southeasternhampshireccgandfareham&gosportccg ... · minutes of the previous meetings purpose...

South Eastern Hampshire CCG and Fareham & Gosport CCGPrimary Care Commissioning Committee in Public

Board Room, CommCen Building, Fort Southwick, james Callaghan Drive, Fareham, PO17 6AR7 March 2018 14:00 - 7 March 2018 15:30

Overall of 66

AGENDA

# Description Owner Time

1 Chair's welcome and apologies Chair 1400

2 Register and declarations of interest

Item 2 - Register of Interest Cover Sheet.docx 5

Item 2 - PCCC Register of Interests.pdf 7

Chair 1402

3 Minutes of previous meeting

Item 3 - minutes of previous meeting cover sheet.d... 11

Item 3 - minutes of previous meeting 2017 12 06.do... 13

Chair 1405

4 Matters arising Chair 1410

5 General Practice ProfileUpdate to note

Item 5 - Performance Profile.docx 19

Primary Care Clinical Lead

1420

6 Finance ReportUpdate to note

Item 6 - finance cover sheet.DOCX 25

Item 6 - finance update.xlsx 27

Chief FinanceOfficer

1440

7 Quality ReportUpdate to note

Item 7 - Quality report coversheet 2018.docx 29

Item 7 - Quality report.pptx 31

Director of Quality and

Nursing

1455

8 Communication and Engagement ReportUpdate to note

Item 8 - Comms and Engagement report cover she... 41

Item 8 Comms and Engement report.docx 43

Director of Primary Care Development

1510

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# Description Owner Time

9 Revised Terms of Referencefor decision

Item 9 - Revised Terms of Reference.docx 49

Item 9 - FG ToRs.docx 51

Item 9 - SEH ToRs.docx 59

Head of Primary Care

1520

10 Any Other Businessfor discussion

Chair 1525

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INDEX

Item 2 - Register of Interest Cover Sheet.docx..............................................................................5

Item 2 - PCCC Register of Interests.pdf.........................................................................................7

Item 3 - minutes of previous meeting cover sheet.docx.................................................................11

Item 3 - minutes of previous meeting 2017 12 06.docx..................................................................13

Item 5 - Performance Profile.docx..................................................................................................19

Item 6 - finance cover sheet.DOCX................................................................................................25

Item 6 - finance update.xlsx............................................................................................................27

Item 7 - Quality report coversheet 2018.docx.................................................................................29

Item 7 - Quality report.pptx.............................................................................................................31

Item 8 - Comms and Engagement report cover sheet.docx...........................................................41

Item 8 Comms and Engement report.docx.....................................................................................43

Item 9 - Revised Terms of Reference.docx....................................................................................49

Item 9 - FG ToRs.docx...................................................................................................................51

Item 9 - SEH ToRs.docx.................................................................................................................59

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1

Primary Care Commissioning Committee

Date of Meeting 7 March 2018

Title Register and Declarations of Interest

Purpose of Paper This paper sets out the relevant and material interests of the members of the Primary Care Commissioning Committee

Executive Summary of Paper

PCCC members and officers are required to declare any personal or business interests they may have which may affect, or be perceived to affect, the conduct of their role within the PCCC. This includes any interests that may influence their judgement in the course of conducting the business of the PCCC. Members must also declare any interests held by family members or persons or bodies with which they are connected.

Key Issues to consider

Interests relating to any item on the agenda Oral updates on the interests of members

Recommendations/ Actions requested

The Primary Care Commissioning Committee is asked to: Receive and note the Register of Interests of Members Receive any oral updates on the Interests of Members Declare any interests relating to any item on the agenda

Author Lesley WinterGovernance and Committee Support Officer

Sponsoring member

Sara TillerDirector of Primary Care

Date 05/03/18

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2

CORPORATE STRATEGIC LINKS

This is a statutory requirementThis is an issue of corporate governance

ENGAGEMENT ACTIVITY

Engagement Activity Not required

EQUALITY AND DIVERSITY

Equality and Diversity Not required

Other committees/ groups where evidence supporting this paper has been considered

None

Supporting documents

None

Page 2 of 2Item 2 - Register of Interest Cover Sheet.docxOverall of 66

Primary Care Commissioning Committee

05 March 2018

First Name Surname Role Declared Interest - Name and Nature of Business CCG?

Sarah Anderson Lay Member Governance & Audit Trustee, No Limits Fareham & Gosport CCG

Sarah Anderson Lay Member Governance & Audit Director and owner of Hollybrook Associates Limited

Fareham & Gosport CCG

Sarah Anderson Lay Member Governance & Audit Trustee and Company Secretary, Moving on Project


Molly Bailey Primary Care Officer No interests to be declared Both

Lisa Baker Primary Care Development Officer Registered patient at Westlands Medical Centre Both

Natalie Barker Primary Care Engagement & Contract Officer

No interests to be declared Both

Julia Barton Director of Quality and Nursing/Registered Nurse

Friends with the family of contractor, Marcus Pullen, director of Blue Donut Studios

Both

Alex Berry Director of Transformation No interests to be declared Both

David Chilvers Clinical Chair GP and Member of the GP Alliance and MCP early adopter


David Chilvers Clinical Chair Partner in GP practice, Waterside, which is now in partnership with Southern Health. Now a salaried employee of Southern Health


David Chilvers Clinical Chair Undertakes section 12(2) Mental Health Act assessments for Social Services


Cynthia Condliffe Designated Nurse Safeguarding Children West Hampshire CCGs

No interests to be declared Other

Lucy Docherty Lay Member Commissioning and Procurement

Spouse works for HCC Childrens services in a senior position



Close relative is an employee of Portsmouth Hospitals NHS Trust



Chair of Portsmouth Diocese Council for Social Responsibility


Page 1 of 4Item 2 - PCCC Register of Interests.pdfOverall of 66



Chair of Fareham Good Neighbours Fareham & Gosport CCG

Alison Edgington Director of Delivery for 3 CCGs Executive Interim Executive Solutions SEH CCG, Fareham & Gosport CCG, Portsmouth CCG

Keeley Ellis Head of Primary Care Sister working in Commissioning Team Both

Susanne Hasselmann Lay Member (Joint Chair of Audit Committee) (Co-Chair: QAC)

Board Member, NHS Clinical Commissioners (Chair of CCG Lay Member Network)

South Eastern Hants CCG


Husband is trustee of Valley Leisure South Eastern Hants CCG


Chair of Wessex PDLP (Performers List Decision Panel)



Husband is Director of System Delivery, Southampton City CCG



Director & Owner of Scirum Ltd South Eastern Hants CCG

Andrew Holden Clinical Lead - Membership Engagement

Partner Swan Medical Group Petersfield South Eastern Hants CCG


Wife is Partner at Liss and Liphook Surgery South Eastern Hants CCG


Local Medical Committee - Representative for Hampshire & IOW LMC



Supporter - Friends of Petersfield Hospital South Eastern Hants CCG


Swan Medical Group is a member practice of South Eastern Hampshire and Fareham and Gosport Alliance Limited



Wenham Holt (Chase Hospital) Beds - medical cover provided by Swan Medical Group



Rowan and Cedar Ward (Petersfield Hospital) -medical cover provided by Swan Medical Group




Paul Howden Chair - Clinical Cabinet Clinical Lead - Elective

Wife works privately as a qualified Foot Health Practitioner (does not work within areas covered by F&G or SHE CCGs)



GP Partner, The Whiteley Surgery Fareham & Gosport CCG


Financial partnership interest in Yew Tree Clinic - Suite of consulting rooms attached to The Whiteley Surgery available for private hire for medical purposes



Diabetes UK - National Clinical Champion 2017-2019


Kate McCandlish Head of Quality (Primary and Community Care)

No interests to be declared Both

Barbara Rushton Chair - Clinical Lead - Integrated out of Hospital Care

I am a partner in a GP practice where partners provide medical cover to Rowan and Cedarwood ward SHFT


Barbara Rushton Chair - Clinical Lead - Integrated out of Hospital Care

GP Principal at Liphook and Liss Surgery which holds contract for microsuction and audiology


Margaret Scott Lay Member (Integrated Care) Governor of University of Portsmouth which provides health education


Pat Shirley Lay Member Patient and Public Involvement

Chair of the Portsmouth and South Eastern/Fareham & Gosport Crisis Care Strategic planning group


Sara Tiller Director of Primary Care Development

Part of role involves supporting the development of the MCP, particularly working with GP practices and Better Local Care

Both

Suzanne Van Hoek Deputy Chief Quality Officer No interests to be declared Both

Nick Wilson Lay Member Public and Patient Involvement

Governor, Treloar School and College South Eastern Hants CCG


Close supportive relationship with Community First HEH



Member of South East England Forum on Ageing (SEEFA) Executive Group




Andrew Wood Chief Finance Officer Nominated Finance Lead for PSEH Accountable Care System

Both


1

Primary Care Commissioning Committee- In Public

Date of Meeting 7th March 2018

Title Minutes of the Previous Meetings

Purpose of Paper The minutes of the meeting held 13th December 2017 are presented for consideration by the Primary Care Commissioning Committee.


Minutes of the previous meetings


The accuracy of the minutes


The committee is asked to: Consider the accuracy minutes of the meetings,

subject to any amendments which will be recorded in the minutes of this meeting

Author Lesley WinterGovernance and Committee Support Officer

Sponsoring member

Margaret ScottCommittee Chair

Date 5th March 2018

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2


Strategic Objectives:This paper links to the following:(delete as appropriate)

1. Work with local people and their communities to prevent the causes of ill health, support healthy lifestyles, reduce health inequalities and to give children the best start in life

2. Integrate primary care, community care, social care and voluntary services to deliver a range of care, close to home that allow people with complex needs and the most vulnerable to stay healthy and feel in control of their health

3. Ensure a range of easily accessed and responsive urgent and emergency care to support people in a crisis

4. Commission consistently high quality planned care services that work with patients to deliver the best outcomes possible

5. Patients using local health services will experience reduced variation in treatment and care standards; they will notice increasing consistency in the quality of services across all care providers

ENGAGEMENT ACTIVITY

Engagement Activity (please provide details of public involvement and engagement activity undertaken in support of this paper where necessary)

N/A


Equality and Diversity (implications/impact)

N/A


N/A

Supporting documents Minutes

Page 2 of 2Item 3 - minutes of previous meeting cover sheet.docxOverall of 66

Minutes of the meeting of the Fareham & Gosport CCG and South Eastern Hampshire CCG Primary Care Commissioning Committees

Held at 2.00pm on Wednesday 6th December in the Board Room, Fort Southwick, PO17 6AR

Meeting in PublicPresentMargaret Scott (Chair) Lay Member for Procurement

and Commissioning South Eastern Hampshire CCG

Lucy Docherty Lay Member for Procurement and Commissioning


Sara Tiller Director of Primary Care Development

Fareham & Gosport and South Eastern Hampshire CCG

Nick Wilson Lay Member for Public and Patient Involvement

South Eastern Hampshire CCG

Sarah Anderson Lay Member , Governance and Audit Fareham & Gosport CCG

Pat Shirley Lay Member for Public and Patient Involvement Fareham & Gosport CCG

In Attendance

Dr Andrew Holden GP Representative South Eastern Hampshire CCG

Dr Ian Reid Guest of the Chair Fareham & Gosport and South East Hants CCG

Sophie Holmes Primary Care Development Officer

Fareham & Gosport and South East Hants CCG

Keeley Ellis Head of Primary Care Fareham & Gosport and South East Hants CCG

Kate McCandlish Head of Quality Primary and Community Care


Molly Bailey Primary Care Engagement and Contracts Officer


David Bailey Deputy Chief Finance Officer Fareham & Gosport and South Eastern Hampshire CCG

Page 1 of 6Item 3 - minutes of previous meeting 2017 12 06.docxOverall of 66

Summary of Actions

Meeting Date

Agenda Item Action Who Deadline Date

Completed06/12/2017 5 Investigate whether the

blood donation service counts platelets

GP Representative for South Eastern Hampshire CCG

07/03/2017

06/12/2017 7 Table more information on the ‘safety’ requires improvement element of CQC reports at the next JQAC

Head of Quality Primary and Community Care

07/03/2017

06/12/2017 7 Find out when the practices who have ‘requires improvement’ elements will be re-inspected

Head of Quality Primary and Community Care

07/03/2017

06/12/2017 7 Organise the development of a communication which provides an update on the position of the MCP.

Director of Primary Care Development

07/03/2017

1 Chair’s WelcomeThe Chair welcomed members and attendees to the meeting.Apologies had been received from Susanne Hasselman, Barbara Rushton, David Chilvers

2 Register and Declarations of InterestThe register of interests was presented and members were advised that they should also raise any interests relating to agenda items being considered at the meeting.

The Primary Care Commissioning Committee noted the declarations of interest.3 Minutes of the Previous Meeting

The minutes of the Public Primary Care Commissioning Committee from 6th September 2017 were approved.

The Primary Care Commissioning Committee confirmed the accuracy of the minutes of the previous meeting.

4 Matters ArisingThe committee agreed all matters arising were captured within the agenda.

5 Local Commissioned Service (LCS) and Local Incentive Scheme (LIS) for 2018/19

The GP representative for South Eastern Hampshire CCG declared his conflict in being a Partner at a member practice of the CCG.

LCSThe Primary Care Development Officer attended the meeting today to present the LCS analysis of 2017/18 and subsequently the recommendations for 2018/19. It was explained that all components within the current years LCS had been recommended to be recommissioned for 2018/19 except for the National Cancer Diagnosis Audit, as it would not make sense to recommission this every year, by the Primary Care Operational Group (PCOG). In place of the National Cancer Diagnosis Audit the following services were recommended by PCOG, to be added to the 18/19 LCS:

- Ring Pessary Fittings- Usage of the Future Planning Template


The Primary Care Development Officer explained that the LCS encompasses clinical services that are over and above the expectations of the General Medical Services (GMS) contract. These services are commissioned to recognise the work moving from secondary to primary care and were derived from the Primary Medical Services (PMS) reviews that were undertaken a few years ago. The GP representative for South Eastern Hampshire CCG further explained that it also recognises work that has been happening within primary care in order to reimburse and invest in general practice.

The committee were assured that the issues with pharmacy coverage in South Eastern Hampshire, in relation to the National Diabetes Prevention Programme, are being rectified and have not impacted the CCGs activity against its target. It was also noted that IUS numbers are declining because the demand for non-contraceptive IUS’s is minimal and coding has improved, however the skillset in primary care is significant due to the volume fitted for contraceptive purposes and therefore this service is best placed within this setting.

The committee were informed that the PCOG had queried the number of zeros across the LCS block contract for 2017/18 and requested that the CCG look into the reasons for this. The conclusions from the audit were that practices either did not hold the skillset or the activity was not there.

The Primary Care Team have since liaised with the Practice Managers Commissioning Advisory Group (PMCAG), Practice Managers Forum and the Commissioning Support Unit (CSU) to obtain support with the approach going forward. As the CCGs have not been explicit in the contract for 2017/18 that every element within the contract is to be provided and to a minimum activity, they aren’t in a position to claw back this year, however next year a relevant clause will be added to the contract.

The Primary Care Development Officer explained that the team have looked into the elements of the contract that require certain skills and training to deliver and have associated a relevant cost to each of them. Having done this piece of work the CCGs have concluded that they save £0.25p per patient population by commissioning the LCS as a block contract rather than an activity based contract.

At the beginning of the year practices that do not have the skills can opt out and not be paid, and those practice who can deliver will be paid regardless of the volume of activity over the year.

The Director of Primary Care Development assured the committee that the level of scrutiny the primary care team undertake on the LCS is a lot greater than some other contracts across the organisation.

Phlebotomy LCSThe Primary Care Development Officer informed the committee that the phlebotomy specification remains unchanged from this year. However the CCG are conscience that the funding associated has remained the same since 2013/14 at £0.70p per patient population and therefore recommended that this is uplifted in line with the growth across contracts.

LIS The Head of Primary Care presented the analysis and evaluation of the 2017/18 LIS and provided the following break down for the 2018/19 contract.

- Component 1 will remain the same as 2017/18 to support clinical commissioning through attendance at forums.

- Component 2 will remain the same as 2017/18 to support prescribing improvement plans and reducing prescribing spend.

- Component 3 will comprise of both existing and new requirements. QUASAR Feedback and QUASAR Primary Usage will be continued and practices will still be required to identify Patient Safety Champions, however the training will not continue in 2018/19, this


will instead be replaced with The Safer Practice Framework. The Safer Practice Framework was designed by clinicians from our own CCG area in partnership with the Wessex Academic Health Science Network Patient Safety Collaborative. The aim of the tool is to not only raise practice level awareness of patient safety but provide primary care with a tool which actually evidences improvements in safety.

- Component 4 predominantly remains the same with some changes and enhancements. The component will be further developed by the inclusion of the following:

o A veteran’s action plan. From 1st April 2018; for all patients that are identified as a veteran; practices should signpost them to the Veterans Gateway. The veteran’s gateway is a first point of contact for whatever support is needed, whether based in the UK or abroad.

o Practices will also be asked in 2018/19 to move from Readcodes to SNOMED codes, a new section of the LIS aims to recognise the workload involved.

o Following membership engagement, the CCG will also be de-commissioning DXS and aiming to use EMIS Resource Publisher to replace it, which will cause a workload for general practice initially.

o Practices will also be asked to focus on cleansing of the electronic patient record. With a specific cohort of patients; the practice will be provided with a protocol for data improvement, and should assess the electronic patient record to ensure the record is accurate and up to date.

o Raised platelet counts are increasingly recognised as a risk marker for cancer. Practices will be required to search for patients over 40 with any raised platelets within the last 12 months (with no previous history of a raised count prior to the 12 month period). Once identified patient notes should be case reviewed to ascertain if there is another cause for this, and if not the patient should be invited to the practice for a clinical review and appropriate clinical intervention. This will build on the work of the cancer audit in 2017/18.

- Component 5 will in principle remain the same in order to build on year two of the GP Forward View Implementation.

- A new Component 6 is proposed for the LIS in 2018/19 to incentivise practices to work with the CCGs to influence and develop the financial savings plans and to further support the organisation to develop robust QIPP (Quality, Innovation, Productivity, Prevention) plans. There is also an aim to use both Rightcare data and Practice Profiles to identify opportunities for pathway development, and reduce unwarranted variation in general practice.

The Head of Primary Care confirmed that the only element of the LIS that is stopping is the patient safety training which has been replaced by the Safer Practice Framework.

The Committee noted the forecast outturn at month six for 2017/18 and the Head of Primary Care explained that this is the first year without a pace of change since moving away for the Local Enhanced Services (LES). The proposed funding for 2018/19 was also noted.

The Primary Care Development Officer recognised the amount of work that had gone into the evaluation and recommendations paper, as well as the process followed and the amount of positive outcomes that have derived from the services.

The Primary Care Commissioning Committee approved all of the following recommendations:

1. Consider and make a decision regarding the recommendations for the re-commissioned services for the 2018/19 LCS

2. Consider and make a decision regarding the recommendations for the de-commissioned service from the 2018/19 LCS

3. Consider and make a decision regarding the additions for the service from the 2018/19 LCS

4. Discuss the proposal for a growth uplift in the phlebotomy contract5. Consider and make a decision regarding the recommendations for the re-

commissioned services for the 2018/19 LIS


6. Consider and make a decision regarding the recommendations for the de-commissioned service from the 2018/19 LIS

7. Consider and make a decision regarding the additions for the service from the 2018/19 LIS

8. Delegate the final sign off of the proposed costing model/s to chair’s action, on the receipt of detailed finances by practice to provide assurance regarding conflicts of interest

6 Finance ReportThe Deputy Chief Finance Officer presented the finance report to the committee and informed them that the CCG are spending roughly five million pounds more this year than last. It was highlighted that ‘other’ on the report refers to an over accrual position.

Fareham and Gosport CCGs Lay Member for Public and Patient Involvement queried whether the CCG pay for GPs indemnity. The Head of Primary Care explained that it is a collaborative fee because certain parts of indemnity can be reclaimed as per the Statement of Financial Entitlements (SFE).

The Head of Primary Care also informed the committee that the CCG are now reimbursing practices for CQC, which hasn’t been done before. The CCG receive an allocation from the government for this and then pay this to practices.

The Primary Care Commissioning Committee noted the Finance Report.7 Quality Report

The Head of Quality Primary and Community Care presented the quality report to the committee for noting.

The committee discussed the progress on the next phase of CQC inspections which have now started. Five practices within Fareham and Gosport are scheduled to be inspected in December 2017 and the CCG have undertaken pre-support visits with those practices.

Fareham and Gosport CCGs Lay Member for Public and Patient Involvement highlighted several areas of ‘safety’ that require improvement across practices and requested further information on what this entails outside of the committee. The Head of Quality Primary and Community Care agreed to bring more detail around this to the next meeting of the Joint Quality Assurance Committee.

It was explained that when a practice requires improvement in any area CQC will re-inspect them within 6 months to allow them to put actions in place to raise their rating to good. The committee noted that some re-inspections that needed to take place had gone past 6 months, the Head of Quality Primary and Community Care agreed to chase this up with CQC.

The Primary Care Commissioning Committee noted the Quality Report.8 Communication and Engagement Report

The Director of Primary Care Development presented the report and specifically brought the committee’s attention to section four of the report which contained details of the volume of engagement happening directly around primary care, ensuring patient views are taken into account.

South Eastern Hampshire CCGs Lay Member for Public and Patient Involvement recognised the amount of engagement happening, however informed the committee that the momentum seems to have dropped around the MCP engagement and people are questioning whether it is still going ahead. The committee discussed that the MCP will flow into the New Care Models work stream and agreed it would be useful to get a communication out that describes the work that has already happened and how it links in with future opportunities.

The Primary Care Commissioning Committee noted the Communication and Engagement Report.


9 Any Other BusinessThere was no further business. The meeting ended at 3.30pm.

10 Date of Next MeetingThe date of the next meeting is:Date: Wednesday 7th March 2018.Venue: Board Room, Fort Southwick, James Callaghan Drive, Fareham, PO17 6AR


Primary Care Commissioning Committee Public Meeting

Date of Meeting7th March 2018

Title General Practice ProfilePurpose of Paper Provide PCCC with the bi-annual report about primary care delivery


This paper highlights: Year on Year changes Areas of focus for the CCG Areas of focus for practices


The Primary Care Commissioning Committeeis asked to:

1. Note progressAuthor

Andrew HoldenPrimary Care Clinical Lead

Sponsoring memberKeeley EllisHead of Primary Care

Date 28th February 2018

CORPORATE STRATEGIC LINKSStrategic Objectives:This paper links to the

following: 1. Ensure a range of easily accessed and responsive urgent and emergency care to support people in a crisis

ENGAGEMENT ACTIVITYEngagement Activity PCOG on 28th February 2018

EQUALITY AND DIVERSITYEquality and Diversity N/AOther committees N/ASupporting documents N/A

Page 1 of 5Item 5 - Performance Profile.docxOverall of 66

Performance Profile

Introduction

This profile has been developed over the last few years as a means to monitor some key metrics for general practices across both Fareham & Gosport and South Eastern Hampshire Clinical Commissioning Groups (CCGs). It will assist the CCG in identifying trends to establish areas in Primary Care where support may be required, as well as areas of best practice for sharing and learning. This information has informed quality assurance visits to practices, locality meeting discussions and the CCG locally commissioned services and local incentive schemes.

As a headline comment it is pleasing to note that the vast majority of practices have decreased the number of “red” metrics in their profile and the only practice that has increased the number of reds is due to a few metrics that are very susceptible to statistical variation (figure 3).

Looking at the results from a CCG perspective comparing year on year there are a lot of positives in terms of improvement with some negatives (figure 1):

NEGATIVES:1. Phone access2. Prevalence3. No of patients per WTE – not necessarily negative but needs highlighting as new

models of care exist4. Flu uptake ISQ5. MH QOF achievement6. Repeat dispensing

POSITIVES:1. CQC report2. Many of the treatment parameters especially diabetes3. QOF exemption rates4. Prescribing parameters especially antibiotics and dressings formula adherence5. Patient recommendations of practice6. Cervical screening and dementia parameters

Figure 1


Performance Area 1617 1718 DifferenceGPPS - Ease of getting through on phone - not at all easy (average 8%) 8 12 4DM - Diabetes Mellitus (17+) prevalance (per cent) 0 4 4Cervical Screening Patients receiving Intervention (per cent) 17 20 3No. Pts WTE GP 4 6 2AF - Atrial Fibralation prevalance (per cent) 6 7 1 POSITIVE CHANGECOPD - Prevelence (per cent) 6 7 1 NEGATIVE CHANGECHD - Coronary Heart Disease prevalance (per cent) 4 5 1Enhanced Services Sign Up 2 2 0Overall QOF Achievement (per cent) 1 1 0Cervical Screening Overall Exception Rate (per cent) 11 11 0Elective Outpatient activity by 1,000 population 0 0 0Number/proportion of Cancer diagnoses presenting as an Emergency 0 0 0HYP006: Blood pressure <=150/90 mmhg in people with Hypertension 6 6 0Flu vaccine Uptake this Year 1 1 0Commissioning Incentive Scheme performance 0 0 0National Diabetes Audit 0 0 0practice referral data against weighted prevalence for the IAPT Service 18 18 0MH QOF Total Acheivement (max points 26 10 10 0Professional Isolation 4 3 -1A&E activity by 1,000 population 1 0 -1NICE Treatment TARGET TYPE 1 Diabetes Cholesterol <5 mmol/L(% Completed)

21 20 -1

NICE Treatment TARGET TYPE 2 DiabetesCholesterol <5 mmol/L(% Completed)

22 21 -1

GPPS - Would you recommend your GP Surgery? NO (average 3%) 9 7 -2Dementia diagnosis rates (CCG Planned Target 66%) 6 4 -2NICE Treatment TARGET TYPE 1 Diabetes HbA1c < =86 mmol/mol (% Comppleted) 17 15 -2

Sum of 5.5 year coverage % Cervical Screening 50-64 4 0 -4Repeat Dispensing Usage 25 21 -4NICE Treatment TARGET TYPE 2 Diabetes BP <=140/80 (% Completed) 16 12 -4

CQC Report (when published) 5 1 -4Prescribing of NSAID’s 24 19 -5NICE Treatment TARGET TYPE 2 Diabetes HbA1c < =86 mmol/mol (% Completed) 14 8 -6

NICE Treatment TARGET TYPE 1 Diabetes BP <=140/80 (% Completed) 14 6 -8

Overall QOF Excemption Rates 12 1 -11DM008: Last HbA1c is <=64mmol/mol in last 12mths 19 8 -11Number of antibiotice per STAR-PU 18 2 -16Non-elective activity by 1,000 population 17 0 -171st Outpatient Referrals by 1,000 population 18 0 -18Adherence to dressings formula 25 7 -18Raw List size 0 N/A N/AQOF Public Health Domain (per cent) 1 N/A N/ASum of 2.5 year coverage % Bowel Cancer Screening 60-74 17 N/A N/ASum of 3.5 year coverage % Cervical Screening 25-49 15 N/A N/ASum of 3.5/5.5-year coverage % Cervical Screening 25-64 9 N/A N/APercentage of Antibiaotics prescribed as 3 C's 7 N/A N/AIncreasing Prescribing of Nitrofurantoin N/A 0 N/ANICE Treatment TARGET Cholesterol <5 mmol/L 31 N/A N/A

KEY THEMES FOR PRACTICES

o PRACTICE PARAMETERS SINGLE HANDED STATUS

Resilience plans have been discussed with all relevant practices although it should be recognised that resilience may be still an issue in larger practices too

GP ACCESS DATA On the whole our access data is better than national average

NO OF PT PER WTE Difficult to interpret rata data due to varied delivery of medical personnel but

helpful for CCG recruitment planningo QOF PERFORMANCE AND PREVALENCE

Above national average as a whole QOF exemption figure have improved


Prevalence data variable Encouraging increase in dementia prevalence as a result of LIS

o PRESCRIBING ANTIBIOTIC DATA

Encouraging clinical use of antibiotics, less than national average REPEAT DISPENSING

Very variable across practices – already at key theme at CA and TARGET DRESSING FORMULARY

Encouraging increase in adherence seeno SECONDARY CARE PERFORMANCE

This data is very difficult to benchmark except A&E data which is benchmarked nationally. The reds are therefore based on lower quartile performance for the others. Cancer presentation in A&E is not able to be benchmarked

o NATIONAL DIABETES AUDIT TYPE 1 DM

Variability in numbers and large year to year variations due to small numbers; patients often not primarily cared for in general practice

TYPE 2 DM Variability in practice achievement noted and practices made aware in CA and

TARGET Incentivised activity improvement through LIS has seen decrease in number of

overall “reds” in all diabetes areaso MENTAL HEALTH

IAPT MH QOF

Same number of reds but average has increased from 22.5 to 24o CQC PERFORMANCE

Above national average of good which is already highest performing sector of NHS

Practice Level (figure 3)

Practice average number of reds is 5.8. Last year 27 practices had 10 or more reds and this year 6 do.

The parameters for what determines a red are based on quartile information from Fingertips data, National average and CCG average – the information is triangulated to set a baseline. This will have had an impact in the reduction of reds depending on CCG performance overall but means ‘reds’ are more significant.


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1


Strategic Objectives:This paper links to the following:

ENGAGEMENT ACTIVITY

Engagement Activity


Equality and Diversity

Primary Care Commissioning Committee – Meeting in Public

Date of Meeting 7th March 2018

Title Primary Care Finance Report, M10 2017/18

Purpose of Paper To report spend against budget for Primary Care in 2017/18.


This report provides an update on Primary Care budgets and forecasts for 2017/18, with further detail on Co-commissioning, Local Commissioning scheme and GP Five Year Forward View spend.


The PCCC should note the maintenance of investment into primary care, at a time when both CCGs are facing increasing financial difficulty.


PCC is asked to: Note/approve the information set out in the paper.

Author Andrew WoodChief Finance Officer

Sponsoring member Andrew WoodChief Finance Officer

Date

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2

Other committees/ groups where evidence supporting this paper has been consideredSupporting documents

Page 2 of 2Item 6 - finance cover sheet.DOCXOverall of 66

South Eastern Hampshire CCG Primary Care Commissioning Summary Annual Budget 17/18 Forecast 17/18 VarianceCo-commissioning 26,412,098 26,018,158 (393,940)

Local Commissioning Schemes 1,017,713 1,079,215 61,502GP IT 592,000 651,000 59,000

Services for Extended Access (£6.00 p/h) 1,302,000 758,830 (543,170)Local investment (£3.00 p/h - split over 2 years) 320,000 250,000 (70,000)

Additional reserve - Local investment 300,000 0 (300,000)Online Consultation 0 0 0

A&C Reception training 37,000 33,170 (3,830)29,980,811 28,790,373 (1,190,438)

Co-commissioning

Summary Description Annual Budget 17/18 Forecast 17/18 Variance

GMS GMS Contract 9,240,000 9,228,716 (11,284)GMS S96 0 155,664 155,664

PMS PMS Contract 8,808,000 8,827,209 19,209PMS PMS Premium 750,750 432,449 (318,301)

QOF QOF 3,100,662 3,100,663 1

DES Minor Surgery 243,000 233,034 (9,966)DES Extended Hours 395,000 394,391 (609)DES Learning Disability 119,000 118,020 (980)DES Out of area 575 575 0

PCO Seniority 264,000 269,030 5,030PCO Retainers 26,000 53,306 27,306PCO Maty/Paty/Adop 80,000 226,778 146,778PCO Sickness 10,000 117,930 107,930PCO Needles/Syringes 6,500 5,997 (503)

Collaborative Collaborative 143,061 142,963 (98)

Drugs Prescribing/Dispensing 325,130 313,258 (11,872)Drugs DSQS 10,900 10,900 0

Premises Premises 2,498,520 2,124,695 (373,825)Premises Premises Improvement Grants 17/18 186,000 186,000 0

Other GP Indemnity 1718 100,000 111,156 11,156Other CQC Fees 105,000 121,639 16,639Other 16/17 Impact 0 (156,215) (156,215)

Total 26,412,098 26,018,158 (393,940)

Local Commissioning Schemes


LCS Commissioning LIS 556,450 621,674 65,224LCS Block LCS 360,330 395,458 35,128LCS Phlebotomy 67,933 74,557 6,624LCS Low Vision/Stable Glaucoma 23,000 36,695 13,695LCS Quasar 10,000 9,500 (500)

Other 16/17 Impact 0 (58,669) (58,669)

Total 1,017,713 1,079,215 61,502

Description Annual Budget 17/18 Forecast 17/18 VarianceGP IT 592,000 651,000 59,000

Description-GPFV Annual Budget 17/18 Forecast 17/18 VarianceServices for Extended Access (£6.00 p/h) 1,302,000 758,830 (543,170)

Local investment (£3.00 p/h - split over 2 years) 320,000 250,000 (70,000)Additional reserve - Local investment 300,000 0 (300,000)

Online Consultation 0 0 0A&C Reception training 37,000 33,170 (3,830)

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Fareham & Gosport CCG Primary Care Commissioning Summary Annual Budget 17/18 Forecast 17/18 VarianceCo-commissioning 24,512,097 24,123,556 (388,540)

Local Commissioning Schemes 1,097,384 1,011,489 (85,895)GP IT 502,000 575,000 73,000

Services for Extended Access (£6.00 p/h) 1,187,000 702,755 (484,245)Local investment (£3.00 p/h - split over 2 years) 306,000 250,000 (56,000)

Online Consultation 0 0 0A&C Reception training 35,000 33,190 (1,810)

27,639,481 26,695,990 (943,491)

Co-commissioning


GMS GMS Contract 14,897,325 14,915,917 18,592GMS S96 0 50,000 50,000

PMS PMS Contract 1,461,573 1,470,663 9,090PMS PMS Premium 145,362 145,362 (0)

QOF QOF 2,778,357 2,778,357 (0)

DES Violent Patients 17,000 12,415 (4,585)DES Minor Surgery 275,000 274,988 (12)DES Extended Hours 368,659 362,610 (6,049)DES Learning Disability 76,000 75,152 (848)DES Out of area 500 563 63

PCO Seniority 230,000 234,317 4,317PCO Retainers 25,000 69,658 44,658PCO Maty/Paty/Adop 130,000 225,474 95,474PCO Sickness 10,000 7,432 (2,568)PCO Needles/Syringes 6,000 6,000 0

Collaborative Collaborative 143,000 142,963 (37)

Drugs Prescribing/Dispensing 172,000 164,336 (7,664)

Premises Premises 3,398,321 3,009,010 (389,311)Premises Premises Improvement Grants 17/18 178,000 178,000 0

Other GP Indemnity 1718 100,000 106,277 6,277Other CQC Fees 100,000 115,764 15,764Other 16/17 Impact 0 (221,701) (221,701)

Total 24,512,097 24,123,556 (388,540)

Local Commissioning Schemes


LCS Commissioning LIS 583,300 583,284 (16)LCS Block LCS 378,200 378,101 (99)LCS Phlebotomy 60,000 59,729 (271)LCS Low Vision/Stable Glaucoma 30,000 24,369 (5,631)LCS Quasar 10,000 9,500 (500)LCS Other 35,884 35,884 0

Other 16/17 Impact 0 (79,378) (79,378)

Total 1,097,384 1,011,489 (85,895)

Description Annual Budget 17/18 Forecast 17/18 VarianceGP IT 502,000 575,000 73,000

Description Annual Budget 17/18 Forecast 17/18 VarianceServices for Extended Access (£6.00 p/h) 1,187,000 702,755 (484,245)

Local investment (£3.00 p/h - split over 2 years) 306,000 250,000 (56,000)Online Consultation 0 0 0

A&C Reception training 35,000 33,190 (1,810)

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FOR THE ATTENTION OF THE JOINT Primary Care Commissioning COMMITTEE

Title of Paper Quality Report- Primary Care Exceptions

Agenda Item Date of meeting

Exec Lead

Julia BartonDirector of Quality and Nursing - South Eastern Hampshire/Fareham and Gosport Hampshire CCG Partnership

Clinical Sponsor Julia Barton

AuthorKate McCandlishHead of Quality for Primary Care & Community ServicesSouth Eastern Hampshire/Fareham and Gosport

To AgreeTo RatifyTo Discuss

Purpose

To Note X

Link to Strategic Objective

Executive Summary

This report describes the current position of Primary Care Quality. It includes an embedded report stating all the published CQC rating for the GP practices in Fareham and Gosport and South Eastern Hampshire CCGs. This paper was presented at joint Quality Assurance Committee on 21.12.17 and comes to PCC for noting.It shows the 2 CCGs have 97% practices at Good compared to the national average of 91%

The Quality Report includes updates on developments, quality assurance visits and actions taken by the Quality Team.

What's going well? Quality team supporting Primary Care developments. Quasar Primary usage increasing. GP Extended Access Quality visits and reporting Support for Care Navigation in primary care (5YFV) -report to note by Sue Clarke on page 6

What requires additional assurance? GP home visiting oversight/reporting.

Recommendations PCC notes the report.

Publication Public Website

Please provide details on the impact of following aspects

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Equality and Quality Impact Assessment No impact

Patient and Stakeholder Engagement No impact

Financial Impact, Legal implications and Risk No impact

Governance and Reporting- which other meeting has this paper been discussedCommittee Name Date discussed Outcome

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Quality Report- Primary Care Providers U

5 March 2018

PCC Quality Update March 2018 1

With thanks to Steve Clarke NEHFCCG for sharing his monthly reporting template.

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Items for PCCC to note are:

• National benchmark CQC primary care ratings on (p3)• CQC rating themes- paper to note (JQAC 21.12.17) (p3)• Quality visit schedule• Quasar usage• The Practice Managers Role in Developing Care Navigators’ Report (p6)

Primary Care & Quality oversight in development:• GP Extended Access Service Quality monitoring

PCC Quality Update March 2018

Executive Summary Primary Care Quality UPDATE Report

2Page 2 of 10Item 7 - Quality report.pptxOverall of 66


• Published data indicates that quality locally in primary care is good– South East Hants -100% practices rated Good– F&G: 1 practice rated Requires Improvement

• Across Hampshire, we have learned unexpected changes in GP practices can have a sudden and detrimental impact on the delivery of services.

Benchmark:

• The national figure is 91% practices at Good or Outstanding.• F&G and SEH combined are at 97%We have no practices rated Inadequate (IA) or in special measures.

Quality Report – Updated CQC ratings



• Reports will be shorter & less repetitive• Greater emphasis on leadership• Targeted on areas of highest concern: little change for primary care

• Next round of inspections: 15-20% of GP practices that re rated Good or OS will be inspected from Nov 2017- particularly those who were inspected earlier in 2014/15

• CCG offer of support:• If any practice requires support to prepare for the next round of inspection, please email [email protected]

• Practices will be triaged according to concerns or last inspection date/rating.

Next phase of CQC regulation for primary care:


mailto:[email protected]

Quality Report - Quality visits & outcomes

Local Quality visits up to March 2018:

1. Bury Road -2 visits- including staff meeting2. Cowplain- The Oaks; followed up with a second nurse focused

meeting (Penny Evison)3. Bridgemary GP coffee meeting re: SCAS incident report

debrief4. Phone calls to Rowner (offered meeting)5. Phone calls to Brockhurst (offered meeting)

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Quality Report – Care Navigator Report: Sue Clarke to note.

‘The Practice Managers Role in Developing Care Navigators’ ReportThis summarises and supports events that the CCG ran during January and February 2018.This report outlines how the CCG supports the process of role transformation of receptionists moving into a care navigation role. A number of suggestions and guidance were identified at these practice managers support events and these have been detailed in this report.


Quality Report – explanation of Quasar SLIDE

PCC Quality Update March 2018 7

Slide 8

• Shows the increased usage of HCP feedback by GP practices

• Shows the majority of feedback is regarding Portsmouth hospitalsThis is shared via Clinical Quality monthly meeting.It has been used to inform the CQC and internal PHT review of radiology.TARGET receive a presentation showing examples of change made as a result of feedback

• The feedback regarding all other health care organisations is growing at a faster rate e.g. SHFT, SPIRE, CareUK, Millbrook.

These services also receive a report at their CQRM.

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AllYr2016

Yr2017

Yr 2018

Jan 36 86 70Feb 44 126 100 Mar 51 153 Apr 72 84 May 88 123 Jun 86 128 Jul 70 121 Aug 106 125 Sep 79 76 Oct 95 81 Nov 61 70 Dec 81 59 TOTAL 869 1232

Yr2016 Yr2017

869

1232

Total HCP Feedback All Organisations

+ 42%

All Organisations PHT

Apr-16 72 48May-16 160 85Jun-16 246 136Jul-16 316 166

Aug-16 422 212Sep-16 501 253Oct-16 596 297Nov-16 657 323Dec-16 738 358Jan-17 824 395Feb-17 950 436

Mar-17 1103 485Apr-17 1187 515

May-17 1310 538Jun-17 1438 561Jul-17 1559 581

Aug-17 1684 625Sep-17 1760 665Oct-17 1841 703Nov-17 1911 739Dec-17 1970 768Jan-18 2039 805Feb-18 2139 856

Mar-18 Apr-18

May-18 Jun-18

Apr-16

May-16

Jun-16

Jul-16

Aug-16

Sep-16

Oct-16

Nov-16

Dec-16

Jan-17

Feb-17

Mar-17

Apr-17

May-17

Jun-17

Jul-17

Aug-17

Sep-17

Oct-17

Nov-17

Dec-17

Jan-18

Feb-18

0

500

1000

1500

2000

2500

72

160

246316

422501

596657

738

824

950

11031187

1310

1438

1559

16841760

18411911

19702039

2139

48 85 136166

212253

297 323358

395436

485 515538 561

581625

665703

739 768805

856

Total QuasarTotal Quasar HCP Feedback HCP Feedback – – CUMMULATIVECUMMULATIVETotal Concerns RaisedTotal Concerns Raised about PHT compared with about PHT compared with Total Concerns Raised about all Organisations (incl. Total Concerns Raised about all Organisations (incl. PHT)PHT)

All Organisations PHT

PHTPHT

AllAllOrgOrg


Quality Report - Primary Care developments

Southern Hampshire Primary Care ALLIANCE Contracts :

1. GP Extended Access Services contract –Quality monitoringClinical Quality Review Meetings –commenced mobilisation and quality outcome monitoring as part of the monthly Contract Review Monitoring process, led by primary care.

– Clinical Quality Visit Petersfield GPEA 24.2.18– Clinical Quality Visit Waterlooville GPEA 24.2.18– Report will be noted at GPEA CQRM

2. GP Home visiting:– Quality indicators into service specification.– Planning for primary care and quality visits in progress.


Quality Update Report Primary Care Update on projects


Patient Safety Champions: • Workshops in TARGET: Q3: patient safety refresher & the safe practice frameworkQ4: safe medicines management: learning from incidents

Quasar Primary:• Supportive reminders sent to practices with low or no reports having a

positive effect: request for more training/advice.• Developing Reports with Practice manager reference group.1- PDF for use with appraisals2-amended downloadable report for CQC/meeting use.• GP extended access.


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Primary Care Commissioning Committee – Meeting in Public

Date of Meeting 7 March 2018

Title Transforming Primary Care – Engaging with our local communities

Purpose of Paper This report provides the Primary Care Commissioning Committee with information on engagement activities with the public and patients that have taken place since the previous meeting.


Fareham and Gosport (F&G) and South Eastern Hampshire (SEH) CCGs engage with local people to support the development of primary care through a number of routes and this report provides the key themes from the feedback received.


The Committee is asked to consider the three main issues raised during this period:

Development of new care models Handling of complaints about primary care services Accessibility of practice websites.

These, and what the CCGs are doing in response, are detailed in section three.


PCC is asked to:

Note the report and consider the issues in section three.

Author Elizabeth KerwoodHead of Communications and Engagement

Sponsoring member Sara TillerDirector of Primary Care Development

Date 1 March, 2018

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Strategic Objectives:This paper links to the following: Engagement is a statutory requirement which supports the CCG to

deliver all of its strategic objectives.

ENGAGEMENT ACTIVITY

Engagement Activity This report details the engagement activities undertaken since the previous meeting.


Equality and Diversity N/A


N/A

Supporting documents N/A

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Transforming Primary CareEngaging with our local communities

1. PurposeThe purpose of this report is to provide members of the Primary Care Commissioning Committee with information on engagement activities with the public and patients that have taken place since the previous meeting.

2. Engaging with local peopleFareham and Gosport (F&G) and South Eastern Hampshire (SEH) CCGs engage with local people to support the development of primary care through the following routes:

Locality Patient Groups (LPGs) – ongoing engagement with Patient Participation Groups (PPGs) through the Locality Patient Groups including representatives being members of the CCGs’ Community Engagement Committees

Multi-specialty Community Provider (MCP) – ongoing engagement in localities about the transformation and development of local services. This includes having representation from Patient Participation Groups and the voluntary sector on established MCP Locality Boards

Changes to primary care services – engagement programmes to support GP practices which would like to make changes to their current services.

3. Feedback received and action takenIn addition the CCGs have received feedback through a number of other routes and these are detailed in Appendix one.

The issues raised and the action taken, or being taken, by the CCGs are set out in Appendix two. Issues to which we would particularly draw the Committee’s attention to are:

New care models – early discussions about the new care models have been positive with feedback including the need for involving local people in both the development and understanding of the future model so they can be supported to engage and understand the way healthcare will be provided in the future. The CCGs will be seeking the views of local people on an ongoing basis, including the second phase of ‘Your Big Health Conversation’ which is currently underway

Handling of complaints about primary care services – Concern has been raised that NHS England deals with complaints about primary care services rather than the CCGs. NHS England has delegated commissioning responsibility for primary care services to the CCGs but not the responsibility for handling complaints. The CCGs will raise this concern with NHS England

Practice websites – As reported in the December report, concern had been raised about the accessibility of practice websites. The CCGs have subsequently held a successful

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website event for the practices and this topic was discussed. Practices are now reviewing how they develop and maintain their websites.

4. Changes to Primary Care servicesThe CCGs are leading/supporting communication and engagement programmes to seek the views of local people on the following potential changes:

Staunton SurgeryStaunton Surgery informed South Eastern Hampshire CCG that they intended to end their contract with us to provide General Medical Services at the site from March 31, 2018. The practice has subsequently withdrawn its notice and is developing plans to continue to provide these services. The CCG is supporting the practice to keep patients and local stakeholders updated as their plans are finalised.

Emsworth PracticeSouth Eastern Hampshire CCG has been supporting this practice to engage with patients about the potential relocation of the practice to a new, purpose-built surgery just over one mile away from its current location. Hampshire Healthwatch is currently independently analysing the feedback received and this results will be taken into account as the practice develops its plans.

Brockhurst PracticeThe practice has been served notice on its current premises and is currently exploring alternatives. Fareham and Gosport CCG is providing the practice with support to do this and will provide them with support to engage their patients in the future if this is required.

5. RecommendationThe Primary Care Commissioning Committee is asked to note this report and consider the CCGs’ responses to the issues highlighted in section three.


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Appendix oneSince the last Committee meeting the CCGs have received feedback through the following routes:

Fareham and Gosport CCG Community Engagement Committee held on January 16 South Eastern Hampshire CCG Community Engagement Committee held on January 17 South Eastern Hampshire Locality Patient Group held on January 18 Mental Health Forum meeting held on January 19 Gosport Locality Patient Group held on January 23 Fareham Locality Patient Group held on February 20.


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Appendix twoThe table below details the themes from the feedback received by the CCGs and the actions that have or will be taken.

Theme Feedback received Actions planned or takenThe new ways of working could offer attractive employment opportunities to health professionals in the futurePeople vary in their ability to understand and use new systems, including new technology, with not everyone having access to or experience of using a computerThe new care models need to reflect how different people are able to self-manage their health and wellbeing and support them to do this whilst also supporting more vulnerable peopleThere is currently variation between different practices and the services they offer (ie in-house pharmacies and approaches to treatment) so the new care models should include aiming for equitable provisionThe different partners in the new care models each offer something different and this needs to be understood and valued

The CCG will take these views into consideration as the new care models are developed. This will include seeking the views of local people, including through the Big Conversation of which phase two is currently underway

The voluntary sector has a key role to play in the new care models

The CCGs fully recognise this and a representative for the voluntary sector is a member of the CCGs’ New Care Models Steering Group

New care models

Some concern has been raised that the projects and pilots in South Eastern Hampshire have needed to end whilst the Vanguard focussed on Fareham and Gosport

NHS England made it a condition of the 2017/18 Vanguard funding that a full new care model was implemented in one geographical area to fully test it. Fareham and Gosport was selected as the most appropriate area but drawing on the learning from the pilots right across the Vanguard area. The next step is to evaluate the progress in Fareham and Gosport and use this to determine the new care models for areas across both CCGs


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Patient representatives have given positive feedback about the future roles being developed in primary care but have raised some concerns about how these will be promoted to local people to avoid confusion between the different choices and help them to understand why they are being asked to see someone different

As the roles are developed and start to support local people we will use a range of routes to promote them to local people and help them to understand which option is most appropriate to provide the care and support they need

Concern has been raised that practices may not embrace the new approach as they are individual businesses

Some of the workforce changes will work better in bigger practices who are able to adapt and we know many practices are considering how they work more closely together to enable this

Locality Patient Groups (LPGs) are supporting Patient Participation Groups to support their practices to identify and register unpaid carers to ensure they are offered the support they may need

The CCGs welcome this approach and are supporting the LPGs by identifying information sources and speakers for meetings

Carers support

Some patient representatives have raised concern about the lack of CCG commissioned carers hubs in Fareham and Gosport

The CCG will look into this in more detail including how Surgery Signposters can support carers to identify the support they need and what is available in the local area

Tier Two services Patient representatives have asked for an update on Tier Two services and to be involved in future development work

The CCGs will update representatives once discussions with current providers have been finalised

Complaints about primary care services

Concern has been raised that NHS England deals with complaints about primary care services rather than the CCGs

NHS England has delegated commissioning responsibility for primary care services to the CCGs but not the responsibility for handling complaints. The CCGs will raise this concern with NHS England

GP phone access Some Patient Participation Groups (PPGs) have raised concern about the ease of getting through on some practice’s telephone numbers

The PPGs continue to raise their concerns with their practices so these can be considered

Practice websites As reported in the December report, concern had been raised about the accessibility of practice websites

The CCGs have subsequently held a successful website event for the practices and this topic was discussed. Practices are now reviewing how they develop and maintain their websites


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Fareham Community Hospital – including the Fareham Same Day Access Service

The Fareham MP is campaigning for the local bus company to provide a bus stop at the hospital. This has included inviting local patients to complete a survey seeking their views on this issue

The CCG has supported the MPs office to promote this survey to patients through the PPGs

New housing developments

Some concerns have been raised about how existing practices will cope with increasing populations from planned new housing developments

The CCGs work closing with the local councils to determine the impact of potentially increasing populations so these can be planned for, including access to primary care services


Primary Care Commissioning Committee Public Meeting

Date of Meeting7th March 2018

TitlePCCC TORs

Purpose of Paper Provide an update of the Primary Care Commissioning Committee Terms of Reference


Revised documentation to meet the current arrangements


The Primary Care Commissioning Committeeis asked to:

1. Note the new documentsAuthor

Nikki RobertsHead of Governance

Sponsoring memberAndy WoodChief Finance Officer

Date 28th February 2018

CORPORATE STRATEGIC LINKSStrategic Objectives:This paper links to the

following: 1. Ensure a range of easily accessed and responsive urgent and emergency care to support people in a crisis

ENGAGEMENT ACTIVITYEngagement Activity PCOG on 28th February 2018

EQUALITY AND DIVERSITYEquality and Diversity N/AOther committees N/ASupporting documents N/A

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Fareham and Gosport NHS Clinical Commissioning Group’s Primary Care Commissioning Committee

Terms of Reference

Introduction 1. Simon Stevens, the Chief Executive of NHS England, announced on 1 May 2014

that NHS England was inviting CCGs to expand their role in primary care commissioning and to submit expressions of interest setting out the CCG’s preference for how it would like to exercise expanded primary medical care commissioning functions. One option available was that NHS England would delegate the exercise of certain specified primary care commissioning functions to a CCG.

2. In accordance with its statutory powers under section 13Z of the National Health Service Act 2006 (as amended), NHS England has delegated the exercise of the functions specified in Schedule 2 to these Terms of Reference to Fareham and Gosport CCG. The delegation is set out in Schedule 1.

3. The CCG will carry out the following activities under delegated authority from NHS England:

a) To plan, including needs assessment, primary medical care services in Fareham and Gosport;

b) To undertake reviews of primary medical care services in Fareham and Gosport;

c) To co-ordinate a common approach to the commissioning of primary care services generally;

d) To manage the budget for commissioning of primary medical care services in Fareham and Gosport.

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4. The CCG has established the Fareham and Gosport CCG Primary Care Commissioning Committee (“Committee”). The Committee will function as a corporate decision-making body for the management of the delegated functions and the exercise of the delegated powers for Fareham and Gosport CCG. The Committee will operate a committees-in-common approach with South Eastern Hampshire CCG.

5. It is a committee comprising voting representatives of the following organisations: Fareham and Gosport CCG

With invitees from:

South Eastern Hampshire CCG Hampshire County Council Public Health Hampshire County Council Health and Wellbeing Board

Statutory Framework 6. NHS England has delegated to the CCG authority to exercise the primary care

commissioning functions set out in Schedule 2 in accordance with section 13Z of the NHS Act.

7. Arrangements made under section 13Z may be on such terms and conditions (including terms as to payment) as may be agreed between the NHS England Board and the CCGs.

8. Arrangements made under section 13Z do not affect the liability of NHS England for the exercise of any of its functions. However, the CCG acknowledges that in exercising its functions (including those delegated to it), it must comply with the statutory duties set out in Chapter A2 of the NHS Act and including:

a) Management of conflicts of interest (section 14O);

b) Duty to promote the NHS Constitution (section 14P);

c) Duty to exercise its functions effectively, efficiently and economically (section 14Q);


3

d) Duty as to improvement in quality of services (section 14R);

e) Duty in relation to quality of primary medical services (section 14S);

f) Duties as to reducing inequalities (section 14T);

g) Duty to promote the involvement of each patient (section 14U);

h) Duty as to patient choice (section 14V);

i) Duty as to promoting integration (section 14Z1);

j) Public involvement and consultation (section 14Z2).

9. The CCG will also need to specifically, in respect of the delegated functions from NHS England, exercise those set out below:

Duty to have regard to impact on services in certain areas (section 13O); Duty as respects variation in provision of health services (section 13P).

10. The Committee is established as a committee of the Governing Body of each named CCG in accordance with Schedule 1A of the “NHS Act”.

11. The members acknowledge that the Committee is subject to any directions made by NHS England or by the Secretary of State.

Role of the Committee 12. The Committee has been established in accordance with the above statutory

provisions to enable the members to make collective decisions on the review, planning and procurement of primary care services in Fareham and Gosport, under delegated authority from NHS England.

13. In performing its role the Committee will exercise its management of the functions in accordance with the agreement entered into between NHS England, Fareham and Gosport CCG, which will sit alongside the delegation, terms of reference, Fareham and Gosport CCG’s Primary Care and Financial Schemes of Delegation.

14. The functions of the Committee are undertaken in the context of a desire to promote increased co-commissioning to increase quality, efficiency, productivity and value for money and to remove administrative barriers. Co-commissioning of primary care will enable the CCGs to meet their strategic goals. Decisions will


4

be taken in the interests of patients and service users and will be developed through working with relevant stakeholders.

15. The role of the Committee shall be to carry out the functions relating to the commissioning of primary medical services under section 83 of the NHS Act, on behalf of the Governing Body.

15.1 This includes the following:

General Medical Services (GMS), Personal Medical Services (PMS) and Alternative Provider Medical Services (APMS) contracts (including the design of PMS and APMS contracts, taking contractual action such as issuing breach/remedial notices, and removing a contract);

Approving newly designed enhanced services - “Local Enhanced or Commissioned Services” (LES or LCS) and “Directed Enhanced Services” (DES);

Approving local incentive schemes as an alternative to the Quality Outcomes Framework (QOF);

Decision making on whether to establish new GP practices in an area; Approving practice mergers; and Making decisions on ‘discretionary’ payment (e.g., returner/retainer schemes).

making recommendations for the annual Primary Care budgets. The budgets will be approved by the Governing Body.

Geographical Coverage 16. The Committee will cover Fareham and Gosport CCG. Membership17. The Committee shall consist of:

Voting Members

Lay Member for Governance and Audit – Fareham and Gosport CCGLay Member for Patient and Public Involvement – Fareham and Gosport CCG Lay Member for Integrated Care – Fareham and Gosport CCGChief OfficerChief Finance OfficerChief Commissioning OfficerChief Development OfficerChief Quality OfficerClinical Chair for Fareham and Gosport CCG

Non-Voting AttendeesClinical Chair for South Eastern Hampshire CCGLay Member for Governance and Audit – South Eastern Hampshire CCG


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Lay Member for Patient and Public Involvement – South Eastern Hampshire CCGLay Member for Integrated Care – South Eastern Hampshire CCGClinical Lead for Primary Care – Fareham and Gosport CCGClinical Lead for Primary Care – South Eastern Hampshire CCGSenior Primary Care Development Officer

18. The Chair of the Committee shall be appointed by the members of the committee and shall be one of the Lay Member representatives of Fareham and Gosport CCG.

19. The Vice Chair of the Committee shall be appointed by the members of the committee. The Vice Chair shall be selected from the lay members of the CCG that is not represented by the Chair.

20. A standing invitation will be offered to a member of Hampshire County Council Public Health and the Health and Wellbeing Board. These attendees will be non-voting and may choose not to attend.

21. In addition, the Chair reserves the right to invite other clinical members and non-clinical officers of the CCG to attend the meeting as required to provide expert clinical and/or non-clinical advice/input to the Committee as required. These attendees will be non-voting.

Meetings and Voting 22. The Committee will operate in accordance with the CCGs’ Standing Orders. The

Secretary to the Committee will be responsible for giving notice of meetings. This will be accompanied by an agenda and supporting papers and sent to each member representative no later than five working days before the date of the meeting. When the Chair of the Committee deems it necessary in light of the urgent circumstances to call a meeting at short notice, the notice period shall be such as s/he shall specify.

23. Each voting member of the Committee shall have one vote. The Committee shall reach decisions by a simple majority of members present, but with the Chair having a second and deciding vote, if necessary. However, the aim of the Committee will be to achieve consensus decision-making wherever possible.


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Quorum

24. The quorum shall be three voting members, which includes a minimum of two lay members and one executive officer.

25. The committee must be quorate when any decisions are made or votes taken.

26. Others may be invited to attend for specific items with the prior agreement of the chair but shall not count towards the quorum or be able to vote.

Frequency of meetings 27. Meetings will be held at least quarterly.

28. Meetings of the Committee shall: a) be held in public, subject to the application of 28(b);

b) the Committee may resolve to exclude the public from a meeting that is open to the public (whether during the whole or part of the proceedings) whenever publicity would be prejudicial to the public interest by reason of the confidential nature of the business to be transacted or for other special reasons stated in the resolution and arising from the nature of that business or of the proceedings or for any other reason permitted by the Public Bodies (Admission to Meetings) Act 1960 as amended or succeeded from time to time.

29. Members of the Committee have a collective responsibility for the operation of the Committee. They will participate in discussion, review evidence and provide objective expert input to the best of their knowledge and ability, and endeavour to reach a collective view.

30. The Committee may delegate tasks to such individuals, sub-committees or individual members as it shall see fit, provided that any such delegations are consistent with the parties’ relevant governance arrangements, are recorded in a scheme of delegation, are governed by terms of reference as appropriate and reflect appropriate arrangements for the management of conflicts of interest.

31. The Committee may call additional experts to attend meetings as required to inform discussions.


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32. Members of the Committee shall respect confidentiality requirements as set out in the CCG’s Constitution.

33. The Committee will present its minutes to NHS England (Wessex) and the governing body of Fareham and Gosport CCG following each meeting for information, including the minutes of any sub-committees to which responsibilities are delegated under paragraph 27 above.

34. The CCG will also comply with any reporting requirements set out in its constitution.

35. It is envisaged that these Terms of Reference will be reviewed annually, reflecting experience of the Committee in fulfilling its functions. NHS England may also issue revised model terms of reference from time to time.

Accountability of the Committee

36. The Committee, on behalf of the Governing Body will make recommendations for the annual Primary Care budgets. The budgets will be approved by the Governing Body.

37. Decisions will be made in accordance with the CCGs’ Scheme of Delegation.

38. For the avoidance of doubt, in the event of any conflict between the Terms of Reference of this Committee and the Standing Orders and Standing Financial Instructions of the CCG, the latter will prevail.

39. The Committee shall have due regard to the legal responsibilities of the CCG:

As set out in paragraph 8 and;

The duties under the Equality Act 2010, including those relating to the public sector equality duty.

Procurement of Agreed Services

40. The detailed arrangements regarding procurement will be set out in the delegation agreement.


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Decisions

41. Taking into account any potential conflicts of interest the Committee shall have due regard to the views of member practices through consultation with the Clinical Assembly and Clinical Cabinet prior to decision-making.

The Committee will make decisions within the bounds of its remit.

42. The decisions of the Committee shall be binding on NHS England, Fareham and Gosport CCG.

43. The Committee will produce an executive summary report which will be presented to NHS England (Wessex) and the governing bodies of Fareham and Gosport CCG each quarter for information.

Schedule 1 – Delegation Agreement – (to be added when final arrangements confirmed)

Schedule 2 – Delegated function - (to be added when final arrangements confirmed)

Schedule 3 - List of Members


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South Eastern Hampshire NHS Clinical Commissioning Group’s Primary Care Commissioning Committee

Terms of Reference

Introduction 1. Simon Stevens, the Chief Executive of NHS England, announced on 1 May 2014

that NHS England was inviting CCGs to expand their role in primary care commissioning and to submit expressions of interest setting out the CCG’s preference for how it would like to exercise expanded primary medical care commissioning functions. One option available was that NHS England would delegate the exercise of certain specified primary care commissioning functions to a CCG.

2. In accordance with its statutory powers under section 13Z of the National Health Service Act 2006 (as amended), NHS England has delegated the exercise of the functions specified in Schedule 2 to these Terms of Reference to South Eastern Hampshire CCG. The delegation is set out in Schedule 1.

3. The CCG will carry out the following activities under delegated authority from NHS England:

a) To plan, including needs assessment, primary medical care services in South Eastern Hampshire;

b) To undertake reviews of primary medical care services in South Eastern Hampshire;

c) To co-ordinate a common approach to the commissioning of primary care services generally;

d) To manage the budget for commissioning of primary medical care services in South Eastern Hampshire.

Page 1 of 8Item 9 - SEH ToRs.docxOverall of 66

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4. The CCG has established the South Eastern Hampshire CCG’s Primary Care Commissioning Committee (“Committee”). The Committee will function as a corporate decision-making body for the management of the delegated functions and the exercise of the delegated powers for South Eastern Hampshire CCG. The committee will operate a committees-in-common approach with Fareham and Gosport CCG.

5. It is a committee comprising voting representatives of the following organisations: South Eastern Hampshire CCG

With invitees from:

Fareham and Gosport CCG Hampshire County Council Public Health Hampshire County Council Health and Wellbeing Board

Statutory Framework 6. NHS England has delegated to the CCG authority to exercise the primary care

commissioning functions set out in Schedule 2 in accordance with section 13Z of the NHS Act.

7. Arrangements made under section 13Z may be on such terms and conditions (including terms as to payment) as may be agreed between the NHS England Board and the CCGs.

8. Arrangements made under section 13Z do not affect the liability of NHS England for the exercise of any of its functions. However, the CCG acknowledges that in exercising its functions (including those delegated to it), it must comply with the statutory duties set out in Chapter A2 of the NHS Act and including:

a) Management of conflicts of interest (section 14O);

b) Duty to promote the NHS Constitution (section 14P);

c) Duty to exercise its functions effectively, efficiently and economically (section 14Q);


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d) Duty as to improvement in quality of services (section 14R);

e) Duty in relation to quality of primary medical services (section 14S);

f) Duties as to reducing inequalities (section 14T);

g) Duty to promote the involvement of each patient (section 14U);

h) Duty as to patient choice (section 14V);

i) Duty as to promoting integration (section 14Z1);

j) Public involvement and consultation (section 14Z2).

9. The CCG will also need to specifically, in respect of the delegated functions from NHS England, exercise those set out below:

Duty to have regard to impact on services in certain areas (section 13O); Duty as respects variation in provision of health services (section 13P).

10. The Committee is established as a committee of the Governing Body of each named CCG in accordance with Schedule 1A of the “NHS Act”.

11. The members acknowledge that the Committee is subject to any directions made by NHS England or by the Secretary of State.

Role of the Committee 12. The Committee has been established in accordance with the above statutory

provisions to enable the members to make collective decisions on the review, planning and procurement of primary care services in South Eastern Hampshire, under delegated authority from NHS England.

13. In performing its role the Committee will exercise its management of the functions in accordance with the agreement entered into between NHS England, South Eastern Hampshire CCG, which will sit alongside the delegation, terms of reference and South Eastern Hampshire CCG’s Primary Care and Financial Schemes of Delegation.

14. The functions of the Committee are undertaken in the context of a desire to promote increased co-commissioning to increase quality, efficiency, productivity and value for money and to remove administrative barriers. Co-commissioning of primary care will enable the CCGs to meet their strategic goals. Decisions will


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be taken in the interests of patients and service users and will be developed through working with relevant stakeholders.

15. The role of the Committee shall be to carry out the functions relating to the commissioning of primary medical services under section 83 of the NHS Act, on behalf of the Governing Body.

15.1 This includes the following:

General Medical Services (GMS), Personal Medical Services (PMS) and Alternative Provider Medical Services (APMS) contracts (including the design of PMS and APMS contracts, monitoring of contracts, taking contractual action such as issuing breach/remedial notices, and removing a contract);

Approving newly designed enhanced services - “Local Enhanced or Commissioned Services” (LES or LCS) and “Directed Enhanced Services” (DES);

Approving local incentive schemes as an alternative to the Quality Outcomes Framework (QOF);

Decision making on whether to establish new GP practices in an area; Approving practice mergers; and Making decisions on ‘discretionary’ payment (e.g., returner/retainer schemes). making recommendations for the annual Primary Care budgets. The budgets

will be approved by the Governing Body.

Geographical Coverage 16. The Committee will cover South Eastern Hampshire CCG.

Membership17. The Committee shall consist of:

Voting Members

Lay Member for Governance and Audit – South Eastern Hampshire CCGLay Member for Patient and Public Involvement – South Eastern Hampshire CCGLay Member for Integrated Care – South Eastern Hampshire CCGChief OfficerChief Finance OfficerChief Commissioning OfficerChief Development OfficerChief Quality OfficerClinical Chair for South Eastern Hampshire CCG

Non-Voting AttendeesClinical Chair for Fareham and Gosport CCG


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Lay Member for Governance and Audit – Fareham and Gosport CCGLay Member for Patient and Public Involvement – Fareham and Gosport CCG Lay Member for Integrated Care – Fareham and Gosport CCGClinical Lead for Primary Care – Fareham and Gosport CCGClinical Lead for Primary Care – South Eastern Hampshire CCGSenior Primary Care Development Officer

18. The Chair of the Committee shall be appointed by the members of the committee and shall be one of the Lay Member representatives of South Eastern Hampshire CCG.

19. The Vice Chair of the Committee shall be appointed by the members of the committee. The Vice Chair shall be selected from the lay members of the CCG that is not represented by the Chair.

20. A standing invitation will be offered to a member of Hampshire County Council Public Health and the Health and Wellbeing Board. These attendees will be non-voting and may choose not to attend.

21. In addition, the Chair reserves the right to invite other clinical members and non-clinical officers of the CCG to attend the meeting as required to provide expert clinical and/or non-clinical advice/input to the Committee as required. These attendees will be non-voting.

Meetings and Voting 22. The Committee will operate in accordance with the CCGs’ Standing Orders. The

Secretary to the Committee will be responsible for giving notice of meetings. This will be accompanied by an agenda and supporting papers and sent to each member representative no later than five working days before the date of the meeting. When the Chair of the Committee deems it necessary in light of the urgent circumstances to call a meeting at short notice, the notice period shall be such as s/he shall specify.

23. Each voting member of the Committee shall have one vote. The Committee shall reach decisions by a simple majority of members present, but with the Chair having a second and deciding vote, if necessary. However, the aim of the Committee will be to achieve consensus decision-making wherever possible.


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Quorum

24. The quorum shall be four voting members, which includes a minimum of two lay members and one executive officer.

25. The committee must be quorate when any decisions are made or votes taken.

26. Others may be invited to attend for specific items with the prior agreement of the chair but shall not count towards the quorum or be able to vote.

Frequency of meetings 27. Meetings will be held at least quarterly.

28. Meetings of the Committee shall: a) be held in public, subject to the application of 28(b);

b) the Committee may resolve to exclude the public from a meeting that is open to the public (whether during the whole or part of the proceedings) whenever publicity would be prejudicial to the public interest by reason of the confidential nature of the business to be transacted or for other special reasons stated in the resolution and arising from the nature of that business or of the proceedings or for any other reason permitted by the Public Bodies (Admission to Meetings) Act 1960 as amended or succeeded from time to time.

29. Members of the Committee have a collective responsibility for the operation of the Committee. They will participate in discussion, review evidence and provide objective expert input to the best of their knowledge and ability, and endeavour to reach a collective view.

30. The Committee may delegate tasks to such individuals, sub-committees or individual members as it shall see fit, provided that any such delegations are consistent with the parties’ relevant governance arrangements, are recorded in a scheme of delegation, are governed by terms of reference as appropriate and reflect appropriate arrangements for the management of conflicts of interest.

31. The Committee may call additional experts to attend meetings as required to inform discussions.


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32. Members of the Committee shall respect confidentiality requirements as set out in the CCG’s Constitution.

33. The Committee will present its minutes to NHS England (Wessex) and the governing body of South Eastern Hampshire CCG following each meeting for information, including the minutes of any sub-committees to which responsibilities are delegated under paragraph 27 above.

34. The CCG will also comply with any reporting requirements set out in its constitution.

35. It is envisaged that these Terms of Reference will be reviewed annually, reflecting experience of the Committee in fulfilling its functions. NHS England may also issue revised model terms of reference from time to time.

Accountability of the Committee

36. The Committee, on behalf of the Governing Body will make recommendations for the annual Primary Care budgets. The budgets will be approved by the Governing Body.

37. Decisions will be made in accordance with the CCGs’ Scheme of Delegation.

38. For the avoidance of doubt, in the event of any conflict between the Terms of Reference of this Committee and the Standing Orders and Standing Financial Instructions of the CCG, the latter will prevail.

39. The Committee shall have due regard to the legal responsibilities of the CCG:

As set out in paragraph 8 and;

The duties under the Equality Act 2010, including those relating to the public sector equality duty.

Procurement of Agreed Services

40. The detailed arrangements regarding procurement will be set out in the delegation agreement.


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Decisions

41. Taking into account any potential conflicts of interest the Committee shall have due regard to the views of member practices through consultation with the Clinical Assembly and Clinical Cabinet prior to decision-making.

The Committee will make decisions within the bounds of its remit.

42. The decisions of the Committee shall be binding on NHS England, South Eastern Hampshire CCG.

43. The Committee will produce an executive summary report which will be presented to NHS England (Wessex) and the governing bodies of South Eastern Hampshire CCG each quarter for information.

Schedule 1 – Delegation Agreement

Schedule 2 – Delegated function - (to be added when final arrangements confirmed)

Schedule 3 - List of Members


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