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Agenda

NHS South Cheshire Clinical Commissioning Group NHS Vale Royal Clinical Commissioning Group

Meeting Name: Primary Care (General Practice) Commissioning Committee (Formal)

Date/Time: Wednesday 30 Nov 2016 13.00 - 15.00

Venue: Board Room, Bevan House, Nantwich

Chair: Terry Savage Meeting No: 09 Reporting Period: 2016/17

Business Subject Topic No.

Topic Name Lead

Time Slot

Reports/ Verbal

Page No.

Committee Management

9.1.1 9.1.2 9.1.3 9.1.4 9.1.5

• Welcome • Apologies for

Absence

Declarations and Conflicts of Interest Confirmation of Quoracy Minutes of the last meeting Action Log

Chair Chair Chair Chair Chair

13.00

13.05

13.10 13.15 13.20

Verbal Verbal Verbal Attached p5 Attached p13

Co-commissioning

9.2.1 9.2.2 9.2.3 9.2.4 9.2.5

Terms of reference - Discussion NHS England update

- Practice Resilience Scheme

Delegated Commissioning Risk Register & Update from Task & Finish Group GP IT Report AUA DES Component 2 – Practice issues

All T Knight C Leese/ C Harley K Highfield C Harley

13.30 13.40 13.50

13.55

14.05

Attached p15 To follow Attached p27 Attached p38 Attached p51

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Agenda


9.2.6 9.2.7 9.2.8 9.2.9

Primary Care Quality & Contracting Meeting update Transformation Update CQC Update for Assurance Training monies for Reception & Clerical Staff – Process & Governance Arrangement

C Leese A Best C Leese/ C Harley C Leese

14.20 14.25 14.30 14.35

Attached p58 Verbal Attached p61 Attached p65

Finance

9.3.1

Finance Update

J Burchell/ Lorraine Weekes

14.45

Attached p70

AOB Next meeting

28 January 2017 Boardroom Bevan House Nantwich

All 15.00 Verbal

Future Dates 29th March 2017

Closed Session

Please see separate addendum.

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Agenda


Circulation list

Name Organisation Job Title

John Clough NHS SCCCG Lay Member

Simon Whitehouse NHS SCCCG & NHS VRCCG Chief Executive

Tracy Parker-Priest NHSSCCCG & NHS VRCCG Director of Operations Lynda Risk NHS SCCCG & NHS VRCCG Chief Finance Officer

Judi Thorley NHS SCCCG & NHS VRCCG Chief Nurse & Director of Quality

Amanda Best NHS SCCCG & NHS VRCCG Service Delivery Manager – Primary Care Transformation

Dr Mark Dickinson NHS SCCCG & NHS VRCCG Medicines Management

Will Greenwood Cheshire Local Medical Committee

Chief Executive & Company Secretary

Julie Hughes Cheshire Local Medical Committee

Head of Business Operations

Dr Annabel London NHS SCCCG & NHS VRCCG Clinical Lead for Primary Care

Diane Noble NHS SCCCG Lay Member

Terry Savage NHS VRCCG Lay Member Patient Engagement

Suzanne Horrill NHS VRCCG Lay Member

Carla Sutton NHS England Contracts Manager – Medical Team

Tom Knight NHS England Head of Primary Care Commissioning

Guy Hayhurst Cheshire East Council Consultant in Public Health

Chris Leese NHS SCCCG & NHS VRCCG Service Delivery Manager – Primary Care Development

Helen Bromley Cheshire West & Chester Consultant in Public Health

Gavin Owen Cheshire East Healthwatch

Lorraine Weekes-Bailey NHSSCCCG & NHS VRCCG Primary Care Accountant

Sam Richards NHSSCCCG & NHS VRCCG Primary Care Contracts Manager

Diane Sandbach NHSSCCCG & NHS VRCCG Practice Engagement Manager

Sharon Yates NHSSCCCG & NHS VRCCG Practice Engagement Manager

Caroline Harley NHSSCCCG & NHS VRCCG Primary Care Contracts

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Manager

Dr Sinead Clarke NHSSCCCG & NHS VRCCG Clinical Lead

Donna Rowell NHSSCCCG & NHS VRCCG Interim Associate Director of Operations

Kevin Highfield NHSSCCCG & NHS VRCCG Service Delivery Manager IT & Information

James Burchell NHSSCCCG & NHS VRCCG Senior Primary Care Accountant NB: Other directors/managers to be invited to discuss areas of risk or operational issues that they are responsible

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Minutes


Meeting Name: Formal Primary Care (GP) Commissioning Committee Date/Time: Wednesday, 28th September 2016 @ 1300-1600

Venue: Board room, Bevan House

Chair: Terry Savage Meeting No.: 8 Reporting Period:2016/17

Membership

Name Organisation Job Title Present

John Clough NHS SCCCG Lay Member Terry Savage NHS VRCCG Lay Member Patient

Engagement

Andrew Wilson NHS SCCCG Clinical Chair X Lynda Risk NHS SCCCG & NHS VRCCG Chief Finance Officer Judith Thorley NHS SCCCG & NHS VRCCG Chief Nurse & Director Quality X Helen Bromley Cheshire West & Chester Consultant in Public health X Guy Hayhurst Cheshire East Council Consultant in Public Health X Carla Sutton NHS England Contracts Manager - Medical

Team X

Thomas Knight NHS England Head of Primary Care Commissioning

John Adams NHS England Finance X Caroline O’Brien Cheshire East Healthwatch X Louise Barry Healthwatch CWAC X Dr Annabel London NHC SCCCG GP X Dr Jean Jenkins NHS VRCCG GP X Mark Dickinson Medicines Management Doctor X Lorraine Weekes NHS SCCCG & NHS VRCCG Finance Chris Leese NHS SCCCG & NHS VRCCG Service Delivery Manager PC

Sam Richards NHS SCCCG & NHS VRCCG Primary Care Quality & Performance Manager

X

Amanda Best NHS SCCCG & NHS VRCCG Service Delivery Manager PC Sharon Yates NHS SCCCG & NHS VRCCG Practice Engagement Manager X

Diane Sandbach NHS SCCCG & NHS VRCCG Practice Engagement Manager X

Caroline Harley NHS SCCCG & NHS VRCCG P C Contracts Manager Kevin Highfield NHS SCCCG & NHS VRCCG IT Manager X Dylan Murphy NHS SCCCG & NHS VRCCG Business Manager Linda Elliott MIAA

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Minutes


Name Organisation Job Title Present

William Greenwood Cheshire Local Medical Committee Limited

Chief Executive and Company Secretary

James Burchell NHS SCCCG & NHS VRCCG Finance Wendy Jeffries NHS SCCCG & NHS VRCCG PA / Minute taker

Ref. Discussion and Action Points Action

8.1 Committee Management 8.1.1 Welcome & Introductions Apologies for Absence

As Chair, Terry Savage (TS) welcomed everyone including William Greenwood from the LMC to the meeting. Apologies were accepted from Sam Richards, Simon Whitehouse, Helen Bromley, Judi Thorley, Andrew Wilson, Jean Jenkins, Annabel London and John Adams.

8.1.2 Declarations and Conflicts of Interest Terry Savage = None

William Greenwood = None Caroline Harley = None Linda Elliott = None Tom Knight = None Lynda Risk = Husband works for Astra Zeneca James Burchell = None Chris Leese = None Lorraine Weekes-Bailey = None Amanda Best = None John Clough = None Dylan Murphy = None

8.1.3 Confirmation of Quoracy

Confirmation that the Quoracy had not changed was given by both Dylan and Chris. Executive Director’s attendance is to be checked and confirmed.

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8.1.4 Minutes of the last meeting (27th July 2016) The Committee approved the minutes from the July meeting as a true and

accurate record.

8.1.5 Matters Arising There were no matters arising.

8.1.6 Action Log The action log had been circulated with the Agenda – please see separate

updated list. Updates: 5.2.1 NHSE Primary Care Commissioning report (CL) to be put in S Whitehouse’s Weekly Brief to show the formal process. There are to be separate discussions with Practices. 6.2.6 Closed – new action 8.1.6 on CL & CH Actions under 8.1.6 (a): CL/CS – KPI’s review : identify appropriate KPI’s – ring fenced for General Practice (b): JB/CL – Meet with LR outside of the meeting to discuss PMS Premium Monies. Further discussion at Delegated Task and Finish.

CL CL / CH CL/CS JB/CL

8.2 Co-Commissioning 8.2.1 Terms of Reference

Dylan to appraise the Committee of changes required from the revised statutory guidance. LE agreed to commission MIAA to provide ‘Best practice’. In relation to Part A: LR will take ToR to the Executive meeting on 3.10.16 for a decision to be made on executive attendance at this Committee to enable link up to Primary Care. TK thought that attendance by the Chief Nurse would be prudent. JC stated that both Annabel London and Sinead Clarke had confirmed that they would try and make themselves available to attend. The current dates are to be changed to enable attendance of our Clinical colleagues.

DM LE LR CH/WJ

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In relation to Part B: WG stated that the LMC should not have any access to Practice information except for the Chief Executive as some practices seek advice from the LMC. It was agreed therefore to retain Part B membership as at now with papers sent in advance or tabled on the day dependant on content. Two separate circulation lists will be maintained. This section will continue to be closed and confidential. Recommendations: a) The Committee noted the requirements of the revised statutory

guidance for CCGs on managing conflicts of interest and their implications for the Committee;

b) Consider the proposed revisions to the terms of reference, particularly the proposal at paragraph 7 below (and section 18 of the terms of reference) regarding GP members’ voting rights on the Committee. NOTED

c) Consider appropriate governance arrangements in relation to Part B, Closed Session, to be effective from the November 2016 meeting. Agreed

d) Subject to consideration of point b) and c) above, approve the revised Committee terms of reference. The Committee Agreed – updated version and progress made to come back to the next meeting.

8.2.2 NHS England Update

TK gave update to the Committee as follows: • CCG’s asked to start considering systems and planning for Winter Plans

return (over and above core systems). A letter will be sent regarding A&E deliverables and there will be further discussion at the A&E Board. LR to ascertain feedback mechanisms for Primary Care.

• AB confirmed that the service specification for PMCF will come to this meeting from November onwards. AB will update at next meeting under agenda item ‘Transformation Update’. WJ to add to agenda

Capita • NHSE continue to escalate the CCG’s issues to the Service

Management Team. Expertise teams from NHSE are to work alongside Capita.

• Current service delivery of main areas is required to have a 4-6 week turnaround, including GP payments.

• NHSE looking at the quality of service provided.

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• WG was assured by TK’s update with regards to escalation process as LMC have asked practices to let them know of any problems they are experiencing.

• CL asked if there was anything we could do now for the Practices in relation to payment, to which TK agreed to share J Adams clarification with JB

TK

8.2.3 Delegated Commissioning Risk Register & Update from Task & Finish Group

The Risk Log circulated with the Agenda pack is the Primary Care Risk Register that feeds in to the Delegated Commissioning Risk Register on the PMO. The Committee reviewed each risk in turn with some risks being identified as being in a position of stability and can be closed or the risk rating lowered. Other issues highlighted were: CL reported that the risk register had been reviewed and asked if there were any comments around grading’s, to which there were none. The Governance and Audit Committee held on 27/9/16 only require information on items above a grading of 12. CL to discuss with JU regarding how risks from this register are escalated to the main risk register

CL

8.2.4 Local Disputes Resolution Policy

It was identified earlier this year that provision needed to be made to agree the local approach to resolving contractual disputes in relation to General Practices GMS and PMS Contracts. It was also agreed via the Delegated Task and Finish Group meetings that the Primary Care Committee would discuss and agree a final version once we were in a position to present this , taking into account learning experiences from the first few months of Delegated responsibility CL explained that the policy deals with local disputes with Practices not National issues and asked for comments from the Committee. It was noted that this has been worked up via the Delegated Task and Finish Group meeting of which NHS England were part of this. The Committee were asked to discuss and review the document and approve / approve with comments where appropriate paying particular attention to: (1) The process and relevant staffing required at each stage (2) Management of Conflict of Interest (3) The need to ensure alignment with the Policy Book for Primary Medical Services, which has been reflected in the process

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The main outcome will be a defined local approach to managing local disputes that can be invoked if Practice disputes a decision made by the CCG, under Delegated Arrangements. The Committee approved the Policy but asked that the following change to be made: LR highlighted the need for a Terms of Reference with the Chair being a Governing Body member. The Chair would also have the casting vote if a vote was necessary. CH to amend the policy as agreed

CH

8.2.5 Memorandum Of Understanding

The Memorandum of Understanding explains the day to day working and processes being followed between NHS South Cheshire CCG and NHS England. The Primary Care Committee is asked to agree the recommendation that the MOU is signed off at a later meeting. The Committee agreed to this recommendation. MOU to be brought back to a later meeting after December for further discussion.

8.2.6 Practice Merger Policy The Committee is asked to discuss and approve the document and

accompanying appendices via the following steps ; (1) The process and timescales (2) Patient Involvement considerations (3) IT funding implications (4) Any further advice required externally e.g legal (5) Circumstances where the process may need to be reconsidered in light of necessity or urgency, including additional funding e.g Practice where sustainability is an issue, notice served on a contract and merger may be an option for securing services for patients etc, including notice period for contracts. (6) The paperwork attached as appendices CL gave an appraisal of the report and asked that the Committee discuss and approve the Practice Merger Policy. • WG stated that people should not under estimate the time this will take

and LMC are happy to help and be involved. • CL highlighted that there needed to be flexibility with regards to the

process e.g with regard to notice periods, patient engagement etc and in some circumstances where merger may be a resilience issues

• IT funding would be part of the application process

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• Each application would be considered as individually to ascertain the degree of flexibility required

• It was agreed that there may be occasions when quorate meetings outside of the current Primary Care Committee structures may be required if a decision is required quickly

• Applications would be considered in Part B The Policy was accepted by the Committee.

8.2.7 Boundary Change Application Policy - Revision to Standard Operating Procedure for Managing an application from a GP practice to change its Practice Patient Registration Area

The Primary Care Committee are asked to agree the following amendments to the original policy approved which were not explicit in the original policy ; 14.9 If the Commissioner declines the proposed changes to the practice area, the contractor should be notified, as soon as possible, in writing of that decision and to include: 14.9.1 the reasons for the decision; 14.9.2 the right of the contractor to appeal and the process for doing so; and 14.9.3 specify any period within which the Commissioner would not consider a further application from this contractor to vary its practice area. This time period suggested would be 6 months. The three points above must be notified to the Practice as per the Policy Book for Primary Medical Services. The 6 months’ timescale is the suggestion of the Primary Care Staff, the timescale is not specified in the Policy Book. A further amendment was made in relation to the timescale to respond to the Practice which is a timescale at the discretion of the CCG, this has been amended from 14 days to 28 days. The Primary Care Committee agreed the amendments detailed in the policy.

8.2.8 GP IT Report No report for this meeting.

8.3 Finance 8.3.1 Finance & Premises Update Report covers April to August 2016 Months 1 – 5.

JB highlighted the following points: • There have been issues with GP payments since April 2016 with the

move of payments services to Capita. This is a national problem that

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NHS E are looking into and monitoring. Payments that have been made to the GP Practices have been, in the majority of cases, timely, but unfortunately there has been many calculation errors, and payments being missed. The CCG Primary Care finance team is now part of a working group with other local delegated CCG’s, NHS England and Capita, to look at how these issues can be resolved quickly. It was agreed that the CCG’s would trial a new data input payment sheet; this will be used by all of the Cheshire and Merseyside delegated CCG’s and NHS England will also use the new form for the CCG’s that are not yet delegated. This will hopefully mitigate future errors and also add some consistency and stability to the method in which the CCG’s makes our payments to the practices. The CCG finance team has offered to visit practices to help them reconcile the payments that have been made in the current financial year, due to some of the errors that have occurred, practices are finding it difficult to reconcile their accounts.

• To enable a better flow of cash to Practices, the finance team are canvassing Practice managers to see if one payment per month would be a better payment method. Currently practices receive two payments per month which is an historic arrangement.

8.4 Any Other Business

• LE tabled the Terms of Reference for the review of Access Arrangements which had been taken at the Governance and Audit Committee who thought relevant to this Committee. AB stated that she has already voiced concerns over naming practices and asked that the responses to be separate for the three areas as there are local sensitivities with GP OOH, GP surgeries and IAPT Processes. CL asked that the data around access needs to reflect local issues. LE will reword response to take into account these discussions Outside of the meeting LE to meet with AB and CL.

• WG thanked the CCG’s on behalf of the LMC for their support to Practices in respect of Capita and other issues.

LE

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Date:

Reference in Minutes

Original Meeting Date Title Description

Action Requirem

entsBy Whom By

When Status Comments

30/03/2016

5.2.1

NHSE Primary Care Commissioning Report AB is to ask the Communications team to create a guidance document to show 'who' is doing what in Primary Care. Update 27/7: awaiting a) guidance to go to practices & b) Cl to check whats gone out already.

CL CLOSED

5.2.7New Models of Care / Winsford Primary Care

Home SY to circulate the embedded document in her report to the attendees SY CLOSED

25/05/2016

6.1.1 PC Delegated Commissioning risk register NHSE to provide summary of local issues, highlighting trends and reasons. TK COMPLETE

6.2.2 Latest Delegated Comm Task & Finish Group Draft Transition Plan for Delegated Functions Action notes from Task & Finish group to come to this Committee CH COMPLETE

6.2.3 Approval of CCG Interim Provider PolicyAB/CH/CL to seek legal advice from Hill Dickinson re Appropriate wording for Item 5 - Process "notwithstanding" - concern re excluding practice.

AB/CH/CL On agenda - COMPLETE

6.2.5 GP IT Report KH to share Communication Plan with Healthwatch - Cheshire West & Cheshire East. KH ONGOING

6.2.6 PMS Review updateFormal Notification letter to be brought to July Committee as there is need to cary out due diligence for monies being reinvested back to PC practices.

CL/CH CLOSED

" TK ti liase with C Sutton with regards to PMS Contracts and report back. TK CLOSED

6.3.1 Finance Update TK offered to ask John Adams NHSE to attend the July Committee. TK CLOSED27/07/2016

7.1.3 Updates from Minutes

Refer to 6.2.1: Lynda Risk (LR) noted that the Terms of Reference for the group would therefore have to be reviewed due to JC’s Declaration of Conflicts of Interest issue Chris Leese (CL) agreed to pick this up with Dylan Murphy.

CL CLOSED

"Refer to 6.2.4: LR noted that the Post-Op Wound Care funding (£40000) to GP practices was only until September 2016 and the wound care issue would therefore need to be picked up with Tina Cookson quickly as part of the Community Services contract group work streams.

LR CLOSED

"

J Burchell agreed to confirm that the money is being forwarded to the CCG to bring a Financial Update to the next meeting as this was part of the assurance in respect of due process and reinvestment of the PMS Premium..

JB CLOSED

7.2.2 Delegated Comm Risk Register CL agreed to accept overall management of the Risk Register & work with CH to review and update the current register. CL/CH ON AGENDA

Co-Commissioning Joint Primary Care Committee Action Log NHS South Cheshire and NHS Vale Royal Clinical Commissioning Groups

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7.2.4 MoU for comments & Acceptance Any comments should be sent through to Chris Leese – the MOU will be brought back to the next meeting in September for approval. CL / ALL CLOSED

7.2.5 MIAA Report CL said he would revisit the timelines as queried by LE. CL CLOSED

7.2.7 Healthwach GP Access reportOnce complete the Report will go to the Governance and Audit Committee and also to this meeting. A Terms of Reference will be provided from LE to this Committee.

LE CLOSED

"TS asked for the presented report to go to the Quality and Performance Committee – CO’B agreed that Veronica Kitton will take to the next Committee.

CO'B/VK CLOSED

7.2.4 Any Other Business

CL highlighted that the Minutes from this Committee do not appear on both NHS SCCCG and NHS VRCCG Internets and as this is a Public meeting they should be available for viewing. It was agreed that the Meeting should be reviewed in accordance with National Guidelines on Delegated Commissioning and a Committee Management approach was required. CL agreed to discuss this further with regards to Governance with Dylan Murphy and Katy Brownbill from a communication perspective.

CL CLOSED

28/09/2016

8.1.6 Action log CL/CS – KPI’s review : identify appropriate KPI’s – ring fenced for General Practice CL/CH

" JB/CL/LR to meet and discuss the PMS Premium Monies JB/CL/LR

8.2.1 Terms of Reference Dylan to appraise the Committee of changes required from the revised statutory guidance

DM

" LE agreed to commission MIAA to provide ‘Best practice’. LE

"LR will take ToR to the Executive meeting on 3.10.16 for a decision to be made on executive attendance at this Committee to enable link up to Primary Care.

LR

"JC stated that both Annabel London and Sinead Clarke had confirmed that they would try and make themselves available to attend. The current dates are to be changed to enable attendance of our Clinical colleagues.

CH/WJ

8.2.2 NHS England UpdateCL asked if there was anything we could do now for the Practices in relation to payment, to which TK agreed to share J Adams clarification with JB

TK

8.2.3 Delegated Comm Risk Register & Update from Task & Finish Group

CL to discuss with JU regarding how risks from this register are escalated to the main risk register CL/CH

8.2.4 Local Disputes resolution PolicyLR highlighted the need for a Terms of Reference with the Chair being a Governing Body member. The Chair would also have the casting vote if a vote was necessary.CH to amend the policy as agreed

CH

8.4 Any other Business LE will reword response to take into account these discussions Outside of the meeting LE to meet with AB and CL LE

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Report

Agenda No.:


Report Author(s) Governing Body Lead Name Dylan Murphy Name Lynda Risk

Title Business Manager Title Chief Finance Officer CCG Strategic Priorities (5+1) supported by this paper Transforming Primary Care

Transforming Mental Health

Transforming Urgent Care

Integration

Person Centred Care

NHS Constitution Targets Outcome Required Approval Assurance Discussion Information

Recommendations: It is requested that the Primary Care (General Practice) Commissioning Committee approved the revised Terms of Reference.

Report To: Primary Care (General Practice) Commissioning Committee

Report Title: Primary Care (General Practice) Commissioning Committee Terms of Reference

Meeting Date: 30th November 2016

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Executive Summary (key points, purpose, outcomes) 1. “Managing Conflicts of Interest: Revised Statutory Guidance for CCGs” was issued at the end of

June 2016. CCGs will be audited on compliance with the revised Guidance during 2016/17. The Guidance has implications for the membership and operation of Primary Care Commissioning Committees.

2. Paragraph 64 states that: “By statute, CCGs must have at least two lay members (one of whom

must have qualifications, expertise or experience such as to enable the person to express informed views about financial management and audit matters and serve as the chair of the audit committee … In light of lay members’ expanding role in primary care co-commissioning, we strongly recommend that all CCGs consider increasing this requirement within their constitution to a minimum of three lay members on their governing body.” Paragraph 64 goes on to say that “We would encourage all three CCG lay members to attend the primary care commissioning committee; the additional third lay member could assume the role of the Chair or Vice-Chair of this committee.”

3. The revised terms of reference include the addition of a third Lay Member. 4. Paragraph 67 states that: “all CCGs should have a Conflicts of Interest Guardian (akin to a

Caldicott Guardian). This role should be undertaken by the CCG audit chair, provided they have no provider interests…” Paragraph 70 of the guidance goes on to state that: “The primary care commissioning committee must have a lay chair and lay vice chair. To ensure appropriate oversight and assurance, and to ensure the CCG audit chair’s position as Conflicts of Interest Guardian is not compromised, the audit chair should not hold the position of chair of the primary care commissioning committee”.

5. The revised terms of reference include the stipulation that the Chair and Vice-Chair of the

Committee should be the Lay Members for Public and Patient Involvement (i.e. not the Lay members who serve as Chair of the Governance and Audit Committee / Conflicts of Interest Guardian).

6. Paragraph 89 states that: “The quorum requirements for primary care commissioning

committee meetings must include a majority of lay and executive members in attendance with eligibility to vote”. Paragraph 90 states that: “In the interest of minimising the risks of conflicts of interest, it is recommended that GPs do not have voting rights on the primary care commissioning committee. The arrangements do not preclude GP participation in strategic discussions on primary care issues, subject to appropriate management of conflicts of interest. They apply to decision-making on procurement issues and the deliberations leading up to the decision”.

7. The revised terms of reference suggest a distinction of voting (i.e. non-GP members) and non-voting members (i.e. GP members) of the Committee. This is recommended in the statutory guidance but is not stipulated as a requirement.

8. Revisions to the terms of reference to incorporate the points above were agreed at the September

2016 meeting. At that meeting it was agreed that Executive membership / attendance be reviewed and clarified at the November 2016 meeting.

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Reviewed by (e.g. committee/team/director) Name (Individual or Group) Date

Chris Leese, Service Delivery Manager (Primary Care Operations) November 2016

Lynda Risk, Chief Finance Officer November 2016

Finance implications Funding required? (Please tick. If yes, please complete section A) Yes No

Section A Service Title Recurrent (£000s) Non-Recurrent (£000s)

Included in 16/17 budget? (Please tick. If no, please complete section B) Yes No Section B Proposed source of funding

n/a

Have the following areas been considered whilst producing this report? Yes N/A

Other resource implications (apart from finances covered above)

Equality Impact Assessment (EIA)

Health Inequalities (JSNA, ISNA)

Risks relating to the paper

Quality & Safeguarding (6 C’s +1, CASE)

Stakeholder engagement/involvement (member practices/GP Federations, patients & public, providers etc.)

Regulatory, legal, governance & assurance implications

Procurement processes

Glossary/Acronyms

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Draft v1.2

NHS South Cheshire Clinical Commissioning Group &

NHS Vale Royal Clinical Commissioning Group

Primary Care (General Practice) Commissioning Committee

Terms of Reference Responsible Person:

Chair of the Primary Care (General Practice) Commissioning Committee

Date approved: Approval Committee:

Primary Care (General Practice) Commissioning Committee

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Document Control:

Amendment History:

NB. The version of the policy posted on the intranet must be a PDF copy of the approved version Document Status: This is a controlled document. Whilst this document may be printed the electronic version posted on the intranet is the controlled copy. Any printed copies of the document are not controlled.

Description Comment Title Primary Care (General Practice) Commissioning

Committee Terms of Reference Document Number

Author Dylan Murphy Date Created 26 October 2015

Date Last Amended 30 March 2016 Version 1.2 DRAFT

Approved By NHS South Cheshire CCG Governing Body NHS Vale Royal CCG Governing Body

Date Approved Review Date

Responsible Person/Owner Chair of Committee Location Bevan House, Nantwich

Publish on Public Web Site Y/N? Constitutional Document Y/N? Y

Requires an Equality Impact Assessment Y/N?

N

Version Date Comment on Changes

V0.1 26 October 2015 Initial draft

V0.2 3rd November 2015

Revised draft following correspondence with NHSE (for inclusion in delegated commissioning application)

V0.3 5th February 2016

Revised draft prepared for return with formal delegation agreement

V0.4 19th February 2016

Further revised draft prepared for return with formal delegation agreement

V0.5 24th March 2016

Further revised draft prepared for return with formal delegation agreement to include amendments agreed by Primary Care Operational Meeting

V0.6 / V1 30th March 2016

Further revised draft prepared for return with formal delegation agreement to include amendments agreed by Joint Committee for Co-Commissioning (Formal)

V1.1 September 2016 Revisions to take account of the revised statutory guidance on Managing Conflicts of Interest

V1.2 November 2016 September 2016 revisions incorporated and Executive membership clarified.

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

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

2. In accordance with its statutory powers under section 13Z of the National Health Service

Act 2006 (as amended), NHS England has delegated the exercise of the functions specified in Schedule 2 to these Terms of Reference to NHS South Cheshire CCG and NHS Vale Royal CCG. The delegation is set out in Schedule 1.

3. The CCG has established the NHS South Cheshire CCG and NHS Vale Royal CCG

Primary Care (General Practice) Commissioning Committee (the “Committee”). The Committee will function as a corporate decision-making body for the management of the delegated functions and the exercise of the delegated powers.

4. It is a committee comprising representatives of the following organisations:

• NHS South Cheshire CCG; • NHS Vale Royal CCG; • Cheshire West and Chester Local Authority (standing attendee); • Cheshire East Local Authority (standing attendee); • Cheshire West and Chester Healthwatch (standing attendee); • Cheshire East Healthwatch (standing attendee); • Local Medical Council (standing attendee); • NHS England (standing invitee).

Statutory Framework 5. NHS England has delegated to the CCGs authority to exercise the primary care

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

6. Arrangements made under section 13Z may be on such terms and conditions (including

terms as to payment) as may be agreed between the Board and the CCGs. 7. Arrangements made under section 13Z do not affect the liability of NHS England for the

exercise of any of its functions. However, the CCG acknowledges that in exercising its functions (including those delegated to it), it must comply with the statutory duties set out in Chapter A2 of the NHS Act and including: a) Management of conflicts of interest (section 14O); b) Duty to promote the NHS Constitution (section 14P); c) Duty to exercise its functions effectively, efficiently and economically (section 14Q); d) Duty as to improvement in quality of services (section 14R);

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e) Duty in relation to quality of primary medical services (section 14S); f) Duties as to reducing inequalities (section 14T); g) Duty to promote the involvement of each patient (section 14U); h) Duty as to patient choice (section 14V); i) Duty as to promoting integration (section 14Z1); j) Public involvement and consultation (section 14Z2).

8. The CCGs will also need to specifically, in respect of the delegated functions from NHS

England, exercise those set out below:

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

9. The Committee is established as a committee of the Governing Body of South

Cheshire CCG and Governing Body of Vale Royal CCG in accordance with Schedule 1A of the “NHS Act”.

10. The members acknowledge that the Committee is subject to any directions made by NHS

England or by the Secretary of State. Role of the Committee 11. The Committee has been established in accordance with the above statutory provisions

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

12. In performing its role the Committee will exercise its management of the functions in

accordance with the agreement entered into between NHS England and NHS South Cheshire CCG and NHS Vale Royal CCG, which will sit alongside the delegation and terms of reference.

13. The functions of the Committee are undertaken in the context of a desire to promote

increased co-commissioning to increase quality, efficiency, productivity and value for money and to remove administrative barriers.

14. The role of the Committee shall be to carry out the functions relating to the

commissioning of primary medical services under section 83 of the NHS Act. 15. This includes the following:

• GMS, PMS and APMS contracts (including the design of PMS and APMS contracts, monitoring of contracts, taking contractual action such as issuing branch/remedial notices, and removing a contract);

• Newly designed enhanced services (“Local Enhanced Services” and “Directed Enhanced Services”) nb Individual CCG Boards retain the ability to establish additional enhanced services if they so wish;

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• Design of local incentive schemes as an alternative to the Quality Outcomes Framework (QOF);

• Design and agreement on out of hospital services commissioned from GP Practices; • Decision making on whether to establish new GP practices in an area; • Approving practice mergers; • Promoting quality within GP Practice service provision; • Making decisions on ‘discretionary’ payment (e.g., returner/retainer schemes).

16. The CCG will also carry out the following activities:

a) To plan, including needs assessment, primary [medical] care services in South Cheshire and Vale Royal;

b) To undertake reviews of primary [medical] care services in South Cheshire and Vale Royal;

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

d) To manage the budget for commissioning of primary [medical] care services in South Cheshire and Vale Royal.

Geographical Coverage 17. The Committee will comprise the NHS South Cheshire CCG and NHS Vale Royal CCG

areas. Membership 18. The Committee shall consist of: Voting Committee Members Member Voting

Member** NHS South Cheshire CCG Lay Member (Patient and Public Involvement)*

Yes Yes

NHS Vale Royal CCG Lay Member (Patient and Public Involvement)*

Yes Yes

NHS Vale Royal CCG or NHS South Cheshire CCG Lay Member (Other)

Yes Yes

NHS South Cheshire CCG & NHS Vale Royal CCG Chief Finance Officer (or nominated deputy)

Yes Yes

NHS South Cheshire CCG & NHS Vale Royal CCG Chief Nurse (or nominated deputy)

Yes Yes

NHS South Cheshire CCG & NHS Vale Royal CCG Executive Director (or nominated deputy)

Yes Yes

NHS South Cheshire CCG & NHS Vale Royal CCG Service Delivery Manager for Primary Care, Operations

Yes Yes

NHS South Cheshire CCG & NHS Vale Royal CCG Head of Prescribing and Medicines Optimisation (or Deputy Head of Prescribing and Optimisation)

Yes Yes

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Non-Voting Committee Members NHS South Cheshire CCG representative (GP Clinical) Yes No NHS Vale Royal CCG representative (GP Clinical) Yes No Non-Voting Committee Attendees Local Medical Council representative No No Cheshire West and Chester Public Health representative No No Cheshire East Public Health representative No No Cheshire West and Chester Healthwatch representative No No Cheshire East Healthwatch representative No No Cheshire West and Chester Health and Wellbeing Board representative

No No

Cheshire East Health and Wellbeing Board representative No No Standing Invitee NHS England representative No No

*To alternate as Chair and Vice-Chair. **Voting Members shall have one vote each. This includes members who represent both CCGs (who have a single vote as a member of the committee, not one vote per CCG they represent). 19. The Chair of the Committee shall be an NHS South Cheshire CCG or NHS Vale Royal

CCG Lay Member (Patient and Public Involvement). 20. The role of Chair will alternate between the Lay Members (Patient and Public

Involvement) of NHS South Cheshire CCG and NHS Vale Royal CCGs. When not serving as Chair, the Lay Members (Public and Patient Involvement) will serve as Vice-Chair

21. Healthwatch, Health and Wellbeing Board, Public Health and Local Medical Council

representatives will be non-voting attendees at the Committee. 22. There will be a standing invitation to NHS England to attend the meeting as an observer. Meetings and Voting 23. The Committee will operate in accordance with the CCGs’ Standing Orders. The

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

24. Any decision which relates solely to NHS South Cheshire CCG or NHS Vale Royal CCG

will be made by members representing the CCG for which the decision is relevant. Members who solely represent the other CCG will abstain from the voting.

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Quorum 25. A quorum necessary for the Committee to undertake its business shall be at least four

voting members, comprising:

• The Committee Chair (or Vice-Chair, if the Chair has declared a conflict of interest); • NHS South Cheshire CCG and NHS Vale Royal CCG Chief Finance Officer (or

nominated deputy); • At least one other NHS South Cheshire CCG & NHS Vale Royal CCG Executive

Director (or nominated deputy) • One other voting Committee member.

26. Where a meeting is not quorate, owing to the absence of certain members, the meeting

will be deferred until such time as a quorum can be convened.

27. Where a quorum cannot be convened from the membership of the meeting, owing to the arrangements for managing conflicts of interest or potential conflicts of interests, the Chair of the meeting shall consult with the CCGs’ Chief Executive Officer on the action to be taken.

Frequency of meetings 28. The Committee will meet on a bi-monthly basis 29. Meetings of the Committee shall:

a) be held in public, subject to the application of 29(b); b) the Committee may resolve to exclude the public from a meeting that is open to the

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

30. Members of the Committee have a collective responsibility for the operation of the

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

31. The Committee may delegate tasks to such individuals, sub-committees or individual

members as it shall see fit, provided that any such delegations are consistent with the parties’ relevant governance arrangements, are recorded in a scheme of delegation, are governed by terms of reference as appropriate and reflect appropriate arrangements for the management of conflicts of interest.

32. The Committee may call additional experts to attend meetings on an ad hoc basis to

inform discussions.

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33. Members of the Committee, including the non-voting members and attendees, shall respect confidentiality requirements as set out in the CCGs’ Constitutions.

34. The Committee will present its minutes to Cheshire and Merseyside Sub Region Area

Team of NHS England and the governing body of NHS South Cheshire CCG and NHS Vale Royal CCG at the next appropriate meeting for information, including the minutes of any sub-committees to which responsibilities are delegated under paragraph 31 above.

35. The CCG will also comply with any reporting requirements set out in its constitution. 36. These Terms of Reference will be reviewed from time to time, reflecting experience of the

Committee in fulfilling its functions. NHS England may also issue revised model terms of reference from time to time.

Accountability of the Committee 37. The decision-making scope of this Committee is outlined within the NHS South Cheshire

CCG and NHS Vale Royal CCGs’ respective Constitutions and specifically the Scheme of Reservation and Delegation.

38. The Committee is accountable to the Governing Body of NHS South Cheshire CCG and

Governing Body of NHS Vale Royal CCG. The minutes of the Committee will be formally recorded and presented to the Governing Body at the earlier practicable meeting.

39. The Committee is responsible for both overseeing the management of primary care

delegated budgets and ensuring decisions made do not exceed the primary care delegated budget.

40. The Committee will ensure that patient/public consultation is considered and undertaken

when appropriate to aid decision making. Procurement of Agreed Services 41. The Committee will ensure that Procurement, Patient Choice and Competition (No.2)

Regulations 2013 are followed. 42. No contracts for NHS healthcare services will be awarded where conflicts or potential

conflicts of interest affect or appear to affect the integrity of the award. Decisions 43. The Committee will make decisions within the bounds of its remit. 44. The decisions of the Committee shall be binding on NHS England and NHS South

Cheshire CCG and NHS Vale Royal CCG.

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45. The Committee will produce an executive summary report which will be presented to Cheshire and Merseyside Sub Region Area Team of NHS England and the Governing Body of NHS South Cheshire CCG and NHS Vale Royal CCG bi-monthly for information.

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Historic Funding issues are well documented Financial N/A

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* Raised with NHS England.* Being managed at the Primary Care Operational Meeting* Delegated commissioning task and finish group commences 15/04/16 and will initially meet fortnightly. Finances are a standing agenda item.

* These are not the final assumptions, another round of costings are due within 2-3 weeks* 12/04/16 - revised assumptions have beeen received and now allocations are closely matched to the expected outgoings (slightly under expected outturn)

* Aug 2016 Further work required to under service charge history.

3 4 12

* Monitor the first couple of months outturns to ensure they are as predicted and then propose to close risk. * June 2016 - spreadsheet for ascertaining potential impact of rent increase applications to be factored in to see if this adds an additional pressure to the Primary Care Budget. * Aug 2016 Work will need to be undertaken with practices to establish the background information around the service charges practices have been claiming * Oct 2016. It was noted in the Delegated task & Finish group meeeting that the the work thus far on service charges has revealed that some agreements have an RPI to be applied & it is unclear whether this has been applied or not. If applied is should make a potential cost ‘saving’. Further work is in progress.

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CQRS is the system used to calculate payments to Practices for the QOF and other Primary Care Payments i.e Enhanced Services. In April 2014 CQRS replaced the Quality Management and Analysis System (QMAS) the system used to calculate payments to general practice for QOF. CQRS calculates payment for Practices across England. It is capable of calculating achievement and payments on quality services delivered by practices, including the QOF, nationally commissioned enhanced services and services commissioned locally from Practices that go beyond the scope of the GP contract. Only the delegated functions have come to the CCG.

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* CCG staff have had initial training and have access to part of the system * NHS England retain back up log in* Standing item for discussion at Delegated commissioning task and finish group * June 2016 - NHS Standard Contracts issued to all practices for sign up of Enhanced Services * No date provided for final handover but HSCIC have requested CCG contact details to update their database, which have been provided* July 2016 - On the 28 June the enhanced services and core contract areas were all offered electronically to practices and practices notified that they need to accept the services by the end of June. 29 of our 30 practices met the deadline. One practice had no admin user available but the CCG established with CQRS that the practice could accept the services on the 3 July and would still be able to claim. Therefore no practice was disadvantaged. Practices are now submitting evidence for approval and payment. Albeit that this moved over quicker than expected the CCG is now administering these services.

* Continued open dialogue with NHS England to support with issues* As of August practices have successfully declared their enhanced service submissions on CQRS & payments have been approved.* The CCG is also able to provide guidance to practices on queries raised so CQRS is running smoothly at present..

* July 2016 - towards the end of June the CCGs discovered that NHS England no longer has access to CQRS for SCCCG & VRCCG so the enhanced services and some core contract areas had not been offered to practices. This was quickly recified by the CCGs (see controls)

2 2 4

Undertake next quarter returns as further assurance Oct 2016 - Quarterly & monthly returns on CQRS have been undertaken without any issues. Nov 2016 - 4 practices are appealing their achievement but this was not due to the CQRS extraction process but due to data entry and coding by the practices.

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NHS England tendered the contract for primary care support services formerly undertaken by Cheshire

Health Agency. The new provider commenced 24th March, however there have been operational issues

with regards to ordering supplies, medical records and payments to practices.

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* CCG Primary Care Team are supporting practices as far as possible with escalating issues direct to Capita (new supplier)* Standing item for discussion at Delegated commissioning task and finish group * Log issue escalated direct to NHSE who attend face to face meetings with Capita* BMA/GPC have written direct to NHS England to raise practices' concerns. * July 2016 NHSE are having regular meetings with Capita * The LMC and GPC continue to support practices in escalating their issues as do the two CCGs.

* Reports back on log issues to the CCG and dialogue between NHSE and CCG re these issues* Aug 2016 CCG, at Primary Care Support England's request, has canvassed practices for any outstanding issues & has forwarded them to a named contact at PCSE

CCG is not direct contract holder with Capita.4 4 16

Ongoing monitoring and escalation process in place for NHS England, CCGs and Practices.

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Budget Allocations given from NHS England Local Office for Primary Care for 2016/17 are

under by £143,000 for South Cheshire CCG and are over £175,000 for Vale Royal CCG.

CQRS - HSCIC programme for payment of enhanced service to GP practices. Timings for

transfer have not been confirmed and no information has been provided. Concern that NHS England will be cut-off from the system,

but that CCG staff will not have been informed that responsibility has transferred and will not

have been fully trained, leading to potential delays in payment.

Primary Care Support Services (NHS England responsibility). Because this is managed by NHS England we are unable to support our

practices to access the appropriate services, leaving them unable to resolve these issues, which could have a significant impact on our

practices ability to deliver care to their patients. Some issue with loss of corporate

memory.

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* Joint Committee for Co-Commissioning established and now developing into Primary Care (Medical Services) Commissioning Committee* CCG Constitution amended to reflect new status* Data sharing agreements with NHS England in place *Support from Governance Team at CCG to review TOR/Approaches to COI within Delegated Commissioning * TOR for the Primary Care (Medical Services) Commissioning Committee formally agreed 25 May 2016. This group will be the decision making group with NHSE as a member for guidance. Revisited July 2016 to reflect CCG internal accountability changes * Internal Audit Review undertaken * COI declarations at meetings* Conflicts of Interest policy has been updated and register refreshed and expanded

* Internal Audit report gave high Assurance *August 2016 PCC Governance Meeting met to review COI and Governance in General giving assurance on processes in place

* Review of Governance following COI revised Guidance underway

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Sept 2016 Due to recent COI guidance the Primary Care (General Practice) Commissioning Committee TOR have been revised. To be presented at the 28 Sept 2016 meeting for acceptance. Oct 2016 - TOR still needs further revision. Committee to be appraised of the changes required. Dec-16 DM reviewing all TOR and new Guidance on COI to be introduced Dec 2016

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The CCG has taken on Delegated Arrangements from 1st April 2016 (full Guidance available on implications of this via NHS England Website). The risk is that the increased workload will impact on all areas of CCG operations unless managed in terms of enough staff to undertake the required roles/manage the workload.

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* an MOU with NHS England is in development with supporting documentation which lists what is expected of the CCG and NHSE *Overarching document which clearly lists the functions within delegated and those outside (e.g complaints) *Additional Staffing in place SDM for Primary Care Operations *Monthly Task and Finish Group meetings in place *Intermittant informal operational meetings in place outside of this between NHSE Staff and CCG staff *Single Operating Model/Policy Document adhered to for contracting issues *NHSE continue to provide contracting support and guidance during transition year *Primary Care Commissioning Committee in place

*Minutes of Task and Finish Group and Primary Care Commissioning Committee reflect actions taken to manage workload and outcomes *Progress against clear contracting issues mapped and overseen using relevant policy book

* Workload implications for Quality in respect of Complaints may need further discussion/assurances but to date no significant increase in workload for Complaints

3 3 9

* Ongoing Monitoring of workloads and issues via the control mechanisms. Further work required in respect of understanding primary care quality and primary care contracting interface. * Sept 2016 MOU finalised and to be presented at Sept Primary Care (General Practice) Commissioning Committee meeting for comments and acceptance. Oct 2016 MOU to be brought back to later meeting

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Extended hours, minor ops, violent patient scheme, out of area registration

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* Handover expected between April and June 2016 of historical information and practices contracted to provide these services.* Contracting Framework will pick up the monitoring and verification of these enhanced services* June 2016 - Spreadsheet of Enhanced Services sign up for 2015-16 supplied by NHSE to provide 2016/17 baseline. * Procesess for circulation and completion of claim forms have been put in place by the finance team.

* NHS England claim form for these services, which CCG can continue to use, pending agreement from NHS England. * CCG constructed own claim form based on NHSE template and the first quarterly claims were made by practcics with no issues.* Payments are being made as per guidance

2 2 4Aug 2016 - reconciliation work will need to be undertaken to map claims in first quarter of 2016/17 with the previous financial year.

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* Quality Assurance Framework will incorporate this within it* High percentage of practices have had CQC inspections, which have focused on access, infection control, safety of premises which are part of the quality assurance and have received generally good outcomes - forming baseline for us to use

Further assurance is required in relation to the process for this year

* Framework still being developed, so will need to be approved by the committee before being implemented. *Need to discuss with Quality Team regarding ownership of QOF

3 3 9* Rolling programme of quality visits will be developed, tying in with contracting visits

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measures in place to safeguard to manage COI particularly in respect of management of the

Primary Care Commissioning Committee

Increased workload due to Delegated Commissioning in respect of Primary Care,

Finance and Quality impacting on existing staff and priorities.

Enhanced service not on CQS manually paid by NHS England on a quarterly basis. Handover of information about practices signed up and NHS

England's monitoring and verification processes

QOF forms a large part of practice income, however visits have not taken place, leaving a

potential gap for the practices. Additionally the CCG capacity to monitor and ensure robust

and consistent procedures across all practices.

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The process has been undertaken by the NHS England Finance Team who were responsible until 2013 for ensuring tri-annual rent reviews were undertaken by the District Valuer for all GP practice premises. Letters with the resulting outcomes were provided to practices and copies held by NHS England. NHS England should also have previous information from the former PCTs & Copies of all practice leases. In 2013 regulations changed and the onus was on the practice, should the landlord review the rent, to agree the change and or a new lease and then apply to NHS England for a rent review. The District Valuer would be instructed to do a review on behalf of NHS England & propose the current market rent.

Financial Treat 4 4 16

* Request for information has been raised with NHS England. * Finance (including premises) is a standing item on the Primary Care (General Practice) Commissioning Committee and on the Delegated Task & Finish Group - this specific issue has been escalated at these meetings.

* NHS England shared appropriate information to ensure that at the final handover everything that should have been in place and completed by the 31 March 2016 has been actioned including all ensuing financial liabilities as of 31 March 2016 have been met by NHS England

* Ensuring CCG has suitable baseline information for rent and rates across the CCG and works with NHS England to establish this.

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* June 2016 - potential impact of rent increase applications to be factored in to see if this adds an additional pressure to the Primary Care Budget. * Aug 2016 - Further discussion regarding CMR 1 form baseline establishing. Further discussion required to establish process and way forward for this.

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been realised until all documentation has been reviewed.

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Report

Agenda No.:


Report Author(s) Governing Body Lead Name Caroline Harley/Chris Leese Name Lynda Risk

Title Service Delivery Manager Title Chief Finance Officer CCG Strategic Priorities (5+1) supported by this paper Transforming Primary Care



Integration

Person Centred Care


Recommendations: The Primary Care (General Practice) Commissioning Committee is asked to note the contents of this report.

• Receive and note the contents of the report • To receive the action notes of the last Delegated Commissioning Task & Finish Group • No formal decisions are required

Executive Summary (key points, purpose, outcomes)

This report is to provide an update on the progress of the key work streams within the Primary Care Delegated Commissioning Task and Finish Transition Plan. This update is for information only. No formal decisions are required.


Report Title: Update on the Key work streams progressed by the Delegated Task & Finish Group and any issues arising

Meeting Date:

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Included in 15/16 budget? (Please tick. If no, please complete section B) Yes No Section B Proposed source of funding N/A Have the following areas been considered whilst producing this report? Yes N/A








Procurement processes Glossary/Acronyms CCG GMS NHSE PMS

Clinical Commissioning Group General Medical Services NHS England Personal Medical Services

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1. Purpose of the paper

1.1. This report is to provide an update on the progress of the key work streams within the Primary

Care Delegated Commissioning Task and Finish Transition Plan as at the 31 August 2016

1.2. The report captures the key areas that have presented difficulties, which are now almost resolved, or areas still raise concern around potential challenges for practices and the delivery of Primary Care Services.

2. Context

NHS South Cheshire & NHS Vale Royal CCGs commenced a Delegated Commissioning Task and Finish Group in April 2016. The group now meets on a monthly basis with an operational meeting a fortnight after each meeting. The group progresses the key work streams with the policies and procedures being created to capture the knowledge and guidance required to substantiate the processes.

3. Risks

3.1 Without the Transition Plan and work with NHSE it would have been difficult for the CCGs to

maintain business as usual for core delivery of the contracting function for the provision of general medical services under co-commissioning.

3.2 The Transition Plan allows both parties to work jointly to achieve pragmatic and flexible solutions thus mitigating the risk of disruption of services to patients.

4. Conclusions

4.1. The Delegated Commissioning Task & Finish Group and the Transition Plan are important

to mitigate the risk of disruption to patients accessing Primary Medical Services and also to prevent the de-stabilising of primary care.

5. Recommendations

The Primary Care (General Practice) Commissioning Committee is asked to consider the following recommendations:

• Receive and note the contents of the report • To receive the action notes of the last Delegated Commissioning Task & Finish Group • No formal decisions are required

Highlighted Areas Funding for a number of services was transferred from NHSE to NHS South Cheshire CCG and NHS Vale Royal CCG in April 2016. Initially NHSE kept responsibility of payments for these services for 6 month. From the 1 October 2016 responsibility for making payments for these services started to transfer to the CCGs. NHS England finance department has written to all companies involved informing them of the changes and requesting they contact the relevant CCG to enable payments to be made.

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The services included: • Language line solutions – Telephone Translation Service for other languages • Sign Language Services • Clinical waste services • Any ad hoc payments With respect to Clinical Waste services, although the responsibility for this has transferred to the CCGs NHSE has launched a new national framework agreement for the collection and disposal of clinical waste from GP surgeries. The framework sets out the terms, relating to price, quality and quantity, which have been agreed with chosen suppliers who bid for the right to be on the clinical waste services framework. NHSE is leading the process on behalf of the CCG. . In addition to this from 1 November 2016 NHSE has also transferred over the process for claiming payments Sections 15-22 – these are payments for: Section 15 – Locums covering maternity, paternity and adoptions leave Section 16 – Locums covering sickness leave Section 18 – Prolonged Study leave Section 20 – Doctors’ Retainer Scheme Section 21 – Returners’ Scheme Section 22 – Flexible Careers Scheme Abridged update NOTES FROM THE DELEGATED COMMISSIONING TASK & FINISH GROUP 14 October 2016 8.1.2 Updates from Previous Meeting Prime Ministers Access Fund - update Letter from CCG re Capita issues – update. Local Disputes Policy – This went to the September Primary Care (General Practice) Commissioning Committee meeting with the amendments from the Task & Finish Group and was agreed. MOU – Again this went to the September Primary Care (General Practice) Commissioning Committee and it will return to the Committee for final agreement in March when the first full year learning is accounted for. Practice Merger Policy - This also went to the September Primary Care (General Practice) Commissioning Committee meeting with the amendments from the Task & Finish Group and was agreed. CQC reports – This is on the agenda but has been presented at the September Primary Care (General Practice) Commissioning Committee for information and assurance as to the current position.

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Workforce Reviews – The reports went to the September Primary Care (General Practice) Commissioning Committee meeting for information. A report outlining key highlights & potential issues will go to the Primary Care Quality & Performance Committee who will agreed actions Christmas & New Year – Discussion CMR1 Form – Discussion Refugee meeting(s) – Assistant Directors of Operations and Commissioning will attend this meeting and feedback. Notes from the Delegated Task & Finish Group – CL advised that although these do go to the Primary Care (General Practice) Commissioning Committee they are summarised. Pharmacy Contracts – Discussion Delegated Commissioning Update 8.2.1 Progress with Transition Plan – areas were reviewed 8.2.2 Covered in 8.1.2 Actions - Letter from CCG re Capita issues. 8.2.3 Delegated Risk Register – Discussion 8.2.4 Issue Tracker – Discussion. 8.2.5 CQC Update – Actions in relation to follow up were noted. 8.2.6 Update from Primary Care Committee – verbal update was given 8.2.8 Winter Resilence Letter – The expectations and systems to be in place for the process were outlined in the correspondence attached with the agenda. Specific guidance will come to CCGs around Christmas & New Year opening times from NHSE England and this letter is expected any day now. Christmas Eve is on a Friday which will be a normal working day. CL advised that once the central letter is received a letter will be sent from the CCG which will also request confirmation of opening times during the period to support capacity planning. 8.2.9 Practice Resilience Funding – Discussion Additional funding has also been made for reception training. CCG has now received these funds and the document below gives further information in respect of how this is to be progressed. Next steps is to consult with Practices regarding the best way to ensure this training is undertaken. See below

Training for reception and clerical staff

As part of the General Practice Forward View, a new five year £45m fund has been created to contribute towards the costs for practices of training reception and clerical staff to undertake enhanced roles in active signposting and management of clinical correspondence.

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Benefits for patients and the practice

In the past 2-3 years, a number of practices, most notably through the Prime Minister’s GP Access Fund, have taken a more systematic approach to identifying the most impactful ways of deploying reception and clerical staff, and have developed formal approaches to processes and training.

We intend to support every practice to have the opportunity to train their staff to undertake one or both of these enhanced roles, through providing bursary funding towards training and backfill costs.

Active signposting by reception staff

This provides patients with a first point of contact which directs them to the most appropriate source of help. Web and app-based portals can provide self-help and self-management resources as well as signposting to the most appropriate professional. Receptionists acting as care navigators can ensure the patient is booked with the right person first time.

Reception staff are given training and access to a directory of information about services, in order to help them direct patients to the most appropriate source of help or advice. This may include services in the community as well as within the practice.

Benefits for practices: This innovation frees up GP time, releasing about 5% of demand for GP consultations in most practices. It makes more appropriate use of each team member’s skills and increases job satisfaction for receptionists.

Benefits for patients: It is easier for patients to get an appointment with the GP when they need it, and shortens the wait to get the right help.

Read more about this innovation.

Correspondence management by clerical staff

A member of clerical staff in the practice is given additional training and relevant protocols in order to support the GP in clinical administration tasks. All incoming correspondence about patients from hospitals is processed by a member of the clerical team. They have received training to deal with most letters themselves. Working against standard protocols developed in-house and refined through continuous improvement, the member of the team reads the letter, enters details into the patient’s record and takes appropriate follow-on action. In some cases this involves other members of the team, or booking the patient an appointment.

Benefits for practices: Using this system, 80-90% of letters can be processed without the involvement of a GP, freeing up approximately 40 minutes per day per GP. For the clerical team, job satisfaction is often increased as well.

Benefits for patients: Practices report they are often able to take speedier action on some issues. More detailed coding of clinical information in the GP record results in improved monitoring and management of certain conditions.

Read more about this innovation.

How will it work?

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https://www.networks.nhs.uk/nhs-networks/releasing-capacity-in-general-practice/messageboard/1-active-signposting

https://www.networks.nhs.uk/nhs-networks/releasing-capacity-in-general-practice/messageboard/4-develop-the-team


A total fund of £45 million is available over the next five years (2016/17 – 2020/21) to develop the capabilities of the practice workforce for these new ways of working. In the first year, £5m will be available, and £10m will be available in each of the subsequent four years.

Central funding will be allocated to CCGs on a per-head-of-population basis, to allow them to disseminate it in the most appropriate way for their practices. It will also make it easier for CCGs to add their own investments in their providers’ sustainability and transformation.

Funding for 2016/17 will be transferred to CCGs in the autumn. In liaison with their practices and the LMC, CCGs will agree how best to distribute money for practices. Details will also be published in the autumn of the arrangements for CCGs to report how this fund is spent to ensure that all money intended for supporting general practice reaches general practice. A new directory of training providers will signpost CCGs and practices to relevant training courses. It will be available on the NHS England website. Please contact [email protected] to suggest training offers for inclusion in the directory.

Criteria for use of this funding

This funding is allocated solely for the purpose of supporting the training of reception and clerical staff in GP practices. The training should cover either:

• the task of active signposting for patients. As described above, this is an enhancement to normal good customer service. It requires the receptionist to be skilled and confident in sensitively ascertaining the nature of the patient’s need and exploring with them safe and appropriate options. These options will usually include sources of advice and support outside the practice as well as within, and will often be drawn from a directory of services. Training should ensure receptionists are confident in communicating available options. Ideally a training experience should include an opportunity for staff to hear from a receptionist who is already working in this way.

• task of managing clinical correspondence. As described above, this is an enhancement to typical tasks of handling correspondence, such as scanning, forwarding to GPs and filing. It requires the staff member to be skilled and confident to make decisions about how to code a letter and its contents in the patient record, how to use an approved protocol for deciding which letters need to be sent to a GP and with what level of urgency, and when to ask for help. Training should also support the practice in establishing its own internal systems including a safe and appropriate protocol to guide staff, a system of supervision (especially for the early stages of implementation) and regular audits of safety and effectiveness. Ideally a training experience should provide opportunities for practice managers, GPs and staff to hear from others who are already working in this way.

Other training needs for clerical and reception staff (for example, customer service, information governance, understanding Read or Snomed codes, safeguarding) remain the responsibility of the employer, and are not covered by this funding.

The CCG and their practices may choose any training provider they deem appropriate. The funds may be used for any of the following:

• The cost of purchasing training • Backfill costs for practices to cover staff time spent undertaking training • Support in kind for practices for planning this change or undertaking training

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mailto:[email protected]


8.2.10 Update from NHS England & DH Event – CL attended the GP Forward View event which outlined the expectations from CCGs. 8.2.11 PMS Funding & KPIs – Discussion – Paper to follow 8.2.12 Interim Provider Policy – Discussion – Paper to follow Finance 8.3.1 Finance Update 8.3.2 Locum fees for Sickness, Paternity, Maternity & Adoption leave are transferring to the CCGs on 1st November. Discussion regarding process. AOB

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Report

Agenda No.:


Report Author(s) Governing Body Lead Name Kevin Highfield Name

Title ICT & Information Service Delivery Manager Title

CCG Strategic Priorities (5+1) supported by this paper

Transforming Primary Care



Integration

Person Centred Care


Recommendations:

To note the current state of the CCG ICT delivery for Primary Care in South Cheshire & Vale Royal. The paper covers the following areas and provides a full update of GP IT for both NHS South Cheshire and NHS Vale Royal CCGs:-

1. Budget Management and GPIT Bids 2016/17 Overall the GPIT is managed within budget with applications for additional capital and revenue resource being sort where possible. The transfer of the contract to Midlands and Lancashire CSU was undertaken at the start of the year and robust contract management is in place.

2. Projects in Delivery There are a number of project currently in delivery:- • MPLS (GPIT Core Network Replacement) • Cheshire Care Record (CCR) • End Of Life Information • SMS Bi Directional Messaging • Reciprocal WiFi

Report To: Primary Care Commissioning Committee

Report Title: IT & Information November 2016

Meeting Date: 30th November 2016

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• Virtual Desktop integration • Order Communication for Radiology with Mid Cheshire Hospitals Foundation Trust • Annual update of GP Hardware • Public WiFi • Upgrade to Internet Explorer 11

Details of the projects are included in Section 2 3. Planned Activities

There are three identified additional activities which will need to be undertaken this year and these are outlined in section 3. They are the identification of additional projects to be funded in 2017/18, the further development and submission of ETTF projects and the implementation of the Local Delivery Plan (LDR) for Cheshire.

4. Pipeline Projects Pipeline Projects a discussed in section 4 and include Risk Stratification, further work in respect of potential practice mergers, the ongoing work in respect of the CCG and GP websites and the investigation of possible additional EMIS Functionality.


The purpose of this report is to provide an update on the ICT work streams that support the Strategic and Operational IT & Information requirements for Primary Care.

Reviewed by (e.g. committee/team/director) Name (Individual or Group) Date Lynda Risk Xx November 2016

Kevin Highfield Xx November 2016



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Included in 15/16 budget? (Please tick. If no, please complete section B) Yes No Section B Proposed source of funding Have the following areas been considered whilst producing this report? Yes N/A








Procurement processes

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1. Budget Management and GPIT Bids 2016/17

1.1. Requirement: Following a procurement the ICT contract transferred to Midland & Lancashire CSU from 1st March 2016, this is now a fixed price contract with multiple NHS organisations across Cheshire over a period of the next three years (with a two year extension option). There was a requirement to novate all the invoicing and for GP services to the new ICT supplier and ensure that a cost recovery exercise was completed for the 1/12th of 2015/16 overpayment contract costs.

1.2. Current Status: Working with the new ICT supplier all the required invoicing has now been moved and feeds into the single cost per month invoicing structure for the ICT services, this aligns with our Primary Care allocation for 16/17. There was a 15/16 revenue cost pressure for the COIN (Community Network) which have now been mitigated from CCG and sits with Mid & Lancs CSU, this was part of the contract renegotiation (covered by an MOU) the new supplier picked up addition costs until they upgrade the network to a new MPLS Network. (see Projects Section). The risk of the Capital monies the CCG we required to provide to the implementation of the MPLS has now been mitigated with notification from NHS England of £225k award; this money will be received in December 2016. The cost recovery of the NW CSU contract overpayment (1/12th) was received in November 2016, to the amount of £3.5k this will be utilised to upgrade ICT hardware for the public Wifi (see Projects section). 1.3. Next Actions: Estates and Technology (ETTF) requirements were submitted to NHS England several months ago for developments in Primary Care (443k in South Cheshire & 306k in Vale Royal); these were produced in conjunction with the GP alliance, CCG staff, GP Practices and our ICT provider. The submission of formal Project Initiation Documents (PID) to support these is expected to be completed by first week of November with notification of successful bids in January 2017. The CCG will start Capital GPIT yearly bids in November 2016 for requirements 2017/18, this will be run as a formal workshop as part of the internal governance, with CCG, GP Alliance, GP Practice leads and Clinicians, MCHfT and Mid & Lancs CSU.

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2. Projects in Delivery

2.1. MPLS (GPIT Core Network Replacement)

2.1.1. Requirement:

This Commissioning Intention will provide a new network solution across Central Cheshire (SCCCG, VRCCG, ECCCG and WCCCGs & associated GP Practices) it supports local integration programmes, key ambitions of the Local Digital Roadmap and new ways of working across the Health and public sectors in Cheshire and adjoining regions. It will permit groups of GPs to combine with nurses, other Community services, hospital specialists, mental health and social care staff and is compliant with standards utilised by other public sector organisations.

2.1.2. Current Status:

There is a monthly programme delivery board with BT, M&L CSU and CCG IT leads. The plan to implement is now running behind schedule due to technical issues with the new enabling firewall (Palo Alto), completion now expected by end of May 2017, the first pilot site is planned for the beginning of December 2016 in Eastern Cheshire. There was previous cost pressures against the capital funding required to complete the project in SC&VR CCG, this has now been mitigated following advice from NHS England we have been successful in the award of 225k GPIT capital monies to cover the costs. There was a further cost pressure of the recurring costs for the old network, this has also been mitigated by the new ICT contract with Mids & Lancs CSU via an MOU, they will continue to cover these costs (£150k per annum) until the new network is in place, the revenue costs will then reduce.

2.1.3. Next Actions:

The Mids & Lancs technical team is working with the supplier to fix the outstanding technical issues and to enable the planned pilot deployment pilot date. CCG communications team is continuing communication updates to GP practices and the formal proposed rollout plan will be shared to GP practices by end of November 2016 to ensure any downtime is minimal utilising PLT days, weekends if required for the larger sites. The pilot site is Meadowside Medical Centre in Eastern Cheshire planned for 7th December 2016.

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2.2. Cheshire Care Record (CCR)

2.2.1. Requirement:

This commissioning intention moves towards the vision of a fully integrated care system that will deliver high quality care for all, now and for future generations. To achieve this there is a need to establish an infrastructure that enables the flow of high quality, comprehensive and up to date information between care professionals having access to the right information at the right time enables excellence. It helps professional’s document handovers accurately and makes it easier to share information quickly across multi-disciplinary teams and with other providers. Transforming the management of long-term conditions, securing the delivery of seven-day services and ensuring we retain world class emergency services for the future, all require the best quality information and insight to be available at the point of care.

2.2.2. Current Status: Summary information from Primary Care, Secondary Care, Mental Health, Community Care, Social Care and Oncology is currently being uploaded into the Cheshire Care Record and relevant staff from each of the Partner Organisations, along with OOH staff has access to the CCR. The majority of GP Practices across Cheshire are uploading data to the CCR but a significant number in South Cheshire are still not signed up to the project. Following discussions at the SC Membership Council, changes to the consent model have been made in the CCR and another concerted effort, to sign up the remaining practices in South Cheshire CCG is taking place.


Work is about to commence to test the upload of medications and problems from GP Practices in ‘real time’, rather than overnight. Once this has been completed it is likely that work will take place for additional data from GP Practices to also upload in ‘real time’. Work is also taking place to include the EPaCCS data form within the record. Resource to sign-up additional practices from South Cheshire CCG to the CCR has been identified, with plans to add the CWP Community data feed by the end of December, along with letters, radiology and pathology details from Mid-Cheshire Hospitals NHS Foundation Trust by the end of March 2017. Access to the CCR will be extended to include Eastern Cheshire Hospice, St Luke’s Hospice and Continuing Healthcare. Discussions are also taking place with The Good Shepherd Hospice and the North West Ambulance Service. There is an outstanding action on the future of programme management for the CCR and who will support phase 2 requirements and benefits realisation, this is currently being reviewed with a decision at the November board meeting. The budget remains in-line with the approved business case.

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2.3. EoL Information Available in Out of Hours via EMIS EPR (Formerly MIG Solution)

2.3.1. Requirement:

This commissioning intention had funding available via the SRG (25k), with the funding required to be spent within 2015/16. The EoL (End of Life) template sits within EMIS and is completed by Practices in South Cheshire & Vale Royal for required patients on that pathway, access was required into the Out of Hours service (OOH) to ensure they had a clinical view of this information and to enable to the correct actions for calls passed from 111 or walk-in patients.


The EMIS software is now installed and configured in OOH (end of July); this included all required staff training. Enthusiasm to use this service since the installation was high but this has decreased and concerns have been raised with our Clinical ICT and EoL lead due to the number of GP practices in South Cheshire & Vale Royal still not activating their Data sharing agreements (DSA’s), a total of 11 practices are still outstanding.


Dr. Sinead Clark is discussing with practices on individual visits where possible to address the Data sharing issues. There is a requirement with the redesign of the OOH service to identify both future requirement and a funding stream to support the revenue costs of the EMIS Licensing circa 10k per annum.

2.4. SMS Bi-Directional

2.4.1. Requirement:

The SMS service used to communicate with patients was previously funded nationally by NHS England via NHS Mail, this funding ceased at the end of September 2015 for all GP Practices. The South Cheshire & Vale Royal CCGs agreed to extend this until end of March 2016 to ensure no patient or practice impact. The new provider of the service “EE” has since developed a solution in partnership with “iPlato” for bi-directional texting to enable cancellations of appointments directly coded into EMIS. This solution was discussed with the GP Alliance around extending functionality and associated costs.


As part of the CCG capital investment from NHS England, funding was provided to implement a new solution to support practices, in partnership with the GP alliance they have agreed to fund the cost of the SMS texts for the 2016/17 financial year (18k). This agreement moves the previous costs from the CCGs in 2015/16.

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The project deployment planned with iPlato, Mids & Lancs CSU and the GP Alliance was for a proposed starts from May 1st 2016, there were delays with the implementation due to contract and billing issues with the new suppliers and resourcing issues on the NHS side. The project was rescheduled and started beginning of July with a 3 month rollout plan, this has been achieved and all GP Practices in South Cheshire & Vale Royal activated the new service by the end of October.


Work with iPlato supplier to renegotiate the contract start date of the service provision and cost of service for 2017/18. There is a requirement to identify recurrent funding streams from the NHS side.

2.5. Reciprocal Wi-Fi

2.5.1. Requirement:

To create a technical solution that will enable Health & Social Care colleagues access to their own organisations wireless identifier “SSID” (NHS-Staff for CCGs & GP practices) so they can log on with their own organisations hardware device (laptop). In practice a CCG laptop at Wyvern house (Eastern Cheshire council building) could logon as you would in Bevan House, Barony, without additional access requirements, reducing cost and improving access at a collaborative level.

The immediate benefits once implemented would be for the “Integrated Care Teams” to be able to visit different buildings for differing patient centered care requirements and have access to their own clinical systems and information about the patient they could then update in real time.


This is currently a proof of concept that is being tested in CWP and East Cheshire Council specific buildings, this was expected to complete by the end of April. Mids & Lancs CSU were requested to cost the implementation and on-going support.


There is a requirement for partner organisations to evaluate the PIA and the IG arrangement within their own orangisations once the pilot is completed.

2.6. Virtual Desktop Integration (Remote Network Access for GP Practices)

2.6.1. Requirement:

The current CITRIX service that’s supports remote network and EMIS access for GP staff through their own devices is now at end of life, and is no longer supported by the supplier. A new service was identified (Horizon VMware) which is currently hosted at Eastern Cheshire Hospital and can be utilised to achieve the required replacement. There is an ongoing revenue cost for the licenses for this service.

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There is an historic cost pressure to GP Practices for access to this service as the required Security VPN tokens have a cost of £180 each which also limits the extent of use of the historic solution.


Although the service is currently running there is a high risk any failures with this service could result in no further remote access (currently 60 staff use this service across South Cheshire & Vale Royal). The ongoing revenue costs for support are included in the new ICT contract with Midlands & Lancashire CSU and would stay the same with a move to the planned VDI solution.

2.6.3. Next Actions: A pilot with GP Practice sites and CCG staff is currently underway, and whilst some technical issues were originally identified these are now resolved and is expected to be signed of by end of November 2016. We are currently awaiting costs from Eastern Cheshire to enable a decision. The GP alliance is looking at funding the ongoing revenue costs for this service as this is seen as a key enabler for providing new models of care via the remote access to a fully functioning EMIS clinical system. Cost proposal expected end of November. 2.7. Order Comms in Mid Cheshire Hospital

2.7.1. Requirement:

In MCHfT all current requests for radiology examinations arrive at the department in paper form. These then have to be scanned into the new RIS (Radiology Information System) at the point of receipt. The introduction of full Order Comms for Radiology would give requesters the ability to electronically order any Radiology examinations from their PC. The request would then appear automatically and immediately within the ‘holding’ area of the RIS ready for booking, vetting or the arrival of the patient. The requestor would be able to follow the progress of the request once it had been accepted by the RIS system, enabling them to know when the patient had arrived, when the examination had been undertaken and when the report was available. There would also no longer be a requirement to store paper requests. The key benefits for GP practices would be the ability to view all the electronic flow and order via their current access to Anglia ICE.


A pilot service has now been identified to test with the Dexa modality based at Vitoria Infirmary. The CCG Practice engagement managers have been working with MCHfT project team to ensure the training material for GP practices is generated and a pilot site has now been identified (Ashfields end of January 2017).

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MCHfT to test the new interface with the supplier by end of November if successful the clinical team will start testing with the Dexa modality internally at MCHfT for an expected four week period. There is no revenue cost to the CCG for this project although staff time is required to assist implementation. 2.8. Replacement of GP Practice Hardware for Business as Usual

2.8.1. Requirement:

As part of the yearly review of hardware replacement requirements there are a number of ongoing Mids & Lancs CSU Projects across GP practices in South Cheshire & Vale Royal. This project stream includes replacement of Access Points (Wifi connection points, upgrade required for public wifi); replacement of end of life support Network Switches, EMIS spoke server replacements (current Windows versions now not supported by EMIS).


The replacement projects are being generally delivered out of hours to avoid any impact to GP practices operational requirements and will continue throughout 2016/17 and are funded by capital bid money and have no ongoing revenue costs, all project resource costs are covered by projects days available in the ICT contract.


Completion of EMIS servers by end December 2016; network switches by end of January 2017 (to enable MPLS deployment), completion of Wifi equipment by February 2017.

2.9. Public Wifi

2.9.1. Requirement

This project will deliver the government ambition of providing free wireless to patients at healthcare locations. The requirement was to utilise the existing network infrastructure hardware to ensure costs were kept to a minimum and the economies of scale were maintained with the ability to flex the service across Cheshire.

2.9.2. Current Status

With the award of capital funding from NHS England a mini procurement through Mids & Lancs led to an award with a Network solution company (TNP). The contract for the solution is for five years and met the requirements. Technical changes to the infrastructure have been completed (updating software versions on network switches) the planned upgrade of the AP (network access points) units was already underway through other capital funding streams.

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The new “NHS-Guest” wifi has been active in the CCG and all but two GP practice sites from the beginning of November 2016 (Ashfields & Dene Drive). There is a daily wifi password available from reception for visitors.

2.9.3. Next Status

The two outstanding sites require all AP units to be replaced and are planned to complete by end of January 2017.

2.10. Upgrade to Internet Explorer 11 for Web Browsing

2.10.1. Requirement The GP surgeries and the CCG’s are currently running on IE 8 which although was industry standard is now out of date with Microsoft announcing they no longer support this and many websites will no longer run using IE8.

2.10.2. Current Status

Mids and Lancs CSU have been requested to upgrade the exiting version of IE to 11 which is now the industry standard. Testing in all GP practices and the CCG staff has bene conducted over the past two months to ensure all business critical web sites and functionality was not affected. The pilot was planned to be rolled out to East Cheshire CGG & Hospital and was due to start in the second week of November 2016, this date has been delayed due to staff resourcing issues in the Mids & Lancs CSU.

2.10.3. Next Status

Awaiting new date from Mids & Lancs CSU to start pilot deployment and rescheduled dates for South Cheshire & Vale Royal GP surgery and CCG staff.

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3. Planned Activities:

• Planning session for 2017/18 GPIT Capital Bids

• Submission of approved ETTF bids

• Develop plan for Local digital Roadmap ambitions

4. Pipeline Project / Requirements:

• Risk Stratification review, current provision via EMIS, new Mids & Lancs CSU BI contract includes as standard offering as part of the costs, EMIS version carries an ongoing revenue cost. GP alliance currently demonstrating new service provision and a request to automate Primary Care data has been made to Mids & Lancs CSU, as currently this is GP manual submissions.

• Possible practice merger requirement, initial ICT requirements scoped, awaiting approval to proceed.

• Health 2 Works contraction extension for CCG & GP Websites, this was previously pre-

paid for three years, the GP Alliance have been in discussion with other suppliers around alternative, CCG discussion required on future scope and content support model required.

• Evaluation of new EMIS products - E-Consult, Video Consultations & EMIS Acute solution,

demonstration at Bevan House, Barony planned for 2nd December 2016. Highlights / Lowlights:

Highlights:

• Appointment of new CCG ICT Strategy Group Chairperson • EMIS EPR (Electronic Patient Record) rollout to Out of Hours completed for Eol template • Implementation of SMS Bi-Directional solution (iPlato) • Implementation of Public Wifi to majority of GP sites • CCR Project Manager extended until end of March 2017 from Mids & Lancs CSU • Submission of Local Digital Roadmap to NHS England

Lowlights:

• Increased delays in project deployments due to resourcing issues in Mids & Lancs CSU

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Glossary/Acronyms CCR MPLS EMIS EPaCCS NSCR MIG RIS LDR CPIS EDL PSN EPS NHSE SMS CCG SRG E-Referral NHS Digital CCE MCHFT UHNM MDGH CWP BMI IDCR M&L CSU CP-IS EoL NWAS VDI Mid & Lancs CSU BAU

Cheshire Care Record Multiprotocol Label Switching Network Egton Medical Information Systems (Primary Care Clinical System) Electronic Palliative Care Coordination Systems National Summary Care Record Medical Information Gateway Radiology Information System Local Digital Road Map Child Protection Information System Electronic Discharge Letters Packet Switching Network Electronic Prescribing NHS England Short Message Service Clinical Commissioning Group Systems Resilience Group Electronic Referral System (Previously Choose & Book) Formerly (Health and Social Care Information Centre) Clinical Commissioning Executive Mid Cheshire Hospital Foundation Trust University of North Midlands Macclesfield District General Hospital Cheshire and Wirral Partnership BMI Healthcare Integrated Digital Care Record Midlands and Lancashire Commissioning Support Unit Child Protection Information System End of Life North West Ambulance Service Virtual Desktop Integration Midlands and Lancashire CSU Business as Usual

A – Cheshire Care cord)

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Report

Agenda No.:


Report Author(s) Governing Body Lead Name Caroline Harley Name Lynda Risk

Title Primary Care Contracts Manager Title Chief Finance Officer CCG Strategic Priorities (5+1) supported by this paper Transforming Primary Care



Integration

Person Centred Care


Recommendations: The Primary Care (General Practice) Commissioning Committee is asked to discuss and approve the attached process for practices who wish to make an appeal against non-achievement of a service payment.


It was identified earlier this year that provision needed to be made to agree the local approach to resolving contractual disputes in relation to General Practices GMS and PMS Contracts. In September 2016 the Primary Care Committee formally approved a Local Dispute Resolution Process for Primary Medical Services. The Policy was designed to:

(1) Address the requirement for a local approach to resolving disputes whereby a General Practice Contractor disputes a decision made by the CCG

(2) As part of this, gives more detail in respect of the local informal steps that should be taken to try and resolve disputes

(3) As part of this, gives more detail in respect of the local formal steps that should be taken to try and resolve disputes.


Report Title: AUA Directed Enhanced Service (DES) Component 2 – Practice Issues and Appeals – Part A

Meeting Date: 30 November 2016

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In October 2016 4 practices, 2 in NHS South Cheshire CCG and 2 in NHS Vale Royal CCG, appealed against the automated payment generated by Calculating Quality Service Process (CQRS). CQRS is the automated payment process that NHSE put in place to extract data from practices against qualifying for payments for Enhanced Services. The Practices were requesting a review based on the evidence that they had done the work. The Local Disputes Policy does not provide provision for practices to appeal a payment achievement process. The Committee are asked to discuss and agree the document with comments where appropriate paying particular attention to;

(1) That the CCG will allow appeals in some circumstances (2) The process and relevant Managers/Clinicians/Committee members required (3) Management of Conflict of Interest (4) The need for the CCGs to make payments under the contract promptly, clause 18.1.1

Making Payments in GMS contract and clause 59.1 Late Payment Notice in the PMS contract

The main outcome will be a defined local approach to managing appeals that can be invoked if Practice disputes a decision, either manual or automated, made by the CCG, under Delegated Arrangements. Reviewed by (e.g. committee/team/director) Name (Individual or Group) Date

Delegated Task and Finish Group November 2016







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Procurement processes Glossary/Acronyms

APMS CCG GMS NHSE PMS

Alternative Medical Services Provider Clinical Commissioning Group General Medical Services NHS England Personal Medical Services

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NHS South Cheshire Clinical Commissioning Group &

NHS Vale Royal Clinical Commissioning Group

Appeals Process for Enhanced Services Payments

Primary Medical Services

Responsible Person: Chair of the Primary Care Commissioning Committee Date approved: Approval Committee: Primary Care Commissioning Committee

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Document Control:

Amendment History:

NB. The version of the policy posted on the intranet must be a PDF copy of the approved version Document Status: This is a controlled document. Whilst this document may be printed the electronic version posted on the intranet is the controlled copy. Any printed copies of the document are not controlled.

Description Comment Title Managing the Appeals Process for Enhanced

Services Payments - Primary Medical Services

Document Number Author Caroline Harley/Chris Leese

Date Created 15 November 2016 Date Last Amended

Version V1 Approved By

Date Approved Review Date 12 months

Responsible Person/Owner Location Bevan House, Nantwich

Publish on Public Web Site Y/N? N Constitutional Document Y/N? N

Requires an Equality Impact Assessment Y/N?

N

Version Date Comment on Changes

V0.1 1 November 2016 Initial draft

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Managing the Appeals Process for Enhanced Services Payments Primary Medical Services

1. Introduction NHS South Cheshire CCG & NHS Vale Royal CCG from 1 April 2016 assumed Delegated Commissioning Authority which offered CCGs full responsibility for the commissioning of local general practice services. As part of this, expectations will be placed on both individual practices making financial claims and NHS South Cheshire CCG and NHS Vale Royal CCG with regards to decisions in relation to contractual payments made accordingly by manual and automated processes. The National Health Service, England General Medical Services Statement of Fees and Entitlement Directions provides information regarding payments to practices by NHS England Commissioning Board and are adhered to by both Delegated Clinical Commissioning Groups. Within these Directions there is a Dispute Resolution Procedure that should be followed if a practice disputes a payment. The procedure requires the Practice and NHS England/ Delegated Clinical Commissioning Groups to make every reasonable effort to communicate and co-operate with each other with a view to resolving the dispute before referring it for determination. The Practice, or NHS England/Delegated Clinical Commissioning Groups may, if they so wish to do so, invite the Local Medical Committee to participate in discussions. Prior to the 1 April 2016 any practice who wished to appeal against a payment made to the practice as part of their GMS or PMS Contract; Enhanced Services that the practices was commissioned to provide, or Quality and Outcome achievement would have gone to NHS England. After the 1 April 2016 as part of Delegated Commissioning this process has now transferred to NHS South Cheshire and NHS Vale Royal CCGs. A process for managing an appeal therefore needs to be agreed and implemented. The Primary Care (General Practice) Commissioning Committee is the decision making body with regards to the management of the delegated functions and the exercise of the delegated powers. This is the appropriate Committee where appeals should be heard and decisions made. This paper sets out the process which will be undertaken at a local level to address this. Proposed Appeals Process

- All practices have the right to make an appeal if a payment has been refused either through a manual or electronic submission if they consider the appropriate work had been undertaken to warrant the payment.

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- Practice should in the first instance contact the Primary Care Team to establish the process that is in place for making an appeal

- Practice will be advised that they need to submit appropriate evidence to support their

appeal

- If evidence is produced then an Appeals Panel will be convened within 28 days of the information

- The Appeals Panel will convene and will consist of:

o Director of /or Head of Primary Care o Director of Nursing /or Clinical Lead for Primary Care o Lay Member o Finance Representative o Quality Representative

- The panel will review the information and identify if further information is required - If no further information required the panel will make a decision based upon the

practice’s submission

- Panel will consider the following documents to consider the query:

o Technical Guidance and/or FAQs o Business Rules o Statement of financial entitlements and/or Regulations o Other organisations as appropriate – CQRS, GPES, HSCIS o Terms of the Enhanced Service (e.g where no appeals are allowed etc). o Advice from NHS England

- Practice will be advised of the outcome within 14 working days of the appeal panel

meeting.

- This would not be universally applied to all Enhanced Services and each case would be reviewed on an individual basis.

- There would be no further appeals process

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Report

Agenda No.:


Report Author(s) Governing Body Lead Name Chris Leese Name Lynda Risk

Title Service Delivery Manager – Primary Care Operations Title Chief Finance Officer

CCG Strategic Priorities (5+1) supported by this paper

Transforming Primary Care



Integration

Person Centred Care


Recommendations: The Primary Care (General Practice) Commissioning Committee is asked to

(a) Note and be assured in respect of ongoing actions (b) Discuss and Agree the actions in relation to Part B of the Primary Care (General Practice)

Committee

Executive Summary (key points, purpose, outcomes) Although the Primary Care Quality ‘function’ sits within the Primary Care Quality team there is of course a cross over and close working between primary care contracts and quality team. In order to support a single approach to Quality across all Providers, the Contracting and Quality Team met to discuss current gaps and a way forward in respect of Primary Care Quality, given that Primary Care Contracting functions are discussed within the Primary Care (General Practice) Commissioning Committee. The Quality and Primary Care Contracting Team met on 28.10 to discuss ways in which the teams will work together in respect of quality and contracting related issues. Actions Agreed / Underway

- Joint Contracting Visits with Practices regarding CQC follow up. Members of the Quality Team

Report To: Primary Care (General Practice) Commissioning Committee –

Report Title: Part A - Primary Care Contracting and Quality Update – Joint Working

Meeting Date: November 2016

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will be attending these visits. - Revisit the Primary Care Quality Dashboards to define further– to be discussed at a follow up

meeting in December in terms of content etc. - Quality Team are supporting and working with the Primary Care Contracting team - Planned visits to Practices in terms of Annual Contracting Visits – Members of staff from

Quality will attend these visits which will be rolled out during 2017 and content/ format of these meetings will be discussed at a future meeting.

- Further work in respect of SEA’s (Significant Event Audits) - Collating and sharing information in relation to Practices - Follow up meeting in December to progress and monitor actions

There was a discussion regarding Quality attendance at Part B of the Primary Care (General Practice) Commissioning Committee to share information and discuss specific Practice issues. The Primary Care (General Practice) Commissioning Committee is asked to ;

(a) Note and be assured in respect of ongoing actions (b) Discuss and agree the proposal for specific Quality related practice issues to be discussed in

Part B of the Committee. Reviewed by (e.g. committee/team/director) Name (Individual or Group) Date





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APMS CCG GMS NHSE PMS


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Report

Agenda No.:




CCG Strategic Priorities (5+1) supported by this paper Transforming Primary Care



Integration

Person Centred Care

NHS Constitution Targets

Outcome Required Approval Assurance Discussion Information

Recommendations: The Primary Care (General Practice) Commissioning Committee is asked to note the position regarding CQC visits that are already in the public domain as below.

Executive Summary (key points, purpose, outcomes) CQC Update for South Cheshire and Vale Royal Localities – October 2016 Vale Royal - All 12 practices within the Vale Royal locality have been inspected and their CQC reports are available on the CQC website, http://www.cqc.org.uk/content/doctorsgps .

Practice name

GP_PRACTICE_CODE

POSTCODE Inspection date Date of

report Inspection Rating

Swanlow N81024 CW7 1AT 10/09/201

5 Good

Firdale N81025 CW8 4AZ 20/08/201

5 Outstanding

High Street N81040 CW7 1AT 07/01/201

6 Good

Weaverham N81051 CW8 3EU 27/08/201

5 Good

Report To: Primary Care (General Practice) Commissioning Committee – Report Title: Part A – General CQC (Care Quality Commission Update) Meeting Date: November 2016

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http://www.cqc.org.uk/content/doctorsgps


Watling Street N81055 CW9 5EX 06/08/201

5 Good

Witton Street N81061 CW9 5QU 10/09/201

5 Good

Oakwood N81067 CW8 4LF 13/08/201

5 Good

Launceston Close N81074 CW7 1LY

27/08/2015 Good

Danebridge N81087 CW9 5HR 06/08/201

5 Good

Middlewich Rd N81113 CW9 7DB

15/10/2015 Good

Willow Wood N81123 CW7 3GY 13/08/201

5 Good

Weaver Vale N81127 CW7 1AT 01/10/201

5 Requires

Improvement South Cheshire - Of the 18 practices within the South Cheshire locality;

• 14 practices have been inspected and their CQC reports are available via the CQC website, http://www.cqc.org.uk/content/doctorsgps

Practice name

GP_PRACTICE_CODE

POSTCODE Inspection date Date of

report Inspection Rating

Audlem N81001 CW3 0AH 28/10/20

16 Good

Cedars N81008 ST7 2LU 05/07/2016 Good

Nantwich N81010 CW5 5NX 05/11/2015 Good

Delamere N81015 CW1 3AW 23/03/2016 Good

Millcroft N81016 CW1 3AW 29/10/15 Good

Ashfields N81032 CW11 1EQ 23/06/201

6 Good

The Oaklands N81039 CW10 9BE 01/10/2015

Requires Improvement

Haslington N81043 CW1 5QY 28/06/2016

Requires Improvement

Hungerford N81044 CW1 5HA

Kiltearn N81047 CW5 5NX 07/01/2016 Good

Earnswood N81053 CW1 3AW 29/12/2015 Good

Grosvenor N81068 CW1 3HB 18/04/2016 Good

Greenmoss N81071 ST7 3BT

Rope Green N81084 CW2 5DA 08/10/2015 Good

Tudors N81090 CW5 5NX 03/08/2016 Good

Merepark N81111 ST7 2LU

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http://www.cqc.org.uk/content/doctorsgps


Wrenbury N81614 CW5 8EW 06/05/2016 Good

Watersedge N81642 CW10 9BH

The Primary Care (General Practice) Commissioning Committee is asked to note the update in respect of CQC information that is in the Public Domain.












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Procurement processes Glossary/Acronyms APMS CCG GMS NHSE PMS


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Report

Agenda No.:




CCG Strategic Priorities (5+1) supported by this paper Transforming Primary Care



Integration

Person Centred Care


Recommendations: The Primary Care (General Practice) Commissioning Committee is asked to discuss and agree the process and governance arrangements for investing /spending the Reception and Clerical Staff Training monies allocated.


As part of the GP Forward View South Cheshire and Vale Royal CCGs have been allocated funds for Reception and Clerical Staff Training. The training should cover either:

• The task of active signposting for patients. • Task of managing clinical correspondence.

The CCG must work with local Practices in respect of implementation of this and the funding is recurrent until 2020/2021. For 16/17 the funds were confirmed in October and therefore in order to ensure investment is made this year it is important we agree a way forward as soon as possible. The Committee is asked to discuss and agree the way forward for these monies for 16/17

Report To: Primary Care (General Practice) Commissioning Committee – Report Title: Reception and Clerical Staff Training Monies Meeting Date: November 2016

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Procurement processes Glossary/Acronyms APMS CCG GMS NHSE PMS


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1.0 BACKGROUND As part of the General Practice Forward View, a new five year £45m fund has been created to contribute towards the costs for practices of training reception and clerical staff to undertake enhanced roles in active signposting and management of clinical correspondence. A total fund of £45 million is available over the next five years (2016/17 – 2020/2021) to develop the capabilities of the practice workforce for new ways of working (described below). In the first year £5m will be available and £10m will be available in each of the subsequent four years.

For this work, for 16/17 Vale Royal CCG has been allocated £9k and South Cheshire CCG £16k – this funding is recurrent until 2020/2021 but the exact levels for future years are not confirmed.

Criteria for use of this funding

(1) This funding is allocated solely for the purpose of supporting the training of reception and clerical staff in GP practices. The training should cover either:

The task of active signposting for patients. This is an enhancement to normal good customer service. It requires the receptionist to be skilled and confident in sensitively ascertaining the nature of the patient’s need and exploring with them safe and appropriate options. These options will usually include sources of advice and support outside the practice as well as within, and will often be drawn from a directory of services. Training should ensure receptionists are confident in communicating available options. Ideally a training experience should include an opportunity for staff to hear from a receptionist who is already working in this way.

o This provides patients with a first point of contact which directs them to the most appropriate source of help. Web and app-based portals can provide self-help and self-management resources as well as signposting to the most appropriate professional. Receptionists acting as care navigators can ensure the patient is booked with the right person first time.

o Reception staff are given training and access to a directory of information about services, in order to help them direct patients to the most appropriate source of help or advice. This may include services in the community as well as within the practice.

o Benefits for practices: This innovation frees up GP time, releasing about 5% of demand for GP consultations in most practices. It makes more appropriate use of each team member’s skills and increases job satisfaction for receptionists.

o Benefits for patients: It is easier for patients to get an appointment with the GP when they need it, and shortens the wait to get the right help.

Task of managing clinical correspondence. This is an enhancement to typical tasks of handling correspondence, such as scanning, forwarding to GPs and filing. It requires the staff member to be skilled and confident to make decisions about how to code a letter and its contents in the patient record, how to use an approved protocol for deciding which letters need to be sent to a GP and with what level of urgency, and when to ask for help. Training should also support the practice in establishing its own internal systems including a safe and appropriate protocol to guide staff, a system of supervision (especially for the early stages of implementation) and regular audits of safety and effectiveness. Ideally a training experience should provide opportunities for practice managers, GPs and staff to hear from others who are already working in this way.

o A member of clerical staff in the practice is given additional training and relevant protocols in order to support the GP in clinical administration tasks.

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o All incoming correspondence about patients from hospitals is processed by a member of the clerical team. They have received training to deal with most letters themselves. Working against standard protocols developed in-house and refined through continuous improvement, the member of the team reads the letter, enters details into the patient’s record and takes appropriate follow-on action. In some cases this involves other members of the team, or booking the patient an appointment.

o Benefits for practices: Using this system, 80-90% of letters can be processed without the involvement of a GP, freeing up approximately 40 minutes per day per GP. For the clerical team, job satisfaction is often increased as well.

o Benefits for patients: Practices report they are often able to take speedier action on some issues. More detailed coding of clinical information in the GP record results in improved monitoring and management of certain conditions.

(2) Other training needs for clerical and reception staff (for example, customer service, information governance, understanding Read or Snomed codes, safeguarding) remain the responsibility of the employer, and are not covered by this funding.

(3) In liaison with their practices and the LMC, CCGs will agree how best to distribute money for practices. Details will also be published in the autumn of the arrangements for CCGs to report how this fund is spent to ensure that all money intended for supporting general practice reaches general practice. A new directory of training providers will signpost CCGs and practices to relevant training courses.

(4) The CCG and their practices may choose any training provider they deem appropriate. The funds may be used for any of the following:

• The cost of purchasing training • Backfill costs for practices to cover staff time spent undertaking training • Support in kind for practices for planning this change or undertaking training

(5) Central funding will be allocated to CCGs on a per-head-of-population basis, to allow them to

disseminate it in the most appropriate way for their practices. It will also make it easier for CCGs to add their own investments in their providers’ sustainability and transformation.

(6) As part of their GP Forward View plan, CCGs should describe how these two new funds will be used for member practices, and may wish to do this collaboratively across the STP footprint. This should include evidence that the plan:

a) has been developed in consultation with general practices themselves; b) will be delivered in alignment with other development activities such as local Time for Care programmes, and wider workforce and technology strategies; c) includes plans to use early adopters to help spread innovations in workforce and technology; and d) provides assurance that this funding is ring-fenced for the intended purposes.

(7) The Planning Guidance states that it would be preferable for practices to undertake training or innovation adoption in local cohorts, rather than on an ad hoc basis

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Steps so far The funding was received into the CCG during October. We immediately communicated via Practice Managers meetings and networks that the money had been received, and asked the Practices their views on ways this could be delivered, what their Priority areas would be, as per the Guidance. For 16/17 in order to ensure that the money is working for frontline staff as required and that training providers are able to deliver etc, there is an urgency to ensure that this is organised as soon as possible. It is assumed that the money will need to be spent this financial year (this is assumed not confirmed) Chris Leese attended the Vale Royal Practice Managers Meeting in October and will attend South CCG Practice Managers in November also (this meeting is not until immediately prior to the Primary Care (General Practice) Committee to discuss and gauge ideas further. Early Feedback (as at time of paper)

• Training needs to ensure covers the difference between larger and smaller Practices • A handful of Providers have been suggested that have been used before • On line/ Face to Face • Challenges of bespoke v general training • Practices have different staffing models and systems of managing correspondence • Challenges of having a one size fits all specification • Using Protected Learning Time in February and March potentially

For Discussion and Agreement

(1) Committee to discuss and agree the governance arrangements for the money including (i) selection of providers (ii) consideration regarding money allocated to practices/groups of practices (iii) establishing/confirming what the money cant be spent on (iv) sign off arrangements (iv) forum for oversight of this spend

(2) Committee to note the links with the GP Forward View Plan and wider Transformational Agenda

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Report

Agenda No.:


Report Author(s) Governing Body Lead Name Lorraine Weekes-Bailey Name Lynda Risk

Title Primary Care Accountant Title Chief Financial Officer CCG Strategic Priorities (5+1) supported by this paper

Transforming Primary Care Yes



Integration

Person Centred Care

NHS Constitution Targets Yes Outcome Required Approval Assurance Discussion Information

Recommendations:

Primary Care Committee are asked to review the current financial position of Primary Care for Month 7


Financial overview and position for the Primary Care Budget and Forecast Outturn for Month 7

Report To: Primary Care Delegated Commissioning Task and Finish Group Report Title: Primary Care Delegated Financial Report Meeting Date: Friday 25th November 2016

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Included in 16/17 budget? (Please tick. If no, please complete section B) Yes No Section B Proposed source of funding

Have the following areas been considered whilst producing this report? Yes N/A









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Primary Care Financial Update November 2016

Financial Position and Overview Month 1-7 Please see below the financial position for April – October 2016. Please note that Prescribing budgets have been removed from this report NHS Vale Royal CCG The Primary Care positions, as at Month 7 is underspent by £32,857 year to date, and the forecast for 16/17 shows a small overspend of £6,011. Within the Local Primary Care budget there is a forecasted pressure of £14,567 that relates to the costs for the post-operative complex wound care scheme; these costs are likely to increase further as the CCG have agreed to fund this service through to November 2016. These costs were not initially projected in the initial Local Primary Care budget. NHS South Cheshire CCG The Primary Care position, as at Month 7 is overspent by £444,382 year to date, this is due to income recharged not being allocated timely for the month 7 position and will be corrected for month 8. The forecast for 16/17 shows a small overspend of £44,460. Similar to the pressure in NHS Vale Royal there is a forecast over spend £25,314 attributed by the post-operative complex wound care scheme; again the CCG has agreed to fund this service through to the end of November 2016.

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NHS Vale Royal CCG Summary Month 1-7

NHS South Cheshire CCG Summary Month 1-7

Annual Budget

Budget Actual YTD Variance Forecast Variance

£ £ £ £ £ £

Primary Care BudgetIDCR -Cheshire Care Record 122,000 71,400 46,782 24,618 80,198 41,802GP I.T 285,000 166,600 173,353 (6,753) 291,177 (6,177)Local Primary Care 1,204,100 700,351 701,191 (840) 1,245,736 (41,636)Primary Care Delegated 12,505,400 7,300,468 7,284,636 15,832 12,505,400 0Total NHS Vale Royal CCG Primary Care Budget 14,116,500 8,238,819 8,205,962 32,857 14,122,511 (6,011)

NHS Vale Royal CCG Primary Care Report

Year to Date Month 7 Forecast Outturn

Annual Budget


£ £ £ £ £ £

Primary Care BudgetGP I.T 574,000 334,250 335,793 (1,543) 574,655 (655)Local Primary Care 1,894,000 1,104,849 1,119,340 (14,491) 1,938,005 (44,005)Primary Care Delegated 22,771,200 13,285,356 13,713,704 (428,348) 22,771,000 200Total NHS South Cheshire CCG Primary Care Budget 25,239,200 14,724,455 15,168,837 (444,382) 25,283,660 (44,460)


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Further analysis is shown below in Table 1a and Table 1b. Table 1a

Annual Budget


£ £ £ £ £ £

IDCR-Cheshire Care RecordIDCR 122,000 71,400 46,782 24,618 80,198 41,802

GP I.TGP I.T 285,000 166,600 173,353 (6,753) 291,177 (6,177)

Local Primary Care Local Quality Scheme 385,000 224,420 230,477 (6,057) 394,967 (9,967)Anti Coagulation 14,700 8,575 9,129 (554) 15,648 (948)Near Patient Testing 83,000 48,417 47,646 771 81,678 1,322 GP Care Homes 304,000 175,666 164,016 11,650 304,000 0GP Practice Staff 299,400 174,510 174,652 (142) 299,400 0Counselling 35,000 20,417 20,416 1 35,000 0Foster & Adoption 10,000 5,833 5,832 1 10,000 0Minor Surgery/Carpal Tunnel Total 16,000 9,333 10,155 (822) 19,476 (3,476)Weaver Lodge 1,000 583 7,500 (6,917) 15,000 (14,000)Vasectomies 47,000 27,347 22,871 4,476 47,000 0Complex Wound Care 0 0 8,497 (8,497) 14,567 (14,567)GP Development Programme - Reception & Clerical Training 9,000 5,250 0 5,250 9,000 0Total Secondary Care Services in a Primary Care Setting 1,204,100 700,351 701,191 (840) 1,245,736 (41,636)

Primary Care DelegatedGMS-Contracts Global Sums & MPIG 7,634,800 4,460,400 4,455,992 4,408 7,638,843 (4,043)PMS-Contracts 670,900 391,300 391,349 (49) 670,900 0QOF 1,447,800 843,710 844,554 (844) 1,447,800 0DES- Enhanced Services 686,000 400,302 406,892 (6,590) 700,800 (14,800)Seniority 162,900 94,990 95,026 (36) 162,900 0Premises 1,683,000 981,561 959,387 22,174 1,631,644 51,356PA Dispensing 101,500 59,283 59,442 (159) 101,500 0Other 118,500 68,922 71,994 (3,072) 151,013 (32,513)Total South Cheshire Primary Care Co-Commissioning 12,505,400 7,300,468 7,284,636 15,832 12,505,400 0

Total Primary Care Budget 14,116,500 8,238,819 8,205,962 32,857 14,122,511 (6,011)

NHS Vale Royal CCG Primary Care Report


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Table 1b

Annual Budget


£ £ £ £ £000 £000

GP I.TGP I.T 574,000 334,250 335,793 (1,543) 574,655 (655)

Local Primary Care Local Quality Scheme 669,000 390,321 394,825 (4,504) 676,844 (7,844)Anti Coagulation 29,000 16,901 19,285 (2,384) 33,059 (4,059)Near Patient Testing 119,000 69,400 69,018 382 118,317 683 GP Care Homes 315,000 183,749 183,588 161 315,000 0GP Practice Staff 590,000 344,149 349,423 (5,274) 599,010 (9,010)Counselling 24,000 13,999 14,164 (165) 24,281 (281)Dermatology 18,000 10,499 10,500 (1) 18,000 0Foster & Adoption 12,000 7,000 7,000 0 12,000 0Minor Surgery/Carpal Tunnel Total 16,000 9,332 6,135 3,197 16,000 0Complex Wound Care 0 14,767 (14,767) 25,314 (25,314)GP Development Programme - Reception & Clerical Training 16,000 9,333 1,400 16,000Vasectomies 86,000 50,166 49,235 931 84,180 1,820Total Secondary Care Services in a Primary Care Setting 1,894,000 1,104,849 1,119,340 (14,491) 1,938,005 (44,005)

Primary Care DelegatedGMS-Contracts Global Sums & MPIG 8,427,000 4,912,845 5,436,274 (523,429) 9,319,327 (892,327)PMS-Contracts 5,765,000 3,367,266 2,842,462 524,804 4,872,773 892,227QOF 2,395,000 1,396,920 1,647,052 (250,132) 2,394,865 135DES- Enhanced Services 1,001,200 584,647 569,193 15,454 1,001,434 (234)Seniority 289,000 168,616 156,108 12,508 288,700 300Premises 3,946,000 2,300,732 2,457,600 (156,868) 3,945,000 1,000PA Dispensing 375,000 220,150 220,687 (537) 375,901 (901)Other 573,000 334,180 384,328 (50,148) 573,000 0Total South Cheshire Primary Care Co-Commissioning 22,771,200 13,285,356 13,713,704 (428,348) 22,771,000 200

Total Primary Care Budget 25,239,200 14,724,455 15,168,837 (444,382) 25,283,660 (44,460)

NHS South Cheshire CCG Primary Care Report


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GP Payments CCG Finance representatives attended the second PCSE (Capita) Finance meeting. Present at the meeting were NHS England, North West CCG finance colleagues and PCSE Finance representatives. The meeting was very productive and a further meeting will take place in December. Main matters were: - The issue with significant amounts of monies owed to 3 GP Practices has now been successfully

resolved. - The new payment system is running well with much fewer errors being made by PCSE. At the meeting PCSE were asked to update us on the progress of GP Solo Forms and the Performer list, it was agreed at the next meeting PCSE will bring a representative who works within this service area. Working Groups As discussed at the last meeting, CCG finance are going to be creating a small working group across both NHS South Cheshire CCG and NHS Vale Royal CCG to look in detail at moving payments on to one single payment per month from 2017/18. This will assist with the Cash flows of Practices, and will reduce work, both in Practice and CCG finance departments. Budget Setting In the New Year, CCG finance will be preparing the budgets ready for the new financial year 2017/18. In order to help with the budget setting CCG finance will be writing out to Practices across the CCG’s to ask them to provide details and costing for their water rates and business rates so we can align them against the budgets that we set. It is also expected that there will be large increases in rates for GP Practices and will need to be reflected in the 17/18 budget setting round.

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