bhr primary care commissioning committee...2020/02/26 · bhr primary care commissioning committee...

BHR Primary Care Commissioning Committee

Committee in Common

PART 1 Date: Wednesday 26 February 2020 Time: 1:00pm – 1:45pm Venue: Boardrooms, 7th Floor, North House, St Edwards Way, Romford RM1 3AE

Item Time Lead Attached or verbal

Purpose

1. Welcome, introductions and apologies 1.1. Declarations of interests

(Types of interest - financial, non-financial professional, non-financial personal, indirect)

1:00 Chair Verbal Attached

For noting

2. Minutes, actions and risks 2.1. Minutes of last meeting 2.2. Actions log 2.3. Risk register

1:05 Chair Attached Attached Attached

For approval For approval For approval

3. Barking & Dagenham, Havering and Redbridge Primary Care Commissioning Committee 3.1. Primary Care budgets 2019/20 update 3.2. GP influenza immunisation uptake rates

for the 2019/20 season

1:10 Rob Adcock Julia Cory

Attached Attached

For noting For noting

4. Barking & Dagenham Primary Care Commissioning Committee 4.1. Developing a new model of care for

Barking Riverside; progress briefing

1:25 Emily Plane

Attached

For noting

5. Questions from the public 1:35 Chair Verbal

6. Any other business 1:40 Chair Verbal

7. Date of next meeting 22 April 2020

Conflics of interest will remain on the register for a minimum of 6 months following expiry

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Non

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Pers

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Aurora Medcare (Previously known as King Edwards Medical Group and Polaris Medicare)

X Direct GP partner Jan 2020(Jun 2010 for King Edwards)

current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Aurora Medcare (Previously known as King Edwards Medical Group and Polaris Medicare)

X Indirect Other GPs are family members Jan 2020(Jun 2010 for King Edwards)


Personalised Care, Healthy London Partnerships, NHS England

X Direct Clinical Lead Mar-17 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

North East London Foundation trust

X Direct GPwSI - Cardiology service, Barking & Dagenham Community Cardiology Service

Aug-11 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Together First (Barking & Dagenham GP Federation)

X Direct Shareholder May-14 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Harley Fitzrovia Health Ltd

X Direct Director and Shareholder Jan-18 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Monifieth Limited (Property and private healthcare)

X Direct Director and Shareholder Mar-18 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Barking & Dagenham Health and Wellbeing Board

X Direct Deputy Chair of the Board 2018 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Anglia Ruskin University Medical School

X Direct Lecturer 2019 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Barking & Dagenham CCG

X Indirect Dr Gurkirit Kalkat, Clinical Director, is also a GP partner in Aurora Medcare

Apr-19 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Historic - Health 1000 X Direct Director. PMCF lead Dec-14 Nov-18 Historic

Thames View Health Centre

X Direct GP principal Apr-17 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Primary Clinical Partnership Ltd

X Direct Director/Shareholder Apr-17 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Apex Healthcare Ltd (who own Knightswood Residential Care Home for the Elderly Ltd)

X Direct Director/Shareholder Apr-17 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Queen Mary Medical School-London

X Direct Honorary Lecturer Apr-17 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.



BHR CCGs Area Prescribing Committee

X Direct Chair Mar-15 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

St Albans Surgery (Urswick MC)

X Direct GP Principal May-16 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Together First Ltd (Barking & Dagenham GP Federation)


NHS England X Direct GP appraiser Dec-16 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Jagan John Governing Body Member - CCG Chair

Date of Interest

Action taken to mitigate riskFrom To

Barking & Dagenham CCG

Joint Committee of Barking and Dagenham, Havering and Redbridge (BHR) CCGs Conflicts of Interest Register, which includes BHR CCGs Governing Body members and other decision makers

HaraRamneek Governing Body Member - Clinical Director

Date - 05 February 2020

First Name Surname

Current position (s) held- i.e.

Governing Body, Member practice,

Employee or other

Declared Interest- (Name of the

organisation and nature of business)

Type of Interest

Gurkirit Kalkat Governing Body Member - Clinical Director

Is the interest direct or indirect?

Nature of Interest

London Deanery X Direct GP registrar and GP appraiser mainly in Havering


Barts Hospital & Queen Mary's university

X Direct Under-graduate tutor Oct-16 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Network East One, Barking and Dagenham PCN

X Direct St Albans Surgery is a member practice

May-19 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Medimmune (Astrazeneca)

X Indirect Spouse is medical director Apr-11 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Abbey Medical Centre X Direct GP Principal. Apr-16 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

BHR CCGs X Direct Diabetes lead Sep-15 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.


X Direct Shareholder and member Apr-17 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

NELFT X Direct GPwSI -Diabetes Mar-10 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

NHSE X Direct GP Appriaser Sep-13 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

London Deanery X Direct GP Trainer Nov-17 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Abbey Medical Centre X Indirect Spouse is the Practice Manager 2017 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

White House surgery, Barking

X

X

X

X

Direct

Indirect

Indirect

Indirect

GP principal

Sister is a GP partner and GPwSI-dermatology

Brother is a GP partner

Father is a GP Principal

01/09/2006

20102017

2008

1998


Castleton Road Health Centre, Redbridge

X

X

X

X

Direct

Indirect

Indirect

Indirect

GP principal

Sister is a GP partner

Brother is a GP partner

Husband is a GP

April 2018

April 2018

April 2018

Sept 2019


B&D CCG X

X

Indirect

Indirect

Brother-in-law is a B&D GP and Clinical director.

Sister is a B&D network lead

April 2018

2018



X Indirect Brother is a director Apr-18 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

MacMillan X Direct GP for Barking and Dagenham 01/06/2015 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Health Education England

X X

X

X

Direct

Indirect

Indirect

FY2 Superviser and GP trainer

Sister is a GP trainer and FY2 trainer

Husband is a GP trainer

2013

2013


NHS London Workforce

X Indirect Sister is clinical lead 2018 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Patient First Social Enterprise Newham

X Indirect Sister is a dermatology GPwSI 2019 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Queen Mary University & Imperial Medical School

X

X

Direct

Indirect

Under-graduate tutor

Sister is an under graduate tutor

2007 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Tulasi Medical Practice

X Direct Salaried GP and medical director

Jul-13 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Rai Governing Body Member - Clinical Director

Sharma Governing Body Member-Clinical Director

Anju Gupta Governing Body Member - Clinical Director

Kanika

Amit

St Albans Surgery X Direct Salaried GP - one session May-17 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

B&D CCG X Direct Macmillan GP Apr-14 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

B&D CCG X Indirect Sister-in-law is a B&D Clinical Director

Nov-11 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

B&D CCG X Indirect Wife is a B&D GP and Network Clinical Director


Barking, Dagenham & Havering LMC

X Direct Member Sep-14 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Care Quality Commission

X Direct GP specialist adviser Nov-14 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Veda Solutions (Providing medical solutions to OOH/ Macmillan/ Locum pay)

X Direct Director Aug-13 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Care City X Direct Test best Clinical Lead Nov-18 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Gables Surgery - Dagenham

X Direct GP partner Oct-15 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.


X Direct Shareholder Oct-15 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Queen Mary's College X Direct Physician associates tutor May-19 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

BHRUT X Indirect Husband is head of department for care of the elderly and elderly care consultant


Babylon GP on-line system

X Indirect GP partner is lead for women's health

Oct-15 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.


X Direct NHS London HEE tutor - not yet employed, but approved as GP registrar


B&D and Havering LMC

X Direct LMC Member Jan-12 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Historic - Astra Zeneca

X Direct Chaired a meeting. Apr-18 N/A as one off.

Historic.

Tower Hamlets GP Care Group CIC

X Direct Social Prescription Manager 18/06/2018 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Newham Deanery CIO

X Direct Trustee 01/06/2016 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Redbridge Healthwatch

X Direct Member 01/04/2013 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

NELFT X Indirect Sister is a chaplain/ spiritual advisor

Mar-19 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Doctor's House GP practice, Redbridge CCG

X Indirect Brother is employed as Practice Manager

09/09/2019 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Sahdia Warraich

Governing Body member - Lay member, PPI

Uzma Haque Governing BodyMember - Clinical Director

Maylands Healthcare X Direct GP Partner Apr-13 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Maylands Healthcare Ltd

X Direct Director and shareholder in on-site pharamcy


Parkview Dental Practice

X Indirect Sister is NHS dentist within Havering


Essex Medicare LLP X Direct Part owner which owns Westland Clinic, Hornchurch. Space rented out to Inhealth (Diagnostic),Nuffield Health (Brentwood), Communitas Clinics (Dermatology & Gynaecology)


Havering Health Ltd X Direct Shareholder. GP partner (Dr Kendall) is a director

Sep-14 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Barking, Dagenham and Havering LMC

X Direct Co-opted member 2013 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Westlands Clinic (Langton Dental)

X Indirect Spouse is a dentist who has an outsourced contract with BHRUT for oral surgery.

May-18 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Havering CCG X Direct Registered as a patient at a GP practice in Havering. Full details provided on DOI form


Havering Health & Wellbeing Board

X Direct Vice Chair 2013 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.



Hornchurch Healthcare

X Direct GP principal 2007 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Havering Health Ltd X Direct Shareholder 2015 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Hornchchurch Healthcare Ltd

X Direct Director 2015 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Hornchchurch Healthcare Ltd

X Indirect Partner's SIPP is the landlord of the Hornchurch Healthcare premises


Rush Green Medical Centre

X Direct GP partner 2000 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Practice Based Clinical Service Ltd (ENT service)

X Direct Director/Shareholder abd GPwSI


Havering CCG X Direct GP Tutor & education lead 2000 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Havering Health Ltd X Direct Shareholder 2014 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Central Park surgery, Harold Hill


Havering Health Ltd X Direct Shareholder Aug-14 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Royal College of GPs and British Society of Rheumotology

X Direct Member 2012 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Havering CCG X Direct GP Appraiser 2012 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Baldwin Governing Body Member-Clinical Director

Atul Governing Body Member - CCG Chair

Havering CCGAggarwal

Maurice Sanomi Governing Body Member - Clinical Director

Tran Governing Body Member - Clinical Director

Alex

Ann


X Direct GP partner Apr-19 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

North East London faculty of RCGP

X Direct Education lead Feb-19 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Barking, Havering and Redbridge University Hospitals Trust

X Indirect Spouse is a consultant oncologist and Chair of safe medicines practice group


Squirrels Heath Infant School

X Direct Governor with responsibility for special education needs



X Direct Salaried GP Oct-17 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Havering CCG X Direct Registered as a patient at a GP practice in Havering.


1-2-1 Social Enterprise (Provides mentoring to the NHS)

X Direct Associate 01/10/2014 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

PriceWaterhouseCooper

X Indirect Nephew is a partner 01/08/2013 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

MC Consulting X Direct Mentor to individuals within NHS bodies outside of North East London


Redbridge CCG X Direct Registered as a patient at a GP practice in Redbridge. Full details provided on DOI form


HistoricBHR CCGs

X Indirect Brother-in-law is Independent GP on the Primary Care Commissioning Committee (resigned wef 31 August 2019)

01/10/2017 31/08/2019 No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Fullwell Cross Medical Centre

X Direct GP partner Apr-13 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Metropolitan Police X Direct Forensic examiner Nov-15 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

The Cleaning Company

X Indirect Sister-in-law is the owner 2013 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

NHSE X Direct GP appraiser Feb-15 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Healthbridge Direct X Direct Shareholder Sep-14 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Fouress enterprises Ltd (Property Services)


Prescan (Healthcare screening)

X Direct Ad-hoc screening work Jan-18 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

London Healthwise Ltd (non-trading)


General Medical Council

X Direct GMC Associate Jan-19 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Redbridge CCG X Direct Registered as a patient at a GP Practice in Redbridge CCG. Full details declared on DOI form


Ernst & Young X Indirect Brother is employed as Associate Director


Governing Body Member - Clinical Director

Richard Coleman Governing Body member - Lay member, PPI

Anil Mehta Governing Body member - CCG Chair

Mary Burtenshaw Governing Body Member - Clinical Director

Redbridge CCG

Gemma Barrett

Redbridge Health and Wellbeing Board

X Direct Vice Chair 2013 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.



The Shrubberies Medical Centre

X Direct GP partner Oct-15 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.


Newbury Group Practice


DMC Healthcare X Direct GPwSI - Dermatology & minor surgery


Excellence in Skin Science (ESS) Wanstead

X Direct GPwSI - Dermatology 2011 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Ealing Hospital Trust X Direct GPwSI - Dermatology 2010 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

NELFT X Direct GPwSI - Diabetes 2007 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Soods Ltd (Locum agency)

X Direct Director and husband is a partner.


NHSE X Direct GP appraiser 2003 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.


X Direct GP trainer and NHS London HEE Associate Director

2004 / Nov-2017


Imperial College X Direct GP trainer 2011 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Royal College of GPs X Direct GPWSi assessor 28/02/2018 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Care Quality Commission

X Direct Special adviser Sep-16 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Healthbridge Direct X Direct Shareholder Apr-17 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Metrolaw Solicitors X Indirect Husband's firm 2002 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Patient First Social Enterprise Newham

X Direct GPwSI - Dermatology Aug-19 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

BHR CCGs X Direct International graduate lead Aug-19 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

HistoricRedbridge LMC

X Direct Member Sep-16 Sep-18 Historic

HistoricCommunitas Clinics

X Direct GPwSI - Dermatology 2013 Jul-18 Historic

Fullwell Avenue Surgery

X Direct Salaried GP Oct-18 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Healthbridge Direct X Direct Shareholder and locum doctor at urgent care centre and BHR GP solutions


Governing Body member - Clinical Director

Sood

Shujah

Jyoti Governing Body Member - Clinical Director

Heyes


Hameed

Sarah

PELC X Direct Locum doctor Apr-16 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Partners in Healthcare Ltd

X Direct Director Apr-16 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

S.I.R Tech Enterprise Ltd

X Direct Director Nov-18 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Historic Castleton Road Health Centre

X Direct GP Partner Apr-17 Jun-18 Historic

Seven Kings surgery X Direct GP partner Oct-17 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Raza Syed Medical Ltd

X Direct Director Jun-14 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Healthbridge Direct X Direct Shareholder and employed as a locum at the hub


London Deanery X Direct GP Trainer 2017 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Wellbeing Group of Pharmacy

X Indirect Brother is a pharmacist Dec-18 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

HistoricPELC

X Direct Locum GP current Oct-19 Historic

Southdene Surgery X Direct GP partner/principal 2008 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Healthbridge Direct X Direct Shareholder 2015 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

NELFT X Direct GPwSI - cardiology 2008 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Avicenna Ltd X Direct Director 2012 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Avicenna Ltd X Indirect Husband is a director 2012 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

British Medical Association (BMA)

X Direct member 2004 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

PCGP X Direct member 2006 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

NHSE X Direct GP appraiser (B&D and Havering)


Historic Healthbridge Direct

X Indirect Daughter works in reception/admin

2015 Jul-18 Historic

Mathukia Surgery X Direct GP principal. Brother is also GP principal



Valia Consultancy (Healthcare Consultancy)

X Direct Director & Shareholder 2014 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

NOCLOR & National Institute of Health Research (NIHR)

X Direct GP research champion 2015 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

NHS England X Direct GP Appraiser Oct-19 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Mehul



Raza Governing Body member - Clinical Director

Ali

Mathukia

Syed

Shabana

HistoricPELC

X Direct GP Locum 2010 Oct-19 Historic

Havering CCG X Direct Registered as a patient at a GP Practice in Havering CCG. Full details declared on DOI form (amendment made Aug 2019)


St Francis Hospice X Indirect Spouse is a regular donor 01/04/2017 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Cancer Research UK X Indirect Spouse is a regular donor 01/04/2017 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

NEL Commissioning Support Unit

X Indirect Partner is employed substantively


NHSE X Indirect Partner on secondment to Central London Community Healthcare as Director of Primary Care Development


Action for stammering X Indirect Partner is a Trustee Oct-13 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Peabody Housing Association

X Direct Non-executive director Jan-17 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

House of St Barnabas; charity

X Direct Member Oct-19 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

HistoricStonewall (charity)

X Direct Ambassador Oct-14 Sep-19 Historic

Barking & Dagenham, Havering and Redbridge University Trust

X Indirect Wife employed as the Assistant Director of Finance

Dec-18 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

NHC Clinical Commissioners Board

X Member Jul-18 Jul-21 No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

HistoricEast London Lift Accommodation Services Ltd

X Direct Director Dec-18 Aug-19 Historic

HistoricEast London Lift Accommodation Services No2 Ltd


HistoricEast London Lift Holdco No2 Ltd






HistoricELLAS No3 Ltd


HistoricELLAS No4 Ltd


HistoricInfracare East London Ltd


Ceri Jacob Employee - Managing Director BHR CCGs

Ruislip Gardens Primary School

X Direct Chair of Governors Feb-18 Current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Jacqui Himbury Employee - Nurse Director, BHR CCGs

Health Incidents Investigation Consultancy Ltd (not trading)

X Direct Director Oct-19 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

NHS Barking and Dagenham CCG

X Direct Lay member, Governance and Audit Chair


NHS Havering CCG X Direct Lay member, Governance and Audit Chair


NHS Redbridge CCG X Direct Lay member, Governance and Audit Chair


University of Essex X Direct Independent Audit Committee member


Employee - Governing Body Executive Member - Accountable Officer, NEL CCGs

Governing Body Member - NELCA Chief Finance Officer

Governing Body Member - Lay member, Governance

Kash Pandya

Ali Governing Body member - Lay member, PPI

Jane

Henry Black

Khalil

MilliganMembers representing BHR CCGs

Southend-on-Sea Borough Council

X Direct Independent Audit Committee member


Brentwood Citizen's Advice Bureau

X Direct General Advisor 2009 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Metro Bank X Indirect Son is employed as Procurement Manager


Accenture X Indirect Son is employeed as Legal Counsel


HistoricPriceWaterhouseCooper

X Indirect Son is employeed as a management accountant

2013 2019 No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Historic Essex Ministry of Justice Advisor Committee

X Direct Lay member, Governance and Audit Chair

2010 2018 Historic

BHR CCGs X Indirect Co-habiting partner is Director of Transformation & Delivery within BHR CCGs




Halbutt Street Surgery X Direct GP 1995 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

PELC X Direct Council Member Dec-13 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.


X Direct Board Member & shareholder Apr-14 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Primary Care Clinical partnership Ltd

X Direct Shareholder 2017 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Loxford Primary Care Network

X Direct Clinical Director Jul-19 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Ilford Medical Centre X Direct GP partner current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Charles Beaumont Independent Lay Member of BHR CCGs Audit & Governance Committee

None

Alison Blair Director of Transition

Hunter Healthcare X Direct Employed under contract to NHS in North East London


Rosewood Medical Centre

X Direct GP Partner 2011 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Havering Health Ltd X Direct Shareholder/Director and company secretary. Rosewood Medical Centre is also a shareholder


PELC X Direct Council member 2013 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Forest Community Health Limited

X Direct Director (part of PELC council member role)


BHRUT X Indirect Wife is an employee 2017 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.


X Direct GP Trainer 2013 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Shabnam Ali

Derby Havering CCG GP and member of BHR CCGs Primary Care Commissioning Committee

Adedeji

David

Stephen

Redbridge CCG GP and member of BHR CCGs' Primary Care Commissioning Committee

Rubery Employee - Director of Commissioning & Performance BHR CCGs

Adedayo Barking & Dagenham CCG GP and member of BHR CCGs Primary Care Commissioning Committee

Other decision makers

Mark Eaton Director of System Recovery

Amnis Ltd (Management Consultancy)

X Direct Shareholder and Director 2004 current Amnis Ltd will not provide any services within NEL.

Jane Gateley Employee - Director, Strategy & Integration BHR CCGs

None

Crescent Pharamcy,Romford

X Direct Paid work - pharmacist. Full details including remuneration - provided on declaration form


Beta Pharmaceuticals Ltd

X Direct Director. Full details including remuneration provided on declaration form


Eaglebond Ltd (Pharmacy)

X Direct Superintendant Pharamcist and director. Full details including remuneration provided on declaration form


Carebright Limited - shareholding company

X Direct Director. 2009 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Beta Charitable Trust X Direct Trustee 2007 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Ilford Medical Centre X Direct Paid work as specialist pharmacist. Full details including remuneration - provided on declaration form


Diabetes UK X Direct Professional member 2017 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

BHR CCGs X Direct Registered as a patient at a GP practice in Redbridge CCG. Full details declared on form


Havering CCG X Direct Registered patient at a GP practice in Havering CCG. Full details provided on form


Pharmacist Guide - website

X Direct Owner of self-funded website. Further details provided on DOI form


Ahmet Koray Employee - Director of Finance, BHR CCGs

None

North East London Local Pharmaceutical Committee (NEL LPC)

X Indirect Husband is an employee Apr-18 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Fontus Health X Indirect Daughter undertakes work with them.


Vertergi Limited X Direct Holder of 100% of the company shares


MCB Software X Direct Holder of 100% of the company shares

The software produced has been purchased by BHR CCGs and is currently in use by the Continuing Healthcare Team

01/06/2016

Amendment August-18

Current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

The Network Group X Direct Vertergi Ltd is a member of the Network Group and I am a named member of the leadershipMCB Software Services is an associate member of the Network GroupThe Network Group was formed to enable small organisations to compete for larger consulting assignments. No work has been secured, but has secured a place on a framework agreement.


Diginex Ltd - technology company

X Direct Shareholder Sep-19 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Sharon Morrow Employee - Director of Transformation & Delivery (Unplanned Care & Mental Health)

None

Saiqa Mughal Employee - Prescribing Advisor; APC Member

BHR CCGs X Direct Registered as a patient at a GP practice in Redbridge CCG. Full details provided on declaration form

2011 ongoing No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Employee - Prescribing Adviser; APC Member

Employee - Chief Pharmacist; APC Member

Mohammed Kanji

Robert Meaker

Employee - QIPP Programme Pharmacist; APC Member

Employee - Innovation & Information Technology Senior Responsible Officer BHR CCGs

Krishek

Kong Vicky

Belinda

Employee - Pharmaceutical Advisor/QIPP Pharmacist; APC Member

Imran Khan

Greenwood Practice, Havering CCG

X Indirect Husband is a salaried GP 01/05/2019 ongoing No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

The New Surgery, Brentwood

X Direct Paid work as a Clinical Pharmacist. Full details including remuneration and list of GP practices provided on declaration form

31/05/2019 ongoing No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Rohpharm Pharmacy X Direct Paid work as a locum at branches owned by family members. Full details including remuneration provided on declaration form

01/05/2019 ongoing No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

DSP Health Solutions (DSPHS) Ltd Financial (Consultancy/Training).

X Direct Director Jun-15 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.


X Indirect Wife is a shareholder in the company

Jun-15 Current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

Sterling Anglian Pharamceuticals (SAP)

X Shareholder (less than 1% of stockholding)



X Direct Paid work as locum pharmacist. Further details and remuneration declared on DOI form


BHR CCGs X Direct Registered patient at a GP practice in Redbridge CCG. Full details provided on form


Greater London Authority (GLA)

X Indirect Husband is area regeneration manager for North East London

2017 on-going No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

City & Hackney CCG X Direct Registered patient at a GP practice where City & Hackney CCG Chair is based. Full details declared on form


NELFT X Indirect Partner is an employee working within Redbridge CAMHS


Waltham Forest CCG X Direct Registered as a patient a GP practice in Waltham Forest CCG which is part of NELCA. Full details provided on DOI form


Springfield Hospital, Chelmsford

X Direct Paid bank work - Pharmacist. Remuneration declared on DOI form.

01/04/2018 current Declared in line with CPOI policy. Will be excluded from any related comissioning or decision making.

BHR CCGs X Direct Registered as a patient at a GP practice in Havering CCG. Full details declared on form


BHR CCGs X Indirect Co-habiting partner is Director of Commissioning and Performance at BHR CCGs



April 2018 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.

OgeHistoric

Chesa Employee - Deputy Chief Pharmacist; APC Member

NICE X Direct Medicines & Prescribing associate. Also Adoption & Impact Programme Reference Panel member

On-going 17-Jun-19 Historic

Forest Edge practice, Hainault

X Direct GP partner Oct-93 01-Jul-19 Historic

Dagenham & Redbridge Football Club

X Direct Medical doctor 1999 01-Jul-19 Historic

Healthbridge Direct X Direct Shareholder 2015 01-Jul-19 Historic

Historic Redbridge Local Medical Committee

X Direct Member 01-Jul-19 Historic

Southdene Surgery X Direct GP partner current 17-Jul-19 HistoricHealthbridge Direct X Direct Shareholder Sep-14 17-Jul-19 HistoricMyChem Ltd X Indirect Husband is owner/director of

pharmacycurrent 17-Jul-19 Historic

Phoenix Medics Ltd X Indirect Brother is a director current 17-Jul-19 HistoricEssex Local prescribing Committee

X Indirect Husband does ad-hoc work current 17-Jul-19 Historic

North Middlesex University Hospital Trust

X Direct Consultant Anaesthetist May-96 Aug-19 Historic

Nadia Medical Secrives Ltd

X Direct Director (provides anaesthetic services)

Mar-15 Aug-19 Historic

BHR CCGs X Indirect Lay member PPI (Havering CCG) PPI is brother in law

01/10/2017 Aug-19 Historic

Arthur Rank Hospice Charity - Cambridge

X Direct Trustee 01/05/2017 Aug-19 Historic

Govering Body member - Clinical Director

Ah-feeHistoric

Tahir

Sanjay Patel

Patel Reema

AnitaHistoric

MuhammadHistoric

Employee - Deputy Chief Pharmacist; APC Member

Employee - Prescribing Advisor, Havering CCG

Historic

Tracy Welsh Employee - Director of Transformation & Delivery (Planned Care)

Marie Price Employee - Corporate Services Director BHR CCGs

Sarah See Employee - Primary Care Transformation Director BHR CCGs

Julia Taylor Employee - Prescribing Advisor; APC Member

ArnoldHistoric

Fertig Independent GP member of BHR CCGs Primary Care Commissioning

Bhatia Governing Body member - Clinical Director

Chan Governing Body member - Secondary Care Consultant

PriceWaterhouseCooper

X Indirect Son is a partner (south Korea) 2015 Aug-19 Historic

Mayor of London (Sadiq khan)

X Indirect Son is a speech writer 2016 Aug-19 Historic

Queen Elizabeth Hospital, Birmingham

X Indirect Son is an employee in middle management

2015 Aug-19 Historic

Barnet CCG X Direct Independent GP Lead for a short time limited project

Oct-18 Aug-19 Historic

Guy's and St Thomas NHS Foundation Trust

X Direct Full time employee and Medical Director of GSTT Healthcare Alliance. Seconded to NHSI two days per week as part of this role.

31/10/2019 Historic

Faculty of Leadership and Management

X Direct Appraiser 31/10/2019 Historic

NHS Professionals X Direct Non-executive director Apr-19 31/10/2019 Historic

KateHistoric

Langford Governing Body member - Secondary Care Consultant, Barking & Dagenham and Havering CCGs

Committee

Draft Part 1 PCCC Minutes 18 December 2019 - draft v3 Page 1 of 5

Part 1 DRAFT

Minutes of the Primary Care Commissioning Committee (a Committee in Common) held on 18 December 2019 at North House

Present:

Barking & Dagenham CCG Havering CGG Redbridge CCG

Sahdia Warraich (SW), Lay Member

Richard Coleman (RC), Chair & Lay Member

Kash Pandya (KP), Lay Member



Sarah See (SS), Director, Primary Care Transformation



Ceri Jacob (CJ), Managing Director



Ahmet Koray (AK), Director of Finance



Dr Gurkirit Kalkat (GK), Clinical Director

Dr Alex Tran (AT), Clinical Director

Dr Shabana Ali (SA), Clinical Director

Dr David Derby (DD), GP

In attendance: Dr Jagan John (JJ) Chair, Barking & Dagenham CCG Dr Sarita Symon (SSy) LMC, Barking, Dagenham and Havering Anne-Marie Dean (AMD) Chair, Healthwatch Havering Matthew Cole (MC) Director of Public Health, London Borough of Barking & Dagenham Alison Goodlad (AG) Head of Primary Care, NELCA Primary Care Commissioning Gohar Choudhury (GC) Assistant Head of Primary Care, NELCA Primary Care

Commissioning Julia Cory (JC) Interim Deputy Director, Primary Care Transformation, BHR CCGs Natalie Keefe (NK) Head of Primary Care Transformation, Redbridge CCG Carolyn Botfield (CB) Director of Estates, NELCA Tim Madelin (TM) Strategic Estates Manager, NELCA Kate Halliday (KH) Strategic Estates Advisor, GB Partnerships Katie McDonald (KMc) Corporate and Governance Administrator, BHR CCGs (Minute taker) Apologies: Khalil Ali (KA) Lay Member, Redbridge CCG Jacqui Himbury (JH), Nurse Director, BHR CCGs Dr Adedayo Adedeji (AAd) GP, Barking & Dagenham CCG Dr Shabnam Ali (ShA) GP, Redbridge CCG Dr Atul Aggarwal (AAg) Chair, Havering CCG Dr Anil Mehta (AM) Chair, Redbridge CCG Terilla Bernard (TB) LMC, Barking, Dagenham and Havering Mark Ansell (MA) Director of Public Health, London Borough of Havering Manisha Madhvadia (MM) Healthwatch Officer, Healthwatch Barking & Dagenham Cathy Turland (CT) Chief Executive, Healthwatch Redbridge Gladys Xavier (GX) Interim Director, Public Health, London Borough of Redbridge Rob Dickenson (RD) Senior Finance Manager, BHR CCGs Ambrish Shah (AS) LMC, Redbridge


Item Action 1. Welcome and apologies

The Chair welcomed those present to the meeting and apologies were noted.

1.1. Declarations of conflicts of interest The Chair reminded members of their obligation to declare any interest they

may have on any issues arising at the meeting which might conflict with the business of the primary care committee and clinical commissioning group. No other additional interests were declared. The register of interests held for BHR CCGs Governing Body (GB) members and staff is available from the Company Secretary.

2. Minutes, action log and risk register 2.1. Minutes of the last meeting

The minutes of the meeting held on 16 October 2019 were agreed as an accurate record.

2.2. Actions log Shabana Ali joined the meeting at 1.05pm

The Committee approved the actions that had been taken since the last meeting. In addition, members agreed to close ACT 146.1, ACT 146.3, ACT 146.4, ACT 146.5, ACT 156 and ACT 157.

2.3. Risk Register The Committee noted and approved the risk register. In addition members

noted: RSK 24 – workforce and estates issues are a significant factor in the viability of GP practices. RSK 26 – work with practices and PCNs s ongoing to improve immunisation rates.

3. Barking & Dagenham, Havering and Redbridge Primary Care Commissioning Committee

3.1. Primary Care budgets 2019/20 update AK advised that the budgets for all three CCGs are break-even at month

seven and are forecast to break even for the year, however this is dependent on investment decisions being agreed. KP queried whether plans have been established to utilise the identified underspends. AK advised that due to conflicts of interest with GP members, this will be discussed at a separate meeting. Alison Goodlad and Gohar Choudhury joined the meeting 1.10pm KP asked what the ramifications will be if Primary Care Networks (PCNs) do not recruit to clinical pharmacist and social prescribing posts from 1 July 2019. SS confirmed that the finances will be committed but as yet no requests for reimbursement have been made this year.


JJ added that some practices have queried the reimbursement process and SS confirmed that two email communications have been sent to PCN directors to clarify. SS also advised that PCNs have been advised that can utilise any in year underspend by recruiting earlier for additional roles (for 2020/21) – although this might be at risk until the respective PCN workforce allocation is confirmed. Alex Tran and Sarita Symon joined the meeting at 1.20pm The committee noted the contents of the report and the potential risks.

3.2. Estates strategy refresh CB presented the estates strategies highlighting that since the 2018 strategy

was published there has been unprecedented growth across BHR with an estimated 148,000 additional patients predicted to add pressure to health and social care systems, thereby requiring a refresh of the ten year plan. This regeneration will bring significant change, however it provides opportunities to develop new models of care. JJ noted that the strategy does not cover workforce requirements and recommended that discussions take place with PCNs as to how general practice can accommodate the growing population. SSy added that PCNs are unaware of the estates resource so would welcome this engagement at a PCN level. SS advised that once the draft capacity plans were available individual PCN workshops would take place to review the plans and agree recommendations with practices. Anne-Marie Dean joined the meeting at 1.30pm SA queried if there would be a floor dedicated to healthcare in the new 42 story building in Ilford town centre. CB advised that healthcare requirements would need to be quantified and communicated to the local authority. Councils should not approve planning permission before finding out the healthcare needs. CB provided an update on the progress of the St Georges development noting that Dr Atul Aggarwal, Havering CCG Chair, and Steve Rubery, Director of Commissioning and Performance, chair the St Georges Service Specification Group and that an outline business case could be approved within the financial year. RC commented on the historic issue with estates billing and queried if there have been improvements. CB explained that the team regularly escalate billing inaccuracies to NHSE and are looking to collate issues at a NEL level. CB recognised that practices are also having numerous issues and advised that practices should pay the parts of the bill which are accurate and dispute the others. Dr David Derby joined the meeting at 1.45pm RC requested an estates update at each primary care commissioning committee. The committee noted the work being undertaken on the Primary Care Estates Strategy refresh and the ICS Estates Strategy.

CB


4. Questions from the public Ms Sharma raised the following questions;

Q1: In relation to the estates item, where have the public been involved in these discussions and where do they have sight on the strategy? A1: Large projects, such as the Barking Riverside Development, have patient participation in the relevant forum. The STP estates strategy 2018 is published online. Q2: As part of the PMS review, why has Redbridge CCG identified additional commissioning intentions including an end of life scheme, additional opening hours and additional consultations, whilst in Barking & Dagenham and Havering the commissioning intentions were limited to additional consultations? A2: As previously explained, BHR CCGs are three separate statutory organisations and are funded according to their allocations. These allocations are calculated on a national basis using a formula which takes into account deprivation and the demographic profile of the borough. Barking & Dagenham and Havering did not receive the same level of growth funding or PMS premium as Redbridge. The CCGs have therefore used the funding available to develop commissioning intentions for each borough that ensure we meet our key performance indicators while supporting access across BHR. Q3: How have the commissioning intentions been prioritised? A3: The process and planning for these began in 2015/16 based on the population needs. Q4: Why are the commissioning intentions confidential? A4: All GPs have a conflict of interest therefore must remain confidential. Once a decision has been made, these will be available in the public domain. Q5: Which practices are vulnerable in Redbridge to having their registration withdrawn by the CQC (risk 21), or still have viability issues (risk 24)? A5: Regulation and inspection of practices is the responsibility of the CQC and we are informed of the outcome of the inspection by the regulators. As CCGs, our primary care team provide ongoing developmental and practical support to help practices to remain resilient, viable and to provide quality care. This support includes;

• Learning and developmental support – access to mandatory training, regular shared learning events, peer support facilitation

• Opportunity to bid for resilience funding (annual budget) to address issues which may affect a practice’s viability

• Facilitating advice and training in BHR to support practise to prepare for inspections and maintain a quality service

• Developmental support (including regular visits) from the BHR Primary Care Improvement Leads (PCILs)

Practice viability can be related to a number of factors – from funding to workforce issues (staff leaving or retiring, staff sickness) or estates issues. While some issues can be planned for others can happen unexpectedly. The PCILs work with practices to discuss identified issues that may affect a practice’s viability and look at how the CCGs can provide support.


Q6: Where is the report about which GP surgeries have not yet had a rent review which was due to be produced for the December meeting? A6: This review is being led by the North East London primary care team. We are expecting a report to our confidential February meeting. We are supporting the review by working with those practices who have not yet completed the documents required for the review. We have also been advised that the District Valuer is addressing a current backlog in property valuations which is also having an impact on the review timeline. Q7: Why is the rent review confidential? A7: The report will contain practices’ financial information which is sensitive data.

5. Any other business There was no other business.

6. Date of next meeting Wednesday 26 February 2020

Actions Log

Log owner: Sarah See, Director of Primary Care Transformation

Log manager: Mary Smith, Primary Care Team

Last Update:

URN Action Part Raised Owner Deadline Completed Status Resolution / Comments / Document RefBarking Riverside Service modelNext report to include financial modelling and any impact on Havering.

1 28/11/2018 Emily Plane 17/04/2019 Open On agenda

ACT126 Shared care LISAA suggested there is a risk practices will not be signing up to the shared care LIS from April and that this should be added to the risk register.

1 20/02/2019 Sarah See 12/06/2019 Open Added to risk register which includes updates

Primary Care budgets 2019/20 updateCT queried how practice participation payments benefit patients. GC explained that the Direct Enhanced Service (DES) which is nationally negotiated, includes patient engagement at a practice and network level. GC agreed to share a copy of the DES with CT

1 16/10/2019 Gohar Choudhary

18/12/2019 Open GC to confirm if the Direct Enhanced Service has been shared. CCG comms team have developed a specification to commission patient engagment support / training for PCNs.

ACT150 Any other businessJJ agreed to circulate the asset register plotted by organisations

1 21/08/2019 Jagan John 16/10/2019 Open Asset registers in place with each borough. Primary Care to liaise with Local Authorities regarding access to these registers in terms of sharing with PCN Link Workers/practices.

ACT 163 Estates strategy refreshRC requested an estates update at each primary care commissioning committee

1 18/12/2019 Carolyn Botfield

26/02/2019 Open Agenda item added to committee forward plan as a standing agenda item Request to close action

12-Feb-20

ACT116

ACT 146

Risk LogLast updated:

URN Impact on Risk and impact Date Opened Part Owner Mitigating Action Prob Imp Severity Category Status Next review Next action / comments

RSK21 All CQC VisitsHigh numbers of GP practice are being rated as ‘requires improvement’ or ‘inadequate’. There is a risk that practices may have their registration withdrawn, increased variation in the quality and safety of services provided by practices, and a reputational risk to the CCGs

01-Sep-16 1 Sarah See 1) Encourage LMCs to provide additional support.2) 2019/20 GPFV resilience programme rolled out.3) CQC attending each of the PLE/PTIs to update on the new inspection regime. 4) Continuing to share learning from ‘good rated’ practices at PLEs/PTIs.

2 3 6 Patient care Open On-goingThe primary care team regularly review the practice profile which includes CQC ratings/inspection reports and offers support where needed. A schedule of practice routine visits has now commenced.

RSK22 B&D Barking Riverside

Long term - new contract and premises to be commissioned from 2020/2021 as part of an integrated model. The risk is that this could cause a cost pressure for the CCG & that the CCG doesn't have the capacity to undertake a procurement with appropriate level of patient and public co-design to develop the model

01-Sep-16 1 Sarah See 1) Work closely with the Local Authority (LA) and other partners to shape the new service model within an agreed financial envelope. 2) Work with LA to access any CILs monies. 3) Explore options with LA to minimise operational commissioning (or procurement) costs by undertaking this process jointly.4) The cost of an additional practice has been built in to the latest PMS calculations5) Task & Finish Group to design hub model established.6) Options for Commissioning Model considered by PCCC.7) Working group established to bottom out the financial envelope for the health element of the model of care

3 3 9 Financial / Reputational

Open On-going On agenda

RSK24 All Viability of Practices - risk that practices could close and we lose clinical staff to the area.

01.08.17 1 Sarah See 1) Work with practices that have expressed concern about viability around different options (merging with other practices, joint working (economies of scale) and network/federation solutions)2) Number of workforce initiatives underway including working with PCN CDs around network solutions3) Developing capacity plans at network level to support practices and to address sustainability issues via Network solutions

3 3 9 Patient Care Open 21-Aug-19 The primary care team has been working at collating data on a range of variables for practices and the aim is that this data can be used as a tool for commissioners and networks to assist in identifying practices that could be described as vulnerable. This could then be used further to inform and facilitate assessment of the type of support packages that could be provided to help practices become more sustainable, resilient and better placed to tackle the challenges faced now and in the future. Further discussion and work on the toolkit is needed before sharing with PCNs, Federations and LMC. Update on the Capacity Plans on February agenda.

RSK 26 All Immunisation & screening rates across Barking & Dagenham, Havering and Redbridge Low vaccination and immunisation rate mean that the boroughs do not achieve 'herd' immunity for the range of imms and vaccs targets - exposing residents to preventable disease / illness

03.10.18 1 Sarah See 1) CCG Primary care and quality teams to work with public health colleagues to develop action plans, which should cover all opportunities to improve vaccs and imms rates2) CCG Primary Care team to work with Comms to develop a comprehensive comms and engagement plan3) CCG Primary Care team to share coverage rates with Federations and Networks to enable peer discussions

3 3 9 Patient Care Open Ongoing CCG to continue to monitor vaccination uptake figures and work with Public Health collegues to develop action plans. Discussions are ongoing for the possibility of commissioning immunisations via the GP Hubs. B&D PCNs undertaking a pilot - learning from pilot could be presented to the PCCC in Spring/Summer.

RSK 30 All Workforce:Significant gaps in workforce across all providers in the ICS, and in particular, Primary Care means that there is a risk to the likelihood of delivering an effective local system and will continue to strain primary care in terms of workload and delivery of services.

21.08.19

1

Jane Lindo/Sarah See/PCN CDs

1) Working with PCN leadership, NEL team to develop a primary care workforce strategy: Strategy to cover new roles as per contract reforms in addition to further skill mix and education & training programme2) Continue with current programmes to support recruitment and retention for GPs/PNs/Clinical Pharmacists/ Social Prescribers and other new roles until agreed action plan is generated as an outcome the Strategy3) Establish a BHR Academy

4 3 12 patient care / reputational / finance

Open Open Item schedule for April meeting

Primary Care Commissioning12-Feb-20

Rating 1 2 3 4 5Description Rare Unlikely Possible Likely Certain

FrequencyNot expected

to occur in years

Expected to occur one a

year

Expected to occur one a

month

Expected to occur weekly

Expected to occur daily

Probability <10% 10% - 24% 25% to 45% 50% - 74% >75%

Risk grading matrix

LikelihoodRa

ting

Desc

riptio

n AObjectives/

projects

BHarm/injury to patients, staff

visitors & others

CActual/potential complaints &

claims

DService

disruption

EStaffing & competence

FFinancial

GInspection/

Audit

HAdverse media

1

Insi

gnifi

cant

Insignificant cost increase/time

slippage. Barely noticeable

reduction in scope or quality

Incident was prevented or

incident occurred and there was no

harm

Locally resolved complaint

Loss/interruption more

than 1 hour

Short term low staffing leading to reduction in quality(less than 1 day)

Small loss <£1000

Minor recommendations Rumours 1 2 3 4 5

2

Min

or Less than 5% cost

or time increase. Minor reduction in quality or scope

Individual(s) required first aid. Staff needed <3 days off work or normal duties

Justified complaint peripheral to clinical care

Loss of one whole working

day

On-going low staffing levels

reducing servicequality

Loss of 0.1% budget.

<£10,000

Recommendations given. Non-

compliance with standards

Local media column 2 4 6 8 10

3

Mod

erat

e

5-10% cost or time increase. Moderate

reduction in scope or quality

Individual(s) require moderate increase

in care. Staff needed >3 days off

work or normal duties

Below excess claim. Justified

complaint involving inappropriate care

Loss of more than one working

day

Late delivery of key objectives/service due to

lack of staff. On-going unsafe staff levels. Small error owing to insufficient

training

Loss of more than 0.25% of

budget. <£100,000

Reduced rating. Challenging

recommendations. Non-compliance with standards

Local media front page story 3 6 9 12 15

4

Maj

or

10-25% cost or time increase. Failure to meet

secondary objectives

Individual(s) appear to have suffered permanent harm.

Staff have sustained a "major injury" as defined by the HSE

Claim above excess level.

Multiple justified complaints

Loss of more than one working

week

Uncertain delivery of services due to

lack of staff. Largeerror owing to insufficient

training

Loss of more than 0.5% of

budget. <£500,000

Enforcement action. Low rating.

Critical report. Major non-

compliance with core standards

Local media short term 4 8 12 16 20

5

Seve

re

>25% cost or time increase. Failure to

meet primary objective

Individual(s) died as a result of the

incident

Multiple claims or single major

claims

Permanent loss of premises or

facility

No delivery of service. Critical error owing to

insufficient training

Loss of more than 1% of

budget. >£500,000

Prosecution. Zero rating. Severely critical report.

National media more than 3

days. MP concern

5 10 15 20 25

Seve

rity

Extreme

High

Medium

Low

Risk category

To: Barking & Dagenham, Havering and Redbridge Primary Care Commissioning Committees

From: Ahmet Koray, Director of Finance Date: 26th February 2020 Subject: Primary Care Budgets 2019/20 Executive summary:

This paper provides the Committee with a summary of the year-to-date and forecast position for the 2019/20 financial year. The budgets for all three CCGs are break-even at month 10 (January) and the forecast is that all this will remain the case at year-end. As in previous years, there are risks associated with the plan and forecasts. These include, demographic growth, retrospective rent reviews, the uptake/achievement of commissioning intentions as part of the PMS review and the impact of the new Primary Care Network Contract. The expectation is that these risks will be managed through to year-end and therefore the contingency budgets each CCG is required to hold. Recommendations:

The committee is asked to:

• Note the financial position at month 10 (January 2020), the forecast for year-end and the risks that remain.

1.0 Purpose of the Report

1.1 This report provides the Primary Care Commissioning Committee with a summary of the financial position for each CCG and the risks within.

2.0 Month 10

2.1 The month 10 position for all three CCGs is a year-to-date and forecast break-even position (appendix 1 shows the breakdown).

2.2 The finance paper presented at the December Committee advised of forecast underspends for Barking & Dagenham CCG and Redbridge CCG, with Havering achieving break-even. Since then a number of factors have been confirmed:

2.2.1 Final practice list sizes have been published, identifying a lower level of growth

than anticipated when setting the opening budgets;

2.2.2 0.5% contingency has now been released into the respective B&D and Redbridge positions. Havering was already released to offset previously identified pressures;

2.2.3 As presented in December 2019, the Primary Care team identified a number of investment opportunities to utilise underspends across all three CCGs. The additional investment will result in all three CCGs achieving a break-even position at year-end.

2.3 Across the three CCGS, the core contractual elements of the budgets, such as

GMS/PMS/APMS contracts are tracking in line with the budget. There are some minor variances in relation to Premises and Enhanced Services, but these are not expected to be significant values at year-end.

2.4 The majority of the Enhanced Services (Extended Hours Access) have now been

transferred to form part of the new funding for networks. We now have full sign-up and confirmed delivery against this, so there will be no variance against this budget. Only the smaller budgets for LD Health Checks and Minor Surgery may see some variance, but the risk of this is small.

2.5 Premises budgets remain a risk area (as noted in the risk section of this paper). Work is

ongoing by the NELCA commissioners to establish a robust estimate for the year as well the historical impact of retrospective rent reviews. The 19-20 budgets include a 3% growth factor, to cover anticipated in-year rental increases. The current assumption remains for budgets to break-even, but recognising the risks that this may change.

2.6 QOF spend in 18-19 equated to approximately 98% of budget across the three CCGs.

The month 10 position assumes the full budget will be spent in 19-20.

2.7 Commissioning Intentions remain one of the main risk areas. At the time of closing down month 10, all three CCGs had made Q1 and Q2 payments to those practices who had submitted their data. In Redbridge Q3 payments have also been made. The forecast achievement for the two access schemes is approximately 77% with Wound Care and End of Life achieving an estimated 90% and 55% respectively. No significant variance is anticipated for Q4.

2.8 Void costs relate to central budget and costs that have been devolved to CCGs. Void costs are being reviewed across the system in an attempt to address the issues and reduce avoidable costs where possible.

2.9 Costs labelled as ‘Other’ in Appendix 1 broadly cover:

- 0.5% contingency - PCCC GP membership - Interpreting costs - GP SPIN - Enhanced GP IT infrastructure and resilience (additional allocation received) - Additional staff costs (being phased out, as agreed by PCCC) - Other uncommitted budget (ongoing work to identify programmes of spend – B&D

only)

3.0 Resources/investment 3.1 There are no additional resource implications/revenue or capital costs arising from this

report.

4.0 Equalities 4.1 There are no equalities implications arising from this report.

5.0 Risk 5.1 As mentioned above, there are a number of risks associated with the reported position,

but at present these are being managed within the resources available. However, as previously reported, risks include:

5.2 Demographic Growth: The main risk facing the Primary Care budgets in 2019/20 is the uncertainty regarding demographic growth. The final list size updates of the financial year have now been received and are presented below:

ContractQ1 - 1st April

Q4 - 1st January

Q1-Q4 Growth

Q1 - 1st April

Q3 - 1st October

Q1-Q4 Growth

Growth within budget

APMS 26,867 27,867 3.72% 23,493 24,709 5.18%GMS 110,495 112,599 1.90% 104,788 106,928 2.04%PMS 90,477 91,266 0.87% 84,011 84,667 0.78%B&D 227,839 231,732 1.71% 212,292 216,305 1.89% 1.80%APMS 8,182 8,431 3.04% 7,011 7,188 2.52%GMS 165,608 164,881 -0.44% 162,955 162,683 -0.17%PMS 107,092 109,047 1.83% 102,961 104,795 1.78%Havering 280,882 282,359 0.53% 272,928 274,665 0.64% 1.10%APMS 3,756 3,835 2.10% 3,324 3,420 2.89%GMS 211,481 214,300 1.33% 188,214 189,406 0.63%PMS 111,999 115,611 3.23% 97,192 99,601 2.48%Redbridge 327,236 333,746 1.99% 288,729 292,427 1.28% 1.70%BHR Combined 835,957 847,837 1.42% 773,949 783,397 1.22% 1.52%

Weighted List AnalysisRaw List Analysis

The raw list sizes are for illustration purposes as the bulk of contractual payments are based on weighted list sizes. The actual growth is within the ONS estimates (shown in the last column) and therefore no risk of cost pressure has materialised. An underspend is anticipated based on these list sizes, but has not yet fully quantified,

5.3 Retrospective rent reviews:

As reported at previous committee meetings, there is a backlog of rent reviews for a number of GP premises. Rent reviews are usually carried out every three years, however some premises have missed more than one review. NELCA colleagues have been carrying out an extensive piece of work to establish the true cost associated with retrospective rent reviews. A number of premises have now been reviewed and retrospective payments have been made. We are awaiting an update to determine the cost associated with those reviews, which will be the basis of estimation for all outstanding reviews. The 2019/20 budgets include a premises contingency of 3%. It is assumed that this will cover the in-year impact of retrospective revaluations and any balance will be met from provisions made in previous years where the rent reimbursement claim had not been settled.

5.4 Uptake and achievement of Commissioning Intentions: The latest review suggests Barking & Dagenham and Havering CCGs still have some risk of overspend, whereas Redbridge CCG is likely to have no risk of overspend at all, and budget can be released for other investments.

5.5 Primary Care Network Contract: The 2019/20 financial year sees the introduction of the new Primary Care Network Contract. As this involves a new way of commissioning and a number of different financial components, there is a risk that assumptions made centrally may not be in line with final outturn. For example, one financial component is the reimbursement of pay for Clinical Pharmacists and Social Prescribing Link Workers. Networks will have to recruit to these posts from 1st July 2019 and reclaim actual costs from the CCG. The timing of recruitment and salary paid may not correlate with the budget plans. Since month 3, payments have been arranged for Extended Hours Access, Clinical Director, PCN support, and Practice Participation. All of which are in line with budgets, with no risk of overspend. The budget for workforce reimbursement has a risk of underspend if networks didn’t recruit to these posts from 1st July 2019. As at month 10 there was no information provided to determine how many posts had been filled and when they were recruited to. As claims are received from networks for reimbursement, it will become clearer as to the level of risk.

6.0 Managing conflicts of interest 6.1 N/A

7.0 Recommendations 7.1 The Primary Care Commissioning Committee is asked to note the content of the report

and the identified risk items.

Author: Rob Dickenson, Senior Finance Manager Date: 19th February 2019

Appendix 1

NHS England - London RegionDelegated Primary CareFinancial Summary - 10 Months to 31st January 2020

DescriptionAnnual Budget Forecast

Outturn

Forecast Variance Surplus / (Deficit)

Annual Budget Forecast

Outturn


Annual Budget Forecast

Outturn


£ £ £ £ £ £ £ £ £

GMSGMS Global Sum & MPIG 9,393,908 9,393,908 0 14,522,614 14,522,614 0 17,112,097 17,112,097 0GMS QIPP Savings 0 0 0 0 0 0 0 0 0GMS Enhanced Services 136,125 129,618 6,508 333,047 339,122 (6,075) 365,475 352,552 12,923GMS Quality and Outcomes Framework (QOF) 1,040,723 1,040,723 (1) 1,897,665 1,897,665 0 2,177,977 2,177,990 (13)GMS Premises Payment 1,780,188 1,780,187 0 2,612,551 2,612,551 0 2,181,660 2,181,660 (0)GMS Seniority 71,577 71,577 0 148,317 148,317 0 135,091 135,091 0GMS Other Administered Funds (Maternity etc) 272,253 272,253 (0) 388,129 388,129 0 550,692 550,692 0GMS Personally Administered Drugs 64,450 64,450 0 119,621 119,621 0 143,236 143,236 0 0 0 0 0 0 0 0 0 0Total GMS 12,759,223 12,752,716 6,507 20,021,944 20,028,019 (6,075) 22,666,228 22,653,318 12,910

PMS PMS Additional and Essential Services 7,493,022 7,493,022 0 9,133,428 9,133,428 0 7,169,724 7,169,724 0PMS QIPP Savings 0 0 0 0 0 0 0 0 0PMS Enhanced Services 125,617 121,501 4,117 166,140 159,135 7,005 79,317 63,647 15,670PMS Quality and Outcomes Framework (QOF) 918,527 918,531 (4) 1,315,176 1,315,177 (1) 869,324 869,324 1PMS Premises Payment 1,604,469 1,604,469 0 1,291,690 1,291,690 0 839,092 839,093 (0)PMS Seniority 0 0 0 85,407 85,407 0 15,588 15,588 0PMS Other Administered Funds (Maternity etc) 215,841 215,841 (0) 259,010 259,010 (0) 216,913 216,913 (0)PMS Personally Administered Drugs 0 0 0 93,915 93,915 0 0 0 0 0 0 0 0 0 0 0 0 0Total PMS 10,357,477 10,353,365 4,113 12,344,767 12,337,762 7,004 9,189,959 9,174,288 15,671

APMSAPMS Essential and Additional Services 2,577,730 2,577,730 0 1,080,967 1,080,967 0 1,865,634 1,865,634 0APMS QIPP Savings 0 0 0 0 0 0 0 0 0APMS Enhanced Services 9,189 15,955 (6,766) 0 3,886 (3,886) 12,600 12,600 0APMS Quality and Outcomes Framework (QOF) 187,311 187,310 0 51,461 51,461 0 184,746 184,747 (1)APMS Premises Payment 647,285 647,285 0 108,819 108,818 0 395,551 395,552 (0)APMS Seniority 0 0 0 0 0 0 0 0 0APMS Other Administered Funds (Maternity etc) 91,956 91,956 0 14,864 14,864 0 48,119 48,119 0APMS Personally Administered Drugs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Total APMS 3,513,471 3,520,236 (6,766) 1,256,110 1,259,997 (3,886) 2,506,650 2,506,651 (2)

Other Medical ServicesPCN Network 1,065,004 1,065,004 0 1,203,400 1,203,400 0 1,305,995 1,305,995 0Occupational Health/ CRB chcks 16,400 16,400 0 16,400 16,400 0 16,400 16,400 0Barking Riverside 196,144 196,144 0 0 0 0 0 0 0Transition Payment 851,640 851,640 0 28 28 0 152,578 152,578 0CCG CI's 1,000,634 905,649 94,985 943,958 998,101 (54,142) 3,097,834 1,859,545 1,238,288Void Costs 214,000 214,000 0 44,000 44,000 0 87,000 87,000 0Other 2,005,008 2,103,846 (98,839) 694,393 637,294 57,100 882,357 2,149,224 (1,266,866)Total Other Medical Services 5,348,829 5,352,683 (3,854) 2,902,179 2,899,222 2,957 5,542,164 5,570,742 (28,578)

Total Primary Care Medical Services 31,979,000 31,979,000 0 36,525,000 36,525,000 0 39,905,000 39,905,000 0

BARKING & DAGENHAM CCG HAVERING CCG REDBRIDGE CCG

To: Meeting of the NHS Barking & Dagenham, Havering and Redbridge (BHR) Clinical Commissioning Groups Primary Care Commissioning Committee

From: Sarah See, Director, Primary Care Transformation Date: 26 February 2020 Subject: Further Update on GP Influenza immunisation uptake rates for the 2019/20 Season Executive summary The purpose of this paper is to update the Barking & Dagenham, Havering and Redbridge Primary Care Commissioning Committee on the current position regarding uptake of Influenza immunisations for the 2019/20 Influenza season (for the period from 1 November 2019 – 31 January 2020). This follows a request at the December Primary Care Commissioning Committee. This paper also outlines further work carried out by the BHR CCGs Primary Care Team throughout the current season to improve Influenza vaccine uptake across member practices in BHR. Uptake for all cohorts remains below national targets, the BHR CCGs primary care team, NEL Project Management Office (PMO), NHS England (NHSE) Immunisation Team and Borough Public Health Teams continue to work collaboratively to improve the uptake of Influenza immunisations across the BHR area. Updates to the GP contract in 2020/21 - 2023/24 will also support flu uptake at the Primary Care Network (PCN) level. This will be achieved through an Investment and Impact Fund (IIF), PCNs, as the vehicle for collaboration between GP practices and community pharmacy, are ideally placed to take the lead on improving flu vaccine coverage. Additional general practice incentives for flu, beyond the Item of service, will therefore ultimately be channelled through the PCN IIF. This will start in 2020/21 with an indicator worth £8m for flu vaccination coverage in over 65s. During 2020/21 NHSE will be reviewing the existing Quality Outcomes Framework (QOF) indicators incentivising flu vaccination for specified at risk groups, worth around £20m nationally, and consolidate an updated set of indicators within the IIF for 2021/22. Recommendations The Barking & Dagenham, Havering and Redbridge Primary Care Commissioning Committee is asked to: • Note the contents of this update report and receive a final report regarding influenza vaccine uptake

at the April 2020 Primary Care Commissioning Committee. 1.0 Purpose of the Report

1.1 The purpose of this paper is to update the Primary Care Commissioning Committee on the

current position regarding uptake of the Influenza immunisations for the 2019/20 Influenza season (for the period from 1 November 2019 – 31 January 2020).

1.2 This paper also highlights current work that is being carried out by the CCG Primary Care Team to mitigate against low uptake in the eligible patient cohorts.

2.0 Current Influenza GP Influenza Like Illness (ILI) Consultations

2.1 GP practices have a key role in ensuring their eligible patients benefit from immunisation against

Influenza during the Influenza season. GP practices are commissioned via a Direct Enhanced Service to provide this service across England by NHS England (NHSE).

2.2 As of week 7 (the week ending 13 February) The overall weekly ILI rate was 9.8 per 100,000 registered population in participating GP practices for England and is below baseline levels. This is a slight decrease from 10.3 per 100,000 in the previous week. During week 06, NHS 111 cold/flu calls decreased.

3.0 Current Uptake

3.1 Current uptake of the Influenza vaccine for all cohorts is outlined in the table below. This is based

on the latest published data which is provisional at end of January 2020 and reflects cumulative uptake data for England on influenza vaccines, given from 1 September to the 31 December 2019.

Source: Public Health England Seasonal Influenza vaccine uptake in GP patients: monthly data, 1st Sept 2019 -31st Dec 2019

3.2 Uptake across London, NEL and BHR continues to be below England target in all cohorts at present. However Havering and Redbridge are above the NEL and London averages with respect to patients aged 65 and over. Barking and Dagenham is below the London & NEL average.

3.3 Barking & Dagenham, Havering, Redbridge are all above the London average for Under 65s at

risk with Barking & Dagenham and Havering now above the NEL Average. In December 2019 Redbridge was the only BHR borough above the NEL average. However all BHR boroughs are below the England average.

3.4 Redbridge is now above the London & NEL average for pregnant women along with Barking &

Dagenham. Havering is lower than NEL and the same as London. All boroughs are below the England average.

3.5 Barking & Dagenham and Redbridge are below the London and NEL averages with respect to 2

year olds. Havering is above the NEL and London average. All boroughs are below the England average.

3.6 Barking & Dagenham is at the NEL average for 3 year olds but below the London average. Havering and Redbridge are above the NEL average with Havering above the London average and Redbridge below the London average. All boroughs are below the England average.

4.0 Actions in place to improve uptake

Action Who Timescales

The CCG are supporting an NHSE Local Improvement Scheme (LIS) to encourage practices to upload influenza data where other providers have vaccinated. This will improve data accuracy and ensure that vaccination uptake figures are as true and accurate as possible

CCG Flu Leads, NHSE & I Immunisation Commissioning

January – March 2020

CCG Chairs have supported a series of communications to practices around call and recall, data collation and accuracy and requesting that practices focus on 2&3 year olds to improve uptake. The Chairs are also using GP protected learning events to highlight their key messages.

CCG Chairs, PCILs and Comms Team

November – January 2020

Influenza data shared at a practice level and support offered if there are data upload issues. Practices are also actively encouraged to use ImmForm and manually upload & update data.

Primary Care Improvement Leads & CCG Flu leads.

October 19 – March 2020

Practices are encouraged to ensure that Influenza clinics are prioritised and that “at risk” patients are called and recalled to maximise uptake (advised via communications from CCGs).

GP Practices September 19 – March 2020

Communications sent to practices around data upload deadlines and manual entry to ensure that Immform and clinical systems are updated for the final extractions in February and March.

CCG Flu Lead February 2020

Joint work with CCG communications around the GP newsletter, highlighting it’s still not too late to get an Influenza vaccine.

CCG Flu Lead & Comms Lead

January 2020

CCGs continue to disseminate Influenza messages across general practice. The CCGs are updating the GP Intranet and GP E-notice boards with key messages as needed.

CCG Primary Care Teams

December 19-February 2020

BHR CCGs continue to engage with the NEL PMO system approach to maintain system governance. This includes the NEL Influenza Local Meeting held on a biweekly basis which reviews data and shares best practice from the NHSE & NEL teams. The CCGs will also play an active part in the forthcoming lessons learned sessions led by NEL PMO and NHSE & I

CCG Primary Care Teams

October 19-February 2020

5.0 Resources/investment 5.1 There are no additional resource implications/revenue or capitals costs arising from this report. 6.0 Equalities 6.1 There are no equalities implications arising from this report. 7.0 Risk 7.1 There continues to be a risk that if the uptake of Influenza vaccine levels remain below target,

sufficient herd immunity will not be attained by the local population. This may mean that patients may not have sufficient protection from Influenza strains that may still be circulating in the

community. This may lead to a late increase in Influenza infection rates and also put the local acute hospitals under greater strain coming out of the winter period.

7.2 To mitigate this risk the CCG Primary Care Team are continuing to ensure that practices are calling and recalling all eligible cohorts and patients to offer the influenza vaccine. This will help to ensure that patients have the opportunity to access the influenza vaccine if they choose to do so.

8.0 Managing conflicts of interest

There have been no conflicts of interest to manage in relation to the decision requested/issues raised in this paper.

Author: Simon Clarke - Primary Care Delivery Manager – BHR CCGs Date: 5 February 2020

To: The NHS Barking & Dagenham, Havering and Redbridge Primary Care Clinical Commissioning Committee

From: Sarah See, Director, Primary Care Transformation Date: Wednesday 26 February 2020 Subject: Developing a new model of care for Barking Riverside progress briefing Executive summary Barking Riverside is a development in the south of Barking, near to Barking Town Centre. By 2037 there will be a new population of around 40,000 people, living in 10,800 new homes on what was previously brownfield site. The Developers are required to provide financial support for health and care infrastructure, and a wellbeing centre will be built to support the new population from 2021. In the short term, the CCG is working with existing practices in the vicinity; Thamesview, and Maplestead Road GP practice, to increase capacity and extend opening hours to provide primary care access to local people from 2017 to 2022, when it is anticipated that the new facility will be in operation. The Primary Care Commissioning Committee (PCC) members received a briefing on Barking Riverside back in June 2019 which described the work that had taken place to submit a Single Client Brief to the Developer, with the outline spatial requirements of the new wellbeing hub, and summary of the key emerging principles for the new model of care. This paper describes the work that has taken place since the June update, sets out the key next steps, and highlights key updates from the Developer in terms of the estimated population moving in to the area, and the date by which the wellbeing hub will be operational. Recommendations The NHS Barking & Dagenham, Havering and Redbridge Primary Care Commissioning Committee is asked to: • Note the progress that has taken place to take forward development of a new model of care for

Barking Riverside • Comment on the progress to date • Receive a further report in six months and continue to engage with the development of proposals for

the new model of care

1.0 Purpose of the Report 1.1 This paper provides a summary of key updates from the Developer in terms of the anticipated

date for the wellbeing hub at Barking Riverside to be operational, refreshed population figures, progress to develop a service specification for the new model of care for Barking Riverside to serve new residents coming in to the area, and key next steps.

1.2 Members are asked to review and comment on the emerging proposal for the clinical element of the wellbeing space, note the progress that has taken place to take forward development of a new model of care for Barking Riverside, and review/approve the next steps.

2.0 Background 2.1 To address the shortage of affordable housing in London, the Greater London Authority in

conjunction with the London Borough of Barking & Dagenham (LBBD) are creating a residential neighbourhood along two miles of the Thames Estuary on the former Barking Power Station site. It is a 443-acre area close to Barking town centre, Canary Wharf and the Lower Lea Valley called Barking Riverside. The development is one of NHS England’s ‘Healthy New Towns’ and provides us with the opportunity to design and embed innovative new approaches to health and wellbeing.

2.2 The significant re-development will accommodate 10,800 new homes and a population increase of a potential upper threshold of 40,000 residents by 2037 in four phases. This has been revised up from an original conservative estimate of 22,000 people based on larger families than originally projected moving into the homes. Phase 1 is completed and includes 1,400 new homes together with three primary schools, a secondary school, a community centre, and retail space. Phase 2 is underway with 4,500 units, and a mix of commercial, leisure, health and care, retail, restaurant and community spaces, new primary, secondary and Special Educational Needs school under construction as well as the extension of the District Line to the new Barking Riverside station.

2.3 The Developer is obliged under planning regulations to make financial contributions for new

community and health infrastructure that is required to support the development. 2.4 In the short term the CCG is working with existing practices in the vicinity; Thamesview, and

Maplestead Road GP practice to increase capacity and extend opening hours to provide primary care access to local people from 2017 to the summer, 2022 until the new wellbeing facility is in operation. This timeline has increased slightly from the original 2020/21 date as the building work on the new Station which precedes the building work of the new wellbeing hub, has taken slightly longer than the Developer originally anticipated.

2.5 In the long term (2022 onwards), a new model of care and potentially different type of contract

for both health and social care that meets the needs of this new population is required.

2.6 This development affords BHR Clinical Commissioning Groups and LBBD the opportunity to crystallise our discussion and strategy around new models of care and integration, in an area of high deprivation; at a time when the national health and care agenda supports this approach.

2.7 The new model needs to be flexible, seamless and person orientated, with a focus on wellbeing,

getting things right first time, and improving outcomes for local people.

2.8 Health and Care partners have been working with the Developer over the past several months through a series of ‘design’ group meetings working with architects to shape the proposals around the physical design of the building.

3.0 Progress since the Single Client Brief was submitted to the Developer 3.1 Primary Care Commissioning Committee members were updated back in June that a ‘Model of

care’ design group has been established to design a proposed new model of care for Barking Riverside, led by local people and health and care staff, including leads from the community and voluntary sector. A local GP trainee is also working with the group to shape the proposals. This is a task and finish group, meeting monthly until the end of March 2020 at which point it is anticipated the group will have developed a clear Service Specification articulating what the new model of care is and how it will operate in practice. The group are taking an ‘Experience Based Design’ approach, described by Kings College London as ‘a change method and process aimed at improving patient and staff experiences of health [and] care.’1 It focusses on designing experiences, not just improving performance, and brings decisions around the design of health and care services back to what works best for local people, and the health and care staff delivering the interventions. Because services are designed with the end user in mind, they are streamlined, with a strong focus on quality. This also lends itself to services which are naturally more efficient. Input from local people will be key to this process and the group are using case studies based on real experiences of those living in the area, to begin to design optimum experiences and pathways. The outputs and proposals from this group will be robustly tested with local people.

3.2 Health and Care partners have come together to create a ‘Thames Ward Locality Board’ which

includes health and care leads, local councillors, and local people to create a long term governance model to oversee the different elements of the Barking Riverside development in which the Wellbeing Hub will sit. This group is chaired by Cllr Worby and reports to the health and Wellbeing Board.

3.3 The Locality Board’s mission is to support the health and wellbeing of the population of Thames Ward by ensuring that health & care services (including wellbeing and prevention programmes) are:

Commissioned and delivered in ways that are consistent with the agreed System for Health/Care Model

High quality Holistic and joined-up Responsive to the needs and aspirations of the local community

3.4 The Board is responsible for:

Securing the voice of residents in decision-making about health & care (including the prevention and wellbeing agenda) services and activity in Thames Ward;

Ensuring health and wellbeing provision is commissioned and delivered in line with the agreed System for Health/Model of Care

Working with partners to ensure these services are high quality and responsive to the needs of the local population;

Working with local commissioners (CCG and LBBD) to inform commissioning decisions;

Working to embed a prevention and wellbeing agenda and activities within the locality

4.0 Progress to develop the proposed model of care for the Barking Riverside wellbeing hub 4.1 The Model of Care Group have developed an early articulation of the model of care in

diagrammatic form, led by local people and health and care staff, including leads from the

1 The Experience-Based Co-Design approach –how the method works, Glenn Robert (Senior Research Fellow, Kings College London)

community and voluntary sector. Early articulation of the draft model of care is illustrated in Appendix 1, which is being built on an ‘Experience Based Design’ approach described above. Case studies are also being developed (see Appendix 2 for an example) which illustrate the anticipated impact that the new model of care will have.

4.2 This is an initial draft only, but begins to highlight the key importance that triage will play to ensure that people are directed to the right support, first time, and seeks to achieve the ambition for the GP to be a point of escalation, rather than the first point of call, addressing a key bottleneck to responsive primary care. The CCG held a ‘critical review’ session on the proposed model of care. Some key actions were agreed from this:

Develop an FAQ document Arrange a meeting with Regulators and separately, The Bromley by Bow Centre to

discuss options for commissioning and regulation in the new year Refresh the Case Studies to highlight the impact of the new model of care vs

services as they are configured now

4.3 The CCG have recruited dedicated project management support to take forward development of the service specification for the new model of care, with the aim of having a comprehensive draft by the end of March 2020.

4.4 Both CCG and Local Authority leads are working to map the financial envelope for the proposed model of care, as well as developing a data set to map the needs of the new population coming in to the area in terms of, for example, impact on non-elective activity etc. This is being used to inform the number of staff required for the service model to meet the needs of local people.

4.5 A workshop was held with NELFT staff on 23 October 2019 to draw out; the current barriers to

the delivery of care to local people, and as well as what works well, what a ‘gold standard’ model of health and care would look like and how we would design and commission this, as well as other key requirements of the building to feed back to the Developer / wellbeing hub design group in relation to community services. A similar workshop with Local Authority care staff will take place on 17 February 2020.

4.6 A meeting was held with the local Riverside secondary school on 18 December 2019 to discuss

opportunities to promote careers in health and care with local school children, and invite them to be more involved in shaping the proposed new model of care. Leads who will be involved in this including the GP trainee and clinicians intend to hold a workshop with the local school to get local school children excited about the opportunities of working in health and care, with a view to creating a local workforce that will be passionate and who will be invested in the local area, and will continue to work there throughout their career.

4.7 A meeting with the Bromley by Bow Centre took place on 5 February to explore in more detail the

model of social prescribing that is in place at the Centre and how this works with the co-located GP practice on the site. Project leads will feed this learning in to the discussion around the proposed model of care, and the potential contracting mechanisms going forward.

4.8 A meeting with Regulators including CQC and NHS England representatives took place with the

CCG, Clinical Leads and BMA representatives on 6 February. This was a useful session, with attendees discussing the impact of regulation requirements on the proposed model of care. It was felt that the current regulation framework would not prohibit the proposals that are being shaped, and useful discussion was had around potential contracting mechanisms, noting that the population size will likely be too small for an Integrated Care Provider contract which was initially explored as a potential option.

4.9 Project leads met with the local Community Action Group on 11 February to discuss the opportunity to hold an initial workshop with the Young Citizens Action Group to further shape the proposed model of care. A workshop is taking place in March which will include a presentation from the Clinical lead for the Barking Riverside project, Dr Jagan John on the proposed model of care, and the opportunity for local people to shape the proposed model of care, and agree a way forward to create a sustainable framework for engagement going forward.

5.0 Next steps 5.1 Continue to develop/design a new model of care for Barking Riverside through the Barking

Riverside New Model of Care Design Group, working closely with local people and operational staff; further Model of Care Meetings have been arranged up to March 2020.

5.2 A workshop with Local Authority care staff on 17 February 2020 to draw out; the current barriers to the delivery of care to local people, and as well as what works well, what a ‘gold standard’ model of health and care would look like and how we would design and commission this, as well as other key requirements of the building to feed back to the Developer / wellbeing hub design group in relation to social care services.

5.3 Workshop in March with leads from across health and care, led by Dr John, and local people to

shape the model of care.

5.4 A session with the local school to promote careers in health and care with local school children, and discuss with them the proposals around the wellbeing hub at Barking Riverside.

5.5 Articulate the emerging model of care as a formal Service Specification for the health and care

element of the wellbeing hub, with a view to developing a final draft by March 2020.

6.0 Resources/investment 6.1 Estates and Technology Transformation Fund (ETTF) monies have been utilised to support the

Barking Riverside development programme to date.

6.2 There may be some financial investment required on an ‘invest to save’ basis (subject to development of business case) for the testing of elements of the model of care at the nearby Thamesview Health Centre who are taking forward a ‘frailty’ project based upon the principles of integrated care.

6.3 There may also be future financial investment implications for the delivery of the required

enablers for the model of care at Barking Riverside e.g. integrated IT systems; work is already underway to take forward these enabling programmes and they will support delivery of the wider BHR Integrated Care aspirations as opposed to solely benefiting the Barking Riverside development.

6.4 A business case will shortly be developed for the new Barking Riverside wellbeing hub, taking in

to account the anticipated frontloading of prevention activity and mapping this forward in terms of developing a model of care that is sustainable. This business case will go through a due diligence process and scrutiny, both locally and through NHSE processes.

7.0 Equalities 7.1 An initial equalities impact assessment has been undertaken for the Barking Riverside wellbeing

hub. This will be reviewed and updated as the programme, and build, progresses.

8.0 Risk 8.1 There are a number of key risks identified in relation to the Barking Riverside development, the

principle risk centres on the impact of any failure to develop a suitable wellbeing hub to meet the needs of local people.

8.2 Another key risk identified with the new model of care in the context of the BHR System Financial challenge, is the need to ensure that funding for the new population coming in to the area is in line with growth, rather than retrospective. BHR CCGs finance team are aware of this key risk and have initiated discussion with the Department of Health to consider how to address this.

9.0 Managing conflicts of interest 9.1 It should be noted that all providers of health and care are potential bidders/providers of the

services that will be delivered from the hub in the future. Attachments: 1. Early draft of the proposed model of care 2. Case study; how the model of care will make a difference to local people (first of a series that

will be developed)

Author: Emily Plane, Head of Primary Care Transformation, NHS Havering CCG Date: 12 February 2020

The Emerging Model of CareEARLY DRAFT

Early articulation of the DRAFT model of care, which is being built on:

NB: 10,000 patient list

size = triage circa 60 people

per day Call Come in

Click(online)

TRIAGE

Receptionist asks the reason for the visit to the practice.Appointment requests are dealt with by trained staff who follow script to handle requests

Nurse/HCA appointments booked directly

GP appointment/home visit requests triaged by senior clinician (call back)

GP appointment request where patient will not give details, routine GP appointment booked

If other info/advice is needed , book with other Healthcare professional or transfer to Care Navigator or Social Prescriber

Escalation progress in place for emergencies. Staff trained to respond to emergency calls and when to call 999GP will prioritise cases such as safeguarding, mental health, ill child, palliative care etc. in order of clinical concern for

urgent appointment

Single phone number for centre.

Health calls – answered by trained staff who follow script to handle requests

Nurse/HCA appointments booked directly

GP appointment/home visit requests triaged by senior clinician (call back)

GP appointment request where patient will not give details, routine GP appointment booked

If other info/advice is needed , book with other Healthcare professional or transfer to Care Navigator or Social Prescriber

Use practice website to access appointment booking online (once signed up as user): HCA/Nurse/NP Other healthcare

professionals TBC Routine GP appointment

Use practice website to access e-consultations to get advice/self help/ pharmacy/ request a consultation.

Use practice website to find easy access info/advice on support services e.g. housing, talking therapies, social care etc.

LeisureAccess to Gym and OT /

Physiotherapy

Community Solutions

& links to wider servicesIncluding Housing and

the Community andVoluntary Sector

Links to local schools and wider community

Social Prescribers

General Practitioners x3

NursePractitioner x2

Health Care Assistants

Social Workers

First Contact Physio

Physicians Assistant

Clinical Pharmacist

Paramedic

District Nurse

Mental Health Link Worker

Health Visitor

ReceptionistsAdmin

Care Navigators

Dentistry

Nutrition and dietetics

Single Care Plan

Virtual Secondary Care Clinics

CTT team base?

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http://www.iconarchive.com/show/vista-people-icons-by-icons-land/Medical-Pharmacist-Female-Dark-icon.html

http://www.iconarchive.com/show/vista-people-icons-by-icons-land/Medical-Pharmacist-Female-Dark-icon.html

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http://www.iconarchive.com/show/medical-icons-by-icons-land/People-Doctor-Female-icon.html

http://www.iconarchive.com/show/medical-icons-by-icons-land/People-Doctor-Female-icon.html

http://www.iconarchive.com/show/vista-people-icons-by-icons-land/Age-Child-Male-Light-icon.html

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http://www.iconarchive.com/show/medical-icons-by-devcom/pregnant-icon.html

http://www.iconarchive.com/show/medical-icons-by-devcom/pregnant-icon.html



Experience Based Design – The Barking Riverside model

job cent

re

plus

10

45 year old Bob was made redundant in 2015

Despite looking, has struggled to find work

He has become less active and put on weight

He has started drinking every evening

Bob feels depressed about his situation and doesn’t know who to speak to for support. He feels embarrassed to speak about how he is feeling with his family and friends

Bob visits his GP because he feels depressed

His GP really wants to help but cannot get to the root of Bob’s depression within a 10 minute appointment

The GP suggests that Bob cuts down his drinking and exercises more but Bob doesn’t feel in the right frame

of mind to achieve this on his own

Bob’s GP isn’t aware of local services that could help in this situation, or how to refer him for support

Bob’s Story Bob’s current pathway

The key outcome that Bob really wants is to feel happy again; he feels that if he is able to get back to work, and find an outlet to socialise that doesn’t involved drinking, this would have a big impact on his wellbeing

Bob calls the wellbeing hub at Barking Riverside; he has seen the number advertised in his building. He hopes that he can talk to someone there about options to improve his health and wellbeing, cut down on his drinking, and get back in to work, without having to see his GP

Impact of the Barking Riverside Model

10am

Bob is triaged by a Care Navigator, and after a few questions to ascertain the nature of his call, is referred to a local Social Prescriber

Bob decides to have his consultation with the Social Prescriber via telephone, rather than coming in to the hub

Bob’s Social Prescriber discusses his situation with him over 20 minutes. Bob feels at ease and is able to discuss his situation frankly, particularly as he is able to have the conversation from his own home, in private

Bob is talked through local opportunities which Bob can become involved in, and he is particularly interested in becoming involved in a local Handy Man scheme, as well as a ‘men in sheds’ group which meets locally where he can make friends

Bob is also given an appointment with a local community group who support local people to improve their CVs and local job applications, the job centre also suggests jobs that Bob had never considered before, including becoming a Porter at his local hospital, where there are currently vacancies

Bob is able to build on his CV through his volunteer work, and improves his applications through working with the advice from his local community support group. Bob eventually gets a job as a Porter in his local hospital. The walking helps to keep his weight down and he loves the people that he works with, feeling real pride in his job, and that he is making a difference to peoples lives.

KEY OUTCOMES:

Bob receives the help he needs, first time Frees up GP time for more complex medical cases Reduction in unemployment Reduction in medication for depression/anxiety Improved wellbeing e.g. reduction in depression, increased healthy weight

Reduction in local health and care service vacancies

bhr primary care commissioning committee...2020/02/26 · bhr primary care commissioning committee...

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