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PRIMARY CARE COMMISSIONING COMMITTEE

HELD IN PUBLIC SESSION ON FRIDAY 30 SEPTEMBER 2016 1:00pm – 3:00pm OWEN HOUSE ROOM 1, (down the service road to the back block), ZION CHRISTIAN

CENTRE, LITTLE CORNBOW, HALESOWEN, B63 3AJ

QUORACY A meeting of the Committee will be quorate provided that at least 4 members are present of which:

one must be either the Chair or Vice-Chair of the Committee

one must be the Chief Finance Officer or Chief Nursing Officer

AGENDA

Item Presented by

1 Apologies Mr S Wellings

2

Declarations of Interest

To request members to disclose any interest they have, direct or indirect, in any items to be considered during the course of the meeting and to note that those members declaring an interest will not be allowed to take part in the consideration or discussion or vote on any questions relating to that item.

This meeting is being held in public and is being recorded purely to assist in the accurate production of minutes, decisions and actions. Once the minutes have been approved the recording will be destroyed. All care is taken to maintain your privacy; however, as a visitor in the public gallery, your presence may be recorded. Should you contribute to the meeting during questions from the public, you agree to being recorded.

Mr S Wellings

3 Questions from the Public Mr S Wellings

4 Minutes of last meeting held on Friday 19 August 2016 Enclosed Mr S Wellings

5 Matters Arising/Action Log Enclosed Mr S Wellings

6

Contractual 6.1 Provision of services from practice premises at 146-148 Coombs Rd 6.2 Report from the Primary Care Operational Group

Enclosed Enclosed

Mr D King Mrs J Robinson

7 Quality

7.1 Report from the Quality and Safety Team

Enclosed

Mr C Brunt

8

Finance

8.1 Finance Report

Enclosed

Mr P Cowley

9 GP Resilience Programme in the West Midlands Enclosed Mr D King

10 Risk Register Enclosed Mr D King

11 Any Other Business

12

Date and Time of Next Meeting Friday 21 October 2016 1pm – 3pm The Board Room, Third Floor, Brierley Hill Health and Social Care Centre

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MINUTES OF THE MEETING HELD IN PUBLIC ON FRIDAY 19 AUGUST 2016

1.00pm – 3.00pm IN THE BOARDROOM, BRIERLEY HILL HEALTH AND SOCIAL CARE CENTRE

Quorum: A meeting of the Committee will be quorate provided that at least four members are present of which one must be either the Chair or Vice Chair of the Committee and one must be the Chief Finance Officer or Chief Nursing Officer. ATTENDEES: Members Mr S Wellings Non-Executive Director for Governance, Dudley CCG (Chair) Mr J Cahill Quality Assurance Manager, Dudley CCG (Deputising for Mrs C Brunt) Mrs S Johnson Deputy Chief Finance Officer, Dudley CCG (Deputising for Mr M Hartland) Dr D Pitches Consultant in Public Health, Dudley MBC In Attendance Dr V K Mittal GP Representative Mr T Thomik Dudley LPC Representative Mrs A Nicholls Senior Contract Manager, NHS England (West Midlands) Dr T Horsburgh Clinical Lead for Primary Care, Dudley CCG Mrs J Robinson Primary Care Contracts Manager, Dudley CCG Mr D Stenson Patient Opportunity Panel Representative Mr P Cowley Senior Finance Manager, Dudley CCG Mrs L Harding Communications Specialist, Dudley CCG Mrs J Hodgson Business Manager, AW Surgeries Mrs J Steventon Practice Manager, The Greens Health Centre Minute Taker: Mrs R Gretton Personal Assistant, Dudley CCG Mr Wellings welcomed members of the public for attending the Committee. He explained how the meeting would be run and advised that item 6.0 would be discussed first. Members of the Committee were asked to introduce themselves and say what their role is on the Committee. Item 4.0, 5.0 and 7.0 were then discussed on the agenda before returning to item 6.1 when the report was continued. Item 10.0 was discussed prior to item 9.0.

1. APOLOGIES FOR ABSENCE

Apologies were received from: Mrs L Broster, Head of Communications and Public Insight, Dudley CCG Dr A Catto, Secondary Care Clinician, Dudley CCG Mr M Hartland, Chief Operating and Finance Officer, Dudley CCG Ms J Emery, Chief Executive, Healthwatch Dudley Dr C Handy, Non-Executive Director for Quality & Safety Mr D King, Director of Membership Development and Primary Care, Dudley CCG Mrs J Taylor, Commissioning Manager for Primary Care, Dudley CCG Mrs E Smith, Governance Support Manager, Dudley CCG Mrs C Brunt, Chief Nurse, Dudley CCG Mrs J Jasper, Lay Member for Patient and Public Involvement, Dudley CCG

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2. DECLARATIONS OF INTEREST

To request members to disclose any interest they have, direct or indirect, in any items to be considered during the course of the meeting and to note that those members declaring an interest would not be allowed to take part in the consideration or discussion or vote on any questions relating to that item: GP members and Practice Managers declared a standing interest, particularly with regards to the contractual items, although they do not have a voting position on the Committee. Mr Stenson declared his standing interest as an Associate Non-Executive Director for Black Country Partnership Foundation Trust.

3. QUESTIONS FROM THE PUBLIC

Mr Wellings had received a question from the public in advance of the Committee which asked This question would be answered as part of the discussion which would take place under agenda item 6.1.

4. MINUTES FROM THE PREVIOUS MEETING HELD ON 15 JULY 2016

The minutes of the Committee held on 15 July were accepted as a true and accurate record.

5. MATTERS ARISING/ACTION LOG

MATTER ARISING The action log was discussed and updated accordingly with the following points noted: PCCC/JAN/2016/6.2 This action was noted to be deferred to October PCCC/MAR/2016/6.2 It was reported that EMIS enterprise costs in relation to training and data

sharing agreements are approximately £1200, which will cover all of Dudley practices. This item was noted to be complete

PCCC/APR/2016/9.1 The Committee was informed that the IT team are still awaiting final roll out

schedules from Dudley Group IT Services PCCC/JUL/2016/6.1 A response has been received from Dr B K Prashara covering all points

raised and providing assurances. In addition, the offer of mentorship has been accepted. This item was noted to be complete

6. CONTRACTUAL

6.1 REPORT FROM THE PRIMARY CARE OPERTAIONAL GROUP (PCOG)

This item was discussed first on the agenda OUTCOMES FOR HEALTH UPDAT Mrs Robinson spoke to this item to update the Committee on the issues discussed at the Primary Care Operational Group (PCOG) held on 3 August 2016. The Committee was informed of three contractual changes; Lapal Medical Practice who have requested the addition of one partner effective from 4 July 2016, Three Villages Medical Practice for the removal of one partner effective from 31 August 2016 and Steppingstones Medical Practice to request the addition of one partner effective from 7 September 2016. PCOG was assured that all necessary steps were in place to support the continued provision of primary medical services.

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Stourside Medical Practice – Branch Surgery, Coombswood Road, Halesowen It was reported that this item had been discussed at every meeting of both the Primary Care Operational Group and Primary Care Commissioning Committee since the closure of Coombswood Surgery at the end of May 2016. An update was received by the group, who considered the contractors current position and the proposed courses of action. It was noted that considerable legal advice had been received by the CCG, that provided the Primary Care Operational Group with assurances that significant progress is being made and that any decision in relation to the contractual position should be deferred until September’s Primary Care Commissioning Committee meeting. It was also agreed by the group that Mills and Reeve provide a formal update of the situation to the Committee and this report is included. Item 6.2 was now discussed by the Committee

The report by Mills and Reeve concisely set out progress to date, along with a background summary of the situation between Dr Hearn and the Landlord. The Committee was informed that the CCG has applied as much pressure as possible for a resolution but this was limited by the statutory actions allowed. With regard to the breach notice, the Committee was informed that this period ends on 19 August 2016. It was proposed by the Chair that the Committee deal with questions received from the public in advance of the meeting during this item given the subject matter. These questions asked: ‘Good Morning, to introduce myself, I am a patient of the above practice, who has been personally affected by its closure. I have had numerous candid conversations with Mr Dan King. Mr King has, on every occasion, dealt with my questions in an exemplary and very professional manner, thank you. I have briefly read with interest the papers on this subject, but simple questions remain. Basically, I understand that this situation came about because of a dispute between the Practice Manager and the Landlord.’ It was corrected that the dispute is between the GP and Landlord, not the Practice Manager. ‘Unfortunately, I am unable to attend on Friday, I would therefore be grateful if the following questions be raised on my behalf, to which I would request a response please, thank you.

Why did the dispute go on for so long? Were the CCG not informed immediately of the situation by the Practice Manager at the outset of the problem/s? if not, why?’

It was reported that the CCG was immediately informed of the situation and had been involved to try to help in a resolution.

‘With the CCG intervention, why has the situation taken so long to progress/come to any conclusion? The practice remains closed.

To my knowledge there has been no press media update, nor has there been any public apology to those affected – why?’

It was noted by Ms Thompson, Acting Practice Manager at Stourside, that a press release was given at the

outset.

‘If the situation is the result of the lack of responsibility of the Practice Manager, are they still employed/practicing? If so why?

Where are we now? Will the practice reopen? If so, and when?

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The situation has certainly damaged, yet again, trust in the NHS, (a service I have worked hard to pay for), and my personal Patient Experience non existent. How do you expect patients to trust this particular Practice Manager again? I certainly would not.’ The remainder of the communication from this question was a comment in relation to personal views of the patient and the effect the situation has had on people. Ms Thompson informed the Committee that she had apologised for the situation and continues to apologise to anyone in Coombswood who has been affected by the closure. Ms Thompson reported that she is not personally responsible for the situation; however being part of the practice is prepared to answer for it. It was noted that the people of Coombswood have been severely affected by the closure and the practice is aware of this and are working towards the surgery re-opening. No appointments have been refused and the GP availability has been kept the same. The only issue the branch surgery had not been able to provide is the service at Coombswood, which is understood to have caused concern. The Committee was informed that extra Reception staff had been working to handle enquiries and daily reports had been made to the CCG. Dudley CCG, in response to notification of the Coombswood closure, immediately sought legal advice as to its legal position. It was reported that as the dispute was between landlord and tenant the CCG do not have any powers to intervene directly and can only act in a facilitative capacity. The Committee was informed that the CCG without its delegated commissioning responsibilities would not have had the capacity to intervene and this then would have been dealt with by NHS England. From an NHS England perspective it was noted to be a very difficult situation to manage in the circumstances. In response to question as to whether NHS England would have dealt with the situation differently, the Committee was informed that priority is to ensure that patients are able to access primary medical services and that NHS England would have taken the same action as done so by Dudley CCG. With regard to the situation, it was clarified that the dispute relates to the terms around changes to the practice, retirements and the takeover of the tenancy. It was reported that any withheld rent was not done so deliberately and that all arrears were settled immediately. Subsequent to this, arrangements have now been made by the CCG to make rent payment directly to the landlord with the parties’ permission. It was clarified to the Committee that execution of rental payments to landlords form part of practice responsibilities and therefore the CCG is not aware of any unpaid rent. The Committee believe it was important to highlight that the first instance Dudley CCG was aware of the re-possession and closure of Coombswood Surgery was following a telephone call on the morning of the closure from the Practice Manager. No prior warning that this course of action would be taken by the landlord was given. In response to a question regarding the nearby Chemist to the branch surgery, Ms Thompson reported that processes had been put in place whereby all prescriptions for Coombswood, unless otherwise required, are processed electronically direct to the Chemist, allowing for collection at the pharmacy used by patients. Allowing for input by a member of the public relating to a permanent closure of the surgery, the Committee reported that it did not wish to see the branch closed and that a robust process was in place to deal with branch closures should this be a consideration and which would include a public consultation. It was noted by members of the public in attendance that further communication would be advantageous as it seems there is some confusion on progress on the situation. In regard to vulnerable patients and patients with mobility problems, the Committee was informed by Ms Thompson that no patients had been refused home visits and that additional home visits had been made

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available to those patients requiring this service. No formal complaints had been received from patients expressing that they had not been able to access the service. In response to another question received from a member of the public; ‘When will it re-open?’ It was reported that this would depend on the resolution of legal questions. ‘Is patient data as risk is computer hardware – swipe cards were seized?’ The Committee noted that NHS swipe cards are held on individual persons and that all data held is encrypted. Furthermore, GP clinical systems are web based, with no hard information held on local drives. A further comment was reiterated by the Chair received from a member of the public; ‘The surgery is / was not as good as when Dr Humphrey was in charge’ It was noted that Dr Humphrey Akufo-Tetteh is the landlord of the premises. The Committee was informed that as part of the Mills and Reeve report, it is asked to considered that should the remedial notice not be satisfied by the 19 August 2016, that the CCG write to the Contractor stating that as the remedial notice has not been satisfied by the end of the remedial notice period, the CCG has the right to terminate the GMS Contract and that it reserves its right to do so, but also reserves the right to explore other options which may allow GMS services to continue to be provided under the Contract. The Committee imparted the importance of a resolution of the situation before the next meeting in September, which will be held at a venue in Halesowen. The disappointment of the Committee was noted, especially on behalf of the patients in regard to this position.

Members of the public left the meeting Item 6.1 was continued following discussion of item 4.0, 5.0 and 7.0. Mrs Robinson spoke to the remainder of the report, which noted the Accessible Information Standard and proposals for monitoring in primary care next year. High Oak Surgery premises were discussed by the PCOG, which considered various options. A short term solution was agreed with agreement that more in depth work would take place in terms of how the premises may align to the Estates Strategy along with contractual options and what they may mean for the future. Communications have taken place with NHS Property Services on the procurement of the extra module, along with discussions with the Council who have indicated that they are unlikely to have any objections to the proposal. It is anticipated that this will be a relatively straight forward process. This process fell within the Director of Primary Care’s authority under the scheme of delegation and therefore was able to move forward quickly. The Committee was informed of an incident reported during the Quality and Safety report that brought into question the appropriateness of faxes between NHS organisations. It was reported that the majority of fax communications entering practices were from the District Nursing Team, who do not have access to email. In addition, Child Health Services who do not have individual email addresses. The Committee endorsed the discontinuation of fax communications by any means possible. It is understood that there may some technical issues around the use of emails and that the Committee wish for the IT group to look at this item.

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Resolved: 1) The Committee noted the actions of the Primary Care Operational Group for assurance 2) The Committee agreed to issue a new public statement with regard to the position in

relation to the closure of Coombswood Surgery 3) The Committee noted the contents of the Mills and Reeve report 4) The Committee noted that if the situation remains unresolved that the Committee will

determine the contractual actions at Septembers meeting 5) The Committee approved the contractual changes recommended by the group 6) The Committee support the costs for an additional module as a short term premises

solution for High Oak Surgery 7) The Committee resolved that the use of fax communications be discontinued and that the

IT group look into this and issues relating to emails

6.2 REPORT FROM MILLS AND REEVE – COOMBSWOOD BRANCH SURGERY

This item was discussed in item 6.1.

7. QUALITY

7.1 QUALITY AND SAFETY REPORT

Mr Cahill spoke to this item and highlighted key points within the report. CQC Inspections The Committee was informed that CQC inspections are being scheduled for those practices previously rated as inadequate. Appendix A within the report shows the current situation of CQC inspections across Dudley. No CQC reports had been published subsequent to the previous meeting and monthly teleconferences with CQC continue. It was reported that Quincy Rise Surgery had been re-inspected to check progress on the first set of enforcement actions and a report is awaited. Bath Street Surgery underwent re-inspection on 26 July and a report is awaited, along with an awaited report on the inspected at St James Medical Practice (Porter) on 2 August 2016. The Committee was informed that a mock inspection had been completed as part of the CCG support to practices following an inadequate rating to Dudley Partnerships for Health. This identified good progress had been made regarding their action plan with evidence available for all aspects. Serious Incidents (SIs) Currently, there are three open SIs with one having been closed since the last report. Infection Prevention & Control (IPC) The Committee was informed four audits had been completed and were rated green overall. Service Developments Datix It was reported that there had been some coding issues which are in resolution and progress is still on going on this item. Conflict Resolution Training Three sessions had now been completed with a further two remaining scheduled for September and October. Further sessions will be provided dependent on demand.

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Resolved: 1) The Committee received the report for assurance

8. FINANCE

8.1 FINANCE REPORT

Mr Cowley spoke to this item. An update on the budget and forecast for quarter two list sizes had been made and detailed adjustments are included in the report. The Committee was informed of a number of internal adjustments to the budgets to reflect the quarterly review of co-commissioning costs which are described in the finance report. Particular attention was drawn to the increase in the level of funding for the Dudley Quality Outcomes for Health framework that comes from the delegated budget. The reasons for this are due to the delegated budget containing an amount of money for collaborative fee payments which will be made from the core CCG budget. It was reported that rather than breaking up the co-commissioning budget and reporting in two separate places, adjustments would be made in this way allowing for funds to be freed within the CCG core allocations preventing several budget transfers. It was reported that other changes were yet to be made in relation to property service charges and adjustments for the Dudley Quality Outcomes for Health pilot payments that will be made next month. The Committee was informed that the Dudley Practice Managers Alliance (DPMA) primary care training programme 2016/17 had been submitted and approved in principal. It was noted that there was a conflict of interest with some of the senior members of the DPMA also being Directors of the company which had been commissioned to carry out some of the training and the steps taken to manage this are highlighted within the report. Resolved:

1) The Committee noted the report for assurance 2) The Committee approved the DPMA primary care training plan 3) The Committee noted the process taken in the management of conflicts of interest for

assurance

9. IMPROVING THE NUMBER OF PATIENTS REGISTERED FOR ONLINE SERVICES Item 9.0 was discussed subsequent to item 10.0

Dr Horsburgh spoke to this item identifying a key work stream from the Primary Care Development Steering Group which looks to increase patient registration for online services. Two aspects of the proposal were described to the Committee to allow firstly, Dudley Practice Managers Alliance (DPMA) to collectively manage an improvement in the numbers of patients registered for online services and secondly, to allow individual practices to achieve a higher rate than that of the CCG target. The Committee was informed that the proposal had been developed in consultation with the various stakeholders who support this approach and the Committee is asked to approve the approach detailed in the report. An appeal was made not to lose focus on those members of the population who do not use/have access to IT services and for possible systems to be put in place to support these people. Resolved:

1) The Committee noted the report and supports the development of this idea, with agreement that the CCG make an offer to the DPMA

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10. UPDATE FROM PRIMARY CARE DEVELOPMENT STEERING GROUP This item was discussed before item 9.0

Dr Horsburgh spoke to this item to provide an update to the Committee from the Primary Care Development Steering Group. The Committee was informed that following legal advice, a finalised Memorandum of Understanding (MOU) had been circulated to practices for signatures. The group will focus on six areas, noted in 2.1 of the report, for development and the first series of projects had been prioritised against the six areas reported on page 4 of the report. Shortlisting and interviews for a Project Manager to support the implementation of projects had taken place, with a successful appointment and commencement of the candidate at the beginning of September. With regard to the Utilisation of patient online services, the group had prepared a paper and this was discussed in item 9.0. It was reported in order to help with the development and progress of work streams, the group requested for the increase of GP Champions on the group from 5 to 8, along with an increase in Practice Nurse Representation from 1 to 2. The Committee was informed of some minor adjustments to the budget plan included within the report, noting that within the Education section a slight adjustment to the EPIC programme had been proposed to increase the amount by another £72k to address specific needs of practices. In the area of wider integration, Support for Extended MDT Working; it was noted that this was a proposed budget that required further discussion. Resolved:

1) The Committee supports the recommendation to increase the number of GP Champions on the group from 5 to 8 and the Practice Nurse representation from 1 to 2

2) The Committee noted that a Project manager has been appointed 3) The Committee noted the budget plan prepared by the group as requested but the

Committee at its meeting in July 4) The Committee noted that each scheme set out in the budget plan will be presented to the

Committee for approval before commencing

11. EVALUATION OF DUDLEY CCG PRACTICE BASED PHARMACIST SERVICE

Mr Johal spoke to this item to provide an evaluation of the Dudley CCG Practice Based Pharmacist Service. A summary of key elements during 2015/16 was presented to the Committee. It was noted that in September 2015 additional investment was made through the EPIC scheme, which saw nine practices receive additional practice pharmacy support. The Pharmacy team had worked with a company called PharmOutcomes to develop a bespoke reporting system which had standardised processes and allowed the team to efficiently capture outcomes on a daily/weekly basis. The key outcomes for the team were reported to be; pharmacist alignment to practice MDT meetings, an extra 45 hours additional time provided to the developing MDTs, ongoing over achievement against QIPP targets and achievement of CCG quality premium for Hypertension. In addition, It was reported that in the EPIC practices who received the extended scope roles, showed that over a six month period there was avoidance of over 200 secondary care admissions or outpatient appointments and over 1100 GP appointments were saved, which equated to a saving of over £45k.

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The service evaluation from Aston School of Pharmacy, which is due for publication in the autumn, supports findings in the annual team report and precludes that continuation and expansion of the pharmacist programme would give a significant return on investment for Dudley CCG. From September 2016 through to March 2017, additional funding had been piloted through the New Care Models work, enabling every practice to receive some additional practice pharmacist time. The Committee noted the good work that had taken place and supported its continuation, though an issue to arise will be around funding and this was recommended for discussion at Finance and Performance Committee. Resolved:

1) The Committee noted the report and support the continued work of the Pharmaceutical Public Health Team to develop this model of Practice Based Pharmacy service for consideration of costing by the Finance and Performance Committee

12. RISK REGISTER

Mr Wellings spoke to this item. Each risk was discussed and members were asked to consider whether the residual score should change since the last Committee and if any additional risks should be added. Following earlier discussion during the meeting, members felt that an additional risk relating to Coombswood surgery should be added to the register. ACTION: MRS ROBINSON Risk 34: The impact of significant individual performance issues in relation to primary medical services that could result in removal of GP member from the Performer’s List. No change. Risk 50: Failure of member practices to meet the standards of the Care Quality Commission risks continuity of service provision in member practices. No change. Risk 59: The ability of member practices to fulfill their contractual obligations and provide primary medical services as a result of difficulties recruiting substantive GPs No change. Risk 69: Loss of Primary Care Medical Services as a result of increasing overheads and financial pressure on member practices beyond their control i.e. increasing cost of medical indemnity insurance, rent increases and financial sustainability of operating branch surgery sites. No change. Risk 76: Member GP practices being significantly underpaid as a result of processing errors by Primary Care Support England (PCSE). Destabilises GP practices and is a reputational to the CCG No change. Risk 81: The reputational risk to the CCG through branch closures No change. Risk 95: That increases in the cost of facilities management and service charges of buildings owned by NHS Property Services (NHSPS) may destabilize the finances of General Practices, leading to loss if services. No change. Resolved:

1) The Committee accepted the updated Risk Register with the aforementioned comments and addition of a new risk in relation to Coombswood Surgery

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13. ANY OTHER BUSINESS

The Committee was informed that Mr Maubach, Chief Executive Officer, is providing support to Walsall CCG, which as part of the effect of this Mr Hartland, Chief Operating and Finance Officer, who is required for quoracy, is now finding it increasingly difficult to attend the Primary Care Commissioning Committee. Following Mr Cowley’s temporary position to fulfill this need, this role will now be taken up by Ms Sue Johnson, Deputy Chief Finance Officer, formally, who will uphold this quoracy in Mr Hartland’s absence. It was noted that the Terms of Reference would need to be amended to reflect this position and approval was sought by the Committee.

ACTION: MRS ROBINSON The Committee understood the necessity of the changes in role to senior members of the CCG and noted concerns that this is drawing a key member of Dudley CCGs senior team away from a very important part of business, which has a consequence on delivering the quality wanted and impacts on the whole system. Resolved:

1. The Committee noted and agreed to the request to change the Terms of References to reflect Ms Johnsons attendance to uphold quoracy

14. DATE AND TIME OF NEXT MEETING

Friday 30 September 2016 1pm – 3pm Zion Christian Centre, Little Cornbow, Halesowen, B63 3AJ MINUTES ACCEPTED AS A TRUE AND CORRECT RECORD

Name Title

Signed Date

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OUTSTANDING ACTION LIST – 30 September 2016

MEETING

REFERENCE ACTION LEAD STATUS DATE COMPLETED

PCCC/JAN/2016/6.2

Report on the Closure of Market Street Surgery Monitoring Exercise to be presented to Committee in six months’ time (June 2016) to take the learning from this process moving forward

Mr King In progress To be reported in October 2016

PCCC/FEB/2016/6.1 Report on the Closure of Masefield Road Surgery Monitoring Exercise to be presented to Committee in six months’ time (July 2016)

Mr King In progress To be reported in October 2016

PCCC/APR/2016/9.1 Finance Report – Practice Wi-Fi Members requested presentation of on-going situation reports for assurance as available

Mr Cowley In Progress

PCCC/AUG/2016/6.1

Report from the Primary Care Operational Group (PCOG) It was agreed that a new statement in regard to the current position in relation to Coombswood branch closure would be issued

Mrs Robinson In Progress

PCCC/AUG/2016/12 Risk Register Following earlier discussion it was felt that a new risk be added to the register in relation to Coombswood Surgery


PCCC/AUG/2016/13 Any Other Business Terms of Reference – The ToR were agreed to be changed to reflect Mr Hartland’s removal and Ms Johnson’s addition


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Date of Committee: 30 September 2016

Report: Report to the Primary Care Commissioning Committee in relation to the provision of services from practice premises at 146-148 Coombs Road

Agenda Item: 6.1

TITLE OF REPORT: Provision of services from practice premises at 146-148 Coombs Road

PURPOSE OF REPORT: To consider the update and recommendations in relation to the closure of Coombswood surgery

AUTHOR OF REPORT: Mr D King, Director of Membership Development and Primary Care

Appendix One - Mills and Reeve Solicitors

MANAGEMENT LEAD: Mr D King, Director of Membership Development and Primary Care

CLINICAL LEAD: Dr T Horsburgh, Clinical Lead for Primary Care

KEY POINTS:

Coombswood surgery, a branch surgery of Stourside Medical Practice has been closed since the 31st May 2016 as a result of repossession by the landlord, Dr Humphrey Akufo-Tetteh in relation to the non-payment of rent.

Dr Hearn has been in breach of her General Medical Services (GMS) contract as a result of being unable to provide services from Coombswood.

At the time of preparing this report, Dr Hearn and Dr Akufo-Tetteh have not come to an agreement on either a tenancy at will, or a new lease that would allow services to re-commence at Coombswood.

The Committee therefore has to consider the attached report, legal advice and recommendation below in relation to Dr Hearn’s GMS contract.

RECOMMENDATION:

The Committee notes, for assurance, the steps taken by the CCG to facilitate Dr Ruth Hearn and Dr Humphrey Akufo-Tetteh to reach agreement in respect of their private dispute that has resulted in the closure of Coombswood branch surgery.

The Committee continues not to exercise its right to terminate the General Medical Services (GMS) contract with Dr Ruth Hearn, Stourside Medical Practice as a result of her failure to remedy a breach to her GMS contract by failing to regain entry to Coombswood.

The Committee notes that the commencement of services at Coombswood can only happen if Dr Hearn and Dr Humphrey Akufo-Tetteh resolve their dispute by agreeing either a new lease

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of the property or a temporary tenancy at will, pending completion of a new lease.

The Committee notes that the CCG has taken all reasonable steps to facilitate service provision starting again from Coombswood.

The CCG continues to contract with Stourside Medical Practice for General Medical Services whilst Dr Hearn and Dr Akufo-Tetteh reach agreement.

The CCG and NHS England continue to offer their support to facilitate discussions between Dr Hearn and Dr Akufo-Tetteh.

The recommendations above are supported by NHS England (West Midlands)

FINANCIAL IMPLICATIONS: £20,000 in direct costs for legal advice

WHAT ENGAGEMENT HAS TAKEN PLACE:

Public statements

Telephone updates and written briefing to MP

Telephone updates to members of the public and local pharmacy

Monthly updates to the Primary Care Commissioning Committee

301 signatures received on a petition to the CCG from members of the public who would “like to see the surgery up and running efficiently”.

ACTION REQUIRED: Decision

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1. BACKGROUND

1.1. On the 31st May the CCG was informed by Dr Hearn at Stourside Medical Practice that the

premises at 146-148 Coombs Road, Halesowen, West Midlands, B63 2AF (“Coombswood”) were repossessed by Dr Akufo-Tetteh following a purported forfeiture of the existing lease for non-payment of rent.

1.2. The attached paper in Appendix One “Advice in relation to the provision of services from practice

premises at 146-148 Coombs Road” provided by Mills and Reeve summarises the actions taken by the CCG to date and confirms that in its view the CCG has done all that it reasonably can to facilitate service provision starting again from Coombswood.

2. CONTEXT

2.1. The closure of Coombswood is as the result of a private legal dispute between Dr Hearn and Dr

Akufo-Tetteh. The CCG has no statutory or legal powers to ensure that Coombswood is reinstated as Practice premises from which services may be re-commenced.

2.2. If the CCG had direct control and ownership of primary care premises the risk of a practice being closed a result of private legal dispute arising from the non-payment of rent would most likely never exist.

2.3. As this is a private legal dispute and the CCG is not party to the negotiations that have been

taking place between Dr Hearn and Dr Akufo-Tetteh, the CCG has been advised by its solicitors (Mills and Reeve) it cannot put details of such negotiations into the public domain as to do so risks prejudicing them and may expose the CCG to liability.

2.4. The CCG has expressed the view to Dr Hearn, Dr Akufo-Tetteh and the public that it wishes to

see services re commence from Coombswood.

2.5. The CCG is frustrated and disappointed that this situation has arisen for all of the patients that have used Coombswood and has taken all reasonable steps to ensure that Dr Hearn and Dr Akufo-Tetteh reach an agreement that enables services to re commence from Coombswood.

3. KEY POINTS

3.1. This forfeiture of the lease has arisen because of non-payment of rent or the period of April 2016 and May 2016.

3.2. The CCG were aware of previous issues relating to the non-payment of rent by Dr Hearn in 2015-

16. At that time, it advised Dr Hearn and Dr Akufo-Tetteh that this was a matter that they should seek to resolve. NHS England was also aware and provided the same advice. The CCG also considered arranging for payments of rent to be made direct, but as it only has the power to do so if both landlord and tenant consent and it did not have the consent of Dr Hearn and Dr Akufo-Tetteh it was unable to do this. This issue was resolved anyway by Dr Hearn paying all rent arrears in March 2016.

3.3. In May 2016 the CCG were made aware that the premises at Coombswood had been

repossessed specifically in relation to non-payment of rent for the period April 2016 and May 2016. The CCG were given no prior warning or notice that Dr Akufo-Tetteh planned to take this action, nor was there any legal obligation on Dr Akufo-Tetteh to do so.

3.4. In June 2016 the CCG obtained the agreement of Dr Hearn and Dr Akufo-Tetteh to make direct

payments of the rent to the Dr Akufo-Tetteh.

4 | P a g e

3.5. The CCG has been informed that the error for non-payment of rent for April 2016 and May 2016 occurred because of an administrative oversight in the Practice where effectively, one person thought another person was making the payments.

3.6. While acknowledging the right of Dr Akufo-Tetteh to forfeit the lease in the event of rent arrears,

the CCG is not aware of any other instances of a landlord forfeiting a lease where the premises are used for the delivery of primary medical services.

3.7. The CCG are disappointed that Dr Akufo-Tetteh provided no prior notification to the CCG that he

intended to forfeit the lease before taking this action. Whilst there is no legal requirement on the landlord to do this, the situation of closing Coombswood to patients and the public could potentially have been avoided by prior engagement with the CCG.

3.8. Since Dr Akufo-Tetteh has taken action to close Coombswood and forfeit the lease, the CCG has

done everything it can to facilitate the resolution of this dispute. This has however; been very difficult because the CCG is exceptionally limited in what action it can take in these circumstances.

3.9. The CCG has no statutory or legal powers that require Dr Hearn or Dr Akufo-Tetteh to resolve

their dispute by agreeing a tenancy at will or a new lease.

3.10. The view of the CCG’s solicitors (Mills and Reeve) is that we have done everything we can reasonably do to facilitate service provision starting again from Coombswood.

3.11. The only practical way in which services can be re commenced at Coombswood are as the result

of Dr Akufo-Tetteh and Dr Hearn resolving their dispute. This involves Dr Hearn and Dr Akufo-Tetteh agreeing either a short term tenancy at will, or licence pending the grant of a formal lease of the Premises. The CCG understand that Dr Hearn’s solicitors have also advised of the possibility of seeking an order for relief from forfeiture.

3.12. Dr Akufo-Tetteh and Dr Hearn have been negotiating on the terms for re occupation of

Coombswood since the 31st May 2016. As of the time of writing, they have been unable to agree the terms of re occupation.

3.13. Dr Hearn was prepared to re-enter the premises as a tenant at will pending resolution of the initial

dispute between her and Dr Akufo-Tetteh to ensure that patient services were continued. Dr Akufo-Tetteh has refused this idea and insisted upon a new lease being put in place, as is his legal right.

3.14. Whilst the negotiations have been on-going between Dr Akufo-Tetteh and Dr Hearn the CCG has

taken action contractually to ensure that all patients have had continued access to services at Stourside Medical Practice, 14 Birmingham St, Halesowen B63 3HN and its other branch surgery site at Tenlands Road, 3 Tenlands Road, Halesowen, B63 4JJ

4. CHALLENGES

4.1. The CCG has consistently expressed the view to Dr Hearn, Dr Akufo-Tetteh and the public that

we are frustrated and disappointed with a number of aspects to this dispute specifically: o That Dr Hearn consistently failed to make rental payments to Dr Akufo-Tetteh

o That patients have been denied access to Coombswood as a result of a private legal dispute

over which it has no control o That Dr Akufo-Tetteh has exercised his right to close Coombswood without first notifying and

discussing this with the CCG and seeking a mutually acceptable resolution with Dr Hearn

5 | P a g e

o That despite nearly four months of negotiation between the Dr Akufo-Tetteh and Dr Hearn through their respective solicitors, no formal agreement has been reached on the terms of re occupation and re commencement of services at Coombswood

o That Dr Akufo-Tetteh has not granted Dr Hearn a tenancy at will – this would have allowed

re-occupation and re-commencement of services whilst a new lease, terminable by Dr Akufo-Tetteh on no notice, was agreed.

o That exercising the only contractual options available to the CCG (either termination of Dr

Hearn’s General Medical Services contract for the Stourside Practice; or considering any application by Dr Hearn to remove Coombswood from that contract) would bring about more inconvenience and loss of services to patient care and would not be in the best interests of patients of the Stourside Practice or the wider Dudley area.

o That it has not been able to bring Dr Hearn and Dr Akufo-Tetteh together to reach a

conclusion to their dispute over the past four months

o That it has had cause to spend money and direct staff time away from investing and developing primary care locally, in favour of facilitating the resolution of a private legal dispute between Dr Hearn and Dr Akufo-Tetteh

o That as it is unable to give full details of this dispute to patients and the public there is a

perception that the CCG is in a position to resolve this dispute and physically re-open Coombswood – which it cannot.

5 IMPACT

5.1 The impact on the list size of Stourside Medical Practice is that there has been a reduction of 86 patients since Coombswood was closed by Dr Akufo-Tetteh. The CCG cannot attribute whether this is directly as a result of the closure of Coombswood or natural turnover of patients at the practice.

5.2 The CCG has received one complaint in writing, from a patient, expressing their extreme anger and disappointment at the closure of Coombswood.

5.3 The CCG has received a further telephone complaint, from Evergreen pharmacy, expressing

their disappointment at the closure of Coombswood.

5.4 The CCG has received a petition, signed by 301 members of the public who wish to see the surgery “up and running efficiently”.

5.5 The practice has not received any formal complaints in relation to the closure of Coombswood

and has been providing updates on the actions taken to their Patient Participation Group (PPG).

6 MITIGATIONS

6.1 The CCG has sought assurance, contractually, that the practice is managing the situation to meet patient needs.

6.2 The practice has been providing the CCG with daily updates and have been able to assure the CCG that:

o full provision of primary medical services is being maintained by the practice at the main

surgery site, or its branch surgery site;

o full provision includes all appointment and nurse clinics that were previously available at Coombswood;

6 | P a g e

o additional reception staff have been provided to manage the additional workload of appointment booking and queries;

o the practice has made additional home visits available to vulnerable patients and patients with

mobility problems; and

o prescriptions are being forwarded electronically to the Evergreen pharmacy, or pharmacy of the patient’s choice.

6.3 The CCG, as the commissioners of primary medical services, are therefore satisfied that practice

continues to provide primary medical services for all their registered patients across the remaining practice sites of Halesowen Health Centre, 14 Birmingham St, Halesowen B63 3HN and Tenlands Road Surgery, 3 Tenlands Road, Halesowen, B63 4JJ

7 CONTRACTUAL POSITION AND OPTIONS

7.1 Dr Hearn has been in breach of her General Medical Services (GMS) contract since the 31st May 2016 as she has not been able to provide services from Coombswood.

7.2 As advised by the CCG’s solicitors regarding actions that the CCG may take under Dr Hearn’s GMS contract the CCG has required Dr Hearn to take all reasonable steps to regain entry to Coombswood and restart services. The consequence of Dr Hearn not regaining entry means that the CCG now has the right to terminate Dr Hearn’s GMS contract.

7.3 Termination by the CCG of the GMS contract for the Stourside Practice may lead to challenge by

Dr Hearn.

7.4 The CCG has been advised by its solicitors that as Dr Hearn has been unable to gain re-entry to Coombswood, the options open to the CCG under her GMS Contract are either: o to terminate the GMS Contract with Dr Hearn; or o consider a request from Dr Hearn to remove Coombswood as premises from which services

will be provided, from the GMS Contract.

7.5 Neither of these options would be in the best interests of patients of the practice or the wider Dudley area. Regarding the second option, the CCG has not received an application from or been in dialogue with Dr Hearn about the closure of Coombswood which would in any event be subject to lengthy consultation and assessment by the CCG on the basis of factors including access to other primary care in the locality, patient demographics and distribution and patient engagement, before it could determine whether to accept any such application from Dr Hearn.

7.6 NHS England (West Midlands) is that a contract termination is unwarranted and unnecessary in

this case.

7.7 NHS England (West Midlands) agree that with the CCG legal advice, in that as Dr Hearn and Dr Akufo-Tetteh appear to be close resolving their dispute, that services are close to restarting at Coombswood and as neither of the options referred to at 7.4 above are in the interests of patients of the practice or the wider Dudley area the CCG should not currently exercise their right to terminate the contract.

7.8 NHS England (West Midlands) wish to see Dr Hearn and Dr Akufo-Tetteh resolve their dispute

with support from the CCG. The CCG has offered to facilitate discussions between Dr Hearn and Dr Akufo-Tetteh and NHS England (West Midlands) have agreed to participate in these meetings as necessary.

7 | P a g e

7.9 The Committee are asked to note that rent arrears have been paid by Dr Hearn to Dr Akufo-Tetteh; Dr Hearn has sought a tenancy at will pending completion of a new lease, and confirmed that she has been engaged in without prejudice discussions with Dr Akufo-Tetteh’s solicitors.

7.10 Dr Hearn has therefore demonstrated her commitment to re gain entry and re commence

services and has agreed to meet with Dr Akufo-Tetteh and his solicitor at a meeting facilitated by the CCG in attempt to resolve the dispute before the 30th September 2016.

8. RECOMMENDATIONS

8.1 The Committee notes for assurance the steps taken by the CCG to remedy the contractual dispute arising from a private legal dispute between Dr Ruth Hearn and Dr Humphrey Akufo-Tetteh that has resulted in the closure of Coombswood branch surgery.

8.2 The Committee does not currently exercise its right to terminate the General Medical Services (GMS) contract with Dr Ruth Hearn, Stourside Medical Practice as a result of failure to remedy a breach to her GMS contract by failing to regain entry to Coombswood

8.3 The Committee notes the solution to re occupation and re commencement of the services at Coombswood can only happen if Dr Hearn and Dr Humphrey Akufo-Tetteh resolve their dispute by agreeing a new lease or tenancy at will.

8.4 The CCG has taken all reasonable steps to enables Dr Hearn and Dr Akufo-Tetteh to resolve their dispute.

8.5 The CCG continues to contract with Stourside Medical Practice for General Medical Services whilst Dr Hearn and Dr Akufo-Tetteh resolve their dispute.

8.6 The CCG and NHS England continue to offer their support to facilitate discussions between Dr Hearn and Dr Akufo-Tetteh.

8.7 The recommendations above are supported by NHS England (West Midlands).

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Report: Update from the Primary Care Operational Group Agenda Item: 6.2

TITLE OF REPORT: Update from the Primary Care Operational Group

PURPOSE OF REPORT: To make a recommendation to the Primary Care Commissioning Committee in respect of contractual changes.

AUTHOR OF REPORT: Mrs J Robinson, Primary Care Contracts Manager



KEY POINTS:

The group considered and recommends the contractual changes set out below in the recommendations

Change requires contract variation to be issued to reflect the revised signatories to the contract

All other terms of the contract remain unchanged

RECOMMENDATION:

The Committee is asked to:

Approve the contractual changes recommended by the group as follows:

AW Surgeries - Addition of a new partner effective 1

July 2016

Thorns Road Medical Practice - Addition of a new

partner effective 1 October 2016

Quarry Bank Medical Centre - 24 Hour retirement of one partner effective 31 Dec 2016

Quarry Bank Medical Centre - Addition of one new partner effective 1 Oct 2016

Quarry Bank Medical Centre - Removal of partner 1 effective 1 Feb 2017

Quarry Bank Medical Centre - Removal of partner 2

effective 1 Feb 2017

FINANCIAL IMPLICATIONS: Not applicable


Not applicable

ACTION REQUIRED: Decision Approval Assurance

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DUDLEY CLINICAL COMMISSIONING GROUP – PRIMARY CARE COMMISSIONING COMMITTEE UPDATE FROM THE PRIMARY CARE OPERATIONAL GROUP

1.0 INTRODUCTION

1.1 During August the Primary Care Operational Group considered contractual changes only. No other urgent considerations were required. The group agreed the recommendations outside of the normal meeting.

2.0 PRIMARY CARE CONTRACTUAL CHANGES

2.1 The group considered and agreed the recommendation to the Committee the following contractual changes.

2.2 With regard to the changes at Quarry Bank Medical Centre, an initial enquiry had been received in

July and the practice was asked to reconsider the plans. The practice revised the original plans and produced a business plan that complied with the recommendations made by the group and provided assurances that the provision of primary medical services would not be affected.

Practice details Variation request Effective

date

Comments

AW Surgeries Addition of a new

partner

1 July

2016

The GP resigned from AW Surgeries on

1 May 2016. She has since re-joined the

partnership.

Thorns Road

Medical Practice

Addition of a new

partner

1 October

2016

Previous salaried GP

Quarry Bank

Medical Centre

24 Hour retirement

of one partner

31 Dec

2016

The doctor will be returning as a partner.

She is aware that she can only work for

16 hours a week in the first month. Her

sessions will be covered by existing

partner and locum doctor

Quarry Bank

Medical Centre

Addition of one

new partner

1 Oct

2016

The GP is currently a locum who has

been working at the surgery for 3 years.

Quarry Bank

Medical Centre

Removal of partner

1

1 Feb

2017

The GP will also be removing himself

from the National Performers List – he

does not plan to continue working in any

capacity

Quarry Bank

Medical Centre

Removal of partner

2

1 Feb

2017

The GP will return as salaried GP.

3 | P a g e

.

5.0 RECOMMENDATION


Approve the contractual changes recommended by the group as follows:

o AW Surgeries - Addition of a new partner effective 1 July 2016

o Thorns Road Medical Practice - Addition of a new partner effective 1 October 2016

o Quarry Bank Medical Centre - 24 Hour retirement of one partner effective 31 Dec 2016

o Quarry Bank Medical Centre - Addition of one new partner effective 1 Oct 2016 o Quarry Bank Medical Centre - Removal of partner 1 effective 1 Feb 2017 o Quarry Bank Medical Centre - Removal of partner 2 effective 1 Feb 2017

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DUDLEY CLINICAL COMMISSIONING GROUP


Date of Meeting: 30 September 2016 Report: Quality & Safety Report

Agenda Item No: 7.1

TITLE OF REPORT: Quality and Safety Report

PURPOSE OF REPORT: To provide on-going assurance to the Primary Care Commissioning

Committee (PCCC) regarding quality and safety in accordance with the

CCG’s statutory duties

AUTHOR(s) OF REPORT: Jim Young, Quality and Patient Safety Manager

MANAGEMENT LEAD: Caroline Brunt, Chief Nurse

CLINICAL LEAD: Dr Ruth Edwards, Clinical Lead, Quality & Safety

KEY POINTS:

Three new CQC inspections have been completed

Four practices have been re-inspected by CQC following previous inadequate or requires improvement ratings

Three CQC reports have been published

RECOMMENDATION:

The Primary Care Commissioning Committee is asked to:

Note this report for assurance

FINANCIAL IMPLICATIONS:

None to report

WHAT ENGAGEMENT HAS

TAKEN PLACE: N/A

ACTION REQUIRED: Assurance

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DUDLEY CLINICAL COMMISSIONING GROUP PRIMARY CARE COMMISSIONING COMMITTEE – 30 SEPTEMBER 2016 QUALITY & SAFETY REPORT

1 Introduction

1.1 A primary care quality and safety report is provided to the CCG Quality and Safety Committee (QSC) and CCG Primary Care Operational Group (PCOG) monthly. This report is a material summation of the report submitted to the QSC in September plus any additional information identified after the QSC report was finalised. There was no PCOG meeting in September.

1.2 The PCCC will be briefed on any contemporaneous matters of consequence arising after submission of this report.

2 CQC Inspections

2.1 Appendix A shows the latest status of CQC inspections across Dudley.

2.2 There have been three CQC reports published since the last meeting.

Quincy Rise has had a re-inspection regarding the first set of enforcement actions. All other actions will be followed up at the full 6 month re-inspection visit.

Bath Street have had a full re-inspection following their previous inadequate rating and have improved to ‘Requires Improvement’ overall.

St James Medical Practice (Dr Porter) have been rated as ‘Requires Improvement’ overall.

2.3 The Waterfront Surgery has had its full re-inspection following its previous inadequate rating

2.4 Bilston Street has recently undertaken a full re-inspection following a previous overall requires improvement rating.

2.5 Norton Medical Practice and High Oak Surgery have both been re-inspected following a previous requires improvement rating for the Safe domain.

2.6 Wychbury Medical Group, Links Medical Practice (previously Netherton Surgery) and Clement Road Surgery have all been inspected for the first time.

3 Serious Incidents (SIs)

3.1 No new SIs have been reported since the last meeting. Currently, there are three open SIs.

4 Infection Prevention & Control (IPC)

4.1 Five IPC audits scheduled for 2016/17 have been completed as planned. All five practices have been rated green overall.

5 Service Developments

5.1 Datix – progress has been delayed due to issues mapping data for NRLS reporting. These have now been addressed and work continues to finalise the configuration work by the end of September for testing within the CCG Q&S team. This will then be developed further for use within primary care.

of 3

APPENDIX A: Overview of CQC Inspections (as of 22/09/16)*

Practice Name Visit Date Report

Published Overall rating

Sa

fe

Effe

ctiv

e

Ca

ring

Re

sp

on

siv

e

We

ll Led

Pedmore Road Surgery 22/10/2015 14/01/2016 RI Inad Good

Good

Good

Good

Steppingstones Surgery 28/10/2015 17/12/2015 Good Good

Good

Good

Good

Good

Rangeways Road Surgery 12/11/2015 07/01/2015 Good Good

Good

Good

Good

Good

Bath Street Surgery 24/11/2015 28/01/2016 Inad Inad Inad

Good

RI Inad

Woodsetton Medical Practice 08/12/2015 04/02/2016 Good RI Good

Good

Good

Good

Bilston Street Surgery – follow up 09/12/2015 14/03/2016 Good RI Good

Good

Good

Good

Lapal Medical Centre 15/12/2015 11/02/2016 Good Good

Good

Good

Good

Good

The Waterfront Surgery 17/12/2015 03/03/2016 Inad Inad RI Inad

RI Inad

The Limes Medical Centre 13/01/2016 11/02/2016 Good RI Good

Good

Good

Good

Moss Grove Surgery 19/01/2016 10/03/2016

Central Clinic - follow up 02/02/2016 03/03/2016 Good Good

Good

Good

Good

Good

Dudley Partnerships for Health 10/02/2016 14/04/2016 Inad Inad RI RI RI Inad

Stourside Medical Practice 16/02/2016 04/04/2016 RI RI Good

RI Good

Good

Lower Gornal Medical Practice 01/03/2016 06/04/2016 Good RI Good

Good

Good

Good

Quincy Rise Surgery 09/03/2016 02/06/2016

AW Surgeries 14/03/2016 11/05/2016

Eve Hill Medical Practice 15/03/2016 17/05/2016

Northway Medical Centre 14/04/2016 09/06/2016

Cross Street Health Centre 25/05/2016 24/06/2016

Feldon Lane Surgery 04/05/2016 30/06/2016

Ridgeway Surgery 17/05/2016 06/06/2016

Quincy Rise – follow up 1 18/07/2016 02/09/2016 No change to ratings from this inspection

Bath Street – follow up 26/07/2016 22/09/2016

St. James Medical Practice (Porter) 02/08/2016 13/09/2016

Bilston Street - follow up (2) 10/08/2016 No report No change to ratings from this inspection

Wychbury Medical Group 16/08/2016

Clement Road Surgery 25/08/2016

Norton Medical Practice – follow up 01/09/2016

Bilston Street - follow up (3) 06/09/2016

The Waterfront Surgery - follow up 06/09/2016

High Oak Surgery - follow up 14/09/2016

Links Medical Practice (Netherton) 20/09/2016

Key:

Good Inadequate Requires Improvement Outstanding

* NB: For clarity, this table excludes those practices where reports were published during 2015

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DUDLEY CLINICAL COMMISSIONING GROUP


Date of Report: 30 September 2016 Report: Finance Report

Agenda item No: 8.1

TITLE OF REPORT: Primary Care Commissioning Finance Report

PURPOSE OF REPORT: The report provides an overview of financial performance against budgets delegated to Committee.

AUTHOR OF REPORT: Mr P Cowley, Senior Finance Manager

MANAGEMENT LEAD: Mr M Hartland, Chief Operating and Finance Officer


KEY POINTS:

There have been no changes to the budget allocated to Committee since the previous report

A break-even position is expected to be achieved against co-commissioning budgets.

A small underspend is forecast against core CCG budgets for membership development

RECOMMENDATION: Committee is requested to

Note the reported financial position for assurance.

FINANCIAL IMPLICATIONS: As above.


None

ACTION REQUIRED: Decision Approval √ Assurance √

Finance Report (August 2016) This report submitted to Dudley CCG Primary Care Commissioning Committee provides a breakdown of financial performance for Co-commissioned Primary Care and other budgets within the remit of the committee during the month of August.

Contents Financial Overview p2 Financial Detail p3

Appendices Appendix 1 Revenue and Resource Limit Appendix 2 Service Level Financial Summary Report

Financial Overview

Budgets reported to the committee have an annual value at August 2 016 of £40,719,000, including both the delegated co-commissioning allocation and core CCG budgets.

There have as yet been no in-year allocation adjustments.

2

Budget Allocations

Performance against Budget

Primary Care Co-

Commissioning

£39,863k

CCG Core Commission

ing £856k

Delegated Co-Commissioning is forecast to break even at the end of the financial year. CCG Core Commissioning budgets are expected to underspend by £30,100, mainly as a result of expected underspends against the Practice Engagement LIS.

Allocation Breakdown

Delegated Co-Commissioning

Co-commissioning budgets continue to see a forecast break-even position, with the only changes during August being the effect of changes to premises reimbursement and payments under the Dudley Quality Outcomes for Health (DQOFH) scheme which were outlined to Committee in the previous report. Further detail on these changes can be found below.

3

Summary Position

Area

Budget

(WTE)

Annual

Budget

(£'000)

Forecast

Variance

(£'000)

GP Contract 25,881 -

QOF and Enhanced Services 6,694 -

Premises Costs 4,701 -

Dispensing/Prescribing Drs 255 -

Other GP Services 818 -

Reserves 1,515 -

Total - 39,863 -

Following the receipt of 16/17 charge information from NHS Property Services the CCG have now amended practice reimbursement levels. This has increased reimbursement levels by £74,000, which equates to a 25% increase. Invoice levels are currently subject to challenge and further adjustments are expected at quarter 3 and quarter 4, so it is likely that further adjustments to reimbursement will be made; these adjustments are not however likely to result in a material change to the financial position.

Premises Adjustment

Following the finalisation of 15/16 practice income levels changes have been made to the payment schedules for the DQOFH, with practices given three weeks in September to raise any queries with their schedule. Following approval from the practices, the first payments under the revised schedules have now been made. The aggregate payment amount has increased by £26,000 from the initial schedules, with this funding being taken from the DES reserve.

Dudley Quality Outcomes for Health Pilot

CCG Core Commissioning

4

Summary Position

• Primary Care Training Budgets are expected to be spent in full, in line with the training plan submitted by the Dudley Practice Managers Alliance. This plan is discussed overleaf

• The Nurse Mentors and EVTS report is showing an underspend by

£6,000. The cause of this underspend is the under-establishment of the Nurse Mentoring Team.

• The Practice Engagement LIS is currently forecast to underspend by

£30,000, as the maximum cost of the published scheme is lower than the available budget.

Recommendation: • Committee is asked to note the reported financial position for assurance.

Area

Budget

(WTE)

Annual

Budget

(£'000)

Forecast

Variance

(£'000)

Primary Care Training 70 -

Nurse Mentors and EVTS 0.84 196 (6)

Practice Engagement LIS 591 (30)

Total 0.84 856 (36)

PRIMARY CARE CO-COMMISSIONING

Recurring

(£000's)

Non Recurring

(£000's)

Total

(£000's)

TOTAL 16/17 NOTIFIED RESOURCE ALLOCATION 39,863 0 39,863

Notified Resource Adjustments

0

0

0

0

0

0

Total Notified Resource Allocation 0 0 0

Anticipated Resource Adjustments

Total Potential Resource Allocation 0 0 0

0 39,863

Appendix 1: Revenue Resource Limit

Period : August 2016

CCG RESOURCE LIMIT 2016/17 : CO-COMMISSIONING 39,863

Appendix 2: Primary Care Service Level Financial Summary Report 2016/17

#REF!

Dudley Clinical Commissioning Group

Primary Care Co-Commissioning WTE

Budget

WTE

Actuals

Annual Budget

£000's

Year to date

Budget £000's

Year to date

Actual £000's

YTD

Variance

£000's

General Practice - GMS 25,413 10,577 10,577 0

General Practice - APMS 468 195 193 (2)

QOF 2,155 542 542 0

Enhanced Services 4,571 2,220 2,221 1

Premises Cost Reimbursement 4,765 2,430 2,429 (1)

Other Premises Costs 9 4 4 (0)

Dispensing/Prescribing Drs 255 106 106 -

Other GP Services 2,227 535 542 6

Primary Care Co-Commissioning Total 39,863 16,609 16,614 5

Primary Care Development WTE

Budget

WTE

Actuals

Annual Budget

£000's

Year to date

Budget

£000's

Year to date

Actual

£000's

YTD

Variance

£000's

Primary Care Training - - 70 29 29 (0)Nurse Mentors and EVTS 0.84 0.80 196 81 66 (15)Practice Engagement LIS - - 591 246 233 (13)Primary Care Investments - - - - 1 1

Primary Care Development Total 0.84 0.80 856 357 329 (28)

1 | P a g e



Report: Update from the Primary Care Operational Group Agenda Item 9.0

TITLE OF REPORT: GP Resilience Programme in the West Midlands

PURPOSE OF REPORT: To inform the Primary Care Commissioning Committee of the draft proposals for GP Resilience Programme and CCG response

AUTHOR OF REPORT: Mr D King, Director of Membership Development and Primary Care



KEY POINTS:

Draft proposals for GP Resilience Programme in the West Midlands attached

NHSE West Midlands receiving £1.2m in 2016/17 to support GP resilience as part of investment into Primary Care as part of the GP Forward View (GPFW)

CCG response is attached and reflects the view of the Committee in that resources and decision making are the responsibility of the CCG under its delegated functions

Walsall and South Worcestershire CCGs have replied to the draft proposals in the same way as Dudley

RECOMMENDATION:


Note the draft proposals for the GP Resilience Programme in the West Midlands

Note the response provided to NHS England on behalf of the Committee

FINANCIAL IMPLICATIONS: Not applicable


Not applicable

ACTION REQUIRED: Decision Approval Assurance

Classification: Official

1

GP Resilience Programme in the West Midlands


2

GP Resilience Programme in the West Midlands

Draft Proposals Version number: 1.1 First published: 19 August 2016 Updated: Prepared by: Direct Commissioning Team, NHS England (West Midlands)

1 Contents

1 Document Purpose .............................................................................................. 3

2 The Proposals ..................................................................................................... 4

2.1 Background ................................................................................................... 4

2.2 National Policy ............................................................................................... 4 2.3 West Midlands Proposals .............................................................................. 5 2.4 Governance ................................................................................................... 6


3

1 Document Purpose This document sets out the DRAFT proposals for the GP Resilience Programme in the West Midlands. The funding can be used to:

• Expand local DCO team capacity and capabilities to provide support directly to practices to ensure ability to respond quickly is in place

• Commissioning support via contracted third party supplier(s) to work with practices where additional expertise is required

• Backfill (or other costs) for individual GPs and other practice team

members to work to provide peer support to practices locally, providing ‘sender’ practices have additional capacity to offer such support

• Section 96 Support and Financial Assistance where there are clear and

exceptional opportunities to support practices directly in delivering the menu of support


4

2 The Proposals

2.1 Background

General practice is the bedrock of the NHS, but it is under pressure from rising demand. Patient satisfaction remains high, with 85.2% of the public reporting a good experience of general practice services in the most recent survey, but this masks variation and difficulties in some parts of the country in accessing convenient appointments. GPs have to deal with difficult issues of increasing demand and rising expectations, and this is in the face of the increasing complexity of the patient workload that they see. The General Practice Forward View, published on 21st April, sets out NHS England’s investment and commitments to strengthen general practice in the short term and support sustainable transformation of primary care for the future. It includes specific, practical and funded actions in five areas – investment, workforce, workload, infrastructure and care design. We recognise that the General Practice Forward View Is not just about sustaining general practice. It is about laying the foundations for the future, so that general practice can play a pivotal role in the future as the hub of population-based health care as envisaged in the New Models of Care programme. Working at scale, with high uptake of new technologies and using the breadth of skills and capabilities across the medical and non-medical workforce, general practice will be better geared to support prevention, to enable self-care and self-management as part of creating a healthier population and a more sustainable NHS. This document outlines the NHS England West Midlands proposal for the implementation of the GP Resilience Programme. Comments are invited on this document until Friday 2nd September 2016.

2.2 National Policy

The nationally developed Practice Resilience Programme (PRR) allows DCO teams to work with constituent CCGs, LMCs representatives and RCGP Faculties and Regional Ambassadors to ensure that the most appropriate package of support is available promptly in order to support practices. Funding is in place to support the programme over the next four years. The funding allows DCOs to invest in support arrangements over the medium term and working with partners to ensure that funds are directed to areas of highest need across the footprint. As part of the overall £40m investment, NHSE West Midlands’ allocation is overleaf.


5

Regional teams

Reg. Population (April 2016)

Indicative Allocation FY16/17

Indicative Allocation FY17/18*



Total Programme Allocation

West Midlands

4,433,101 £ 1,230,738 £ 615,369 £ 615,369 £ 615,369 £ 3,076,845

Nationally the anticipated areas of support (referred to as ‘menu’) include:

• Rapid intervention and management support for practices at risk of closure • Change management and improvement support to individual practices or

group of practices • Diagnostic services to quickly identify areas for improvement support. • Specialist advice and guidance – e.g. Operational HR, IT, Management,

and Finance • Coaching / Supervision / Mentorship as appropriate to identified needs • Practice management capacity support • Coordinated support to help practices struggling with workforce issues

The funding can be used to:

• Expand local DCO team capacity and capabilities to provide support directly to practices to ensure ability to respond quickly is in place

• Commissioning support via contracted third party supplier(s) to work with practices where additional expertise is required

• Backfill (or other costs) for individual GPs and other practice team members to work to provide peer support to practices locally, providing ‘sender’ practices have additional capacity to offer such support

• Section 96 Support and Financial Assistance where there are clear and exceptional opportunities to support practices directly in delivering the menu of support

2.3 West Midlands Proposals

The West Midlands Primary Care Team has an excellent track record in supporting Practices in difficulties as well as working with CCGs as part of the Primary care Hub arrangements to ensure arising issues are managed and addressed.

• Commissioning support via contracted third party supplier(s) to work with practices o NHS England West Midlands had previously engaged PCC to provide

support under the Vulnerable Practices programme - this remains available for the GPRP.

o NHS England is centrally procuring a framework of support packages form a range of providers, which will be in place for October 2016. This will speed up local ability to secure provider support for GP practices (and other primary care providers).

o We will use this framework as it will enable us to access solutions quickly.


6

• Backfill (or other costs) for individual GPs and other practice team members to work to provide peer support to practices locally, providing ‘sender’ practices have additional capacity to offer such support o NHS England (WM) will procure additional ad-hoc clinical support as

needed to provide advice and guidance in addition to managerial support.

o We recognise the power of peer support and using the funding flexibly to secure practical workforce support via establishment of local ‘pools of expert peer support’ by funding key elements of GP costs (e.g. General Medical Council fees and appraisal toolkit fees) in return for securing a minimum clinical commitment to work to support practices.

• Section 96 Support and Financial Assistance where there are clear

and exceptional opportunities to support practices directly in delivering the menu of support o We will work closely with partners to ensure the most appropriate levels

of support are offered to those very challenged practices.

• Expand local DCO team capacity and capabilities to provide support directly to practices to ensure ability to respond quickly is in place o We propose to strengthen the GP Medical Services team in NHS

England to provide greater support to practices and CCGs in times of crisis.

o The ability of the team to respond rapidly to challenging situations and support CCGs when required has proven crucial to mitigating impact on patient care. Our ability to respond where input is most needed and flex resources accordingly is key to a positive outcome for contractors and patients across the West Midlands.

o The additional resource enables us to dedicate a Primary Care lead manager for every STP footprint. This will provide greater capacity to manage issues at a local level, and will support Primary Care engagement in the longer term sustainability and transformational agenda in every STP.

2.4 Governance

NHS England West Midlands will establish a GP Forward View Delivery Group with a number of sub-groups. The overall group will be chaired by an NHS England (West Midlands) Director. Representations will be sought from other NHS England Directorates, Health Education England, the LMCs and the CCGs. It is expected that at this group, there will be one representative for the CCGs and one representative of the LMCs. A number of sub groups will be established, including a sub group focusing on the delivery of the GP resilience programme. This will involve all CCGs and local LMCs with conversations about their local needs and issues. This group will meet monthly. The West Midlands GP Resilience Delivery Group will have the flexibility to quickly identify practices for support under the GPRP by selecting:


7

• Practices assessed initially but not subsequently prioritised for support • Practices offered support but who did not take up the offer • Groups of practices where practice based assessments identify a need in a

particular locality or place (e.g. support offered to a group of 5 practices in a locality because 3 practices are struggling and there is a risk of the domino effect impacting other practices unless support targeted at scale).

Decisions about the support will be made on the basis of local intelligence and decisions as to where the greatest impact can be achieved using the available resources – we will manage this through the Transformation Board. We propose to refresh the assessments on a regular basis to ensure support is directed as most appropriate. More information on the GPFV governance structure in the West Midlands will be available at the start of September.

2nd Floor, Brierley Hill Health & Social Care Centre

Venture Way Brierley Hill

West Midlands DY5 1RU

Tel: 01384 321868 Fax: 01384 322414

Email: [email protected]

1 September 2016 Martina Ellery Deputy Head of Primary Care NHS England – Midlands and East (West Midlands) Wildwood Drive Wildwood Worcester WR5 2LG Dear Martina RE: DUDLEY CCG RESPONSE - GP RESILIENCE PROGRAMME IN THE WEST MIDLANDS Thank you for sending me a copy of the draft proposals for a GP Resilience Programme in the West Midlands. Firstly, we are very encouraged that NHSE West Midlands will be receiving £1.2m to support GP resilience. In respect of comments and feedback from Dudley CCG we are very supportive of the principles set out in the document particularly in relation to expanding capacity for direct support, providing commissioning support and backfill, and providing financial assistance. From our perspective its fundamental that delegated CCGs have the freedom and flexibility to manage this resource, and expand on the schemes that we already have in place to support GP resilience. We have a number of examples in Dudley where we are already running schemes and commissioning third party providers to run a number of innovate programs that are well evidenced, and supporting practice resilience. We already provide mentorship, and extensive support through our delegated functions, and also through our development activities related to our work as vanguard MCP site – particularly in terms of preparing and developing primary care for their role in an emerging MCP. I would therefore want to see our existing schemes and capacity expanded in response to these draft proposals. This is consistent and in line with out our delegated functions and the way that we work at present. I appreciate that it may not be possible or agreeable that delegated CCGs effectively take their own share of the resource however, our feedback is that delegated CCGs should have the flexibility to design, develop and commission schemes locally, and have the ability to invest and expand on their current work programs where this aligns in delivering GP resilience. In respect of the governance, our view is that delegated CCGs will have the responsibility to agree and sign off proposals to develop and implement schemes that would support GP resilience, and the role of the West Midlands GP Resilience Delivery Group would be to assure itself that delegated CCGs are managing this responsibility – in the same way that NHSE will assure itself of our ability to commission primary medical services under our scheme of delegation.

mailto:[email protected]

I hope that this is helpful. I am happy to discuss, and look forward to participating in the West Midlands GP Resilience Delivery Group. Kind regards Yours sincerely Daniel King Director of Membership Development & Primary Care

Dudley CCG Combined Board Assurance Framework and Corporate Risk Register 2015/16

08-Sep-16

1A Primary care and MCP development

NOTE: TREND IN RESIDUAL RISK AGAINST PREVIOUS MONTH IS SHOWN //=

ID Original Date Last Review

(Committee

Date)

Last Update

(Risk

Amended)

LIN

K T

O C

OR

PO

RA

TE

OB

JE

CT

IVE

(S

EE

KE

Y

AB

OV

E)

Risk Description Accountable

Committee

Accountability

Sponsor & Owner

Management Lead

P I

Initial Risk

Score

(PxI)

Score

before any

controls

are in

place.

Key Controls

What controls/systems are in

place to assist in securing

delivery of our

objective. Such as strategies,

policies and procedures

Gaps in Control

Where are we failing to put

controls/ systems in place. /

Where are we failing in

making them effective. For

example lack of training or

no regular review of

performance

Gaps in Assurance

Where are we failing to gain

evidence that our controls/

systems, on which we place

reliance, are effective. Such

as no assurance a strategy or

policy is effective

(R) P (R) I

Residual

Risk Score

(PxI)

Score

following

controls put

in place

Risk Trend Internal Assurances

Board Reports,

Minutes of meetings

External Assurances

Internal and External

Audit Reports, CQC

Reports

Actions

To improve control,

ensure delivery of

principal objectives,

gain assurance

Timescales

Date action will be

completed

COMMENTS

34 22/04/2013 19/08/2016 07/03/2016 2

The impact of significant individual

performance issues in relation to

primary medical services that could

result in removal of GP member from

the Performers' List

PCC Steve Wellings Dan King 4 4 16

GP Contracts / Appraisals

Peer Review Audit

Training and Education

GMC Registration

GP under performance referred to

the NHS England Professional &

Practice Information Gathering

Group (PIGG)

None identified. None identified 2 1 2 =

Primary Care

Operational Group

reporting into Primary

Care Commissioning

Committee and Quality

and Safety Committee

GMC Registration

Two way communication

between the CCG PCOG

and the PIGG at NHS

England

GP / Nurse Mentoring

Commissioning of

Services for Primary

Care

GP Education, training

and Development

On-going

50 04/08/2014 15/07/2016 15/07/2016 2

Failure of member practices to meet

the standards of the Care Quality

Commission risks continuity of service

provision in member practices.


Relationship with the Link Inspector

at the CQC who is invited to attend

the Primary Care Operational

Group (PCOG).

Training and Development with

Practices to help them manage

inspections.

Blue Stream online academy.

Quality Assurance Manager for

Primary Care appointed and in

post. PCOG and PCC following

NHS England "Framework for

responding to CQC inspections of

GP practices". CCG has support

process and package in place for

all practices.

Further develop the working

arrangements with NHS

England Professional & Practice

Information Gathering Group.

None identified 4 3 12

All CQC inspection

reports considered in the

Primary Care

Operational Group and

coordinated actions in

place between CCG,

NHS England and CQC.

CQC Reports and

associated action plans

from GP Practices.

Develop a quality

framework and Care

Quality Review Meeting

(CQRM) for Primary

Care

On-Going

Residual risk score increased

from 9 to 12 as a result of CQC

inspection and statutory

enforcement notices issued to

Quincy Rise

59 29/10/2014 19/08/2016 27/05/2016 3

The ability of member practices to

fulfil their contractual obligations and

provide primary medical services as a

result of difficulties recruiting

substantive GPs


Developing and implementing the

new model of care - Dudley

Multispecialty Community Provider

(MCP). As part of the new model,

developing and investing in the

clinical and non clinical

infrastructure and estate to deliver

the model.

N/A 3 3 9 =

Engagement visits with

all GP practices.

Workforce data

collection. Developing

and investing in the


infrastructure and

professional

development to

implement the new

model of care.

NHS England and Health

Education England

commitment to training

and professional

development. New

models of care team

supporting the Dudley

Vanguard MCP model of

care and development.

Successful bids to the

new models of care

team for additional

investment and support

to enable the

implementation of the

new model of care.

On-GoingResidual Risk score to be

considered by the Committee

69 22/05/2015 19/08/2016 15/07/2016 2

Loss of Primary Care Medical

Services as a result of increasing

overheads and financial pressure on

member practices beyond their

control i.e. increasing cost of medical

indemnity insurance, rent increases

and financial sustainability of

operating branch surgery sites.





(MCP). As part of the new model,

developing and investing in the


infrastructure and estate to deliver

the model.

None identified. N/A 1 3 3 =

Engagement visits with

all GP practices.

Workforce data

collection. Developing

and investing in the


infrastructure and

professional

development to

implement the new

model of care.

Successful bids to the

new models of care

team for additional

investment and support

to enable the


new model of care.

New models of care team

supporting the Dudley

Vanguard MCP model of

care and development.

Education, training and

support. Providing

access to specialist

advice and support.

Coordinating and

supporting practices

liaising with NHS

property services

regarding rent

increases. Investing in

systems and creating

processes that enable

improvements in

practise efficiency i.e.

practice development

programmes.

Implementation of the

new model of care

including successful bid

to the new model of

care team for additional

investment, and the

development and


estates strategy.

Publication of the GP

Forward View

Mar-17

76 17/07/2015 19/08/2016 15/07/2016 4

Member GP practices being

significantly underpaid as a result of

processing errors by Primary Care

Support England (PCSE). De-

stabilises GP practices and is a

reputational to the CCG.

PCC Dr Tim Horsburgh Dan King 2 2 4

GP practices advised to escalate

through CCG to NHS E. In extreme

cases CCG to make payments on

account to cover shortfalls.

None

NHS E not provided assurance

around continuity plans as the

service is transferring to a new

provider from September 2015.

2 2 4 =

Monitoring incidences

and reporting through

finance report to PCCC.

All CCG finance leads

meeting with NHS

England (commissioner

of PCS) and NHS

England escalating

issues to PCSE for

resolution.

Consultation and liaison

with the PCS and NHS

England.

Escalation to NHS

England as and when

issues occur.

Complete

RECOMMENDATION TO AUDIT

COMMITTEE TO CLOSE THIS

RISK as there are systems now in

place to ensure this does not

occur.

3. Improving quality and safety 3A Ensure on-going safety and performance of the system

4. System effectiveness

4B Primary Care contract

STRATEGIC AIMS

1. Reducing health inequalities

2. Delivering best possible outcomes

4A Procure the MCP

4C Actively participate in the Black Country STP

OBJECTIVES 2016/17

2A Ensure appropriate procurement of secondary care services

2B Public engagement on model and procurement

2C Develop the CCG: Fit for purpose for the future2D Performance management of the system and VP implementation

ID Original Date Last Review

(Committee

Date)

Last Update

(Risk

Amended)

LIN

K T

O C

OR

PO

RA

TE

OB

JE

CT

IVE

(S

EE

KE

Y

AB

OV

E)

Risk Description Accountable

Committee

Accountability

Sponsor & Owner

Management Lead

P I

Initial Risk

Score

(PxI)

Score

before any

controls

are in

place.

Key Controls

What controls/systems are in

place to assist in securing

delivery of our

objective. Such as strategies,

policies and procedures

Gaps in Control

Where are we failing to put

controls/ systems in place. /

Where are we failing in

making them effective. For

example lack of training or

no regular review of

performance

Gaps in Assurance

Where are we failing to gain

evidence that our controls/

systems, on which we place

reliance, are effective. Such

as no assurance a strategy or

policy is effective

(R) P (R) I

Residual

Risk Score

(PxI)

Score

following

controls put

in place

Risk Trend Internal Assurances

Board Reports,

Minutes of meetings

External Assurances

Internal and External

Audit Reports, CQC

Reports

Actions

To improve control,

ensure delivery of

principal objectives,

gain assurance

Timescales

Date action will be

completed

COMMENTS

81 05/10/2015 19/08/2016 27/05/2016 1The reputational risk to the CCG

through branch closuresPCC Steve Wellings Dan King 4 4 16

GP Practices need to undertake

statutory Consultation and apply to

CCG, which has full authority to

decide on an application

None None 3 3 9 =Application considered

by PCOG decision by

PCCC

NHS England Policy

which CCG adopted

under delegated primary

care commissioning

Support GP Practices

in the consultation

process.

Primary Care contracts

manager meeting

practices to take

through contractual

process in terms on

branch closures.

Finance & IT provide

advice on financial

advice and IT

infrastructure advice.

Oct-16

96 17/06/2016 19/08/2016 17/06/2016 4

That increases in the cost of facilities

management and service charges of

buildings owned by NHS Property

Services (NHSPS) may destabilise

the finances of General Practices,

leading to loss of services.

PCC Tim Horsburgh Daniel King 2 3 6

The CCG has set up a working

group of affected practices to

ensure visibility of issues and co-

ordinate practice responses, and

has offered to act on practices’

behalf in dealing with NHSPS to

resolve existing disputes.

Further development of CCG

and practice relationships with

NHS Property Services is

required.

2 3 6 =

Liaise with NHS

Property Services on

behalf of General

Practices and use

tenants’ forum to

identify common issues

and approaches to

resolution

Sep-16

100 31/05/2016 19/08/2016 19/08/2016 1Unexpected branch closure due to

dispute between landlord and tenantPCC Tim Horsburgh Daniel King 4 4 16

General Medical Services

Contract.None

General Medical Services limited

when matter relates to private

legal dispute disrupting the

provision of General Medical

Services.

3 3 12 NEWRegular reports to

PCOG and PCCC

Press statements, briefing

to MP, Health Overview

and Scrutiny Committee

Direct rental payments

arranged with landlord,

legal advice sought to

facilitate dispute, public

communication on the

dispute and actions

taken to resolve.

Sep-16Risk created from Committee in

August 2016 Julie Robinson to

complete a New Risk Form

105 08/06/2016

To be reviewed

and agreed at

Committee

4B

Lack of resilience within the primary

care workforce and the fragmented

nature of current GP provision results

in a failure to meet patient demandPCC Tim Horsburgh Daniel King 3 3 9




(MCP). NHSE GP Resilience

Programme. Dudley Primary Care

Development Group & investment.

None None 2 2 4 NEW

Primary Care

Development Steering

Group reports to Primary

Care Commissioning

Committee.

Implementation updates

provided to NHS England

and New Care Models

Team.

None identified Mar-17

106 08/06/2016

To be reviewed

and agreed at

Committee

4B

Any adverse impact upon NHS

England delegated primary care

commissioning funding and/or

political interference results impacts

upon the CCGs ability to deliver the

required changes to primary medical

services

PCC Tim Horsburgh Daniel King 3 3 9Full delegation legally established

with devolved budget.None

GPFW investment may be

allocated centrally within NHSE

rather than through delegated

CCGs.

1 1 1 NEW

Annual review by the

Primary Care

Commissioning

Committee

CCG involved in GPFW

implementation groups

within NHS England.

None identified On-going

117 08/06/2016To be reviewed at

Committee1A

Failure to provide sufficient

differential benefit from the MCP to

adequately engage primary care and

get buy-in


Primary Care Development

Steering Group established,

practices invited to agree

Memorandum of Understanding.

Engagement plan in place.

None identified. None identified 3 3 9 NEW

Primary Care


Group reports to the

Primary Care

Commissioning

Committee

Primary Care

Commissioning

Committee reports to

NHS England

None identified Mar-17Originally under CDC - NB

Suggests its PCC.

118 08/06/2016

To be reviewed

and agreed at

Committee

1A

Lack of clinical and managerial

capacity and capability for primary

care to deliver the required

transformation and operate primary

care at scale


Primary Care Development

Steering Group established and co-

ordinating and developing plans to

enable practices to improve and

change.


Primary Care


Group reports to the

Primary Care

Commissioning

Committee

Primary Care

Commissioning

Committee reports to

NHS England

None identified Mar-17

119 08/06/2016

To be reviewed

and agreed at

Committee

4B

Poor quality GP estate that

compromises the ability of practices

to deliver General Medical Service

contracts


Primary Care Estates Strategy and

participation and support of CCG to

enable access to National funding

streams.


CCG Estates Strategy

published. Practical

support available to

practices to prepare and

access National funding

streams.

None identified None identified On-going

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