agenda - west suffolk clinical commissioning group · 6/24/2020 · west suffolk ccg. primary care...

WEST SUFFOLK CCG PRIMARY CARE COMMISSIONING COMMITTEE

Wednesday, 24 June 2020 – 2.00pm

In response to the challenges facing the NHS and to reduce the risk of coronavirus

transmission, members of the public will not be able to attend this meeting but are invited to submit questions relating to agenda items via email to [email protected]. The minutes of the meeting and answers to any questions submitted by the public will be published on the

CCG website after the meeting.

AGENDA

1400 1. Apologies for Absence Chair 1402 2. Declarations of Interest and hospitality and gifts All 1403 3. Minutes of Previous Meeting

To approve minutes of West Suffolk CCG Primary Care Commissioning Committee meetings held on 26 February 2020.

Chair

1404 4. Matters arising and review of outstanding actions.

To review outstanding issues from the previous meeting of the West Suffolk CCG Primary Care Commissioning Committee.

Chair

1410 5. General Update

To receive a verbal report from the Director of Integration, West Suffolk CCG

Kate Vaughton

1415 6. Covid-19 Update from GP Services

To receive and note a report from the Deputy Director of Primary Care

Lois Wreathall (WSCCG PCCC 20-09)

1425 7. Primary Care Contracts Performance Report

To receive and note a report from the Senior Primary Care Manager

Kate Vaughton (WSCCG PCCC 20-10)

1435 8. Primary Care Delegated Commissioning – Finance Report

To receive and note a report from the Director of Finance Jane Payling

(WSCCG PCCC 20-11) 1445 9. Care Quality Commission

To receive and note a report from the Senior Primary Care Manager

Rachel Seago (WSCCG PCCC 20-12)

1455 10. Annual Plan of Work 1458 11. Date and Time of next meeting

mailto:[email protected]

2.00pm – 4.00pm, Wednesday, 26 August 2020, Conference Room West, West Suffolk House, Western Way, Bury St Edmunds, Suffolk

1500 12. Questions from the public – 10 minutes

(See above)

Exclusion of the Press and Public

The Primary Care Commissioning Committee is recommended to exclude representatives of the press, and other members of the public, from the meeting having regard to the confidential nature of the business to be

transacted, publicity on which would be prejudicial to the public interest; Section 1(2), Public Bodies (Admission to Meetings) Act 1960.

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Minutes of a meeting of the West Suffolk CCG Primary Care Commissioning Committee held in public on Wednesday, 26 February 2020 at

Conference Room West, West Suffolk House, Western Way, Bury St Edmunds, Suffolk

PRESENT: Lynda Tuck Lay Member, Patient and Public Involvement (Chair) Geoff Dobson Lay Member for Governance Mark Game Deputy Director of Finance Kate Vaughton Director of Integration Dr Christopher Browning West Suffolk CCG Chair IN ATTENDANCE: Jo Mael Corporate Governance Officer Julie White Primary Care Development Manager Lois Wreathall Head of Primary Care

20/01 APOLOGIES FOR ABSENCE

Apologies for absence were noted from; Steve Chicken Lay Member Ed Garratt Chief Executive Jane Payling Director of Finance Simon Jones Local Medical Committee Stuart Quinton Suffolk Primary Care Contracts Manager, NHS England Cllr James Reeder Health and Wellbeing Board Andy Yacoub Healthwatch

20/02 DECLARATIONS OF INTEREST

No declarations of interest were received.

20/03 MINUTES OF THE PREVIOUS MEETING

The minutes of a West Suffolk CCG Primary Care Commissioning Committee meeting held on 27 November 2019 were approved as a correct record.

20/04 MATTERS ARISING AND REVIEW OF OUTSTANDING ACTIONS

There were no matters arising and the action log was reviewed and updated.

20/05 GENERAL UPDATE

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The Director of Integration reported:

• That West Suffolk NHS Foundation Trust had signed off the Glemsford vertical

integration business case. • Communications from members of the public in relation to the provision of GP services

in Haverhill continued and a health-hub event was planned. • Oakfield surgery’s move to Newmarket Hospital was progressing. • The Primary Care Network contract was being reviewed and, as yet, there had been

no guidance in respect of funding. • Educational events for GPs and practice nurses continued and relationships were being

built with medical secretaries both within primary care and the acute sector. • Corona virus advice to ring 111 in the first instance had been issued to patients and

advice from the centre was updated on a daily basis.

Concern was raised that, although GP services in Haverhill was recognised as a risk on the CCG’s Governing Body Assurance Framework (GBAF), there was no oversight of the GBAF or risk registers by the Primary Care Commissioning Committee. The Deputy Director of Primary Care agreed to incorporate any potential risks into the resilience map when presented. The Committee noted the update.

20/06 ANNUAL REVIEW OF TERMS OF REFERENCE

The Committee was in receipt of its terms of reference for annual review.

It was noted that two minor changes were required in respect of a change of job titles and to the date of review going forward. Having reviewed the terms of reference the Chair requested that the Committee received minutes from the Estates Operational Group going forward.

Subject to minor amendment as discussed, the Committee recommended its revised terms of reference to the Governing Body for approval.

20/07 VIRTUAL MEETINGS HELD SINCE PREVIOUS MEETING.

The Committee was in receipt of a decision notice from a ‘virtual’ meeting held from 12-19

December 2019, and was reminded of the circulation on 16 January 2020 of information in respect of NHS Direct Enhanced Service (DES) specifications for 2020/21. The Committee endorsed the decision and noted the update.

20/08 PRIMARY CARE CONTRACTS AND PERFORMANCE

The Committee was in receipt of a report which provided an update on contractual and

performance related matters in respect of GP Practices, together with actions taken. The report provided information and outlined ongoing actions in respect of the following areas; • Prescribing and medicines management • Learning Disabilities (LD) health checks • Severe mental illness physical health checks • Dementia

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Key points highlighted during discussion included; • Serious mental illness and LD physical health checks were not on target, although it was

hoped that performance would improve during the final quarter. The Director of Integration agreed to bring back further information on the work being carried out.

• Although learning disability health checks were also below target, the data did not reflect any that might be partially completed as it was difficult to encourage individuals to attend for appointments.

• Dementia diagnosis performance had declined and there were currently delays associated to the memory assessment service. North East Essex CCG had improved its performance and work was underway to identify any lessons that could be learnt.

The Committee noted the content of the report.

20/09 CARE QUALITY COMMISSION (CQC)

The CQC continued to re-inspect GP practices in West Suffolk using the pre-arranged structured telephone call for practices rated good or outstanding. The telephone inspections would take place within five years of the full face to face-to-face inspection. Within that time-frame some practices would be randomly selected for a full face-to-face inspection regardless of their rating. All practices rated as inadequate or requiring improvement would receive a full face-to-face inspection. Current status of practices was detailed within Section 2 of the report. The Committee noted the report.

20/10 PRIMARY CARE DELEGATED COMMISSIONING – FINANCE REPORT

The Committee was provided with an overview of the Primary Care Delegated

Commissioning Budget at month 10. At the end of month 10, the GP Delegated Budget spend was £545k over spent.

Risks not reflected in the above full year forecasts were further increases in rent reimbursement and additional practice management support. Next year funding streams were, as yet, unknown. Having questioned whether monies had been received in respect of the CCG now being responsible for Steeple Bumpstead, the Committee was reassured that all spend had been tracked and the situation would be addressed at year-end. The Deputy Director of Finance agreed to clarify. The Committee noted the financial performance at month ten.

20/11 PRIMARY CARE NETWORK FUNDING

As part of PCN development, funds had been allocated in 2019/20 to assist in the resilience,

and the maturity of the networks as follows;

GP retention £56,475 GP Hub and other projects Practice resilience £35,642 Purchase Clarity team Net Clerical & Reception training, £42,670 Care Navigator courses, Note summarising

courses, Pharmacy technician courses Online Consultation system £69,778 eConsult Primary Care Networks £194,274 10 % to be spent on clinical director training

and 90% on projects to help the PCN

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mature. The maturity schemes will be signed off by this committee

An update on the funding was set out within Section 2 of the report with detail on reimbursed roles set out in Section 3. In response to questioning the Deputy Director of Finance agreed to clarify the deadline associated to eConsult. The Committee noted the report.

20/12 PERSONAL MEDICAL SERVICES (PMS) CONTRACT EXTENSION

The Personal Medical Services (PMS) development framework was re-negotiated on an

annual basis. The process took place to reflect; changes in annual target, national requirements which were published in the annual planning framework and other local priorities. It had been more problematic to engage in negotiations with the Local Medical Committee (LMC) due to the impending publication of the Primary Care Network guidance and specifications. It was anticipated that those specifications and other elements of the contract would impinge upon the remit of the PMS development framework. As a result, it was being proposed to the LMC that the existing arrangements would be extended by three months to the 30 June 2020. The Committee was informed that, at its meeting held on 25 February 2020, Ipswich and East Suffolk’s Primary Care Commissioning Committee had agreed that, whilst aiming to complete by 30 June 2020, it would extend the PMS Development Framework for a six month period. The Committee therefore approved; That, whilst aiming to complete by 30 June 2020, the existing PMS development framework be extended for a six month period.

20/13 WORKFORCE UPDATE

The Committee was provided with an update on the work of the Primary Care Development

Team in delivering the Suffolk and North East Essex workforce plan and the Suffolk and North East Essex Training Hub and the impact on local workforce. The NHS Long Term Plan, The GP Contract and the development of Primary Care Networks were all having an impact on the General Practice Workforce. NHS England and Health Education England were channelling resources into the ICS and CCGs to develop the workforce to deliver those strategies. The whole sector was continuing to face workforce challenges and the establishment of the Local Workforce Advisory Groups provided a platform for collaborative working but the local Training Hub Advisory Groups focussed just on the Primary Care workforce and provided opportunities to implement local initiatives to recruit and retain staff. The report went on to detail work that was underway. Workforce continued to be the biggest challenge facing General Practice and the wider health and social care sector but there were increasing opportunities to work collaboratively to

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increase student placements, embrace apprenticeships, provide career progression and make Suffolk a desirable place to work. There were dedicated funding streams from NHSE/HEE to support workforce development and that was making an impact on Practices, PCNs and future workforce reports should evidence staff growth and the impact on staff to patent ratios. Comments included; • It was clarified that the GP clinical lead role in respect of education was in addition to

those for new roles across the Integrated Care System (ICS). • Having queried some of the content in the appendix to the report, the need to try and

reflect a true picture through publication of quarter three data was emphasized. • It was explained that local workforce information was being developed which would be

reported in future and would include details of student placements and development of roles. There was a need for a narrative as well as workforce data.

• It was suggested that thought be given as to how information from the Suffolk GP Federation and Local Medical Committee might be incorporated.

• Having noted the intended development plan for GPs, it was queried whether a similar plan might be developed for the nursing workforce. A two year fellowship programme for GPs and nurses was to be funded which, although primarily for newly qualified individuals, was also for aspiring leaders.

The Committee noted the report.

20/14 ANNUAL PLAN OF WORK

The annual plan of work was received and it was noted that it would be updated in line with today’s discussions which would include movement of the LES to June 2020 and PMS Development Framework to April 2020.

20/15 DATE OF NEXT MEETING

The next meeting was scheduled to take place on Wednesday, 29 April 2020, Ground

Floor Room 14, West Suffolk House, Western Way, Bury St Edmunds, Suffolk

10/16 QUESTIONS FROM THE PUBLIC

No questions were received.

WEST SUFFOLK CCG – PRIMARY CARE COMMISSIONING COMMITTEE

ACTION LOG: 26 February 2020 (updated)

MINUTE DETAILS ACTION BY WHOM TIMESCALE/UPDATE Meeting of 24 July 2019 19/47 Enhanced Service

Review Whilst overall the enhanced services were felt to be effective, it was suggested that, in order for the Committee to gain assurance, that the development of more robust evaluation and monitoring information be explored.

Lois Wreathall 26/02/20 – having queried whether there would be an uplift for 2020-21, it was noted that would be discussed by the CCGs Financial Performance Committee - ongoing.

Meeting of 22 October 2019 19/62 Primary Care Estates

Strategy Framework Having considered the report, and with the above in mind, the Committee approved the framework and suggested that a different, more Alliance based approach be taken to further development of the strategy.

Daniel Turner 26/02/20 – April 2020

Meeting of 26 February 2020 20/05 General Update Concern was raised that, although GP services in

Haverhill was recognised as a risk on the CCG’s Governing Body Assurance Framework (GBAF), there was no oversight of the GBAF or risk registers by the Primary Care Commissioning Committee. The Deputy Director of Primary Care agreed to incorporate any potential risks into the resilience map when presented

Lois Wreathall

20/06 Annual Review of Terms of Reference

Having reviewed the terms of reference the Chair requested that the Committee received minutes from the Estates Operational Group going forward. Subject to minor amendment as discussed, the Committee recommended its revised terms of reference to the Governing Body for approval.

Amanda Lyes Approved by Governing Body on 20 May 2020 - Complete

20/08 Primary Care Contracts and Performance

Serious mental illness and LD physical health checks were not on target, although it was hoped that performance would improve during the final quarter. The Director of Integration agreed to bring back further information on the work being carried out.

Kate Vaughton

20/10 Primary Care Delegated Commissioning – Finance Report

Having questioned whether monies had been received in respect of the CCG now being responsible for Steeple Bumpstead, the Committee was reassured that all spend had been tracked and the situation

Mark Game

MINUTE DETAILS ACTION BY WHOM TIMESCALE/UPDATE would be addressed at year-end. The Deputy Director of Finance agreed to clarify.

20/11 Primary Care Network Funding

In response to questioning the Deputy Director of Finance agreed to clarify the deadline associated to eConsult.

Lois Wreathall

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PRIMARY CARE COMMISSIONING COMMITTEE Agenda Item No. 06

Reference No. WSCCG PCCC 20-09

Date. 24 June 2020 Title

Covid 19 Update from GP services

Lead Director

Kate Vaughton, Director of Integration

Author(s)

Lois Wreathall and Oge Chesa

Purpose

This paper gives an update on GP services with focus on the local primarycare Covid-19 response and the start of local recovery planning.

Applicable CCG Priorities 1. Develop clinical leadership x 2. Demonstrate excellence in patient experience & patient engagement 3. Improve the health & care of older people 4. Improve access to mental health services 5. Improve health & wellbeing through partnership working x 6. Deliver financial sustainability through quality improvement Action required by the Primary Care Commissioning Committee: Information only

1. Background 1.1 The formal response to Covid-19 began in March 2020, after the NHS’s preparation and

response to Covid19 was triggered with the declaration of a Level 4 National Incident in January. In late May the recovery process began.

1.2 During the Covid-19 response, GP service provision has changed significantly, adopting new

ways of working including widespread use of video and telephone appointments. Risks have been mitigated through agreed escalation processes with funding to deal with mitigating service requirements having been resourced, where appropriate, through national funding streams.

2. Next steps 2.1 Prioritisation of GP activities

Prompted by a smaller workforce and the need to protect staff and patients, prioritisation of activity process was undertaken which ensured that capacity would continue to best meet the needs of patients

The decision to pause elements of pre-covid activity in West Suffolk CCG has been based on the joint BMA/NHSE/RCGP Guidance on workload prioritisation during COVID-19 and the NHSE Primary Care preparedness letter both released March 2020. Each practice has decided its own level of activity based on their particular circumstances.

2.2 Bank Holiday working

Practices and the wider NHS were asked by NHSE to work both the Easter and May (8.5.20 only) bank holidays. In Suffolk, practices also opened on the Saturday and Sunday. This was to address, at the time, an ever-increasing pressure on health services and an anticipation of a peak for people showing symptoms of Covid-19.

To facilitate this, changes were made to the GP contract, so those bank holiday days were treated as normal working days for GP practices. During Easter practices were paid at a rate agreed within the ICS. During May, the rate was mandated directly from NHSE.

2.3 Hot hubs and rooms

The CCG engaged early with primary care and the PCN Clinical Directors to design a model that allowed people with suspected COVID-19 to be seen safely. The individual PCNs put in place a mixture of sites, and rooms to accommodate face to face appointments with suspected C19 patients. Practices amended their CQC statement of intent to cover any new ways of working or service delivery.

2.4 Social Prescribing

The social prescribing team were moved to support the council run Home but not Alone scheme where they were able to support the shielded patients in accessing food and medication. They returned from this role to PCNs on 1 June 2020.

PCN New referrals 1/6/20-

14/6/20 (2 week period)

Total Referrals since 18/5/20 (4 weeks)

Current Active Caseload (14/6/20)

Bury Rural/Blackbour 1 1 9

ne

WGGL/Sudbury Rural 2 4 12

Haverhill 1 2 74 Forest Heath

(Brandon, Newmarket and Mildenhall)

3 4 108

Bury Town 2 4 45 Sudbury Town 0 2 46 2.5 Covid visiting service

The Suffolk Federation were commissioned to provide a COVID Home Visiting (HV) service for (suspected) COVID19 patients who are home-bound and require a face-to-face review in primary care. The service commenced on April 16th. A dedicated car operates between 0800-1800 and is resourced with a GP.

The scope of the service also includes non-COVID19 home-bound patients who live with (suspected) COVID19 patients and this includes patients in care homes. Guidance has been produced to support primary care deciding who is responsible for the home visit. The scope also includes Verifications of Expected Deaths (VOEDs).

For the purpose of this service, the term home-bound has been used to describe those patients who are unable to attend the practice due to being shielded or self-isolating. It includes those patients who are care home residents.

2.6 Asymptomatic testing

Suffolk and North East Essex volunteered their Primary Care sites for a best practice project to understand the prevalence of COVID-19 among NHS staff and patients. Front line primary care staff workers were tested for COVID-19. Preliminary results will be used to inform policy and guidance.

In West Suffolk there was one case identified out of approximately 200 swabs. The testing occurred 8th and 9th of May, with 20/24 practice participating.

2.7 Care homes

On the 1st May 2020 NHS England and NHS Improvement wrote to CCGs to request that they urgently commence the care home support offer from primary care. The model requests that practices and community services ensure: • Timely access to clinical advice for care home staff and residents • Proactive support for people living in care homes, including through personalised care and

support planning as appropriate • Care home residents with suspected or confirmed COVID-19 are supported through remote

monitoring – and face-to-face assessment where clinically appropriate – by a multidisciplinary team (MDT) where practically possible (including those for whom monitoring is needed following discharge from either an acute or step-down bed)

• Sensitive and collaborative decisions around hospital admissions for care home residents if they are likely to benefit.

Specific requirements are as follows: • Delivery of a consistent weekly ‘check-in’, to review patients identified as a clinical priority

for assessment and care

• Development and delivery of personalised care and support plans for care home residents • Provision of pharmacy and medication support to care homes West Suffolk has a Care Home LES in place which covered these elements, with a payment mechanism already in place. NHSE added 10 learning disability care homes to be included in the requirements above. Each has a lead GP practice and has full-service delivery. The CCG funded point of care testing kits and IPADS to all homes.

2.8 Shielding

The GP practices participated in the national shielding programme that identified individuals at highest clinical risk from Covid-19. The advice was that those with highest clinical risk of mortality and severe morbidity from COVID-19 should shield, stay at home and avoid face-to-face contact for a period of at least 12 weeks.

Practices were asked to review the Shielded Patients List containing individuals identified nationally through the clinical algorithm and by secondary care providers, adding flags where practices agreed individuals to be Clinically Extremely Vulnerable (CEV). Practices were also asked to review individuals who self-identified as CEV and asked to review and update care plans and undertake any essential follow up. The CCG sought assurance on the progress with this with all practices completing the initial process. Practices are continuing this with any new patients identified.

2.9 Personal Protective Equipment (PPE)

The availability of Personal Protective Equipment (PPE) has been an ongoing risk. National shortages have meant there have been issues for practices ordering PPE from their suppliers. Although national guidance has been clear as to what equipment should be utilised within practices, the CCG has worked to support particular concerns from clinicians and facilitate enhanced PPE where necessary.

At the onset of Covid-19 the CCG set up a central PPE team who ordered and delivered

equipment to primary care. Items included but was not limited to: • Disposable apron/gown • Disposable Gloves • Eye protection/face visor • Sanitiser • Enhanced PPE – i.e. FFP3 • Surgical masks

Practices have been able to escalate their needs through a dedicated e-mail address leading to emergency supplies being delivered until practice suppliers can meet supply needs.

2.10 Sitreps

The CCG have been receiving regular SITREP reports from each practice. The purpose of which has been to monitor emerging risks in primary care. The daily data collection included markers such as workforce, capacity, system issues, and PPE.

Each day the CCG RAG rates primary care for the incident room. Issues have been captured as part of this process which feed into the incident room for a response, escalation, or action.

2.11 DoS

In April, the CCG adopted NHSE’s Coronavirus (COVID-19) standard operating procedure. The purpose of the protocol is to provide real-time information to NHS 111, 111 Online and integrated urgent care (IUC) about the status of each primary care site. Furthermore, it enables signposting and supports the referrals process across the urgent and emergency care system.

DoS reporting provides intelligence on primary care capacity and any associated challenges that will:

• Support the COVID-19 primary care operating model and pandemic response • Provide oversight of service’s capacity at a regional and national level • Require robust processes in place so that changes to DoS are reported • Enable service changes to be reviewed by commissioning teams and acted upon if required • Support (but not replace) commissioners’ local escalation processes Practices update by exception.

2.12 Digital The CCG digital IT team have worked with primary care from the outset of Covid-19 practices to bridge any gaps that hinder service delivery. This work has led to new ways of working. Initiatives put in place to deal with Covid-19 include: • Video conferencing that allows practices to video consult all patients regardless of

whether the patient has signed up to online access. This has increased practice ability to remodel their workforce structure so remote working can be put in place through video conferencing software.

• Webcams and headsets. • CCG built laptops to mitigate the international hardware shortage of computer products

due to new shipping rules. Multiple Laptops have been delivered across the CCG. • “Away from My Desk Licenses” which is an IT solution that enables staff to log into

onsite systems through their own personal computers and undertake clinical activities safely. This has helped minimise the risk of exposure to COVID-19 and support self-isolation.

2.13 Practice Manager’s meetings

The CCG introduced a daily TEAMS meeting with practice managers. To date the attendance has been excellent with most practices joining each call.

The structure of the meeting is to allow practices to escalate concerns and request updates on key policies or initiatives. Discussions to date have included: • Care homes • COVID-19 coding • Eclipse live • Shielding • Hot sites • Asymptomatic testing • Antibody testing We have also had guest speakers from the CQC, IT team, and safeguarding team

2.14 Clinical Directors meetings

Before Covid-19 the CCG met monthly with the PCN clinical directors. Since April, the CCG have been meeting weekly, via TEAMS, to engage with PCN Clinical Directors to discuss matter largely related to the local Covid-19 response. Discussions to date have included: • Care homes and End of Life • Home visiting • Estates issues • Personal Protective Equipment (PPE)

2.15 Daily Primary Care Communications

The CCG have communicated on a daily basis dedicated communication to the practices, some by a newsletter, others by individual emails, according to how they prefer to work. The

messages have related to matters affecting them and have been shaped by introducing a process for system partners to share information they wish to have included.

The benefit of this daily communications has been that information is shared immediately and that everybody has access to the same message, avoiding confusion and misinterpretation of the facts.

2.16 West Suffolk GP practice recovery

The CCG began the process of developing a strategy to shift into recovery during May 2020. This followed a set of steps that had been determined within the ICS, which is coordinating the wider programme. The process includes: • Mapping and clinically prioritising activities through a practice facing toolkit • Defining primary care readiness through a practice level self-assessment tool • Engagement with stakeholders and interdependent partners • Identifying innovation and best practice • Understanding risk and impacts • Test and review with Clinical directors and Elected Members • Alignment with the West Suffolk Alliance Recovery plan

Currently no national guidance exists in a form that can be definitively used to inform recovery. On that basis a local approach will develop with future national guidance weaving into the roadmap.

3 Recommendation

3.1 The Committee is asked to note the report.

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Reference No. WSCCG 20-10


Primary Care Contracts Performance Report

Lead Director

Kate Vaughton, Director of Integration

Author(s)

Emma Gaskell

Purpose

To provide the committee with an overview of primary care services in West Suffolk including performance information relating to specific data and the wider context

Applicable CCG Clinical Priorities: 1. Develop clinical leadership 2. Demonstrate excellence in patient experience & patient engagement 3. Improve the health & care of older people 4. Improve access to mental health services 5. Improve health & wellbeing through partnership working 6. Deliver financial sustainability through quality improvement Action required by Primary Care Commissioning Committee: To consider and discuss contractual obligations and other information contained within the Primary Care Dashboard and agree any appropriate actions required.

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Purpose To update the Committee on contractual and performance related matters in respect of GP practices and actions taken, to seek further recommendations, and highlight areas for consideration for NHSE and the Primary Care Team. 1. Prescribing and Medicines Management

Overall, there was a positive end to the financial year (2019/20) despite the impact of Covid-19 on March prescribing spend. Please see below for end of year figures: Prescribing budget (YTD March 2020 – excluding unavoidable cost pressures due to

MTX injection and the national cost pressures) • Underspent by £527K – 1.4% • 13/24 practices ‘green’ (i.e. under budget) • 21/24 practices with overspend < 5% (with one more practice just slightly over 5%)

Antibiotic prescribing (12 months to March 2020) • WSCCG within the NHSE QP target for broad-spectrum antibiotic prescribing • WSCCG within upper limit of the NHSE QP target for all antibiotic prescribing

QIPP (YTD February 2020 – excluding national cost pressures) – YTD March 2020

report pending • £705,887 savings against £1,078,917 YTD planned savings

Examples of the impact of COVID-19 on prescribing between Feb and March 2020: • Many patients were switched from warfarin to a DOAC, to reduce requirements for

blood tests. Prescribing costs for anticoagulants increased by £50k per month • Prescribing of steroid inhalers increased significantly, probably as a precautionary

measure for patients with respiratory conditions. Prescribing costs increased by £130k per month

• Overall prescribing increased as medicines were stockpiled, e.g. insulin costs increased by £40k per month, and blood glucose test strips increased by £20k per month

• Many drugs were affected by national supply issues and price increases, e.g. prescribing costs for sertraline 100mg tablets alone increased by £8k per month. Where cost-effective options promoted by the medicines management team were not available, prescribers switched to higher acquisition cost alternatives

2. Serious Mental Illness (SMI) and Physical Health Checks

In the Five Year Forward View for Mental Health, NHS England committed to leading work to ensure that by 2020/21, 280,000 people living with severe mental illness (SMI) would have their physical health needs met by increasing early detection and expanding access to evidence-based physical care assessment and intervention each year. The LES aims to achieve 60% of the population with SMI on the GP register are receiving an annual physical health check and appropriate follow-up care. 50% of these checks are to take place in primary care and 10% are to take place in secondary care.

At the end of Q4 19/20,1560 people were on the GP SMI register, 38.1% had received all six elements of the physical health check with 37.3% other follow-up interventions related to blood lipid including cholesterol.

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This data is representative of 21 practices. For those practices on S1, an auto-extraction takes place at the end of each quarter, whereby EMIS practices are required to pull down their own data and populate a spreadsheet that reflects their SMI activity. An issue was found with the quality of the data used with the auto-extraction, which meant that some patients who were in remission had been counted when they shouldn’t have been. This has had a negative impact on our overall percentage of the six elements of the physical health check.

We are working with those 3 EMIS practices who did not submit data to understand their position and activity around conducting SMI physical health checks. We are also in the process of looking at how we can safely introduce these checks again as we start to look at recovery across Primary Care following Covid 19.

3. Learning Disabilities (LD) Health Checks

In 2009 the Department of Health introduced a Directed Enhanced Service (DES) to encourage the delivery of an annual health check for patients with a Learning Disability (LD) in General Practice. The introduction of this enhanced service was in recognition that many patients living with a Learning Disability experience more health problems and have a lower life expectancy. Target: 75% of adults and young people (over 14) with learning disabilities to have an Annual

Health Check. LD Health Checks Completed in Q3: 14.2% (up 1.4% on same period last year) LD Health Checks Completed in Q4: 16.5% (Q4 last year 23%) subject to a little

change when all the missing results are factored in LD Health Checks 2019/20 Overall: 52.6% (last year 59.9%) also subject to a little

change NHS England advised via the GP Preparedness letter on the 14th April that GP practices

suspend annual health checks, but to consider where possible and appropriate those particularly vulnerable patients who would benefit from a health check being undertaken either face to face or virtually.

In order to support our LD population, the following steps have been implemented:

• The NSFT Primary Care Learning Disability Liaison Nurses have been promoted to primary care as a method of advice and guidance, as well as liaison to other services.

• The nurses now have access to every practice clinical system where the practice is using SystmOne. For EMIS practices, the practices have shared their LD register with their aligned nurse.

• Using the practice LD registers and the Social Care register, the nurses have established which patients are not in receipt of social care and written to each of these patients with a pack of easy read resources about COVID.

• The nurses have also been working closely with ACE Anglia to 1) identify where easy read COVID resources are needed (which ACE have then produced) and 2) created short health information videos which have been shared on the Suffolk Ordinary Lives website.

• As well as creating and disseminating COVID resources, ACE Anglia have also been hosting a weekly virtual health and wellbeing session, which the liaison nurses also join. The meeting has been really helpful in offering reassurance and guidance. The CCG are also receiving feedback about how our local LD population are feeling and how they can be supported.

Next Steps:

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The actions described above are likely to become business as usual, however there are a number of other actions and areas of other work that need to be considered in order for us to fully support our LD population.

• LD Care Homes: NHS England have asked that CCGs roll out the PCN DES care home

model which was due to start in October immediately. At the time of writing, GP practices/clinical leads have been aligned to each LD CQC registered care home and work is underway to establish pharmacist support, observations equipment and training for the homes.

• Annual health checks: work is taking place to establish what a robust and effective physical health check could look like in the current COVID situation. It is expected that the vast majority of checks will be completed virtually but it is understood that some patients will need to be seen face to face and steps will be put in place to offer assurance to patients who may be troubled by this.

4. Dementia Diagnosis:

We are now seeing the impacts of Covid 19. Current monitoring is moving away from planned trajectories to looking at the national and regional changes in the interim. In April, National figures reduced by 2% to 65.4% and regional figures also reduced by 2% to 63.4%. This trend has continued.

March 2020 April 2020 May 2020 WSCCG 61.4 % 60.6 % 59.2 % EoE 65.4 % 63.4 % 61.9 %

Target Achievement Pre CV-19: 66.7% by Nov 2020 For a more detailed breakdown by locality, see Appendix 1. Updates: • Jill Warn from EQUIP is working with 10 practices to undertake an audit in diagnosis

from the memory service (MATS) • Additional resource added to Dementia Together to ensure there is support during covid

19 for carers and those with memory concerns or living with dementia • Suffolk Dementia Forum has become the Suffolk Dementia Covid19 Sub Group which

supports the wider Dementia Subgroup of the Mental Health, Emotional Wellbeing & Learning Disability Cell

Achievements to date:

o Suffolk Dementia Covid19 Sub Group virtual weekly meetings which include North East Essex and Waveney (shared learning)

o Suffolk Dementia Forum distribution list with over 70 members to share information and advice

o Suffolk Dementia Forum Facebook page for Suffolk and wider with members of the Forum part of the group to offer advice and support throughout covid19 – monitored and updated 7 days a week https://www.facebook.com/groups/260503958466679/

o Closer working with VCS, carers and those living with dementia to inform what is the right support that is needed

o Emotional Wellbeing booklets produced by Cat Ritson (Care Home Lead ESNEFT) for care home staff, domiciliary staff and family carers

o Pilot for assistive technology “Alcove” through SCC via Suffolk Family Carers and Dementia Together – simple tablet to connect with those unable to currently communicate with loved ones / can be used for clinical conversations

https://www.facebook.com/groups/260503958466679/

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o Dementia tab on the Healthy Suffolk website https://www.healthysuffolk.org.uk/covidhub/i-am-supporting-someone-with-dementia offering support for carers and professionals, updated regularly and informed by the group

o Herbert Protocol in place across Suffolk and wider, also looking at working with Dementia Buddies

o Recovery planning started using signs of safety to look at ways to move forward positively

o Work continues to develop the Dementia Intensive Support Team West (DISTW) into a 7 day service

Virtual meetings; • SNEE Joint memory assessment service meeting across all services

MAS/MATS/CMAS • Alliance Dementia & Later life Operational Groups reinstated in West and Ipswich &

East • All Sub Groups reinstated to support the Operational Group • SNEE mapping across the ICS to identify gaps and shared best practice

5. Recommendation 5.1 The Committee is invited to note the above information and consider any further appropriate

action.

https://www.healthysuffolk.org.uk/covidhub/i-am-supporting-someone-with-dementia

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Appendix 1 – Dementia diagnosis by locality

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Primary Care Delegated Commissioning – Finance Report

Lead Director

Jane Payling, Director of Finance

Author(s)

Jane Payling, Director of Finance

Purpose

To provide the committee with an overview of the 20-21 budget and forecast for Primary Care- GP Delegated Commissioning.

Applicable CCG Priorities 1. Develop clinical leadership x 2. Demonstrate excellence in patient experience & patient engagement 3. Improve the health & care of older people 4. Improve access to mental health services 5. Improve health & wellbeing through partnership working x 6. Deliver financial sustainability through quality improvement Action required by the Primary Care Commissioning Committee:

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1. Purpose

1.1 To provide the committee with an overview of the 20-21 budget and forecast for Primary Care- GP Delegated Commissioning.

2. Key Points

2.1 The CCG receives a separate ring-fenced allocation for GP Delegated commissioning which is used to meet the statutory contractual obligations and any changes to GP contracts as per the NHS Long Term Plan such as the PCN development. The allocation is based on contract payments made to practices at national GMS rate.

2.2 In addition to this, the CCG commissions other primary care services such as Local Enhanced Services and OOH services which are funded through the CCG programme budgets.

2.3 The Financial Framework for CCGs for 2020/21 is still emerging. CCG revised allocations were released late May 2020 for the period April 20 to July 20 (M1-4). The allocations for M5 (Aug 20) onwards will be notified later this month.

2.4 The delegated primary care budgets are largely unaffected by these changes and as such the CCG financial plan submitted in April 2020 has been used as a starting point to set budgets for 20-21.

2.5 The plan showed that Primary Care- GP Delegated Commissioning plan matched the allocation received and any additional costs (in excess of allocation) will be met through use of CCG programme allocation.

2.6 The planning figures have now been adjusted for material changes such as list size adjustments and further guidance received in respect of PCN development payments to calculate the expected cost pressure on Primary Care- GP Delegated Commissioning. Key changes to GP contracts are highlighted on Appendix 1. The budget set and the expected forecast for 20-21 is as follows:

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West Suffolk CCGPrimary Care Delegated Commissioning

Budget 2020-21

Application of FundsBudget

Expected Forecast Variance Notes

£'000 £'000 £'000General Practice - GMS 7,507 7,525 (17) Reflects 19/20 global sum rate £88.96 -> £93.46 per cwpGeneral Practice - PMS 15,156 17,951 (2,794) Reflects 19/20 global sum rate £88.96 -> £93.46 per cwpOther List-Based Services (APMS incl.) 3,972 4,175 (203)Premises cost reimbursements 2,471 2,514 (43)Primary Care Network 1,597 1,458 138Other premises costs 139 145 (6)Enhanced services 1,174 1,165 9QOF 3,580 3,594 (15)Other - GP Services 70 121 (51)Delegated Contingency 1,329 0 1,329

Primary Care Delegated Commissioning Budget 36,995 38,648 (1,653) To be funded from CCG programme allocationcwp- contracted weighted population

20-21

3. Risks

3.1 As highlighted in the table above, there is a significant cost pressure against the General Practice - PMS budget as the PMS practices within the CCG are paid at a higher rate than rate at which the CCG is funded. It is anticipated that this cost pressure and any other risks will be covered from the Delegated contingency, any year-end flexibilities and the balance from main CCG programme contingency.

3.2 Although, the delegated primary care budgets are largely unaffected by these

changes to the new financial framework, the CCG programme allocations are reduced compared with those previously announced leaving additional shortfalls in many budgets. Any further reductions to the CCG programme allocations from M5 onwards will have a resulting impact on the CCG’s ability to cover the primary care budget shortfall.

4. Recommendation

4.1 The Committee is asked to note the budget and FOT for 20-21. Any further risks or opportunities will be highlighted in the finance report during the year.

.

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Appendix 1 Key changes to the GP Contract in 2020-21 are as follows:

The Primary Care delegated budget will deliver a 4 % increase to the GP contract through inflation and other changes.

Core Funding:

GP Practice will see changes in core funding as set out below.

GMS PMS APMS£/weighted £/weighted £/weighted

patient patient patient

MPIG reinvestment A [£0.45] - -

B b[£0.50] [£0.50]

C c c[£2.63] [£2.63] [£2.63]A+B+C b+c c[£3.58] [£3.13] [£2.63]

Contract price per weighted patient £93.46 £109.22 £108.56

Seniority reinvestment -

Inflation and other changes - net uplift

Total uplift (D)

• Phasing out of the Minimum Practice Income Guarantee (MPIG) correction factor, which began in 2014/15 has reached its conclusion and the aggregate funds reinvested into the GMS global sum.

• The implementation of phasing out of seniority payments began in October 2015

concluding in March 2020, with a reduction in payments and simultaneous reinvestment into core funding each year. New investment included in the global sum for 2020/21 includes:

• funding for a universal 6-8-week post-natal check for new mothers with maternity

medical services becoming an essential service • uplifts to pay, staff and other expenses as well as population growth.

QOF:

The value of QOF points has been increased with changes as shown below.

2019/20 2020/21 QOF point £187.74 £194.83

- increase in points from 559 to 567

- recycling of 97 points into 11 more appropriate indicators

- a new QOF indicator - annual blood glucose testing for non-diabetic hyperglycemia

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- improvements to the asthma, COPD and heart failure domain.

Primary Care Networks (PCNs):

- A new Investment and Impact Fund (IIF) was due to be introduced in April 2020 however because of the impact of Covid19 it has been delayed for at least 6 months. The IIF will reward PCNs for delivering objectives set out in the NHS Long Term Plan and GP Contract agreement and will operate in a similar way to QOF. As a result of the postponement the IIF has been replaced with a PCN Support payment based on PCN list size.

- In recognition of the differential extra workload, a new Care Home Premium payment, worth £120 per bed per year is due to start on 30 September. Every care home will be supported by a single PCN with a named GP or GP team.

- The Additional Roles Reimbursement Scheme (ARRS) has been extended to include the following roles shown below. From April 2020, all roles will be reimbursed at 100% of actual salary plus defined on-costs up to the maximum reimbursable amounts. The CCG allocation includes 60% of the total available funding, the remaining 40% allocation can be claimed by the CCG once the initial funding is fully utilised.

Role Indicative AfC band

Annual maximum

reimbursable amount per

role (2020/21)

Maximum reimbursable amount per

month (2020/21)

Limit on staff eligible for reimbursement per PCN

Clinical pharmacist 7-8a 55,670.00£ 4,639.17£ No limitPharmacy technician 5 35,389.00£ 2,949.08£ One individual pharmacy technician per PCN where

the PCN’s Patients number 99,999 or less.

Two individual pharmacy technicians per PCN where the PCN’s Patients number 100,000 or over. **

Social prescribing link worker Up to 5 35,389.00£ 2,949.08£ No limitHealth and wellbeing coach Up to 5 35,389.00£ 2,949.08£ No limitCare coordinator 4 29,135.00£ 2,427.92£ No limitPhysician associate 7 53,724.00£ 4,477.00£ No limitFirst contact physiotherapist 7-8a 55,670.00£ 4,639.17£ One WTE per PCN where the PCN’s Patients number

99,999 or less.

Two WTE per PCN where the PCN’s Patients number 100,000 or over. **

Dietician 7 53,724.00£ 4,477.00£ No limitPodiatrist 7 53,724.00£ 4,477.00£ No limitOccupational therapist 7 53,724.00£ 4,477.00£ No limit

NoteThe maximum reimbursable amount is the sum of:(a) the weighted average salary for the specified AfC band PLUS(b) associated employer on-costs

• These amounts do not include any recruitment and reimbursement premiums that PCNs may choose to offer and which are not reimbursable• ** The commissioner may waive any limits in Table 1 where this is agreed by the PCN, the commissioner and the relevant Integrated Care System (ICS)

Annual maximum reimbursable amount per role

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It is for each PCN to determine the best skill mix for their network.

The table below shows the

• PCN funding received in the PC Delegated allocation

• Additional ARRS funding available

• funding available within the CCG programme allocation.

• Example of funding available to a CCG with a list size of 30,000 patients

CCG EXAMPLENumber of registered patients 257,134 30,000Weighted list size 263,909 30,158Number of CQC registered care home beds 1,831 20

PCN-Clinical Director £185,746 £21,671PCN-Care Home Premium £109,860 £1,200PCN-Impact & Investment Fund £172,602 £20,138PCN-Additional Roles Reimbursement Scheme 60% £1,129,093 £129,026

£1,597,301 £172,035PCN Practice Participation DES (Enhanced Services) £464,744 £53,108PCN-Extended Hours (Enhanced Services) £372,441 £43,453

£2,434,486 £268,596

PCN-ARRS remaining 40% £752,729 £86,018

PCN-Core Funding-CCG programme allocation £385,701 £45,000£2,735,731 £303,053

PCN FUNDING INCLUDED IN THE PRIMARY CARE DELEGATED ALLOCATION

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PRIMARY CARE COMMISSIONING COMMITTEE

Agenda Item No. 09


Date. 24 June 2020

Title

Care Quality Commission (CQC)

Lead Director

Kate Vaughton, Chief Operating Officer/ Director of Integration and Partnership

Author(s)

Rachel Seago, Senior Primary Care Manager

Purpose

The purpose of this report is to inform the Committee about Care Quality Commission (CQC) inspections of West Suffolk GP practices.

Applicable CCG Priorities 1. Develop clinical leadership 2. Demonstrate excellence in patient experience & patient engagement x 3. Improve the health & care of older people x 4. Improve access to mental health services 5. Improve health & wellbeing through partnership working x 6. Deliver financial sustainability through quality improvement Action required by the Primary Care Commissioning Committee: The Committee are invited to note the CQC’s report findings with regard to the West Suffolk practices to date and consider any further actions for the CCG or NHS England at this stage.

1. Background 1.1 The CQC continues to re-inspect GP practices in West Suffolk using the pre-arranged

structured telephone call for practices rated good or outstanding, these telephone inspections will take place within 5 years of the full face-to-face inspection. Within this time-frame some practices will be randomly selected for a full face-to-face inspection regardless of their rating. All practices rated as inadequate or requiring improvement will receive a full face-to-face inspection within 6 months of their rating.

1.2 The CQC have developed a further set of questions for practices which forms the Emergency Support Framework (ESF); this framework is essentially the practice’s response to Covid 19 (see Appendix 1 to this report). Practices are expected to prepare and evidence change to processes that demonstrates an effective response to Covid 19 noting changes to policies such as Business Continuity, Health and Safety etc. All practices have been categorised according to CQC rating and recent contact with CQC. For example: practices who require improvement are categorised as high risk and would expect a telephone call to discuss their ESF. We know that Reynard have already received this call on 11.6.2020 and await the outcome. We understand that this ESF will form part of the practices annual review.

1.3 Committee to note that we have a new Inspector in West Suffolk, Anna Gleadell, both Rachel and Lois Wrethall have met Anna virtually. Anna is due to attend a virtual daily telephone call with Practice Managers on 16.6.20.

2. Current Status 2.1 Below summarises the current status of our practices, there are currently 22 rated as good

or outstanding with 2 requiring improvement. Latest inspections are in red.

WSCCG Practices Rating Last face to face

Telephone inspection

Angel Hill Good 18/01/2018 17/3/2020 Guildhall & Barrow Good 04/02/2019 18/3/2020 Mount Farm Good 12/12/2016 23/07/2019 Swan Good 23/08/2018 19/09/2019 Victoria Good 13/07/2018 19/3/2020 Christmas Maltings and Clements RI 24/01/2019 F2F: 21/08/19

Haverhill Family Practice Good 28/11/2018 F2F: 21/11/19

Glemsford Good 01/11/2016 28/08/2019 Guildhall Clare Good 28/11/2016 14/06/2019 Long Melford Good 15/08/2017 Wickhambrook Good 16/03/2017 31/07/2019 Hardwicke House Good 05/05/2017 Siam Good 01/02/2016 26/06/2019 Brandon Good 11/04/2018 17/12/20 Forest Group Good 02/03/2017 19/09/2019 Lakenheath Good 08/01/2019 Market Cross Outstanding 23/12/2016 06/08/2019 Oakfield Good 13/02/2017 05/11/2019 Orchard House Outstanding 07/01/2018 Reynard RI 04/09/2017 F2F: 18/09/2019 Rookery Good 03/12/2018 Stanton Good 24/08/2018

Botesdale Good 05/03/2015 FULL INSPECTION: 26/07/2019

Woolpit Good 31/05/2017 21/09/2019

2.2 The CCG has mapped all 24 reports into a single learning document. This has been analysed for overall learning and updated after every subsequent inspection, this is used as a reference to support practices.

2.3 Below is a fuller description of those two practices with required improvement status: Reynard

Surgery, Red Lodge and Christmas Maltings & Clements, Haverhill. Christmas Maltings & Clements Practice This section is primarily information for the provider The practice was re-inspected on 21 August 2019 and although improvements were acknowledged, particularly around Regulation 13 HSCA (RA) Regulations 2014 Safeguarding service users from abuse and improper treatment – the practice was rated as ‘good’ in this indicator. Areas where improvement must be made:

• Effective services – requires improvement • Providing caring services – requires improvement • Providing responsive services – inadequate • Providing well-led services – requires improvement

The report advised the practice to:

• Continue to monitor and improve the uptake of childhood immunisations and cancer

review and ensure data is submitted to Public Health England in a timely way. • Continue to monitor and improve the uptake of cervical Screening. • Continue to embed and sustain the systems and process to ensure patients receive

appropriate reviews in a timely manner. • Continue to review, monitor and improve patient feedback to ensure patients receive

timely access to care and treatment. • Continue to review and reduce prescribing of antibiotics for uncomplicated urinary

tract infections. A further full face-to-face inspection would have been due around February 2020, but as yet

the date has not been announced. We would expect CQC to contact the practice to go through the Emergency Support Framework.

An update was received from the Practice Manager, Andrew Cutting who advised on the 3

‘live actions’: outstanding medication reviews, working on their workflow and ensuring HR policies and procedures inc: mandatory training requirements are met. They continue to monitor their plans.

Reynard Surgery The narrative below shows the legal requirements that the service provider was not meeting, with an update from 8.6.20, virtual meeting with the Practice Managers in italics. Regulation 17 HSCA (RA) Regulations 2014 Good governance How the regulation was not being met:

• Actions to mitigate risk following the fire risk assessment had not been completed. Now complete.

• Staff vaccination status was not known for all staff and the staff member that refused to confirm immunity had not been risk assessed. Named nurse responsible ensuring all appropriate staff vaccines are now in place and up to date - also ongoing monitoring of this status to be put in place.

• There was no formal, documented process of the review of work undertaken by nurses working in extended roles. Named GP has been assigned to each ANP to

select notes on a random weekly basis to assess work that is being undertaken and learning from this.

• Legionella risk assessment had not been actioned there was no process to check water temperatures. To date they practice has spent £10K bringing the water system up to date, this work is almost complete and water temperature checks are taking place.

• Dispensary security had not been risk assessed Regulation. A combination lock has now been fitted.

There are other areas in the 'should do' section that they are also working on i.e. staff training records, note summarising etc.

3. Recommendation

3.1 The Committee is asked to note this report.

WSCCG PRIMARY CARE COMMISSIONING COMMITTEE ANNUAL PLAN OF WORK:

January 26 February 2020 March • General Update

• Primary Care Contracts and Performance Incl CQC report

• Finance Report • Enhanced Service Review

29 April 2020 May 24 June 2020 • General Update • Primary Care Contracts and Performance

Finance Report

• General Update • Primary Care Contracts and Performance

Report • Finance Report • Estate update • IT update • TOR • LES 2020 sign off incl review and evaluation of

previous year

July 26 August 2020 September

• General Update • Primary Care Contracts and Performance Report • Finance Report • Estate update • IT update • Primary Care Estates Strategy Outline

27 October 2020 (in common) November 2019 23 December 2020 Apprenticeships from Remcom 11 Feb 20 • General Update

• Primary Care Contracts and Performance Report

• Finance Report

agenda - west suffolk clinical commissioning group · 6/24/2020 · west suffolk ccg. primary care...

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