primary care committee agenda · carol varlaam (cv) lay member, patient and public involvement...
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W A N D S W O R T H C C G P A G E 1 O F 1
Board Intelligence Hub template
Primary Care Committee Agenda
Meeting of the Primary Care Committee
Thursday 23rd January 2020
15:00 – 17:00
Nightingale House
AGENDA – PART 1
P A R T A | M E E T I N G O P E N S T A R T D U R A T I O N
A01 Apologies, Declarations, Quorum Pg.2 CV 15:00
5 mins
A02 Chair’s Opening Remarks CV 15:00
A03 Minutes: Approval and Status of Actions Pg.6 CV 15:00
A04 Decisions ratified outside of the meeting since
the last meeting on 3rd September 2019 CV 15:00
P A R T B | D E C I S I O N S A N D D I S C U S S I O N S
B01 NHS Digital Update Pg.16 KB 15:05 30 mins
B02 PCN Development Update incl. additional roles
reimbursement update Pg.37 HP 15:35 10 mins
B03 Integrated Primary Care Commissioning Paper
incl finance Pg.53
KS, EG
and
NMD
15:45 15 mins
B04 PMS Specification Review Pg.69 TS 16:00 10 mins
B05 Governance of Primary Care across SWL Pg.80 KB/AMc 16:10 15 mins
B06 Any Other Business CV 16:25 5 mins
P A R T C | P A R T 1 M E E T I N G C L O S E
C01 Chair’s Closing Remarks CV 16:30 5 mins
C02 Close of Part 1 16:30
C03
Date of next meeting
Tuesday 3rd March 2020 at 09:30 am
Nightingale House
W A N D S W O R T H C C G P A G E 1 O F [ X ] W A N D S W O R T H C C G P A G E 1 O F [ X ]
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Register of Interests (updated November 2019)
All GPs have declared an interest in Primary Care Networks
Name
Current position (s) held in the CCG i.e.
Governing Body member; Committee
member; Member practice; CCG
employee or other
Do you
have any
interests to
declare?
(Y or N)
Declared Interest
(Name of the organisation and nature of business)
Fin
anci
al In
tere
st
No
n-F
inan
cial
pro
fess
ion
al
Inte
rest
No
n-F
inan
cial
Pe
rso
nal
Inte
rest
Ind
ire
ct
Inte
rest
Nature of Interest
From To
Action taken to mitigate
risk
James Blythe Managing Director
Governing Body Member
Member of Executive Management
Team
Member of Primary Care
Commissioning Committee
Member of Finance Committee in
Common
Member of Integrated Governance
Quality Committee
Y
1. Spouse is no longer an employee of St George's University Hospitals NHS
Foundation Trust and has a specialist training number with HEE South London
2. Spouse is an employee of Kingston Hospital from Oct 2019.
1
2
1. May 2017
2. Oct 2019
1. Oct 2019 I am not present at specific
discussions relating to the
relevant service.
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Name
Current position (s) held in the CCG i.e.
Governing Body member; Committee
member; Member practice; CCG
employee or other
Do you
have any
interests to
declare?
(Y or N)
Declared Interest
(Name of the organisation and nature of business)
Fin
anci
al In
tere
st
No
n-F
inan
cial
pro
fess
ion
al
Inte
rest
No
n-F
inan
cial
Pe
rso
nal
Inte
rest
Ind
ire
ct
Inte
rest
Nature of Interest
From To
Action taken to mitigate
risk
Neil McDowell Director of Finance for Merton and
Wandsworth CCGs
Member of Governing Body, Merton
and Wandsworth CCGs
Member of Finance Committee, Merton
and Wandsworth CCGs
Member of Audit & Governance
Committee, Merton and Wandsworth
CCGs
Member of Primary Care Commissioning
Committee, Merton and Wandsworth
CCGs
Member of Executive Management
Committee
Member of Integrated Governance and
Quality Committee
Y
1. Spouse is Chief Finance Officer for Surrey Heartlands CCGs. 1 Adherence to COI policy
Julie Hesketh Director of Quality and Corporate
Governance, LDU
Member of Governing Body Merton and
Wandsworth
Member of Executive Management
Committee
Member of Integrated Governance and
Quality Committee
Member of Audit and Governance
Committee Merton and Wandsowrth
Y
1. Personal involvement in Richmond Education Network (not for profit organisation).
This is done outside of CCG hours.
1 Adherence to COI policy
Katharine (Katie) Bugler Director of Primary Care Transformation
Member of MCCG Governing Body
Member of WCCG Board
Member of LDU Clinical Oversight Group
Member of Executive Management
Team
Member of Merton Primary Care
Committee
Member of Wandsworth Primary Care
Committee
N
No interests declared Adherence to COI policy
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Name
Current position (s) held in the CCG i.e.
Governing Body member; Committee
member; Member practice; CCG
employee or other
Do you
have any
interests to
declare?
(Y or N)
Declared Interest
(Name of the organisation and nature of business)
Fin
anci
al In
tere
st
No
n-F
inan
cial
pro
fess
ion
al
Inte
rest
No
n-F
inan
cial
Pe
rso
nal
Inte
rest
Ind
ire
ct
Inte
rest
Nature of Interest
From To
Action taken to mitigate
risk
John Atherton Director of Performance Improvement
Member of Governing Body
Member of Integrated Governance and
Quality Committee
Member of Executive Management
Committee
Interim Director of Commissioning (from
November 2019)
N
No interests declared Adherence to COI policy
Stephen Hickey Wandsworth CCG - Governing Body
(Vice Chair);
Lay Member, Governance Wandsworth -
Health and Wellbeing Board;
LDU and SWL Finance Committee in
Common;
Audit Committee (Chair); Remuneration
Committee (Chair);
Workforce Committee;
Primary Care Committee;
Integrated Quality & Governance
Committee
Y
1. Trustee for Merton Community Transport Charity.
2. Occasional consultancy with Eastside Primetimers (voluntary sector consultancy
organisation).
3. Chair Designate, Healthwatch Wandsworth (to take effect April 2020)
2
3
1 1. 01/12/2017
2. 2012
3. April 2020
Transparency if relevant
issues arise and declare if
EP bid for work related to
the CCG.
Dr Mike Lane Governing Body voting member
CCG Deputy Clinical Chair
Joint Wandle Locality Lead
Member of Integrated Governance
Quality Committee member
Wandsworth Primary Care Committee
member
Y
1. Non-partner GP, Grafton Medical Partners (Grafton Primary Care Network)
2. Practice is a member of Battersea Healthcare CIC but Dr Lane holds no director post
and has no specific responsibilities within that organisation other than those of other
member GP.
3. London Maternity Lead, Royal College of General Practitioners.
4. Volunteer Doctor - Crisis Homeless charity.
5. Volunteer Doctor - St Johns Ambulance Charity.
6. Member - National Maternity Transformation Board Stakeholder
1
3
6
4
5
1. 2019
2. 2014
3. 2006
4. 2006
5. 2016
6. 2016
1-6 Adherence to COI
policy
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Name
Current position (s) held in the CCG i.e.
Governing Body member; Committee
member; Member practice; CCG
employee or other
Do you
have any
interests to
declare?
(Y or N)
Declared Interest
(Name of the organisation and nature of business)
Fin
anci
al In
tere
st
No
n-F
inan
cial
pro
fess
ion
al
Inte
rest
No
n-F
inan
cial
Pe
rso
nal
Inte
rest
Ind
ire
ct
Inte
rest
Nature of Interest
From To
Action taken to mitigate
risk
Dr Kieron Earney Joint West Wandsworth Locality Lead
Y
1. GP Partner, Putneymead Group Medical Practice.
2. Putneymead is a member of Battersea Healthcare CIC although I hold no role within
that organisation.
3. Putneymead Group Medical Practice is a member of the West Wandsworth Primary
Care Network.
1
2
1. July 2016 1. and 2 adherence to COI
policy
Chris Savory Lay Member, Finance
LDU Finance Committee
Wandsworth Audit Committee
Wandsworth Primary Care Committee
Y
1. Chair of Lyme Regis branch of the Liberal Democrats. 1 1. Oct 2019 Adherence to COI policy
Dr Waqaar Shah Wandsworth CCG Governing Body
member.
Joint Wandle Locality Lead.
Wandsworth Health and Wellbeing
Board member.
Finance Committee in Common.
Y
1. GP partner at Chatfield Health Care (practice is a member of Battersea Healthcare
CIC and of Wandsworth Primary Care Network).
2. Chairman of the Neonatal Infection Guideline Committee, National Institute for
Health and Care Excellence.
3. Royal College of General Practitioners National Representative in Eye Health.
4. Eye Health Forum member, Department of Health.
5. Board member, Clinical Council for Eye Health Commissioning.
6. Honorary Treasurer, Section of Primary Care and General Practice, Royal Society of
Medicine.
7. Expert Adviser, Centre for Guidelines, National Institute for Health and Care
Excellence.
1
2
3
4
5
6
7
1. 2017
2. 2018
3. 2017
4. 2017
5. 2017
6. 2017
7. 2018
1-7 To declare this interest
at the start of any meeting
where a conflict may be
relevant; to discuss with
the chair at the outset
whether participation is
possible or appropriate; to
step out of meetings or
decision making if the
conflict cannot be
managed
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Name
Current position (s) held in the CCG i.e.
Governing Body member; Committee
member; Member practice; CCG
employee or other
Do you
have any
interests to
declare?
(Y or N)
Declared Interest
(Name of the organisation and nature of business)
Fin
anci
al In
tere
st
No
n-F
inan
cial
pro
fess
ion
al
Inte
rest
No
n-F
inan
cial
Pe
rso
nal
Inte
rest
Ind
ire
ct
Inte
rest
Nature of Interest
From To
Action taken to mitigate
risk
Carol Varlaam Wandsworth CCG Board Lay Member,
Patient and Public Involvement
Integrated Governance & Quality
Committee
Audit Committee
Remuneration Committee
PPI reference Group (Chair)
Primary Care Committee (Chair)
N
No interests declared Adherence to COI policy
Shaun Stoneham Director of System Resilience and
Transformation
Nothing to declare
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Minutes of the meeting of the Primary Care Commissioning Committee (Part 1) held on
Tuesday 3rd September 2019 at Nightingale House
Chair: Carol Varlaam Present: Voting Members Carol Varlaam (CV) Lay Member, Patient and Public Involvement Katie Bugler (KB) Director of Primary Care Transformation Stephen Hickey (SH) Lay member, Audit Dr Natasha Curran (NaC) Secondary Care Doctor Neil McDowell (NM) Director of Finance Non-Voting Members Dr Mike Lane (ML) Locality lead for Wandle Dr Ismat Nasiruddin (IN) LMC representative Dr Nicola Jones (NJ) CCG Chair In attendance: Emma Gillgrass (EG) Associate Director of Primary Care
Transformation Kate Symons (KS) Associate Director of Primary Care
Transformation Kasia Gaj (KG) Deputy Head of Primary Care, NHS England -
South West London Primary Care Team Hannah Pearson (HP) Primary Care Transformation Manager Muna Ahmed (MA) Interim Governance Officer Apologies: James Blythe (JB) Managing Director Julie Hesketh (JH) Director of Quality and Governance Nick Cuff (NiC) Associate Lay Member Dr Waqaar Shah (WS) Locality lead for Wandle James Gillespie (JG) Wandsworth Healthwatch Dr Kieron Earney (KE) West Wandsworth LCG Lead John Atherton (JA) Director of Performance Chris Savory (CS) Lay member Josh Potter (JP) Director of Commissioning Dr Nicola Williams (NW) Clinical Director Battersea Councillor Melanie Hampton (MH) London Borough of Wandsworth Public in attendance: Ritu Vadhera Takeda Hannah Redman Takeda
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A01
Apologies, Declarations, Quorum
Apologies were received as above. No additional conflicts of interest were declared. The meeting was declared quorate.
A02
Clinical Chair’s Opening Remarks
None.
A03
Minutes of Previous Meeting on 28 May 2019 and action log
Minutes The minutes of the 28th May meeting were approved, as an accurate record of the meeting, subject to the removal of the percentage sign after “348” on page 3. Action log None.
A04
Decisions ratified outside of the meeting
The following items were ratified outside the meeting by James Blythe:
1. Minutes from Sept and December 2018 2. Updated guidance on Managing Serious Incidents in General Practice 3. Special Allocation Scheme service for SWL (excluding Croydon) 4. NHS Transformation Funding 5. Applications for Primary Care Networks in Wandsworth
The Primary Care Committee NOTED the decisions ratified outside of the meeting.
B01
Terms of Reference
The Primary Care Committee noted the changes made, following the previous meeting and APPROVED the Terms of Reference.
B02
Integrated Primary Care Commissioning
KS reported that the Primary Care Operations Group (PCOG) have been developing Primary Care Networks which will be discussed in detail, later in the meeting. PCOG also looked at locality initiatives. There was a focus on the re-procurement of the Citizens Advice and Welfare Service and interpreting services. Members forums will feed into the procurement process. The Junction procurement – the Primary Care Committee agreed to re-procure on an APMS contract. The procurement process is underway and the deadline for bidders is 16th September. This Committee will make the decision to award the contract in a private meeting in November. Joint Primary Care Quality Review Group (PCQRG)
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Lavender Hill Group Practice CQC report – the practice was rated overall as “requires improvement”. The CCG has met with the practice to discuss the outcomes of the report and the contractual breaches and to ensure action plans are in place to address the issues raised. The practice has also been offered support through the Practice Support Team (PST), in addressing the areas identified as requiring improvement. NJ highlighted the blank prescriptions issue. Guidance has been given to the practice and will be shared with other practices at the PCQRG. It was felt it needs to be fed back to the CQC. National GP Patient Survey 2019 An annual survey. A small sample of patients responded. In Wandsworth, 16,880 surveys were sent out, with a response rate of 24%. This is a lower response rate than England (33%) and South West London (29%). EG highlighted:
- For the overarching question, “Overall, how would you describe your experience of your GP practice”, 87% of Wandsworth patients rated their surgery as Fairly or Very Good, ranging for individual practices from 71% to 96%. This is above the national (England) rating of 83% and South West London (Croydon, Kingston, Merton, Richmond, Sutton, Wandsworth CCGs) average of 85%.
- Wandsworth is generally rated in line with or above the South West London (SWL), London and England averages.
Areas identified for improvement at a borough level, either because they have the lowest average scores or the biggest variation between practices include:
- Overall experience of making an appointment. - How easy is it to get through to someone on the phone. - How easy is it to use your GP practice’s website, to look for information
or access services. Survey results compared to last year – there have been slight decreases in the following questions:
- Overall how would you describe your experience of making an appointment? (% Good) – decrease by 1%.
- Generally, how easy is it to get through to someone at your GP surgery on the phone? (% Easy) – decrease by 2%.
- How easy is it to use your practice’s website to look for information or access services? (% easy) – decrease by 5%.
Borough level results and the individual results have been discussed at PCQRG and shared with practices to identify where they can make improvements. SH queried whether we have data to say how long patients are waiting for appointments in Wandsworth. KB explained that we do not have this data and use patient feedback. However, a national tool to do this is being developed to measure this.
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IN asked whether there was any scope to look at the impact of NHS 111 and 8-8 blocking appointments. EG stated that we do look at 8-8 appointment utilisation. KB added that emergency department re-directions to practices is good. NHS 111 re-directions could be improved. ML commented that every practice handles access differently. Many use digital solutions or a telephone triage. KB stated that practices make their appointments available to cater for the needs of their patient cohort – i.e. digital/online, phones. There is no direct question asking how long someone had to wait for an appointment. It is difficult to know what improvements need to be made. Infection Control - each year a list of GP practices are prioritised for infection control audit visits by the Infection Prevention and Control team. In 2019-20, approximately 4 practices in Wandsworth will be audited. The PCQRG reviewed the current inspection ratings for practices and identified those whose last inspection was more than three years ago, and one practice that had a more recent inspection but was rated amber and so due for a follow up. Mental Capacity Act - information was shared relating to a new template and guidance for completing Mental Capacity Act assessments. This has also been shared with practices. Learning from Incidents - recent learning has followed two incidents relating to the monitoring of patients on anti-psychotic medication, ordering and collecting prescriptions. Work is ongoing to share the learning and guidance with practices and to support them in implementing appropriate systems. The Committee noted the contracting decisions. CV noted that recruitment is not included in the update and felt it would be useful to have this information. It was explained that the CCG reviews the workforce for practices but is not responsible for recruitment in practices. NJ added that international GP recruitment has been slow. Action B02.1: KB to bring update on workforce within practices in Wandsworth. The Primary Care Committee NOTED the Primary Care Commissioning Update Report.
B03 Practices half day closure review
KG provided an introduction and stated that in April 2018, NHS England guidance was sent to Commissioners outlining the expectations for the review of GP practice access arrangements, for assurance they meet the reasonable needs of their patients during core hours. Last year’s focus was on the practices who had declared regular periods of half day closing on the annual electronic GP Practice self-declaration (eDec). A number of practices had also declared that they were also closed regularly more than 7.5 hours per week during core hours or are open 45 hours or less. The core hours are 52.5 hours. The guidance requests that a review of the access arrangements for this cohort of practices is also undertaken. There are 6 practices in Wandsworth who have declared regular periods of closure during core hours in 2018/19. Three of these practices have declared
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regular closing of 7.5 hours or more per week, and the SWL Primary Care Team have followed up with the practices concerned. The Committee discussed and reviewed the 6 practices. The first practice corrected the opening hours. However, they still remain closed between 1.30pm-3.30pm four days of the week. They advised that the practice and clinical staff are available during this time. The second practice closes between 1pm-2pm five days per week. On following up with the practice they have confirmed that:
- There are reception staff on duty. - Patients can still gain physical access to the practice and by phone. - A GP is available for urgent appointments. - Their Patient and Public Group (PPG) and the CCG have been
informed of these arrangements. The third practice has declared they close Monday, Tuesday, Thursday and Friday 1.30pm-2.30pm. During this time cover is provided by Care UK and they have the contact details for the GP on call who provides triage and deals with any urgent appointments. There are no reception staff and there is poster in the entrance. An automated telephone message provides patients with the contact number for Care UK. The practice advised that this arrangement has been in place for many years and that the arrangements have been discussed/agreed with CCG. A fourth practice closes between 1pm-2pm Monday to Friday. On following up with the practice they confirmed that they have emergency mobile access number only, which is used by patients to access the on-call clinician. They have advised that they have consulted their PPG and that the CCG are aware of this arrangement. A fifth practice confirmed they close intermittently each month on a Monday for a practice meeting, on a Tuesday for staff training, on a Wednesday for a reception staff meeting, and on a Thursday for a practice staff and clinical meeting. A sixth practice declared half day closing in 2017/18 which was queried by the commissioning team and has since confirmed the practice no longer closes half day. However, their website still needs updating, so requires further follow up by the SWL Primary Care Team. The practice has also declared that they close between 1pm-4pm Monday to Friday, and cover is provided by Care UK who provide a telephone answering service, and a receptionist is available for face to face contact. This is currently being reviewed by the CCG. Next steps The CCG will need to provide assurance to NHSE that the arrangements in place meet the needs of patients. KS highlighted that the practices are contracted to provide the core hours of 52.5 hours and that the Primary Care Network DES regarding access specifies that all practices should offer the core contract in the PCN, as it will have an impact on a network. It was noted that some practices close for various reasons, included staff training, lunchtime, some smaller practices do not have the staff to cover lunch breaks. It was felt that there should be consistency with what practices are
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doing. There was a discussion about whether protected learning time was the best way forward in SWL. The Committee queried whether PCNs could be utilised to provide cover. KG clarified that each practice is required to provide the core contracted hours. There was a discussion about the limitations of sub-contracting to fulfil contracting requirements, such as having staff at a reception desk. The Committee AGREED to delegate the task of taking this forward to the Primary Care Operations Group, to devise a plan for the next 6-12 months. The Committee would like an update on the progress at a future meeting. It was noted that in that time, with the introduction of PCNs, there may be a different approach.
B04
Finance Report
NM highlighted from the month 4 finance report:
- The financial position is at break even. - PCN DES budget currently has an underspend. - CCG adjustment line i.e. the difference between the allocation and the
CCG plan is a shortfall of £1.1m. Will be managed by accruals, any underspend and the overall CCG position.
- The £1.50 per head allocation is committed for this financial year. NJ queried why MSK is included within Primary Care. NM explained that this is the MCAS service which is part of the MCP. NJ raised concern that money may be taken from the Primary Care budget, if there was an overspend in MSK elsewhere. NM noted the concern and stated that it will be clearer in future reports where there are pressures for Primary Care.
The Primary Care Committee NOTED the Primary Care Finance Report.
B05 Primary Care Networks (PCN) Development and Primary Care at Scale (PCAS) Update
HP provided the key highlights from the paper. Primary Care Transformation Funding 2019-20 HP informed all that this is the second year of transformation funding from NHS England. The CCG will receive £2.2m which will fund the 8-8 extended access and Primary Care at Scale (PCAS). The key requirements of the PCAS funding are to build upon the work undertaken last year on transformation, to support the development of general practices. Battersea Healthcare (BHCIC) will continue to deliver the PCAS. EG highlighted some of BHCIC’s achievements to date, including the delivery of workforce projects such as development of a local locum bank, induction model, introduction of joint and new roles and the development of a model for enhanced support to care homes. In 2019-20, BHCIC has been consulting with their practices and the newly formed networks to identify what support they think they will require and develop a coordinated approach and offer. Five workstreams have been identified, which are – 1) PCN support and development; 2) PCN specific and
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borough wide projects; 3) Business intelligence; 4) Workforce and 5) Policies and procedures. Extended access will continue to be delivered in the three hubs. The Primary Care team will be working with BHCIC to develop specific areas of work and measures via KPIs. New Roles - during 2019/20 a key area for development is the introduction of the new roles in primary care networks, in particular: Clinical Directors, Social Prescribing Link Workers and Clinical Pharmacists. Primary Care Network Development Based on learning to date (including from Merton, where there is a well-developed social prescribing service which has delivered positive outcomes for patients and practices), the CCG offered to hold a contract for service delivery across PCNs and to ‘top up’ the NHS England funding to enable delivery of elements which cannot be covered within the salary funding. This includes areas such as training, supervision and role development of the Link Worker. Seven of the nine Wandsworth PCNs signed up to this model and a procurement process is underway to identify a suitable provider. The other two PCNs have chosen to proceed independently, working directly with a provider with whom they have worked previously. Additional clinical pharmacy input in primary care brings significant opportunities to improve patient care, particularly supporting the proactive management of patients with complex needs. PCNs are currently focussing on introducing clinical pharmacists, associated ways of working and key areas of focus. The CCG’s Medicines Management Team is providing support and guidance and work is underway in terms of determining the most appropriate linkages between different pharmacy roles. PCN Maturity Matrix and diagnostic tool The PCN maturity matrix outlines components that will underpin the successful development of networks. It sets out a progression model that evolves from the initial steps and actions that enable networks to begin to establish through to growing the scope and scale of the role of networks in delivering greater integrated care and population health for their neighbourhoods. The PCN maturity matrix is made up of the following 5 components: 1. Leadership, planning and partnerships; 2. Use of data and population health management; 3. Integrating care; 4. Managing resources; 5. Working with people and communities. It is designed to support network leaders, working in collaboration with systems, places and other local leaders within neighbourhoods, to work together to understand the development journey both for individual networks, and how groups of networks can collaborate together across a place in the planning and delivery of care. The accompanying diagnostic tool will help PCNs and other local organisations involved in the development of PCNs to self-assess the current maturity of a network and to help understand the development trajectory of the network.
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Next steps Work is underway to map current priorities and plans to the PCN maturity matrix and to use the matrix to identify any additional opportunities and gaps. This will be used to develop a roadmap to describe the anticipated development journey of the Wandsworth PCNs. With the support of the Federation and the CCG, Wandsworth PCNs are currently in the process of identifying where they are within the PCN Maturity matrix, where they want to be and what support they may require to achieve this. This information will feed into a South West London plan. CV queried whether there are enough clinical pharmacists in SWL and nationally. HP explained that the roles will vary in different practices and therefore require different skills. NJ added that there is a network of pharmacists working across Wandsworth and SWL. It was clarified that partners have started discussing what the integrated teams will look like. Discussions are taking place at the Transformation Group. The new PCN Clinical Directors are meeting on a monthly basis and have been reviewing how their time will be allocated. Clinical Directors have been asked to identify priority areas for training and development. There is a variation in training needs. The Committee NOTED the Primary Care Networks Development and the use of the Primary Care at Scale Funding.
B06
Any Other Business
1. It was clarified that there will be a part 2 WPCCC meeting after the Board on 6th November, for voting members only.
2. NC informed all that she will be stepping down from the Wandsworth Board at the end of the September. CV thanked NC for her contribution to the meetings and stated that she will be missed. The Committee wished NC all the best for the future.
There were no questions from the public.
Close of Part 1
Date of next meeting: The next meeting will be held on Thursday 23rd January 2020, 15:00-17:00, Nightingale House.
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ACTION LOG
Date Minute Ref Action Description Responsible Officer Target Completion Date Update Status CCG Committee Type
03.09.19 B02.1 Part 1 Integrated
Primary Care Commissioning: CV noted that recruitment is
not included in the update and felt it would be useful to
have this information. KB to bring an update on workforce
within practices in Wandsworth.
Katie Bugler (nee
Denton)
23.01.20 Open Wandsworth Primary Care Action
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Wandsworth Clinical Commissioning Group Primary Care Commissioning Committee
Date Thursday, 23 January 2020
Document Title Digital First Accelerator Programme Update
Lead Director (Name and Role)
Katharine Bugler, Director for Transforming Primary Care
Clinical Sponsor (Name and Role)
Author(s) (Name and Role)
Francis Masinde, Programme Manager Digital First
Agenda Item No. B01 Attachment No. B01i
Purpose (Tick as Required) Approve Discuss Note
Executive Summary
Background: The Digital First Accelerator Programme is an NHS England funded programme which aims to enhance and streamline digital service delivery across primary and urgent care.
Purpose: This report provides the Wandsworth Primary Care Committee with an update on the Digital First Accelerator Programme in Merton and Wandsworth CCGs, which have been identified as pilot sites for this programme in South West London.
Reason for Committee Review: The Committee are asked to note the progress on the programme to date.
Key Issues: The slide pack summarises the following issues:
• The strategic objectives of the Digital First programme and the case for change
• The programme development process
• The key local priorities and deliverables for Merton and Wandsworth
• A focus on how we will use PCNs to champion the successful roll out of digitalinitiatives.
Conflicts of Interest: As per the usual GP COI
Mitigations: As per the usual GP COI
Recommendation:
XX
YES
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The Committee are asked to note the ongoing work.
Corporate Objectives This document will impact on the following CCG Objectives:
Improving Outcomes and Reducing Inequalities: Ensuring access to high quality and sustainable care.
Risks This document links to the following CCG risks:
None
Mitigations Actions taken to reduce any risks identified:
N/A
Financial/Resource/ QIPP Implications
NHS England have allocated funding of £636k to South West London for delivery of the Digital First Accelerator Programme over the coming year (2020/21)
Has an Equality Impact Assessment (EIA) been completed?
EIAs have been completed for individual work-streams within the Digital Accelerator programme.
Are there any known implications for equalities? If so, what are the mitigations?
None.
Patient and Public Engagement and Communication
• Patient workshop held as part of project scoping.
• A focus group has been created that will test elements of the programme as they roll out.
Previous Committees/ Groups Enter any Committees/ Groups at which this document has been previously considered:
Committee/Group Name: Date Discussed:
Outcome:
N/A Click here to enter a date.
Click here to enter a date.
Click here to enter a date.
Supporting Documents Slide pack to be presented at the Committee
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NHS England and NHS Improvement
South West London Digital First Accelerator Programme
(Merton and Wandsworth CCGs – Digital First Pilot Site for SWL)
Presenting to Wandsworth Primary Care Commissioning Committee
23rd January 2020
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Principles of Digital First
1. Strategic priorities
Allows for nationwide system maturing.
It is an opportunity to build the digital ecosystem’s
aligned with national deliverables and strengthens
the system to work together.
1 Strategic priorities 2 Local priorities 3 Accelerator 4 Pathway design 5 Maturing 6 Outputs
19 of 90
Benefits of Digital First
1. Strategic priorities
Allows for nationwide system maturing.
It is an opportunity to build the digital ecosystem’s
aligned with national deliverables and strengthens
the system to work together.
1 Strategic priorities 2 Local priorities 3 Accelerator 4 Pathway design 5 Maturing 6 Outputs
Streamlined and integrated
patient flows across primary and
urgent care services
• Streamlining and integrating patient flows across primary and urgent care services;
• Making better use of clinical time by enabling access to the right skillset the first time;
• Optimising demand and capacity across the system.
Improved access and patient
experience
• Quick, convenient and secure alternative ways to access Primary Care;
• Enhanced ability to make an appointment, order repeat prescriptions and view medical records;
• Availability of timely, trusted and locally sensitive advice online
Encouraging innovation• Enriched and developed supplier market to support future NHS ambitions;
• Development of a single digital front door for all NHS services.
Embedded change management
• Wider and more standardised adoption of digital technologies through embedding business change
techniques;
• Reduced duplication, project management effort and spend by CCGs on implementing disjointed,
fragmented digital solutions
1
2
3
4
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Local Priorities – Wandsworth Landscape
2. Local priorities
Local analysis that identify local population
needs addressing variation and alignment with
clinically driven requirements. A number of
local priorities will be applicable to other
London STPs.
1 Strategic priorities 2 Local priorities 3 Accelerator 4 Pathway design 5 Maturing 6 Outputs
• 40 GP practices• 9 Primary Care
Networks • 1 GP Federation - all
practices are members• Extended access
services delivered via a combination of individual practices and 3 practice based access hubs
• 4 Out of Hours bases• 2 Urgent Treatment
Centres• 1 major acute trust with
increasing pressures on A&E
Digital First Accelerator Pilot21 of 90
The Programme Design Process
3. Accelerator
Are defined areas with susceptibility for technology
enabled change. Identifies
challenges with current pathways, iteratively
develops solutions, supports national targets
and PCN development.
3. Accelerator
Are defined areas with susceptibility for technology
enabled change. Identifies
challenges with current pathways, iteratively
develops solutions, supports national targets
and PCN development.
4. Digital products embedded in redesign
pathways
The development of products are produced collaboratively between
clinicians, the wider workforce and patients bringing the market alive
to respond to system challenges. Process involves workflows and
pathways, supporting emerging healthcare technologies and ultimately
delivering digital maturity.
1 Strategic priorities 2 Local priorities 3 Accelerator 4 Pathway design 5 Maturing 6 Outputs
We gathered our delegates and stakeholders together across 3 pathway mapping
sessions
1. Cost-Benefit : What are the predicted short, medium and long term cost savings for this project/resolving this issue2. Patient Experience: Perceived impact on experience relative to other focus areas3. Staff Experience: Impact on staff dissatisfaction/wellbeing (stress leave, burnout measures) relative to other focus areas4. Clinical Risk: Clinical Risk (impact x likelihood) of not addressing issue identified5. Non-Clinical Risk: Operational and Organisational Risk Scores (impact x likelihood) of not addressing issue identified6. Alignment with National and SWL Strategy: Does this align with clinical strategy or NHS long term plan, GPFV, Must dos7. Cross-Over with Existing Programmes: Being addressed through other SWL programmes, or at a London level?8. Feasibility: Can this project/issue be addressed within the programme timeframe and cost constraints, 9. Viability: Will the solution/project have sustained success and required patient/staff utilisation 10. Usability: Will the focus area deliver a solution that can be used by target audience/ will there be a large training burden
We identified a number of key criteria to help us
prioritise our work programme
We formed a network of partnerships to achieve our
local priorities together.
Workshop 16th June 19
Clinical Focus
18 Delegates
Workshop 215th July 19
Patient Focus
11 Delegates
Workshop 330th July 19
Prioritisation
12 Delegates
Workshop 16th June 19
Clinical Focus
18 Delegates
Workshop 215th July 19
Patient Focus
11 Delegates
Workshop 330th July 19
Prioritisation
12 Delegates
Workshop 16th June 19
Clinical Focus
18 Delegates
Workshop 215 th July 19
Patient Focus
11 Delegates
Workshop 330 th July 19
Prioritisation
12 Delegates
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Accelerator Shortlisting
PRIORTY FOCUS AREA PROBLEM STATEMENT POTENTIAL PROJECTS
1Demand & capacity optimisationfor both in hours service and out of hours services
Inappropriate or avoidable clinical face-to-face appointments leading to significant risks and negatively impacting on cost, staff and patient experience.
1. Pilot use of A&E waiting time app
2. Identify and target patients who use NHS services frequently and inappropriately
3. Utilise digital GP Online Consultation hub models
4. Pooling access to extended access hubs in general with access via the NHS App
2Effective triage tools/ effective risk stratification and processes
1. Real-world evaluation of the Doctorlink's symptom checker
2. Identify and incorporate red flags from systems in different care settings
3. Standardising practice's online appointment offering (DOS)
4. Pilot and evaluate e-triage within UCC or A&E setting via check-in tablets
3 Video consultation1. Pilot and evaluate Doctorlink's (or multi-vendor's) video consultation solutions
2. Evaluate impact of video consultation within care homes
3. Support the adoption of video consultation within extended access hubs
4Improve Telephony functionality/ variability
1. Identify and pilot and evaluate an advanced telephony solution within W&M LDU
2. Identify best solutions and standardise telephony systems across W&M LDR.
5 Photo sharing ability
Clinicians not being able access relevant clinical information at the appropriate time and patients having to repeat their story multiple times.
1. Identify and implement a secure messaging system that allows patients to share pictures
6 Two-way messaging1. Identify and implement more appropriate text messages to direct patients to services
2. Pilot and evaluate two-way clinician patient messaging system
7 Access to shared records 1. Linking patient record systems together
8Having patient record delegated access / proxy access for carers
Family and carers not being able access a person's relevant clinical information at the appropriate time for the purposes of direct care.
1. Work with supplier and carers to incorporate proxy access within solution/s.
9Incorporate Wearable Technology in unscheduled care pathways
Clinicians not being able access data from wearable technologies (especially in the context of vulnerable patients)
1. Identify most clinically impactful wearable technology and associated data to share with clinicians
2. Pilot and evaluate the linkage of a wearable technology's data into patient record.
3. Accelerator
Are defined areas with susceptibility for technology
enabled change. Identifies
challenges with current pathways, iteratively
develops solutions, supports national targets
and PCN development.
3. Accelerator
Are defined areas with susceptibility for technology
enabled change. Identifies
challenges with current pathways, iteratively
develops solutions, supports national targets
and PCN development.
4. Digital products embedded in redesign
pathways
The development of products are produced collaboratively between
clinicians, the wider workforce and patients bringing the market alive
to respond to system challenges. Process involves workflows and
pathways, supporting emerging healthcare technologies and ultimately
delivering digital maturity.
1 Strategic priorities 2 Local priorities 3 Accelerator 4 Pathway design 5 Maturing 6 Outputs
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Accelerator plans to April and Beyond
3. Accelerator
Are defined areas with susceptibility for technology
enabled change. Identifies
challenges with current pathways, iteratively
develops solutions, supports national targets
and PCN development.
3. Accelerator
Are defined areas with susceptibility for technology
enabled change. Identifies
challenges with current pathways, iteratively
develops solutions, supports national targets
and PCN development.
4. Digital products embedded in redesign
pathways
The development of products are produced collaboratively between
clinicians, the wider workforce and patients bringing the market alive
to respond to system challenges. Process involves workflows and
pathways, supporting emerging healthcare technologies and ultimately
delivering digital maturity.
1 Strategic priorities 2 Local priorities 3 Accelerator 4 Pathway design 5 Maturing 6 Outputs
PCN Development
Immediate priority
Heathier cities initiatives / Social
prescribing / personalisation
Medium Priority
LHCRE / Access to records
collaboration and joining to App
Medium Priority
Telephony Access to services / IVR and redirection
High priority
Low Priority
Demand and capacity (Real time) management
of access
High priority
Evaluation of impact on front line services to
date
Medium Priority
Digital Outpatients / Scheduled care initiatives
High priority
Proactive care LTP
requirements /
personalisation local services
Medium Priority
Mental Health
access via the NHS app
Medium Priority
Directory of services integration with the NHS
app /local cleansing
High priority
Horizon scanning and prioritising opportunities
Beyond April 2020
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Innovating through Merton & Wandsworth PCNs with Digital First: Improving signposting through Doctorlink integration with the Directory
of Services (DOS)
25 of 90
SWL – Digital First Programme Scope – The Directory of Services
1. Strategic priorities
Allows for nationwide system maturing.
It is an opportunity to build the digital ecosystem’s
aligned with national deliverables and strengthens
the system to work together.
1 Strategic priorities 2 Local priorities 3 Accelerator 4 Pathway design 5 Maturing 6 Outputs
What is the Directory of Services?
• The Directory of Services (DoS) is a central directory that is integrated with NHS Pathways and is automatically accessed if the patient does not require an ambulance or by any attending clinician in the urgent and emergency care services.
• MIDOS – is a third party application that feeds off the main DOS system, allowing clinical staff to search the DOS and sign post patients to other available services which could appropriately treat the patient, such as those offered by pharmacies and other community services.
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SWL – Digital First Programme Scope – Initial Pilot PCNs
1. Strategic priorities
Allows for nationwide system maturing.
It is an opportunity to build the digital ecosystem’s
aligned with national deliverables and strengthens
the system to work together.
1 Strategic priorities 2 Local priorities 3 Accelerator 4 Pathway design 5 Maturing 6 Outputs
Wand CCGWest Wandsworth
PCN
No. of Practices: 4List Size: 39,365
Selected Pilot PCNs (Total 6)
Selection Criteria
Wand CCGWandsworth PCN
No. of Practices: 6List Size: 44,283
Wand CCGNightingale PCN
No. of Practices: 3List Size: 33,778
Merton CCGEast Merton PCN
No. of Practices: 5List Size: 45,930
Merton CCGSouth West Merton PCN
No. of Practices: 2List Size: 39, 030
Merton CCGMorden PCN
No. of Practices: 4List Size: 37,735
• Rates of non-elective ambulatory activity per head of population (Essential) – 20%• Clinical Sponsor and Leadership (Essential) – 10%• Percentage of patients with detailed care record access (Essential) – 15%• Percentage of online booking activity – Direct booking (GP Hubs and in-hours) (Essential) – 17.5%• Patient engagement and experience survey results – 17.5%• Patient Champions – 10%• Population Insights - 10% 27 of 90
Doctorlink integrates with GP systems
3. Accelerator
Are defined areas with susceptibility for technology
enabled change. Identifies
challenges with current pathways, iteratively
develops solutions, supports national targets
and PCN development.
3. Accelerator
Are defined areas with susceptibility for technology
enabled change. Identifies
challenges with current pathways, iteratively
develops solutions, supports national targets
and PCN development.
4. Digital products embedded in redesign
pathways
The development of products are produced collaboratively between
clinicians, the wider workforce and patients bringing the market alive
to respond to system challenges. Process involves workflows and
pathways, supporting emerging healthcare technologies and ultimately
delivering digital maturity.
1 Strategic priorities 2 Local priorities 3 Accelerator 4 Pathway design 5 Maturing 6 Outputs
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Doctorlink pathway: Patient signposted to GP appointment in-hours
3. Accelerator
Are defined areas with susceptibility for technology
enabled change. Identifies
challenges with current pathways, iteratively
develops solutions, supports national targets
and PCN development.
3. Accelerator
Are defined areas with susceptibility for technology
enabled change. Identifies
challenges with current pathways, iteratively
develops solutions, supports national targets
and PCN development.
4. Digital products embedded in redesign
pathways
The development of products are produced collaboratively between
clinicians, the wider workforce and patients bringing the market alive
to respond to system challenges. Process involves workflows and
pathways, supporting emerging healthcare technologies and ultimately
delivering digital maturity.
1 Strategic priorities 2 Local priorities 3 Accelerator 4 Pathway design 5 Maturing 6 Outputs
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Doctorlink Pathway: Patient Signposted to GP out of hours (AS-IS)
3. Accelerator
Are defined areas with susceptibility for technology
enabled change. Identifies
challenges with current pathways, iteratively
develops solutions, supports national targets
and PCN development.
3. Accelerator
Are defined areas with susceptibility for technology
enabled change. Identifies
challenges with current pathways, iteratively
develops solutions, supports national targets
and PCN development.
4. Digital products embedded in redesign
pathways
The development of products are produced collaboratively between
clinicians, the wider workforce and patients bringing the market alive
to respond to system challenges. Process involves workflows and
pathways, supporting emerging healthcare technologies and ultimately
delivering digital maturity.
1 Strategic priorities 2 Local priorities 3 Accelerator 4 Pathway design 5 Maturing 6 Outputs
GP practice not open in timeframe
appointment needed
Patient advised to call 111 or attend Urgent
Care Centre
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Doctorlink Pathway: Patient Signposted to GP out of hours (TO-BE)
3. Accelerator
Are defined areas with susceptibility for technology
enabled change. Identifies
challenges with current pathways, iteratively
develops solutions, supports national targets
and PCN development.
3. Accelerator
Are defined areas with susceptibility for technology
enabled change. Identifies
challenges with current pathways, iteratively
develops solutions, supports national targets
and PCN development.
4. Digital products embedded in redesign
pathways
The development of products are produced collaboratively between
clinicians, the wider workforce and patients bringing the market alive
to respond to system challenges. Process involves workflows and
pathways, supporting emerging healthcare technologies and ultimately
delivering digital maturity.
1 Strategic priorities 2 Local priorities 3 Accelerator 4 Pathway design 5 Maturing 6 Outputs
GP practice not open in timeframe
appointment needed
Doctorlink maps to MiDOS to identify the
closest OOH/IUC centre that could see the
patient
Patient told location and
opening hours of nearby IUCs
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Doctorlink pathway: Signposting to alternative services via MiDOS
3. Accelerator
Are defined areas with susceptibility for technology
enabled change. Identifies
challenges with current pathways, iteratively
develops solutions, supports national targets
and PCN development.
3. Accelerator
Are defined areas with susceptibility for technology
enabled change. Identifies
challenges with current pathways, iteratively
develops solutions, supports national targets
and PCN development.
4. Digital products embedded in redesign
pathways
The development of products are produced collaboratively between
clinicians, the wider workforce and patients bringing the market alive
to respond to system challenges. Process involves workflows and
pathways, supporting emerging healthcare technologies and ultimately
delivering digital maturity.
1 Strategic priorities 2 Local priorities 3 Accelerator 4 Pathway design 5 Maturing 6 Outputs
Doctorlink signposts to more appropriate
service
Pharmacy
Optician
Dentist
Self-care
Sexual health clinic
IUC/UEC
Doctorlink provides the patient details
of the most appropriate service
to meet their clinical need, with their
opening hours and location details
Current priority: DOS integration
Future possibility?: direct booking via
connected appointments
Doctorlink directly booking an
appointment into the recommended service at a time suitable for the
patient
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SWL – Digital First Programme – Benefits of Signposting
1. Strategic priorities
Allows for nationwide system maturing.
It is an opportunity to build the digital ecosystem’s
aligned with national deliverables and strengthens
the system to work together.
1 Strategic priorities 2 Local priorities 3 Accelerator 4 Pathway design 5 Maturing 6 Outputs
Benefits of Signposting
• Better experience for patients• Increased patient safety• Appropriate use of NHS resources • Reduction in GP workload when patients directed to self-care/pharmacy• Reduced failure demand across the system by reduction in inappropriate appointments and reduction in patients having
multiple contacts with different providers• Reduced workload for GP administrative staff and for 111 through digital signposting• Improved staff satisfaction
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Maturing our footprint – starting with PCN’s
5. Maturing Landscape
Continued evolvement and a consistent
platform with the objective to iteratively
improve services. Requires agile responses
and learning from past experiences to deliver
required services.
6. Outputs
New technology and ways of working for clinicians offering
better access for patients and wider workforce. Delivers
co-designed solutions developing outcomes
for transformational and cultural change.
1 Strategic priorities 2 Local priorities 3 Accelerator 4 Pathway design 5 Maturing 6 Outputs
Access
Timely advice,
information and
services
Reduced waiting
times
Convenience
Support people who
prefer to access care
remotely
Patient experience
High levels of
satisfaction
Feel more at ease
Continuity of care
Avoid the waiting
room
Save time/cost in
travelling
Quality ofcare
Pick up red flags
early using triage
Comprehensive
symptom enquiry
Empower
self-care
Prioritise care based
on needs
Efficiency
Signpost patients to
the right place or
professional
Optimise appropriate
use of skill-mix
Clinician has access
to the history before
the consultation
Less time spent
documenting and
better data capture
Supportingstaff
Greater control over
workload
Opportunities for
flexible and remote
ways of working
increasing staff
retention and practice
capacity
Give people the time
they need
Staff satisfaction
Save time in travelling
What improvements did we want to see? (Clinicians and Patients)
We asked our PCN colleagues and
Digital colleagues what changes and
improvements would be important
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Maturing our footprint in PCNs – Empowering Patients & Communities
5. Maturing Landscape
Continued evolvement and a consistent
platform with the objective to iteratively
improve services. Requires agile responses
and learning from past experiences to deliver
required services.
6. Outputs
New technology and ways of working for clinicians offering
better access for patients and wider workforce. Delivers
co-designed solutions developing outcomes
for transformational and cultural change.
1 Strategic priorities 2 Local priorities 3 Accelerator 4 Pathway design 5 Maturing 6 Outputs
✓ PPG QI Initiative
✓ Engage with digitally uninterested and non-digital patients at PCN
✓ Mapping the patient journey
✓ Digital Insight work
✓ Identify Champions
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NHS England and NHS Improvement
Thank you
36 of 90
Wandsworth Clinical Commissioning Group
Primary Care Commissioning Committee Part 1
Date Thursday, 23 January 2020
Document Title Primary Care Network Development Update
Lead Director (Name and Role)
Katie Bugler, Director for Transforming Primary Care
Clinical Sponsor (Name and Role)
Author(s) (Name and Role)
Hannah Pearson, Primary Care Transformation Manager
Emma Gillgrass, Associate Director for Transforming Primary Care
Agenda Item No. B02 Attachment No. B02
Purpose (Tick as Required) Approve Discuss Note
Executive Summary
This report provides an update on the development of Primary Care Networks (PCNs).
This follows a report that came to the Primary Care Commissioning Committee (PCCC)
in September 2019.
Key Issues:
The GP contract framework sets out seven national service specifications that will be
added to the Network Contract DES. Draft outline service specifications for the first five
services were released on 23rd December 2019.
Wandsworth PCNs are developing plans for the use of additional funding for Primary
Care Network development. (Information about this funding was provided in the
September PCCC paper and further details are included in this report).
Conflicts of Interest: GP members and their practices are members of Primary Care
Networks and the GP Federation.
Mitigations: N/A – no specific decision making is associated with this paper.
Recommendation:
Wandsworth Primary Care Committee is asked to note the developments described in
the paper.
Corporate Objectives This document will impact on
the following CCG Objectives:
• Improving Outcomes and Reducing Inequalities:
Ensuring access to high quality and sustainable care.
• Leading with ambition for our communities, driving
transformation through innovation: Delivering better
care and a better patient experience.
✓
XX
✓
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• Working Together: Continually improve delivery by
listening to and collaborating with our patients,
members, partners, communities and other
stakeholders.
• Meeting our performance and financial objectives:
Make the best use of our resources to benefit our
patients and communities.
Risks This document links to the
following CCG risks:
No specific risks in relation to the content of this report
have been identified.
Mitigations Actions taken to reduce any
risks identified:
N/A
Financial/Resource/
QIPP Implications
There are various funding flows associated with PCNs and
the Network Contract DES provides funding entitlements.
There is new dedicated PCN development funding. The
allocation for South West London is £1.134m for 19/20.
Wandsworth has received £277,000 which is an equitable
share based on list size as approved at the South West
London Finance Committee on 29th October 2019.
Has an Equality Impact
Assessment (EIA) been
completed?
Not applicable for this report.
EIAs would need to be completed in relation to new
initiatives once the detailed implications have been
considered.
Are there any known
implications for
equalities? If so, what
are the mitigations?
It is anticipated that developments will improve equity of
outcomes and that there will be no negative implications
for equalities.
Patient and Public
Engagement and
Communication
High level information about Primary Care Networks and
the direction of travel has been shared with the
Wandsworth Patient and Public Involvement Reference
Group (PPIRG). However, significant patient engagement
has not yet been undertaken and consideration is being
paid to how engagement with local people and
communities could best be undertaken at a PCN level.
Previous
Committees/
Committee/Group Name: Date
Discussed:
Outcome:
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Groups Enter any
Committees/
Groups at which
this document has
been previously
considered:
N/A Click here to
enter a date.
Click here to
enter a date.
Click here to
enter a date.
Supporting Documents
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1) Introduction
Following the publication of the NHS Long Term Plan and the five year GP Contract Reforms
a new Primary Care Network Contract went live on 1st July 2019. In Wandsworth practices
have formed into nine Primary Care Networks, which were approved by the Primary Care
Commissioning Committee (PCCC) in May 2019.
In September 2019 the PCCC reviewed 2019/20 plans for the use of Primary Care at Scale
funding and received an update on PCN development, including the additional funding to
support the evolution of networks in line with the PCN Maturity Matrix.
2) Primary Care Network Development
2.1 National Supporting Documents
The September update for the Primary Care Commissioning Committee provided
information about the following national documents:
• PCN Development Support Prospectus – which describes good development support
and sets out an agreed consistent view for regional and local teams to use and build
upon to ensure any support put in place meets local needs.
• PCN Maturity Matrix – which outlines components that will underpin the successful
development of networks and sets out a progression model that evolves from the
initial steps and actions that enable networks to begin to establish through to growing
the scope and scale of the role of networks in delivering greater integrated care and
population health for their neighbourhoods.
• PCN Maturity Matrix diagnostic tool – which should help primary care networks and
other local organisations involved in the development of PCNs to self-assess the
current maturity of a network and to understand the development trajectory of the
network.
2.2 PCN Development Funding
Nationally, new dedicated PCN support funding is being provided to help networks mature
and be in a position to operate and deliver care differently. Development support has been
released and the allocation for South West London is £1.134m for 2019/20. Funding is
expected to be recurrent for five years dependant on need and effective use.
Report to Wandsworth Primary Care Commissioning Committee
Update on Primary Care Network Development
23rd January 2020
W A N D S W O R T H C C G
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Approximately 10% of the funding should be used for Clinical Director development, and the
rest for PCN Development Support. The funding is intended to help PCNs make early
progress against their objectives, for example supporting closer collaboration between
PCNs and their community partners. It should also support preparatory activity for the
forthcoming national service specifications.
In South West London it has been agreed that the development funding should be split
between CCGs according to list size, an approach consistent with previous allocations to
primary care. This approach has been approved through the Transforming Primary Care
Group, and was ratified at the SWL Finance Committee on 29th October 2019. This means
that the funding available for Wandsworth in 2019/20 is £277,000.
2.3 Funding Allocation
In light of the maturity matrix, Clinical Directors and PCNs have identified their priorities
regarding development. How the borough’s allocation is split between PCNs is for local
determination, and there will be further discussions regarding some elements of
development plans to establish which are best delivered at PCN level and where there may
be areas more effectively delivered at either borough or SWL level.
The following principles have been supported in terms of splitting the funding:
• Funding for Clinical Director (CD) development allocated per Clinical Director (rather
than per PCN – as a number of PCNs have joint CDs).
• Majority of the PCN funding allocated per PCN in line with their list size (in keeping
with the manner that funding is being allocated to each CCG).
• An amount of funding allocated to borough wide initiatives which address priority
areas for all PCNs.
Clinical Director Development
Clinical Directors (CDs) have considered their training needs. To support this a template
was produced which involved reflecting upon the level of need for training and support in
relation to the skills and areas of understanding included within the national PCN
Development Support prospectus.
There are varied development needs and priorities amongst the CDs but some common
themes include:
• Using data and information to drive change and support clinical decision making
• Managing finances and budgets
• Understanding the needs of local communities and utilising the voice of local citizens
• Change management and leadership development
• Developing the workforce, including understanding newer primary care roles and how
they can best be deployed
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Collaborative discussions have taken place and feedback has included:
• Training and development need to be tailored to the individual and it will be important
for there not to be a 'one size fits all' solution. Different approaches for delivery are
being considered, for example:
- Attending a structured course
- Attending one day courses on specific subjects such as finance, HR etc.
- Having a mentor/ coach (which could be valuable and support a personalised
approach)
• Approaches need to take into consideration the busy schedules of CDs.
• Innovative/ creative methods may be beneficial and virtual learning should be
considered.
• Training/ development needs beyond CDs (to support other professionals in PCNs)
are also very important and consideration should be paid to upskilling the ‘next
generation’ of CDs.
• There is the potential for PCNs at the same level of development to work together on
common goals (possibly using the National Association of Primary Care (NAPC)),
and CD training could also be linked to the PCN action plan sessions that are
currently being arranged with the NAPC (see commentary below under ‘PCN
Development’).
Battersea Healthcare has developed a Clinical Director Development Options Paper which
provides a ‘menu’ of options which CDs can consider. Where there are opportunities to
coordinate initiatives, these will be taken forward.
PCN Development
A number of areas have been identified already by PCNs that the development funding
could support. These include:
• Organisational development specific to individual PCNs
• Business intelligence / analytics
• Interoperability and data sharing
• Patient / community / other partner engagement
• Governance and system integration
It has been identified that the provision of backfill for practice staff will be needed so that
practices within a PCN can have dedicated time to develop and deliver their action plans to
progress through the maturity matrix.
Outcomes expected to be delivered from the development funding (dependant on specific
activities undertaken) include:
• PCNs have an agreed vision and direction of travel and have established
development plans for the short, medium and longer term that produce tangible
benefits to practices and their patients
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• Effective decision-making processes and communication approaches are in place for
PCNs
• PCN governance is strengthened and linkages are established with wider ‘system
governance’. Joint work is undertaken with other providers, to identify and implement
PCN related developments, including how to achieve greater alignment with PCNs
and how to improve collaborative working to provide enhanced care and support for
complex patients
• Appropriate data sharing arrangements are in place to enable read/write access to
records within networks that have been reviewed via the Londonwide LMC assurance
process.
• PCNs undertake workforce planning and are in a position to support new roles
effectively and in a position to embed within practice and PCN teams.
• Staff from across PCNs work more closely as a single team and have established
shared processes and ways of working where appropriate.
• PCNs have mechanisms to engage with patients, communities and other partners
• Inclusion of all levels of practice staff so everyone feels part of a PCN.
• Business intelligence and population health analytics are deployed in a strategic and
systematic way. There is dedicated input and support to provide relevant information/
dashboards that is meaningful for PCNs.
• Expertise is sourced externally where services have already been established that
meet priorities identified by Wandsworth PCNs.
In relation to overall PCN development, it was agreed at the September Clinical Directors
Forum that arranging facilitated sessions with each PCN would be the best way to develop
action plans and progress through the maturity matrix. This will be supported by the
National Association of Primary Care (NAPC). As an introduction to this work and to
support other areas, the NAPC has run an initial session with all the CDs and it is
anticipated that most of the initial individual PCN facilitated sessions will take place in
January 2020.
3) Draft Outline Service Specifications
3.1 Context
The GP contract framework sets out seven national service specifications that will be added
to the Network Contract DES. Draft outline specifications for the first five services were
released on 23rd December 2019. These services are as follows:
• Structured Medications Review and Medicines Optimisation
• Enhanced Health in Care Homes
• Anticipatory Care
• Personalised Care
• Supporting Early Cancer Diagnosis
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The document including the specifications is available at the website address below, along
with a link to a survey which can be used to provide feedback (until 15th January 2020).
https://www.engage.england.nhs.uk/survey/primary-care-networks-service-specifications/
The purpose of the document is to provide PCNs, community services providers, wider
system partners and the public with further detail of – and seek views on – the draft outline
requirements for the services, as well as plans for phasing and supporting implementation.
3.2 Summary
Included below are some overall key messages from the documentation (regarding all of the
specifications).
Developing the outline service specifications:
• NHS England and NHS Improvement (NHSE/I) has undertaken a wide-ranging
process of evidence-gathering and engagement in order to inform the outline service
specifications.
• The service requirements set out in the specifications focus on interventions and
cohorts where there is significant scope to improve outcomes and people’s health and
wellbeing.
• The outline service specifications illustrate proposed metrics which – through a new
Network Dashboard – will enable PCNs to understand their own position and support
peer learning and quality improvement.
• The final version of the specifications will be published in early 2020 as part of the
wider GP contract package for 2020/21. The final versions will include further detail for
each requirement, followed by guidance, to support PCNs and other providers to deliver
the requirements as effectively as possible.
Funding and Additional Roles:
• Funding is not allocated directly for delivery of the service specifications. The largest
portion of network funding provides reimbursement for additional workforce roles that
PCNs can engage to support the delivery of the specifications and alleviate wider
workforce pressures. There will be significant additional capacity within primary care in
2020/21 to deliver the specifications.
• CCGs will be asked to support PCNs and their community providers to institute shared
workforce models that can help maximise the collaboration between local partners to
deliver the specifications and build the wider PCN.
• Under NHSE/I’s proposals, community services providers will take a significant role in
co-delivery in two of the service specifications - Enhanced Health in Care Homes and
Anticipatory Care, enabling the development of integrated multidisciplinary teams.
Phasing of service requirements:
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• NHSE/I is proposing to phase in the requirements over time in order to ensure that
they are deliverable as PCN workforce capacity grows, and as the wider system
infrastructure develops to support them. This means:
o implementing the requirements of Structured Medication Reviews and Optimisation
and Enhanced Health in Care Homes in full from 2020/21, as agreed in the GP contract
framework; and
o phasing in the requirements of the Anticipatory Care, Personalised Care and Early
Cancer Diagnosis specifications over the period from 2020/21 to 2023/24.
• There are also significant overlaps between the requirements of the specifications and
with other elements of the wider GP contract package.
Support from the wider system:
• The establishment of PCNs will improve the links between providers of primary and
community services, so that general practice feels much more connected and supported
by the wider NHS system. CCGs will be required to play a major role in helping to co-
ordinate and support delivery of the specifications, in particular those that involve close
collaboration with other partners such as the care homes specification. CCGs will also
support PCNs to develop standard operating processes for their partnership, and ensure
a clear and agreed contribution to service delivery is made by other system partners
within Integrated Care Systems (ICSs) – documented in a local agreement. It is
recommended that the Local Medical Committee should be involved in the development
of any local agreement.
• Where the outline specifications contain requirements for community services
providers, the intention is to incorporate these into the NHS Standard Contact from
2020/21 to ensure they are taken forward in a consistent way.
• Where PCNs are struggling to recruit, CCGs and systems should take action to support
them.
Relationship with existing locally commissioned services:
• These proposals are in draft: Clinical Commissioning Groups (CCGs) should not,
therefore, take final decisions about existing locally commissioned services until the final
Network Contract DES for 2020/21 is published.
• CCGs should work with PCNs, community services providers, Local Medical
Committees (LMCs), and other stakeholders to support the transition – and, where
required, enhancement – of existing local service arrangements to meet the new
requirements.
• Funding previously invested by CCGs in local service provision which is delivered
through national specifications in 2020/21 should be reinvested within primary medical
care and community services in order to deliver the £4.5bn additional funding guarantee
for these services.
3.3 Overview of Specifications
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Structured Medications Review and Medicines Optimisation
Structured Medication Reviews (SMRs) are a NICE approved clinical intervention that help
people who have complex or problematic polypharmacy. SMRs are designed to be a
comprehensive and clinical review of a patient’s medicines and detailed aspects of their
health and are delivered by facilitating shared decision making conversations with patients
aimed at ensuring that their medication is working well for them.
The specification involves providing SMRs to people who have been identified by the PCN
as most likely to benefit from the intervention. A number of patient groups are provided and
potential tools to support with identification are suggested.
Enhanced Health in Care Homes
The Long-Term Plan and GP Contract Framework made a commitment to implementing the
clinical elements of Enhanced Health in Care Homes (EHCH) Framework nationally during
2020/21. Implementation of the EHCH service is a national priority for primary and
community care-based service integration, and the expectation is for all ICSs/STPs and
CCGs to prioritise supporting full and successful delivery.
The EHCH service will focus on national roll out of the first four clinical elements of the
EHCH framework: enhanced primary care support; multidisciplinary team support;
reablement and rehabilitation; and high-quality end-of-life care and dementia care. The
service requirements are shared across both PCNs and other providers (particularly
community services) who will work together to deliver the model.
Anticipatory Care
Anticipatory care helps people to live well and independently for longer through proactive
care for those at high risk of unwarranted health outcomes. Typically, this involves structured
proactive care and support from a multidisciplinary team (MDT). It focuses on groups of
patients with similar characteristics (for example people living with multimorbidity and/or
frailty) identified using validated tools (such as the electronic frailty index) supplemented by
professional judgement, refined on the basis of their needs and risks (such as falls or social
isolation) to create a dynamic list of patients who will be offered proactive care interventions
to improve or sustain their health.
The specification outlines that it is expected that, by 2023/24, all PCNs and community
service providers – working together – will offer an Anticipatory Care model which includes
the following components:
• Identification of specified key segments of the PCN’s registered practice populations who
have complex needs and are at high risk of unwarranted health outcomes.
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• Maintenance of a comprehensive and dynamic list of identified individuals who would
benefit from anticipatory care, based on the outcome of population segmentation.
• The delivery of a comprehensive set of support for those individuals identified as eligible
through the anticipatory care list, through an MDT based across PCNs and community
service providers.
Proposed service requirements for 2020/21 are included for PCNs and community services
providers which will support the delivery of the model.
Personalised Care
Chapter one of the NHS Long Term Plan (LTP) makes personalised care business as usual
across the health and care system as one of the five major, practical changes to the NHS
service model. Personalised care means people have choice and control over the way their
care is planned and delivered, based on ‘what matters’ to them and their individual diverse
strengths, needs and preferences.
Universal Personalised Care: Implementing the Comprehensive Model is the delivery plan
for personalised care, published by NHS England in January 2019 following the LTP. The
Comprehensive Model for Personalised Care brings together six evidence-based and inter-
linked components, each of which is defined by a standard, replicable delivery model. The
six key components are:
1. Shared decision making
2. Personalised care and support planning
3. Enabling choice, including legal rights to choose
4. Social prescribing and community-based support
5. Supported self-management
6. Personal health budgets (PHBs) and integrated personal budgets.
The specification includes increasing levels of activity across the six component areas over
the period 2020/21 to 2023/24.
Supporting Early Cancer Diagnosis
The NHS Long Term Plan (LTP) sets an ambition that, by 2028, the proportion of cancers
diagnosed at stages 1 and 2 will rise from around half now to three-quarters (75%) of cancer
patients. The specification aims to support the improvement of local early diagnosis rates.
The requirements in the specification relate to the following three domains:
• Improve referral processes across GP practices, including by introduction of locally agreed
standardised systems and processes for identifying people with suspected cancer, referral
management and safety netting.
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• Lead and coordinate the contributions of practices and the PCN to efforts to increase the
uptake of existing National Cancer Screening programmes among their local populations.
• Improve outcomes through reflective learning and collaboration with local partnerships.
The requirements will be phased over time, as capacity both within PCNs and the wider
pathway for cancer diagnosis and treatment increases. The specification summarises the
expected phasing of objectives from 2020/21 to 2023/24 and it is noted that specific
requirements will be determined in future years.
3.4 Next Steps
At the time of writing initial feedback about the specifications is being collated and will be
submitted by Wandsworth and Merton CCGs as part of the engagement process. Local work
and collaborative discussions have commenced and a programme of work will be developed
to explore the implications for PCNs and other partners, the overlap and alignment between
the specifications and existing services and initiatives and the joint work that will be required
to support implementation.
An initial facilitated session is being held between PCNs and CLCH on 16th January to discuss PCN/ community services alignment. The session will encompass benefits of alignment, process improvements and next steps.
4) Summary and Next Steps
Collaborative work is taking place involving PCNs and their Clinical Directors, Battersea
Healthcare, the CCG and other partners to support PCN development, including meeting
the priorities as detailed in the Network Contract as well as progressing local programmes.
During the remainder of 2019/20, there will be a focus on maximising the impact of the
available PCN development funding, which will include creating an action plan for each PCN,
and on planning for the introduction of the new network specifications from April 2020.
The intention is to adopt a collaborative and supportive approach to ensure the successful
delivery of new models of care and greater integration between health and care services for
the benefit of Wandsworth patients.
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Additional Roles Reimbursement 2019/20
1. Purpose
This briefing provides information regarding the 2019/20 additional roles reimbursement funding to
aid financial forecasting and to support Primary Care Networks (PCNs) to make informed decisions
about the use of their allocation.
2. Funding for Additional Roles
2.1 2019/20
In 2019/20, as part of the Network Contract Directed Enhanced Service (DES), from July 2019 all
PCNs are entitled to receive funding for one Social Prescribing Link Worker (SPLW) (100%
reimbursement) and one Clinical Pharmacist (CP) (70% reimbursement).
The associated funding is shown in the tables below. For each Wandsworth PCN the maximum
allocation (for both roles) is £53,942.25 and for Wandsworth CCG as a whole (comprising 9 PCNs) the
maximum allocation is £485,480.25.
PER PCN
Maximum reimbursable amount per annum
Maximum reimbursable amount per month
Maximum 19/20 allocation (9 months - Jul-19 to Mar-20)
Social Prescribing Link Worker (SPLW) £34,113.00 £2,842.75 £25,584.75
Clinical Pharmacist (CP) £37,810.00 £3,150.83 £28,357.50
TOTALS £71,923.00 £5,993.58 £53,942.25
WANDSWORTH (9 PCNs)
Maximum reimbursable amount per annum
Maximum reimbursable amount per month
Maximum 19/20 allocation (9 months - Jul-19 to Mar-20)
Social Prescribing Link Worker (SPLW) £307,017.00 £25,584.75 £230,262.75
Clinical Pharmacist (CP) £340,290.00 £28,357.50 £255,217.50
TOTALS £647,307.00 £53,942.25 £485,480.25
As stated in Additional Roles Reimbursement Guidance1, if PCNs do not spend their entitlement at
the start of the year as a result of a lag in recruiting the additional roles, they can look to bring
forward the recruitment of a further SPLW or CP into 2019/20 in order to use the full entitlement.
1 Available here: https://www.england.nhs.uk/wp-content/uploads/2019/12/network-contract-des-additional-roles-reimbursement-scheme-guidance-december2019.pdf
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2.2 2020/21
From April 2020, each PCN will be allocated a single combined maximum additional roles reimbursement sum which will be based on the PCN’s weighted population share (in relation to England’s total weighted population). PCNs will be able to recruit from the following roles as they require to support delivery of the Network Contract DES requirements: clinical pharmacists, social prescribing link workers, physician associates and physiotherapists. (From April 2021, paramedics can also be appointed). The total amount that can be claimed in any given year for all roles – except social prescribing link
workers - will be 70% of actual full-time equivalent salary plus employer on-costs (NI and pension) in
respect of individual additional staff, up to the maximum amounts for the relevant role.
3. 2019/20 Forecast
Across all PCNs, the projected spend for SPLWs and CPs has been calculated, and in light of this, also
the projected unallocated funding. The principles and findings of this are summarised below.
Maximum 19/20 funding:
• For each PCN, the maximum 19/20 new roles funding is £53,942.25. This is the payment that would be associated with nine months employment of 1 SPLW and 1 CP
(from Jul-19 to Mar-20).
• Across all nine Wandsworth PCNs, the maximum 19/20 new roles funding is £485,480.25 (‘Value A’).
Social Prescribing Link Workers:
• Seven Wandsworth PCNs signed up to a social prescribing model where the CCG holds the contract. For these PCNs:
o SPLW start date: 1st November 19 o Projected number of months a SPLW will be in post: 5 months o 19/20 projected spend per PCN: £14,213.75
• Two PCNs chose to proceed independently, working directly with a provider with whom they have worked previously. For these PCNs:
o SPLW start date estimate: 1st September 19 o Projected number of months a SPLW will be in post estimate: 7 months o 19/20 projected spend per PCN estimate: £19,899.25
• Across all Wandsworth PCNs, the 19/20 projected spend for currently employed SPLWs is £139,294.75 (‘Value B’).
Clinical Pharmacists:
• Six Wandsworth PCNs have a CP in post. One of these PCNs has 2 CPs. o Start dates varied from 1st June 19* to 2nd December 19. (*1 PCN appointed a CP before
1st July 19 which was when the additional new roles funding commenced). o Projected number of months a CP will be in post in 19/20 ranges from 4 to 9. o 19/20 projected spend per PCN ranges from £12,501.69 to £28,357.50.
• Three PCNs do not have a CP in post currently. It is possible that they could have their first CP in place for 2 months of 19/20.
o Potential CP start date: 1st February 2020 o Potential number of months a CP will be in post: 2 months
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o Potential 19/20 spend per PCN: £6,301.67 • Across all Wandsworth PCNs, the 19/20 projected spend for PCN CPs is £145,151.78 (‘Value C’).
o For 6 PCNs this includes the projected spend of currently employed CPs and for 3 PCNs the spend is included if CPs come into post from Feb 20.
o This reflects 1 CP per PCN; the second CP employed by 1 PCN is not included.
Projected unallocated spend:
• Across Wandsworth the total projected unallocated funding is £201,033.72 (Value A - (Value B + Value C).
• The projected unallocated funding for individual PCNs ranges from £11,371.00 to £33,426.83. • These values are underpinned by several estimates/ assumptions (as noted above).
4. Considerations
4.1 Individual PCN decision making regarding bringing forward recruitment
As a joint approach with the South West London team who are managing the payments for the
additional roles and other funding flows which form part of the Network DES, further details
regarding the roles reimbursement funding can be shared with Wandsworth PCNs. Whilst all
relevant guidance regarding roles reimbursement and the Network DES has been shared, PCNs may
benefit from considering the local calculations outlined above as PCNs may not have explored this
individually.
PCNs may want to use their current projected unallocated funding to bring forward the recruitment
of a further SPLW or CP. One PCN already has a second PCN CP in place and another has a second CP
starting imminently so the funding could be used for these roles.
However, it is relevant to note that at present it is felt that there is a level of uncertainty regarding
the new network specifications which may affect PCN decision making regarding recruiting more
staff at this point. In addition, as noted above, for 2020/21 practices will receive a single sum for four
new roles and PCNs will need to consider the implications of introducing additional CP/ SPLW
capacity in relation to what complement of staff they would be able to employ with their 2020/21
allocation.
4.2 Reallocation of funds across PCNs
There is the following statement in the Additional Roles Reimbursement Guidance published in
December (see link on pg 1): ‘NHS England strongly encourages CCGs to put in place local schemes to
share that unused financial entitlement across the other PCNs in the area to enable them to carry
out further recruitment’
At present there are no plans in place to reallocate funding across Wandsworth PCNs. There was an
early discussion about potential risks of this sort of approach at a PCN Clinical Directors meeting and
it was felt that this could create a competitive rather than collaborative ethos which would not be
desirable. However, formal decisions have not been made regarding whether this would be pursued,
and this is an area that could be considered by the Wandsworth Primary Care Commissioning
Committee.
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For 2019/20 the viability of this would need to be considered and bearing in mind the timescales
establishing a process for this is unlikely to be feasible. In addition, all PCNs have a reasonable
‘projected unallocated sum’ which should generally be able to ‘cover’ any additional recruitment
which they wish to undertake for the remainder of 2019/20.
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Wandsworth Clinical Commissioning Group Primary Care Commissioning Committee
Date Thursday, 23 January 2020
Document Title Integrated Primary Care Commissioning Update Paper
Lead Director (Name and Role)
Katherine Bugler, Director for Transforming Primary Care
Clinical Sponsor (Name and Role)
Author(s) (Name and Role)
Kate Symons & Emma Gillgrass
Agenda Item No. B03 Attachment No. B03i
Purpose (Tick as Required) Approve Discuss Note
Executive Summary Background: This report provides the Wandsworth Primary Care Committee with an update on how delegated Primary Care commissioning is being managed in Wandsworth; providing an update on some of the key programmes of work. Purpose: This paper provides the Committee with an update on the following:
• Winter COPD Scheme
• Practice Variation Visits
• An update from the Joint Primary Care Quality Review Group
• A summary of the primary care contracting decisions Reason for Committee Review: 1. The Committee are asked to note the updates for both the Winter COPD Scheme and
Practice Variation Visit update.
2. The Committee are asked to note the update from the Primary Care Quality Review
Group with specific focus on Learning Disabilities Health Checks, and QOF Results.
3. The Committee are asked to note the decisions taken over the last quarter.
Key Issues: 1. See above points
Conflicts of Interest:
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YES
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As per the usual GP COI
Mitigations: As per the usual GP COI
Recommendation: The Committee are asked to note the ongoing work that has been jointly implemented
across Primary Care under delegated commissioning arrangements.
Corporate Objectives This document will impact on the following CCG Objectives:
Improving Outcomes and Reducing Inequalities: Ensuring access to high quality and sustainable care.
Risks This document links to the following CCG risks:
None
Mitigations Actions taken to reduce any risks identified:
N/A
Financial/Resource/ QIPP Implications
None
Has an Equality Impact Assessment (EIA) been completed?
N/A
Are there any known implications for equalities? If so, what are the mitigations?
N/A.
Patient and Public Engagement and Communication
N/A.
Previous Committees/ Groups Enter any Committees/ Groups at which this document has been previously considered:
Committee/Group Name: Date Discussed:
Outcome:
Click here to enter a date.
Click here to enter a date.
Click here to enter a date.
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Supporting Documents
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General Purpose – Integrated Primary Care
Commissioning Paper Author: Kate Symons & Emma Gillgrass Sponsor: Katharine Bugler Date: January 2020
The Report 1. Winter COPD Local Incentive Scheme
The Winter COPD scheme aims to support winter resilience in 2019/20 by looking at the management of Chronic Obstructive Pulmonary Disease in Primary Care. The aim of the scheme is to improve the quality of care for patients on the Primary Care COPD QOF register, as well as to reduce A&E attendances and admissions for this population by running alongside and supporting QOF COPD reviews. A further aim of this scheme is to try to identify undiagnosed cases of COPD within the general population. The project was first run in Merton in 2017/18. Looking at secondary care data during the period the scheme was rolled out and comparing with the same period during the previous 12 months there was a reduction of 35 emergency admissions, equating to a saving of £87,500. The rationale for this scheme is that if practices were incentivised to proactively manage their COPD cohort beyond current national quality standards requirements, it is expected that there would be an improvement in quality of care provided to patients and less A&E attendances and emergency admissions. As part of the LIS practices are asked to attend a training session on COPD to include Spirometry and use of hand-held spirometers, appropriate prescribing of inhalers and inhaler technique training, use of rescue packs and latest guidance from NICE and use of EMIS search. They then have to contact patients on their COPD register to offer a rescue pack and ensure that patients have been offered smoking cessation advice where relevant and referred to Pulmonary Rehabilitation if eligible. For the case-finding arm of the project they are asked to perform an EMIS search to highlight possible cases of undiagnosed COPD and then review these patients. This project was presented through the Primary Care Ops Group and was then approved by the LMC. The offer to participate was distributed to practices in January 2020 and will run till 31st March 2020.
2. Practice Variation Visits
In 2019/20 the Primary Care Team are continuing with the Practice Variation Visit
Programme across all practices in Wandsworth. Following the successful practice variation
visits carried out by Merton CCG in 2016/17, it was recognised that it would be beneficial to
carry out similar visits with Wandsworth practices.
The Wandsworth visits started in 2017/18 and form part of the Referral Management
Programme. Due to the challenges facing the local health system and ever-increasing
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pressures on secondary care; the CCG has continued these clinically led visits to practices
with one visit per practice each year. The purpose of these visits is to identify best practice,
as well as explore areas where we know there is variation in activity, which practices may
need support to address. The feedback from these visits has been very positive and
practices have found it useful to see a breakdown of their referral rates, which enables them
to investigate specific areas further.
The 2019/20 visits are underway; 40% of Wandsworth practices have been visited and the
rest of the visits are due to take place between Jan-Mar 2020.
3. Joint Primary Care Quality Review Group (PCQRG) Update
Learning Disabilities Health Checks The NHS Long Term Plan commits to improving uptake of the existing annual health check in primary care for people aged over 14 years with a learning disability (LD), so that at least 75% of those eligible have an LD health check each year. The care of patients with learning disabilities is incentivised in primary care via QOF and the learning disability health check DES. Both of these areas of work are contractually optional but across Wandsworth all practices deliver QOF and all submit data for the LD Health Check DES. The learning disability health check DES requires practices to agree a register of patients aged 14 and over who have a learning disability and are eligible to receive a health check. Practices are then required to provide the health check on an annual basis. The intended focus is on people with moderate and severe needs. Data for 2018/19 suggests that Wandsworth Practices did not achieve the 75% target (a 55% completion rate was reported). Some local issues which may be affecting this target were identified, including the following:
• Coding issues which mean the LD registers are not complete
• Incorrect use of templates leading to data not being captured accurately
• Misinterpretation of the DES claim process (i.e. the need to submit register numbers on a quarterly, not annual, basis).
• The use of some historic read codes
• Training needs to improve confidence in coding and offering LD health checks. Following the identification of these issues, a summary document has been developed, to provide practices with additional information around the LD Health check coding and reporting process. This has been developed in collaboration with local Clinical Leads and the LMC and will be circulated to GP Practices in January 2020. The aim is to support practices in the process and show improvement against local achievement targets. The data submitted by Practices will continue to be monitored on a quarterly basis, and further support offered where appropriate. Quality and Outcomes Framework (QOF) Results 2018-19
The Quality and Outcomes Framework (QOF) is a voluntary annual reward and incentive programme for all GP surgeries in England. The objective is to improve the quality of care
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patients are given by rewarding practices, based on a number of indicators across a range of key areas. The QOF contains three main components (domains):
• Clinical: 65 indicators across 19 clinical areas, maximum 435 points available
• Public Health: Seven indicators across four clinical areas, maximum 97 points available
• Public Health Additional Services: Five indicators across two service areas, maximum 27 points available
The maximum number of points a practice could achieve in 2018-19 was 559, with each point having a value of £179.26 In 2018-19 Wandsworth practices had an average overall achievement of 96.06%, compared to a national average of 96.16%. The table below breaks down the overall achievements to Primary Care Network (PCN) level.
Area Achievement (%) Clinical
Exception Rate (%)
Overall Clinical
domains Public health
domains
Wandsworth CCG 96.06% 96.02% 96.17% 7.98%
South West London 97.26% 97.34% 96.99% 8.39%
England 96.16% 96.01% 96.85% 10.05%
Wandsworth Primary Care Networks
Balham, Tooting & Furzedown 95.44% 95.08% 96.71% 6.65%
Battersea 97.37% 97.70% 96.24% 7.69%
Brocklebank 98.17% 97.96% 98.92% 10.82%
Grafton 95.09% 94.94% 95.65% 6.84%
Nightingale 95.99% 96.42% 94.47% 8.35%
Wandle 94.24% 94.10% 94.74% 7.93%
Wandsworth 96.12% 96.19% 95.85% 9.71%
Wandsworth PRIME 96.44% 96.79% 95.22% 7.62%
West Wandsworth 96.28% 95.96% 97.40% 10.12%
The clinical domains where less than half the practices achieved 100% were Diabetes, Mental Health and Secondary Prevention of CHD. This is in line with previous years. Diabetes and Mental Health are also the clinical domains with the highest number of indicators, Diabetes has 11 indicators, and Mental Health has 7 indicators (Secondary Prevention of CHD has 4). A number of practices were identified that has a significant change either positive or negative in their total achievement, clinical achievement or clinical exception rates compared to 2017-18 data. The data for these practices will be looked at in further detail to identify of there is any support that could be offered to the practices going forward.
4. What general Primary Care Contracting decisions have been made in the last quarter?
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The following details the primary care contracting decision made from for Q3 of 2019/2020;
under business as usual arrangements.
C O N C L U S I O N
The Committee are asked to note the ongoing work that has been jointly implemented
across Primary Care under delegated commissioning arrangements.
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Wandsworth Clinical Commissioning Group Primary Care Commissioning Committee
Date Thursday, 23 January 2020
Document Title Month 5 Finance report
Lead Director (Name and Role)
Neil McDowell, Local Director of Finance
Clinical Sponsor (Name and Role)
N/A
Author(s) (Name and Role)
Robert Hudson, Local Deputy Director of Finance
Agenda Item No. B03 Attachment No. B03iii
Purpose (Tick as Required) Approve Discuss Note
Executive Summary This report covers the spend up to month 5 on Primary Care Co-commissioning, core allocation funded primary care and prescribing. Overall the Primary care budget is forecast to be £725k overspent.
The overspend is due to –
• Delegated commissioning £383k due to overall contracts and commitments beinggreater than allocation. This has been in part mitigated by non-recurrentmeasures but £383k remains outstanding.
• Prescribing £410k over due to both higher costs and usage.
• Partial mitigation due to underspend on OOH contract.
Reason for Committee Review: To note
Key Issues: 1.Significant overspend on PCC and prescribing.2.Use of non-recurrent mitigations means problem in 20/21 will be greater
Conflicts of Interest: N/A
Mitigations: N/A
XX
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Recommendation: The Committee is asked to: Note
Corporate Objectives This document will impact on the following CCG Objectives:
Statutory financial duties
Risks This document links to the following CCG risks:
N/A
Mitigations Actions taken to reduce any risks identified:
N/A
Financial/Resource/ QIPP Implications
N/A
Has an Equality Impact Assessment (EIA) been completed?
N/A
Are there any known implications for equalities? If so, what are the mitigations?
N/A
Patient and Public Engagement and Communication
N/A
Previous Committees/ Groups Enter any Committees/ Groups at which this document has been previously considered:
Committee/Group Name: Date Discussed:
Outcome:
Click here to enter a date.
Click here to enter a date.
Click here to enter a date.
Supporting Documents Primary care finance report
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Wandsworth Clinical Commissioning Group
Primary Care Finance Report
PCC - December 2019
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Wandsworth Clinical Commissioning Group
1. Month 9 Background & Overview
2. Month 9 Primary Care Overall Position
3. Primary Care Narrative
4. Recommendations
Contents
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Wandsworth Clinical Commissioning Group
• Background
• Primary Care Delegated Commissioning was introduced on 1st April 2016.
• This paper reflects information available to the CCG to support the financial position for
the nine months ended 31st December 2019
• For prescribing there is a two months time lag on receipt of data therefore forecast is
based on seven months of data
• This report covers services that are paid out of the programme and primary care
allocations. The latter covers the costs of running general practice whilst the former
covers services that the CCG has always commissioned such as local enhanced
services and prescribing.
• Overview
• Overspent by £725k due to delegated commissioning £383k and prescribing of
£410k with the balance being covered by a net underspend on Core funded primary
care excluding prescribing.
1. Month 9 Background & OverviewDecember 2019
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Wandsworth Clinical Commissioning Group
2. Primary Care Position
Full Year Budget Budget to Date Actual to Date Variance to Date Forecast ActualForecast
Variance
£000s £000s £000s £000s £000s £000s
Essential and Additional Services 37,711 28,220 28,233 (13) 37,723 (12)
Enhanced Services 450 386 374 12 442 8
Quality and Outcomes Framework (QOF) 3,084 2,390 2,390 0 3,084 0
Premises Payment 7,007 5,162 5,182 (20) 7,052 (45)
Seniority 277 208 196 12 265 12
Other Administered Funds (Maternity etc) 1,011 758 712 46 1,011 0
Personally Administered Drugs 175 131 145 (14) 175 0
Other Medical Services (15) (11) (7) (4) (15) 0Primary Care Networks
1,938 1,344 1,081 263 1,594 344
CCG Adjustments (1,105) (829) 0 (829) (177) (928)
Prior Year Accruals 0 0 (198) 198 (238) 238
Total Primary Care Delegated Budgets 50,533 37,759 38,108 (349) 50,916 (383)
Local Enhanced Services 2,200 1,650 1,640 11 2,200 0
Out Of Hours 2,622 1,967 1,793 174 2,390 232
Prescribing 36,241 27,180 27,488 (308) 36,651 (410)
Other Primary Care Budgets 7,427 5,571 5,625 (55) 7,587 (160)
Total Primary Care - BAU 99,023 74,127 74,654 (527) 99,745 (721)
Practice Transformation Support/PCN Development (£1.50 per head) 610 458 458 0 610 0
Winter COPD Scheme (QIPP Investment) 92 69 69 0 92 0
Clinical Decision Support Tool (2019-20) (QIPP Investment) 93 70 78 (8) 104 (11)
GPFV - GP Access Initiatives (WCCG) 1,601 1,201 1,195 5 1,594 7
GPFV - Primary Care at Scale - WCCG 600 450 450 0 600 0
0 0
Primary Care Investments 2,996 2,247 2,249 (3) 2,999 (3)
Total Primary Care 102,019 76,374 76,903 (530) 102,744 (725)
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Wandsworth Clinical Commissioning Group
2. Primary Care delegated budgets
£000's £000's £000's £000's £000's £000's
PMS
Essential and Additional Services 32,670 24,473 24,473 0 32,670 0
Enhanced Services 407 347 342 (5) 402 (5)
Quality and Outcomes Framework (QOF) 2,669 2,078 2,079 1 2,669 0
Premises Payment 5,949 4,383 4,405 22 5,995 46
Seniority 237 177 168 (9) 224 (13)
Other Administered Funds (Maternity etc) 881 661 664 3 881 0
Personnally Administered Drugs 157 118 129 11 157 0
Total PMS 42,970 32,237 32,261 24 42,998 28
GMS
Global Sum & MPIG 3,933 2,920 2,921 1 3,933 0
Enhanced Services 37 32 30 (2) 37 0
Quality and Outcomes Framework (QOF) 354 266 266 0 354 0
Premises Payment 681 501 501 0 681 0
Seniority 41 30 28 (2) 41 0
Other Administered Funds (Maternity etc) 103 77 43 (34) 103 0
Personnally Administered Drugs 14 10 12 2 14 0
Total GMS 5,162 3,838 3,800 (38) 5,162 0
APMS
Essential and Additional Services 1,108 827 838 11 1,120 13
Enhanced Services 7 7 3 (4) 3 (4)
Quality and Outcomes Framework (QOF) 61 46 46 0 61 0
Premises Payment 377 278 276 (2) 377 0
Seniority 0 0 0 0 0 0
Other Administered Funds (Maternity etc) 26 20 5 (15) 26 0
Personnally Administered Drugs 4 3 3 0 4 0
Total APMS 1,583 1,180 1,172 (8) 1,592 9
Other Medical Services
Indemnity Insurance 0 0 0 0 0 0
Premises valuation and other associated costs 0 0 0 0 0 0
Primary Care Networks 1,938 1,344 1,081 (263) 1,594 (344)
CCG Adjustments (1,105) (829) 0 829 (177) 928
Prior Year Accruals 0 0 (198) (198) (238) (238)
Other (15) (11) (7) 4 (15) 0
Total Other Medical Services 818 504 876 372 1,164 346
Total Primary Care Medical Services 50,533 37,759 38,108 349 50,916 383
Forecast Variance
DescriptionAnnual Budget YTD Budget
YTD Actual
Expenditure
YTD
Variance
Forecast
Outturn
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Wandsworth Clinical Commissioning Group
3. Primary Care Narrative
Delegated budgets
• £349k overspend year to date, forecast £383k by year end. However this is supported by £759k of
non-recurrent measures including old year accruals and slippage on PCN. Without non recurrent
measures the budget would be £1.1m over.
• Within the contracts themselves the budget is broadly in line.
Prescribing
• Prescribing continues to overspend, forecasted to be £0.4m over by year end. This is caused by
increases in Libre, DOAC and Cat M with flu expected to impact in the winter months.
Core funded Primary Care
• Broadly in line with an underspend on the Out of Hours Contract covering a shortfall of income on the
Junction.
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Wandsworth Clinical Commissioning Group
4. Recommendations
The Primary Care Committee are asked to note the outturn financial
position.
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Wandsworth Clinical Commissioning Group Primary Care Committee Meeting
Date Thursday, 23 January 2020
Document Title Wandsworth PMS Specification Update
Lead Director (Name and Role)
Katie Bugler, Director for Transforming Primary Care
Clinical Sponsor (Name and Role)
N/A
Author(s) (Name and Role)
Tanya Stacey – Senior Primary Care Commissioning Manager
Agenda Item No. B04 Attachment No. B04i
Purpose (Tick as Required) Approve Discuss Note
Purpose The purpose of this paper is to provide the Wandsworth Primary Care Committee (PCC) with an update on the progress of the PMS premium services which were implemented following a review and development process in 2017. Where required, data submissions are received from Practices on a quarterly or annual basis and are monitored by the CCG. This paper presents the findings to date of this data analysis and recommendations for actions resulting from this.
Reason for Committee Review:
The monitoring of Practice data submissions has allowed us to identify some encouraging
improvements which will result in improved patient care. The Primary Care Committee
are asked to note the information in this paper and the planned next steps.
Key Issues: The key area for the Committee to note is:
• Analysis section – outcomes from data analysis in relation to the following specifications: o PS1: Improvement in the Provision of a Comprehensive Annual Diabetes Review
(8 care processes) in Primary Care o PS2: Increasing the uptake of Influenza Vaccination in Primary Care for over 65s o PS3: To Support Improvement in Uptake of Childhood Immunisations o PS4: Supporting uptake of Bowel Cancer Screening in Primary Care
Conflicts of Interest: N/A
XX
YES
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Mitigations: N/A
Recommendation: N/A
Corporate Objectives This document will impact on the following CCG Objectives:
This document impacts on the following Corporate Objectives:
• Commission high quality services which improve outcomes and reduce inequalities
• Make the best use of resources, continually improve performance and deliver statutory responsibilities
• Develop the CCG as a continuously improving and effective commissioning organisation
Risks This document links to the following CCG risks:
N/A
Mitigations Actions taken to reduce any risks identified:
N/A
Financial/Resource/ QIPP Implications
N/A
Has an Equality Impact Assessment (EIA) been completed?
N/A
Are there any known implications for equalities? If so, what are the mitigations?
N/A
Patient and Public Engagement and Communication
N/A
Previous Committees/
Committee/Group Name: Date Discussed:
Outcome:
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Groups Enter any Committees/ Groups at which this document has been previously considered:
N/A Click here to enter a date.
Supporting Documents
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Wandsworth PMS Specification Update Author: Tanya Stacey Sponsor: Katharine Bugler Date: January 2020
Executive Summary
Context The purpose of this paper is to provide the Wandsworth Primary Care Committee (PCC)
with an update on the progress of the PMS premium services which were implemented
following a review and development process in 2017. Where required, data submissions are
received from Practices on a quarterly or annual basis and are monitored by the CCG. This
paper presents the findings to date of this data analysis and recommendations for actions
resulting from this.
Question(s) this paper addresses
This paper addresses the following key question:
• What themes have been identified from the PMS Premium Service data that
has been submitted to date?
Data related to the following premium services has been reported in this paper;
• PS1: Improvement in the Provision of a Comprehensive Annual Diabetes Review (8
care processes) in Primary Care
• PS2: Increasing the uptake of Influenza Vaccination in Primary Care for over 65s
• PS3: To Support Improvement in Uptake of Childhood Immunisations
• PS4: Supporting uptake of Bowel Cancer Screening in Primary Care
Conclusion
The monitoring of Practice data submissions has allowed us to identify some encouraging
improvements which will result in improved patient care. The Primary Care Committee are
asked to note the information in this paper and the planned next steps.
W A N D S W O R T H C C G P A G E 1 O F 7
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The Report
F U R T H E R C O N T E X T
Background to the PMS Review Process
The importance of continuing to develop a strong and stable General Practice infrastructure
across Wandsworth cannot be understated. Primary Care is crucial to managing the out of
hospital challenges facing the local health and social care sector .
The most recent PMS Review in 2017 was an opportunity for the CCG to contractualise the
delivery of a number of key strategic initiatives within General Practice. A PMS Working
Group was established and regular meetings with the Local Medical Council (LMC) took
place in order to refine and develop the local PMS premium offer.
Following discussions with the Executive Management Team (EMT) a number of
overarching priorities were agreed which the PMS offer would support the CCG in delivering
against. These included:
• Delivering quality across Primary Care,
• Creating sustainability in Primary Care,
• Supporting Primary Care Transformation.
The PMS Premium relates to the locally designed service areas that were developed as part
of the review process in conjunction with local clinicians and clinical leads, clinical reference
groups, Public Health and the LMC. They are as follows;
• PS1: Improvement in the Provision of a Comprehensive Annual Diabetes Review (8
care processes) in Primary Care
• PS2: Increasing the uptake of Influenza Vaccination in Primary Care for over 65s
• PS3: To Support Improvement in Uptake of Childhood Immunisations
• PS4: Supporting uptake of Bowel Cancer Screening in Primary Care
• PS5: Increasing Use of Referral Management Software to Support Appropriate &
High Quality Referrals from Primary Care
• PS6: Make a Difference (MAD) Alerts
• PS7: Registered Patients Residing in Deprived Areas
• PS8: Supporting the management of Children in Primary Care (under 5s)
In total there are 39 Practices in Wandsworth; 28 of which are PMS Practices, 9 GMS and
2 APMS Practices.
Following the implementation of the above specifications, a PMS Review group was set up
which meets quarterly to monitor and discuss the data that has been submitted by Practices
as part of their PMS reporting requirements. The validity and appropriateness of the PMS
Premium specifications is also continually reviewed at these meetings.
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The purpose of this paper is to update the committee on any observations made to date
regarding performance against the aims of the PMS Premium specifications. Due to the
nature and frequency of data submitted, this paper will focus on the following areas;
• PS1: Improvement in the Provision of a Comprehensive Annual Diabetes Review (8
care processes) in Primary Care
• PS2: Increasing the uptake of Influenza Vaccination in Primary Care for over 65s
• PS3: To Support Improvement in Uptake of Childhood Immunisations
• PS4: Supporting uptake of Bowel Cancer Screening in Primary Care
A N A L Y S I S
What themes have been identified from the PMS Premium specification data
submitted to date?
1. PS1: Improvement in the Provision of a Comprehensive Annual Diabetes Review
(8 care processes) in Primary Care
The Wandsworth PMS service specification relating to diabetes has been in place since 1st
April 2018 in all PMS and GMS Practices in the borough). The specification supports GP
practices to provide a comprehensive and proactive annual review of their diabetic patients.
This aims to reduce morbidity and encourage self-management and lifestyle changes with
the benefit of reducing the need for unplanned care in primary and secondary care.
NICE guidelines set out eight clinical care processes that should be completed, which are
as follows;
• Weight
• Blood Pressure
• Smoking Status
• HbA1c
• Urinary Albumin
• Serum Creatinine
• Cholesterol
• Foot Surveillance
As part of the specification, Practices have been required to participate annually in the
National Diabetes Audit (NDA), using their previous audit results as a baseline. The NDA
monitors the percentage of patients who have received the eight care processes.
Achievement targets were set for each Practice, taking into account their baseline
performance in the NDA 2015/16, the Wandsworth CCG average and the London and
England averages for this indicator. Practices have been asked to submit their achievement
against these targets on an annual basis. Figure 1 outlines the progress of each Practice as
of 31st March 2019, and demonstrates the following;
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• 25 out of 37 Practices (68%) have already met or exceeded their 2020/21 target
• 32 out of 36 Practices (89%) demonstrated an improvement in 2018/19 when
compared to the previous year (one Practice did not submit data)
• 31 out of 34 Practices (91%) demonstrated an improvement in 2018/19 when
compared to the 2015/16 baseline data (data not available for 3 Practices)
2. PS2: Increasing the uptake of Influenza Vaccination in Primary Care for over 65s
Influenza occurs every winter in the UK and is a key factor in the NHS in Winter Pressures.
It impacts on those who become ill, the NHS Service that provide direct care, and on the
wider health and social care system that support the at risk groups. In the two years prior
to the PMS premium specification being introduced, there was a decline in the percentage
uptake of influenza vaccine in those over 65 years old.
The specification aims to support practices to implement systems to help support
improvements in the uptake of the flu vaccination.
Practices have been set achievement targets based around a stepped improvement model
which aims to see all practices achieving the national target requirements (70%) by 2020/21.
As uptake data is submitted on an annual basis, the most recent data available is from Q4
2018/19 which tells us the following;
• 15 Practices have demonstrated an increase in uptake rates when compared to their
baseline uptake (recorded February 2017).
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WCCG PS1: Diabetes Annual ReviewDiabetic patients in whom all 8 care processes measurements have been undertaken annually
2018/19
Q1 YE Baseline (National NDA Data) 2020/21 Target 2020/21 TargetPMS GMS
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• 14 Practices exceeded their 2018/19 target.
Those practices who did not meet their 2018/19 targets were asked to submit an action plan
to identify a method for increasing uptake during 2019/20. The CCG also reviews this
information and offers support to Practices where appropriate. As data is submitted on an
annual basis, the impact of this work will be assessed after the end of Q4 2019/20.
3. PS3: To Support Improvement in Uptake of Childhood Immunisations
Primary Care offer a schedule of immunisations to children from birth to 5 years of age. This
programme ensures that Children are protected from serious disease and complications of
those diseases. There are many reasons for non-attendance for immunisations and this
affects uptake rates. It is also important to identify patients who are not attending as it may
present a safeguarding concern.
The premium service supports practices in establishing and subsequently reviewing their
systems for calling children who do not attend their routine immunisations. Practices are
required to submit the following:
• Practices to complete and submit an initial baseline assessment template by 31st
March 2018
• Report the number of children aged 1 whose notes record the 5-in-1 vaccine has been
administered.
• Report the number of children over 2 and less than 3 who have received the
recommended immunisation courses
• Report the number of children over 5 and less than 6 who have received the
recommended reinforcing doses
• Practices to submit a progress report at 6 months
• Practices to submit an annual action plan which will include lesson learned and
information regarding the number of non-attendees and the reasons given i.e.
recurrent non responder, declined, accessing vaccination privately or abroad
When comparing the data received in Q1 2017/18 to that received in Q1 2018/19, we can
observe the following points;
• There was an improvement in immunisations rates for 2 year olds in 13 Practices
• There was an improvement in immunisations rates for 5 year olds in 8 Practices
Looking at immunisation data on a London and national level, it is evident that meeting the
national target of 90% coverage is a widespread challenge. Using the data and action plans
submitted through the PMS premium requirements, it will be important for learning to be
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shared and for Practices to be offered support to implement new processes to improve
uptake in the remaining practices.
4. PS4: Supporting uptake of Bowel Cancer Screening in Primary Care
Bowel Cancer is the third most common cancer in Wandsworth in both sexes and the
incidence has been rising. Bowel Cancer screening uptake has been historically poor in
Wandsworth at around 40% compared to the National Quality Standard of 60%.
As part of the PMS Premium which commenced from 1st April 2019, Practices have been
asked to identify and contact patients who have not responded to the bowel screening invite
and encourage participation by practice endorsement, advice and help. Practices are also
asked to identify all non-responders within the last 12 months using searches, they will then
be expected to contact these patients via a letter or telephone call to promote and endorse
the screening service. Evidence shows that such GP endorsement of bowel screening can
increase uptake by 10%.
When comparing the Q1 2018 submission to the Q2 2019 submission (latest data available),
the following points emerge;
i. Uptake of Bowel Cancer Screening
• As shown in the graph overleaf, 25 of the 37 reporting Practices demonstrated an
increase in uptake, compared to only 10 Practices who saw a decrease (2 Practices
saw no change)
• The Practices who reported a decrease in uptake saw quite a significant decrease,
with ranges from -3% to -55%, whereas where increases were reported, these were
less significant at +3% to +28%.
• However, overall there has been a 6% reduction in the uptake of bowel cancer
screening across all reporting Practices
Based on the above observations, it is recommended that the CCG works with the 10
Practices who reported decreases in uptake to better understand any reasoning behind this.
Based on Practice feedback, it would also be beneficial to ensure the searches being used
are accurate. Additionally, it will be important to ask Practices who reported an increase in
uptake how this was achieved with the view to share learning across the borough.
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ii. Number of people who have not responded to bowel screening invitation
• Overall, 865 more people did not respond to their bowel screening invite.
iii. Number of people who have been contacted via information letter, leaflet or telephone
• Overall, 1610 more people have been contacted by their Practice after not responding
to their bowel screening invitation. This demonstrates that Practices are being more
proactive and have put systems in place to contact non-responders.
iv. Number of people who have actively declined bowel cancer screening
• Overall, 313 more people actively declined bowel cancer screening. The majority of
these (275) were at one Practice so it is recommended that the CCG works with this
Practice to look into any reasons relating to this significant change.
C O N C L U S I O N
Following the implementation of the PMS premium services, as detailed in this paper, the
consistent monitoring of Practice data submissions has allowed us to identify some
encouraging improvements which will result in improved patient care. The Primary Care
Committee are asked to note the information in this paper and the planned next steps.
0%
10%
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Uptake of Bowel Cancer ScreeningQ1 2018/19 vs Q2 2019/20
Q1 2018/19 Q2 2019/20
PMS GMS
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For Reference Edit as appropriate:
1. The following were considered when preparing this report:
The long-term implications [Yes]
The risks [Yes]
Impact on our reputation [Yes]
Impact on our patients [Yes]
Impact on our providers [Yes]
Impact on our finances [Yes]
Equality impact assessment [Not applicable]
Patient and public involvement [Not applicable]
2. This paper relates to the following corporate objectives:
• Commission high quality services which improve outcomes and reduce
inequalities [Yes]
• Make the best use of resources, continually improve performance and deliver
statutory responsibilities [Yes]
• Continually improve delivery by listening to and collaborating with our patients,
members, stakeholders and communities [Not applicable]
• Transform models of care to improve access, ensuring that the right model of care
is delivered in the right setting [Not applicable]
• Develop the CCG as a continuously improving and effective commissioning
organisation [Yes]
3. Executive Summaries should not exceed 1 page. [My paper does comply]
4. Papers should not ordinarily exceed 10 pages including appendices.
[My paper does comply]
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Wandsworth Clinical Commissioning Group Primary Care Commissioning Committee
Date Thursday, 23 January 2020
Document Title Governance for Primary Care Across SWL
Lead Director (Name and Role)
Andrew McMylor SWL Director Primary Care
Clinical Sponsor (Name and Role)
Author(s) (Name and Role)
Andrew McMylor SWL Director Primary Care
Agenda Item No. B05 Attachment No. B05i
Purpose (Tick as Required) Approve Discuss Note
Executive Summary Background: The paper, along with the attached FAQ slide set, articulate the process for primary care
governance from April 1st 2020. This governance principally concerns matters pertaining
to core general practice contracts, and follows an established process across the UK.
Within SWL we have ensured these processes can be transacted as locally as possible,
in order to strengthen and empower primary care within each Borough. This enables each
Borough to maintain control over primary care budgets and strategy; but safe in the
knowledge there is an agreed process for ensuring the contracting of primary care is
conducted as efficiently as possible.
Reason for Committee Review: 1. The Committee are asked to note the proposals for the new governance arrangements
in particular the role of the new SWL Primary Care Committee from April 2020.
Key Issues: 1. The Role of the SWL PCCC from 1st April 2. The Worked Examples 3. The reporting arrangements
Conflicts of Interest: As per the usual GP COI
Mitigations:
XX
YES
80 of 90
As per the usual GP COI
Recommendation: The Committee are asked to note the proposals for the new governance arrangements
for Primary Care across SWL in particular the role of the new SWL Primary Care
Committee
Corporate Objectives This document will impact on the following CCG Objectives:
Improving Outcomes and Reducing Inequalities: Ensuring access to high quality and sustainable care.
Risks This document links to the following CCG risks:
None
Mitigations Actions taken to reduce any risks identified:
N/A
Financial/Resource/ QIPP Implications
None
Has an Equality Impact Assessment (EIA) been completed?
N/A
Are there any known implications for equalities? If so, what are the mitigations?
N/A.
Patient and Public Engagement and Communication
N/A.
Previous Committees/ Groups Enter any Committees/ Groups at which this document has been previously considered:
Committee/Group Name: Date Discussed:
Outcome:
Click here to enter a date.
Click here to enter a date.
Click here to enter a date.
81 of 90
Supporting Documents
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General Purpose – Integrated Primary Care Commissioning Paper Author: Andrew McMylor Date: January 2020
The Report 1. The Function of Primary Care Commissioning Committees
Primary Care Commissioning Committees (PCCCs) deliver the statutory functions of
CCGs as set out by NHS England as part of the delegation agreement for primary
care.
Functions PCCCs deliver include ratifying new incentive schemes, agreeing significant
changes to practices or overseeing primary care contracts.
We currently have six PCCCs in SWL (i.e. one for each CCG). All operate with very
similar terms of reference and membership given the statutory functions are the same
for each.
Each PCCC is supported locally by Primary Care teams with the support of the SWL
contracting team.
Typically they meet every two to three months in public and along with ensuring the
statutory functions are delivered, also provide a steer on the local primary care
strategy and budget.
2. The role of the SWL PCCC from April 1st 2020
In keeping with the commitment to maintain and enhance primary care locally, we
propose to transact as much business as possible at Borough level. The terms of
reference for the PCCC are attached as an appendix to this paper, and have been
developed following detailed discussions with the Surrey & Sussex Local Medical
Committee.
Whilst we are required to have a single PCCC for SWL to mirror one CCG, the PCCC
only needs to ensure the statutory functions are delivered. These are articulated in the
attached terms of reference and include the following;
• GMS, PMS and APMS contracts; taking contractual action such as issuing
breach/remedial notices, and removing a contract;
• Ratification of newly designed Local Incentive Schemes (LISs) on the
recommendation of the relevant Borough Committee of the CCG.
• Ratification of newly designed local incentive schemes as an alternative to the
Quality Outcomes Framework (QOF) on the recommendation of the relevant
Borough Committee of the CCG.
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• Decision making on whether to establish new GP practices in an area on the
recommendation of the relevant Borough Committee of the CCG.
• Approving practice mergers on the recommendation of the relevant Borough
Level Committee of the CCG; and
• Making decisions on ‘discretionary’ payments where Standard Operating
Procedures do not exist on the recommendation of the relevant Borough
Committee of the CCG.
It is important to note that the PCCC membership will contain a representative of the
Wandsworth Committee.
The terms of reference for the PCCC are very similar to the existing Wandsworth
PCCC given the statutory functions will be the same. We envisage the PCCC meeting
every two months in public initially.
This approach will ensure that primary care continues to be strengthened and
empowered within Wandsworth with only matters needing formal PCCC ratification
being escalated.
3. The role of the Wandsworth Primary Care Management Group
Wandsworth will have its own formal Primary Care Management Group (PCMG) where
the vast majority of business can be agreed, delivered and monitored. Typically this
will be chaired by a Wandsworth senior manager with membership including local GP
colleagues.
The PCMG will report into the Wandsworth Committee who in turn will ensure the
PCCC receive the appropriate papers.
Only decisions formally needing PCCC approval will be sent to the PCCC.
The Wandsworth Committee may ask for advice or guidance from SWL colleagues
before making a local decision. Such an advisory group would help us share our
learning and make sure we are making the right decisions for local people, including
managing any conflicts of interest if these could not be resolved locally.
4. Reporting Arrangements
In order to ensure the smooth running of the PCCC, the Wandsworth Committee and
the PCMG need to establish clear reporting lines.
Wandsworth Primary Care Management Group:
Reports to. The Wandsworth Committee; establishing appropriate relationships with
other committees for example quality and finance where required. It should be noted
the vast majority of primary care contracting is considered ‘business as usual’ and
would not need discussion at the PCMG.
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Membership. Monthly meeting chaired by a Wandsworth senior manager with
membership including local GPs, the LMC and the SWL contracting team. Its function
is to have an understanding of all matters concerning local primary care, with a specific
approvals and recommendations remit.
Responsible for. Across London and the UK, Standard Operating Protocols have
been agreed covering a number of transactional elements. For example, a request to
vary a contract (e.g. one Partner retiring) or a small boundary change amendment
request. These areas can be discussed and agreed at the PCMG without further
escalation providing any conflicts of interest are managed accordingly.
However, there will be a number of functions that cannot be resolved by the PCMG.
For example, a contract termination. On these matters the PCMG will develop a paper
for the Wandsworth Committee and/or key officers to scrutinise before a paper along
with recommendation is sent to the PCCC to make a formal decision.
The Wandsworth Committee may not require papers for some functions however it is
suggested members receive the papers before being sent to the PCCC, and as such
the Wandsworth Committee will act as a gate-keeper for the PCCC. This will ensure
that all local leaders are fully sighted on Wandsworth primary care matters.
Worked example – new APMS contract
Where it has been identified a new APMS contract is required in Wandsworth area (for
example, a closure of a large practice requiring new capacity) the following process
would be used;
The Primary Care Management Group would develop the procurement documents,
and with the input of local GPs, recommend any relevant targets for any new provider
to attain.
The Wandsworth Committee would take a wider-system view in ensuring that the
service provider will play a strong role in the Wandsworth health and care system, and
also that the PCMG has developed a strong service model for the provider to deliver
against. The Wandsworth Committee would then recommend approval to the PCCC.
The Primary Care Commissioning Committee would formally authorise the
establishment of a new APMS provider and assure itself that the process followed in
Wandsworth was compliant with good-practise procurement and will deliver value for
money.
Members of the Primary Care Management Group would then oversee the
implementation of the contract, and offer support to the new provider.
Worked example - Practices merging
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Members of the Primary Care Management Group would meet with the practices to
understand the proposal and to work with them to ensure due process is followed, for
example, to consult with patients and to ensure the proposal would maintain or
enhance existing service delivery.
The Primary Care Management Group (managing conflicts of interest accordingly)
would scrutinise the subsequent business case proposal from the practices and
assure itself that any service changes are clearly articulated, for example, a change
of location(s) or opening hours of bases. In addition to ensure that any risks are
highlighted and mitigated.
The Primary Care Management Group would also work with the practice to ensure key
changes, for example, new IT configuration have a deliverable action plan.
The Wandsworth Committee will seek assurances from the PCMG that the proposal
supports the wider primary care strategy of the borough, for example, in the
development of Primary Care Networks.
The Wandsworth Committee, or key officer(s) will make a formal recommendation to
the Primary Care Commissioning Committee that due process has been followed and
the proposal maintains or enhances existing service delivery.
The Primary Care Commissioning Committee would formally authorise the merger
assuring itself that all the appropriate documentation has been completed satisfactorily
via the PCMG and Wandsworth Committee. Where members of the PCCC require
further information, this will be provided in advance so that a decision can be made at
the next available opportunity. As applications to merge must be submitted four months
in advance, scheduling onto a PCCC agenda will be achieved without causing a delay
to the process.
Members of the Primary Care Management Group would then oversee the contract,
as per other primary care contracts.
5. Summary
The paper, along with the attached terms of reference for the Wandsworth PCMG,
SWL PCCC and FAQ slide set, articulate the process for primary care governance
from April 1st 2020. This governance principally concerns matters pertaining to core
general practice contracts, and follows an established process across the UK.
Within SWL we have ensured these processes can be transacted as locally as
possible, in order to strengthen and empower primary care within each Borough. This
enables each Borough to maintain control over primary care budgets and strategy; but
safe in the knowledge there is an agreed process for ensuring the contracting of
primary care is conducted as efficiently as possible.
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Within Wandsworth, work has begun to ensure the PCMG will begin to operate
effectively ahead of April 1st so that there is sufficient time to embed ways of working
in the context of one SWL PCCC.
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Primary Care Governance Summary – conflicts will need to be managed at all levels
PCMG Local Committee SWL PCCC
Chaired by Locally agreed senior person A local GP/ other if conflicted A lay member of the CCG governing body
Meeting frequency / notes Monthly Reports to the Local Committee
Monthly Every two months Reports to the CCG governing body
Key members Will include a number of local GPs including the LMC
Members of the local primary care team
Retains clinical majority – if conflicted will manage these locally on advice from the PCCC
Will include a representative of each local committee
LMC to be present as a non-voting member mirroring current arrangements
Primary care remit Oversee the day-to-day business of primary care; including making decisions where a clear procedure exists (see below)
Making recommendations to the Local Committee (and/or key officers) where a SWL PCCC decision is needed
Maintaining primary care at the heart of local system plans
Receiving papers from the PCMG and making formal recommendations to the SWL PCCC
Comply with the statutory duties the CCG has with regards to primary care
Outline of key primary care responsibilities
Agreeing a number of actions where clear procedures exist, for example;List closureList suspensionBoundary changesDiscretionary paymentsContractual changes (transactional)Locum reimbursementsGP performer payments, e.g. sick pay
Develop and oversee the implementation of the primary care strategy
Ensure the wider health and care system is inclusive of primary care and that primary care views are taken account
To receive papers and recommendations from the Local Committee (having first been developed by the PCMG) in respect of;Taking contractual action such as issuing breach noticesApproving new local incentive schemesApproving practice mergersEstablishing new GP practices
Comparison to now Each PCMG meets in a similar manner to what is being proposed however not all have an approvals role. By ensuring clear decision-making at PCMG we will reduce duplication and reduce the time it takes to make decisions, without the need for PCCC approval
Whilst there is no Local Committee, the existing CCG governing bodies perform a similar role in setting the overall primary care strategy
The six existing PCCCs often undertake the roles that PCMGs can deliver, and thereby we are confident that moving to one PCCC will not mean six times the work
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Primary Care Commissioning - FAQ
Who will the voting members be on the SWL PCCC, and how different is it to now?
In keeping with NHS England requirements, the PCCC will be chaired by a lay member along with key CCG officers. Local GPs will be non-voting members so they can provide advice and guidance to the voting members. The voting members are very similar to the existing PCCCs. This is because the requirements from NHS England on this are very clear.
Why can’t local GPs be a voting member of the PCCC?
Again, the requirements from NHS England are clear on this, and since PCCCs started over three years ago, none have had local GPs as voting members. The PCCC exists to ensure that any possible conflicts of interest, for example in the development of a new service with funding going to local GPs, are managed appropriately.
The PCCC has a vital governance role in ensuring that matters around individual contracts or new services have been developedfairly and there is no risk of a legal challenge. In fulfilling this role the PCCC acts as an important safety net to protect the integrity of the CCG and its Member practices.
What will be the relationship between the SWL PCCC and the Local Committee and PCMG?
The local PCMG and Local Committee will be responsible for developing any proposals that require the approval of the PCCC. Typically this is where the proposal recommends payment to GP practices or a decision has a large impact on one individual contract. The PCCC will receive all its information, along with a recommendation from the Local Committee on what to approve andwhy. The PCCC then acts as the final check to ensure the proposal represents good value for money and has been developed fairly.
Will the SWL PCCC reject local recommendations?
This is not the intention of the SWL PCCC. In the unlikely event the SWL PCCC had reason to question how a service or a proposal was developed, before approving it, the PCCC would wish to work with the Local Committee and PCMG to answer any questions.
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Primary Care Commissioning - FAQ
Will the SWL PCCC be responsible for the primary care strategy across each Borough?
No, this sits firmly with the Local Committee and our commitment to enhance primary care support locally.
Won’t the SWL PCCC just do all the work of the six existing PCCCs?
Many changes affecting GP practices do not need the approval of the PCCC. For example, discretionary payments, GP rent reviewprocess, boundary changes, infection control and contract changes (for example, addition of a new Partner) can all be approved locally. Where items that significantly affect a contract require approval, for example a PMS Review, contract termination or merger along with the award of a new contract, only these matters need the approval of the PCCC. As stated, before they reach the SWL PCCC each will have been discussed locally with a recommendation made to the SWL PCCC.
Won’t have a meeting every two months slow our progress locally if we want to deliver a service?
Firstly, we would expect that the SWL PCCC will ‘forward plan’ so would know in advance of any new proposals requiring its approval, so that it could be timetabled accordingly. However if something required an urgent approval, then there are a number of options available. For example, the Chair could take a ‘Chair’s action’ in consultation with other voting-members to approve with the decision communicated at the next meeting in public. Of course, we could decide to meet more frequently and as such we will keep this under review.
Will the SWL PCCC manage primary care budgets?
No, this is delegated to the Local Committee to manage accordingly. This includes both core contracts as well as locally designed incentive schemes.
How will we ensure sufficient local debate and input into primary care?
By having more local GP input at the PCMG including the LMC we are confident this will ensure a healthy and robust debate. Equally, by having a clinical majority on the Local Committee, and by having the budgets delegated locally, there are a number of ways in which to input into primary care.
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