primary care commissioning committee (part i) · molcv medicines of limited clinical value mou...
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PRIMARY CARE COMMISSIONING COMMITTEE (Part I) 2.30pm-3.10pm Wednesday 27th March 2019 Committee Rooms , 4th Floor, Unex Tower, 5 Station Street, London E15 1DA
Statement of advice on declaring interests at NCCG meetings
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or as soon as it becomes apparent be that before or at the meeting. If during the course of a meeting an interest not previously declared is identified, this must be declared at that time.
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Direct Financial Interest • If you have a direct financial interest in any matter on the agenda you must not participate in any
discussion or vote on that matter. If you do so you may be committing a criminal offence, as well as a Breach of the Conflict of Interest Policy and the CCG Code of Conduct. The individual should leave the meeting (including any public seating area) during consideration of the matter.
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Interest. Any Member who does not declare these interests in any matter when they apply may be in breach of the Policy and Code of Conduct.
Other Interest • You are required to declare an interest where a decision in relation to the business of the meeting
might reasonably be regarded as affecting your well-being or financial standing, or a member of your family, or a person with whom you have a close association with to a greater extent than it would affect the majority of the GPs or other Board Members.
If in doubt you should assume that a potential conflict of interest exists.
Action upon declaration of an interest at a meeting • For direct financial interests you must leave the meeting for that item• For indirect financial interests and for other interests the action required will vary dependent upon
the interpretation of the extent and influence of the interest and may involve;o leaving the meeting,o remaining at the meeting and not voting or speaking,o remaining at the meeting and both speaking and voting
Chairs ruling • For the avoidance of doubt the Chairs decision on a declaration of interest
and its management is final
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ACRONYM MEANING
A&E Accident & Emergency
ACS Accountable Care System
APMS Alternative Provider Medical Services (a type of Primary care contract)
AQP Any qualified provider
BAF Board Assurance Framework
Bart's / BHT Barts Health NHS Trust
BAU Business as usual
BCP Business continuity plan
BHRUT Barking, Havering and Redbridge University Hospitals NHS Trust
BMA British Medical Association
CAS Clinical Assessment Service
CCG Clinical Commissioning Group
CCG IAF Clinical Commissioning Group Improvement and Assessment Framework
CCU Critical Care Unit
CEG Clinical Effectiveness group
CEPN Community Education Provider Network
CHN Community Health Newham Directorate
CHP Community Health Partners
CHS Community Health Systems
CIL Construction Industry Levy
CPD Continuing Professional Development
CQC Care Quality Commission
CQRM Clinical Quality Review Meeting
CQUINs Commissioning for Quality and Innovation (Payment Framework)
CSU Commissioning Support Unit
CYP Children and Young People
DASL Drug and Alcohol Service in London
DES Direct Enhanced Service
DoH/ DH Department of Health
DoPM Department of Psychological Medicine
DRSS Diabetes Retinopathy Screening Service
DToC Delayed Transfers of Care
ED Emergency Department
ELFT East London Foundation Trust
ELHCP East London Health and Care Partnership
EMIS web Egton Medical Information Systems (System that records patient consults)
EPCS Extended Primary Care Service
EPCT Extended Primary Care Team
EPR Electronic Patient Record
ETTF Estates and Technology Transformation Fund
FOI Freedom of Information
GB Governing Body
GIA Gross internal area
GLA Greater London Authority
GMC General Medical Council
GMS General Medical Services (a type of Primary care contract)
GP General Practitioner
HBPoS Health Based Places of Safety
HEE Health Education England
HLP Healthy London Partnership
HMT Her Majesty's Treasury
HoT Heads of Terms (Contract Summary)
HUH The Homerton University Hospital NHS Foundation Trust
IAPT Increasing Access to Psychological Therapy
ICC Integrated Care Committee
ICP Integrated care partnership
ICS Integrated Care System
IG Information Governance
IMCA Independent Mental Capacity Advocate
IMT Information Management and Technology
INEL Inner North East London
IPS Individual placement and support schemes
ITT Invitation to Tender
ITU Intensive Therapy Unit
IUC Integrated urgent care
JCC Joint Commissioning Committee
JSNA Joint Strategic Needs Assessment
KGH King George Hospital
KPI Key Performance Indicator
LAP Local Area Partnership
LAS London Ambulance Service
LAs Local Authorities
LBN London Borough of Newham
LBWF London Borough of Waltham Forest
LCFS Local Counter Fraud Specialist
LD Learning Disability
LD SAF Learning Disability Self-Assessment Framework
LEB London Estates Board
LEDU London Estates Development Unit
LES Local enhanced service
LMC Local Medical Committee
MHCC Mental Health Commissioning Committee
MM Medicines management
MoLCV Medicines of limited clinical value
MOU Memorandum of understanding
MPIG Minimum Practice Income Guarantee
MSK Musculoskeletal
NAFO Newham Alternative Funding Option
NCCG Newham Clinical Commissioning Group
NDPP National diabetes prevention programme
NEL North East London
NELCA North East London Commissioning Alliance
NELCSU North East London Commissioning Support Unit
NELFT North East London Foundation Trust
NHC Newham Health Collaborative
NHS PS NHS Property Services
NHSE NHS England
NHSI NHS Improvement
NICE National Institute of Health and Care Excellence
NUH Newham University Hospital
NWP Newham Wellbeing Partnership
OOH Out of hours
OPD Outpatient department
OPE One Public Estate
PALS Patient Advice and Liaison Service
PCCC Primary Care Commissioning Committee
PCH Primary Care Home
PCT Primary Care Trusts
PHE Public Health England
PMS Personal Medical Services (a type of Primary care contract)
PPE Patient and Public Engagement
PPG Patient and Public Group
PREM Patient Reported Experience Measure
PROM Patient Reported Outcome Measures
QIPP Quality, Innovation, Productivity and Prevention
QOF Quality Outcome Framework (Assessor Validation Reports)
R&D Research & Development
RAG Red, Amber, Green
RICS Royal Institute of Chartered Surveyors
RLH Royal London Hospital
ROI Return on Investment
RTT Referral to treatment
SEP Strategic Estates Plan
SMI Severe mental illness
SPA Single Point of Access
SPR Service Program Review
STP Sustainability and Transformation Plan or Partnership
THCCG Tower Hamlets Clinical Commissioning Group
TOR Terms of reference
TSCL Transforming Services Changing Lives
TST Transforming Services Together
UCC Urgent Care Centre
UCLP UCLPartners/ University College London Partners
UCWG Urgent Care Working Group
UEC Urgent and Emergency Care
UTC Urgent Treatment Centre
WELC Waltham Forest, East London and City (Integrated Care Programme)
WFCCG Waltham Forest Clinical Commissioning Group
Whipps X / WX Whipps Cross Hospital
WTE Whole Time Equivalent
Primary Care Commissioning Committee Part I – 2.30pm – 3.10pm Wednesday 27th March 2019 Committee rooms, 4th Floor Unex Tower, 5 Station Street, London E15 1DA
Agenda
No Time Item Action Required
Page Presenter
1. Administration and updates
1.1
2.30pm
Welcome, introductions and apologies Chair
1.2 Declarations of interests Monitor Chair
1.3 Minutes of previous meetings: • 30 January 2019
Approve Page 7 Chair
1.4 Action log Monitor Page 11 Chair
1.5 In-housing of the Primary Care Commissioning Team
Information Page 12 A Goodlad
1.6 Proposal for Establishment of a North East London Primary Care Commissioning Committee in Common
Decision Page 15 A Goodlad
1.7 Five Year Framework for GP Contract Reform 2019-23
Information Page 21 J Mazarelo
2 Discussion Items
2.1 3.00pm Primary Care Strategy Gap Analysis Discussion Page 34 J Mazarelo
2.2 3.10pm PC Access Update Verbal J Mazarelo
2.3 3.15pm Primary Care Commissioning Committee Risk Register
Information To be tabled J Mazarelo
3. Any other business
3.1 3.25pm AOB
3.2 Next meeting: 29 May 2019 (business meeting) 2.30-3.30pm Committee rooms 4th Floor, Unex Tower, 5 Station Street, London E15 1DA
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Primary Care Commissioning Committee Part I meeting: 2.30-3.30pm Wednesday 30th January 2019 Committee rooms, 4th Floor, Unex Tower, 5 Station Street, E15 1DA
Minutes
Voting members present:
Andrea Lippett (Chair) Lay Member Remuneration, NCCG
Ingrid McKitty Assistant Finance Director, NCCG
Nadeem Faruq GP Board Member, NCCG
Fiona Smith Registered Nurse, NCCG
Non-voting members present:
Jenny Mazarelo Associate Director Primary Care, NCCG
Alison Goodlad Head of Primary Care Commissioning, NELCA
In Attendance:
Yusuf Olow (minutes) Interim Committee Officer, NCCG
Susan Masters Lead for Health and Adult Social Care, LBN
Lorna Hutchinson Assistant Heath of Primary Care, NELCA
Rehan Qureshi ELHCP
Dr Anil Shah GP, Lord Lister Health Centre
Apologies:
Selina Douglas Managing Director, NCCG
Leonardo Greco Healthwatch Newham
Fiona Hackland Head of Commissioning, Public Health – Adults, LBN
Livia Royle Director of Public Health, LBN
Satbinder Sanghera Director of Governance and Partnerships, NCCG
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No Item
1.1
1.2
Welcome, introduction, apologies for absence and declarations of interest
No conflicts of interest noted.
1.3 Minutes of last meeting
The Minutes of the last meeting held on 28th November 2018 were approved as an accurate record of the meeting.
1.4 Action log
The Chair noted that two of the actions had deadlines of March and May respectively, adding that she was standing down in March 2019. It was important to ensure that these actions are carried through and relayed to the successor Chair accurately. The Chair requested that YO and JM ensure that this is the case.
1.5 GMS Practice Change
L Hutchinson updated the Committee. Dr Driver and Partners is the official name of a GMS contract, however Dr Driver retired in June 2018 and the medical practice was proposing, following extensive patient consultation, that its name be changed to ‘The Forest Practice.’ L Hutchinson recommended that the Committee agree to a variation of the contract to reflect the new name.
The Committee approved the contract variation from Dr Driver and Partners to The Forest Practice.
2. Strategic items
2.1 North East London Primary Care Strategy
J Mazarelo and R Qureshi updated the Committee.
The Committee heard that the NHS Operational Planning and Contracting guidance, published on 10 January 2019, included a requirement on Sustainability and Transformation Plans (STP)/Integrated Care Systems (ICS) to have a primary care strategy by Autumn 2019 in response to the Long Term Plan, published on 7 January 2019. This strategy will need to set out how the STP/ICS will ensure the sustainability and transformation of primary care and general practice, as part of its overarching strategy to improve population health.
This strategy development work was already under development in North East London and a draft summary pertaining to the development of the North East London Primary Care strategy was presented for discussion, comment and feedback. The CCG’s Primary Care Strategy On A Page published in February 2017 was also considered by way of comparison.
F Smith noted that the Newham strategy was to get GP practices to a good basic standard of delivery which involved reducing the number of practices and improving the quality of remaining ones.
The Committee subscribed to the NEL primary care vision, however it was noted that the CCG was not, as yet, an equal partner in a co-operative relationship and it was hoped that the plan would enable this to occur.
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Questions were raised regarding the aim of making North East London a desirable place to live and work and retaining GPs, noting that GPs are not included in key worker housing schemes and that Brexit may reduce the number of GPs that can be recruited from the EU. The Chair suggested the Joint Commissioning Committee should consider the pay rates of GPs in regards to encouraging GP’s to live and work in the borough. Cllr Masters questioned the priority of GPs for key worker housing, noting that GP salaries were sufficient to purchase property in Newham and that it was important to ensure that other health and social care staff, such as nurses, who are paid less should be the focus of such key worker provisions.
F Smith suggested that the NEL Joint Committee may be an appropriate forum to consider a workforce model that would deliver standardisation of terms and conditions of service and salaries for practice staff that would address some of the challenges described and impact positively on recruitment and retention.
The Committee noted the NEL PCS summary and requested a gap analysis of the CCG’s PCS in relation to this for discussion at the next meeting.
Action: J Mazarelo to present a gap analysis of the CCG’s PCS in relation to the developing NEL PCS for the next meeting.
Action: J Mazarelo to liaise with the ELHCP & TST Workforce workstream with regard to a NEL workforce model that would deliver the proposed standardisation.
2.2 PC Access Update
J Mazarelo updated the Committee.
The matter was discussed in November 2018 and a number of actions were agreed, however not all of them had been completed.
J Mazarelo reported that she had taken the deep dive to the Newham LMC meeting in December for discussion. There had been a consensus on variability and confusion on contract requirements resulting in NHSE requirements being interpreted differently across the country.
One of the LMC GP members had advised against decommissioning the Group Extended Hours Service, as it was felt to be valuable for patients, however the variation in service delivery made for a compelling reason to review service delivery.
The Committee noted the update.
2.3 Primary Care Commissioning Committee Risk Register
J Mazarelo updated the Committee.
The Committee’s risk register had been amended to reflect the new Primary Care governance arrangements agreed by the Board in December as covering areas which would be the responsibility of the PCCC. FS requested that a summary be provided at the next meeting of which Committee each of the risks would be responsible for going forward and that the wording of each risk be reviewed and updated to include mitigation and a plan for reduction.
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The Committee discussed the risks going forward and the Chair noted that risk needed to linked to the broader strategy as well as specifics and requested the risks listed should include context, mitigation and a clear plan to reduce the risk rating.
Action: J Mazarelo to provide an updated risk register for review at the next meeting
2.4 Primary Care Finance & QIPP Report
I McKitty updated the Committee and highlighted the key parts of her report.
The CCG had an allocation of circa £52.5 million and an underspend £19k. The budget is forecasted to break even by the end of the fiscal year.
I McKitty also brought to the Committee’s attention that it was likely there would be an increase in leasing costs within Primary Care following finalisation of the national lease negotiations.
The Committee noted the update.
3. AOB
3.1 No other business
3.2 Next meeting: Wednesday 27th February 2019 (discussion meeting) 2.30-3.30pm Committee rooms 4th Floor, Unex Tower, 5 Station Street, London E15 1DA
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Action reference Meeting date Action Owner Deadline Update
PCCC94 29/11/2017Review of Roma Community access to Primary CareThe proposal for roll out of this training across Newham GP practices to be discussed by the Committee early 2018.
S Sanghera May-19An update/review of findings on the general access issues and bespoke barrier issues for each Seldom Heard Groups to be presented
PCCC108 10/09/2018 Revised AQP Minor Surgery specifcation to be reviewed by PCCC to ensure no Directed Enhanced Service omissions. L Sibbons Mar-19
Minor Surgery DES 2019/20 requirements to be published by 31/03/19. Proposal for Community Minor Surgery Service specification delayed due to impact of complexity of service analysis. Item to be deferred to May 2019.
PCCC109 30/11/2018 PC Access Deep Dive - J Mazarelo to implement actions agreed at the meeting. J Mazarelo Mar-19 On agenda
PCCC111 31/10/2018Strategic Estates PlanStrategic Estates Plan approved by PCCC on 31.10.18 on an annual review cycle
A Lippett Nov-19 Not due
PCCC112 31/10/2018
Commissioning Intentions - New Transitional TeamJ Mazarelo to discuss the Newham Transitional Team cohort of patients with S Sanghera as part of the Roma Community/hard to reach groups as part of the CCG Strategy
J Mazarelo Apr-19 To be reviewed as part of APMS Tranche 7 procurement process
PCCC113 31/10/2018
Healthwatch 1. J Mazarelo to review which Committee/Group the Hearing Loop survey of accessibility would sit to take this forward2. J Mazarelo to discuss the access for hard to reach groups with SSanghera for November’s meeting
J Mazarelo Apr-19 Agreed that both items be considered by QPF going forward
PCCC114 30/01/2019NEL Primary Care StrategyTo present a gap analysis of the CCG’s PCS in relation to the developing NEL PCS for the next meeting
J Mazarelo Mar-19 On agenda
PCCC115 30/01/2019
NEL Primary Care StrategyTo liaise with the ELHCP & TST Workforce workstream with regard to a NEL workforce model that would deliver standardisation of T&Cs and salaries to support the recruitment and retention of primary care staff across NEL.
J Mazarelo Mar-19
The ELHCP Workforce Lead has confirmed that there is work underway to standardise apprentice and Physician's Associate T&Cs across NEL.
Diiscussions have commenced about this important area in the light of the GP contract changes for 2019-23 and it is anticipated that as Primary Care Networks mature that more robust MOUs and larger scale recruitment models are introduced to achieve this.
PCCC116 30/01/2019 Primary Care Risk RegisterJM to provide an updated risk register for review at the next meeting J Mazarelo Apr-19 Review and revision underway
item 1.4 - 27 March 2019 Primary Care Commissioning Committee - Action Log Part I
Highlighted items represent a recommendation to remove from register
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Primary Care Commissioning Committee Part I – 2.30-3.30pm Wednesday 27 March 2019The Committee Rooms, 4th Floor, Unex Tower, 5 Station Street, London E15 1DA
Title In-housing of the Primary Care Commissioning Team
Agenda item 1.5
Author Alison Goodlad, Head of Primary Care Commissioning, NELCA
Presented by Alison Goodlad, Head of Primary Care Commissioning, NELCA
Contact for further information
Alison Goodlad, Head of Primary Care Commissioning, NELCA [email protected]
This paper is for ☐ Decision ☐ Monitor ☐ Discussion ☒ For Information
Action required To note for Information
Executive summary
In May 2017, the NHS England (NHSE) Primary Care Commissioning Team serving North East London (NEL) were embedded within North East London Commissioning Alliance (NELCA), and for all intents and purposes have been working as part of the CCGs since then, rather than NHSE. As from 1 April 2019, the team will formally TUPE across into the Strategic Transformation Partnership.
Supporting papers Letter to Andrea Lippett from Ceri Jacob Re: In-housing of Primary Care Commissioning Team
Next Steps/ Onward Reporting
As from 1 April 2019, the NEL Primary Care Commissioning Team will formally TUPE across into the STP
Where has the paper been already presented?
• No previous presentation to any previous meetings/forums
How does this fit with NHS Newham
To commission and develop GP services that are modern, accessible and fit for the future in caring for our residents
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CCG strategic Priorities?
We will ensure we plan, design, and commission accessible high quality services for our residents with our residents
We will improve access to, and, the quality of, Primary Care
Risk BAF.07.01 Failure to effectively deliver a primary care strategy that is adequately resourced to service Newham residents
Equality impact N/A
Stakeholder engagement
This is part of a communications plan for the staff transition to ensure that all relevant stakeholders are made aware.
Financial Implications
Full funding for the staff is being transferred to the STP by NHS England.
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Primary Care Commissioning Committee Part I – 2.30pm – 3.10pm Wednesday 27 March 2019 Committee rooms, 4th Floor Unex Tower, 5 Station Street, London E15 1DA
Title Proposal for Establishment of a North East London Primary Care
Commissioning Committee in Common
Agenda item 1.6
Author Alison Goodlad, Head of Primary Care Commissioning, NELCA
Presented by Alison Goodlad, Head of Primary Care Commissioning, NELCA
Contact for further information
Alison Goodlad, Head of Primary Care Commissioning, NELCA
This paper is for ☐ Decision ☐ Monitor ☒ Discussion ☐ For Information
Action required
The Primary Care Commissioning Committee is asked to approve the proposal set out in this report.
Executive summary
The East London Health and Care Partnership (ELHCP) reviewed and updated its primary care strategy in 2018. As part of this review, five workstreams were identified, one of which was tasked with reviewing how the Primary Care Commissioning Committees work in each of the North East London Commissioning Alliance (NELCA) CCGs in the discharge of the delegated primary care commissioning function. To support this workstream a task and finish group was established consisting of:
• 5 PCCC Lay Chairs • ELHCP Primary Care SRO • NELCA Head of Primary Care Commissioning
The following report sets out for discussion a proposed approach to achieving the potential benefits of working at a NELCA level in respect of Primary Care Commissioning whilst retaining local sovereignty and control of a delegated function. It is proposed that once a quarter the seven NELCA PCCCs meet in common to:
• Take any decisions that will be common to all seven Committees for example the procurement of the Special Allocation Service
• Discuss any live issues which will be common to each CCG area, but which will need to be enacted at the local level with the intention of achieving a common approach
• Share any learning points from the individual PCCC meetings.
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Supporting papers
None
Next Steps/ Onward Reporting
• Barking & Dagenham, City & Hackney, Havering, Redbridge, Tower Hamlets & Waltham Forest PCCC – March/April 2019
• Practice Council – April 2019 • Newham LMC – April 2019 • Newham CCG Board for approval – April 2019
Where has the paper been already presented?
• No previous presentation to any previous meetings/forums
How does this fit with NHS Newham CCG strategic Priorities?
Strategic Priorities: • To commission and develop GP services that are modern, accessible and fit
for the future in caring for our residents Enabling Priorities:
• Securing financial stability • Making sure our governance is fit for purpose • Ensuring we maintain our performance across the key business areas
Outcomes:
• We will spend the Newham pound wisely, ensuring value for money and maintaining financial balance
• We will improve access to, and, the quality of, Primary Care • We will clearly be able to demonstrate how we have improved outcomes for
our residents • We will support our entire CCG workforce to deliver what we need to for our
residents
How does this fit with NHS Newham Values and Behaviours
• We are transparent • We are ambitious and innovative
Risk
BAF.07.01 Failure to effectively deliver a primary care strategy that is adequately resourced to service Newham residents
Equality impact N/A
Stakeholder engagement
Two meetings with Lay Chairs of all seven NEL Primary Care Commissioning Committees
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Financial Implications
At present there are no substantial financial implications found in the report. Finance colleagues would seek to work with commissioners if these recommendations are approved to detail any impact on CCG budgets, in light of the tight financial landscape that the CCG is currently operating within.
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1. Background
1.1 1.2 1.3
The East London Health and Care Partnership (ELHCP) reviewed and updated its primary care strategy in 2018. As part of this review 5 workstreams were identified, one of which was tasked with reviewing how the Primary Care Commissioning Committees work in each of the North East London Commissioning Alliance (NELCA) CCGs in the discharge of the delegated primary care commissioning function. To support this workstream a task and finish group was established consisting of:
• 5 PCCC Lay Chairs • ELHCP Primary Care SRO • NEL Head of Primary Care Commissioning
The following report sets out for discussion a proposed approach to achieving the potential benefits of working at a NELCA level in respect of Primary Care Commissioning whilst retaining local sovereignty and control of a delegated function.
2. Review of Current Primary Care Commissioning Committee Meeting Structure
2.1 2.2 2.3 2.4 2.5 2.6
Each CCG in NEL has accepted delegated responsibility from NHS England for the commissioning of GP services. To enact this function all CCGs in NEL have established a Primary Care Commissioning Committee (PCCC) chaired by a Lay Governing Body member. The three CCGs in BHR have chosen to meet in common as this aligns with the federated approach the CCGs have taken to all aspects of their work. Each of the other CCGs, including Newham, maintains a separate PCCC. A review of the agendas of each of the committees was carried out. This found that overall, there were 25% of items for decision and 75% of items for discussion/noting.
• 42% of agenda items could potentially be consolidated across NEL • 46% of agenda items were specific to an individual CCG • 12% of agenda items could be taken to a different committee.
Overall, the majority of Individual CCG Specific Items are taken in the confidential part two section of the Committees. Part one of the meeting is held in public in all CCGs.
In addition to the agenda review noted above, the task and finish group discussed the relative merits and dis-merits of holding Committees separately or in common at a NELCA level. The key points identified through this discussion include:
• The 7 PCCCs could not meet as a joint committee as the function has already been delegated from NHS England to the CCGs. They could only meet in common
• Some committees include items on the agenda that are not strictly related to primary care commissioning, although all items are related to primary care ie. Transformation
• Maintaining decision making at the local level is very important to the CCGs • The NEL PCC Team frequently take the same paper to 5 different committee
meetings (noting that the 3 BHR CCGs already meet in common) to achieve sign off and this does not represent good use of time in a very small team
• There are varying levels of expertise and capacity in the local CCG teams
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• There is more the PCCCs could do to actively share learning and intelligence • It would not be helpful to take individual practice issues into a committee in common
as they would only be relevant to the particular CCG • Subsidiarity is important • Patient and public involvement should not be diluted through this process.
3 Proposed PCCC meeting structure
3.1 3.2 3.3
Taking account of the review and discussion noted above and taking account of the implications of the Long Term Plan and the need to implement Integrated Care Systems, the following is a proposed approach to achieving the benefits of working as part of the NELCA whilst retaining the benefits of local decision making and engagement. The purpose of the PCCCs at local and NELCA level is:
• to support the development of General Practice to enable it to play the role envisaged in the Long Term Plan and local integration plans. Primarily this will entail enacting transformation plans through the agreement of new contracts and incentive schemes
• to support work to improve the quality of core GP services and reduce variation in quality across NEL. This will be achieved primarily through the use of contract levers approved through the PCCCs.
It is proposed that once a quarter the 7 NELCA PCCCs meet in common to:
• Take any decisions that will be common to all 7 committees for example the procurement of the Special Allocation Service
• Discuss any live issues which will be common to each CCG area but which will need to be enacted at the local level with the intention of achieving a common approach
• Share any learning points from the individual PCCC meetings
4 Governance
4.1 4.2 4.3 4.4
As the meeting is held in common reporting lines to the individual CCG Governing Bodies remains unchanged. Notes of the quarterly Committee in Common will be routinely shared with the 5 individual PCCCs. As this will be a committee in common, all members of existing committees will automatically be a member of the committees in common and have the right to attend. However, recognising that existing PCCCs may wish to reduce the number of people at the committees in common the requirement is simply that each of the committees is quorate within the terms set out in their own TORs. It is suggested that two HealthWatch representatives, who are non-voting members, are identified for the Committees in Common meetings to ensure the patient voice is not weakened through this process. HealthWatches will be asked to identify their representatives. All other decision making will be held at the local PCCC level unless agreed by the 7 PCCCs. Local PCCCs will continue to meet monthly (or at the frequency they currently meet). Agendas will be set locally and will include as a minimum:
• Local contract performance issues • Local primary care incentive schemes specific to that CCG area
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4.5 4.6
• Any other local issues as determined by the local CCG As contract performance issues may need to be decided upon in the same month as the quarterly NEL PCC arrangements will be put in place for individual PCCCs to meet immediately before or after the NEL meeting if required, thereby reducing the need for additional meetings whilst still progressing business in a timely manner. PCCCs may also wish to consider electronic approval processes in line with any requirements set out in the CCG Constitution. The proposal above will not require changes to CCG constitutions as the committees will be meeting in common rather than delegating decision making. If this proposal is accepted it is proposed that quarterly committees in common would commence in June 2019.
5 Recommendation
5.1 The Primary Care Commissioning Committee is asked to:approve the proposal set out in this report.
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Primary Care Commissioning Committee Part I – 2.30-3.30pm Wednesday 27 March 2019 The Committee Rooms, 4th Floor, Unex Tower, 5 Station Street, London E15 1DA Title Five Year Framework for GP Contract Reform 2019-23
Agenda item 1.7
Author Jenny Mazarelo, Associate Director Primary Care, NHS Newham CCG
Presented by Jenny Mazarelo, Associate Director Primary Care, NHS Newham CCG
Contact for further information
Jenny Mazarelo, Associate Director Primary Care, NHS Newham CCG T: 020-3688-2156 / E: [email protected]
This paper is for ☐ Decision ☐ Monitor ☐ Discussion ☒ For Information
Action required
To note for Information
Executive summary
On 31 January 2019, NHS England published new GP Contract arrangements covering the next five years, various elements of which will be introduced throughout the five years with the most substantial changes commencing from April 2019.
The changes should provide much needed support and resources for general practice, expanding the workforce, reducing workload, increasing funding, retaining GP and partnership autonomy and ensuring GPs have a leadership role at the centre of primary care.
Supporting papers
Appendix 1: Summary of Five Year Framework for GP Contract Reform Changes
Next Steps/ Onward Reporting
An update on the progress of changes relevant to this Committee’s remit will be provided at future meetings as required.
Where has the paper been already presented?
• GP Transformation Sub-Group – 21 February 2019
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How does this fit with NHS Newham CCG strategic Priorities?
To commission and develop GP services that are modern, accessible and fit for the future in caring for our residents
We will ensure we plan, design, and commission accessible high quality services for our residents with our residents We will improve access to, and, the quality of, Primary Care
Risk
BAF.07.01 Failure to effectively deliver a primary care strategy that is adequately resourced to service Newham residents
Equality impact N/A
Stakeholder engagement
Newham LMC – 26 February 2019 Evening Cluster meeting – 6 March and 4 April 2019 Practice Council – 22 February and 22 March 2019
Financial Implications
Newham CCG faces a significant financial challenge in 2019/20 and is undertaking a range of measures to ensure sustainability including the 2019/20 QIPP program. This report presents issues that may have financial consequences. These are yet to be fully determined but if not already embedded in budgets or reserve provision, a further Board decision would be required to release any additional expenditure commitment.
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FIVE YEAR FRAMEWORK FOR GP CONTRACT REFORM 2019-2023
FOR IMPLEMENTING THE NHS LONG TERM PLAN
PRIMARY CARE COMMISSIONING COMMITTEE
27 MARCH 2019
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COMPONENTS:1. SEEKS TO ADDRESS WORKLOAD ISSUES RESULTING FROM WORKFORCE
SHORTFALL2. BRINGS A PERMANENT SOLUTION TO INDEMNITY COSTS AND COVERAGE3. IMPROVES THE QUALITY AND OUTCOME FRAMEWORK (QOF)4. INTRODUCES AUTOMATIC ENTITLEMENT TO A NEW PRIMARY CARE NETWORK
(PCN) CONTRACT5. HELPS JOIN UP URGENT CARE SERVICES6. ENABLES PRACTICES AND PATIENTS TO BENEFIT FROM DIGITAL
TECHNOLOGIES7. DELIVERS NEW SERVICES TO ACHIEVE NHS LONG TERM PLAN COMMITMENTS8. PROVIDES FIVE-YEAR FUNDING CLARITY AND CERTAINTY FOR PRACTICES9. TESTS FUTURE CONTRACT CHANGES PRIOR TO INTRODUCTION
24
WORKFORCE• EXPANSION OF THE MULTI-DISCIPLINARY TEAM THROUGH RECURRENT REIMBURSEMENT FROM
1 JULY 2019 OF CLINICAL PHARMACISTS, SOCIAL PRESCRIBING LINK WORKERS, PHYSICIAN’S ASSOCIATES, FIRST CONTACT PHYSIOS AND FIRST CONTACT PARAMEDICS
• EXTENSION OF EXISTING PROGRAMMES:– INTERNATIONAL RECRUITMENT– RETAINED DOCTORS– GP RETENTION PROGRAMMES– PRACTICE RESILIENCE PROGRAMME– SPECIALIST MENTAL HEALTH SERVICES FOR GPs WHO NEED HELP– TIME FOR CARE NATIONAL DEVELOPMENT PROGRAMME
• INTRODUCTION OF A NEW PRIMARY CARE FELLOWSHIP (2 YEAR VOLUNTARY PROGRAMME) FOR NEWLY QUALIFIED NURSES AND DOCTORS ENTERING GENERAL PRACTICE
• ESTABLISH PC TRAINING HUBS FROM 2020/21• MAJOR EXPANSION IN COMMUNITY MENTAL HEALTH WORKFORCE AND INTEGRATION BETWEEN
PHYSICAL AND MENTAL HEALTH
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INDEMNITY• A STATE-BACKED NEW CLINICAL NEGLIGENCE SCHEME WILL START
FROM 1 APRIL 2019 FOR GENERAL PRACTICE STAFF (GP PRINCIPALS, SALARIED GPs, LOCUMS, PRISON GPs, NURSES, ALLIED HEALTH PROFESSIONALS AND ALL OTHER PROFESSIONAL GROUPS DELIVERING PRIMARY MEDICAL SERVICES
• INCLUDES OUT OF HOURS PROVISION• ALL NHS PROVIDERS DELIVERING PRIMARY MEDICAL SERVICES WILL
BE ELIGIBLE TO BECOME MEMBERS OF THE SCHEME• NO SUBSCRIPTION PAYABLE FROM 1 APRIL 2019 ONWARDS• PRACTICES AND STAFF WILL STILL NEED TO TAKE OUT SEPARATE
MEDICAL DEFENCE COVER FOR PROFESSIONAL PRACTICE, ADDITIONAL ADVISORY SERVICES AND PRIVATE WORK
26
QOF• FROM APRIL 2019, 28 INDICATORS WILL BE RETIRED (WORTH 175
POINTS OF THE 559 POINTS AVAILABLE IN 2018/19)– 101 POINTS WILL BE RECYCLED INTO 15 MORE CLINICALLY APPROPRIATE
INDICATORS• TWO NEW QUALITY IMPROVEMENT MODULES FOCUSSING ON
PRESCRIBING SAFETY AND END-OF-LIFE CARE• NO THRESHOLD INCREASES• VALUE OF QOF POINT INCREASES FROM £179.26 TO £187.74• CHANGES PLANNED IN 2020/21 FOR HEART FAILURE, ASTHMA AND
COPD INDICATORS• CHANGES PLANNED IN 2021/22 FOR MENTAL HEALTH INDICATORS
27
TECHNOLOGY• PRACTICES WILL BE EXPECTED TO MAKE 25% OF APPOINTMENTS BOOKABLE ONLINE FROM
JULY 2019 (ONLINE CONSULTATIONS WILL COUNT TOWARDS THIS TARGET)• ALL NEW PATIENTS SHOULD HAVE ACCESS TO THEIR DIGITAL RECORDS AND BE ABLE TO ORDER
REPEAT PRESCRIPTIONS ELECTRONICALLY FROM APRIL 2019• NHS111 WILL, AFTER TRIAGE, BEGIN BOOKING INTO PRACTICE APPOINTMENTS FROM APRIL 2019
(ONE APPOINTMENT PER 3,000 PATIENTS TO BE MADE AVAILABLE EACH DAY FOR THIS)• FROM APRIL 2020:
– ALL PRACTICES TO PROVIDE ONLINE CONSULTATIONS– ALL PATIENTS SHOULD HAVE ONLINE ACCESS TO THEIR FULL RECORD, INCLUDING CORRESPONDENCE
AND ADDING THEIR OWN INFORMATION– PRACTICES SHOULD NO LONGER USE FAX MACHINES FOR NHS WORK OR PATIENT CORRESPONDENCE
• PRACTICES WILL BE EXPECTED TO ENSURE THAT DATA RELATING TO ACTIVITY, CAPACITY AND WAITING TIMES IS ACCURATELY RECORDED, SO THAT IT CAN BE CAPTURED BY NHSE
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PRIMARY CARE NETWORKS
• PRIMARY CARE NETWORKS (PCNs) OF 30,000-50,000• PCNs SHOULD FORM A SINGLE COHERENT AREA,
WITHOUT ANY GAPS IN COVERAGE WITHIN THE NETWORKS OUTER BOUDARIES
• PCNs WILL COMPRISE MULTI-DISCIPLINARY TEAMS OF 100-200 HEALTH AND SOCIAL CARE STAFF AND BE LED BY A CLINICAL DIRECTOR
• PCN DIRECTED ENHANCED SERVICE (DES) TO COMMENCE ON 1 JULY 2019
• DES TO BE UNDERPINNED BY A NETWORK AGREEMENT• MORE GUIDANCE TO BE PUBLISHED ON 29 MARCH 2019
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PRIMARY CARE NETWORK DES 3 COMPONENTS National Network Service Specifications for:
Structured Medications Review and Medicines Optimisation (2020/21) Enhanced Health Care in Care Homes (2020/21) Anticipatory Care Personalised Care Supporting Early Cancer Diagnosis CVD prevention and diagnosis Inequalities
National Network Financial Entitlements with clear transparency requirements, including for sub-contracting arrangements Supplementary Network Services – local schemes funded by local resources, i.e.
EPCS, LIS, QIS, ?Some Newham Outcome Measures
In 2020, a Network Investment and Impact Fund will be introduced to cover five elements – avoidable A&E attendances, avoidable emergency admissions, timely hospital discharge, out-patient redesign and prescribing costs.
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TIMETABLE• February-April 2019 Practices meet to discuss forming PCNs and
begin to put together the Network registration requirements [Newham CCG/NHC/LMC/GP Practice Summit arranged for 6 March 2019]
• By 29 March 2019 NHS England and GPC England jointly issue the Network Agreement and 2019/20 Network DES Specification
• By 30 April 2019 Primary Care Networks submit registration information to their CCG
• By 31 May 2019 CCGs confirm network coverage• Early June, NHS England and GPC England jointly work with CCGs
and LMCs to resolve any issues• 1 July 2019 Network DES goes live
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GO LIVE – 1 JULY 20191 July 2019-31 March 2020 National entitlements under the 2019/20 Network Contract start:– Participation payment to practices of £1.761 per weighted patient
(monthly payment)– Year 1 of the additional workforce reimbursement scheme ~ 70% of
salary + on-costs for Clinical Pharmacists, Social Prescribing Link Workers; Year 2 Advanced Practice Physios and Physicians Associates; Year 3 Advanced Paramedic Practitioners
– Recurrent contribution towards funding for the Clinical Director (1 WTE for 50,000 patients)
– Recurrent £1.50/head for Network Administration (from CCG allocations)
– £1.45 per patient in 2019/20 for Extended Hours DES– £6 per patient in 2020/21 for GPFV Primary Care Seven Day Access
Service
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URGENT CARE SERVICES• ACCESS REVIEW TO START IN 2019 FOR FULL
IMPLEMENTATION BY 2021/22• PCNs JOINING UP THE DELIVERY OF URGENT CARE IN THE
COMMUNITY THROUGH:– EXTENDED HOURS ACCESS DES + SEVEN DAY ACCESS
FUNDING WILL FUND A SINGLE COMBINED ACCESS OFFER BY APRIL 2021
– DELIVERY OF CONVENIENT APPOINTMENTS IN HOURS, REDUCED DUPLICATION AND BETTER INTEGRATION BETWEEN 111, URGENT TREATMENT CENTRES AND GP PRACTICES
– PAYMENTS REFLECTING IMPACT ON A&E ATTENDANCES FROM 2020
33
Primary Care Commissioning Committee Part I – 2.30pm – 3.30pm Wednesday 27 March 2019 Committee rooms, 4th Floor Unex Tower, 5 Station Street, London E15 1DA Title Newham CCG Primary Care Strategy Gap Analysis
Agenda item 2.1
Author Jenny Mazarelo, Associate Director Primary Care, NHS Newham CCG
Presented by Jenny Mazarelo, Associate Director Primary Care, NHS Newham CCG
Contact for further information
Jenny Mazarelo Tel: 020-3688-2156 / E: [email protected]
This paper is for ☐ Decision ☐ Monitor ☒ Discussion ☐ For Information
Action required
The Committee is asked to discuss the contents of this report and make recommendations to the GP Transformation Sub-Group in respect of closing the identified gaps.
Executive summary
The NHS Operational Planning and Contracting Guidance was published on 10 January 2019 and included a requirement on Sustainability and Transformation Partnerships (STP)/Integrated Care Systems (ICS) to have a primary care strategy as part of the system strategy that will be developed in Autumn 2019 response to the Long Term Plan. This will need to set out how STP/ICS will ensure the sustainability and transformation of primary care and general practice as part of their overarching strategy to improve population health. This strategy development work was already under development in North East London and a draft summary was discussed at the last meeting. The Committee requested a gap analysis of the CCG’s Primary Care Strategy in comparison to the draft NEL version.
Supporting papers
Appendix 1 Gap Analysis
34
Next Steps/ Onward Reporting
This gap analysis, along with the updated NEL Primary Care Strategy will become the responsibility of the GP Transformation Sub-Group going forward
Where has the paper been already presented?
This report has not previously been presented at a meeting or Forum
How does this fit with NHS Newham CCG strategic Priorities?
• Strategic Priorities – To commission a Newham-based integrated health and care system
which delivers high quality services for the residents of Newham, in accordance with statutory requirements
– To commission and develop GP services that are modern, accessible and fit for the future in caring for our residents
• Enabling Priorities – Making sure our governance is fit for purpose – Valuing and enabling our staff, Board and Clinical Leaders to learn
and develop thereby enabling them to deliver against the CCG Priorities
– Ensuring we maintain our performance across the key business areas
• Outcomes – We will spend the Newham pound wisely, ensuring value for money
and maintaining financial balance – We will have a borough based Integrated Care System that is utilised,
understood and valued by our residents – We will ensure we plan, design, and commission accessible high
quality services for our residents with our residents – We will improve access to, and, the quality of, Primary Care – We will clearly be able to demonstrate how we have improved
outcomes for our residents – We will support our entire CCG workforce to deliver what we need to
for our residents
Risk
• BAF.07.01 Failure to effectively deliver a primary care strategy that is adequately resourced to service Newham residents
Equality impact This report relates to all Newham residents in the nine protected characteristics that
are covered by the Equality Act 2010 and our Equality Duties. An Equality Impact assessment will be completed as part of this initiative.
Stakeholder engagement
• East London Health & Care Partnership (ELHCP) Primary Care Transformation Board on 27th February 2019
• GP Transformation Sub-Group – February and April 2019 • LMC – February and April 2019
Financial Implications
There is no financial impact of this report.
35
15/01/2019
Gap Analysis of Newham CCG’s Primary Care Strategy
Primary Care Commissioning Committee
27 March 2019
36
Newham’s PC Strategy• Developed in 2013 Refreshed in
February 2017• Focus on “Developing primary care
services to meet demand now and into the future”
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Six Key Areas• Building resilient primary care services• Integrating local healthcare systems• Improving population health• Investing in primary care facilities• Developing a sustainable workforce• Using technology to improve patient care
38
Successes• Investing in primary care facilities
– Establishment of an Alternative Finance Organisation (LBN/ELFT/NHC) to deliver fit-for-purpose VFM facilities with affordable, keyworker housing
• Improving population health, e.g. Extended Primary Care Service programme: Pre-Diabetes, Diabetes, Latent TB
• Integrating local healthcare systems, e.g. East London Shared Care Record, establishment of ICS
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Good Progress Made• Developing a sustainable workforce, e.g.
General Practice Nurse programme, Clinical Pharmacists, Medical Assistants, GP Retention Intensive Support Site, Care Navigator training, Physician’s Associates trained
• Using technology to improve patient care, e.g. Online/video consultations, Point of Care/Diagnostic testing closer to home
40
Further Work Required• Building resilient primary care services:
– Variation in access and quality (currently ranked 191st of 197 CCGs for our CQC ratings)
– Unplanned practice closures– Poor succession/retirement planning– Role of the GP Federation, Newham Health
Collaborative– Role of Newham GP Co-Operative as provider of
scheduled and unscheduled care41