receive social prescribing referrals

from the Social Prescribing Link Worker;

b. work collaboratively with all local partners to contribute towards supporting

the local VCSE organisations and community groups to become

sustainable and that community assets are nurtured, through sharing

intelligence regarding any gaps or problems identified in local provision

with commissioners and local authorities;

c. have a role in educating non-clinical and clinical staff within the PCN

through verbal or written advice or guidance on what other services are

available within the community and how and when patients can access

them;


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B3.8. A PCN must be satisfied that organisations and groups to whom the Social

Prescribing Link Workers(s) directs patients:

a. have basic safeguarding processes in place for vulnerable individuals; and

d. provide opportunities for the patient to develop friendships and a sense of

belonging, as well as to build knowledge, skills and confidence.

B3.9. A PCN must ensure that all staff working in practices that are members of the

PCN are aware of the identity of the Social Prescribing Link Worker(s) and the

process for referrals.

B3.10. A PCN must work in partnership with commissioners, social prescribing

schemes, Local Authorities and voluntary sector leaders to create a shared

plan for social prescribing which must include how the organisations will build

on existing schemes and work collaboratively to recruit additional social

prescribing link workers to embed one in every PCN and direct referrals to the

voluntary sector.

B.4. Health and Wellbeing Coach

B4.1. Where a PCN employs or engages a Health and Wellbeing Coach under the


Health and Wellbeing Coach:

a. is enrolled in, undertaking or qualified from appropriate health coaching

training covering topics outlined in the NHS England and NHS

Improvement Implementation and Quality Summary Guide79, with the

training delivered by a training organisation listed by the Personalised

Care Institute80;

b. adheres to a code of ethics and conduct in line with the NHS England and

NHS Improvement Health coaching Implementation and Quality Summary

Guide;

c. has formal individual and group coaching supervision which must come

from a suitably qualified or experienced individual; and

d. working closely in partnership with the Social Prescribing Link Worker(s) or

social prescribing service provider to identify and work alongside people

who may need additional support, but are not yet ready to benefit fully

from social prescribing

79 https://www.england.nhs.uk/publication/health-coaching-summary-guide-and-technical-annexes/ 80 https://www.england.nhs.uk/personalisedcare/supporting-health-and-care-staff-to-deliver-

personalised-care/personalised-care-institute/


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https://www.england.nhs.uk/publication/health-coaching-summary-guide-and-technical-annexes/




B4.2. Where a PCN employs or engages one or more Health and Wellbeing

Coaches under the Additional Roles Reimbursement Scheme, the PCN must

ensure that each Health and Wellbeing Coach has the following key

responsibilities, in delivering health services:

a. manage and prioritise a caseload, in accordance with the health and

wellbeing needs of their population through taking an approach that is

non-judgemental, based on strong communication and negotiation skills,

while considering the whole person when addressing existing issues.

Where required and as appropriate, the Health and Wellbeing Coach will

refer people back to other health professionals within the PCN;

b. utilise existing IT and MDT channels to screen patients, with an aim to

identify those that would benefit most from health coaching;

c. provide personalised support to individuals, their families, and carers to

support them to be active participants in their own healthcare; empowering

them to manage their own health and wellbeing and live independently

through:

d. coaching and motivating patients through multiple sessions to identify their

needs, set goals, and supporting patients to achieve their personalised

health and care plan objectives;

e. providing interventions such as self-management education and peer

support;

f. supporting patients to establish and attain goals that are important to the

patient;

g. supporting personal choice and positive risk taking while ensuring that

patients understand the accountability of their own actions and decisions,

thus encouraging the proactive prevention of further illnesses;

h. working in partnership with the social prescribing service to connect

patients to community-based activities which support them to take

increased control of their health and wellbeing;

i. increasing patient motivation to self-manage and adopt healthy

behaviours;

j. work with patients with lower activation scores to understand their level of

knowledge, skills and confidence (their “Activation” level), when engaging

with their health and well-being and subsequently supporting them in

shared decision-making conversations;

k. utilise health coaching skills to support people with lower levels of

activation to develop the knowledge, skills, and confidence to manage


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their health and wellbeing, whilst increasing their ability to access and

utilise community support offers; and

l. explore and support patient access to a personal health budget, where

appropriate, for their care and support.

B4.3. The following sets out the key wider responsibilities of Health and Wellbeing

Coaches:

a. develop collaborative relationships and work in partnership with health,

social care, and community and voluntary sector providers and multi-

disciplinary teams to holistically support patients’ wider health and well-

being, public health, and contributing to the reduction of health

inequalities;

b. provide education and specialist expertise to PCN staff, supporting them to

improve their skills and understanding of personalised care, behavioural

approaches and ensuring consistency in the follow up of people’s goals

with MDT input; and

c. raise awareness within the PCN of shared-decision making and decision

support tools.

B4.4. A PCN must be satisfied that organisations and groups to whom its Health and

Wellbeing Coach(es) directs patients:


b. provide opportunities for the patient to develop friendships and a sense of




the PCN’s Health and Wellbeing Coach(es). This could be provided by one or

more named individuals within the PCN. The Health and Wellbeing Coach

must have access to regular supervision from a health coaching mentor. In

addition to this, formal and individual group coaching supervision must come

from a suitably qualified or experienced health coaching supervisor.

B4.6. A PCN will ensure the PCN’s Health and Wellbeing Coach(es) can discuss

patient related concerns and be supported to follow appropriate safeguarding

procedures (e.g. abuse, domestic violence and support with mental health)

with a relevant GP.


PCN are aware of the identity of the PCN’s Health and Wellbeing Coach(es).


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B.5. Care Coordinator

B5.1. Where a PCN employs or engages a Care Coordinator under the Additional

Roles Reimbursement Scheme, the PCN must ensure that the Care

Coordinator:

a. is enrolled in, undertaking or qualified from appropriate training as set out

by the Personalised Care Institute81; and

b. works closely and in partnership with the Social Prescribing Link Worker(s)

or social prescribing service provider and Health and Wellbeing

Coach(es),


B5.2. Where a PCN employs or engages one or more Care Coordinators under the

Additional Roles Reimbursement Scheme, the PCN must ensure that each

Care Coordinator has the following key responsibilities, in delivering health

services:

a. utilise population health intelligence to proactively identify and work with a

cohort of patients to deliver personalised care;

b. support patients to utilise decision aids in preparation for a shared

decision-making conversation;

c. holistically bring together all of a person’s identified care and support

needs, and explore options to meet these within a single personalised

care and support plan (PCSP), in line with PCSP best practice, based on

what matters to the person;

d. help people to manage their needs through answering queries, making

and managing appointments, and ensuring that people have good quality

written or verbal information to help them make choices about their care;

e. support people to take up training and employment, and to access

appropriate benefits where eligible;

f. support people to understand their level of knowledge, skills and

confidence (their “Activation” level) when engaging with their health and

wellbeing, including through the use of the Patient Activation Measure;

g. assist people to access self-management education courses, peer support

or interventions that support them in their health and wellbeing and

increase their activation level;

81 https://www.england.nhs.uk/personalisedcare/supporting-health-and-care-staff-to-deliver-

personalised-care/personalised-care-institute/


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h. explore and assist people to access personal health budgets where

appropriate;

i. provide coordination and navigation for people and their carers across

health and care services, working closely with social prescribing link

workers, health and wellbeing coaches, and other primary care

professionals; and

j. support the coordination and delivery of MDTs within the PCN.

B5.3. The following sets out the key wider responsibilities of Care Coordinators:

a. work with the GPs and other primary care professionals within the PCN to

identify and manage a caseload of patients, and where required and as

appropriate, refer people back to other health professionals within the

PCN;

b. raise awareness within the PCN of shared-decision making and decision

support tools; and

c. raise awareness of how to identify patients who may benefit from shared

decision making and support PCN staff and patients to be more prepared

to have shared decision-making conversations.

B5.4. A PCN must be satisfied that organisations and groups to whom its Care

Coordinator directs patients:


b. provide opportunities for the patient to develop friendships and a sense of




the PCN’s Care Coordinator(s). This could be provided by one or more named

individuals within the PCN.

B5.6. A PCN will ensure the PCN’s Care Coordinator(s) can discuss patient related

concerns and be supported to follow appropriate safeguarding procedures

(e.g. abuse, domestic violence and support with mental health) with a relevant

GP.


PCN are aware of the identity of the PCN’s Care Coordinator(s).


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B.6. Physician Associates

B6.1. Where a PCN employs or engages a Physician Associate under the Additional

Roles Reimbursement Scheme, the PCN must ensure that the Physician

Associate:

a. has completed a post-graduate physician associate course (either PG

Diploma or MSc);

b. has maintained professional registration with the Faculty of Physician

Associates and/or the General Medical council following implementation of

statutory regulation, working within the latest code of professional conduct

(CIPD); and

c. has passed the UK Physician Associate (PA) National Re-Certification

Exam, which needs to be retaken every six years;

d. participates in continuing professional development opportunities by

keeping up to date with evidence-based knowledge and competence in all

aspects of their role, meeting clinical governance guidelines for continuing

professional development (CPD), and

e. is working under supervision of a doctor as part of the medical team,


B6.2. Where a PCN employs or engages one or more Physician Associates under


Physician Associate has the following key responsibilities, in delivering health

services:

a. provide first point of contact care for patients presenting with

undifferentiated, undiagnosed problems by utilising history-taking, physical

examinations and clinical decision-making skills to establish a working

diagnosis and management plan in partnership with the patient (and their

carers where applicable);

b. support the management of patient’s conditions through offering

specialised clinics following appropriate training including (but not limited

to) family planning, baby checks, COPD, asthma, diabetes, and

anticoagulation;

c. provide health/disease promotion and prevention advice, alongside

analysing and actioning diagnostic test results;

d. develop integrated patient-centred care through appropriate wording with

the wider primary care multi-disciplinary team and social care networks;


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e. utilise clinical guidelines and promote evidence-based practice and

partake in clinical audits, significant event reviews and other research and

analysis tasks;

f. participate in duty rotas; undertaking face-to-face, telephone, and online

consultations for emergency or routine problems as determined by the

PCN, including management of patients with long-term conditions;

g. undertake home visits when required; and

h. develop and agree a personal development plan (PDP) utilising a

reflective approach to practice, operating under appropriate clinical

supervision.

B6.3. A PCN’s Core Network practices must identify a suitable named GP

supervisor for each physician associate, to enable them to work under

appropriate clinical supervision.

B.7. First Contact Physiotherapists

B7.1. Where a PCN employs or engages a First Contact Physiotherapist under the

Additional Roles Reimbursement Scheme, the PCN must ensure that the First

Contact Physiotherapist:

a. has completed an undergraduate degree in physiotherapy;

b. is registered with the Health and Care Professional Council;

c. holds the relevant public liability insurance;

d. has a Masters Level qualification or the equivalent specialist knowledge,

skills and experience;

e. can demonstrate working at Level 7 capability in MSK related areas of

practice or equivalent (such as advanced assessment diagnosis and

treatment);

f. can demonstrate ability to operate at an advanced level of practice,


B7.2. Where a PCN employs or engages one or more First Contact Physiotherapist

under the Additional Roles Reimbursement Scheme, the PCN must ensure

that each First Contact Physiotherapist has the following key responsibilities,

in delivering health services:

a. work independently, without day to day supervision, to assess, diagnose,

triage, and manage patients, taking responsibility for prioritising and

managing a caseload of the PCN’s Registered Patients;


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b. receive patients who self-refer (where systems permit) or from a clinical

professional within the PCN, and where required refer to other health

professionals within the PCN;

c. work as part of a multi-disciplinary team in a patient facing role, using their

expert knowledge of movement and function issues, to create stronger

links for wider services through clinical leadership, teaching and

evaluation;

d. develop integrated and tailored care programmes in partnership with

patients, providing a range of first line treatment options including self-

management, referral to rehabilitation focussed services and social

prescribing;

e. make use of their full scope of practice, developing skills relating to

independent prescribing, injection therapy and investigation to make

professional judgements and decisions in unpredictable situations,

including when provided with incomplete or contradictory information. They

will take responsibility for making and justifying these decisions;

f. manage complex interactions, including working with patients with

psychosocial and mental health needs, referring onwards as required and

including social prescribing when appropriate;

g. communicate effectively with patients, and their carers where applicable,

complex and sensitive information regarding diagnoses, pathology,

prognosis and treatment choices supporting personalised care;

h. implement all aspects of effective clinical governance for own practice,

including undertaking regular audit and evaluation, supervision and

training;

i. develop integrated and tailored care programmes in partnership with

patients through:

i. effective shared decision-making with a range of first line management

options (appropriate for a patient’s level of activation);

ii. assessing levels of Patient Activation to support a patient’s own level

of knowledge, skills and confidence to self-manage their conditions,

ensuring they are able to evaluate and improve the effectiveness of

self-management interventions, particularly for those at low levels of

activation;

iii. agreeing with patient’s appropriate support for self-management

through referral to rehabilitation focussed services and wider social

prescribing as appropriate; and


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iv. designing and implementing plans that facilitate behavioural change,

optimise patient’s physical activity and mobility, support fulfilment of

personal goals and independence, and reduce the need for

pharmacological interventions;

j. request and progress investigations (such as x-rays and blood tests) and

referrals to facilitate the diagnosis and choice of treatment regime

including, considering the limitations of these investigations, interpret and

act on results and feedback to aid patients’ diagnoses and management

plans; and

k. be accountable for decisions and actions via Health and Care Professions

Council (HCPC) registration, supported by a professional culture of peer

networking/review and engagement in evidence-based practice.

B7.3. The following sets out the key wider responsibilities of First Contact

Physiotherapists:

a. work across the multi-disciplinary team to create and evaluate effective

and streamlined clinical pathways and services;

b. provide leadership and support on MSK clinical and service development

across the PCN, alongside learning opportunities for the whole multi-

disciplinary team within primary care;

c. develop relationships and a collaborative working approach across the

PCN, supporting the integration of pathways in primary care;

d. encourage collaborative working across the wider health economy and be

a key contributor to supporting the development of physiotherapy clinical

services across the PCN;

e. liaising with secondary and community care services, and secondary and

community MSK services where required, using local social and

community interventions as required to support the management of

patients within the PCN; and

f. support regional and national research and audit programmes to evaluate

and improve the effectiveness of the First Contact Practitioner (FCP)

programme. This will include communicating outcomes and integrating

findings into own and wider service practice and pathway development.

B.8. Dieticians

B8.1. Where a PCN employs or engages a Dietician under the Additional Roles

Reimbursement Scheme, the PCN must ensure that the Dietician:


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a. has a BSc or pre-reg MSc in Dietetics under a training programme

approved by the British Dietetic Association (BDA);

b. is a registered member of the Health and Care Professionals Council

(HCPC);

c. is able to operate at an advanced level of practice; and

d. has access to appropriate clinical supervision and an appropriate named

individual in the PCN to provide general advice and support on a day to

day basis,


B8.2. Where a PCN employs or engages one or more Dieticians under the


Dietician has the following key responsibilities, in delivering health services:

a. provide specialist nutrition and diet advice to patients, their carers, and

healthcare professionals through treatment, education plans, and

prescriptions;

b. educate patients with diet-related disorders on how they can improve their

health and prevent disease by adopting healthier eating and drinking

habits;

c. provide dietary support to patients of all ages (from early-life to end-of-life

care) in a variety of settings including nurseries, patient homes and care

homes;

d. work as part of a multi-disciplinary team to gain patient’s cooperation and

understanding in following recommended dietary treatments;

e. develop, implement and evaluate a seamless nutrition support service

across the PCN, working with community and secondary care where

appropriate, and aimed at continuously improving standards of patient

care and wider multi-disciplinary team working;

f. work with clinicians, multi-disciplinary team colleagues and external

agencies to ensure the smooth transition of patients discharged from

hospital back into primary care, so that they can continue their diet plan;

g. make recommendations to PCN staff regarding changes to medications for

the nutritional management of patients, based on interpretation of

biochemical, physiological, and dietary requirements; and

h. implement all aspects of effective clinical governance for own practice,

including undertaking regular audit and evaluation, supervision and

training.


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B8.3. The following sets out the key wider responsibilities of Dieticians:

a. undertake a range of administrative tasks such as ensuring stock levels

are maintained and securely stored, and equipment is kept in good

working order; and

b. ensure delivery of best practice in clinical practice, caseload management,

education, research, and audit, to achieve corporate PCN and local

population objectives.

B.9. Podiatrists

B9.1. Where a PCN employs or engages a Podiatrist under the Additional Roles

Reimbursement Scheme, the PCN must ensure that the Podiatrist:

a. has a BSc or pre-reg MSc in Podiatry under a training programme

approved by the College of Podiatry;


(HCPC);




day basis,


B9.2. Where a PCN employs or engages one or more Podiatrists under the


Podiatrist has the following key responsibilities, in delivering health services:

a. work as part of a PCN’s multi-disciplinary team to clinically assess, treat,

and manage a caseload of patients of all ages with lower limb conditions

and foot pathologies, using their expert knowledge of podiatry for specific

conditions and topics;

b. utilise and provide guidance to patients on equipment such as surgical

instruments, dressings, treatment tables and orthotics;

c. prescribe, produce, and fit orthotics and other aids and appliances;

d. provide specialist treatment and support for high-risk patient groups such

as the elderly and those with increased risk of amputation;

e. support patients through the use of therapeutic and surgical techniques to

treat foot and lower leg issues (e.g. carrying out nail and soft tissue

surgery using local anaesthetic);

f. deliver foot health education to patients;


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g. implement all aspects of effective clinical governance for their own

practice, including undertaking regular audit and evaluation, supervision,

and training;

h. liaise with PCN multi-disciplinary team, community and secondary care

staff, and named clinicians to arrange further investigations and onward

referrals;

i. communicate outcomes and integrate findings into their own and wider

service practice and pathway development; and

j. develop, implement and evaluate a seamless podiatry support service

across the PCN, working with community and secondary care where

appropriate, and aimed at continuously improving standards of patient

care and wider multi-disciplinary team working.


a. undertake continued professional development to understand the

mechanics of the body in order to preserve, restore, and develop

movement for patients;

b. provide leadership and support on podiatry clinical service development

across the PCN, alongside learning opportunities for the whole multi-

disciplinary team within primary care;

c. provide education and specialist expertise to PCN staff, raising awareness

of good practice in good foot health;

d. ensure delivery of best practice in clinical practice, caseload management,


population objectives; and

e. undertake a range of administrative tasks such as ensuring stock levels

are maintained and securely stored, and equipment is kept in good

working order.

B.10. Occupational Therapists

B10.1. Where a PCN employs or engages an Occupational Therapist under the


Occupational Therapist:

a. has a BSc in or pre-reg MSc in Occupational Therapy under a training

programme approved by the Royal College of Occupational Therapists;


(HCPC);


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day basis,


B10.2. Where a PCN employs or engages one or more Occupational Therapists

under the Additional Roles Reimbursement Scheme, the PCN must ensure

that each Occupational Therapist has the following key responsibilities, in

delivering health services:

a. assess, plan, implement, and evaluate treatment plans, with an aim to

increase patients’ productivity and self-care;

b. work with patients through a shared-decision making approach to plan

realistic, outcomes-focused goals;

c. undertake both verbal and non-verbal communication methods to address

the needs of patients that have communication difficulties;

d. work in partnership with multi-disciplinary team colleagues,

physiotherapists and social workers, alongside the patients' families,

teachers, carers, and employers in treatment planning to aid rehabilitation;

e. where appropriate, support the development of discharge and contingency

plans with relevant professionals to arrange on-going care in residential,

care home, hospital, and community settings;

f. periodically review, evaluate and change rehabilitation programmes to

rebuild lost skills and restore confidence;

g. as required, advise on home, school, and workplace environmental

alterations, such as adjustments for wheelchair access, technological

needs, and ergonomic support;

h. advise patients, and their families or carers, on specialist equipment and

organisations that can help with daily activities;

i. help patients to adapt to and manage their physical and mental health

long-term conditions, through the teaching of coping strategies; and

j. develop, implement and evaluate a seamless occupational therapy

support service across the PCN, working with community and secondary

care where appropriate, and aimed at continuously improving standards of

patient care and wider multi-disciplinary team working.


a. provide education and specialist expertise to PCN staff, raising awareness

of good practice occupational therapy techniques; and


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b. ensure delivery of best practice in clinical practice, caseload management,


population objectives.


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of 2


Date: 20 May 2020

Paper Title: Primary Care Network Participation 2020-2021


Sponsor:

Presenter:

Lucy Dadge, Chief Commissioning Officer Attachments/ Appendices:

Nottingham and Nottinghamshire PCN information pack

Helen Griffiths, Associate Director of Primary Care Networks

Purpose: Approve ☐ Endorse ☐ Review ☐ Receive/Note for:


☒

Executive Summary

In accordance with the Network Contract Directed Enhanced Services Contract specification 2020-2021 practices were required to confirm their participation in the Network Contract DES for 2020-2021 by completing a declaration form for each PCN.

I can confirm that there have been no changes to the previous year’s PCN arrangements for Nottingham and Nottinghamshire.

Attached is the Nottingham and Nottinghamshire PCN information pack for your information.

The PCCC are asked to acknowledge this paper and receive the details for your information and assurance purposes.


Compliance with Statutory Duties ☒ Wider system architecture development (e.g. ICP, PCN development)

☐


☐

Performance Management ☐ Procurement and/or Contract Management ☒







Primary Care Network Participation 2020-2021

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of 2




Yes ☐ No ☐ N/A☒ Not applicable to this item


Yes ☐ No ☐ N/A☒ Not applicable to this item

Risk(s):

No risks have been identified

Confidentiality:

☒No

Recommendation(s):

1. The PCCC are asked to acknowledge this paper and receive the details for your information and assurance purposes


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Nottingham and Nottinghamshire PCNs:information pack

Contents

Introduction ....................................................................................................................................................................... 2

Mid Nottinghamshire......................................................................................................................................................... 3Overview......................................................................................................................................................................... 3Mansfield and Ashfield ................................................................................................................................................... 4

Ashfield North PCN .................................................................................................................................................... 4Ashfield South PCN.................................................................................................................................................... 5Mansfield North PCN.................................................................................................................................................. 5Rosewood PCN .......................................................................................................................................................... 6

Newark and Sherwood .................................................................................................................................................. 7Newark PCN............................................................................................................................................................... 8Sherwood PCN........................................................................................................................................................... 8

Nottingham City ................................................................................................................................................................ 9Overview......................................................................................................................................................................... 9

Bulwell and Top Valley PCN ..................................................................................................................................... 10BACHS PCN ............................................................................................................................................................ 10Radford and Mary Potter PCN.................................................................................................................................. 11Bestwood and Sherwood PCN ................................................................................................................................. 11Nottingham City East PCN ....................................................................................................................................... 12Nottingham City South PCN ..................................................................................................................................... 12Clifton and Meadows PCN ....................................................................................................................................... 13Unity (Nottingham) PCN ........................................................................................................................................... 13

South Nottinghamshire................................................................................................................................................... 14Overview....................................................................................................................................................................... 14Nottingham North and East ......................................................................................................................................... 15

Byron PCN ............................................................................................................................................................... 16Arnold and Calverton PCN ....................................................................................................................................... 16Arrow Health PCN .................................................................................................................................................... 16Synergy Health ......................................................................................................................................................... 17

Nottingham West ......................................................................................................................................................... 18Nottingham West PCN ............................................................................................................................................. 18Nottingham West PCN: Beeston neighbourhood ..................................................................................................... 19Nottingham West PCN: Eastwood neighbourhood ................................................................................................... 19Nottingham West PCN: Stapleford neighbourhood .................................................................................................. 19

Rushcliffe ..................................................................................................................................................................... 20Rushcliffe PCN ......................................................................................................................................................... 21Rushcliffe PCN: Central neighbourhood................................................................................................................... 21Rushcliffe PCN: North neighbourhood...................................................................................................................... 21Rushcliffe PCN: South neighbourhood ..................................................................................................................... 22

Practice directory............................................................................................................................................................ 23Mansfield and Ashfield ................................................................................................................................................. 23Newark and Sherwood ................................................................................................................................................ 26Nottingham City ........................................................................................................................................................... 27Nottingham North and East .......................................................................................................................................... 32Nottingham West ......................................................................................................................................................... 35Rushcliffe ..................................................................................................................................................................... 37


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Introduction

This pack has been created to provide committee members with information about the CCG localities in relation to their primary care networks. The pack is divided by Integrated Care Partnership (ICP) – Mid Nottinghamshire, Nottingham City, and South Nottinghamshire; then by Primary Care Network (PCN), and neighbourhood (where applicable). There are maps of each ICP area, and maps showing PCN/neighbourhoods and practice locations, as well as details of the PCN leadership and member practices.

After the PCN/neighbourhood information there is a practice directory, presenting more detailed information on every practice in the three ICP areas.

Figure 1. The three Nottingham and Nottinghamshire ICP footprints

Nottingham City

South Nottinghamshire

Mid Nottinghamshire


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Mid Nottinghamshire

Overview

Mid Nottinghamshire comprises six PCNs:

∑ Mid Nottinghamshire:∑ Mansfield and Ashfield:

∑ Ashfield North PCN∑ Ashfield South PCN∑ Mansfield North PCN∑ Rosewood PCN

∑ Newark and Sherwood:∑ Newark PCN∑ Sherwood PCN

Figure 2. The overall footprint of Mid Nottinghamshire, showing PCNs

Locality health profiles

Nottingham Insight provides health profiles for each local authority in Mid Nottinghamshire; link below. These are produced and maintained by Nottinghamshire County Council.

https://www.nottinghaminsight.org.uk/Document-Library/Document-Library/aAXSDJM

Mansfield

Forest Town

Mansfield

Underwood

Westwood

Selston

Annesley

Kirkby in Ashfield

Sutton in AshfieldHuthwaite

Stanton Hill

Skegby

Warsop

Meden ValeChurch Warsop

Sutton on Trent

Newark on TrentCoddington

BaldertonFarndon

Southwell

Collingham

Carlton on Trent

Farnsfield

Bilsthorpe

Eakring

Caunton

Wellow

New Ollerton

Ollerton

Ollerton

Oxton

Edwinstowe

Clipstone

Ravenshead

Rainworth

Bleasby

Syerston

Blidworth

Winthorpe

North Muskham

South Muskham

Cromwell

M&A | Ashfield North PCN

M&A | Ashfield South PCN

M&A | Mansfield North PCN

M&A | Rosewood PCN

N&S | Newark PCN

N&S | Sherwood PCN


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Mansfield and Ashfield

Overview

Figure 3. Mansfield and Ashfield, showing PCNs and practices

The following sections summarise the Mansfield and Ashfield PCNs. For more practice information, refer to the Practice directory.

Ashfield North PCN

Area covered: Sutton in Ashfield, Harlow Wood, Huthwaite, Fackley, Teversal, Skegby.

Clinical director(s)

Dr Andrew Pountney, Woodlands Medical Practice

Deputy: Dr Gavin Lunn, Brierley Park Medical Practice

Practices

Practice name ODS Contract Cap. (01/01/20)

Willowbrook Medical Practice C84012 GMS 14,041

Woodlands Medical Practice C84014 GMS 10,235

Kings Medical Centre C84061 PMS 8,954

Brierley Park Medical Centre C84077 GMS 9,328

Skegby Family Medical Centre C84114 GMS 9,010

51,568

Mansfield

Forest Town

Mansfield

Underwood

Selston

Annesley

Skegby

Meden ValeChurch Warsop


Ashfield North

3

21

5

4

1

2

3

4

5

Brierley Park

Kings

Skegby Family

Willow brook

Woodlands

Ashfield South

10

9

8

13

1211

7

6

6

7

8

9

10

11

12

13

Ashfield House

Family

Health Care Complex

Jacksdale MC

Kirkby

Kirkby Community PCC

Low moor Road

Selston

Mansfield North

20

16

15

14

19

18

14

15

16

17

18

19

20

21

Bull Farm PCRC

Meden

Oakw ood

Orchard

Pleasley

Riverbank

Sandy Lane

St Peters

Rosewood

25

24

22

23

24

25

26

Acorn

Churchside

Forest

Millview

Roundw ood


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Ashfield South PCN

Area covered: Kirkby-In-Ashfield, Annesley, Underwood, Jacksdale, Barrows Green, Selston Green, Hall Green.


Dr Junaid Dar, Family Medical Centre (Kirkby)

Associate clinical director: Dr Deepa Balakrishnan, Lowmoor Road Surgery

Practices


Ashfield House (Annesley) C84067 GMS 6,039

Family Medical Centre (Kirkby) C84074 GMS 4,240

Kirkby Health Centre C84076 GMS 4,149

Lowmoor Road Surgery C84140 GMS 5,100

Selston Surgery C84142 PMS 4,968

Health Care Complex (Kirkby) C84629 PMS 4,225

Jacksdale Medical Centre C84654 PMS 4,037

Kirkby Community Primary Care Centre Y05690 APMS 6,579

39,337

Mansfield North PCN

Area covered: Meden Vale, Church Warsop, Warsop Vale, Spion Kop, Mansfield Woodhouse, Ravendale, Mansfield, Pleasley.


Dr Khalid Butt, Oakwood Surgery

Deputy: Dr James Mills, Orchard Medical Practice

Practices


Oakwood Surgery C84016 PMS 13,120

St Peters Medical Practice C84031 PMS 2,785

Orchard Medical Practice C84051 PMS 19,853

Pleasley Surgery C84057 GMS 3,538

Riverbank Medical Services C84127 PMS 4,563

Sandy Lane Surgery C84637 PMS 6,101

Meden Medical Services C84658 GMS 6,097

Bull Farm Primary Care Resource Centre C84710 APMS 2,773

58,830


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Rosewood PCN

Area covered: Mansfield, Newton Town, Ladybrook, Bleak Hills, Berry Hill, Forest Town.


Dr Milind Tadpatrikar, Roundwood Surgery

Practices


Churchside Medical Practice C84020 GMS 6,624

Forest Medical Group C84036 GMS 15,767

Roundwood Surgery C84069 GMS 13,298

Mill View Surgery C84106 GMS 8,127

The Acorn Medical Practice C84679 GMS 3,299

47,115


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Newark and Sherwood

Overview

Figure 4. Newark and Sherwood, showing PCNs and practices

The following sections summarise the Newark and Sherwood PCNs. For more practice information, refer to the Practice directory.

Coddington

BaldertonFarndon

Southwell

Carlton on Trent

Farnsfield

Eakring

Caunton

Wellow

New Ollerton

Ollerton

Ollerton

Oxton

Ravenshead

Bleasby

Syerston

Winthorpe

North Muskham

South Muskham

Cromwell

Newark and Sherwood

Newark

5

6

7

4

1

2

3

1

2

3

4

5

6

7

Balderton PCC

Barnby Gate

Collingham

Fountain

Hounsfield

Lombard

Southw ell

Sherwood

12

13

14

11

8

9

10

8

9

10

11

12

13

14

Abbey

Bilsthorpe

Hill View

Major Oak

Middleton Lodge

Rainw orth HC

Sherw ood Partnership


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Newark PCN

Area covered: Newark-on-Trent, Southwell, Balderton, Collingham, Sutton-on-Trent, Norwell,Caunton, Oxton, Fernwood.


Dr James Cusack, Lombard Medical Centre

Practices


Southwell MC C84049 GMS 12,427

Barnby Gate Surgery C84009 GMS 13,909

Fountain Medical Centre C84019 GMS 13,553

Lombard Medical Centre C84029 GMS 19,287

Collingham MC C84045 GMS 7,226

Balderton PCC (C84648) Y05369 APMS 5,928

Hounsfield Surgery C84660 GMS 4,265

76,595

Sherwood PCN

Area covered: Ravenshead, Oxton, Farnsfield, Bilsthorpe, Ollerton, New Ollerton, Edwinstowe, Kirton, Boughton, Walesby, Perlethorpe, Kings Clipstone, Clipstone, Newlands, Rainworth, Blidworth.


Dr Kevin Corfe, Abbey Medical Group

Practices


Abbey Medical Group C84037 GMS 12,115

Rainworth HC C84087 GMS 6,018

Bilsthorpe Surgery C84123 GMS 3,409

Hill View Surgery C84656 GMS 3,229

Middleton Lodge Practice C84021 GMS 12,853

Sherwood Medical Partnership C84059 GMS 16,177

Major Oak MP C84113 GMS 6,533

60,334


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Nottingham City

Overview

The Nottingham City ICP is coterminous with Nottingham City; see the map below.


Nottingham Insight provides health profiles for each Nottingham City local authority ward. These are produced and maintained by Nottingham City Council and available at the link below.


The ward health profiles relevant for each PCN are referenced in the PCN information below.

Nottingham City

Overview

Nottingham City has a total registered population of 395,694 (as at 1st January 2020). There are eight PCNs in Nottingham City, all with a total list size above 30,000; covering 100% of the population, providing geographical contiguity, and including every constituent practice.

Figure 5. Nottingham City, showing PCNs and practices

The following sections summarise the Nottingham City PCNs. For more practice information, refer to the Practice directory.

Mapperley

Wollaton

Bulw ell

Nuthall

Nottingham City

Bulw ell and Top Valley

4

61

2

381

2

3

4

5

6

7

8

Leen View

Parkside

Queens Bow er

Rise Park

Riverlyn

Southglade

Springfield

St Albans

BACHS

1715

1613

1012

9

9

10

11

12

13

14

15

16

17

Aspley

Beechdale

Bilborough

Bilborough MC

Chuchfields

Greenfields

Limetree

Melbourne Park

RHR

Radford and Mary Potter

18

1921

22

18

19

20

21

22

23

Fairf ields

Forest

High Green

Radford

Radford - Phillips

St Lukes

Bestwood and Sherwood

24

25

29

30

31

26

2728

24

25

26

27

28

29

30

31

Alice

Elmsw ood

Hucknall Road

Sherringon Park

Sherw ood Rise

The Medical Centre

Tudor House

Welbeck

Nottingham City East

38

35

3732

3334

32

33

34

35

36

37

38

39

Bakersfield

Family

Greendale PCC

Mapperley Park

NEMS Platform One

Victoria & Mapperley

Wellspring

Windmill

Nottingham City South

42

43

40 41

40

41

42

43

Deer Park Family

Derby Road

Grange Farm

Wollaton Park

Clifton and Meadows

44

4845

46

47

44

45

46

47

48

Bridgew ay

Clif ton

John Ryle

Meadow s HC

Rivergreen

Unity (Nottingham)

49

50

49

50

Cripps

Sunrise


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Bulwell and Top Valley PCN

Area covered: Bulwell, Highbury Vale, Rise Park, Top Valley.

Nottingham Insight Ward health profile: Care Delivery Group 1


Dr Andrew Foster, Parkside Medical Practice

Deputy: Dr Mark Salisbury, Rise Park Surgery

Practices

Practice name ODS Contract Cap (01/01/20)

Leen View Surgery C84043 GMS 9,365

Parkside Medical Practice C84064 GMS 7,807

Queens Bower Surgery C84135 GMS 4,123

Rise Park Surgery C84129 GMS 7,512

Riverlyn Medical Centre C84717 PMS 2,999

Southglade Medical Practice Y05622 APMS 3,296

Springfield Medical Centre C84138 GMS 2,564

St Alban's Medical Centre/Nirmala (The Practice) C84004 GMS 7,321

44,987

BACHS PCN

Area covered: Aspley, Beechdale, Bilborough, Broxtowe, Cinderhill, Old Basford, Strelley.



Dr Jonathan Harte, Aspley Medical Centre

Deputy: Dr Subeer Satyam, Churchfields Medical Practice

Practices


Aspley Medical Centre C84091 PMS 8,205

Beechdale Surgery C84704 PMS 5,724

Bilborough Medical Centre Y06356 APMS 9,792

Bilborough Surgery C84647 GMS 1,553

Churchfields Medical Practice C84034 GMS 9,320

Lime Tree Surgery C84694 PMS 3,710

Greenfields Medical Practice C84676 GMS 6,713

Melbourne Park Medical Centre C84116 GMS 8,842

RHR Medical Centre [merged w/Beechdale Surgery] C84680 PMS 4,842

Strelley Health Centre [CLOSED] C84698 PMS 639

59,340


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Radford and Mary Potter PCN

Area covered: Hyson Green, Radford, Forest Fields, Bobbers Mill, The Park.



Dr Josephine Guha, The Forest Practice

Deputy: Dr Musarat Ali, High Green Medical Practice

Practices


Fairfields Practice C84105 GMS 7,463

Highgreen Practice C84691 PMS 8,732

The Forest Practice C84103 PMS 4,477

Radford Medical Practice (Kaur) C84117 PMS 22,528

Radford Health Centre (N Phillips) C84096 PMS 3,412

St Luke’s Practice C84136 GMS 4,067

50,679

Bestwood and Sherwood PCN

Area covered: Bestwood, Carrington, New Basford, Sherwood, Sherwood Rise.

Nottingham Insight Ward health profile: Care Delivery Groups 2 & 5


Dr Mike Crowe, Hucknall Road Medical Centre

Deputy: Dr Tolulope Atiomo, The Alice Medical Centre

Practices


Hucknall Road Medical Centre C84078 GMS 13,309

The Alice Medical Centre C84695 GMS 3,547

Sherwood Rise Medical Centre C84628 GMS 6,492

Elmswood Surgery C84011 GMS 9,021

Sherrington Park Medical Practice C84682 GMS 4,749

Tudor House Medical Practice C84619 PMS 6,691

Welbeck Surgery C84664 GMS 4,564

The Medical Centre C84151 PMS 2,566

50,939


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Nottingham City East PCN

Area covered: Lace Market, Mapperley, Mapperley Park, St Anns, Sneinton.



Dr Hussain Gandhi, Wellspring Surgery

Dr Margaret Abbott, Windmill Practice

Deputy: Robana Hussain-Mills, NEMS Platform One

Practices


Bakersfield Medical Centre C84693 PMS 5,476

Family Medical Centre C84018 GMS 10,979

GreenDale Primary Care Centre C84063 GMS 9,427

Mapperley Park Medical Centre [CLOSED] C84602 GMS 701

Victoria & Mapperley Practice C84085 GMS 9,731

Wellspring Surgery C84072 PMS 9,876

NEMS – Platform One Practice Y02847 APMS 10,824

Windmill Practice C84683 PMS 9,336

66,350

Nottingham City South PCN

Area covered: Old Lenton, Wollaton.



Dr Katherine O’Connor, Wollaton Park Medical Centre

Deputy: Dr Greg Rose, Deer Park Family Medical Practice

Practices


Deer Park Family Medical Practice C84044 PMS 10,330

Derby Road Health Centre C84039 GMS 12,091

Grange Farm Medical Centre Y03124 APMS 5,907

Wollaton Park Medical Centre C84122 PMS 8,761

37,089


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Clifton and Meadows PCN

Area covered: Clifton, The Meadows, Wilford.



Dr Heetan Patel, Clifton Medical Practice

Deputy: Dr Manik Arora, Rivergreen Medical Practice

Practices


Bridgeway Practice C84092 GMS 4,445

Clifton Medical Practice C84046 GMS 8,161

John Ryle Medical Practice C84081 GMS 6,344

Meadows Health Centre C84144 GMS 3,988

Rivergreen Medical Centre C84060 GMS 9,073

32,011

Unity (Nottingham) PCN

Area covered: Clifton, Dunkirk, Lenton Abbey, New Lenton.

Nottingham Insight Ward health profile: Care Delivery Group 7 (University of Nottingham Health Service) and Care Delivery Group 8 (Sunrise Medical Practice)


Dr Matthew Litchfield, The University of Nottingham Health Service

Deputy: Dr Rashbal Ghattaora, Sunrise Medical Practice

Practices


The University of Nottingham Health Service C84023 GMS 47,560

Sunrise Medical Practice C84714 PMS 6,739

54,299


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South Nottinghamshire

Overview

South Nottinghamshire is composed of six PCNs which, in some cases, are further broken down into administrative ‘neighbourhoods’:

∑ South Nottinghamshire:∑ Byron PCN∑ Arnold and Calverton PCN∑ Arrow Health PCN∑ Synergy Health∑ Nottingham West PCN:

∑ Beeston neighbourhood∑ Eastwood neighbourhood∑ Stapleford neighbourhood

∑ Rushcliffe PCN:∑ North neighbourhood∑ Central neighbourhood∑ South neighbourhood

Figure 6. The overall footprint of South Nottinghamshire, showing PCNs and neighbourhoods

Epperstone

Calverton

WoodboroughGonalston

Lam bley

Burton Joyce

Lowdham

Caythorpe

Gedling

Arnold

Hoveringham

Carlton

Netherfield

Colwick

Gunthorpe

Bestwood Village

Hucknall

Papplewick

Newstead Village

Beeston

Chilw ell

Toton

Stapleford

Kimberley

Awsworth

Giltbrook

Eastw ood

Brinsley

Newthorpe

Bramcote

East Bridgford

Orston

Aslockton

WhattonBingham

Newton

Radcliffe on Trent

West Bridgford

Wilford

Ruddington

Keyworth

Cotgrave

Cropwell Bishop

Tythby

Langar

Granby

Colston Bassett

Kinoulton

Tollerton

Plum tree

Gotham

East Leake

Sutton Bonnington

Wysall

Widmerpool

Ratcliffe on SoarBunny

Costock

NNE | Byron PCN

NNE | Arnold and Calverton PCN

NNE | Arrow Health PCN

NNE | Synergy Health PCN

NW | Beeston neighbourhood

NW | Eastwood neighbourhood

NW | Stapleford neighbourhood

Rushcliffe | Central neighbourhood

Rushcliffe | North neighbourhood

Rushcliffe | South neighbourhood


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Nottingham Insight provides health profiles for each local authority in South Nottinghamshire; link below. These are produced and maintained by Nottinghamshire County Council.

https://www.nottinghamshireinsight.org.uk/Libraries/Document-Library/aAXSxW8

Nottingham North and East overview

Nottingham North and East has a total registered population of 141,876 (as at 1st January 2020)across 17 practices. The practice areas are located across four local authority areas, namely Gedling, Ashfield, Nottingham City, and Newark and Sherwood.

The locality is divided into four PCNs: Byron (Hucknall), Arnold & Calverton, Arrow Health (Carlton and villages), and Synergy Health (Carlton, Netherfield, Lowdham).

Figure 7. Nottingham North and East CCG, showing PCNs and practices

The following sections summarise the NNE PCNs. For more practice information, refer to the Practice directory.

Epperstone

Calverton

WoodboroughGonalston

Lambley

Burton Joyce

Lowdham Hoveringham

Carlton

Colwick

Gunthorpe

Bestwood Village

Hucknall

Papplewick

Newstead Village

Nottingham North and East

Byron

2 1

43

1

2

3

4

Oakenhall

Om

Torkard Hill

Whyburn

Arnold and Calverton

76

55

6

7

Calverton

Highcroft

Stenhouse

Arrow Health

9

8

14

11

10

12

8

9

10

11

12

13

14

Daybrook

Ivy

Ivy (branch)

Peacock

Plains View

Unity

Westdale Lane

Synergy Health

16

15

18

17

15

16

17

18

Jubilee

Park House

Trentside

West Oak


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Byron PCN

Area covered: Hucknall, Bestwood Village, Papplewick, Linby.


Dr Adam Connor, Whyburn Medical Practice

Practices


Oakenhall Medical Practice C84095 GMS 7,304

The Om Surgery Y00026 PMS 2,158

Torkard Hill Medical Centre C84053 GMS 15,780

Whyburn Medical Practice Y06443 APMS 11,688

36,930

Arnold and Calverton PCN

Area covered: Arnold and Calverton and surrounding villages.


Dr Kate Evans, Stenhouse Medical Centre

Practices


The Calverton Practice C84047 PMS 9,690

Highcroft Surgery C84055 PMS 11,926

Stenhouse Medical Centre C84026 PMS 11,989

33,605

Arrow Health PCN

Area covered: Carlton, Daybrook, Mapperley, Burton Joyce, Lowdham.


Dr Umar Ahmad, Plains View Surgery

Practices


Daybrook Medical Practice C84066 PMS 9,587

The Ivy Medical Group C84646 PMS 7,147

Peacock Practice C84133 PMS 5,536

Plains View Surgery C84115 PMS 7,291

Unity Surgery C84150 PMS 3,872

Westdale Lane Surgery C84033 GMS 8,158

41,591


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Synergy Health

Area covered: Carlton, Mapperley, Netherfield, Burton Joyce, Lowdham.


Dr Ian Campbell, Park House Medical Centre

Practices


The Jubilee Practice C84613 GMS 2,333

Park House Medical Centre C84709 PMS 10,134

Trentside Medical Group C84010 PMS 11,697

West Oak Surgery C84696 5,586

29,750


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Nottingham West overview

Nottingham West has a total registered population of 106,394 (at 1st January 2020) across 12 practices.

The locality is coterminous with a single Nottingham West PCN. This PCN is divided into three administrative neighbourhoods: Beeston, Eastwood, and Stapleford.

Figure 8. Nottingham West CCG and PCN, showing neighbourhoods and practices

The following sections summarise the single Nottingham West PCN, and the separate PCNneighbourhoods. For more practice information, refer to the Practice directory.

Nottingham West PCN

Area covered: Nottingham West CCG locality.


Dr Tim Heywood, Chilwell Valley & Meadows Practice

Individual leads have also been nominated for the PCN neighbourhoods; see the individual neighbourhoods section below.

Practices

See individual neighbourhood sections below for practice information.

Toton

Kimberley

Awsworth

Eastwood

Brinsley

Newthorpe

Nottingham West

Beeston

4

12

3

1

2

3

4

5

Abbey

Bramcote

Chilw ell Valley & Meadow s

Manor

Oaks

Eastwood

6

7

8

9

6

7

8

9

Eastw ood PCC

Giltbrook

Hama

New thorpe

Stapleford

10

11

12

10

11

12

Hickings Lane

Linden

Saxon Cross


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Nottingham West PCN: Beeston neighbourhood

Area covered: Beeston, Bramcote, Chilwell.

Clinical lead

Dr Emma Shapiro, The Manor Surgery

Practices


Abbey Medical Centre C84065 GMS 5,394

Bramcote Surgery C84112 GMS 3,565

Chilwell Valley and Meadows Practice C84120 GMS 15,156

Manor Surgery C84080 GMS 12,980

Oaks Medical Centre C84030 GMS 10,686

47,781

Nottingham West PCN: Eastwood neighbourhood

Area covered: Eastwood, Newthorpe, Giltbrook, Kimberley.

Clinical lead

Dr Paul Scullard, Eastwood Primary Care Centre

Practices


Eastwood PCC C84032 GMS 19,552

Giltbrook Surgery C84667 PMS 5,036

Hama Medical Centre C84624 PMS 5,081

Newthorpe Medical Centre C84131 PMS 7,512

37,181

Nottingham West PCN: Stapleford neighbourhood

Area covered: Stapleford.

Clinical lead

Dr Mike O’Neil, Saxon Cross Surgery

Practices


Hickings Lane Medical Centre C84705 PMS 6,138

Linden Medical Group C84107 GMS 7,845

Saxon Cross Surgery C84042 PMS 7,449

21,432


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Rushcliffe overview

Rushcliffe has a total registered population of 129,825 (as at 1st January 2020) across 12 practices.

The locality is coterminous with a single Rushcliffe PCN. This PCN is divided into threeadministrative neighbourhoods: Central (West Bridgford & Gamston practices), North (Belvoir, East Bridgford, & Radcliffe on Trent practices), and South (East Leake, Keyworth, Orchard, & Ruddington practices).

Figure 9. Rushcliffe CCG and PCN, showing neighbourhoods and practices

Collectivised general practice

Collectivised general practice is well established and mature in Rushcliffe with collectivisation coordinated by Partners Health, a limited liability partnership solely owned by the Rushcliffe practices. There is established and shared expertise in network management, shared business and clinical operations successfully delivered via Partners Health.

The following sections summarise the single Rushcliffe PCN, and the separate PCN neighbourhoods. For more practice information, refer to the Practice directory.

East Bridgford

Orston

Aslockton

Whatton

Newton

Radcliffe on Trent

Keyworth

Cropwell Bishop

Tythby

Langar

Granby

Colston Bassett

Kinoulton

Tollerton

Plumtree

East Leake

Sutton Bonnington

Wysall

Widmerpool

Ratcliffe on SoarBunny

Costock

Rushcliffe

Central

52

14

3

1

2

3

4

5

Castle Healthcare

Gamston

Musters

St Georges

West Bridgford

North

68

7

9

10

6

7

8

9

10

Belvoir

Belvoir (branch 1)

Belvoir (branch 2)

East Bridgford

Radclif fe on Trent

South

15

14

17

16

11

13

12

11

12

13

14

15

16

17

East Leake

East Leake (branch 1)

East Leake (branch 2)

Keyw orth

Orchard

Orchard (branch 1)

Ruddington


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Rushcliffe PCN

Area covered: Rushcliffe CCG locality.


Dr Gurvinder Sahota, Keyworth Medical Practice

The clinical leadership team, which will support the neighbourhoods, is:

Dr Stephen Shortt, East Leake Medical Group

Dr Pete Mahony, Belvoir Health Group

Dr Lynn Ovenden, Castle Healthcare Practice

Dr Nigel Cartwright, Orchard Surgery

Dr Matt Jelpke, St George’s Medical Practice

Practices

See individual neighbourhood sections below for practice information.

Rushcliffe PCN: Central neighbourhood

Area covered: West Bridgford, Wilford, Gamston.

Practices


Castle Healthcare Practice C84605 PMS 16,908

Gamston Medical Centre C84703 PMS 5,861

Musters Medical Practice C84090 PMS 9,837

St George's Medical Practice C84086 PMS 11,865

West Bridgford Medical Centre C84621 PMS 4,448

48,919

Rushcliffe PCN: North neighbourhood

Area covered: East Bridgford, Bingham, Radcliffe-on Trent.

Practices


Belvoir Health Group C84017 GMS 24,831

East Bridgford Medical Centre C84025 PMS 7,057

Radcliffe On Trent Health Centre C84084 GMS 8,158

40,046


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Rushcliffe PCN: South neighbourhood

Area covered: Keyworth, East Leake, Kegworth, Ruddington.

Practices


East Leake Medical Group C84005 PMS 14,412

Keyworth Medical Practice C84048 GMS 10,875

Orchard Surgery C82040 GMS 8,684

Ruddington Medical Centre C84028 GMS 6,889

40,860


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Practice directory


The Acorn Medical Practice (C84679)PCN: RosewoodContract: GMSCap: 3,299 at 01/01/2020Practice manager: Alison BaileySenior partner: Dr K A RahmanGPs: Dr Dar Dr Horsfield

Ashfield House (Annesley) (C84067)PCN: Ashfield SouthContract: GMSCap: 6,039 at 01/01/2020Practice manager: Debbie PartlowSenior partner: Dr G PlaceGPs: Mrs Jenny Roby (ANP Partner)

Brierley Park Medical Centre (C84077)PCN: Ashfield NorthContract: GMSCap: 9,328 at 01/01/2020Practice manager: Liz GriffinSenior partner: Dr H LovelockGPs: Dr Genillard Dr Prasad Dr Wormall

Dr Lunn Dr Skelton

Bull Farm Primary Care Resource Centre (C84710)PCN: Mansfield NorthContract: APMSCap: 2,773 at 01/01/2020Practice manager: Denise McpheeSenior partner: Dr S PatelGPs: Dr Crossland

Churchside Medical Practice (C84020)PCN: RosewoodContract: GMSCap: 6,624 at 01/01/2020Practice manager: Sharon AthertonSenior partner: Dr V PearceGPs: Dr Barry Dr Dhamrait Dr Harrison

Family Medical Centre (Kirkby) (C84074)PCN: Ashfield SouthContract: GMSCap: 4,240 at 01/01/2020Practice manager: Sue JacksonSenior partner: Dr DarGPs: Dr H Horsefield Dr Rahman

Forest Medical Group (C84036)PCN: RosewoodContract: GMSCap: 15,767 at 01/01/2020Practice manager: Nicola RyanSenior partner: Dr R ParkGPs: Dr Britchford Dr Smith Dr Worley

Dr Hill Dr Wootton

Health Care Complex (Kirkby) (C84629)PCN: Ashfield SouthContract: PMSCap: 4,225 at 01/01/2020Practice manager: Mel YorkeSenior partner: Dr P OzaGPs: Dr R Nam


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Jacksdale Medical Centre (C84654)PCN: Ashfield SouthContract: PMSCap: 4,037 at 01/01/2020Practice manager: Mel LindleySenior partner: Dr BrownGPs: Dr S Hussain (long-term locum)

Kings Medical Centre (C84061)PCN: Ashfield NorthContract: PMSCap: 8,954 at 01/01/2020Practice manager: Louise NewSenior partner: Dr D ChakrabortyGPs: Dr Chilamkurthi Dr Yadlapalli

Kirkby Community Primary Care Centre (Y05690)PCN: Ashfield SouthContract: APMSCap: 6,579 at 01/01/2020Practice manager: Donna RevillSenior partner: Dr K SallisGPs: Dr K Hussain (long-term locum) Dr A Miah (long-term locum) Dr T Tong (long-term locum)

Kirkby Health Centre (C84076)PCN: Ashfield SouthContract: GMSCap: 4,149 at 01/01/2020Practice manager: Tracy DudleySenior partner: Dr Prabu RamanGPs: Dr S Ward (long-term locum)

Lowmoor Road Surgery (C84140)PCN: Ashfield SouthContract: GMSCap: 5,100 at 01/01/2020Practice manager: Jane WardleSenior partner: Dr S BarishGPs: Dr D Balakrishnan Dr N Karunaratne

Meden Medical Services (C84658)PCN: Mansfield NorthContract: GMSCap: 6,097 at 01/01/2020Practice manager: Jackie JonesSenior partner: Dr S AllenGPs: Dr K Sallis

Mill View Surgery (C84106)PCN: RosewoodContract: GMSCap: 8,127 at 01/01/2020Practice manager: Kerry DowsonSenior partner: Dr H FieldGPs: Dr Maddock Dr Ravi Dr Sommers

Dr Mann

Oakwood Surgery (C84016)PCN: Mansfield NorthContract: PMSCap: 13,120 at 01/01/2020Practice manager: Ros ReavillSenior partner: Dr K ButtGPs: Dr F Fenojo Dr J Sanders Dr P De Silva

Dr A Lucassen Dr J Sidaway

Orchard Medical Practice (C84051)PCN: Mansfield NorthContract: PMSCap: 19,853 at 01/01/2020Practice manager: Rebecca TateSenior partner: Dr D TempleGPs: Dr W Freeman Dr C MacGregor Dr H Wagstaff

Dr J Jones Dr A Mallik Dr K WestDr P Law Dr J Mills


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Pleasley Surgery (C84057)PCN: Mansfield NorthContract: GMSCap: 3,538 at 01/01/2020Practice manager: Denise McpheeSenior partner: Dr S PatelGPs: Dr Crossland

Riverbank Medical Services (C84127)PCN: Mansfield NorthContract: PMSCap: 4,563 at 01/01/2020Practice manager: Philippa HutchinsonSenior partner: Dr A Kaistha

Roundwood Surgery (C84069)PCN: RosewoodContract: GMSCap: 13,298 at 01/01/2020Practice manager: Gillian SlackSenior partner: Dr S CappinGPs: Dr Carter Dr Johnson Dr Tadpatrikar

Dr Glover

Sandy Lane Surgery (C84637)PCN: Mansfield NorthContract: PMSCap: 6,101 at 01/01/2020Practice manager: Jill TownsSenior partner: Dr H MasudGPs: Dr M Aghel Dr H Qureshi

Selston Surgery (C84142)PCN: Ashfield SouthContract: PMSCap: 4,968 at 01/01/2020Practice manager: Sue SmithSenior partner: Dr S BassiGPs: Dr S Shah

Skegby Family Medical Centre (C84114)PCN: Ashfield NorthContract: GMSCap: 9,010 at 01/01/2020Practice manager: Nicole KeelingSenior partner: Dr R HookGPs: Dr Dykes Dr Glover Dr O'Callaghan

St Peters Medical Practice (C84031)PCN: Mansfield NorthContract: PMSCap: 2,785 at 01/01/2020Practice manager: Sandra ChatwinSenior partner: Dr R S Sharma

Willowbrook Medical Practice (C84012)PCN: Ashfield NorthContract: GMSCap: 14,041 at 01/01/2020Practice manager: Mohammed IslamSenior partner: Dr J JenkinsGPs: Dr Berhanu Dr Watts Dr Woods

Dr Singh

Woodlands Medical Practice (C84014)PCN: Ashfield NorthContract: GMSCap: 10,235 at 01/01/2020Practice manager: Patricia BrownSenior partner: Dr N PoundGPs: Dr Aldread Dr Laird Dr Russell

Dr Das Dr Poutney


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Newark and Sherwood

Abbey Medical Group (C84037)PCN: SherwoodContract: GMSCap: 12,115 at 01/01/2020Practice manager: Rick GoochSenior partner: Dr MJ DaltonGPs: Dr Caroline Ahrens Dr James Mattick Dr Chloe Whittard

Dr Thilan Bartholomeuz Dr Amandeep Sanghera Dr Matthew WilkinsDr Kevin Corfe

Balderton PCC (C84648) (Y05369)PCN: NewarkContract: APMSCap: 5,928 at 01/01/2020Practice manager: Frances ChaterSenior partner: Dr K SallisGPs: Dr K Laurie (regular locum) Dr R Whitbread (regular locum)

Barnby Gate Surgery (C84009)PCN: NewarkContract: GMSCap: 13,909 at 01/01/2020Practice manager: Sally DixonSenior partner: Dr J BarkerGPs: Dr R Granfield Dr C Phillips Dr D Valluvassery

Dr N Mulhern

Bilsthorpe Surgery (C84123)PCN: SherwoodContract: GMSCap: 3,409 at 01/01/2020Practice manager: Nikki StewartSenior partner: Dr Leah RobinsonGPs: Dr Jeremy Hill

Collingham MC (C84045)PCN: NewarkContract: GMSCap: 7,226 at 01/01/2020Practice manager: Julie ReidSenior partner: Dr K FearnGPs: Dr A Caulton-Tordoff Dr L Li Dr L Walker

Fountain Medical Centre (C84019)PCN: NewarkContract: GMSCap: 13,553 at 01/01/2020Practice manager: Lisa Sandland-TaylorSenior partner: Dr J E SelwynGPs: Dr W Aye Dr A Dean Dr M Jefford

Dr J Bignall Dr M Folman Dr D Wicks

Hill View Surgery (C84656)PCN: SherwoodContract: GMSCap: 3,229 at 01/01/2020Practice manager: Amanda BrownSenior partner: Dr IC JairamGPs: Dr Pradeep Shrestha

Hounsfield Surgery (C84660)PCN: NewarkContract: GMSCap: 4,265 at 01/01/2020Practice manager: Alison AddisonSenior partner: Dr K MoloneyGPs: Dr V Clarke Dr E Vipas


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Lombard Medical Centre (C84029)PCN: NewarkContract: GMSCap: 19,287 at 01/01/2020Practice manager: Debbie SwainSenior partner: Dr D WathernGPs: Dr S Brenchley Dr R Goodwin Dr A Micklethwaite

Dr J Cusack Dr F Hickling Dr J YouattDr S Farmilo Dr R Hull

Major Oak MP (C84113)PCN: SherwoodContract: GMSCap: 6,533 at 01/01/2020Practice manager: Jacquie MikhailSenior partner: Dr W MikhailGPs: Dr Emad Gabrawi Dr Gopinath Singaravel Gopi Dr Therese Jordan

Middleton Lodge Practice (C84021)PCN: SherwoodContract: GMSCap: 12,853 at 01/01/2020Practice manager: Jonathan CumminsSenior partner: Dr Walden EffinghamGPs: Dr Colin Durnin Dr Claire Edmondson Dr Khondaker Mahmud

Dr Olivia Dyer Dr Gemma Greenacre

Rainworth HC (C84087)PCN: SherwoodContract: GMSCap: 6,018 at 01/01/2020Practice manager: Leigh NashSenior partner: Dr BolsherGPs: Dr Phil Parker Dr Kerrie Wilkins

Sherwood Medical Partnership (C84059)PCN: SherwoodContract: GMSCap: 16,177 at 01/01/2020Practice manager: Michelle BarksbySenior partner: Dr J SmithGPs: Dr Subash Das Dr Miranda Jones Dr Adam Liew

Dr Natascha Glover Dr Matthew Lea Dr Gregory ThurlandDr Belinda Hirsh

Southwell MC (C84049)PCN: NewarkContract: GMSCap: 12,427 at 01/01/2020Practice manager: Nigel KenwardSenior partner: Dr S ReevesGPs: Dr A Bajracharya Dr C Clarke Dr R Kalia

Dr S Bajracharya Dr Z Hafeez

Nottingham City

The Alice Medical Centre (C84695)PCN: Bestwood and SherwoodContract: GMSCap: 3,547 at 01/01/2020Senior partner: Dr AtiomoComment: Singled handed GP practice

Aspley Medical Centre (C84091)PCN: BACHSContract: PMSCap: 8,205 at 01/01/2020Senior partner: Dr Wright


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Bakersfield Medical Centre (C84693)PCN: Nottingham City EastContract: PMSCap: 5,476 at 01/01/2020Senior partner: Dr Mehat

Beechdale Surgery (C84704)PCN: BACHSContract: PMSCap: 5,724 at 01/01/2020Senior partner: Dr BicknellComment: Part of Beechdale Medical Group

Bilborough Medical Centre (Y06356)PCN: BACHSContract: APMSCap: 9,792 at 01/01/2020Senior partner: Nottingham City General Practice Alliance (NCGPA)Comment: Care-taker contract with NCGPA due to incumbent provider serving notice. Contract expires March 2021

Bilborough Surgery (C84647)PCN: BACHSContract: GMSCap: 1,553 at 01/01/2020Senior partner: Dr PhilipsComment: Singled handed practice

Bridgeway Practice (C84092)PCN: Clifton and MeadowsContract: GMSCap: 4,445 at 01/01/2020Senior partner: Dr Kiran

Churchfields Medical Practice (C84034)PCN: BACHSContract: GMSCap: 9,320 at 01/01/2020Senior partner: Dr Roy

Clifton Medical Practice (C84046)PCN: Clifton and MeadowsContract: GMSCap: 8,161 at 01/01/2020Senior partner: Dr Taylor

Deer Park Family Medical Practice (C84044)PCN: Nottingham City SouthContract: PMSCap: 10,330 at 01/01/2020Senior partner: Dr Merry

Derby Road Health Centre (C84039)PCN: Nottingham City SouthContract: GMSCap: 12,091 at 01/01/2020Senior partner: Dr Hambleton

Elmswood Surgery (C84011)PCN: Bestwood and SherwoodContract: GMSCap: 9,021 at 01/01/2020Senior partner: Dr Malik

Fairfields Practice (C84105)PCN: Radford and Mary PotterContract: GMSCap: 7,463 at 01/01/2020

Family Medical Centre (C84018)PCN: Nottingham City EastContract: GMSCap: 10,979 at 01/01/2020Senior partner: Dr Sood


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The Forest Practice (C84103)PCN: Radford and Mary PotterContract: PMSCap: 4,477 at 01/01/2020

Grange Farm Medical Centre (Y03124)PCN: Nottingham City SouthContract: APMSCap: 5,907 at 01/01/2020Senior partner: DRHC LimitedComment: Contract held by DRHC ltd. GP partners are linked to Derby Road Health Centre. Contract expires March 2021

GreenDale Primary Care Centre (C84063)PCN: Nottingham City EastContract: GMSCap: 9,427 at 01/01/2020Senior partner: Dr Layzell

Greenfields Medical Practice (C84676)PCN: BACHSContract: GMSCap: 6,713 at 01/01/2020Senior partner: Dr Rao

Highgreen Practice (C84691)PCN: Radford and Mary PotterContract: PMSCap: 8,732 at 01/01/2020

Hucknall Road Medical Centre (C84078)PCN: Bestwood and SherwoodContract: GMSCap: 13,309 at 01/01/2020Senior partner: Dr Crowe

John Ryle Medical Practice (C84081)PCN: Clifton and MeadowsContract: GMSCap: 6,344 at 01/01/2020Senior partner: Dr Ko

Leen View Surgery (C84043)PCN: Bulwell and Top ValleyContract: GMSCap: 9,365 at 01/01/2020Senior partner: Dr Pabla

Lime Tree Surgery (C84694)PCN: BACHSContract: PMSCap: 3,710 at 01/01/2020Senior partner: Dr Raj

Mapperley Park Medical Centre (C84602)PCN: Nottingham City EastContract: GMSCap: 701 at 01/01/2020Senior partner: Dr StevensComment: GP retired and contract terminated 30th June 2019. List being dispersed

Meadows Health Centre (C84144)PCN: Clifton and MeadowsContract: GMSCap: 3,988 at 01/01/2020Senior partner: Dr Jadoon

The Medical Centre (C84151)PCN: Bestwood and SherwoodContract: PMSCap: 2,566 at 01/01/2020Senior partner: Dr IrfanComment: Singled handed GP practice


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Melbourne Park Medical Centre (C84116)PCN: BACHSContract: GMSCap: 8,842 at 01/01/2020Senior partner: Dr Ridley

NEMS – Platform One Practice (Y02847)PCN: Nottingham City EastContract: APMSCap: 10,824 at 01/01/2020Senior partner: NEMS HealthcareComment: Contract expires March 2021

Parkside Medical Practice (C84064)PCN: Bulwell and Top ValleyContract: GMSCap: 7,807 at 01/01/2020Senior partner: Dr Deolkar

Queens Bower Surgery (C84135)PCN: Bulwell and Top ValleyContract: GMSCap: 4,123 at 01/01/2020Senior partner: Dr AryaComment: Single handed practice

RHR Medical Centre (C84680)PCN: BACHSContract: PMSCap: 4,842 at 01/01/2020Senior partner: Dr BicknellComment: Part of Beechdale Medical Group

Radford Health Centre (N Phillips) (C84096)PCN: Radford and Mary PotterContract: PMSCap: 3,412 at 01/01/2020Comment: Singled handed GP practice

Radford Medical Practice (Kaur) (C84117)PCN: Radford and Mary PotterContract: PMSCap: 22,528 at 01/01/2020Comment: A university practice with a branch site based near Arboretum for Nottingham Trent University

Rise Park Surgery (C84129)PCN: Bulwell and Top ValleyContract: GMSCap: 7,512 at 01/01/2020Senior partner: Dr Salisbury

Rivergreen Medical Centre (C84060)PCN: Clifton and MeadowsContract: GMSCap: 9,073 at 01/01/2020Senior partner: Dr Arora


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Riverlyn Medical Centre (C84717)PCN: Bulwell and Top ValleyContract: PMSCap: 2,999 at 01/01/2020Senior partner: Dr Tangri

Sherrington Park Medical Practice (C84682)PCN: Bestwood and SherwoodContract: GMSCap: 4,749 at 01/01/2020Senior partner: Dr Vindla

Sherwood Rise Medical Centre (C84628)PCN: Bestwood and SherwoodContract: GMSCap: 6,492 at 01/01/2020Senior partner: Dr Iqbal

Southglade Medical Practice (Y05622)PCN: Bulwell and Top ValleyContract: APMSCap: 3,296 at 01/01/2020Senior partner: Nottingham City General Practice Alliance (NCGPA)Comment: Care-taker contract with NCGPA due to incumbent provider serving notice. Contract expires March 2020

Springfield Medical Centre (C84138)PCN: Bulwell and Top ValleyContract: GMSCap: 2,564 at 01/01/2020Senior partner: Dr MohindraComment: Singled handed GP in partnership with a non-clinical partner

St Alban's Medical Centre /Nirmala (The Practice) (C84004)PCN: Bulwell and Top ValleyContract: GMSCap: 7,321 at 01/01/2020Senior partner: The Practice Group plcComment: Nirmala is a branch surgery

St Luke’s Practice (C84136)PCN: Radford and Mary PotterContract: GMSCap: 4,067 at 01/01/2020

Strelley Health Centre (C84698)PCN: BACHSContract: PMSCap: 639 at 01/01/2020Senior partner: Dr BicknellComment: Practice closed 7 June 2019. Mutual termination of contract in progress

Sunrise Medical Practice (C84714)PCN: Unity (Nottingham)Contract: PMSCap: 6,739 at 01/01/2020Senior partner: Dr GhattaoraComment: Located on the Nottingham Trent University Clifton campus

Tudor House Medical Practice (C84619)PCN: Bestwood and SherwoodContract: PMSCap: 6,691 at 01/01/2020Senior partner: Dr Henry

The University of Nottingham Health Service (C84023)PCN: Unity (Nottingham)Contract: GMSCap: 47,560 at 01/01/2020Senior partner: Dr NashComment: Located on the University of Nottingham campus


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Victoria & Mapperley Practice (C84085)PCN: Nottingham City EastContract: GMSCap: 9,731 at 01/01/2020Senior partner: Dr MawjiComment: Branch site is Mapperley surgery

Welbeck Surgery (C84664)PCN: Bestwood and SherwoodContract: GMSCap: 4,564 at 01/01/2020Senior partner: Dr Worth

Wellspring Surgery (C84072)PCN: Nottingham City EastContract: PMSCap: 9,876 at 01/01/2020Senior partner: Dr Teed

Windmill Practice (C84683)PCN: Nottingham City EastContract: PMSCap: 9,336 at 01/01/2020Senior partner: Dr Abbott

Wollaton Park Medical Centre (C84122)PCN: Nottingham City SouthContract: PMSCap: 8,761 at 01/01/2020Senior partner: Dr Silcock

Nottingham North and East

The Calverton Practice (C84047)Address: 2A St Wilfrid's Square, Calverton, Nottingham NG14 6FPPCN: Arnold and Calverton PCNPhone: 0115 9657801Contract: PMSCap: 9,690 at 01/01/2020Practice manager: Bridget HallSenior partner: Dr Philip RaynerGPs: Dr Jessica Brown (Partner) Dr Tanya Lachman (Registrar) Dr Mitesh Patel (Registrar)

Dr Emma Fleming (Salaried) Dr Sheena Lanyon (Salaried) Dr Petra Richmond (Salaried)Dr James Hopkinson (Partner) Dr Tim Oliver (Registrar) Dr Emma Sherwood (Partner)Dr Owen Hughes (Registrar) Dr Jane Partington (Partner) Dr Caroline Wight (Partner)

Daybrook Medical Practice (C84066)Address: Salop Street, Daybrook, Nottingham NG5 6HPPCN: Arrow Health PCNPhone: 0115 9267628Contract: PMSCap: 9,587 at 01/01/2020Practice manager: Debi RattraySenior partner: Dr Gerry GallagherGPs: Dr Lisa Boruch (Partner) Dr Helen Erhayiem (Salaried) Dr Christina Sharkey (Salaried)

Dr Lucy Daly Dr Kirsty Moseley

Highcroft Surgery (C84055)Address: High Street, Arnold, Nottingham NG5 7BQPCN: Arnold and Calverton PCNPhone: 0115 8832330Contract: PMSCap: 11,926 at 01/01/2020Practice manager: Emma RoweSenior partner: Dr John Brendan McKeatingGPs: Dr Ashish Alurwar (Partner) Dr Jeffrey Ho (Salaried) Dr Laura Whitehorn (Salaried)

Dr Laura Axinte (Registrar) Dr Smita Jobling (Partner) Dr Andrew Wrench (Salaried)Dr Jessica Halliley (Registrar)


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The Ivy Medical Group (C84646)Address: 6 Lambley Lane, Burton Joyce, Nottingham NG14 5BGPCN: Arrow Health PCNPhone: 0115 9312500Contract: PMSCap: 7,147 at 01/01/2020Practice manager: Diane HallSenior partner: Dr Paramjit PanesarGPs: Dr Philippa Gallivan (Salaried) Dr Audrey Russell Dr Sherene Thomas (Salaried)

Dr Sarah Parish (Locum) Dr Arun Shetty (Salaried)

The Jubilee Practice (C84613)Address: Francklin Road, Lowdham, Nottingham NG14 7BGPCN: Synergy HealthPhone: 0115 9663633Contract: GMSCap: 2,333 at 01/01/2020Practice manager: Rachel WhiteSenior partner: Dr Claire HattonGPs: Dr Anna Kirby Dr Tania May

Oakenhall Medical Practice (C84095)Address: Bolsover Street, Hucknall, Nottingham NG15 7UAPCN: Byron PCNPhone: 0115 9633511Contract: GMSCap: 7,304 at 01/01/2020Practice manager: Lisa EllisonSenior partner: Dr Clare RoughtonGPs: Dr Rachel Andrews (Salaried) Dr Susan Sturrock (Partner) Dr Sarah Webster (Partner)

Dr Kaushik Morar

The Om Surgery (Y00026)Address: 112 Watnall Road, Hucknall, Nottingham NG15 7JPPCN: Byron PCNPhone: 0115 9632184Contract: PMSCap: 2,158 at 01/01/2020Practice manager: Reeta MohindraSenior partner: Dr Suman MohindraGPs: Dr Sharma (Locum) Dr Amna Yasmin (Locum)

Park House Medical Centre (C84709)Address: 61 Burton Road, Carlton, Nottingham NG4 3DQPCN: Synergy HealthPhone: 0115 9404333Contract: PMSCap: 10,134 at 01/01/2020Practice manager: Michelle TurpinSenior partner: Dr Ian CampbellGPs: Dr Kevin Bratt (Locum) Dr Luke Louca (Partner) Dr Emma Pooley (Locum)

Dr Rachael Daly (Salaried)

Peacock Practice (C84133)Address: 428 Carlton Hill, Carlton, Nottingham NG4 1HQPCN: Arrow Health PCNPhone: 0115 9580415Contract: PMSCap: 5,536 at 01/01/2020Practice manager: Yvonne WaltersSenior partner: Dr Richard Baynham

Dr JonesGPs: Dr A Subramanian (Salaried) Dr Anita Zawadzka (Salaried)

Plains View Surgery (C84115)Address: 57 Plains Road, Mapperley, Nottingham NG3 5LBPCN: Arrow Health PCNPhone: 0115 9621717Contract: PMSCap: 7,291 at 01/01/2020Practice manager: Michele BlissSenior partner: Dr Chic PillaiGPs: Dr Umar Ahmad (Partner) Dr Minosha Fernando (Salaried)


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Stenhouse Medical Centre (C84026)Address: 66 Furlong Street, Arnold, Nottingham NG5 7BPPCN: Arnold and Calverton PCNPhone: 0115 9673777Contract: PMSCap: 11,989 at 01/01/2020Practice manager: Martin RowlattSenior partner: Dr Ann CockburnGPs: Dr Joanne Carey (Partner) Dr Kate Evans (Partner) Dr C Strickland-Palmer (Partner)

Dr Madhavi Chawla (Partner) Dr Lis Gibbon (Salaried) Dr Ruth Watson (Registrar)Dr Helen Eisenhauer (Salaried) Dr Elaine Maddock (Partner) Dr Caroline White (Partner)

Torkard Hill Medical Centre (C84053)Address: Farleys Lane, Hucknall, Nottingham NG15 6DYPCN: Byron PCNPhone: 0115 9633676Contract: GMSCap: 15,780 at 01/01/2020Practice manager: Joanne HickenSenior partner: Dr Maria DaltonGPs: Dr Hannan Abdel-Salam (Partner) Dr Alex Brodie (Partner) Dr Prakash Kachhala (Partner)

Dr Natalie Alva (Salaried) Dr Jenny French (Partner) Dr Tom Reid (Salaried)Dr Aneel Bilkhu (Partner) Dr Vidya Johnson (Salaried)

Trentside Medical Group (C84010)Address: 2a Forester Street, Netherfield, Nottingham NG4 2NJPCN: Synergy HealthPhone: 0115 9403775Contract: PMSCap: 11,697 at 01/01/2020Practice manager: Vicky WallSenior partner: Dr Caitriona KennedyGPs: Dr Sumbal Ali (Salaried) Dr Simone Elliss (Salaried) Dr Harish Pathy (Partner)

Unity Surgery (C84150)Address: 318 Westdale Lane, Mapperley, Nottingham NG3 6EUPCN: Arrow Health PCNPhone: 0115 9877604Contract: PMSCap: 3,872 at 01/01/2020Practice manager: Ruth CutlerSenior partner: Dr Azim KhanGPs: Dr Zahir Ahmed Dr Tim Coleman Dr Minna Jacob

West Oak Surgery (C84696)Address: 319 Westdale Lane, Mapperley, Nottingham NG3 6EWPCN: Synergy HealthPhone: 0115 9525320Contract: GMSCap: 5,586 at 01/01/2020Practice manager: Alisa WhiteSenior partner: Dr Manas KarphaGPs: Dr Sarah Adams (Partner) Dr Elizabeth Roberts (Salaried)

Westdale Lane Surgery (C84033)Address: 20-22 Westdale Lane, Gedling, Nottingham NG4 3JAPCN: Arrow Health PCNPhone: 0115 9613968Contract: GMSCap: 8,158 at 01/01/2020Practice manager: Paula WattsSenior partner: Dr Umar KhaliqGPs: Dr Neyha Aggarwal (Salaried) Dr Venessa Doel (Salaried) Dr Akila Malik (Salaried)

Dr Padma Chintala (Salaried) Dr Khandaker Islam (Registrar) Dr Lauren Taylor (Trainee)Dr Yann-Eric Courcha (Trainee) Dr Rajnish Kacker (Trainee)

Whyburn Medical Practice (Y06443)Address: Curtis Street, Hucknall, Nottingham NG15 7JEPCN: Byron PCNPhone: 0115 8832150Contract: APMSCap: 11,688 at 01/01/2020Practice manager: Sally HaywoodSenior partner: Dr Adam ConnorGPs: Dr Sarah Cluroe (Locum) Dr Kerthi Galappatty (Locum) Dr Afsheen Kirun (Registrar)


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Nottingham West

Abbey Medical Centre (C84065)Address: 63 Central Avenue, Beeston, Nottingham NG9 2QPPCN: Nottingham West PCNNeighbourhood: BeestonPhone: 0115 9255323 Contract: GMSCap: 5,394 at 01/01/2020Senior partner: Dr David CavanaghGPs: Dr Joanne Taplin Dr Lyndsey Wheeler Dr Kaye Sethi

Bramcote Surgery (C84112)Address: 2a Hanley Avenue, Bramcote, Nottingham NG9 3HFPCN: Nottingham West PCNNeighbourhood: BeestonPhone: 0115 9224960Contract: GMSCap: 3,565 at 01/01/2020Senior partner: Dr Liz JordanGPs: Dr Andrew Hopwood

Chilwell Valley and Meadows Practice (C84120)Address: The Valley Surgery, 81 Bramcote Lane, Chilwell, Nottingham NG9 4ET

Chilwell Meadows Surgery, Ranson Road, Chilwell, Nottingham NG9 6DXPCN: Nottingham West PCNNeighbourhood: BeestonPhone: 0115 9430530 / 0115 9462767Contract: GMSCap: 15,156 at 01/01/2020Senior partner: Dr Katie RhodesGPs: Prof Tony Avery Dr Amanda Gunther Dr Sonal Nicum

Dr Susanne Bond Dr Timothy Heywood Dr Victoria Robinson Dr Natalie Chersich Dr Kate Hodson Dr Sarah Thomas Dr Richard Churchill Dr Fiona McCracken Dr Jim ThrelfallDr Nicola Egan Dr Alison McKnespiey

Eastwood PCC (C84032)Address: The Surgery, Church Walk, Eastwood, Nottingham NG16 3BH

Church Street Medical Centre, 11b Church Street, Eastwood, Nottingham NG16 3BSPCN: Nottingham West PCNNeighbourhood: Eastwood/KimberleyPhone: 01773 304700Contract: GMSCap: 19,552 at 01/01/2020Senior partner: Dr Kelvin LimGPs: Dr Fereshteh Akbari Dr Thankam (Reshmi) Dickson Dr Summer Scullard

Dr Nicole Atkinson Dr Mark Dickson Dr Subramaniam SivanDr Marcia Clark Dr Beth Homer Dr Hersad VaghelaDr Jennifer Dickinson Dr Paul Scullard Dr Syed Zaidi

Giltbrook Surgery (C84667)Address: 492 Nottingham Road, Giltbrook, Nottingham NG16 2GEPCN: Nottingham West PCNNeighbourhood: Eastwood/KimberleyPhone: 0115 9383191 Contract: PMSCap: 5,036 at 01/01/2020Senior partner: Dr Jacques RansfordGPs: Dr Sandhya Gopakumar Dr Abda Noreen

Hama Medical Centre (C84624)Address: 11a Nottingham Road, Kimberley, Nottingham NG16 2NPPCN: Nottingham West PCNNeighbourhood: Eastwood/KimberleyPhone: 0115 9382101Contract: PMSCap: 5,081 at 01/01/2020Senior partner: Dr Tariq HamaGPs: Dr Zahida Hama


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Hickings Lane Medical Centre (C84705)Address: Ryecroft Street, Stapleford, Nottingham NG9 8PNPCN: Nottingham West PCNNeighbourhood: StaplefordPhone: 0115 9395555Contract: PMSCap: 6,138 at 01/01/2020Senior partner: Dr John DoddyGPs: Dr Benjamin Davis Dr Kate Foley Dr Shaista Khan

Dr Laura Durber

Linden Medical Group (C84107)Address: Stapleford Care Centre, Church Street, Stapleford, Nottingham NG9 8DAPCN: Nottingham West PCNNeighbourhood: StaplefordPhone: 0115 8752000Contract: GMSCap: 7,845 at 01/01/2020Senior partner: Dr Syrus AdlGPs: Dr Jenny Lee Dr Aarlin Muthoot Dr Upendra Singh

Dr Indu Mendis Dr Kate Rees

The Manor Surgery (C84080)Address: Middle Street, Beeston, Nottingham NG9 1GAPCN: Nottingham West PCNNeighbourhood: BeestonPhone: 0115 9076960Contract: PMSCap: 12,980 at 01/01/2020Senior partner: Dr David CharlesGPs: Dr Lorraine Easson Dr Sudam Prabhu Dr Emma Shapiro

Dr Michael Mannion Dr James Read Dr Ruth WiecekDr Louis Mok

Newthorpe Medical Centre (C84131)Address: Harvest Road, Eastwood, Nottingham NG16 3HUPCN: Nottingham West PCNNeighbourhood: Eastwood/KimberleyPhone: 01773 535511 Contract: PMSCap: 7,512 at 01/01/2020Senior partner: Dr Sarah BamfordGPs: Dr Chris Cooley Prof Denise Kendrick Dr Peter Machin

The Oaks Medical Centre (C84030)Address: 20 Villa Street, Beeston, Nottingham NG9 2NYPCN: Nottingham West PCNNeighbourhood: BeestonPhone: 0115 9254566Contract: GMSCap: 10,686 at 01/01/2020Senior partner: Dr Paul JacklinGPs: Dr Rodderick Addis Dr Sarah Johns Dr Lucy Laurance

Dr Punsisi Burns Dr Justine Killingley Dr Donna SmithDr Veerinder Jandhu

Saxon Cross Surgery (C84042)Address: Stapleford Care Centre, Church Street, Stapleford, Nottingham NG9 8DAPCN: Nottingham West PCNNeighbourhood: StaplefordPhone: 0115 9392444Contract: PMSCap: 7,449 at 01/01/2020Senior partner: Dr Helen O'NeilGPs: Dr Solomon Akwei Dr Ritu Kothari Dr Mike O'Neil

Dr Kelly Finlay Dr Rishi Mosaheb


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Rushcliffe

Belvoir Health Group (C84017)PCN: Rushcliffe PCNNeighbourhood: NorthContract: GMSCap: 24,831 at 01/01/2020Senior partner: Dr Martin LowdenGPs: Dr Stuart Alexander Dr Anna Griffiths Dr Nick Manning

Dr Rachel Britton Dr Jessica Hall Dr Claire MartinDr Charlotte Camm Dr Jessica Keeley Dr Jess PatelDr Angela Chandrasena Dr Emma Kelly Dr Rukshala ReidDr Lucy Clayton Dr Melanie Lewis Dr Richard StrattonDr Daniel Crowfoot Dr Alex Macdonald Dr Heather TaskerDr Laura Dewey Dr Pete Mahoney

Castle Healthcare Practice (C84605)PCN: Rushcliffe PCNNeighbourhood: CentralContract: PMSCap: 16,908 at 01/01/2020Senior partner: Dr Nick PageGPs: Dr Jonathan Ashton Dr Nicholas Hutchinson Dr Pargat Singh

Dr Joanne Chapman Dr Rachel Janyshiwskyj Dr Arjun TewariDr Alison Di Mambro Dr Claire McCall Dr Helen WalshDr Jeremy Griffiths Dr Lynn Ovenden

East Bridgford Medical Centre (C84025)PCN: Rushcliffe PCNNeighbourhood: NorthContract: PMSCap: 7,057 at 01/01/2020Senior partner: Dr Rob ScaffardiGPs: Dr Christopher Cope Dr Meg Pryor Dr Ann-Marie Stewart

East Leake Medical Group (C84005)PCN: Rushcliffe PCNNeighbourhood: SouthContract: PMSCap: 14,412 at 01/01/2020Senior partner: Dr Stephen ShorttGPs: Dr Imran Arshad Dr Nicolas Milhavy Dr Claudia Petillon

Dr Neil Fraser Dr Rahul Mohan Dr Rachel ShawDr Oxana Iwanskyj

Gamston Medical Centre (C84703)PCN: Rushcliffe PCNNeighbourhood: CentralContract: PMSCap: 5,861 at 01/01/2020Senior partner: Dr Linda KandolaGPs: Dr Kate Bishton Dr Barbara Collinson Dr Preya Patel

Keyworth Medical Practice (C84048)PCN: Rushcliffe PCNNeighbourhood: SouthContract: GMSCap: 10,875 at 01/01/2020Senior partner: Dr Jill LangridgeGPs: Dr Asifa Akhtar Dr Jennifer Moore Dr Neil Shroff

Dr Louise Glasgow Dr Gurvinder Sahota Dr Suzanne SivanandanDr Tina Marwaha Dr Sukhveer Sandhu

Musters Medical Practice (C84090)PCN: Rushcliffe PCNNeighbourhood: CentralContract: PMSCap: 9,837 at 01/01/2020Senior partner: Dr Libby SmithGPs: Dr Richard Barnsley Dr John Prestage Dr Nicola Turner

Dr Gavin Derbyshire Dr Laura Turnbull


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Orchard Surgery (C82040)PCN: Rushcliffe PCNNeighbourhood: SouthContract: GMSCap: 8,684 at 01/01/2020Senior partner: Dr Nicholas FosterGPs: Dr Nigel Cartwright Dr Helen Eglitis Dr Clare Pollock

Dr Tim Daniel Dr Omar Khalique

Radcliffe On Trent Health Centre (C84084)PCN: Rushcliffe PCNNeighbourhood: NorthContract: GMSCap: 8,158 at 01/01/2020Senior partner: Dr Ram PatelGPs: Dr Abigail Broderick Dr Mandeep Mandhar Dr Kareen Marwick

Dr Caroline Brown Dr Rebecca Mansfield Dr Natasha TurnerDr Michael Ekwuru

Ruddington Medical Centre (C84028)PCN: Rushcliffe PCNNeighbourhood: SouthContract: GMSCap: 6,889 at 01/01/2020Senior partner: Dr Jag RaiGPs: Dr Sandeep Missan Dr Claire Schofield Dr Jaspal Singh

Dr Preeti Patel

St George's Medical Practice (C84086)PCN: Rushcliffe PCNNeighbourhood: CentralContract: PMSCap: 11,865 at 01/01/2020Senior partner: Dr Matt JelpkeGPs: Dr Kate Bedforth Dr Chris Connor Dr Alan Loverseed

Dr Louise Bevan Dr Debbie Hapgood Dr David Peachy

West Bridgford Medical Centre (C84621)PCN: Rushcliffe PCNNeighbourhood: CentralContract: PMSCap: 4,448 at 01/01/2020Senior partner: Dr Sean OtteyGPs: Dr Sunita Rana


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of 2

Meeting Title: Primary Care Commissioning Committee

(Open Session) Date: 20 May 2020

Paper Title: Commissioning and Procurement of

Primary Medical Care Services Internal Audit Report


Sponsor:

Presenter:

- Attachments/ Appendices:

Internal Audit Report

Joe Lunn, associate Director of Primary Care

Purpose: Approve ☐ Endorse ☐ Review


Assurance

Information

☒

Executive Summary

The CCG is mandated to request an independent review of it delegated functions for primary care on an annual basis. The review has been conducted by the CCG’s internal auditors and an audit opinion of ‘substantial assurance’ has been issued. Three low level risk actions have been agreed and have been addressed.



☐


☐














Internal Audit Report: Delegated Primary Medical Care Functions

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of 2

Risk(s):

No risks have been identified

Confidentiality:

☒No

Recommendation(s):

1. To RECEIVE for assurance the Commissioning and Procurement of Primary Medical Care Services Internal Audit Report


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Commissioning and Procurement of Primary

Medical Care Services

Nottingham and Nottinghamshire CCGs*

April 2020 1920/NNCCGs/12

Final Report

* Comprising: NHS Nottingham City CCG NHS Nottingham North and East CCG NHS Nottingham West CCG NHS Rushcliffe CCG NHS Mansfield and Ashfield CCG NHS Newark and Sherwood CCG


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Advisory | Counter Fraud | Internal Audit and Assurance | IT Risk Management and Assurance | PPV | Security Management Services | Training

Table of contents

Heading Page

Executive summary 2

Detailed report 2

Appendix A – risk matrix and opinion levels 11

Distribution

Name For action For information

Lucy Dadge – Chief Commissioning Officer

Amanda Sullivan – Accountable Officer

Joe Lunn- Associate Director of Primary Care

Lynette Daws – Head of Primary Care

Stuart Poynor – Chief Finance Officer

Lucy Branson – Associate Director of Governance

Key dates

Report stage Date

Discussion draft issued: 11 and 24 February 2020

Comments received by Phone: 16 March 2020

Final draft issued: 16 March 2020

Client approval received: 27 April 2020

Final report issued: 28 April 2020

Contact information

Name / role Contact details

Tim Thomas, Director [email protected] 01709 422 113


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Name / role Contact details

Glynis Onley, Assistant Director [email protected] 0115 883 5310

Claire Page, Client Manager [email protected] 0115 883 5307

Tiffany Hey, Assistant Client Manager [email protected] 07919 542523

Reports prepared by 360 Assurance and addressed to the Nottingham and Nottinghamshire CCGs’* directors or officers are prepared for the sole use of the Organisations, and no responsibility is taken by 360 Assurance or the auditors to any director or officer in their individual capacity. No responsibility to any third party is accepted as the report has not been prepared for, and is not intended for, any other purpose and a person who is not a party to the agreement for the provision of Internal Audit between the Nottingham and Nottinghamshire CCGs and 360 Assurance dated 1 April 2019 shall not have any rights under the Contracts (Rights of Third Parties) Act 1999.

The appointment of 360 Assurance does not replace or limit the Nottingham and Nottinghamshire CCGs’ own responsibility for putting in place proper arrangements to ensure that their operations are conducted in accordance with the law, guidance, good governance and any applicable standards, and that public money is safeguarded and properly accounted for, and used economically, efficiently and effectively.

The matters reported are only those which have come to our attention during the course of our work and that we believe need to be brought to the attention of the Nottingham and Nottinghamshire CCGs. They are not a comprehensive record of all matters arising and 360 Assurance is not responsible for reporting all risks or all internal control weaknesses to the Nottingham and Nottinghamshire CCGs.

This report has been prepared solely for your use in accordance with the terms of the aforementioned agreement (including the limitations of liability set out therein) and must not be quoted in whole or in part without the prior written consent of 360 Assurance.

*Comprising:

NHS Nottingham City CCG NHS Rushcliffe CCG

NHS Nottingham North and East CCG NHS Mansfield and Ashfield CCG

NHS Nottingham West CCG NHS Newark and Sherwood CCG


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1

Executive summary

Introduction and background

The Nottingham and Nottinghamshire CCGs assumed full delegated responsibility for primary medical care commissioning from NHS England from 1 April 2015.

Although NHS England has delegated functions to CCGs, it retains overall accountability and is, therefore, responsible for obtaining assurances that its functions are being discharged effectively.

From 2018/19, NHS England (NHSE) has required independent assurances to be provided that delegated functions have been appropriately discharged. NHSE’s Internal Audit Framework sets out the requirement for independent assessments to be undertaken across four domains, on a cyclical basis. These are:

Commissioning and Procurement of Services

Contract Oversight and Management Functions

Primary Care Finance

Governance (common to each of the above areas).

CCGs are required to tailor their approach to take account of the findings from any previous or related audit work, and make use of local assessment of risk to determine appropriate focus within the scope of work detailed.

For the six CCGs, the Governance and Risk Management Review (report reference: 1920/NNCCGs/06, issued in November 2019 with significant assurance) has been taken into account in complying with the requirements of the Framework.

The Framework requires that the outcome of each annual internal audit is reported to the CCGs’ Audit and Governance Committees using the opinion levels specified in the Framework; these are provided at Appendix A. The Primary Care Commissioning Committee will have a lead role in discussing and agreeing the report.

Audit objective

The objective of our audit was to determine whether a robust, efficient and effective control environment is in place in relation to commissioning and procurement of primary medical care services as detailed within the Delegation Agreement between the CCGs and NHSE.

Audit opinion

Substantial assurance

The controls in place do not adequately address one or more risks to the successful achievement of objectives; and/or one or more of the controls tested are not operating effectively, resulting in unnecessary exposure to risk.

Our opinion is limited to the controls examined and samples tested as part of this review.


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Advisory | Counter Fraud | Internal Audit and Assurance | IT Risk Management and Assurance | PPV | Security Management Services | Training 2

Executive summary

The opinion level we are required to use is as specified by NHSE. The assurance levels defined by NHSE:

are not comparable with ISAE 30001

differ to the assurance levels used by 360 Assurance for other reviews completed as part of the agreed internal audit programme of work.

Summary findings

There are strong governance arrangements in place, with the Primary Care Commissioning Committees (PCCC) having appropriate membership and meeting frequently. The Committees’ Terms of Reference were approved by the Governing Bodies in June 2019 to reflect the aligned governance arrangements. The Governing Bodies receive assurance regarding the work of the Committees through the receipt of highlight reports from the Chair of the PCCC and ratified minutes.

Accountability for primary medical care services (PMCS) rests with the Chief Commissioning Officer who is supported by the CCGs’ Primary Care Team and the NHSE Primary Care Hub which provides services in accordance with the Memorandum of Understanding between the Primary Care Hub and the CCGs. Services are commissioned in accordance with NHSE’s Policy Guidance Manual which the CCGs have adopted and relevant staff are aware of.

Effective arrangements are in place for planning PMCS and conducting needs assessments. We reviewed a sample of 18 decisions made by the PCCC and identified that there is further scope to improve clarity and focus within papers to PCCC that all relevant NHSE statutory duties and other responsibilities have been considered and addressed.

The CCGs have documented arrangements for Local Enhanced Services (LES) and these were all approved by the PCCC. The CCGs have been reviewing future arrangements for LES for when the new merged CCG is established in April 2020. Relevant procurement advice has been considered.

The CCGs have appropriate arrangements in place for emergency practice closures, or if there is disruption to services, through the use of caretaker arrangements and the use of Alternative Provider Medical Services (APMS) contracts. There were nine of these at the time of our review across all six CCGs. Updates on APMS contracts are reported to the PCCC and are overseen by the APMS Procurement Group which has been established in year.

Summary of actions

High Medium Low Total

Agreed actions 0 0 3 3

1 International Standard on Assurance Engagements (ISAE) 3000 Assurance Engagements Other than Audits or

Reviews of Historical Financial Information issued by the International Audit and Assurance Standards Board


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3

Detailed report

Audit scope

Scope area Audit testing

Effective governance arrangements are in place through the Primary Care Commissioning Committee that support the CCG in discharging delegated functions relating to commissioning and procurement.

We reviewed the CCGs’ Constitutions and associated Schemes of Reservation and Delegation (SORD) to assess whether they specified the role of the Primary Care Commissioning Committee. We compared PCCC Terms of Reference to the Standing Documents and the Delegation Agreement with NHSE. We assessed whether the Terms of Reference were approved by the Governing Bodies and that membership and reporting to the Governing Bodies was as expected.

We reviewed whether responsibility for primary medical care services is assigned to an appropriate director at the CCGs and if any external support is provided to deliver this agenda.

We reviewed whether the CCGs have adopted NHSE’s Policy Guidance Manual (PGM) which was updated in 2019, or if they have their own policy. We assessed whether all relevant CCG staff are aware of the Policy and how they demonstrate compliance with it.

Effective arrangements are in place for planning the provision of primary medical care services in the area, including carrying out health needs assessments, assessment of provider landscape and consulting with the public and other relevant agencies as necessary.

We interviewed CCG and NHSE Primary Care Hub officers to assess how the CCGs document that they have planned PMCS including conducting needs assessments.

Effective arrangements are in place for the procurement of PMCS, including decisions to extend existing contracts.

We interviewed officers to establish who is accountable for PMCS and where external support is received that this is recorded within an agreed Memorandum of Understanding and services are received as expected.

We requested copies of the central database of contracts with practices and evidence that these are managed proactively and where relevant procurement legislation is applied.

We reviewed agendas, papers and minutes of the PCCC to assess that procurement and commissioning decisions are recorded appropriately.

Effective arrangements are in place for the involvement of patients/public in those commissioning and procurement decisions.

We interviewed the Head of Primary Care and NHSE Primary Care Hub officers to ascertain the responsibility of the practices to engage with patients and other stakeholders for procurements and commissioning decisions. We tested a sample of 18 decisions made by the PCCCs between June and November 2019 to assess the level of engagement.

Effective arrangements are in We interviewed the Head of Primary Care to understand the


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Detailed report

Scope area Audit testing

place for the commissioning of Directed Enhanced Services (DES) and any Local Incentive Schemes (LIS), including the design of such schemes.

process for commissioning DES, Local Enhanced Services (LES) and LIS.

We reviewed PCCC agendas and papers to assess what Local Enhanced Services have been designed and approved by the PCCCs.

We restricted our testing to LES as the CCGs have no role with regards to DES and there are no Local Incentive Schemes in Nottinghamshire in 2019/20.

Effective arrangements are in place to respond to urgent GP practice closures or disruption to service provision.

We reviewed PCCC agendas and papers to identify if there have been any urgent GP practice closures or other disruption to services, eg through closure of list sizes or boundary changes, and how these were managed by the PCCCs.

Limitations of scope:

The scope of our work was limited to the systems and controls identified in the Terms of Reference agreed with the Chief Commissioning Officer in November 2019.

Excluded from the scope was the management of conflicts of interest which is subject to a separate mandated internal audit framework.

We have not provided assurance on the controls in place within the Primary Care Hub as that is subject to separate internal audit arrangements through NHS England.

In carrying out our work, and in reporting our findings, we have satisfied ourselves that any common arrangements in place are operating consistently across all the CCGs and have reported where that was found not to be the case.

Key findings

The following sections of the report summarise the findings of our review. Our risk assessment process aligns with the ISO 31000 principles and generic guidelines on risk management. The risk matrix we use, along with definitions of different opinion levels, is provided at Appendix A.

1. Governance arrangements

Primary Care Commissioning Committees

The PCCCs’ Terms of Reference were approved by the Governing Bodies meeting in common in August 2019 and are consistent with the CCGs’ Constitutions, associated Schemes of Reservation and Delegation and the Delegation Agreements between each CCG and NHSE. Membership of the PCCCs is predominantly Lay Members and Executive Directors but two Independent GP Advisors have voting rights along with the Chief Nurse to provide clinical insight. The PCCCs meet monthly in public and confidentially and we confirmed in our separate review of Governance and Risk Management Arrangements that there are robust arrangements in place for reporting from the Committees to the Governing Bodies through the provision of ratified minutes and highlight reports from the Chair of the Committees. The CCG issue Primary Care Activity Reports (PCARs) to NHSE to provide an update on primary care activity and copies of these were provided to us for the previous year 2018/19.


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Detailed report

Accountability for primary medical care services

We confirmed that the Chief Commissioning Officer is the executive lead for primary medical care services and is supported by the CCGs’ Primary Care Team and receives operational support from NHSE’s Primary Care (PC) Hub.

There is an agreed Memorandum of Understanding (MOU) in place, and associated Handbook, which specifies the respective responsibilities of the CCGs and the PC Hub. This was approved by the PCCCs in September 2019. In accordance with the MOU, the PC Hub presents a performance report to the PCCCs on a quarterly basis, the most recent being for the period ended October 2019. We reviewed this and consider it to provide a good summary of contracts in place with GP practices and those practices that have made requests to change boundaries, merge with others and close list sizes to new patients. There is also a record of all practices that have signed up to the national Directed Enhanced Services which are managed by NHSE.

Through our review of papers reported to the PCCCs and also in discussion with the Head of Primary Care we confirmed that the PC Hub is providing services as detailed within the MOU.

Policy for primary medical care services

We confirmed that the CCGs have adopted the Policy Guidance Manual issued by NHSE which was updated in 2019. The PCCCs received a paper ‘The Delegation Agreement – Delivery and Oversight Arrangements’ at its public meeting in June 2019. This paper set out the CCGs’ intention to follow the PGM and also to develop a local policy for discretionary payments to ensure consistency in approach.

1. Local policy for discretionary payments

Finding: The PCCCs were advised at their meeting in June 2019 that a local policy would be developed on discretionary payments to ensure consistency in approach. To date, the existing policy used by Nottingham City CCG is being referred to but this is out of date and does not reflect the current governance arrangements in place.

Risk: If a local policy or guidance on discretionary payments is not available then the CCGs could be challenged regarding consistency of process in making discretionary payments and decisions could be overturned.

Low (Impact x Likelihood)

2 x 3

Action: The Associate Director of Primary Care should develop guidance or a local policy on discretionary payments and this should be approved by the PCCCs.

Responsible officer: Joe Lunn, Associate Director of Primary Care

Implementation date: December 2020

Management response: Agreed. We will endeavour to draft this and have it approved by PCCC in December 2020 subject to any requirements of the CCG team to deliver the CCG’s response to Covid-19.

2. Planning primary medical care services

The PCCCs’ Terms of Reference mirror the Delegation Agreement with NHSE and incorporate responsibility for planning primary medical care services and conducting needs assessments.


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Detailed report

We identified that this responsibility has been addressed through the following methods:

The Commissioning Strategy was submitted to NHSE in July 2019 to support the CCGs’ merger application. It refers to population needs assessment and planning services. Section 3 specifically refers to the population health needs within Nottingham and Nottinghamshire and the joint working with strategic partners, as well as utilising the Joint Strategic Needs Assessment (JSNA) to assist with this.

Specific reference is made within the Commissioning Strategy to the Primary Care Strategy where more demographics of Nottingham and Nottinghamshire are recorded. Section 4 incorporates data on demographics and health inequalities.

From our review of a sample of 18 decisions made by the PCCCs between June and November 2019 we confirmed that papers incorporated data on practice sizes and patient information, as well as other local practices, which were used to support the decision making process. Where relevant we could confirm that EQIAs had been completed to support the decision making process.

The Aligned Governance Framework in place since June 2019 has included the establishment of two advisory groups, the Public and Patient Engagement Committees (PPEC), to represent the patient voice in Mid-Nottinghamshire and Greater Nottinghamshire. A specific objective of these Groups is to provide a patient and public perspective in the planning and commissioning of health and care services for their respective populations.

We have raised no further recommendation here.

3. Commissioning and procuring primary medical care services

We noted from our review of the Quarterly Contract Report presented to the PCCCs in November 2019 that the CCGs have contracts with 131 practices (76 GMS, 46 PMS and 9 APMS).

The CCGs’ Primary Care Team is in the process of populating the Contracts Database to cover the whole of Nottingham and Nottinghamshire and this will include recording patient data and aligning each practice to a Primary Care Network. Some progress has been made to record CQC results from visits but actual contract type, be it General Medical Services (GMS), Personal Medical Services (PMS) or Alternative Provider Medical Services, is still outstanding. We also identified that there were in excess of 131 contracts listed in the database which differs from the information reported by the PC Hub.

Commissioning Strategy (2020 - 2022)

Nottingham and Nottinghamshire ICS

Draft Primary Care Strategy (2019 to 2024)

Needs assessments which are recorded within

PCCC papers

Completion of Equallity Impact Assessments (EQIA) which cover patient

needs for those with protected characteristics

Establishment of 2 Public and Patient

Engagement Committees as advisory groups


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Detailed report

2. Accuracy of contract database for primary medical care services

Finding: We compared the number of contracts reported on the quarterly performance report prepared by the NHSE Primary Care Hub (which is reported to the PCCCs) and the contract database maintained by the Primary Care Team at the CCGs. The CCGs have 139 practices on the database and not 131 as reported by the Primary Care Hub.

Risk: If the contract database held by the CCGs is not correct then it may be difficult to effectively manage contracts with primary care providers when the NHSE PC Hub is no longer responsible or arrangements change from 1 April 2020.

Low (Impact x Likelihood)

2 x 3

Action: The Associate Director of Primary Care should request the contracts database from NHSE colleagues and ensure that it is reconciled with the CCG database. Arrangements for keeping the contract database up to date should be assigned to relevant officers in the Primary Care Team at the CCG.


Implementation date: July 2020

Management response: Agreed.

Commissioning and procurement decisions

We reviewed agendas, minutes and papers for the PCCCs. We selected a sample of 18 decisions made by the Committees been June and November 2019. In summary, these 18 decisions related to the following CCGs:

9 for Nottingham City CCG

1 for Nottingham North and East CCG

1 for Rushcliffe CCG

1 for Nottingham West CCG

1 for Newark and Sherwood CCG

3 for Mansfield and Ashfield CCG

1 for Mid–Nottinghamshire CCGs

1 for all CCGs regarding Flu Local Enhanced Services.

The decisions covered requests to change practice boundaries, merge practices, terminate contracts, close list sizes to new patients, make discretionary payments and review and approve Local Enhanced Services.

As part of our testing we assessed how clear the cover sheets or associated papers were in providing assurance that there was:


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Detailed report

For the sample tested we confirmed that for 14 out of 18 decisions either the cover sheet or the actual paper recorded a reference to the Policy Guidance Manual with the actual relevant section being quoted, as well as what options are available to the PCCCs.

When requests were being made to merge practices, change boundaries and close list sizes again in the majority of cases it was clear either on the cover sheet or in the paper itself that there had been engagement with patients), other affected practices and the Primary Care Networks. In some instances the associated Equality Impact Assessment (EQIA) was attached to the paper provided to PCCCs.

For the majority of decisions made by the PCCCs it was not necessary to confirm that procurement legislation had been complied with because reference to the PGM was quoted.

We could not confirm in any of the sample selected that the consideration of NHSE’s statutory duties recorded within the PGM at Section 4 and included in the Delegation Agreement had been considered.

3. Papers for the Primary Care Commissioning Committee provide assurance to Committee members that all relevant NHSE statutory duties and responsibilities have been considered

Finding: A standard cover sheet template is used for Governing Body and committee papers. It is, therefore, not possible to add in specific headings onto the cover sheet to demonstrate compliance with the Delegation Agreement with NHSE for PCCC decisions. From our review of 18 decisions made we considered that there could be greater clarity and focus within the papers to demonstrate that all duties and responsibilities have been considered and addressed.

Risk: If a decision is made by the PCCC and there is lack of evidence that there has been compliance with the Policy Guidance Manual, appropriate patient and stakeholder engagement has taken place, consideration of NHSE statutory duties and compliance with procurement legislation then the decision could be challenged and overturned. There could be an impact on the CCG’s reputation and patient experience and care.

Low (Impact x Likelihood) (2 x 3)

Action: The Associate Director of Primary Care should develop a standard paper format for reports to the PCCC which should require authors to consider and document that the following information has been considered and addressed:

the relevant section of the Policy Guidance Manual

engagement with patients and stakeholders

that procurement rules have been considered and action


Implementation date: May 2020

Compliance with PGM

Appropriate engagement

Compliance with NHSE statutory

duties

Consideration of needs

assessments

Compliance with

procurement legislation


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Detailed report

taken where applicable

NHSE statutory duties listed within the Delegation Agreement and also in the Policy Guidance Manual have been addressed and action taken. This could include cross references to the Quality Impact Assessments (QIA) and the Equality Impact Assessments

any needs assessment relevant to the decision

Management response: Agreed. We will endeavour to implement this action for the May PCCC meeting subject to capacity of the Primary care Team in the light of the Covid-19 pandemic.

Development and approval of Local Enhanced Services

We confirmed from our review of PCCC agendas, papers and minutes that the PCCCs had approved the following Local Enhanced Services between June and November 2019:

Mid-Nottinghamshire CCGs - LES including micro suction (paper 19/027C)

All CCGs - In/Out of Seasonal Flu LES (paper 19/092)

Nottingham City CCG - Latent TB infection testing and treatment LES (paper 19/093).

For each of these LES they were schemes in place in previous years and so it was possible to assess the design of the schemes.

We did note that there is reference to procurement legislation for each of these and the low risk associated with them in the direct award that was made.

We also noted from our review of PCCC minutes that there is to be a full review of all Local Enhanced Services across Nottingham and Nottinghamshire to ensure consistency in approach going forward. We have not made any recommendations in this area.

Commissioning response to urgent practice closures or disruption to services

The CCGs’ Primary Care Team working with the Primary Care Hub has oversight of arrangements with practices and liaises with the CQC.

At their meeting in September 2019 the PCCCs were advised of the governance arrangements in place with regards the Alternative Provider Medical Services and were asked to approve the recommendations from the APMS Procurement Group which was established to manage the APMS contracts. The approach taken is to establish caretaker arrangements following urgent closures either because a practice is being closed by the CQC or the partners/organisation have served notice on their primary care contract or previously failed procurements. The caretaker contracts are awarded for a contract term of 2 years.

The APMS Procurement Group’s membership is derived from the CCGs’ Primary Care Team, NHSE’s Primary Care Hub and Arden and Gem Commissioning Support Unit. The Group is responsible for managing procurements to an agreed timeline, to oversee the production and sign off of the procurement documents and to oversee provider exit and mobilisation, as necessary.

The Group meets on a monthly basis. The PCCCs received updates on progress with the nine APMS contracts in place currently at their meetings in September 2019 and January 2020.


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Detailed report

An update is also included within the quarterly performance report prepared by the PC Hub which is reported to the PCCCs.

We confirmed that there had been urgent practice closures for two practices in the Nottingham City CCG area and that all relevant updates were provided to the PCCC and decisions were recorded.

We have raised no recommendations in this area.

Follow up

Actions from this review will be followed up via the online electronic tracker system which is being introduced in 2020/21. This will include obtaining documentary evidence to demonstrate that actions agreed as part of this review have been implemented.


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Appendix A: Risk matrix and opinion levels

Risks contained within this report have been assessed using the standard 5x5 risk matrix below. The score has been determined by consideration of the impact the risk may have, and its likelihood of occurrence, in relation to the system’s objectives. The two scores have then been multiplied in order to identify the risk classification of low, medium, high or extreme.

Score Impact Likelihood Impact

1 Negligible Rare 1 2 3 4 5

2 Low Unlikely

Like

liho

od

1 L L L L L

3 Medium Possible 2 L L L M M

4 High Likely 3 L L M M H

5 Extreme Almost Certain 4 L M M H H

5 L M H H E

The audit opinion has been determined in relation to the objectives of the system being reviewed. It takes into consideration the volume and classification of the risks identified during the review.

These are the opinion levels as prescribed within NHS England’s Internal Audit Framework for Delegated Clinical Commissioning Groups.

Audit opinions

Full assurance

The controls in place adequately address the risks to the successful achievement of objectives; and the controls tested operate effectively.

Substantial assurance

The controls in place do not adequately address one or more risks to the successful achievement of objectives; and/or one or more of the controls tested are not operating effectively, resulting in unnecessary exposure to risk.

Limited assurance

The controls in place do not adequately address multiple significant risks to the successful achievement of objectives; and /or a number of controls are not operating effectively, resulting in exposure to a high level of risk.

No assurance

The controls in place do not adequately address several significant risks leaving the system open to significant error or abuse; and/or the controls tested are wholly ineffective, resulting in an unacceptably high level of risk to the successful achievement of objectives.


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Date: 20 May 2020

Paper Title: Primary Care Quality Report May 2020 Paper Reference: PCC 20 083

Sponsor:

Presenter:

Rosa Waddingham, Chief Nurse Attachments/ Appendices:

Appendix 1 – CQC Emergency Support FrameworkEsther Gaskill, Head of Quality Primary

Care

Purpose: Approve ☐ Endorse ☐ Review ☐ Receive/Note for:


☒

Executive Summary

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

It includes:

•Primary Care Quality Dashboard - An overall summary of the Quarter 4 quality dashboard ratings and actions identified to be taken with either individual practices or where an issue has been identified in relation to several practices or all practices.

•Primary Care Quality Groups / Primary Care Quality Team – An update on the activity of the Primary Care Quality groups and Primary Care quality team.

•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’.

•An overview of any practices currently receiving an enhanced level of support from the Primary Care quality team and activity undertaken to support practices / remain assured of quality of services during the COVID-19 pandemic.



☐


☐

Performance Management ☐ Procurement and/or Contract Management ☒








Primary Care Quality 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 Primary Care Quality Report May 2020


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1

Primary Care Quality Report May 2020

1. Primary Care Quality Dashboard

The 2019/20 Quarter 4 dashboard results were available for all Nottingham and Nottinghamshire practices at the end of April 2020. This included Mid-Nottinghamshire practices for the first time, the majority (32 out of 40) having received an introductory meeting from the Primary Care Quality team. The outstanding meetings will take place once the response to the Covid-19 pandemic allows. Most practices achieved an overall ‘Green *’ or ‘Green’ rating (84 out of 130). 46 practices achieved an overall ‘Amber’ rating; no practices received an overall ‘Red’ rating.

Within the Clinical Outcomes domain it was identified that several practices (83) continue to struggle with achieving the 80% target for cervical screening and some, (14) the 52% bowel screening target, and that this is likely to deteriorate with the disruption to screening due to the Covid-19 pandemic. TheCCG’s cervical screening checklist is available for practices to undertake and identify if there are any additional actions they can implement to help reach the 80% marker. A similar bowel screening checklist, also endorsed by Cancer Research UK, is ready to share with practices at an opportune time, as and when the national screening programmes and practices have resumed routine work. A breast screening check list is in development. 30 practices did not meet the 70% breast screening target on the Quarter 4 dashboard.

Six practices were noted to have nine or more adverse indicators within the Clinical Outcomes domain and will receive a support call from the Primary Care Quality team to ensure awareness and provide recommendations about where improvements can be made.

Within the Patient Experience domain, improvement from Quarter 3 in the number of practices achieving the ‘% of list size recorded as a carer’ and ‘% of patients on the end of life register who have their preferred place of death recorded’ indicators was noted. However, it is anticipated that the volumeof learning disability health checks and health checks for those with a mental health condition will decrease significantly as a result of practices having to postpone all routine work.

The Quarterly Primary Care Quality Dashboard Development Group due to be held in April 2020 was cancelled as colleagues focussed on the CCG’s response to the Covid-19 pandemic.

0

5

10

15

20

25

30

35

40

Green * Green Amber Red

South Notts

Mid Notts

City


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2. Primary Care Quality Groups

A quarterly meeting of a Primary Care Quality Group for each Integrated Care Partnership (ICP), including standardised terms of reference, membership, work plan and governance and reporting arrangements, is now established. The Terms of Reference have been reviewed and shared for information with the Primary Care Commissioning Committee.

At the Quarter 4 meetings, in addition to review of the dashboard and actions identified above, theQuarter 4 Patient Experience and Primary Care Patient Safety Incidents reports were presented and reviewed by the group.

The Patient Experience report identified that during Quarter 4 there were 41 contacts received by the CCG about a primary care issue. Of these 32 were enquiries which were handled by the Patient Experience team, and 9 were complaints which at the request of the complainant, were passed to NHS England to investigate. Over the year, the Patient Experience team handled 260 contacts about a primary care issue and 85 complaints were passed to NHS England to investigate. A common source of enquiry throughout the year has been about the availability of appointments and problems experienced in not being able to obtain an appointment; this has not been specific to one particular practice or area. In Quarter 1, the closure of 2 practices in the City locality led to an increased number of contacts about GP registration issues and requests for information about how to find and register with a new GP practice.

NHS England has advised that they received and handled 33 complaints in January and February2020, 6 of which were upheld. Data is not available from NHS England for March 2020 due to the Covid-19 pandemic. The table below demonstrates that over the whole year NHS England handled 180 complaints. 12 complaints were upheld.

Complaints handled by NHS England

Quarter 1 19/20

Quarter 2 19/20

Quarter 319/20

Quarter 419/20

YEARTOTAL

April May June July Aug Sept Oct Nov Dec Jan Feb Mar

CITY13 4 6 5 6 4 4 9 7 7 5 - 70

NNE2 3 5 3 4 2 0 4 4 1 6 - 34

NW3 4 1 1 5 0 1 1 2 1 2 - 21

RUSH1 1 1 0 1 0 1 0 0 0 1 - 6

M&A4 2 1 4 2 4 0 1 1 1 4 - 24

N&S2 3 1 1 5 4 0 3 1 3 2 - 25

TOTAL 57 51 39 33 180

The quality group reviewed the number of complaints per practice and identified that of the 100 practices that had received a complaint; the majority had only received 1 or 2. One practice had received 5, which when further investigated, were from the same complainant and were not upheld.

The Primary Care Patient Safety Incidents report provides a quarterly update on the patient safety incidents within primary care that have been reported to the CCG. The Primary Care Quality team review all patient safety incidents reported, which can be from a variety of sources (e.g. the practice itself, another provider, a healthcare professional, eHealthscope or the National Reporting and Learning System). Incidents are categorised as either a serious incident (SI) (meeting the national serious incident criteria) or are deemed ‘not an SI’. They are then logged and support/feedback is provided to the practice to ensure appropriate investigation and subsequent sharing of lessons learned facilitated by the Primary Care Quality team. Specialist advice and guidance from CCG colleagues is


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sought as required, for example, where an issue regarding safeguarding or medicines management has been highlighted.

During Quarter 4, 39 patient safety incidents were received by the CCG relating to primary care. Of these, 25 were stage 3 or 4 pressure ulcer alerts, 9 were regarding medication and 5 miscellaneous. Over the year, there were 154 incidents reported, 104 pressure ulcer related, 29 regarding medication and 21 miscellaneous.

Of the 154 incidents reported, 5 were deemed to reach the SI threshold. Four of these were related to pressure ulcers where the practice felt it could have implemented actions to potentially prevent / reduce the risk of a pressure ulcer developing. The fifth was regarding infection control and adequate cleaning of the minor operations room within the practice. The investigation identified no harm serious harm to patients and the practice implemented appropriate actions to prevent a similar incident in the future. The Primary Care Quality group did not identify any specific concerns in relation to a group of practices or an individual practice from review of the patient safety incident report. A ‘lessons learned’ communication will be developed and circulated to all practice colleagues.

3. Care Quality Commission (CQC)

The chart below provides a summary of the CQC’s overall rating of practices in Nottingham and Nottinghamshire as of 1 May 2020. 19 are rated ‘Outstanding’, 105 ‘Good’, 3 ‘Requires Improvement’, 2 ‘Inadequate’ and 1 ‘Not rated’. This is Bilborough Medical Centre (Nottingham City ICP), which although inspected in January 2020 was not given an overall rating as the CQC were unable to rate thepractice for providing effective and responsive services. This was because whilst improvements had been made by the new provider since the last inspection, there was no published data available as yetto support their findings.

CQC reports published since the Quarter 3 Primary Care Quality report includes the following:

Bakersfield Medical Centre, City locality: ‘Good’ overall, previously ‘Requires Improvement’.Clifton Medical Centre, City locality: ‘Good’ overall, previously ‘Good’.Meden Vale, Mid Notts locality: ‘Good’ overall, previously ‘Requires Improvement’ under

different provider.

Overall Rating (May 2020)

Outstanding

Good

Requires Improvement

Inadequate

Not Rated


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The table below identifies practices with either an overall CQC rating of ‘Inadequate’ or ‘Requires Improvement’ as of 1 May 2020, and actions being taken to support each practice.

Integrated Care Partnership

Practice Current Overall CQC Rating (Report Published)

Actions / Support In Place

Nottingham City

Queen’s Bower Surgery

Inadequate (11.02.2020)

Quality and contractual assurance meetings in progress and improvements being evidenced against an assurance matrix.

Nottingham City

Beechdale Surgery

Requires Improvement (07.08.19)

Quality and contractual assurance meetings are in progress and improvements being evidenced against an assurance matrix.Re-inspection in relation to a warning notice at RHR Medical Centre was undertaken in January 2020 and the CQC have identified that the requirements have been met.

Nottingham City

RHR Medical Centre

Requires Improvement(24.07.19)

Nottingham City

Greenfields Medical Practice

Requires Improvement(10.07.18)

Re-inspection anticipated post-merger, CCG’s quality team to undertake pre CQC support visit.

Mid Notts Hounsfield Surgery

Inadequate(10.10.19)

Quality and contractual assurance meetings are in progress and improvements being evidenced against an assurance matrix.Re-inspection in relation to 2 warning notices was undertaken in January 2020 and the CQC have identified that the requirements have been met.Full re-inspection was due to take place by mid-April 2020, however this has been postponed due to the Covid-19 pandemic.

For ‘Good’ and ‘Outstanding’ Practices the CQC stated they would continue to inspect at least every 5 years but in between are carrying out an Annual Regulatory Review (ARR) through a structured ARR telephone call. Inspectors are identifying 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 during the ARR call.

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 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.

In response to the Covid-19 pandemic, the CQC has paused their routine inspections and launched an Emergency Support Framework - the Primary Care Quality team developed a summary of this which can be found at Appendix 1 and has been shared with all practices. Throughout the pandemic, a fortnightly meeting has taken place with CQC colleagues and the Primary Care Quality team to share intelligence and identify where support for practices / clarification on any issues from practices may be required.


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4. Updates

St. Peter’s Surgery (Mid Nottinghamshire)

St. Peter’s Surgery continues to receive support from the CCG’s primary care quality and locality teams as the lead GP remains on sick leave. The practice is taking all appropriate steps to ensure a safe and effective service is in place for patients during this time.

Covid-19 Pandemic

The Primary Care Quality team have continued to support the E-Healthscope issues log where practice colleagues are able to post enquiries / issues / concerns about another provider. Recent posts have included concerns about 2 week wait and other referrals which the team have been able to action and respond back to on the practices’ behalf.

Members of the Primary Care Quality team have supported the CCG’s Primary Care Incident Cell participating in the duty rota and responding to practice queries.

During the pandemic each practice has been submitting a daily status report to the CCG. This Opel reporting has been reviewed by the Primary Care Quality team and links maintained with Primary Care and Locality team colleagues in order to identify any potential quality concerns and to observe for correlation with any other sources of intelligence and information.

The CCG’s Quality team members have played a pivotal role in supporting the establishment of Clinical Management Centres across Nottingham and Nottinghamshire. This has included provision of infection, prevention and control expertise and review of Equality and Quality Impact Assessments to ensure any potential adverse impacts on patients and people from protected characteristic groups are identified and mitigated.


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Appendix 1


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CQC Emergency Support Framework May 2020

Using and sharing information

Having open and honest conversations

Gathering and recording information

Taking action to keep people safe

Sharing

Information will be collected and monitored through the usual sources.

Efforts to encourage feedback from the public and care staff will be increased.

New information sources will be introduced where required, such as the CQC’s daily tracker for care at home services.

Key trends and issues will be shared with local and national partners to help them mitigate and manage risks, and to mobilise additional support where it’s needed most.

Conversations will aim to understand and explore:The current stresses and challenges & how services are using innovative ways to manage.

Prioritising of services to call will be done using existing and new information.

If low risk level, there may not be a call, but the local inspector will be available to offer support and services are encouraged to call them for advice.

If higher risk level there will be more contact as CQC will continue to monitor and engage until the emergency period is over.

The calls will focus on:Safe care and treatmentStaffing arrangementsProtection from abuseAssurance processes, monitoring, and risk management.

Calls should not take more than an hour. Inspectors will contact services first to arrange a convenient date and time.

Notes of the discussion around the four key areas and the challenges for the service, and the wider local care system will be taken.

Examples of good practice and innovations will be noted and shared.

In exceptional cases evidence about specific risks and issues may be required.

A summary of the conversation will be emailed to the service. It will:

List the questions and appropriate standard wording that reflects the service’s answerSummarise the specific internal and external risks and challenges discussedIdentify any sources of support that CQC suggestedSummarise whether the service is ‘managing’ or ‘needs support’Detail any innovative ways that have been developed to manage the situation.

This process is not an inspection, the summary record is not an inspection report, and there is no rating as a result. As such, usual steps such as the factual accuracy process do not apply.CQC will not publish the call recordon their website.

The information gathered during a call will help CQC form a view about how a service is coping during the pandemic. They will add this to their records to support regulatory planning during and beyond the pandemic.

Services will be assessed as either:Managing, orNeeds support.

If CQC receive information, either from an external source or through the call, that results in serious concerns they will decide to either:Provide additional sources of supportArrange a follow-up callUse inspection and enforcement processes

If there is a decision to inspect, CQC will follow existing approaches and processes. This means a focused inspection for primary medical services.

Where unsafe or poor care is found, CQC will use their powers or work with a system partner to take action to make sure that risks to people are reduced.

In exceptional circumstances, CQC can still use enforcement processes, and will follow them when needed. They will carefully assess whether they need to take any regulatory action at this particularly difficult time. Panels will review any proposals to take enforcement action and the CQC’s Chief Inspectors will make final decisions.

CQC will not publish the summary record on their website.

However, if they decide to inspect a service, they will publish an inspection report.

To ensure transparency, at a national level, they will share information on decisions they’ve taken as part of this process.

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Prim

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Date: 20 May 2020

Paper Title: Risk Report Paper Reference:

PCC 20 084

Sponsor: N/A Attachments/ Appendices:

Risk Report

Risk Register (Extract) - Appendix A

Presenter: Siân Gascoigne, Head of Corporate Assurance

Summary Purpose:

Approve ☐ Endorse ☐ Review ☐ Receive/Note for:


☒

Executive Summary

The purpose of this paper is to present the Primary Care Commissioning Committee with risks relating to the Committee’s responsibilities. The paper provides assurance that primary care risks are being systematically captured across the Nottingham and Nottinghamshire CCG and sufficient mitigating actions are in place and being actively progressed.



☐

Financial Management ☐ Cultural and/or Organisational Development ☐











Yes ☐ No ☐ N/A☒ None required for this paper.

Risk(s):

Report contains all risks from the CCG’s Corporate Risk Register which fall under the remit of the Primary Commissioning Committee.

Risk Report

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

☒No


☐The document contains Personal information

☐The CCG is in commercial negotiations or about to enter into a procurement exercise

☐The document includes commercial in confidence information about a third party

☐The document contains information which has been provided to the CCG in confidence by a third party

☐The discussion relates to policy development not yet formalised by the organisation

☐The document has been produced by another public body

☐The document is in draft form

Recommendation(s):

1. COMMENT on the risks shown within the paper (including the high/red risk) and those at Appendix A; and

2. HIGHLIGHT any risks identified during the course of the meeting for inclusion within the Corporate Risk Register.

Risk Report

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Primary Care Commissioning Committee

Monthly Risk Report

1. Introduction

The purpose of this paper is to present the Primary Care Commissioning Committee with risks relating

to the Committee’s responsibilities. It provides assurance that primary care risks are being

systematically captured across the Nottingham and Nottinghamshire CCG and sufficient mitigating

actions are in place and being actively progressed.

2. Risk Profile

There are currently four risks relating to the

Committee’s responsibilities (as detailed in

Appendix A).

Since the last meeting, risks have been

reviewed by the Head of Corporate

Assurance and Associate Director of Primary

Care.

The table to the right shows the current risk

profile of the four risks. There is one high /

red risk in the Committee’s remit as outlined

below.

Risk

Reference Risk Narrative

Current Risk

Score

RR 032

Reducing workforce capacity within General Practice may impact the

sustainability of some GP Practices. In responding to these

challenges, Practices should consider adapting their workforce

models to enable the sustained delivery of core services, whilst also

ensuring sufficient capacity to deliver/contribute to system and

transformation requirements.

Lack of pace of change may present a risk that the CCG's population

access needs are not met, adversely impacting patient experience

and/or outcomes.

Mitigating action(s): Focus on GP workforce capacity is currently

centred around the Covid-19 emergency response. However, it is

recognised that there continues to be a significant risk around the

longer-term capacity within primary care and the need to attract and

retain GPs and senior clinician leaders.

This is being managed via the ICS Primary Care Workforce Strategy,

alongside work undertaken as part of established

schemes/programmes (e.g. GP Retention Scheme, GP 10 Point

Plan, Phoenix Programme pharmacy and nursing recruitment

programmes, etc.)

Overall Score

16: Red

(I4 x L4)

Risk Matrix

Imp

act

5 - Very High

4 – High 1 1 1

3 – Medium 1

2 – Low

1- Very low

1

- R

are

2 -

unlik

ely

3 -

Po

ssib

le

4 -

Lik

ely

5 -

Alm

ost

Cert

ain

Likelihood

Risk Report

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3. Risk Identification

A new risk has been identified in relation to the impact of Covid-19 on primary care workforce.

Risk

Reference Risk Narrative

Current Risk

Score

RR 126

Covid-19 may adversely impact the ability for members of the

CCG's population to access primary care.

This may be due to GP workforce having to 'shield' or self-isolate,

lack of PPE to ensure safe working, or challenges with GP

Practice estate not meeting social distancing requirements.

This risk may be more significant to those areas where single

handed practices exist.

Overall Score 12:

Amber/Red

(I4 x L3)

4. Archiving of Risks

There are no risks being proposed for archiving since the last meeting.

5. Amendments to Risk Score/Narrative

There have been no amendments to risk score or risk narrative since the last meeting.

6. Recommendations

The Committee is 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.

Siân Gascoigne

Head of Corporate Assurance

May 2020

Risk Report

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Risk Ref Oversight Committee Directorate Date Risk

Identified Risk Description Risk Category Existing Controls Mitigating Actions Mitigating Actions Progress Update:

Last Review

DateTrend

(Relevant committee in

the CCG's governance

structure responsible for

monitoring risks relating

to their delegated duties)

(as per April 2020

CCG structure)

(Date risk

originally

identified)

(These are operational risks, which 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).

(Movement

in risk score

since

previous

month)

RR023 Primary Care

Commissioning

Committee

Commissioning 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

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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.

Action: To escalate larger GP practice debts to NHSE/I for further national support.

3 3 9 May 2020: CCG primary care staff, in conjunction with finance colleagues, are supporting GP Practices in identifying solutions

to their premises cost issues, with areas of most concern (e.g. largest debt) being prioritised. Those specific Practices with

significant debts are being revisited with support from the national team.

Clear advice has been given by the CCG (and LMC) to Practices to pay reimbursable costs and pay costs not in dispute.

13/05/2020 ↔

RR032 Primary Care

Commissioning

Committee

Commissioning Jul-19 Reducing workforce capacity within General Practice may impact the sustainability of some GP

Practices. In responding to these challenges, Practices should consider adapting their workforce

models to enable the sustained delivery of core services, whilst also ensuring sufficient capacity to

deliver/contribute to system and transformation requirements.

Lack of pace of change (e.g. adaption of workforce models) may present a risk that the CCGs'

population access needs are not met, adversely impacting patient experience and/or outcomes.

Commissioning

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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.

• Establishment of Primary Care Cell , as part of CCG's Covid-19 incident

response

• ICS Primary Care Workforce Strategy; ICS Primary Care Board

• Establishment of Primary Care Networks (PCNs) (and/or other

collaboration/federation activities)

• 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.

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 May 2020: Focus on GP workforce capacity is currently centered around the Covid-19 emergency response (see risk RR 126).

However, it is recognised that there continues to be a significant risk around the longer-term capacity within primary care

and the need to attract and retain GPs and senior clinician leaders.

The ICS Primary Care Workforce Strategy continues to be in place; updates in relation to the delivery of this work have been

requested from relevant CCG colleagues. The delivery of this Strategy is recognised as not being a short-term 'fix' for current

workforce challenges. Other mechanisms are in place to support the management of this risk; such as GP Retention Scheme,

GP 10 Point Plan, Phoenix Programme (with LMC), pharmacy and nursing recruitment programmes, wider training and

development activities/placements (via Nottinghamshire Alliance Training Hub), work with the LMC and PCNs. Work

undertaken by the Primary Care Contracting Team around the GP Forward View also contributes to the management of this

risk (e.g. 'roving' Practice Managers, Clinical Receptionist training, etc.)

14/05/2020 ↔

RR104 Primary Care

Commissioning

Committee

Commissioning 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.

Quality

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sa W

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ingh

am

Dan

ni B

urn

ett

4 3 12 • Quality Intelligence reporting (to the Primary Care and Quality and

Performance Committees)

• Primary Care Quality Sub-Groups

• Enhanced surveillance processes

• Primary Care Network (PCN) collaborative arrangements / business

continuity arrangements.

Action: To embed quality intelligence reporting within the committee structure. 4 2 8 May 2020: A Quality & Safety Intelligence Highlight Report was presented to the weekly NEDs assurance meeting on the 29

April. This highlighted that four GP practices across Nottinghamshire are subject to enhanced surveillance. Assurance was

provided that all four are engaging with the CCG and actions are being taken in response to CQC inspections and/or

complaints.

Work to be undertaken in relation to the risk narrative to ensure it is reflective of specific GP practices where quality

concerns exist.

04/05/2020 ↔

RR126 Primary Care

Commissioning

Committee

Commissioning May-20 Covid-19 may adversely impact the ability for members of the CCG's population to access primary

care.

This may be due to GP workforce having to 'shield' or self-isolate, lack of PPE to ensure safe

working, or challenges with GP Practice estate not meeting social distancing requirements.

This risk may be more significant to those areas where single handed practices exist.

Workforce

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4 4 16 • Primary Care 'Cell' within the CCG's emergency response infrastructure

• Roll-out of IT infrastructure/technology to support virtual working (e.g.

telephone appointments, etc.)

• Routine OPEL reporting and escalation processes

• Establishment of CMCs and ability to step up/step down if needed

• PCN 'buddying' processes in place

Action: To continue with incident response structures as described. 4 3 12 May 2020: GP workforce capacity is being monitored daily via the Primary Care Cell (which has been established as part of

the incident response structure).

A daily Primary Care OPEL report has been established to monitor primary care workforce and service pressure. In addition,

each Primary Care Network (PCN) has identified a business continuity plan to respond to workforce pressures. Joint working

through local 'hub' arrangements are also taking place / being developed as part of the Covid-19 response. This will build

more capacity and resilience to delivering core General Practice services.

14/05/2020 New

Current Risk RatingInitial Risk Rating

NHS Nottingham and Nottinghamshire CCG Corporate Risk Register (May 2020)

Exe

cuti

ve L

ead

Ris

k O

wn

er

Risk R

eport

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Meeting Title: Primary Care Commissioning Committees (Open Session)

Date: 20 May 2020

Paper Title: Briefing Paper - Primary Care Networks &

Clinical Director Changes (South locality) Paper Reference: PCC 20 085

Summary Purpose:

Approve ☐ Endorse ☐ Review


Assurance

Information

☒

Executive Summary

Primary Care Networks were established across Nottingham and Nottinghamshire on 1st July 2019, and each network was required to appoint a Clinical Director as its named accountable leader, responsible for delivery.

The purpose of the paper is to update the Committee of changes to the Clinical Director positions for Nottingham West and Rushcliffe Primary Care Networks.

Key points

There are twenty registered Primary Care Networks across Nottingham and Nottinghamshire

South Nottinghamshire locality has six Primary Care Networks which cover a total registered

population of 378,0951

Nottingham West and Rushcliffe are single Primary Care Networks covering their entire CCG areas,

but incorporating a neighbourhood approach

Nottingham West’s Clinical Director Nicole Atkinson has taken up the role of ICS Clinical Lead and

South Notts ICP Lead.

Rushcliffe has adopted a clinical executive with a named Clinical Director approach to leadership for

their network, resulting in six GP leads including a named Clinical Director for the purposes of the

network agreement and registration of the network.

Dr Stephen Shortt is currently the named Clinical Director for Rushcliffe, but this will need to be

amended, due to Dr Shortt taking on the role of CCG Clinical Chair from 1st April 2020.

Nottingham North and East has four Primary Care Networks, with one named Clinical Director per

network


Compliance with Statutory Duties ☐ Establishment of a Strategic Commissioner ☐

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

☒

1 As at 1

st January 2020

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Performance Management ☐ Cultural and/or Organisational Development

☐

Strategic Planning ☐ Procurement and/or Contract Management ☐




Yes ☐ No ☐ N/A ☒ Not required for this item.


Yes ☐ No ☐ N/A ☒ Not required for this item.

Risk(s):

No risks identified

Confidentiality:

☒No

Recommendation(s):

1. NOTE the information provided within the paper.

Primary Care Networks – Clinical Director Changes (South Nottinghamshire)

Background

Primary Care Networks (PCNs) were introduced across England as part of the NHS Long Term Plan,

published in January 2019. The 2019 General Practitioner contract gave the opportunity for GP practices

to join networks, each with between 30,000 and 50,000 patients. The aim is to create fully integrated

community-based health services.

1,259 primary care networks have been established across England, covering an average population

size of 139,469 each. To be eligible for the Network Contract Directed Enhanced Service (DES), a

Primary Care Network had to provide six factual pieces of information, including a named accountable

Clinical Director.

During the establishment phase in 2019, a central process for appointing Clinical Directors was

facilitated by the CCG, in conjunction with Nottinghamshire Local Medical Committee.

Once established, PCNs could agree the process for appointing new Clinical Directors, but are required

need to include the method of appointment in the PCN agreement Schedule One.

Clinical Director Changes

Nottingham West

Dr Nicole Atkinson resigned as Clinical Director end December 2019, in order to take up her new role as

Clinical Lead for the Integrated Care System (ICS), and for South Notts Integrated Care Partnership

(ICP).

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Following an expression of interest and interview process, Dr Tim Heywood from Chilwell Valley and

Meadows practice was successful and will take up the post of Clinical Director from 1st March 2020.

Rushcliffe

Rushcliffe agreed to create a Clinical Executive team of six GPs, with one of those six, Dr Stephen

Shortt, as the named Clinical Director for PCN registration and Network Agreement purposes.

The six GPs are as follows:

Dr Nigel Cartwright, Orchard Surgery, Kegworth

Dr Matt Jelpke, St Georges Medical Practice, West Bridgford

Dr Lynn Ovenden, Castle Healthcare Practice, West Bridgford

Dr Gurvinder Sahota, Keyworth Medical Practice, Keyworth

Dr Stephen Shortt, East Leake Medical Group, East Leake, Ruddington and Sutton Bonington

Dr Richard Stratton, Belvoir Health Group, Bingham, Cotgrave and Cropwell Bishop

As a result of Dr Shortt and Dr Stratton taking up roles within Nottingham and Nottinghamshire Clinical

Commissioning Group from 1st April 2020, there will be the following changes.

Dr Stephen Shortt will remain as one of the six Clinical Executives, but will be removed as the

named Clinical Director from 1st April 2020. Dr Sahota will replace Dr Shortt as the named

Clinical Director for the purposes of the PCN agreement and registration.

Dr Richard Stratton will be taking up a Governing Body role on 1st April 2020, and will be replaced

by Dr Pete Mahony (Belvoir Health Group) following an expression of interest and interview

process.

Communication

The changes have been communicated to the CCG’s Head of Primary Care, and the Primary Care lead

at NHS England and Improvement at Birch House, using a locality developed template.

Recommendation

The Primary Care Commissioning Committee is asked to NOTE the information provided within the

paper.

Jacki Moss

Senior Service Transformation Manager, South Nottinghamshire

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