meeting agenda ( public session) primary care ... · agenda 2 of 152 09:00 - 10:35, zoom...

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Meeting Agenda (Public Session)

Primary Care Commissioning Committee Wednesday 19 August 2020 9:00-10:35

Zoom Meeting

Time Item Presenter Reference

09:00 Introductory Items

1. Welcome, introductions and apologies Eleri de Gilbert PCC/20/074

2. Confirmation of quoracy Eleri de Gilbert PCC/20/075

3. Declarations of interest for any item on the agenda Eleri de Gilbert PCC/20/076

4. Management of any real or perceived conflicts of interest

Eleri de Gilbert PCC/20/077

5. Questions from the public Eleri de Gilbert PCC/20/078

6. Minutes from the meeting held on 15 July 2020 Eleri de Gilbert PCC/20/079

7. Action log and matters arising from the meeting held on 15 July 2020


8. Actions arising from the Governing Body Eleri de Gilbert PCC/20/081

09:10 Committee Business

9. Draft Annual Work Programme and Terms of Reference

Siân Gascoigne PCC/20/082

09:15 Covid-19 Recovery and Planning

10. Third Phase of NHS Response to Covid-19 Joe Lunn PCC/20/083

11. Integrated Care System (ICS) Seasonal Flu Plan Danielle Burnett PCC/20/084

12. Covid-19 GP Practice Additional Expenses’ Joe Lunn PCC/20/085

13. General Practice Vulnerable Staff Risk Assessment Exercise: Outcome

Lynette Daws PCC/20/086

09:40 Items for Approval

14. Primary Care support for Care Homes in South Nottinghamshire

Fiona Callaghan PCC/20/087

09:55 Items for Assurance

15. Primary Care Workforce Update Andrea Brown PCC/20/088

16. GP Survey Results Joe Lunn PCC/20/089

17. Quarterly Quality Update Danielle Burnett PCC/20/090

10:20 Financial Management

18. Finance Report Michael Cawley PCC/20/091

Chair: Eleri de Gilbert

Enquiries to: ncccg.notts - [email protected]

Agenda

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mailto:ncccg.notts%20-%[email protected]

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10:25 Risk Management

19. Risk Report Siân Gascoigne PCC/20/092

10:30 Closing Items

20. Any other business Eleri de Gilbert PCC/20/093

21. Key messages to escalate to the Governing Body Eleri de Gilbert PCC/20/094

22. Date of next meeting:

16/09/2020

Zoom Meeting


Confidential Motion: The Primary Care Commissioning Committee will resolve that representatives of the press and other members of the public be excluded from the remainder of this meeting, having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest (Section 1[2] Public Bodies [Admission to Meetings] Act 1960)

Agenda

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Name Current position (s)

held in the CCGs

Declared

Interest

(Name of the

organisation

and nature of

business)

Nature of Interest

Fin

an

cia

l In

tere

st

No

n-f

ina

nc

ial

Pro

fes

sio

na

l

Inte

res

ts

No

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ial

Pe

rso

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sts

Ind

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Inte

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t

Da

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rom

:

Da

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o:

Action taken to mitigate risk

AINSWORTH, David Locality Director Mid-Notts Erewash Borough Council Lay Member of the

Remuneration Committee

01/01/2019 Present This interest will be kept under review

and specific actions determined as

required.

AINSWORTH, David Locality Director Mid-Notts Consultancy Ad hoc nurse consultancy to

provider organisations



required.

AINSWORTH, David Locality Director Mid-Notts Saxon Cross Surgery Registered Patient

-

Present This interest will be kept under review


required - as a general guide, the

individual should be able to participate in

discussions relating to this practice but AUDIS, Adrian NHS England/NHS

Improvement

Commissioning Manager

No relevant interests declared Not applicable

- -

Not applicable

BEEBE, Shaun Non-Executive Director Eastwood Primary Care Centre Family members are registered

patients

-

01/03/2020 Interest expired - no action required

BEEBE, Shaun Non-Executive Director University of Nottingham Senior manager with the

University of Nottingham

-



required.

BEEBE, Shaun Non-Executive Director Nottingham University Hospitals

NHS Trust

Patient in Ophthalmology

-



required.

BURNETT, Danni Deputy Chief Nurse NHS England and Improvement Spouse employed as Senior

Delivery and Improvement Lead



required.

BURNETT, Danni Deputy Chief Nurse Nottingham and Nottinghamshire

CCGs

Family member employed as

Head of Service Improvement

and BCF



required.

Register of Declared Interests

• As required by section 14O of the NHS Act 2006 (as amended), the CCG has made arrangements to manage conflicts and potential conflicts of interest to ensure

that decisions made by the CCG will be taken and seen to be taken without being unduly influenced by external or private interests.

• This document is extracted, for the purposes of this meeting, from the CCG’s full Register of Declared Interests (which is publically available on the CCG’s website).

This document was extracted on 16 July 2020 but has been checked against the full register prior to the meeting to ensure accuracy .

• The register is reviewed in advance of the meeting to ensure the consideration of any known interests in relation to the meeting agenda. Where necessary

(for example, where there is a direct financial interest), members may be fully excluded from participating in an item and this will include them not receiving

the paper(s) in advance of the meeting.

• Members and attendees are reminded that they can raise an interest at the beginning of, or during discussion of, an item if they realise that they do have a (potential) interest

that hasn’t already been declared.

• Expired interests (as greyed out on the register) will remain on the register for six months following the date of expiry.

Declarations of interest for any item

on the agenda

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held in the CCGs

Declared

Interest

(Name of the

organisation

and nature of

business)

Nature of Interest

Fin

an

cia

l In

tere

st

No

n-f

ina

nc

ial

Pro

fes

sio

na

l

Inte

res

ts

No

n-f

ina

nc

ial

Pe

rso

na

l In

tere

sts

Ind

ire

ct

Inte

res

t

Da

te F

rom

:

Da

te T

o:


BURNETT, Danni Deputy Chief Nurse NHS England and Improvement Family member employed as

Contracts Manager



required.

BURNETT, Danni Deputy Chief Nurse NEMS Community Benefit Services

Ltd

Family member employed as

Finance Accountant



required.

BURNETT, Danni Deputy Chief Nurse Academic Health Science Network Family member employed in

Project Team



required.

BURNETT, Danni Deputy Chief Nurse Castle Healthcare Practice Registered Patient 01/07/2018 Present This interest will be kept under review




discussions relating to this practice but

be excluded from decision-making.

CALLAGHAN, Fiona Locality Director - South

Nottinghamshire

Radcliffe on Trent Health Centre Registered Patient

-







CAWLEY, Michael Operational Director of

Finance

Castle Healthcare Practice Registered Patient

-







DADGE, Lucy Chief Commissioning Officer Mid Nottinghamshire and Greater

Nottingham Lift Co (public sector)

Director 01/10/2017 Present This interest will be kept under review


required.

DADGE, Lucy Chief Commissioning Officer Pelham Homes Ltd – Housing

provider subsidiary of

Nottinghamshire Community

Housing Association



required.

DADGE, Lucy Chief Commissioning Officer 3Sixty Care Ltd – GP Federation,

Northamptonshire

Chair 01/01/2017 Present This interest will be kept under review


required.

DADGE, Lucy Chief Commissioning Officer First for Wellbeing Community

Interest Company (Health and

Wellbeing Company)



required.

DADGE, Lucy Chief Commissioning Officer Valley Road Surgery Registered Patient 19/06/1905 Present This interest will be kept under review







on the agenda

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held in the CCGs

Declared

Interest

(Name of the

organisation

and nature of

business)

Nature of Interest

Fin

an

cia

l In

tere

st

No

n-f

ina

nc

ial

Pro

fes

sio

na

l

Inte

res

ts

No

n-f

ina

nc

ial

Pe

rso

na

l In

tere

sts

Ind

ire

ct

Inte

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t

Da

te F

rom

:

Da

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o:


DADGE, Lucy Chief Commissioning Officer Nottingham Schools Trust Chair and Trustee 01/11/2017 Present This interest will be kept under review


required.

DAWS, Lynette Head of Primary Care Rivergreen Medical Centre Family members are registered

patients

-







DE GILBERT, Eleri Non-Executive Director Middleton Lodge Surgery Individual and spouse registered

patients at this practice

-







DE GILBERT, Eleri Non-Executive Director Rise Park Practice Son and Daughter in Law

registered patients



required.

DE GILBERT, Eleri Non-Executive Director Nottingham Bench Justice of the Peace

-



required.

DE GILBERT, Eleri Non-Executive Director Sherwood and Newark Citizens

Advice Bureau

Trustee on the board 01/03/2016 07/02/2020 Interest expired - no action required

DE GILBERT, Eleri Non-Executive Director Major Oak Medical Practice,

Edwinstowe

Son, daughter in law and

grandchild registered patients

-



required.

GASCOIGNE, Sian Head of Corporate

Assurance

Nottingham University Hospitals

NHS Trust

Husband is the Integration

Manager



required.

GASCGOIGNE, Sian Head of Corporate

Assurance

Radcliffe Health Centre Patient

Participation Group

Father is a member 01/01/2019 Present This interest will be kept under review


required.


Assurance

Nottinghamshire Healthwatch Father is a volunteer 01/01/2019 Present This interest will be kept under review


required.


Assurance

Castle Healthcare Practice Registered Patient

-








on the agenda

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held in the CCGs

Declared

Interest

(Name of the

organisation

and nature of

business)

Nature of Interest

Fin

an

cia

l In

tere

st

No

n-f

ina

nc

ial

Pro

fes

sio

na

l

Inte

res

ts

No

n-f

ina

nc

ial

Pe

rso

na

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tere

sts

Ind

ire

ct

Inte

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t

Da

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rom

:

Da

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o:


GASKILL, Esther Head of Quality Intelligence Mapperley and Victoria Practice Registered Patient

-







GRIFFITHS, Helen Associate Director of Primary

Care Networks

Musters Medical Practice Registered Patient 01/04/2013 Present This interest will be kept under review







Care Networks

Castle Healthcare Practice

(Rushcliffe Practice)

Spouse is GP Partner 01/10/2015 Present To be excluded from all commissioning

decisions (including procurement

activities and contract management

arrangements) relating to services that

are currently, or could be, provided by

this practice


Care Networks

Embankment Primary Care Centre Spouse is Director 01/10/2015 Present This interest will be kept under review


required.


Care Networks

NEMS Healthcare Ltd Spouse is shareholder 01/04/2013 Present This interest will be kept under review


required.


Care Networks

Partners Health LLP Spouse is a member 01/10/2015 Present This interest will be kept under review


required.


Care Networks

Principia Multi-specialty Community

Provider

Spouse is a member 01/10/2015 Present This interest will be kept under review


required.


Care Networks

Nottingham Forest Football Club Spouse is a Doctor for club 01/04/2013 Present This interest will be kept under review


required.

LUNN, Joe Interim Associate Director of

Primary Care

Kirkby Community Primary Care

Centre

Registered Patient

-







STRATTON, Dr Richard GP Representative Belvoir Health Group GP Partner 01/08/2012 Present To be excluded from all commissioning



arrangements) relating to services that

are currently, or could be, provided by

GP Practices.


on the agenda

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held in the CCGs

Declared

Interest

(Name of the

organisation

and nature of

business)

Nature of Interest

Fin

an

cia

l In

tere

st

No

n-f

ina

nc

ial

Pro

fes

sio

na

l

Inte

res

ts

No

n-f

ina

nc

ial

Pe

rso

na

l In

tere

sts

Ind

ire

ct

Inte

res

t

Da

te F

rom

:

Da

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o:


STRATTON, Dr Richard GP Representative PartnersHealth LLP GP member 01/11/2015 Present To be excluded from all commissioning



arrangements) in relation to services

currently provided by Partners Health

LLP; and Services where it is believed

that Partners Health LLP could be an

interested bidder.

SUNDERLAND, Sue Non-Executive Director Joint Audit Risk Assurance

Committee, Police and Crime

Commissioner (JARAC) for

Derbyshire / Derbyshire

Constabulary



required.

SUNDERLAND, Sue Non-Executive Director NHS Bassetlaw CCG Governing Body Lay Member 16/12/2015 Present This interest will be kept under review


required.

SUNDERLAND, Sue Non-Executive Director Inclusion Healthcare Social

Enterprise CIC (Leicester City)

Non-Executive Director 16/12/2015 Present This interest will be kept under review


required.

TILLING, Michelle Locality Director - City No relevant interests declared Not applicable

- -

Not applicable

TRIMBLE, Dr Ian Independent GP Advisor Occasional consultancy work for

other CCGs

Occasional consultancy work for

other CCGs



required.

TRIMBLE, Dr Ian Independent GP Advisor Unity Surgery, Mapperley Registered Patient

-







TRIMBLE, Dr Ian Independent GP Advisor National Advisory Committee for

Resource Allocation

Independent GP Advisor 01/04/2013 Present This interest will be kept under review






WRIGHT, Michael LMC Representative, CEO Practice Support Services Limited -

Nottinghamshire

Support service as for profit

subsidiary of LMC



required.

WRIGHT, Michael LMC Representative, CEO LMC Buying Groups Federation Manager 01/04/2016 Present This interest will be kept under review


required.


on the agenda

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held in the CCGs

Declared

Interest

(Name of the

organisation

and nature of

business)

Nature of Interest

Fin

an

cia

l In

tere

st

No

n-f

ina

nc

ial

Pro

fes

sio

na

l

Inte

res

ts

No

n-f

ina

nc

ial

Pe

rso

na

l In

tere

sts

Ind

ire

ct

Inte

res

t

Da

te F

rom

:

Da

te T

o:


WRIGHT, Michael LMC Representative, CEO GP-S coaching and mentoring Support service as for profit

subsidiary of LMC



required.

WRIGHT, Michael LMC Representative, CEO Nottinghamshire GP Phoenix

Programme

Manager 01/04/2016 Present This interest will be kept under review


required.

WRIGHT, Michael LMC Representative, CEO Castle Healthcare Practice Registered Patient 30/09/2016 Present This interest will be kept under review


required.

WRIGHT, Michael LMC Representative, CEO Notspar and Trent Valley Surgery

Special Allocation Schemes (violent

patient schemes)



required.


on the agenda

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Managing Conflicts of Interest at Meetings

1. A “conflict of interest” is defined as a “set of circumstances by which a reasonable person

would consider that an individual’s ability to apply judgement or act, in the context of

delivering commissioning, or assuring taxpayer funded health and care services is, or could

be, impaired or influenced by another interest they hold”.

2. An individual does not need to exploit their position or obtain an actual benefit, financial or

otherwise, for a conflict of interest to occur. In fact, a perception of wrongdoing, impaired

judgement, or undue influence can be as detrimental as any of them actually occurring. It is

important to manage these perceived conflicts in order to maintain public trust.

3. Conflicts of interest include:

Financial interests: where an individual may get direct financial benefits from the

consequences of a commissioning decision.

Non-financial professional interests: where an individual may obtain a non-financial

professional benefit from the consequences of a commissioning decision, such as

increasing their reputation or status or promoting their professional career.

Non-financial personal interests: where an individual may benefit personally in ways

which are not directly linked to their professional career and do not give rise to a direct

financial benefit.

Indirect interests: where an individual has a close association with an individual who has

a financial interest, a non-financial professional interest or a non-financial personal

interest in a commissioning decision.

The above categories are not exhaustive and each situation must be considered on a case

by case basis.

4. In advance of any meeting of the Committee, consideration will be given as to whether

conflicts of interest are likely to arise in relation to any agenda item and how they should be

managed. This may include steps to be taken prior to the meeting, such as ensuring that

supporting papers for a particular agenda item are not sent to conflicted individuals.

5. At the beginning of each formal meeting, Committee members and co-opted advisors will be

required to declare any interests that relate specifically to a particular issue under

consideration. If the existence of an interest becomes apparent during a meeting, then this

must be declared at the point at which it arises. Any such declaration will be formally

recorded in the minutes for the meeting.

Management of any real or perceived conflicts of interest

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6. The Chair of the Committee (or Deputy Chair in their absence, or where the Chair of the

Committee is conflicted) will determine how declared interests should be managed, which is

likely to involve one the following actions:

Requiring the individual to withdraw from the meeting for that part of the discussion if the

conflict could be seen as detrimental to the Committee’s decision-making arrangements.

Allowing the individual to participate in the discussion, but not the decision-making

process.

Allowing full participation in discussion and the decision-making process, as the potential

conflict is not perceived to be material or detrimental to the Committee’s decision-making

arrangements.

Management of any real or perceived conflicts of interest

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NHS Nottingham and Nottinghamshire Clinical Commissioning Group

Public Session of the Primary Care Commissioning Committee

Unratified minutes of the meeting held on

15/07/2020, 9.00-09:45

Zoom Meeting

Members present:

Eleri de Gilbert Non-Executive Director (Chair)

Shaun Beebe Non-Executive Director

Danielle Burnett Deputy Chief Nurse

Michael Cawley Operational Director of Finance

Lucy Dadge Chief Commissioning Officer

Helen Griffiths Associate Director of Primary Care Networks

Joe Lunn Interim Associate Director of Primary Care

Dr Richard Stratton GP Representative

Sue Sunderland Non-Executive Director

Dr Ian Trimble Independent GP Advisor

In attendance:

Adrian Audis Commissioning Manager, NHS England/Improvement GP Hub

Helen Brocklebank-Clark Corporate Governance Officer (minutes)

Lynette Daws Head of Primary Care

Siân Gascoigne Head of Corporate Assurance

Esther Gaskill Head of Quality – Primary Care

Michelle Tilling Locality Director, Nottingham City (item PCC/20/065)

Michael Wright Nottinghamshire Local Medical Committee

Cumulative Record of Members’ Attendance (2020/21)

Name Possible Actual Name Possible Actual

Shaun Beebe 4 4 Joe Lunn 4 3

Michael Cawley 4 4 Dr Richard Stratton 4 4

Lucy Dadge 4 4 Sue Sunderland 4 4

Eleri de Gilbert 4 4 Dr Ian Trimble 4 4

Helen Griffiths 4 4 Danielle Burnett 4 2

Introductory Items

PCC 20 057 Welcome and Apologies

Eleri de Gilbert welcomed everyone to the public session of the Primary Care

Commissioning Committee meeting, which was being held virtually due to the Covid-19

pandemic.

No apologies had been received.

Minutes from the meeting held on 15 July 2020

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PCC 20 058 Confirmation of Quoracy

The meeting was declared quorate

PCC 20 059 Declaration of interest for any item on the shared agenda

No interests were declared in relation to any item on the agenda.

The Chair reminded members of their responsibility to highlight any interests should

they transpire as a result of discussions during the meeting.

PCC 20 060 Management of any real or perceived conflicts of interest

As no conflicts of interest had been identified, this item was not necessary for the

meeting.

PCC 20 061 Questions from the public

No questions had been received.

PCC 20 062 Minutes from the meeting held on 17 June 2020

It was agreed that the minutes were an accurate record of the meeting.

PCC 20 063 Action log and matters arising from the meeting held on 17 June 2020

Eleri de Gilbert provided a verbal update in relation to action PCC 20 049: feedback to

Healthwatch the value in revisiting the survey in relation to the differential impact of

Covid-19 on the Black, Asian and Minority Ethnic (BAME) population. It was agreed that

this action could be closed on the Primary Care Commissioning Committee (PCCC)

action log as the Quality and Performance Committee, in light of Covid-19, were

considering the wider issue of health inequalities, and the impact on the BAME

population and considering next steps.

Contract Management and Applications

PCC 20 064 Orchard Medical Practice: List Closure Update

Lynette Daws introduced the item and highlighted the following points:

a) In September 2019, Mansfield and Ashfield CCG’s Primary Care Commissioning

Committee approved an application for Orchard Medical Practice to close their

patient list for a period of twelve months to address workforce challenges.

b) Since the list closure a current salaried GP joined the partnership and the practice

has successfully recruited a salaried GP, a Nurse Practitioner, and a Pharmacy

Technician. However, the practice still has a salaried GP vacancy and a Nurse

Practitioner vacancy.

c) The GP to patient ratio remains below the NHS England//Improvement and British

Medical Association (BMA) average.

d) The main impact of the list closure is on neighbouring practices; however, there is

currently no real impact on the Mansfield North Primary Care Network (PCN) and

although Rosewood PCN has seen an increase in its list size, it had previously

expressed positivity towards registering more patients.

e) During discussions the practice has informally requested to defer the reopening of


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their list by three to six months as result of Covid-19. However, as the maximum

time period for a list closure has been reached, a formal application would need to

be submitted to the CCG, for consideration by the Committee.

f) As such, it is anticipated that Orchard Medical Practice will reopen its patient list on

the 1 October 2020.

The following points were made in discussion:

g) It was positive to see that the workforce challenges experienced by the practice had

improved through successfully recruitment to vacant staff groups.

h) The Committee welcomed the reopening of the patient list on the 1 October 2020.

The Primary Care Commissioning Committee:

NOTED the information contained in the paper

Items for Approval

PCC 20 065 Nottingham City: First Contact Physiotherapists and Care Coordinators

Additional Roles

Michelle Tilling was in attendance to present this item. The following points were

highlighted:

a) This paper related to First Contact Physiotherapists and Care Coordinators within

Nottingham City.

b) Under the Primary Care Network Contract Directed Enhanced Service (PCN DES),

funding is made available to PCNs through the Additional Roles Reimbursement

Scheme (ARRS) to recruit additional staff members across a range of specific roles,

including First Contact Physiotherapists (FCPs) and Care Coordinators.

c) FCPs are physiotherapists with enhanced skills who are able to see patients with

musculoskeletal (MSK) issues directly without needing a referral from their GP; this

is a role anticipated to be much sought after through the Covid-19 recovery phase

as numbers of people experiencing MSK issues is anticipated to increase.

d) In contrast to previous versions of the PCN DES, the most recent version, released

on 31 March 2020, limited the number of FCPs a PCN was eligible to be reimbursed

for to “one WTE per PCN where the PCN’s patients number 99,999 or less”.

However, “the commissioner may waive any limits in Table 1 where this is agreed by

the PCN, the commissioner, and the relevant Integrated Care System”.

e) The Radford and Mary Potter, Nottingham City East and Clifton and Meadows PCNs

request that this waiver is applied to allow them to continue with their plans to recruit

up to 2.0 Whole Time Equivalent (WTE) FCPs, 1.8 WTE FCPs and 2.0 WTE FCPs

respectively, in the year 2020/21, to meet the identified needs of their patient

populations.

f) Nottingham City East PCN wishes to employ a Care Coordinator under the ARRS

scheme with a sole focus on managing the workload generated by an increase in

safeguarding concerns. This is a slight deviation from the key responsibilities of the

Care Coordinator as detailed in the PCN DES, although three of the responsibilities

will be met indirectly by this role.


g) It was explained that from the perspective of the CCG’s Quality Team, the role of

Care Coordinator would be a fantastic asset to complement the primary care


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workforce, which would receive wraparound support from the clinical roles in the

practice and would work closely with the CCGs safeguarding capacity.

h) Discussion took place regarding whether the role of Care Coordinator needed to be

approved by the PCCC. It was confirmed that although the PCN DES did not

explicitly state that PCCC approval was required; it was being sought as the role

was prescriptive and not all of its key responsibilities would be directly met. In

addition, it provided an opportunity to ensure the PCCC was sighted on the

innovation and creativity emerging during the early stages of PCN development.

i) Members were advised that the national allocation for roles and reimbursements for

2020/21 had not yet been confirmed. This is of local and national concern, and was

not felt to detract from the need for the Committee to consider the proposed

changes to the outlined roles, although it was noted if recruitment were to occur then

at the current time this would be at risk to the CCG.

j) Concern was raised that Clifton and Meadows PCN had identified that they might

not be able to maintain the level of staffing associated with the increase in WTE

FCPs in the long term. It was emphasised that longer term sustainability was key to

approval .

k) Members were supportive of increasing the number of WTE FCPs and the proposed

safeguarding focus for the Care Coordinator role. However, it was recognised that

there was currently tension associated with the requirement to deliver a key part of

the NHS long term plan whilst the allocations to fund these roles had not yet been

confirmed to the CCG.


APPROVED the increase in number of WTE First Contact Physiotherapists eligible

to be reimbursed to the Radford & Mary Potter PCN under the Additional Roles

Reimbursement Scheme for 2020/21 from 1.0 WTE to 2.0 WTE.


to be reimbursed to the Nottingham City East PCN under the Additional Roles



to be reimbursed to the Clifton & Meadows PCN under the Additional Roles


APPROVED the proposed safeguarding focus for the Care Coordinator role within

the Nottingham City East PCN under the Additional Roles Reimbursement Scheme

for 2020/21.

Covid-19 Update

PCC 20 066 Primary Care Recovery Group Terms of Reference

Joe Lunn introduced the item, highlighting the following points:

a) A Primary Care Recovery Group has been established to support primary care

through the period of restoration and recovery, and establish a ‘new normal’.

b) Following review at the June meeting, the Committee asked for the Group’s terms of

reference to be updated to reflect the outputs of the Group, how these would be

delivered and how the reporting requirements for other CCG cells (once established)


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would be incorporated.

c) The terms of reference have been updated accordingly, with the addition of a

change to the frequency of the meetings which are now weekly rather than bi-

weekly.

d) The changes were approved by the Primary Care Recovery Cell on the 9 July 2020

and are presented to the Committee for information.


e) Members were happy that the revised terms of reference reflected comments made

at the June meeting.


NOTED the updated Terms of Reference for the Primary Care Recovery Group.

PCC 20 067 Covid-19 GP Practice Additional Expenses’

Joe Lunn introduced the item and highlighted the following key points:

a) The purpose of this paper is to provide the Committee with an overview of the

Covid-19 additional expense claims for May 2020.

b) The total cost of the claims submitted for May is £539,277.91, of which £419,068.34

has been approved for payment. This includes payment of new claims for May,

claims previously on hold and a small amount of late submission claims.

c) An additional £10,126.42 worth of equipment claims has also been approved for

payment this month.


d) It was confirmed that although the process is currently working well, if the rules

change the CCG might not be in a position to reimburse costs received beyond the

payment deadline. Proactive action is being taken to encourage practices to submit

their claims for reimbursement as soon as possible, and review the backlog of

outstanding claims. Additionally, a communication will be circulated via TeamNet to

remind practices of the July deadline for submitting a claim.

e) Confirmation was received that the CCG has recently received reimbursement from

NHS England/Improvement for the claims processed within the deadline.

f) It was suggested that it would be useful to share with practices the areas of spend,

broken down by percentage, to increase awareness and provide a guide to what

they can claim for. Joe Lunn agreed to include this on the TeamNet communication,

and highlighted that the paper was available for review on the CCG’s website.

g) Members were pleased to see a proactive approach was being taken to clear the

backlog and were assured that the process was working.

ACTION:

Joe Lunn to share, via TeamNet, the categories of spend, broken down by

percentage, to increase practice awareness of what they can submit a

reimbursement claim for.


NOTED the information for assurance purposes.


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For Assurance

PCC 20 068 Workforce Scoring Matrix for List Closures - Practice Data Comparison

Joe Lunn presented this item and highlighted the following points:

a) At the May 2020 meeting the Committee agreed in principle to the use of the

Workforce Scoring Matrix Template to capture all information required in support of

decisions relating to list closure applications, subject to the completion of a testing

exercise.

b) This paper presents the outcome of the exercise to compare the General Practice

Workforce Data returns against the workforce measures referenced in each of the

last three list closure applications received by the predecessor Primary Care

Commissioning Committee’s in 2019.

c) The outcome of the testing exercise revealed that the accuracy of the data

submitted by the practices across Nottingham and Nottinghamshire varied. In

mitigation, the Primary Care Team is developing local guidance to support practices

to submit accurate data to the National Workforce Reporting System (NWRS) portal.

d) In all three instances, the workforce position faced by the practice was considered

as part of the decision to approve the list closure and in all cases had improved

during the period of closure.

e) It is important to note that other challenges faced by practices were also taken into

account as part of the list closure application process.

f) Of the practices reviewed, practice A has already reopened its practice list and

practice B and C are due to open their lists in October and September respectively.


g) Members were assured that both workforce planning and the process for

considering list closure applications would be made more robust by the availability of

accurate workforce data.

h) It was noted that it was positive that during the period of closure all three practices

had taken steps to address workforce challenges to allow them to reopen as

anticipated.


RECEIVED the revised comparison of the workforce data for three list closure

applications

Financial Management

PCC 20 069 Finance Report

Michael Cawley presented this item, highlighting the following points:

a) As at month three, the revised financial regime continues; with a revised non-

recurrent primary care budget of £47.45 million for months one to four, against the

expected budget requirement calculated by the CCG finance team of £50.49 million.

b) Although the year to date financial position for the CCG is showing an overspend

position of £2.94 million, a breakeven position at month three is reported, as it is still

anticipated that NHS England/Improvement will provide a further allocation.

c) However, the position at month three is challenging as the national allocation for

roles and reimbursements for 2020/21 has not yet been confirmed, resulting in a

tension between allocation yet to be received and current/future spend.


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d) Members noted that the revised financial regime continues, and recognised the

challenges this presents to the CCG.


NOTED the contents of the Primary Care Commissioning Finance Report.

APPROVED the Primary Care Commissioning Finance Report as at month

three.

Risk Management

PCC 20 070 Risk Report

Siân Gascoigne was in attendance to present this paper and highlighted the following

points:

a) There are five risks relating to the Committee’s responsibilities, all of which have

been reviewed by the Head of Corporate Assurance, Chief Commissioning Officer

and the Interim Associate Director of Primary Care since the last meeting.

b) It is proposed that the risk score for RR 032 relating to workforce capacity within

General Practice is reviewed; however following discussion it was agreed to

postpone this until August when an update on General Practice workforce would be

provided by Andrea Brown.

c) A risk around delays in the national allocation for roles and reimbursements, and

consideration of this in commissioning decision making, for 2020/21 has been

incorporated on the Finance and Turnaround Committee’s risk report.

d) No new risks had been identified during the course of the meeting and no further

points were raised in discussion.


COMMENTED on the risks shown within the paper (including the high/red risk) and

those at Appendix A, noting that RR032 be reviewed following the next month’s

presentation and discussion on workforce planning in General Practice.

Closing Items

PCC 20 071 Any other business

No other business was identified.

PCC 20 072 Key messages to escalate to the Governing Body

a) Confirmation that the Orchard Medical Practice patient list is to reopen as planned;

b) Approval of the increase in WTE First Contact Physiotherapists at the Radford &

Mary Potter PCN, the Nottingham City East PCN and the Clifton & Meadows PCN

under the Additional Roles Reimbursement Scheme for 2020/21.

c) The approval of the proposed safeguarding focus for the Care Coordinator role

within the Nottingham City East PCN under the Additional Roles Reimbursement

Scheme for 2020/21.

d) The outcome of the exercise to compare the General Practice Workforce Data

returns against the workforce measures referenced in each of the last three list

closure applications received by the predecessor Primary Care Commissioning

Committee’s in 2019.


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PCC 20 073 Date of next meeting:

19/08/2020

Zoom Meeting

Confidential Motion: The Primary Care Commissioning Committee resolved that representatives of the press

and other members of the public be excluded from the remainder of this meeting, having

regard to the confidential nature of the business to be transacted, publicity on which

would be prejudicial to the public interest (Section 1[2] Public Bodies [Admission to

Meetings] Act 1960)


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Primary Care Commissioning Committee Action Log for the meeting held on 15 July 2020

MEETING

DATE

AGENDA

REFERENCE

AGENDA ITEM ACTION LEAD DATE TO BE

COMPLETED

COMMENT

ACTIONS OUTSTANDING

No actions outstanding

ACTIONS ONGOING/NOT YET DUE

No actions ongoing/not yet due

ACTIONS COMPLETED

17/06/2020 PCC 20 049 Healthwatch

Report

To feedback to Healthwatch the

value in revisiting the survey in

relation to the differential impact

of Covid-19 on the Black, Asian

and Minority Ethnic (BAME)

population.

Eleri de Gilbert 15/07/2020 At the July meeting it was

agreed that this action

could be closed on the

PCCC action log as the

Quality and Performance

Committee is considering

the wider issue of BAME

and health inequalities in

light of Covid-19 and will be

addressing next steps.

Action log and m

atters arising from the m

eeting held on 15 July 2020

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MEETING

DATE

AGENDA

REFERENCE


COMPLETED

COMMENT

15/07/2020 PCC 20 067 Covid-19 GP

Practice

Additional

Expenses’

Joe Lunn to share, via TeamNet,

the categories of spend, broken

down by percentage, to increase

practice awareness of what they

can submit a reimbursement

claim for.

Joe Lunn 19/08/2020 This information was

shared via the TeamNet

weekly bulletin on 14

August 2020.

Action log and m

atters arising from the m

eeting held on 15 July 2020

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Primary Care Commissioning Committee OPEN ACTION LOG from the Governing Body on 5 August 2020

MEETING

DATE

CCG AGENDA

REFERENCE


COMPLETED

COMMENT

ACTIONS OUTSTANDING

No actions outstanding

ACTIONS ONGOING/NOT DUE

No actions ongoing/not due

Actions arising from

the Governing B

ody

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Meeting Title: Primary Care Commissioning Committee

(Open Session)

Date: 19 August 2020

Paper Title: 2020/21 Committee Work Programme Paper Reference: PCC 20 082

Sponsor:

Presenter:

N/A Attachments/

Appendices:

A: Terms of

Reference

B: Summary of

Committee Roles and

Responsibilities

C: 2020/21

Committee Work

Programme

Siân Gascoigne, Head of Corporate

Assurance

Purpose: Approve ☒ Endorse ☐ Review

☐ Receive/Note for:

Assurance

Information

☒

Executive Summary

The purpose of this report is to:

Provide the Committee’s Terms of Reference for members’ information and to clarify the role of the

Committee in relation to the remainder of the CCG’s governance structure; and

Present an opening initial work programme for the Committee for 2020/21 for review and discussion.

Relevant CCG priorities/objectives:

Compliance with Statutory Duties ☒ Wider system architecture development

(e.g. ICP, PCN development)

☒

Financial Management ☒ Cultural and/or Organisational

Development

☐

Performance Management ☒ Procurement and/or Contract Management ☒

Strategic Planning ☒

Conflicts of Interest:

☒ No conflict identified

Completion of Impact Assessments:

Equality / Quality Impact

Assessment (EQIA)

Yes ☐ No ☐ N/A ☒ Not required for this item.

Draft Annual Work Programme and Terms of Reference

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Data Protection Impact

Assessment (DPIA)


Risk(s):

No risks are identified within this report.

Confidentiality:

☒No

Recommendation(s):

The Primary Care Commissioning Committee is requested to:

1. APPROVE its initial 2020/21 Work Programme (Appendix C), with a further iteration to be presented to

the 16 September 2020 meeting.


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Primary Care Commissioning Committee Work Programme

1. Introduction

1.1. The purpose of this report is to present the Primary Care Commissioning Committee’s

Terms of Reference for information, which outlines the committee’s duties, alongside

an initial committee work programme for review and approval.

1.2. Due to the need to prioritise the CCG’s response to the COVID-19 pandemic, there

has been a delay in developing the work programme for this year, therefore it is

proposed that the work programme covers the remainder of 2020/21 and also

incorporates the first four months of 2021/22 to enable consideration of a full 12 month

business cycle.

1.3. The work programme will be subject to further review over the coming weeks to ensure

that it accurately captures all reporting requirements, and in particular those relating to

the CCG’s restoration and recovery plans in response to COVID-19. It will continue to

be reviewed on a regular basis throughout the period covered.

2. Background Information

2.1. Good governance practice dictates that Committees should be supported by a work

programme, which sets out a coherent cycle of business for the next year of meetings.

The Work Programme is a key mechanism to ensure appropriately timed governance

oversight, scrutiny and transparency in a way that doesn’t place an onerous burden on

those in executive roles or create unnecessary or bureaucratic governance processes.

3. Terms of Reference

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

Service Act 2006 (as amended), NHS England has delegated the exercise of specified

primary care commissioning functions and powers to NHS Nottingham and

Nottinghamshire CCG. The Primary Care Commissioning Committee has been

established as the corporate decision-making body for the management of the

delegated functions and the exercise of the delegated powers.

3.2. More detailed information on the specific and general obligations relating to the

delegated functions are also set out in the Committee’s Terms of Reference, which are

provided for information at Appendix A. A summary of the roles and responsibilities of

all Committees within the governance structure is also provided at Appendix B, to

support members in understanding the inter-relationships with other committees within

the governance framework.

4. Delegated Financial Limits

4.1. The Governing Body has determined the financial limits that the Committee is required

to work within when discharging its duties relating to primary care transformation


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funds, contract awards, lease extensions and rent calculations. These are set out in

the CCG’s Standing Financial Instructions and can be summarised, as follows:

Matter delegated Delegated to

Revenue spend (primary care

transformation funds)

Investments:

a) to £50,000 a) Chief Commissioning Officer

(retrospectively reported to the Primary

Care Commissioning Committee)

b) 50,001 and above b) Primary Care Commissioning Committee

Contract awards

Where the CCG is a single or multi-

participant in a contract for services/works

or the purchase of goods, either via

competition or direct award (i.e. waiver

of quotation/tender requirements) the

following shall apply:

Primary Medical Services:

a) Total contract value/purchase price –

unlimited, within the delegated primary

co-commissioning budgets (in line with

the Delegation Agreement)

a) Primary Care Commissioning Committee

Agreements/Licenses

Primary Care:

a) Extensions to existing leases – value

up to £15,000

a) Associate Director of Estates and CFO

b) Extensions to existing leases – value

£15,001 and above

b) Primary Care Commissioning Committee

c) Approval of rent calculation – value up

to £15,000

c) Associate Director of Estates and CFO

d) Approval of rent calculation – value

£15,001 and above

d) Primary Care Commissioning Committee

5. Meeting Schedule

5.1. Meetings of the Primary Care Commissioning Committee are held on a monthly basis,

during the third week of the month on a Wednesday morning.

5.2. The continued avoidance of face-to-face meetings is one of the on-going measures to

limit the spread of COVID-19. Therefore, Primary Care Commissioning Committee

meetings will continue to be held virtually until further notice.

5.3. In the interests of openness and transparency, all open sessions of the Primary Care

Commissioning Committee will be held via the Zoom application to allow members of

the public to watch proceedings.


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6. Work Programme 2020/21

6.1. The proposed work programme for 2020/21 is attached at Appendix C. This has been

designed around the following key areas to support good governance, and following

discussions with the Committee’s Chair and the Chief Commissioning Officer:

a) Strategy, Planning and Service Transformation

b) Commissioning, Procurement and Contract Management

c) Quality Improvement

d) Financial Management

e) Risk Management

f) Committee Business

The work programme will be subject to change throughout the year, but will steer

agenda planning going forward.

6.2. Members are asked to note that the items on the work programme have deliberately

been kept at a ‘high-level’ to focus on the discharge of committee duties, rather than

the detail of specific reports. Details on papers will be kept by the Committee

Secretary as part of the Committee’s comprehensive forward work plan.

6.3. In addition to the specific papers detailed within the work programme, the Committee

will also:

a) Routinely consider the registered and declared interests of Committee members

at the start of each meeting.

b) Receive minutes from the previous meeting, along with updates against an on-

going log of agreed actions.

c) Progress actions arising from Governing Body meetings that have been

delegated to the Committee.

d) Make decisions in relation to the following delegated responsibilities, as and

when required:

Establishing new GP practices (including branch surgeries)

Managing GP practices providing inadequate standards of patient care

Dispersing the lists of GP practices

Agreeing variations to the boundaries of GP practices

Approving GP practice mergers and closures

Decisions about discretionary payments in accordance with the Statement

of Financial Entitlements Directions

Decisions relating to Premises Costs Directions functions.

e) Approve primary care transformation fund investment proposals in line with the

thresholds set out in the CCG’s Standing Financial Instructions.


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f) Agree on key messages and any issues to escalate to the Governing Body.

6.4. The Associate Director of Primary Care, with support from the Operational

Director of Finance, will continue to have responsibility for the approval of new GP

Retention Scheme applications and renewals, as agreed at the July 2019 meeting in

common of the six predecessor Nottingham and Nottinghamshire CCGs.

7. Recommendations

7.1. The Primary Care commissioning Committee is asked to:

APPROVE its initial 2020/21 Work Programme (Appendix C), with a further

iteration to be presented to the 16 September 2020 meeting.

Lucy Branson

Associate Director of Governance

August 2020


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Appendix A – Primary Care Commissioning Committee – Terms of Reference

1. Introduction /

Statutory

Framework

In accordance with its statutory powers under section 13Z of the

National Health Service Act 2006 (as amended), NHS England has

delegated the exercise of the primary care commissioning functions

specified in Schedule 1 to these Terms of Reference to NHS

Nottingham and Nottinghamshire CCG. More detailed information

on the specific and general obligations relating to the delegated

functions are also set out in Schedule 1. Details of those functions

reserved to NHS England are set out at Schedule 2.

Arrangements made under section 13Z may be on such terms and

conditions (including terms as to payment) as may be agreed

between NHS England and the CCG.

Arrangements made under section 13Z do not affect the liability of

NHS England for the exercise of any of its functions. However, the

CCG acknowledges that in exercising its functions (including those

delegated to it), it must comply with the statutory duties set out in

Chapter A2 of the NHS Act and including:

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

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

c) Duty to exercise its functions effectively, efficiently and

economically (section 14Q);

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

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

14S);

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

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

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

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

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

The CCG will also need to specifically, in respect of the delegated

functions from NHS England, exercise those in accordance with the

relevant provisions of section 13 of the NHS Act.

The Committee is subject to any directions made by NHS England

or by the Secretary of State.

The Primary Care Commissioning Committee has been established

in accordance with the CCG’s Constitution. The Committee will

function as a corporate decision-making body for the management

of the delegated functions and the exercise of the delegated

powers.

The Committee may delegate tasks to such individuals, sub-

committees or individual members as it shall see fit, provided that

any such delegations are consistent with the parties’ relevant

governance arrangements, are recorded in a scheme of delegation,


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are governed by terms of reference as appropriate and reflect

appropriate arrangements for the management of conflicts of

interest.

For the avoidance of doubt, in the event of any conflict between the

terms of the Delegation Agreement in place between NHS England

and NHS Nottingham and Nottinghamshire CCG, these terms of

reference for the Primary Care Commissioning Committee and the

CCG’s Standing Orders or Standing Financial Instructions, then the

Delegation Agreement will prevail.

2. Duties The Committee has been established in accordance with the above

statutory provisions to enable the Committee to make collective

decisions on the review, planning and procurement of primary care

services in Nottingham and Nottinghamshire, under delegated

authority from NHS England.

In performing its role the Committee will exercise its management of

the functions in accordance with the agreement entered into

between NHS England and NHS Nottingham and Nottinghamshire

CCG, which will sit alongside the delegation and the Terms of

Reference.

The functions of the Committee are undertaken in the context of a

desire to promote increased co-commissioning to increase quality,

efficiency, productivity and value for money and to remove

administrative barriers.

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

to the commissioning of primary medical services under section 83

of the NHS Act.

This includes the following:

a) Decisions in relation to the commissioning, procurement and

management of GMS, PMS and APMS contracts (including the

design of PMS and APMS contracts, monitoring of contracts,

taking contractual action such as issuing branch/remedial

notices, and removing a contract), including but not limited to the

following activities:

i) Decisions in relation to Enhanced Services;

ii) Decisions in relation to Local Incentive Schemes (including

the design of such schemes);

iii) Decisions in relation to the establishment of new GP

practices (including branch surgeries) and closure of GP

practices;

iv) Decisions about ‘discretionary’ payments;

v) Decisions about commissioning urgent care (including home

visits as required) for out of area registered patients;

a) The approval of practice mergers;

b) Planning primary medical care services in Nottingham and


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Nottinghamshire, including carrying out needs assessments;

c) Undertaking reviews of primary medical care services in

Nottingham and Nottinghamshire;

d) Decisions in relation to the management of poorly performing

GP practices and including, without limitation, decisions and

liaison with the CQC where the CQC has reported non-

compliance with standards (but excluding any decisions in

relation to the performers list);

e) Management of the delegated funds for primary care medical

services;

f) Making decisions on premises costs directions functions; and

g) Co-ordinating a common approach to the commissioning of

primary care services generally.

The Committee will also:

h) Oversee delivery of the General Practice Forward View;

i) Oversee and monitor Primary Care Network (PCN) delivery;

j) Review and approve policies specific to the Committee’s remit;

and

k) Oversee the identification and management of risks relating to

the Committee’s remit.

3. Membership The Primary Care Commissioning Committee will have ten

members, comprised as follows:

Non-Executive Members

a) Three Non-Executive Directors

Clinical Members

b) GP Representative

c) An Independent GP Advisor

d) Deputy Chief Nurse

Managerial Members

e) Chief Commissioning Officer

f) Associate Director of Primary Care

g) Associate Director of Primary Care Network Development

h) Operational Director of Finance

There will be a standing invitation to the following to offer

representation in a non-voting capacity on the Committee:

a) Locality Directors for Mid-Nottinghamshire, Nottingham City and

South Nottinghamshire

b) Nottinghamshire Local Medical Committee

c) Healthwatch Nottingham and Nottinghamshire

d) Nottingham City Health and Wellbeing Board


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e) Nottinghamshire County Health and Wellbeing Board

Other CCG officers may be invited to attend meetings when the

Committee is discussing items that fall within their areas of

expertise and/or responsibility.

4. Chair and

Deputy

The Primary Care Commissioning Committee will be chaired by a

Non-Executive Director other than the Audit and Governance

Committee Chair.

In the event of the Chair being unable to attend all or part of the

meeting, a replacement from within the Committee’s non-executive

membership will be nominated to deputise for that meeting. In such

circumstances, care will be taken to ensure that the Audit and

Governance Committee Chair’s role of Conflicts of Interest

Guardian is not compromised.

5. Quorum The Primary Care Commissioning Committee will be quorate with a

minimum of five members, to include:

a) Two Non-Executive Directors;

b) Either the Independent GP Advisor or the Deputy Chief Nurse;

and

c) Either the Chief Commissioning Officer or the Associate Director

of Primary Care.

To ensure that the quorum can be maintained, Committee members

are able nominate a suitable deputy to attend a meeting of the

Committee that they are unable to attend to speak and vote on their

behalf. Committee members are responsible for fully briefing their

nominated deputies and for informing the secretariat so that the

quorum can be maintained.

If any Committee member has been disqualified from participating in

the discussion and/or decision-making for an item on the agenda,

by reason of a declaration of a conflict of interest, then that

individual shall no longer count towards the quorum.

If the quorum has not been reached, then the meeting may proceed

if those attending agree, but no decisions may be taken.

For the sake of clarity, no person can act in more than one capacity

when determining the quorum.

6. Decision-making Arrangements

Each member of the Committee shall have one vote. The

Committee shall reach decisions by a simple majority of members

present, but with the Chair having a second and deciding vote, if

necessary. However, the aim of the Committee will be to achieve

consensus decision-making wherever possible.

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

The decisions of the Committee shall be binding on NHS England

and NHS Nottingham and Nottinghamshire CCG.

On occasion, the Committee may be required to take urgent

decisions. An urgent decision is one where the requirement for the


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decision to be made arises between the scheduled monthly

meetings of the Committee and in relation to which a decision must

be made prior to the next scheduled meeting.

Where an urgent decision is required a supporting paper will be

circulated to Committee members by the secretary to the

Committee.

The Committee members may meet either in person, via telephone

conference or communicate by email to take an urgent decision.

The quorum, as described in section 5, must be adhered to for

urgent decisions.

A minute of the discussion (including those performed virtually) and

decision will be taken by the secretary to the Committee and will be

reported to the next meeting of the Committee for formal ratification.

7. Frequency of

Meetings

Meetings of the Primary Care Commissioning Committee will be

scheduled on a monthly basis and the Committee will meet, as a

minimum, on a bi-monthly basis.

Meetings of the Primary Care Commissioning Committee, other

than those regularly scheduled above, shall be summoned by the

secretary to the Committee at the request of the Chair. When the

Chair of the Committee deems it necessary in light of urgent

circumstances to call a meeting at short notice, the notice period

shall be such as s/he shall specify.

8. Admission of public and the press

Meetings of the Primary Care Commissioning Committee will

normally be open to the public.

However, the Committee may, by resolution, exclude the public

from a meeting that is open to the public (whether during the whole

or part of the proceedings) wherever publicity would be prejudicial to

the public interest by reason of the confidential nature of the

business to be transacted or for other special reasons stated in the

resolution and arising from the nature of that business or of the

proceedings or for any other reason permitted by the Public Bodies

(Admission to Meetings) Act 1960 as amended or succeeded from

time to time.

In the event the public could be excluded from a meeting of the

Committee, the CCG shall consider whether the subject matter of

the meeting would in any event be subject to disclosure under the

Freedom of Information Act 2000, and if so, whether the public

should be excluded in such circumstances.

The Committee may resolve (as permitted by Section 1(8) Public

Bodies (Admissions to Meetings) Act 1960 as amended from time to

time) to exclude the public from a meeting (whether during whole or

part of the proceedings) to suppress or prevent disorderly conduct

or behaviour.

The Chair (or Deputy Chair) as the person presiding over the

meeting shall give such directions as he/she thinks fit with regard to


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the arrangements for meetings and accommodation of the public

and representatives of the press such as to ensure that the

Committee’s business shall be conducted without interruption and

disruption.

Matters to be dealt with by the Committee following the exclusion of

representatives of the press, and other members of the public shall

be confidential to the members of the Committee.

Members of the Committee and any member or employee of the

CCG in attendance or who receives any such minutes or papers in

advance of or following a meeting shall not reveal or disclose the

contents of papers marked 'In Confidence' or minutes headed 'Items

Taken in Private' outside of the Committee, without the express

permission of the Committee. This will apply equally to the content

of any discussion during the Committee meeting which may take

place on such reports or papers.

9. Secretariat and

Conduct of

Business

Secretariat support will be provided to the Primary Care

Commissioning Committee to ensure the day to day work of the

Committee is proceeding satisfactorily.

Agendas and supporting papers will be circulated no later than five

calendar days in advance of meetings and will be distributed by the

secretary to the Committee.

Any items to be placed on the agenda are to be sent to the

secretary no later than seven calendar days in advance of the

meeting. Items which miss the deadline for inclusion on the agenda

may be added on receipt of permission from the Chair.

The Committee agenda will be agreed with the Chair prior to the

meeting.

Members of the Committee have a collective responsibility for the

operation of the Committee. They will participate in discussion,

review evidence and provide objective expert input to the best of

their knowledge and ability, and endeavour to reach a collective

view.

10. Minutes of

Meetings

Minutes will be taken at all meetings and presented according the

corporate style.

The minutes will be ratified by agreement of the Primary Care

Commissioning Committee at the following meeting.

The Chair of the Committee will agree minutes if they are to be

submitted to the Governing Body prior to formal ratification.

11. Conflicts of

Interest

Management

In advance of any meeting of the Primary Care Commissioning

Committee, consideration will be given as to whether conflicts of

interest are likely to arise in relation to any agenda item and how

they should be managed. This may include steps to be taken prior

to the meeting, such as ensuring that supporting papers for a

particular agenda item are not sent to conflicted individuals.


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At the beginning of each Committee meeting, members and

attendees will be required to declare any interests that relate

specifically to a particular issue under consideration. If the existence

of an interest becomes apparent during a meeting, then this must

be declared at the point at which it arises. Any such declarations will

be formally recorded in the minutes for the meeting.

The Chair of the Committee will determine how declared interests

should be managed, which is likely to involve one the following

actions:

a) Requiring the individual to withdraw from the meeting for that

part of the discussion if the conflict could be seen as detrimental

to the Committee’s decision-making arrangements.

b) Allowing the individual to participate in the discussion, but not

the decision-making process.

c) Allowing full participation in discussion and the decision-making

process, as the potential conflict is not perceived to be material

or detrimental to the Committee’s decision-making

arrangements.

12. Reporting

Responsibilities

and Review of

Committee

Effectiveness

The Primary Care Commissioning Committee will report to the

Governing Body through regular submission of minutes from its

meetings (and those of any sub-committees to which responsibilities

have been delegated), accompanied by executive summary reports.

Any items of specific concern, or which require Governing Body

approval, will be the subject of a separate report.

The Committee will provide minutes and reports to NHS England for

information, at a frequency determined by the NHS England Local

Team.

The Committee will provide an annual report to the Governing Body

to provide assurance that it is effectively discharging its delegated

responsibilities, as set out in these terms of reference. The

Committee will conduct an annual review of its effectiveness to

inform this report.

13. Review of Terms

of Reference

These terms of reference will be formally reviewed on an annual

basis, but may be amended at any time in order to adapt to any

national guidance as and when issued.

Any proposed amendments to the terms of reference will be

submitted to the Governing Body for approval.

Issue Date:

June 2020

Status:

FINAL

Version:

1.1

Review Date:

March 2021


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Schedule 1 - Delegated Functions

Part 1: Specific obligations regarding the carrying out of each of the delegated functions.

Delegated Function Specific Obligations

1. Primary Medical

Services Contract

Management

The CCG must:

a) Manage the Primary Medical Services Contracts on behalf of NHS England and perform all of NHS

England’s obligations under each of the Primary Medical Services Contracts in accordance with the terms

of the Primary Medical Services Contracts as if it were named in the contract in place of NHS England;

b) Actively manage the performance of the counter-party to the Primary Medical Services Contracts in order to

secure the needs of people who use the services, improve the quality of services and improve efficiency in

the provision of the services including by taking timely action to enforce contractual breaches and serve

notice;

c) Ensure that it obtains value for money under the Primary Medical Services Contracts on behalf of NHS

England and avoids making any double payments under any Primary Medical Services Contracts;

d) Comply with all current and future relevant national Guidance regarding PMS reviews and the management

of practices receiving Minimum Practice Income Guarantee (MPIG) (including without limitation the

Framework for Personal Medical Services (PMS) Contracts Review guidance published by NHS England in

September 2014 (http://www.england.nhs.uk/wp-content/uploads/2014/09/pms-review-guidance-

sept14.pdf));

e) Notify NHS England immediately (or in any event within two (2) Operational Days) of any breach by the

CCG of its obligations to perform any of NHS England’s obligations under the Primary Medical Services

Contracts;

f) Keep a record of all of the Primary Medical Services Contracts that the CCG manages on behalf of NHS

England setting out the following details in relation to each Primary Medical Services Contract:

Name of counter-party;

Location of provision of services; and

Amounts payable under the contract (if a contract sum is payable) or amount payable in respect of each

patient (if there is no contract sum).

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g) For the avoidance of doubt, all Primary Medical Services Contracts will be in the name of NHS England.

h) The CCG must comply with any Guidance in relation to the issuing and signing of Primary Medical Services

Contracts in the name of NHS England.

i) The CCG must actively manage each of the relevant Primary Medical Services Contracts including by:

Managing the relevant Primary Medical Services Contract, including in respect of quality standards,

incentives and the QOF, observance of service specifications, and monitoring of activity and finance;

Assessing quality and outcomes (including clinical effectiveness, patient experience and patient safety);

Managing variations to the relevant Primary Medical Services Contract or services in accordance with

national policy, service user needs and clinical developments;

Agreeing information and reporting requirements and managing information breaches (which will

include use of the HSCIC IG Toolkit SIRI system);

Agreeing local prices, managing agreements or proposals for local variations and local modifications;

Conducting review meetings and undertaking contract management including the issuing of contract

queries and agreeing any remedial action plan or related contract management processes; and

Complying with and implementing any relevant Guidance issued from time to time.

j) In relation to any new Primary Medical Services Contract to be entered into, the CCG must:

Consider and use the form of Primary Medical Services Contract that will ensure compliance with NHS

England’s obligations under Law including the Public Contracts Regulations 2015/102 and the National

Health Service (Procurement, Patient Choice and Competition) (No. 2) Regulations 2013/500 taking into

account the persons to whom such Primary Medical Services Contracts may be awarded;

Provide to NHS England confirmation as required from time to time that it has considered and complied

with its obligations under this Agreement and the Law; and

For the avoidance of doubt, Schedule 3 (Financial and Decision-Making Limits) deals with the sign off

requirements for Primary Medical Services Contracts.

2. Enhanced Services a) The CCG must manage the design and commissioning of Enhanced Services, including re-commissioning

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these services annually where appropriate.

b) The CCG must ensure that it complies with any Guidance in relation to the design and commissioning of

Enhanced Services.

c) When commissioning newly designed Enhanced Services, the CCG must:

Consider the needs of the local population in the Area;

Support Data Controllers in providing ‘fair processing’ information as required by the DPA;

Develop the necessary specifications and templates for the Enhanced Services, as required to meet the

needs of the local population in the Area;

When developing the necessary specifications and templates for the Enhanced Services, ensure that

value for money will be obtained;

Consult with Local Medical Committees, each relevant Health and Wellbeing Board and other

stakeholders in accordance with the duty of public involvement and consultation under section 14Z2 of

the NHS Act;

Obtain the appropriate read codes, to be maintained by the HSCIC;

Liaise with system providers and representative bodies to ensure that the system in relation to the

Enhanced Services will be functional and secure; and

Support GPs in entering into data processing agreements with data processors in the terms required by

the DPA.

3. Design of Local

Incentive Schemes

a) The CCG may design and offer Local Incentive Schemes for GP practices, sensitive to the needs of their

particular communities, in addition to or as an alternative to the national framework (including as an

alternative to QOF or directed Enhanced Services), provided that such schemes are voluntary and the CCG

continues to offer the national schemes.

b) There is no formal approvals process that the CCG must follow to develop a Local Incentive Scheme,

although any proposed new Local Incentive Scheme:

Is subject to consultation with the Local Medical Committee;

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Must be able to demonstrate improved outcomes, reduced inequalities and value for money; and

Must reflect the changes agreed as part of the national PMS reviews.

c) The ongoing assurance of any new Local Incentive Schemes will form part of the CCG’s assurance process

under the CCG Assurance Framework.

d) Any new Local Incentive Scheme must be implemented without prejudice to the right of GP practices

operating under a GMS Contract to obtain their entitlements which are negotiated and set nationally.

e) NHS England will continue to set national standing rules, to be reviewed annually, and the CCG must

comply with these rules which shall for the purposes of this Agreement be Guidance.

4. Making Decisions on

Discretionary Payments

a) The CCG must manage and make decisions in relation to the discretionary payments to be made to GP

practices in a consistent, open and transparent way.

b) The CCG must exercise its discretion to determine the level of payment to GP practices of discretionary

payments, in accordance with the Statement of Financial Entitlements Directions.

5. Making Decisions about

Commissioning Urgent

Care for Out of Area

Registered Patients

a) The CCG must manage the design and commissioning of urgent care services (including home visits as

required) for its patients registered out of area (including re-commissioning these services annually where

appropriate).

b) The CCG must ensure that it complies with any Guidance in relation to the design and commissioning of

these services.

6. Planning the Provider

Landscape

a) The CCG must plan the primary medical services provider landscape in the Area, including considering and

taking decisions in relation to:

Establishing new GP practices in the Area;

Managing GP practices providing inadequate standards of patient care;

The procurement of new Primary Medical Services Contracts (in accordance with any procurement

protocol issued by NHS England from time to time);

Closure of practices and branch surgeries;

Dispersing the lists of GP practices;

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Agreeing variations to the boundaries of GP practices; and

Coordinating and carrying out the process of list cleansing in relation to GP practices, according to any

policy or Guidance issued by NHS England from time to time.

7. Approving GP Practice

Mergers and Closures

a) The CCG is responsible for approving GP practice mergers and GP practice closures in the Area.

b) The CCG must undertake all necessary consultation when taking any decision in relation to GP practice

mergers or GP practice closures in the Area, including those set out under section 14Z2 of the NHS Act

(duty for public involvement and consultation). The consultation undertaken must be appropriate and

proportionate in the circumstances and should include consulting with the Local Medical Committee.

c) Prior to making any decision, the CCG must be able to clearly demonstrate the grounds for such a decision

and must have fully considered any impact on the GP practice’s registered population and that of

surrounding practices. The CCG must be able to clearly demonstrate that it has considered other options

and has entered into dialogue with the GP contractor as to how any closure or merger will be managed.

d) In making any decisions, the CCG shall also take account of its obligations as set out at 1 j) above, where

applicable.

8. Information Sharing with

NHS England in relation

to the Delegated

Functions

a) The CCG must provide NHS England with:

Such information relating to individual GP practices in the Area as NHS England may reasonably

request, to ensure that NHS England is able to continue to gather national data regarding the

performances of GP practices;

Such data/data sets as required by NHS England to ensure population of the primary medical services

dashboard;

Any other data/data sets as required by NHS England; and

The CCG shall procure that providers accurately record and report information so as to allow NHS

England and other agencies to discharge their functions.

b) The CCG must use the NHS England approved primary medical services dashboard, as updated from time

to time, for the collection and dissemination of information relating to GP practices.

c) The CCG must (where appropriate) use the NHS England approved GP exception reporting service (as

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notified to the CCGs by NHS England from time to time).

d) The CCG must provide any other information, and in any such form, as NHS England considers necessary

and relevant.

e) NHS England reserves the right to set national standing rules (which may be considered Guidance for the

purpose of this Agreement), as needed, to be reviewed annually. NHS England will work with CCGs to

agree rules for, without limitation, areas such as the collection of data for national data sets and IT intra-

operability. Such national standing rules set from time to time shall be deemed to be part of this

Agreement.

9. Making Decisions in

relation to Management

of Poorly Performing GP

Practices

a) The CCG must make decisions in relation to the management of poorly performing GP practices and

including, without limitation, decisions and liaison with the CQC where the CQC has reported non-

compliance with standards (but excluding any decisions in relation to the performers list).

b) The CCG must:

Ensure regular and effective collaboration with the CQC to ensure that information on general practice

is shared and discussed in an appropriate and timely manner;

Ensure that any risks identified are managed and escalated where necessary;

Respond to CQC assessments of GP practices where improvement is required;

Where a GP practice is placed into special measures, lead a quality summit to ensure the development

and monitoring of an appropriate improvement plan (including a communications plan and actions to

manage primary care resilience in the locality); and

Take appropriate contractual action in response to CQC findings.

10. Premises Costs

Directions Functions

a) The CCG must comply with the Premises Costs Directions and will be responsible for making decisions in

relation to the Premises Costs Directions Functions.

b) In particular, the CCG shall make decisions concerning:

Applications for new payments under the Premises Costs Directions (whether such payments are to be

made by way of grants or in respect of recurring premises costs); and

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Revisions to existing payments being made under the Premises Costs Directions.

c) The CCG must comply with any decision-making limits set out in Schedule 3 (Financial and Decision-

Making Limits) when taking decisions in relation to the Premises Costs Directions Functions.

d) The CCG will comply with any guidance issued by the Secretary of State or NHS England in relation to the

Premises Costs Directions, including the Principles of Best Practice, and any other Guidance in relation to

the Premises Costs Directions.

e) The CCG must work cooperatively with other CCGs to manage premises and strategic estates planning.

f) The CCG must liaise where appropriate with NHS Property Services Limited and Community Health

Partnerships Limited in relation to the Premises Costs Directions Functions.

Part 2: General obligations regarding the carrying out of the delegated functions.

Delegated Function General Obligations

1. Planning and reviews a) The CCG is responsible for planning the commissioning of primary medical services. The role of the CCG

includes:

Carrying out primary medical health needs assessments (to be developed by the CCG) to help

determine the needs of the local population in the Area;

Recommending and implementing changes to meet any unmet primary medical service needs; and

Undertaking regular reviews of the primary medical health needs of the local population in the Area.

2. Procurement and new

contracts

a) The CCG will make procurement decisions relevant to the exercise of the Delegated Functions and in

accordance with the detailed arrangements regarding procurement set out in the procurement protocol

issued and updated by NHS England from time to time.

b) In discharging its responsibilities, the CCG must comply at all times with Law including its obligations set

out in the National Health Service (Procurement, Patient Choice and Competition) (No. 2) Regulations

2013/500 and any other relevant statutory provisions. The CCG must have regard to any relevant

guidance, particularly Monitor’s guidance Substantive guidance on the Procurement, Patient Choice and

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Delegated Function General Obligations

Competition Regulations

(https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/283505/SubstantiveGuidanc

eDec2013_0.pdf).

c) Where the CCG wishes to develop and offer a locally designed contract, it must ensure that it has consulted

with its Local Medical Committee in relation to the proposal and that it can demonstrate that the scheme

will:

Improve outcomes;

Reduce inequalities; and

Provide value for money.

3. Integrated working a) The CCG must take an integrated approach to working and co-ordinating with stakeholders including NHS

England, Local Professional Networks, local authorities, Healthwatch, acute and community providers, the

Local Medical Committee, Public Health England and other stakeholders.

b) The CCG must work with NHS England and other CCGs to co-ordinate a common approach to the

commissioning of primary medical services generally.

c) The CCG and NHS England will work together to coordinate the exercise of their respective performance

management functions.

4. Resourcing a) NHS England may, at its discretion provide support or staff to the CCG. NHS England may, when

exercising such discretion, take into account, any relevant factors (including without limitation the size of the

CCG, the number of Primary Medical Services Contracts held and the need for the Local NHS England

Team to continue to deliver the Reserved Functions).

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Schedule 2 - Reserved Functions

This Schedule sets out further provision regarding the carrying out of the reserved functions. The CCG will work collaboratively with NHS

England and will support and assist NHS England to carry out the reserved functions.

Reserved function Further provisions

1. Management of the

national performers list

a) NHS England will continue to perform its primary medical care functions under the National Health Service

(Performers Lists) (England) Regulations 2013.

b) NHS England’s functions in relation to the management of the national performers list include:

Considering applications and decision-making in relation to inclusion on the national performers list,

inclusion with conditions and refusals;

Identifying, managing and supporting primary care performers where concerns arise; and

Managing suspension, imposition of conditions and removal from the national performers list.

c) NHS England may hold local Performance Advisory Group (“PAG”) meetings to consider all complaints or

concerns that are reported to NHS England in relation to a named performer and NHS England will

determine whether an initial investigation is to be carried out.

d) NHS England may notify the CCG of all relevant PAG meetings at least seven (7) days in advance of such

meetings. NHS England may require a representative of the CCG to attend such meetings to discuss any

performer concerns and/or quality issues that may impact on individual performer cases.

e) The CCG must develop a mechanism to ensure that all complaints regarding any named performer are

escalated to the Local NHS England Team for review. The CCG will comply with any Guidance issued by

NHS England in relation to the escalation of complaints about a named performer.

2. Management of the

revalidation and

appraisal process

a) NHS England will continue to perform its functions under the Medical Profession (Responsible Officers)

Regulations 2010 (as amended by the Medical Profession (Responsible Officers) (Amendment)

Regulations 2013).

b) All functions in relation to GP appraisal and revalidation will remain the responsibility of NHS England,

including:

The funding of GP appraisers;

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Quality assurance of the GP appraisal process; and

The responsible officer network.

c) Funding to support the GP appraisal is incorporated within the global sum payment to GP practices.

d) The CCG must not remove or restrict the payments made to GP practices in respect of GP appraisal.

3. Administration of

payments and related

performers list

management activities

a) NHS England reserves its functions in relation to the administration of payments to individual performers

and related performers list management activities under the National Health Service (Performers Lists)

(England) Regulations 2013 and other relevant legislation.

b) NHS England may continue to pay GPs who are suspended from the national performers list under the

Secretary of State’s Determination: Payments to Medical Practitioners Suspended from the Medical

Performers List (1 April 2013).

c) For the avoidance of doubt, the CCG is responsible for any ad hoc or discretionary payments to GP

practices (including those under section 96 of the NHS Act), including where such payments may be

considered a consequence of actions taken under the National Health Service (Performers Lists) (England)

Regulations 2013.

4. Section 7A Functions a) NHS England retains the Section 7A Functions and will be responsible for taking decisions in relation to the

Section 7A Functions.

b) The CCG will provide certain management and/or administrative services to NHS England in relation to the

Section 7A Functions.

5. Capital Expenditure

Functions

c) NHS England retains the Capital Expenditure Functions and will be responsible for taking decisions in

relation to the Capital Expenditure Functions.

6. Functions in relation to

complaints management

a) NHS England retains its functions in relation to complaints management and will be responsible for taking

decisions in relation to the management of complaints. Such complaints include (but are not limited to):

Complaints about GP practices and individual named performers;

Controlled drugs; and

Whistleblowing in relation to a GP practice or individual performer.

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b) The CCG must immediately notify the Local NHS England Team of all complaints received by or notified to

the CCG and must send to the Local NHS England Team copies of any relevant correspondence.

c) The CCG must co-operate fully with NHS England in relation to any complaint and any response to such

complaint.

d) NHS England may ask the CCG to provide certain management and/or administrative services to NHS

England (from a date to be notified by NHS England to the CCG) in relation to the handling and

consideration of complaints.

7. Such other ancillary

activities that are

necessary in order to

exercise the Reserved

Functions

a) NHS England will carry out such other ancillary activities that are necessary in order for NHS England to

exercise the Reserved Functions.

b) NHS England will continue to comply with its obligations under the Controlled Drugs (Supervision of

Management and Use) Regulations 2013.

c) The CCG must assist NHS England’s controlled drug accountable officer (“CDAO”) to carry out its functions

under the Controlled Drugs (Supervision of Management and Use) Regulations 2013.

d) The CCG must nominate a relevant senior individual within the CCG (the “CCG CD Lead”) to liaise with and

assist NHS England to carry out its functions under the Controlled Drugs (Supervision of Management and

Use) Regulations 2013.

e) The CCG CD Lead must, in relation to the Delegated Functions:

On request provide NHS England’s CDAO with all reasonable assistance in any investigation involving

primary medical care services;

Report all complaints involving controlled drugs to NHS England’s CDAO;

Report all incidents or other concerns involving the safe use and management of controlled drugs to

NHS England’s CDAO;

Analyse the controlled drug prescribing data available; and

On request supply (or ensure organisations from whom the CCG commissions services involving the

regular use of controlled drugs supply) periodic self–declaration and/or self-assessments to NHS

England’s CDAO.

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Schedule 3 – Financial and Decision-Making Limits

The CCG has certain limitations placed on it in relation to its delegated functions, which need to be kept in mind when decisions are being

made. This Schedule sets out three specific categories where decisions can only be taken following the receipt of prior approval from NHS

England. The individuals that need to be involved in the decision-making process are also set out below.

Decision NHS England Approval CCG Approval

Taking any step or action in relation to the

settlement of a claim, where the value of the

settlement exceeds £100,000.

NHS England Head of Legal Services

and

Local NHS England Team Director or

Director of Finance

Accountable Officer or Chief Finance

Officer or Chair

Any matter in relation to the delegated functions

which is novel, contentious or repercussive.


Director of Finance

or

NHS England Regional Director or

Director of Finance

or

NHS England Chief Executive or Chief

Financial Officer


Officer or Chair

The entering into any Primary Medical Services

Contract, which has, or is capable of having, a term

which exceeds five years.


Director of Finance


Officer or Chair

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Appendix B - Summary of Committee Roles and Responsibilities

Committee Role/Responsibilities

Audit and

Governance

Committee

Chair: Sue Sunderland

Type: Statutory

Focus: Internal

Purpose: Scrutiny

and Assurance

Internal audit, external audit, counter fraud

Risk management and incident management

Probity arrangements

Annual report and accounts

Information governance

Health and safety

EPRR and business continuity arrangements

Statutory and mandatory training compliance

Remuneration and

Terms of Service

Committee

Chair: Jon Towler

Type: Statutory

Focus: Internal

Purpose: Decision-

making

Remuneration, fee, allowances, contractual

terms (non-A4C)

Termination and special payments (incl.

redundancy, severance)

Human resources policies

Gender pay gap

Primary Care

Commissioning

Committee


Type: Statutory

Focus: External

Purpose: Decision-

making

Decisions on delegated functions (incl.

commissioning, procurement and

management of GMS, PMS and APMS

contracts, enhanced services, practice

mergers and closures, discretionary

payments, premises costs directions)

GP Forward View

Primary Care Network (PCN) delivery

Quality and

Performance

Committee


Type: Non-Statutory

Focus: External

Purpose: Scrutiny

and Assurance

Quality and performance of commissioned

services

Safeguarding vulnerable adults and children

Patient and public engagement

Equality, diversity and inclusion (relating to

CCG role as commissioner)

Finance and

Resources Committee

Chair: Shaun Beebe

Type: Non-Statutory

Focus: Internal

Purpose: Scrutiny

and Assurance

Financial performance, QIPP and contract

activity

Procurement decisions/ contract awards for

non-healthcare contracts

Annual organisational priorities

Green Plan

Workforce and organisational development

Equality, diversity and inclusion (relating to

CCG role as employer)


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Committee Role/Responsibilities

IM&T

Prioritisation and

Investment

Committee

Chair: Jon Towler

Type: Non-Statutory

Focus: External

Purpose: Decision-

making

Commissioning decisions (new investments,

recurrent funding allocations and

decommissioning and disinvestment of

services)

Procurement decisions/ contract awards for

healthcare contracts

Evaluate return on investment (reduced

health inequalities and improved health

outcomes)

Patient and Public

Engagement

Committee

Chair: Sue Clague

Type: Non-Statutory

Focus: External

Purpose: Advisory

Feeding views of patients, carers, community

groups into the CCG’s decision-making

processes


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Appendix C: 2020/21 Primary Care commissioning Committee Work Programme Please Note: All reporting timeframes are currently indicative and subject to review and confirmation.

Agenda Item/ Purpose 2020/21 2021/22

19

Aug

16

Sep

21

Oct

18

Nov

16

Dec

20

Jan

17

Feb

17

Mar

21

Apr

19

May

16

Jun

21

Jul

COVID-19 Response

COVID-19 Restoration and Recovery

To present a range of updates in relation to the CCG’s restoration and

recovery plans in response to COVID-19.

COVID-19 Related GP Practice Additional Expenses

To present a monthly update on COVID-19 related additional expenses

throughout 2020/21. Exact reporting requirements will be kept under review

during the course of the period.

Strategy, Planning and Service Transformation

Primary Care Network (PCN) Delivery

To present updates in relation to PCN development and the PCN Directed

Enhanced Services (DES) implementation.

Primary Care Workforce Planning

To present updates in relation to the delivery of the Primary Care Workforce

Strategy. This will include reporting on approved GP Retention Scheme

applications.

Primary Care Estates Strategy

To present updates in relation to the delivery of the Primary Care Estates

Strategy, including strategic estates planning and management.

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19

Aug

16

Sep

21

Oct

18

Nov

16

Dec

20

Jan

17

Feb

17

Mar

21

Apr

19

May

16

Jun

21

Jul

Primary Care Digital Strategy

To present updates in relation to the delivery of the Primary Care Digital

Strategy.

General Practice Forward View (GPFV)

To present the latest position in relation to GPFV planning and delivery1.

Commissioning, Procurement and Contract Management

Enhanced Services

To present the annual enhanced services commissioning proposal for

consideration and approval.

Local Incentive Schemes

To present Local Incentive Schemes for GP practices, in addition to or as

an alternative to the national framework, for consideration and approval.

Primary Care Hub Memorandum of Understanding (MoU) and

Handbook

To present the Primary Care Hub MoU and Handbook for review and

approval and to receive assurance in relation to the associated delivery

requirements.

Quality Improvement

Quality Report

To present a quarterly assurance report regarding the monitoring of quality

performance, and improvement, of primary care medical services.

GP Patient Survey

To present an analysis of the results from the national GP patient survey.

1 Note: Reporting requirements will be reflected once known, following receipt of national guidance.

Draft A

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Aug

16

Sep

21

Oct

18

Nov

16

Dec

20

Jan

17

Feb

17

Mar

21

Apr

19

May

16

Jun

21

Jul

Financial Management

Finance Report

To present a bi-monthly update on the position of the delegated funds, in

accordance with business rules and national guidance.

Risk Management

Risk Report

To present routine updates on risks relating to the Committee’s

responsibilities for scrutiny and review of the management actions being

implemented to mitigate the risks.

Committee Business

Committee Work Programme

To present an annual work programme for consideration and agreement

that sets out a coherent cycle of business for the next year of meetings in

line with the Committee’s terms of reference.

Committee Annual Report

To consider and agree an annual report to be presented to the Governing

Body to provide assurance that the Committee is effectively discharging its

responsibilities.

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Meeting Title: Primary Care Commissioning Committee (Open Session)


Paper Title: NHS England & Improvement – Third Phase of NHS Response to COVID-19

Paper Reference: PCC 20 083

Sponsor:

Presenter:

Joe Lunn – Interim Associate Director of Primary Care

Attachments/ Appendices:

Joe Lunn – Interim Associate Director of Primary Care

Purpose: Approve ☐ Endorse ☐ Review ☐ Receive/Note for:

∑ Assurance∑ Information

☒

Executive Summary

Arrangements for Discharging Delegated Functions

Delegated function 2 – Planning the provider landscape

Delegated function 4 – Decisions in relation to the commissioning, procurement and management of primary medical services contracts

The committee are asked to NOTE the Third Phase of NHS Response to COVID-19.


Compliance with Statutory Duties ☐ Wider system architecture development (e.g. ICP, PCN development)

☐

Financial Management ☐ Cultural and/or Organisational Development

☐

Performance Management ☐ Procurement and/or Contract Management ☐





Equality / Quality Impact Assessment (EQIA)

Yes ☐ No ☒ N/A☐ NHS England/Improvement (NHSEI) letter shared for information

Data Protection Impact Assessment (DPIA)

Yes ☐ No ☒ N/A☐ NHSE/I letter shared for information

Risk(s):

No risks identified

Confidentiality:

Third Phase of NHS Response to Covid-19

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☒No

Recommendation(s):

1. NOTE the NHS England & Improvement – Third Phase of NHS Response to COVID-19


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Skipton House 80 London Road London SE1 6LH

[email protected]

From the Chief Executive Sir Simon Stevens & Chief Operating Officer Amanda Pritchard

To:

Chief executives of all NHS trusts and foundation trusts

CCG Accountable Officers

GP practices and Primary Care Networks

Providers of community health services

NHS 111 providers

Copy to:

NHS Regional Directors

Regional Incident Directors & Heads of EPRR

Chairs of ICSs and STPs

Chairs of NHS trusts, foundation trusts and CCG governing bodies

Local authority chief executives and directors of adult social care

Chairs of Local Resilience Forums

31 July 2020

Dear Colleague

IMPORTANT – FOR ACTION – THIRD PHASE OF NHS RESPONSE TO COVID-19

We are writing to thank you and your teams for the successful NHS response in the face of this

unprecedented pandemic, and to set out the next – third – phase of the NHS response, effective

from 1 August 2020.

You will recollect that on 30th January NHS England and NHS Improvement declared a Level 4

National Incident, triggering the first phase of the NHS pandemic response. Since then the NHS has

been able to treat every coronavirus patient who has needed specialist care – including 107,000

people needing emergency hospitalisation. Even at the peak of demand, hospitals were still able to

look after two non-Covid inpatients for every one Covid inpatient, and a similar picture was seen in

primary, community and mental health services.

As acute Covid pressures were beginning to reduce, we wrote to you on 29 April to outline agreed

measures for the second phase, restarting urgent services. Now in this Phase Three letter we:

• update you on the latest Covid national alert level;

• set out priorities for the rest of 2020/21; and

• outline financial arrangements heading into Autumn as agreed with Government.


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Current position on Covid-19

On 19 June 2020 the Chief Medical Officers and the Government’s Joint Biosecurity Centre

downgraded the UK’s overall Covid alert level from four to three, signifying that the virus remains

in general circulation with localised outbreaks likely to occur. On 17 July the Government set out

next steps including the role of the new Test and Trace programme in providing us advance notice

of any expected surge in Covid demand, and in helping manage local and regional public health

mitigation measures to prevent national resurgence.

Fortunately, Covid inpatient numbers have now fallen nationally from a peak of 19,000 a day, to

around 900 today. As signalled earlier this month, the current level of Covid demand on the NHS

means that the Government has agreed that the NHS EPRR incident level will move from Level 4

(national) to Level 3 (regional) with effect from tomorrow, 1 August. This approach matches the

differential regional measures the Government is deploying, including today in parts of the North

West and North East. The main implications of this are set out in Annex One to this letter.

However Covid remains in general circulation and we are seeing a number of local and regional

outbreaks across the country, with the risk of further national acceleration. Together with the Joint

Biosecurity Centre and Public Health England (PHE) we will therefore continue to keep the

situation under close review, and will not hesitate to reinstate the Level 4 national response

immediately as circumstances justify it. In the meantime NHS organisations will need to retain their

EPRR incident coordination centres and will be supported by oversight and coordination by

Regional Directors and their teams.

NHS priorities from August

Having pulled out all the stops to treat Covid patients over the last few months, our health services

now need to redouble their focus on the needs of all other patients too, while recognising the new

challenges of overcoming our current Covid-related capacity constraints. This will continue to

require excellent collaboration between clinical teams, providers and CCGs operating as part of

local ‘systems’ (STPs and ICSs), local authorities and the voluntary sector, underpinned by a

renewed focus on patient communication and partnership.

Following discussion with patients’ groups, national clinical and stakeholder organisations, and

feedback from our seven regional ‘virtual’ frontline leadership meetings last week, we are setting

out NHS priorities for this third phase. Our shared focus is on:

A. Accelerating the return to near-normal levels of non-Covid health services, making full use

of the capacity available in the ‘window of opportunity’ between now and winter

B. Preparation for winter demand pressures, alongside continuing vigilance in the light of

further probable Covid spikes locally and possibly nationally.

C. Doing the above in a way that takes account of lessons learned during the first Covid peak;

locks in beneficial changes; and explicitly tackles fundamental challenges including:

support for our staff, and action on inequalities and prevention.

As part of this Phase Three work, and following helpful engagement and discussion, alongside this

letter yesterday we published a more detailed 2020/21 People Plan, and will shortly do the same on


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inequalities reduction. DHSC are also expected to set out equivalent phase three priorities and

support for social care.

Nationally, we will work with the wide range of stakeholders represented on the NHS Assembly to

help track and challenge progress against these priorities. As we do so it is vital that we listen and

learn from patients and communities. We ask that all local systems act on the Five principles for the

next phase of the Covid-19 response developed by patients’ groups through National Voices.

A: Accelerating the return of non-Covid health services, making full use of the capacity

available in the window of opportunity between now and winter

A1. Restore full operation of all cancer services. This work will be overseen by a national

cancer delivery taskforce, involving major patient charities and other key stakeholders.

Systems should commission their Cancer Alliance to rapidly draw up delivery plans for

September 2020 to March 2021 to:

• To reduce unmet need and tackle health inequalities, work with GPs and the public locally

to restore the number of people coming forward and appropriately being referred with

suspected cancer to at least pre-pandemic levels.

• Manage the immediate growth in people requiring cancer diagnosis and/or treatment

returning to the service by:

- Ensuring that sufficient diagnostic capacity is in place in Covid19-secure environments,

including through the use of independent sector facilities, and the development of

Community Diagnostic Hubs and Rapid Diagnostic Centres

- Increasing endoscopy capacity to normal levels, including through the release of

endoscopy staff from other duties, separating upper and lower GI (non-aerosol-

generating) investigations, and using CT colonography to substitute where appropriate

for colonoscopy.

- Expanding the capacity of surgical hubs to meet demand and ensuring other treatment

modalities are also delivered in Covid19-secure environments.

- Putting in place specific actions to support any groups of patients who might have

unequal access to diagnostics and/or treatment.

- Fully restarting all cancer screening programmes. Alliances delivering lung health

checks should restart them.

• Thereby reducing the number of patients waiting for diagnostics and/or treatment longer

than 62 days on an urgent pathway, or over 31 days on a treatment pathway, to pre-

pandemic levels, with an immediate plan for managing those waiting longer than 104 days.

A2. Recover the maximum elective activity possible between now and winter, making full use

of the NHS capacity currently available, as well as re-contracted independent hospitals.

In setting clear performance expectations there is a careful balance to be struck between the

need to be ambitious and stretching for our patients so as to avoid patient harm, while setting a

performance level that is deliverable, recognising that each trust will have its own particular

pattern of constraints to overcome.


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4

Having carefully tested the feasible degree of ambition with a number of trusts and systems in

recent weeks, trusts and systems are now expected to re-establish (and where necessary

redesign) services to deliver through their own local NHS (non-independent sector) capacity the

following:

• In September at least 80% of their last year’s activity for both overnight electives and

for outpatient/daycase procedures, rising to 90% in October (while aiming for 70% in

August);

• This means that systems need to very swiftly return to at least 90% of their last year’s

levels of MRI/CT and endoscopy procedures, with an ambition to reach 100% by

October.

• 100% of their last year’s activity for first outpatient attendances and follow-ups (face

to face or virtually) from September through the balance of the year (and aiming for

90% in August).

Block payments will flex meaningfully to reflect delivery (or otherwise) against these important

patient treatment goals, with details to follow shortly once finalised with Government.

Elective waiting lists and performance should be managed at system as well as trust level to

ensure equal patient access and effective use of facilities.

Trusts, working with GP practices, should ensure that, between them, every patient whose

planned care has been disrupted by Covid receives clear communication about how they

will be looked after, and who to contact in the event that their clinical circumstances change.

Clinically urgent patients should continue to be treated first, with next priority given to the

longest waiting patients, specifically those breaching or at risk of breaching 52 weeks by the

end of March 2021.

To further support the recovery and restoration of elective services, a modified national contract

will be in place giving access to most independent hospital capacity until March 2021. The

current arrangements are being adjusted to take account of expected usage, and by October/

November it will then be replaced with a re-procured national framework agreement within

which local contracting will resume, with funding allocations for systems adjusted accordingly.

To ensure good value for money for taxpayers, systems must produce week-by-week

independent sector usage plans from August and will then be held directly to account for

delivering against them.

In scheduling planned care, providers should follow the new streamlined patient self isolation

and testing requirements set out in the guideline published by NICE earlier this week. For many

patients this will remove the need to isolate for 14 days prior to a procedure or admission.

Trusts should ensure their e-Referral Service is fully open to referrals from primary care. To

reduce infection risk and support social distancing across the hospital estate, clinicians should

consider avoiding asking patients to attend physical outpatient appointments where a

clinically-appropriate and accessible alternative exists. Healthwatch have produced useful

advice on how to support patients in this way. This means collaboration between primary and

secondary care to use advice and guidance where possible and treat patients without an onward

referral, as well as giving patients more control over their outpatient follow-up care by adopting

a patient-initiated follow-up approach across major outpatient specialties. Where an outpatient


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5

appointment is clinically necessary, the national benchmark is that at least 25% could be

conducted by telephone or video including 60% of all follow-up appointments.

A3. Restore service delivery in primary care and community services.

• General practice, community and optometry services should restore activity to usual

levels where clinically appropriate, and reach out proactively to clinically vulnerable

patients and those whose care may have been delayed. Dental practices should have now

mobilised for face to face interventions. We recognise that capacity is constrained, but will

support practices to deliver as comprehensive a service as possible.

• In restoring services, GP practices need to make rapid progress in addressing the backlog of

childhood immunisations and cervical screening through specific catch-up initiatives and

additional capacity and deliver through their Primary Care Network (PCN) the service

requirements coming into effect on 1 October as part of the Network Contract DES.

• GPs, primary care networks and community health services should build on the enhanced

support they are providing to care homes, and begin a programme of structured medication

reviews.

• CCGs should work with GP practices to expand the range of services to which patients can

self-refer, freeing-up clinical time. All GP practices must offer face to face appointments

at their surgeries as well as continuing to use remote triage and video, online and telephone

consultation wherever appropriate – whilst also considering those who are unable to access

or engage with digital services.

• Community health services crisis responsiveness should be enhanced in line with the goals

set out in the Long Term Plan, and should continue to support patients who have recovered

from the acute phase of Covid but need ongoing rehabilitation and other community

health services. Community health teams should fully resume appropriate and safe home

visiting care for all those vulnerable/shielding patients who need them.

• The Government is continuing to provide funding to support timely and appropriate

discharge from hospital inpatient care in line with forthcoming updated Hospital Discharge

Service Requirements. From 1 September 2020, hospitals and community health and social

care partners should fully embed the discharge to assess processes. New or extended health

and care support will be funded for a period of up to six weeks, following discharge from

hospital and during this period a comprehensive care and health assessment for any ongoing

care needs, including determining funding eligibility, must now take place. The fund can

also be used to provide short term urgent care support for those who would otherwise have

been admitted to hospital.

• The Government has further decided that CCGs must resume NHS Continuing Healthcare

assessments from 1 September 2020 and work with local authorities using the trusted

assessor model. Any patients discharged from hospital between 19 March 2020 and 31

August 2020, whose discharge support package has been paid for by the NHS, will need to

be assessed and moved to core NHS, social care or self-funding arrangements.


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A4. Expand and improve mental health services and services for people with learning

disability and/or autism

• Every CCG must continue to increase investment in mental health services in line with the

Mental Health Investment Standard and we will be repeating the independent audits of this.

Systems should work together to ensure that funding decisions are decided in partnership

with Mental Health Providers and CCGs and that funding is allocated to core Long Term

Plan (LTP) priorities.

• In addition, we will be asking systems to validate their existing LTP mental health service

expansion trajectories for 2020/21. Further advice on this will be issued shortly. In the

meantime:

- IAPT services should fully resume

- the 24/7 crisis helplines for all ages that were established locally during the pandemic

should be retained, developing this into a national service continue the transition to

digital working

- maintain the growth in the number of children and young people accessing care

- proactively review all patients on community mental health teams’ caseloads and

increase therapeutic activity and supportive interventions to prevent relapse or

escalation of mental health needs for people with SMI in the community;

- ensure that local access to services is clearly advertised

- use £250 million of earmarked new capital to help eliminate mental health dormitory

wards.

• In respect of support for people with a learning disability, autism or both:

- Continue to reduce the number of children, young people and adults within a specialist

inpatient setting by providing better alternatives and by ensuring that Care (Education)

and Treatment Reviews always take place both prior to and following inpatient

admission.

- Complete all outstanding Learning Disability Mortality Reviews (LeDeR) by December

2020.

- GP practices should ensure that everybody with a Learning Disability is identified on

their register; that their annual health checks are completed; and access to screening and

flu vaccinations is proactively arranged. (This is supported by existing payment

arrangements and the new support intended through the Impact and Investment Fund to

improve uptake.)

B: Preparation for winter alongside possible Covid resurgence.

B1. Continue to follow good Covid-related practice to enable patients to access services safely

and protect staff, whilst also preparing for localised Covid outbreaks or a wider national wave.

This includes:

• Continuing to follow PHE’s guidance on defining and managing communicable disease

outbreaks.

• Continue to follow PHE/DHSC-determined policies on which patients, staff and members

of the public should be tested and at what frequency, including the further PHE-endorsed


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actions set out on testing on 24 June. All NHS employers should prepare for the likelihood

that if background infection risk increases in the Autumn, and DHSC Test and Trace

secures 500,000+ tests per day, the Chief Medical Officer and DHSC may decide in

September or October to implement a policy of regular routine Covid testing of all

asymptomatic staff across the NHS.

• Ongoing application of PHE’s infection prevention and control guidance and the actions set

out in the letter from 9 June on minimising nosocomial infections across all NHS settings,

including appropriate Covid-free areas and strict application of hand hygiene, appropriate

physical distancing, and use of masks/face coverings.

• Ensuring NHS staff and patients have access to and use PPE in line with PHE’s

recommended policies, drawing on DHSC’s sourcing and its winter/EU transition PPE and

medicines stockpiling.

B2. Prepare for winter including by:

• Sustaining current NHS staffing, beds and capacity, while taking advantage of the

additional £3 billion NHS revenue funding for ongoing independent sector capacity,

Nightingale hospitals, and support to quickly and safely discharge patients from NHS

hospitals through to March 2021.

• Deliver a very significantly expanded seasonal flu vaccination programme for DHSC-

determined priority groups, including providing easy access for all NHS staff promoting

universal uptake. Mobilising delivery capability for the administration of a Covid19 vaccine

if and when a vaccine becomes available.

• Expanding the 111 First offer to provide low complexity urgent care without the need for

an A&E attendance, ensuring those who need care can receive it in the right setting more

quickly. This includes increasing the range of dispositions from 111 to local services, such

as direct referrals to Same Day Emergency Care and specialty ‘hot’ clinics, as well as

ensuring all Type 3 services are designated as Urgent Treatment Centres (UTCs). DHSC

will shortly be releasing agreed A&E capital to help offset physical constraints associated

with social distancing requirements in Emergency Departments.

• Systems should maximise the use of ‘Hear and Treat’ and ‘See and Treat’ pathways for 999

demand, to support a sustained reduction in the number of patients conveyed to Type 1 or 2

emergency departments.

• Continue to make full use of the NHS Volunteer Responders scheme in conjunction with

the Royal Voluntary Society and the partnership with British Red Cross, Age UK and St.

Johns Ambulance which is set to be renewed.

• Continuing to work with local authorities, given the critical dependency of our patients –

particularly over winter - on resilient social care services. Ensure that those medically fit for

discharge are not delayed from being able to go home as soon as it is safe for them to do so

in line with DHSC/PHE policies (see A3 above).


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C: Doing the above in a way that takes account of lessons learned during the first Covid

peak; locks in beneficial changes; and explicitly tackles fundamental challenges including

support for our staff, action on inequalities and prevention.

C1. Workforce

Covid19 has once again highlighted that the NHS, at its core, is our staff. Yesterday we

published We are the NHS: People Plan for 2020/21 - actions for us all which reflects the

strong messages from NHS leaders and colleagues from across the NHS about what matters

most. It sets out practical actions for employers and systems, over the remainder of 2020/21

ahead of Government decisions in the Autumn Spending Review on future education and

training expansions. It includes specific commitments on:

• Actions all NHS employers should take to keep staff safe, healthy and well – both

physically and psychologically.

• Specific requirements to offer staff flexible working.

• Urgent action to address systemic inequality that is experienced by some of our staff,

including BAME staff.

• New ways of working and delivering care, making full and flexible use of the full range of

our people’s skills and experience.

• Growing our workforce, building on unprecedented interest in NHS careers. It also

encourages action to support former staff to return to the NHS, as well as taking steps to

retain staff for longer – all as a contribution to growing the nursing workforce by 50,000,

the GP workforce by 6,000 and the extended primary care workforce by 26,000.

• Workforce planning and transformation that needs to be undertaken by systems to enable

people to be recruited and deployed across organisations, sectors and geographies locally.

All systems should develop a local People Plan in response to these actions, covering expansion

of staff numbers, mental and physical support for staff, improving retention and flexible

working opportunities, plus setting out new initiatives for development and upskilling of staff.

Wherever possible, please work with local authorities and local partners in developing plans for

recruitment that contribute to the regeneration of communities, especially in light of the

economic impact of Covid. These local People Plans should be reviewed by regional and

system People Boards, and should be refreshed regularly.

C2. Health inequalities and prevention.

Covid has further exposed some of the health and wider inequalities that persist in our society.

The virus itself has had a disproportionate impact on certain sections of the population,

including those living in most deprived neighbourhoods, people from Black, Asian and

minority ethnic communities, older people, men, those who are obese and who have other long-

term health conditions and those in certain occupations. It is essential that recovery is planned

in a way that inclusively supports those in greatest need.

We are asking you to work collaboratively with your local communities and partners to take

urgent action to increase the scale and pace of progress of reducing health inequalities, and


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regularly assess this progress. Recommended urgent actions have been developed by an expert

national advisory group and these will be published shortly. They include:

• Protect the most vulnerable from Covid, with enhanced analysis and community

engagement, to mitigate the risks associated with relevant protected characteristics and

social and economic conditions; and better engage those communities who need most

support.

• Restore NHS services inclusively, so that they are used by those in greatest need. This will

be guided by new, core performance monitoring of service use and outcomes among those

from the most deprived neighbourhoods and from Black and Asian communities, by 31

October. Develop digitally enabled care pathways in ways which increase inclusion,

including reviewing who is using new primary, outpatient and mental health digitally

enabled care pathways by 31 March.

• Accelerate preventative programmes which proactively engage those at greatest risk of poor

health outcomes. This should include more accessible flu vaccinations, the better targeting

of long-term condition prevention and management programmes, obesity reduction

programmes including self-referral to the NHS Diabetes Prevention Programme, health

checks for people with learning disabilities, and increasing the continuity of maternity

carers including for BAME women and those in high risk groups.

• Strengthen leadership and accountability, with a named executive Board member

responsible for tackling inequalities in place in September in every NHS organisation. Each

NHS board to publish an action plan showing how over the next five years its board and

senior staffing will in percentage terms at least match the overall BAME composition of its

overall workforce, or its local community, whichever is the higher.

• Ensure datasets are complete and timely, to underpin an understanding of and response to

inequalities. All NHS organisations should proactively review and ensure the completeness

of patient ethnicity data by no later 31 December, with general practice prioritising those

groups at significant risk of Covid19 from 1 September.

Financial arrangements and system working

To support restoration, and enable continued collaborative working, current financial arrangements

for CCGs and trusts will largely be extended to cover August and September 2020. The intention is

to move towards a revised financial framework for the latter part of 2020/21, once this has been

finalised with Government. More detail is set out in Annex Two.

Working across systems, including NHS, local authority and voluntary sector partners, has been

essential for dealing with the pandemic and the same is true in recovery. As we move towards

comprehensive ICS coverage by April 2021, all ICSs and STPs should embed and accelerate this

joint working through a development plan, agreed with their NHSE/I regional director, that

includes:

• Collaborative leadership arrangements, agreed by all partners, that support joint working and

quick, effective decision-making. This should include a single STP/ICS leader and a non-

executive chair, appointed in line with NHSE/I guidance, and clearly defined arrangements

for provider collaboration, place leadership and integrated care partnerships.


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• Organisations within the system coming together to serve communities through a Partnership

Board, underpinned by agreed governance and decision-making arrangements including high

standards of transparency – in which providers and commissioners can agree actions in the best

interests of their populations, based on co-production, engagement and evidence.

• Plans to streamline commissioning through a single ICS/STP approach. This will typically lead

to a single CCG across the system. Formal written applications to merge CCGs on 1 April 2021

needed to give effect to this expectation should be submitted by 30 September 2020.

• A plan for developing and implementing a full shared care record, allowing the safe flow of

patient data between care settings, and the aggregation of data for population health.

Finally, we are asking you – working as local systems - to return a draft summary plan by 1

September using the templates issued and covering the key actions set out in this letter, with final

plans due by 21 September. These plans need to be the product of partnership working across

STPs/ICSs, with clear and transparent triangulation between commissioner and provider activity

and performance plans.

Over the last few months, the NHS has shown an extraordinary resilience, capacity for innovation

and ability to move quickly for our patients. Like health services across Europe, we now face the

double challenge of continuing to have to operate in a world with Covid while also urgently

responding to the many urgent non-Covid needs of our patients. If we can continue to harness the

same ambition, resilience, and innovation in the second half of the year as we did in the first, many

millions of our fellow citizens will be healthier and happier as a result. So thank you again for all

that you and your teams have been – and are – doing, in what is probably the defining year in the

seven-decade history of the NHS.

With best wishes,

Simon Stevens Amanda Pritchard

NHS Chief Executive NHS Chief Operating Officer


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ANNEX ONE: IMPLICATIONS OF EPRR TRANSITION TO A LEVEL 3 INCIDENT

As previously signalled, effective 1 August 2020 the national incident level for the Covid19

response will change from level 4 (an incident that requires NHS England National Command and

Control to support the NHS response) to level 3 (an incident that requires the response of a number

of health organisations across geographical areas within an NHS England region), until further

notice.

It is entirely possible that future increases in Covid demands on the NHS mean that the level 4

incident will need to be reinstated. In which case, there will be no delay in doing so. However this

change does, for the time being, provide the opportunity to focus local and regional NHS teams on

accelerating the restart of non-Covid services, while still preparing for a possible second national

peak.

The implications of the transition from a level 4 to level 3 incident are as follows:

• Oversight: Transition from a national command, control and coordination structure to a regional

command, control and coordination structure but with national oversight as this remains an

incident of international concern.

• Reporting: We will be stopping weekend sit rep collections from Saturday 8 August 2020

(Saturday and Sunday data will be collected on Mondays with further detail to follow). Whilst

we are reducing the incident level with immediate effect reports will still be required this

weekend (1 and 2 August 2020) and we will subsequently need to be able to continue to align to

DHSC requirements. Additional reporting will be required for those areas of the country

experiencing community outbreaks in line with areas of heightened interest, concern or

intervention.

• Incident coordination functions: The national and regional Incident Coordination Centres will

remain in place (hours of operation may be reduced). The frequency of national meetings will

decrease (for example IMT will move to Monday, Wednesday, Friday). Local organisations

should similarly adjust their hours and meeting frequency accordingly. It is however essential

that NHS organisations fully retain their incident coordination functions given the ongoing

pandemic, and the need to stand up for local incidents and outbreaks.

• Communications: All communications related to Covid19 should continue to go via established

Covid19 incident management channels, with NHS organisations not expected to respond to

incident instructions received outside of these channels. Equally, since this incident continues to

have an international and national profile, it is important that our messaging to the public is

clear and consistent. You should therefore continue to coordinate communications with your

regional NHS England and NHS Improvement communications team. This will ensure that

information given to the media, staff and wider public is accurate, fully up-to-date and aligns

with national and regional activity.


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12

ANNEX TWO: REVISED FINANCIAL ARRANGEMENTS

The current arrangements comprise nationally-set block contracts between NHS providers and

commissioners, and prospective and retrospective top-up funding issued by NHSE/I to

organisations to support delivery of breakeven positions against reasonable expenditure. The M5

and M6 block contract and prospective top-up payments will be the same as M4. Costs of testing

and PPE will continue to be borne centrally for trusts and general practices funded by DHSC who

continue to lead these functions for the health and social care sectors.

The intention is to move towards a revised financial framework for the latter part of 2020/21, once

this has been finalised with Government.

The revised framework will retain simplified arrangements for payment and contracting but with a

greater focus on system partnership and the restoration of elective services. The intention is that

systems will be issued with funding envelopes comprising funding for NHS providers equivalent in

nature to the current block and prospective top-up payments and a system-wide Covid funding

envelope. There will no longer be a retrospective payment mechanism. Providers and CCGs must

achieve financial balance within these envelopes in line with a return to usual financial disciplines.

Whilst systems will be expected to breakeven, organisations within them will be permitted by

mutual agreement across their system to deliver surplus and deficit positions. The funding

envelopes will comprise:

• CCG allocations – within which block contract values for services commissioned from NHS

providers within and outside of the system will continue to be nationally calculated;

• Directly commissioned services from NHS providers – block contract values for specialised and

other directly commissioned services will continue to be nationally calculated;

• Top-up – additional funding to support delivery of a breakeven position; and

• Non-recurrent Covid allocation – additional funding to cover Covid-related costs for the

remainder of the year.

Funding envelopes will be calculated on the basis of full external income recovery. For

relationships between commissioners and NHS providers we will continue to operate nationally

calculated block contract arrangements. For low-volume flows of CCG-commissioned activity,

block payments of an appropriate value would be made via the Trust’s host CCG; this will remove

the need for separate invoicing of non-contract activity.

However block payments will be adjusted depending on delivery against the activity restart goals

set in Section A1 and A2 above.

Written contracts with NHS providers for the remainder of 2020/21 will not be required.

For commissioners, non-recurrent adjustments to commissioner allocations will continue to be

actioned – adjustments to published allocations will include any changes in contracting

responsibility and distribution of the top-up to CCGs within the system based on target allocation.

Reimbursement for high cost drugs under the Cancer Drugs Fund (CDF) and relating to treatments

under the Hepatitis C programme will revert to a pass-through cost and volume basis, with

adjustments made to NHS provider block contract values to reflect this. For the majority of other

high cost drugs and devices, in-year provider spend will be tracked against a notional level of spend


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13

included in the block funding arrangements with adjustments made in-year to ensure that providers

are reimbursed for actual expenditure on high cost drugs and devices. This will leave a smaller list

of high cost drugs which will continue to be funded as part of the block arrangements.

In respect of Medical pay awards, on 21 July 2020 the Government confirmed the decision to uplift

pay in 2020/21 by 2.8% for consultants, specialty doctors and associate specialists, although there

is no uplift to the value of Clinical Excellence Awards, Commitment Awards, Distinction Awards

and Discretionary Points for 2020/21. We expect this to be implemented in September pay and

backdated to April 2020. In this event, NHS providers should claim the additional costs in

September as part of the retrospective top-up process. Future costs will be taken into account in the

financial framework for the remainder of 2020/21, with further details to be confirmed in due

course.


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of 2



Paper Title: Integrated Care System (ICS) Flu Plan 2020/21


Sponsor:

Presenter:

Danni Burnett, Deputy Chief Nurse Attachments/ Appendices:

N/A

Danni Burnett, Deputy Chief Nurse


Information☒

Executive Summary

Delivery of this year’s Flu Vaccination Programme, the biggest in history, will be particularly challenging given the current COVID-19 pandemic and will require, more than ever before, a collaborative system approach and response.

The Nottingham and Nottinghamshire ICS Flu Plan 2020/21 sets out the local ICS led approach to achieving the National Flu Programme for 2020/21 and the general NHS response to flu outbreaks. In addition, itdescribes the interface between NHSE/I direct commissioning functions and the Nottingham and Nottinghamshire ICS and Nottingham and Nottinghamshire Clinical Commissioning Group (CCG) flu planning, setting out respective responsibilities and accountabilities.

Over 300,000 flu vaccinations are expected to be administered to the initial eligible cohorts and there will need to be a significant increase in uptake of vaccinations to meet the 2020/21 ambitions (75% for each group) for the flu vaccination programme.

Additional challenge will also arise following the announcement of the expansion of the programme to include year seven children, household contacts of those on the NHS Shielded Patient List, health and social care workers employed through direct payments or personal health budgets and possibly 50 to 64 year olds.

A Flu Planning and Delivery Group (FPDG) led by a newly appointed system Flu co-ordinator and with representatives from across the ICS, has been established and will ensure that co-ordination, oversight and performance is managed on behalf of the system.

The FPDG will hold system partners to account for delivery against the plan and will publish a weekly dashboard and exception report for the CCG Executive and the Health Protection Board. The report will include risks and issues that cannot be mitigated at a local level.


Compliance with Statutory Duties ☒ Wider system architecture development (e.g. ICP, PCN development)

☐


☐



Integrated Care System (ICS) Seasonal Flu Plan

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of 2





Yes ☐ No ☐ N/A☒ Not required for this item



Risk(s):

Potential significant and high risks in relation to remote working identified within briefing.

Confidentiality:

☒No

Recommendation(s):

1. NOTE the ICS Flu Plan 2020/21.


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0 Version 3.0 FINAL 13.8.20

Nottingham and Nottinghamshire ICS

Seasonal Flu Plan 2020/21


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Document purpose

This policy is written to ensure that there is clarity about system arrangements for the 2020/21 Flu vaccination campaign and ensure that all partners understand their responsibilities in relation to this. To provide assurance to the Midlands regional flu and immunisation board about the robustness of ICS plans

Version Version 3.0 Final Draft

Title Nottingham and Nottinghamshire ICS Seasonal Flu Plan

Nominated Lead

Rosa Waddingham – ICS and CCG Chief Nurse Tracy Madge – ICS Flu Lead

Approval Date

Approving Committee

ICS Executive Meeting System Health Protection Board

Review Date

Groups/staff Consulted

Target audience All staff members involved in the planning for and delivery of the Nottingham and Nottinghamshire Flu Campaign. This document is based on an NHSE template


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Contents 1. Introduction ............................................................................................................................ 4

2. Governance and planning arrangements within ICS........................................................... 5

2.1 Planning .......................................................................................................................... 5

2.1.1 Population Health Management ....................................................................................... 5

2.1.2 Planning to meet the needs of Vulnerable Groups ............................................................ 6

2.1.3 System collaborative planning .......................................................................................... 6

2.1.4 Flu Planning Timeline ....................................................................................................... 7

2.2 Governance .................................................................................................................... 7

3. Assurance processes and findings around: ........................................................................ 8

3.1 Sufficient and correct flu vaccines ordered ................................................................. 8

3.2 Clarity on which GP Practices are operating as hot/cold sites ................................... 8

3.3 Clarity of PPE requirements and provision .................................................................... 9

3.4 Monitoring how long it takes to administer a flu vaccine due to COVID-19 req’ ......... 9

3.5 Additional staffing requirements .................................................................................... 9

3.6 Additional venue requirements ..................................................................................... 10

3.7 Domiciliary service for housebound / shielded patients ............................................. 10

3.8 Cold chain storage requirements .................................................................................. 10

3.9 Enhanced call/recall requirements ............................................................................... 11

4. Practice support .................................................................................................................. 11

4.1 Plan for low performers from last year ......................................................................... 11

4.2 Monitoring vaccine orders and transfers ..................................................................... 12

4.3 Immunisation training provision and assurance ......................................................... 12

4.4 Managing performance through the season ................................................................ 12

4.4.1 Weekly/monthly uptake reports ........................................................................................ 12

4.4.2 IMMFORM submission ..................................................................................................... 13

5. Review of local priorities ..................................................................................................... 13

5.1 Demographic description and identification of vulnerable groups .......................... 13

5.2 Review of last year’s uptake ........................................................................................ 15

5.3 Approach to health inequalities .................................................................................. 16

6. Local arrangements ............................................................................................................. 16

6.1 Maternity and In-patient/Out-patient ........................................................................... 16

6.2 Workforce Vaccination Plans ...................................................................................... 17

6.3 School Age Immunisation Service (SAIS) .................................................................. 17

7. Outbreak management – Linking in with local EPRR arrangements ............................... 18

7.1 Outbreak Management ................................................................................................... 18

7.2 Treatment – use of antivirals ......................................................................................... 18

8. Requests to NHSE for local commissioning ...................................................................... 18

8.1 Care Homes .................................................................................................................. 18

8.2 Community Pharmacies ............................................................................................... 18

8.3 PCN proposals .............................................................................................................. 19

8.4 Plans for 50-64 yr olds ................................................................................................. 19


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9. Communications and engagement..................................................................................... 19

10. Action Plan ........................................................................................................................... 21

Annex 1 Population Health Management and Flu ..................................................................................................... 24

Annex 2 Acute Hospital Processes for in/out patient vaccination ............................................................................ 29


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1. Introduction

This Nottingham and Nottinghamshire Integrated Care System (ICS) Flu Plan is complementary to the

NHS England/Improvement (NHSE/I) Regional Flu Plan which outlines the scope and ambitions of the

National Flu Programme for 2020/21. The primary purpose of this plan is to set out the local ICS led

approach to achieving the National Flu Programme for 2020/21 and the general NHS response to flu

outbreaks. In addition, this plan will describe the interface between NHSE/I direct commissioning

functions and the Nottingham and Nottinghamshire ICS and Nottingham and Nottinghamshire Clinical

Commissioning Group (CCG) flu planning, setting out respective responsibilities and accountabilities.

Delivery of this year’s Flu Vaccination Programme, the biggest in history, will be particularly challenging

given the current COVID-19 pandemic and will require, more than ever before, a collaborative system

approach and response.

We expect to give in the region of 300,000 vaccinations for the initial eligible cohorts and will need to

increase uptake of vaccinations significantly to meet the anticipated 2020/21 ambitions for the flu

vaccination programme. The 2020/21 uptake ambitions have been identified in Table 1 as follows:

Table 1:

In addition, a Coronavirus vaccine may also become available during the flu season and the logistics of

delivering this in conjunction with the flu vaccine are being worked through.

Additional challenge will also arise following the announcement of the expansion of the programme to

include year 7 children, household contacts of those on the NHS Shielded Patient List, health and social

care workers employed through direct payments or personal health budgets and possibly 50 to 64 year

olds.

ICS partners with the support of the Local Resilience Forum (LRF) Data Cell have undertaken analysis

of the number of patients that are identified as eligible to receive the flu vaccine, including those in at risk

groups and cohorts included in the expansion to the programme. Further analysis is also expected in

relation to last year’s uptake, which will inform locality planning and identify any potential short falls in

vaccinations.

For the possible expansion of the flu programme for the 50-64 year olds it is anticipated that there will a

further 101,316 vaccinations offered to reach a target of 75% within this cohort. For age 11 children to

achieve 75% uptake there will be 8,607 vaccinations offered.

All partner plans have fed into the system plan and all organisations have a nominated Flu lead.


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2. Governance and planning arrangements within ICS

The Nottingham and Nottinghamshire ICS covers a diverse population of over 1 million people living

in the City of Nottingham (332,000) and Nottinghamshire County (764,700), however, this does not

include the residents of Bassetlaw as this is part of the South Yorkshire and Bassetlaw healthcare

system.

2.1 Planning 2.1.1 Population Health Management

Population Health Management (PHM) is the approach in which data is used to understand the needs of

the population, enabling focus and resources to be tailored to areas where the impact can have

maximum impact. It is helping us understand our current, and predict our future, health and care needs

so we can take action in tailoring better care and support with individuals, design more joined up and

sustainable health and care services, and make better use of public resources.

Our ICS has developed a partnership approach across the NHS and other public services including:

councils, the public, schools, fire service, voluntary sector, housing associations, social services and

police. All have a role to play in in addressing the interdependent issues that affect people’s health, care

and wellbeing.

We will use PHM principles to support our flu planning and delivery by using segmentation, stratification

and impactability modelling to identify local ‘at risk’ cohorts – to prevent ill-health and to improve care

and support while reducing unwarranted variations in outcomes.

A key element of flu planning is to identify those cohorts who meet the national definition as per Table 1

above. Our local PHM approach and data infrastructure will enable us to identify this cohort down to

PCN level:-

While our local flu plan will be produced using national definitions, our PHM approach will allow the

system to produce a culturally competent plan to meet the needs of the most vulnerable citizens in our


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society. Understanding and addressing inequalities is crucial to ensuring a systematic approach to flu

planning.

When looking at implementing our plan we will ensure that wider determinants are a core characteristic

in our stratification process. Nottingham and Nottinghamshire has wide variation in healthy life

expectancy, and deprivation. These inequalities will need to be considered when looking at targeted flu

interventions to reduce further impact, and improve outcomes. Further detail is provided in Annex 1.

2.1.2 Planning to meet the needs of Vulnerable Groups

Vulnerable groups have been identified and discussions commenced within localities to determine how

these groups can be best reached and by which providers. The vulnerable groups include

housebound/shielded, learning disability, homeless, black and minority ethnic groups and travelling

communities.

The locality teams are also planning to collaborate with faith and community leaders to develop

specifically targeted communications to encourage people with faith based uncertainties regarding the

vaccines (e.g. Muslims and porcine content) to get their vaccinations.

Communications will also go out through the City and County Councils to raise awareness in partner

organisations and the third sector.

Learning from the response to COVID-19 and drawing upon the approach to engage and work with the

‘shielding’ population will be essential and will inform the locality implementations plans.

2.1.3 System collaborative planning

Based on our system model PCNs will deliver their plans at local level as shown in the diagram below:

ICPs will lead a coordinated delivery across a place based area supported by the ICS. This collaboration

between the ICS and ICP footprints will enable coordinated delivery and support learning together as

one system.

System Level co-ordination

deliver elements that are best

delivered at system - i.e. Childrens

Co-ordinate and report on

performance

ICP support and Collaboration

Maximise local collaboration

Deliver place based system approachs -

MECC

Provider staff planning

PCN Delivery

Working to deliver to key at risk groups

Support to care homes with wrap around enhanced support at ICP

level


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Across the Nottingham and Nottinghamshire ICS system there are:

127 GP practices

212 Community Pharmacies

324 care homes (94 nursing homes and 230 residential care homes)

75 Home Care Agencies

271 personal assistants

16 Specialist Schools

304 Primary Schools

58 Secondary Schools

2 Acute NHS Trusts

1 Combined Mental Health/Community Health NHS Provider

1 Community Provider (City)

2 Local Authorities

2.1.4 Flu Planning Timeline

Additional detail provided in Annex 6

2.2 Governance

There is already a well-established Derby and Nottinghamshire Midlands Seasonal Flu Planning group

(DeNo) which is chaired by Public Health England (PHE) and oversees the key components of a high

quality, consistent, comprehensive, robust and equitable Seasonal Flu Vaccination Programme in

Derbyshire and Nottinghamshire.

The chart below demonstrates the reporting / group arrangements for the flu vaccination programme,

green boxes are Nottinghamshire specific.

14 August 2020

Weekly ICS meeting

x3 weekly touchpoint

meeting

30 August 2020

Staff capacity and competency

assured

4 Sept. 2020

weekly data collation

process and dashboard mobilised

7 Sept. 2020

aTIV & QIVc over 65 yrs

Sequirus

Vaccine released

PCN delivery

7 - 28 Sept. 2020

Seqirus Vaccines released system delivery

Cohort 1 (over 65):

At risk groups

vaccinated

28 Sept. 2020

Sanofi Vaccines

QIVe under 65yrs

Vaccine released

PCN delivery-

18 Sept (TBC)

Children's vac LAIV delivered

12 Oct. 2020

20% sanofi Flu Vaccine

released system delivery

Cohort 2 and

Staff vaccination

28 Oct 2020



Cohort 1: Mop up and

Staff vaccination

9 Nov. 2020



Cohort 2: Mop up

Staff vaccination

9 Nov 2020 Cohort 3:

50-64


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The ICS Flu Planning and Delivery Group (FPDG) is chaired by the Associate Chief Nurse who is the

ICS Flu Lead supported by the CCG Quality Flu Lead reporting directly to the CNO. On behalf of the

Health Protection Board, the FPDG oversees the development and delivery of the ICP and system

partner flu plans, sharing innovative ideas and learning, whilst developing monitoring arrangements. The

group will report into the CCG, Health Protection Board, DeNo Seasonal Group, and the Midlands Flu

and Immunisation Board.

3. Assurance processes and findings around:

3.1 Sufficient and correct flu vaccines ordered

Public Health England in collaboration with CCG officers have worked with GP practices to undertake a

desktop exercise to provide assurance that sufficient and correct vaccines have been ordered by GP

practices across Nottingham and Nottinghamshire.

Across the 127 practices a total of 229,830 vaccines have been ordered and an estimated further 70,000

vaccines procured for Care Home/Home Care staff and NHS provider staff. These orders are based on

the previous years’ at risk groups and uptake ambitions and do not take account of the expansion of the

programme to 50 to 64yrs.

In the event that there are issues with the delivery of vaccines, the locality teams will work with practices

and PCNs to ensure the available stock is deployed as effectively as possible. This will be dependent on

national arrangements to allow sharing of vaccines between practices being operationalised.

It is anticipated that there may be a greater demand for the flu vaccine this year as the public respond to

the pandemic. In addition, a Coronavirus vaccine may also become available during the flu season and

the logistics of delivering this in conjunction with the flu vaccine are being worked through.

3.2 Clarity on which GP Practices are operating as hot/cold sites

Practices within the ICPs have plans to use cold sites arrangements support the vaccination of COVID-

19 shielded people, for example different entrances. The following provides specific detail:

Midlands Regional Flu and Immunisation Board

Nottingham &

Nottinghamshire ICS Health

Protection Board

Nottingham and Nottinghamshire System Exec

Nottingham & Nottinghamshire ICS System Flu Planning and Delivery Group

PHE Screening and Imms

Programme

City and County Child

Flu Group

Provider Task Group

Local Authority

Task Group

Community Pharmacy Task

Group

ICP Locality Flu Task Groups


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South Nottinghamshire ICP

Practices are currently managing their flow of ‘hot’ and ‘cold’ patients within their individual premises.

There are plans in place to instigate Clinical Management Centres (CMC) within PCNs to centralise and

support the management of ‘hot’ patients should the need arise.

Nottingham City ICP

Nottingham City ICP has a CMC which is currently operating as a ‘hot’ site from Bulwell Riverside,

although this will be transferred to Upper Parliament Street by the end of July 2020.

It is likely that PCNs 4 and 8 will also start to utilise the CMC alongside PCNs 1, 3, & 6, who are already

using it.

PCNs 5, 7 and Unity PCN are managing their flow of ‘hot’ and ‘cold’ patients within their PCNs.

Mid Nottinghamshire ICP

GP practices are currently managing their flow of ‘hot’ and ‘cold’ patients within their individual premises.

There are plans in place to instigate CMCs within PCNs in the event of a significant second wave of

COVID to centralise and support the management of ‘hot’ patients should the need arise.

3.3 Clarity of PPE requirements and provision

With the support of Infection Control and Public Health colleagues PPE requirements are being

confirmed irrespective of location. Practices have been advised by the CCG to calculate requirements

based on a separate set of gloves and apron for each individual patient receiving the vaccination1.

Providers will do their own risk assessment on the use of PPE.

Plans have been implemented to source centrally and distribute PPE specifically for the flu programme

(this supply is separate from other contingency stocks). Plans include a central supply which will be

distributed according to the different models for providing the vaccines i.e. for individual clinicians

carrying out home visits, GP Practices or in the event of larger flu clinics. Supplies will include gloves,

aprons and masks.

Individual provider plans will include detail of PPE requirements and sourcing.

3.4 Monitoring how long it takes to administer a flu vaccine due to COVID-19 req’

The Royal College of GPs has released a document 'Delivering Mass Vaccinations during COVID-19 - A

Logistical Guide for General Practice’. This identifies that administration of a flu vaccine in line with the

current COVID-19 requirements will take approximately double the length of time than in previous years,

3 – 6 minutes per patient as opposed to 1 – 3 minutes. This information has been shared with practices

and the locality teams to inform planning and to highlight the requirement for practices to monitor this to

inform any required adjustments to their individual practice or PCN plans.

Individual provider plans will also need to reflect this increased delivery time where there is sufficient

volume of staff for this to be a significant impact.

3.5 Additional staffing requirements

Each ICP has identified flu as a clinical priority and aims to maximise vaccination opportunities through

effective collaborative and partnership working. A flu task and finish group has been established within

each ICP with clinical and managerial resource aligned to support. The locality teams are working

closely with PCNs to deliver bespoke plans to deliver an effective and efficient vaccination programme

according to local requirements.

1 NHSE are reviewing the national guidance


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Although planning is in the preliminary stages for each of the ICP flu task and finish groups, the

challenges around increased vaccination times for each individual patient and other logistics as a result

of COVID-19 have been recognised and consideration is being given to:

Resourcing drive through provision including any additional staffing requirements;

Practices to identify additional capacity to deliver the flu campaign and access an Enhanced

Care Response Team if required;

Maximise commissioned services such as community nurses to deliver the vaccine to shielded

people, their carers and care home residents;

Maximise the use of community pharmacies to support delivery especially in care homes;

Re-instating the extended access service provision with a focus on flu vaccination;

Supporting other staff e.g. district nurses and care home staff to vaccinate on behalf of the GP

practice;

Using PHM data capture and deploying additional staff to support vaccination where uptake is

low or at risk groups require targeted support;

Roving flu nurses.

In addition the Learning Disabilities Liaison Nurses within the community provider are working with

patients and carers providing patient information, health promotion and desensitisation for needle phobic

patients whilst linking with GP practices to increase uptake for patients and carers being vaccinated at

the same time.

Discussions with partner providers of community, schools and social services are underway to ensure

the most efficient use of staff and resources across the ICS footprint. Considerations will also include

any potential for a COVID-19 vaccination to be offered should this become available.

3.6 Additional venue requirements

Planning across the localities is currently in its formative stage, however, a mixture of practice-based,

central vaccination (in large GP practices) and partnership models are being explored which includes

how throughput can be managed.

Close working with district councils, voluntary agencies and health partners is also being established to

support delivery of the programme.

Work is to be led through the recently established LRF Testing Cell building upon the learning from

COVID and the military support.

3.7 Domiciliary service for housebound / shielded patients

A domiciliary service to support the vaccination of housebound / shielding patients is being considered

by the locality task and finish flu groups and PCNs are being encouraged to develop this with CCG

officers exploring the question of how this is resourced and paid for when the flu campaign is

commissioned directly from GP practices. An inter-agency agreement developed for the 2019/20

programme will be adapted for use where necessary in 2020/21.

3.8 Cold chain storage requirements

All sites undertaking Flu practices are aware of cold chain storage requirements. If plans involve

movement of vaccinations from the initial location (i.e. GP surgery or community pharmacy) to

elsewhere, for example a care home / drive through facility / other location, then cold chain storage

requirements and maintaining of the cold chain will be addressed as part of those plans. This will also be

managed in line with MHRA guidance which has been relaxed to accommodate increased flu targets.

Where Care homes are aligned, and practices are in agreement, the vaccines could come from the

practice but they would need to be transported in validated cool boxes and returned to the practice

within appropriate timescales ensuring that the cold chain has been assured throughout.


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A drive through assessment checklist is in development to support providers in establishing standard

operating procedures and health and safety measures as various options are considered around how

the flu programme can be delivered safely and effectively in potentially different settings.

If there is an incident where the cold chain has been, or may have been broken, then the incident

reporting process and documentation for alerting PHE and NHSE/I will be undertaken and appropriate

investigation and lessons learned identified and shared.

Now the flu vaccination programme has been extended, logistics around transportation and safe storage

of additional vaccines needs to be considered and potential alternative storage arrangements identified.

For example, exploration/discussion with NHS Blood Donation and Emergency Planning Teams to

understand whether there are any opportunities to learn from and whether they are able to offer any

support.

The following is taken into consideration as part of the provider / locality plans:

Specialist Pharmaceutical Fridges should be used to store vaccines. Domestic fridges should not

be used

Clinical specimens and food should not be stored alongside vaccines

The fridge temperatures should be maintained between +2 and +8 degrees centigrade

It is best practice to record minimum, maximum and actual temperatures of the medicines fridge

twice daily when the practice / location is open

Ideally an independent thermometer and data logger should be in place, to provide a method of

cross checking temperature accuracy. This reduces the potential risk of having to waste vaccines

and revaccinate patients

The risk of an interruption in the electricity supply to the fridge should be reduced by either

installing a switchless socket or clearly labelling the refrigerator plug with a cautionary: DO NOT

UNPLUG/SWITCH OFF notice

Vaccine fridges should be large enough to allow sufficient space around the vaccine packaging

for air to circulate. To allow this, fridges should be stocked to no more than 50% capacity

The fridge should be kept in a well-ventilated position away from any heat source

The fridge must be cleaned regularly and serviced each year

Vaccines must be kept in their original packaging to protect from light, as this affects vaccine

efficacy

When transporting vaccines, validated cool boxes from a recognised medical supplier should be

used

All those involved in vaccine administering / cold chain management should access immunisation

update training / flu update every year.

3.9 Enhanced call/recall requirements

All practices have well established mechanisms for enhanced call/recall of patients. As part of the

COVID-19 response all practices were provided with MJog, a two-way digital messaging facility which

will enable practices to send out text message invitations and reminders to patients. Any good practice

around call and recall of patients, including assurance to patients about attending the practice / place of

vaccination, will be collated by the locality task and finish flu groups and can be shared via the CCG’s

communications team on TeamNet – a communication tool, again now accessible to all practice staff as

part of the COVID-19 response.

The FPDG are also aware that NHSE/I are developing a national call and recall service to support local

call and recall provision and to ensure that all eligible patients are informed of their eligibility.

4. Practice support

4.1 Plan for low performers from last year

Through collaborative work between PHE and the locality teams, low performing practices will be

identified as part of last year’s analysis of uptake (see section 5.2) and the approach to supporting these


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practices to improve uptake for this year will be determined. This will be based on the location and PCN

within which the practices sit. Insights from any successful approach taken last year will be used to

inform the actions to be taken.

In addition, schools where vaccination uptake is low will be contacted through education links to identify

specific reasons for low uptake and what support can subsequently be offered.

Improving uptake for care home staff is also a priority and how this information can be accessed and

acted upon is being worked through and is yet to be confirmed, whilst recognising that this is an

occupational health vaccine. There will be a vaccination campaign for frontline staff in the County

Council offering Boots pharmacy vouchers or on-site vaccinations commissioned through a local

pharmacy provider. This offer will include County Council run residential homes, Short Breaks services

and children’s centre staff. Frontline staff at special schools will also be offered a flu vaccination through

the Council’s staff programme. In addition, the County Council has commissioned ‘myth-busting’ Q&A

sessions for frontline teams and targeted care homes to be delivered by NEMS.

The County Council is also reviewing targeted communications for areas of low uptake as well

promoting the flu programme and encouraging all eligible residents to get their flu vaccination.

4.2 Monitoring vaccine orders and transfers

As detailed in section 3.1, PHE in collaboration with CCG officers have undertaken a desktop exercise to

establish that sufficient and correct vaccines have been ordered by GP practices. It is anticipated that

this may need to be repeated as the flu programme is extended and practices may or may not be

required to undertake additional ordering, depending upon whether there is a centralised supply

approach or not.

In the event that there are issues with the delivery of vaccines, the locality teams will work with practices

and PCNs to ensure the available stock is deployed as effectively as possible. Monitoring of transfer of

vaccines will be confirmed if and managed according to guidance released by the MHRA which requires

CCG assurance.

4.3 Immunisation training provision and assurance

It is recognised that during the pandemic, it is likely that the opportunity to attend face to face,

classroom-based training will continue to be severely limited due to social distancing advice. Immunisers

can therefore utilise e-learning, online and virtual training sessions to access foundation and update

training rather than the face to face or the mixed delivery learning approaches recommended in the

standards documents. NHSE/I, together with PHE, have published clinical guidance for healthcare

professionals on maintaining NHS immunisation programmes during COVID-19.

This includes sign posting to a comprehensive immunisation e-learning programme available on the

Health Education England e-Learning for Healthcare website. This is free of charge and open access to

all. The e-learning programme has been written in line with the recommendations made in the training

standards and covers the core areas of immunisation with which healthcare practitioners need to be

familiar to deliver immunisations safely. The e-learning programme is relevant to healthcare practitioners

with a role in immunisation whatever their background and the setting in which they give or advise on

vaccination.

4.4 Managing performance through the season

4.4.1 Weekly/monthly uptake reports

The FPDG will be responsible for managing and reporting on performance against the plan to the Health

Protection Board and the CCG Executives. The group will produce a programme plan which will include

identified risks and issues in relation to the safe and effective achievement of the programme.


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Task groups reporting to the FPDG will be responsible for submitting plans and reports to the FPDG

either weekly or monthly or as requested. Task groups include the following:

NHS Providers

Local Authority, staff and care sector (via the care operational oversight partnership)

Primary Care Networks

Community Pharmacy

PHE screening

Task groups will each provide a highlight report to the FPDG which will then provide a collated highlight

report to the CCG Executive and the Health Protection Board weekly or as required. This will include a

data dashboard.

It is recognised that live data is imperative in enabling effective overview and subsequent support where

performance requires improvement. Some CCG officers will set up access to IMMFORM, which will form

part of the weekly dashboard produced by the FPDG. The dashboard will detail the following:

a) The capacity across the system

b) Performance trajectories and comparison of equivalent performance from last year

c) OPEL reporting, shared across partners to support and improve performance.

d) Providers’ staff uptake.

There will need to be a mechanism for services to inform GP practices when they have administered a

vaccine to ensure this can then be reported onto IMMFORM and captured in the overall reporting.

Uptake monitoring from all the task groups to evaluate effectiveness of approaches will be monitored at

the ICS FPDG.

4.4.2 IMMFORM submission

Practices submissions will automatically be uploaded to IMMFORM and the CCG will ensure each

practice has registered with IMMFORM and has the correct codes to enable upload of data. Pharmacies

in Nottinghamshire use PharmOutcomes to notify practices of vaccinations carried out. The

PharmOutcomes system uses different methods to notify practices to ensure that GP Practices receive

the relevant information. A legacy challenge has been other services notifying GP Practices of flu

vaccinations and the CCG is investigating the option to use an app called FUSION to support this.

5. Review of local priorities

5.1 Demographic description and identification of vulnerable groups Identification of at risk groups below, further detail about population demographics can be found in

section 2.1.1 and in Annex 1.

Our most at risk What we are doing

Over 65s Leadership and involvement from Primary

Care Networks (PCNs) taking the learning

from responding to the pandemic and the

ability to mobilise clinical management centres

and approaching information sharing in a

timely manner

Opportunities around mobile and in-reach

solutions, for example Drive-Through

vaccination centres, as some traditional

delivery methods, such as vaccination clinics

at GP practices may not be practicable due to

social distancing restrictions

Making the most of Every Contact Counts with

Nottingham City is the 8th most deprived district

in the country. 61 of the 182 City Lower Super

Output Areas fall amongst 10% most deprived in

the country and 110 fall in the 20% most deprived

Nottingham has a higher than average rate of

people with a limiting long-term illness or

disability

35% of population of Nottingham City are from

black and minority ethnic (BME) groups who may


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have beliefs that make them reluctant or refuse

vaccinations

all system partners exploring options, including

our Hospital Trusts offering vaccinations to

pregnant women attending maternity

appointments and to those clinically at risk

eligible patients attending ED, in- and out-

patient appointments, and continuing to work

with specialties such as Renal

Approach to logistics, alternative vaccination

locations and adjustments that may be

required in the event of any local lockdown

restrictions

Services and community pharmacies and GP

practices in vaccination of residents and staff

in residential care and nursing homes

Earlier engagement from all partners with local

communities and faith leaders to ensure

equitable uptake compared to the population

as a whole and help protect those who are

more at risk

Utilisation of e-Consent forms and text

messaging services, Fluathons, Flu week,

utilising social media, and cascade of vouchers

for our care sector

System oversight and early intervention such

as the approach to OPEL reporting and

partners working to one data set

Exploration of delivery of vaccinations outside

normal working hours to accommodate the

working population and particularly the 50 – 64

yrs cohort (eg. Extended community pharmacy

opening hours)

Delivery of the programme whilst following

infection, prevention and control guidance and

guidelines on social distancing and the

standard operating procedures currently in

place for General Practice, community

pharmacy and community health services

Ensuring appropriate measures are in place to

keep patients safe from COVID-19 and

reassuring them that this is the case,

particularly those that are on the NHS Shielded

Patient List

Ensuring all providers meet their responsibility

to protect their staff by providing vaccination

Over 2 in 5 households do not have access to a

car, with the highest level of bus use per head

outside of London

20% of the population of Nottinghamshire County

are aged 65+, compared to the England average

of 18%

2476 people live in a nursing care home and

4396 live in a residential care where we have

seen large numbers of COVID-19 related deaths

Improving uptake for care home staff is also a

priority and how this information can be

accessed and acted upon is being worked

through and is yet to be confirmed, whilst

recognising that this is an occupational health

vaccine.

There will be a vaccination campaign for

frontline staff in the County Council offering

Boots pharmacy vouchers or on-site


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vaccinations commissioned through a local

pharmacy provider

The County Council is also reviewing targeted

communications for areas of low uptake as

well promoting the flu programme and

encouraging all eligible residents to get their

flu vaccination.

Low performing practices Through collaborative work between PHE and

the locality teams, will be identified as part of

last year’s analysis of uptake (see section 5.2)

and the approach to supporting these

practices to improve uptake for this year will

be determined. This will be based on the

location and PCN within which the practices

sit.

Insights from any successful approach taken

last year will be used to inform the actions to

be taken.

Schools where vaccination uptake is low These will be contacted through education

links to identify specific reasons for low uptake

and what support can subsequently be

offered.

This offer will include County Council run

residential homes, Short Breaks services and

children’s centre staff.

Frontline staff at special schools will also be

offered a flu vaccination through the Council’s

staff programme. In addition, the County

Council has commissioned ‘myth-busting’

Q&A sessions for frontline teams and targeted

care homes to be delivered by NEMS.

5.2 Review of last year’s uptake

A review of last year vaccination programme highlights the areas we are focussing on this year.

Detailed analysis of the 2019/20 adult’s flu uptake is in progress and will identify individual practices /

PCNs / localities where additional support and focus will be required this year.

It identifies that historically uptake is better in the county for each adult cohort, and that vaccination of

the under 65 at risk and pregnant women groups is particularly challenging.

Analysis of the 2019/20 children’s flu uptake historically is better in the county and also that uptake in

primary aged children decreased significantly in the city last year. The Nottingham City and

Nottinghamshire County Child Flu Group are aware of this and are developing plans to facilitate

improvement, including early contact with schools and faith leaders to support communications to

parents and guardians. The Child Flu Group plan will be embedded within this plan once finalised.

Based on e-healthscope an analysis has been undertaken to determine how many anticipated vaccines

with the 50-64 year old and 11 year olds would be needed to be offered to reach a target of 75%. The

number of people this affects is 123, 052.


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5.3 Approach to health inequalities

The Flu planning embeds a population health management approach to ensure that there is an active

approach to managing health inequalities, further detail about this can be found in section 2.1.1 and at

Annex 1

6. Local arrangements The local system with ICP leadership will work together to ensure the expansion of the flu vaccination

programme is coordinated and data captured to ensure the safety of the population.

Our partners are committed to making every contact count. Where possible people will be offered the flu

vaccine at every contact with health services for example:

Hospital appointments and as inpatients.

Community pharmacy delivery in care homes.

Astra Zeneca support to the children’s programme

6.1 Maternity and In-patient/Out-patient

SFHT and NUH Maternity and Renal Patients

The process for vaccinating Renal and Obstetrics patients is the same for both NUH and SFHFT and are

well used pathways which NUH has implemented for a number of years. The process is attached at

Annex 2.

For the first time, the Maternity Service will be offering flu vaccinations to patients in both acute trusts.

In and Outpatients

SFHFT and NUH have not previously vaccinated any in-patients, out-patients or people attending the

emergency department, however, discussions are to be held with SFHT to consider how ‘every contact

counts’ principles can be extended to flu vaccination, including vaccination of those in the eligible

cohorts attending the trust and where that is not possible, sign posting patients to their GP practice /

local pharmacy to obtain the flu vaccine.

Woodthorpe Hospital – Ramsay Healthcare UK

The Woodthorpe Hospital has not previously provided flu vaccinations to patients however, the hospital

is considering how to implement ‘every contact counts’ with their patients this year in relation to the flu

vaccination programme.

BMI Healthcare – The Park

The Park has not previously provided flu vaccinations but plans to consider how to implement ‘every

contact counts’ with their patients this year in relation to the flu vaccination programme.


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6.2 Workforce Vaccination Plans

The table below shows Nottingham and Nottinghamshire staff groups and who is accountable for

vaccination uptake:

Workforce Accountable body

13,288 Care home staff Local Authority

3,000 Home care staff Local Authority

40,000 plus acute, ambulance, mental health and community staff

NHS Provider

470 ICS / CCG staff CCG

4,200 GP practice staff CCG

271 health funded Personal Assistants CCG

Up to 800 county Personal Assistants (social care) funded staff through direct payments Awaiting city detail

Local Authority

Twenty staffing agencies including NHS Professionals

Utilised directly by providers, care homes/home care

Workforce vaccination plans are being developed.

6.3 School Age Immunisation Service (SAIS) There will be a 100% offer to:

Children in primary school year groups: R, Y1, Y2, Y3, Y4, Y5, Y6

Children in secondary school year group: Y 7

All children attending special schools catering for vulnerable health groups.

The cohort includes those in the above groups who are home educated or those not attending school for

other reasons.

The ambition is to complete immunisations by 15 December 2020. The majority of vaccinations will be

administered in school settings with catch up clinics for those who miss their school session. There will

be additional catch up clinics in community settings from 15 December 2020 until 8 January 2021.

Electronic consent will be used again, and partners have agreed to support in promoting use of this. Last

year was the first year of use. Some schools embraced it, others will need encouragement this year.

Schools up to October half-term have already been contacted and asked to send out e-consent.

To improve uptake in 2020 the service is:

Offering 2 sessions to schools that had low uptake last year. Most of the city schools are in this

group

Recruiting a Health Promotion Practitioner with a remit of improving uptake by working with

schools and communities to promote immunisation and encourage completion of e-consent

Exploring widespread use of MJog or System One and EMIS texting. This will enable the SAIS to

share the e-consent link with parents reinforcing a 100% offer

Sending a letter to all home educated children who are registered on SystmOne and EMIS.

The county council offered support to the School Imms Service last year when there was resistance

following the introduction of e-consent. They will be encouraging all head teachers to support the flu

vaccination programme, particularly with the introduction of the Y7 cohort.


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7. Outbreak management – Linking in with local EPRR arrangements

7.1 Outbreak Management

In the initial stages it is unlikely that a symptomatic outbreak will be clearly identifiable as either Flu or

COVID and there is therefore complete alignment with a single local outbreak plan covering both Flu and

COVID.

The Local Outbreak Plan will have within scope all care homes and also all areas that have shared

communal facilities such as extra care and other assisted living facilities. The first draft of the plan was

submitted on 30 June 2020 to the regional team and work is on-going to review resource required and

testing support that will be needed.

Any respiratory outbreak identified will be reported via the care home directly to IPC, PHE or the Incident

Management Centre in the CCG. A request for swabbing will be made by IPC/PHE and the swabbing

resource deployed (to be agreed via local outbreak plan as above). Swabs will be taken for influenza

and COVID-19. IPC advice and support will be given to the setting at this point and further testing of

residents and staff will be undertaken if the individual is positive for COVID-19. If positive for influenza

then anti-virals will be recommended. Whether COVID-19 or influenza positive, the outbreak plan will be

enacted if a positive case occurs within a residential setting.

7.2 Treatment – use of antivirals

We have local systems in place for the provision of antiviral treatment and prophylaxis during an

outbreak of influenza both in and out of the flu season. In season, GP Practices can prescribe for

treatment of influenza as per their contract and a separate agreement is required for prophylaxis.

During previous flu seasons this has been managed through a local enhanced service agreement with

GP Practices for “in season”. Also, the CCG has held an agreement with the out of hours provider

NEMS to provide anti-viral treatment and prophylaxis out of season and prophylaxis in season. For

2020/21 the CCG are working with NEMS on a proposal that will better support the system overall,

allowing for a full responsive approach within the required 24 hour period both in and out of flu season.

8. Requests to NHSE for local commissioning

8.1 Care Homes

The ECRT could be used to support the vaccination programme but they are currently not

commissioned for this service. The expanded programme for 50-64 years may need this additional

capacity.

The ICS ambition also includes a plan to vaccinate the 13,288 care home staff across Nottingham and

Nottinghamshire, recognising that the vaccination of staff will be more challenging.

The logistics of the above are to be confirmed as consideration needs to be made as to whether

honorary contracts are required, whether care home staff can be included (as it is recognised that staff

vaccination is an occupational health vaccination programme and the responsibility of the employer) and

access to training, transportation and storage of vaccinations.

The County Council has commissioned a specialist nurse to target at least the top 20 care homes (from

last year’s outbreaks) to educate staff about flu and encourage vaccinations

8.2 Community Pharmacies

There are 212 community pharmacies in the ICS foot print and it is expected that at least 90% will offer

the National Community Pharmacy Commissioned Flu Service.


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The Community Pharmacy Seasonal Influenza Advanced Service Framework has amended to enable

community pharmacies to vaccinate both residential care/nursing home residents and staff in the home

setting in a single visit to increase uptake rates and offer further protection to this vulnerable group of

patients.

It would be helpful if the use of this resource could be considered as the key mechanism for delivery of

the 50-64 vaccination as this will allow additional mobility for working age cohorts to choose multiple

sites for receipt of vaccination.

8.3 PCN proposals

Planning is in its final stages and is in collaboration with the CCG’s Primary Care Recovery Cell and the

ICP flu task and finish groups. Clinical Directors are leading work in the PCNs to maximise a local

approach and share and enhance schemes which have worked well within localities in previous years.

The concept of a ‘Flu week’ across the City and County is being explored and has worked previously

with schools and pre-schools, particularly including a FLuathon day last year with child friendly

entertainment at practices to incentivise parents to take children.

Other novel approaches are being explored with a view to overcoming some of the obstacles posed. For

example:

Sharing of vaccines across providers, where permitted

Payment mechanism more easily adaptable for ICP Partner collaboration

Providing incentivisation for collaboration rather than competition

Drive through clinics and alternative vaccination venues within a PCN footprint.

8.4 Plans for 50-64 yr olds

PCNs are exploring vaccine delivery to support who is best placed to lead/deliver on this expanded

groups. The following options are some of the additional proposals for this cohort:

Access in other areas e.g. working in other geographies

Community pharmacy support where sufficient vaccines are available

9. Communications and engagement

Communication teams across all partner organisations are working towards a System wide

Communication and Engagement Plan with identified leads and a coordinated, joined up approach to

promoting the flu vaccination programme to staff, target groups and the public.

Planning is underway and will potentially include an NHS system wide staff incentive that has proven to

work well in the patch in previous years.

A draft CCG communications plan is developed.

This year more people are eligible for the vaccination and it is important the communications strategy

targets these key groups as a priority.

The communication plan specifically targets the usual groups such as over 65s, under 65s at risk,

pregnant women and children. However, it will also encompass shielding groups, Year 7 children and

once those groups have been immunised it will look to target 50 – 64 year olds.

The CCG communications plan focuses on three aspects: external communications to the public,

internal communications to staff and help and support to GPs and care homes.


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A Flu toolkit for GPs will be created on TeamNet to support GPs share communications and key

messaging with their patients and we will also be encouraging GPs to share best practice between each

other to encourage a larger uptake of the vaccine.

National PHE and NHSE/I collateral will be utilised, and the ‘Catch it, kill it, bin it’ campaign commences

in September.

External communications with the media will play a key role. The CCG will work with BBC Radio

Nottingham to encourage uptake of the vaccine and myth busting hard to reach communities and key

spokespeople will be used to encourage uptake and provide key information to the public. Case studies

and videos will also be shared with the media.

This year there is a big focus on making our communications as accessible as possible. The CCG will

be working to make sure key messages are translated into multiple languages and signed videos will

also be used to reach the deaf communities. As part of the Flu plan it is also important to tie these key

messages in with the winter plan, which will encompass choosing the right service and a push to use

111 online. These will all tie in with the Flu messaging in order to maintain that NHS services are used

safely throughout a winter with COVID-19.

Timeline for winter (subject to change):

August 2020 – staff-facing collateral will become available

August to September 2020 – external messaging focuses on access for GPs

October 2020 – patient-facing collateral will become available

National paid adverts e.g. Media communications

October to December 2020 – messaging focuses on having the flu vaccination (note: the

campaign is designed to ‘mop up’ those that haven’t had their vaccination yet. It is the role of

the GPs to contact the patients on their list in ‘at risk’ groups)

December 2020 – Think 111 messaging / campaign begins

December 2020 to January 2021 – messaging focuses on norovirus.

National materials have not yet been released but the above indicative timescales have been

communicated for ordering.

There will be a vaccination campaign for frontline staff in the County Council offering Boots pharmacy

vouchers or on-site vaccinations by commissioned through a local pharmacy provider. This offer will

include County Council run residential homes, short breaks services and children’s centre staff.

Frontline staff at special schools will also be offered a flu vaccination through the Council’s staff

programme.

General communications will be undertaken through County Council networks potentially including local

advertising targeted in areas of poor uptake previously. School leads will provide support for the Schools

Immunisations Service.

Through the County Council’s Public Health Team a specialist nurse has been commissioned to provide

myth busting sessions for frontline teams, care homes staff (targeted to homes which have had

outbreaks previously) and children’s centres. A video resource is in production for internal use with

frontline County Council staff.

Communication across County Council staff will also encourage them to raise vaccination with

vulnerable service users and to promote the flu vaccination through the NHS programme.


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21

10. Action Plan A detailed programme plan and action plan is under development. Below are the main actions.

Reference Action Lead Due date Update Status

FLU 01 Outstanding GP Orders: (2 GP practices) To secure solutions to ensure sufficient vaccinations will be available

CCG Head of Primary Care / CCG Quality Team

7 August 2020 Expected update on position 10 August 2020

open

FLU 02

To work with the Care Home & Home Cell to develop a flu plan for residents and workforce including the utilisation of the ECRT

CCG / LA Quality Leads via the Care Home & Home Care Cell

31 August 2020

40 ECRT nurses identified. Training in August ready to deploy Sept. Indemnity and honorary contracts to be in place with all practices requiring support

open

FLU 03

To review vaccination orders for the expanded cohort, depending upon whether there is a centralised supply approach or not.

NHSEI Screening & immunisation Team with the support of ICS Partners

30 September 2020

Additional vaccine expected

open

FLU 04 Develop a mechanism assurance and monitoring reports into the ICS System Flu Planning Group.

ICS Flu Planning & Delivery Group (FPDG)

30 September 2020

PHM data and OPEL reporting to be confirmed 13.08.20

open

FLU 05

Respond to expected national announcement of the expansion of the programme, reflecting actions within this plan and ICP implementation actions

FPDG 11.08.20 Plan allows for expansion if vaccines available

open

Integrated Care S

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FLU 06 ICPs to develop Implementation Plans ICP Flu Leads TBC Awaiting ICP boards sign off

open

FLU 07 To work with CCG/TCG Cells to learn from COVID to inform planning of the necessary logistics plans in relation to roll out

FPDG

13.08.20 PHM and OPEL reporting expected proposal 13.08.20

open

FLU 08

Undertake further discussions with SFHT, NHCT and NUH regarding exploration of administration of flu vaccinations for in-patient/out-patient and ED attenders.

FPDG 30 September 2020

Provider task group to meet from 18.08.20

open

FLU 09

Explore the potential of LD liaison nurses undertaking flu vaccination of LD patients.


ECRT can be utilised if required open

FLU 10

Review vaccination training availability and requirements in terms of competency assessment / HCA training and supervision requirements.


Notts Training Alliance Hub supporting additional training. Provider task group to clarify training available

open

FLU 11

Undertake analysis of last years’ cohort numbers and % uptake to inform partner plans around where additional support may be required and in addition this years’ expanded programme numbers and where possible projected uptake.

FPDG 31 August 2020 PHM and OPEL reporting expected proposal 13.08.20

open

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FLU 12

Based on above analysis, undertake a modelling exercise to establish potential timescales and operational requirements, including additional staff, for delivery of the expanded flu programme.


PHM and OPEL reporting expected proposal 13.08.20

open

FLU 13

Develop a Flu Programme Delivery timeline to identify timescales and key milestones.

FPDG 31 August 2020 Included in the plan closed

FLU 14

Develop a vaccination delivery plan for nursing care homes, inclusive of addressing any training needs/ cold chain requirements / GP practice liaison and funding.

ICP Flu Leads 30 September 2020

Progress update 13.08.20 open

FLU 15

Develop a domiciliary vaccination delivery plan for housebound / shielded patients inclusive of addressing any training needs/ cold chain requirements / GP practice liaison and funding.

ICP Flu Leads 30 September 2020

Provider task group to clarify position 18.08.20

open

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24

Annex 1 Population Health Management and Flu

Population Health Management (PHM) is the approach in which data is used to understand the

needs of the population, enabling focus and resources to be tailored to areas where the impact

can have maximum impact. It is helping us understand our current, and predict our future,

health and care needs so we can take action in tailoring better care and support with

individuals, design more joined up and sustainable health and care services, and make better

use of public resources.

Our ICS has developed a partnership approach across the NHS and other public services

including: councils, the public, schools, fire service, voluntary sector, housing associations,

social services and police. All have a role to play in in addressing the interdependent issues

that affect people’s health, care and wellbeing.

We will use PHM principles to support our flu planning and delivery by using segmentation,

stratification and impactability modelling to identify local ‘at risk’ cohorts – to prevent ill-health

and to improve care and support while reducing unwarranted variations in outcomes. This will

be delivered by utilising our 6 step process below.


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A key element of flu planning is to identify those cohorts who meet the national definition as

outlined in the main document.

While our local flu plan will be produced using national definitions, our PHM approach will allow

the system to produce a culturally competent plan to meet the needs of the most vulnerable

citizens in our society. Understanding and addressing inequalities is crucial to ensuring a

systematic approach to flu planning.

When looking at implementing our plan we will ensure that wider determinants are a core

characteristic in our stratification process. The charts below shows that Nottingham and

Nottinghamshire has wide variation in healthy life expectancy, and deprivation. These

inequalities will need to be considered when looking at targeted flu interventions to reduce

further impact, and improve outcomes.

Male Female Male Female Male Female

Mid Ashfield North Ashfield North 76.6 80.6 57.4 58.2 19.2 22.4 29

Mid Ashfield South Ashfield South 78.9 83.2 60.1 62 18.8 21.2 22.9

Mid Mansfield North Mansfield North 77.4 81.5 57.4 58.1 20 23.4 28.5

Mid Newark Newark 80.3 83.3 65.2 65.8 15.1 17.5 17.6

Mid Rosewood Rosewood 78.1 81.7 59.5 61.1 18.6 20.6 27.5

Mid Sherwood Sherwood 78.6 82 60.5 62 18.1 20 21.3

City BACHS BACHS 76.4 80.5 55.6 55.3 20.8 25.2 48.5

City Bestwood & Sherwood Bestwood & Sherwood 76.7 81.9 58.8 60.5 17.9 21.4 32.6

City Bulwell & Top Valley Bulwell & Top Valley 76 79.9 56.5 57.3 19.5 22.6 43.4

City City South City South 79.1 84.5 62 62.9 17.1 21.6 22.3

City Clifton & Meadows Clifton & Meadows 78.8 81.9 60.3 60.1 18.5 21.8 33.8

City City East City East 76.5 80.3 57.2 57.1 19.3 23.2 40

City Radford & Mary Potter Radford & Mary Potter 74.5 79.5 55.3 55.3 19.2 24.2 39

City Unity Unity 76 82.5 57.5 60.3 18.5 22.2 23.3

South Arnold & Calverton Arnold & Calverton 80.4 83.4 64 65.2 16.4 18.2 15.7

South Arrow Health Arrow Health 80 83.6 64.3 66.8 15.7 16.8 13.1

South Byron Byron 79.6 82 61.7 61.9 17.9 20.1 22.5

South Nottingham West Beeston 80.7 83.9 66 66.5 14.7 17.4 11.7

South Nottingham West Eastwood 80.9 83.6 63.7 63.7 17.2 19.9 16.4

South Nottingham West Stapleford 79.6 84.4 62.5 64.4 17.1 20 17.6

South Rushcliffe Rushcliffe Central 82 85 68.4 69.3 13.6 15.7 6.7

South Rushcliffe Rushcliffe North 80.5 84.4 67.2 68.8 13.3 15.6 9.2

South Rushcliffe Rushcliffe South 81.8 85.1 68.5 69.7 13.3 15.4 7.2

South Synergy Synergy 78.5 83.1 61.5 63.9 17 19.2 17.6

ICP PCN PCN/Neighbourhood IMDLife expectancy Healthy life expectancy Years in poor health

Life Expectancy and Healthy Life Expectancy – Heat Map


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Mid Notts – Wider determinant information

City – Wder determinant information


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South Notts – Wider determinant information


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Annex 2 Acute Hospital Processes for in/out patient vaccination

Process

Patient attends their clinic or dialysis session

The nurse/midwife asks the patient if they have had their flu vaccination

If patients say they have not had it and would like it, it is administered (see PGD

attachment

embedded below)

If NUH staff administer the injection, the patient’s GP is notified and the administration is

recorded in the patient’s record (see GP notification attachment embedded below).

Training

Only staff who have completed the Trust Flu vaccination training can administer the

injection

The training must be undertaken each year and the portal will go live mid-August 2020

The training covers injection technique, adverse reactions and treatment and patient

advice.

Flu Campaign

The flu vaccine was ordered in March 2020 (the order takes into account the renal and

obstetrics requirement)

Expected date of arrival of the vaccine is 18th September 2020

NUH’s flu vaccination goes live 21st September

Renal and Obstetrics patients will be offered the vaccine from 21st September.


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(Open Session)


Paper Title: Overview of GP Practice Additional

Expenses in Relation to COVID-19.


Sponsor:

Presenter:

Joe Lunn, Interim Associate Director of

Primary Care

Attachments/

Appendices:

Joe Lunn, Interim Associate Director of

Primary Care

Purpose: Approve ☒ Endorse ☐ Review


Assurance

Information

☒

Executive Summary


Delegated function 3 – Management of the delegated funds

This paper provides an overview of the COVID-19 additional expense claims for June and July. This is a

further update to the previous papers which were presented to the committee meetings held on 22 April

2020, 20 May 2020 and 15 July 2020, which detailed the cost of claims submitted in March, April and May

respectively.


Compliance with Statutory Duties ☐ Wider system architecture development


☐

Financial Management ☒ Cultural and/or Organisational

Development

☐


Strategic Planning ☐





Assessment (EQIA)


Data Protection Impact Yes ☐ No ☐ N/A ☒ Not required for this item.

Covid-19 GP Practice Additional Expenses’

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Assessment (DPIA)

Risk(s):

There are no risks identified with this paper.

Confidentiality:

☒No

Recommendation(s):

1. NOTE the information for assurance purposes.


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GP Practice Additional Expenses due to COVID 19 Pressures

1. Background and Payment Summaries

Since the COVID-19 outbreak, additional pressures and costs have been placed on General Practice in order

for them to respond to the needs of patients whilst maintaining a safe environment for their staff and patients.

On the 3 April 2020, a message was distributed to practices via TeamNet outlining a process for which

practices could claim back additional expenses from the CCG in relation to costs incurred due to COVID-19.

This process has continued through the months of May, June and July.

Practices can claim for additional expenses incurred due to COVID-19 pressures such as; staff overtime costs,

locum support for ill or self-isolating GPs, additional Personal Protective Equipment (PPE) or additional cleaning

items. However, in order to be accepted under the reimbursement arrangement, the costs have to be additional

to the practice’s regular orders and outgoings and items must be appropriate and necessary in dealing with the

COVID-19 outbreak.

The CCG is currently supporting additional costs as a result of COVID-19 at risk. The CCG will seek to reclaim

expenditure from NHS England but need to be able to evidence and demonstrate to NHS England that all costs

are appropriate and will satisfy their processes.

1.1 Overview of Claims Submitted in June

Practices were asked to submit their June expenses by 3 July 2020 in order to receive timely payment. Only

claims dated between 1 March and 30 June would be accepted for this submission and practices were required

to submit backing rationale and evidence of spend with their claim. An on-going review of previously withheld

claims originally submitted in March and April is also taking place, allowing payment of these claims once

appropriate information is received.

Summary of June Claims:

64 practices submitted claims

The total cost of the claims submitted was £225,776.35; this is a reduction on the previous month’s claim

From this total £200,403.05 has been approved for payment

o From the total of approved claims, £21,761.14 relates to March claims. The total sum of paid March

claims now stands at £197,797.77

o From the total of approved claims, £55,455.28 relates to April claims. The total sum of paid April

claims now stands at £768,976.06

o From the total of approved claims, £17,039.59 relates to May claims. The total sum of paid May

claims now stands at £436,107.93.

1.2 Overview of Claims Submitted in July

Practices were asked to submit their June expenses by 5 August 2020 in order to receive timely payment. Only

claims dated between 1 March and 31 July would be accepted for this submission and practices were required

to submit backing rationale and evidence of spend with the claim. As part of this claim, practices were asked to

submit any outstanding items and were encouraged to reconcile currently outstanding items in order for the

CCG to ensure payment was received from NHS England and NHS Improvement.

Summary of July Claims:

92 practices submitted claims

The total cost of the claims submitted was £407,129.43; this figure includes all of the outstanding claim

items to date as well as new submissions. This cost is therefore an increase on the previous month. The


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total sum of outstanding claims is £111,713.02.

From this total £295,416.41 has been approved for payment

o From the total of approved claims, £18,566.93 relates to March claims. The total sum of paid March

claims now stands at £216,349.62. A further £13,212.24 remains outstanding.

o From the total of approved claims, £75,139.17 relates to April claims. The total sum of paid April


o From the total of approved claims, £23,759.24 relates to May claims. The total sum of paid May


o From the total of approved claims, £91,961.64 relates to June claims. The total sum of paid June

claims now stands at £292,389.61. A further £25,535 remains outstanding.

Claims were withheld from payment due to the following reasons:

No backing evidence of spend was provided

Practices did not submit forms correctly

Practices did not provide appropriate rationale for the claim

The CCG are awaiting further supporting evidence to allow a review of clinical need for appropriate medical

equipment to be undertaken

Following clinical review the item may or may not be deemed as appropriate or necessary in relation to

COVID-19

Where the above information has since been provided the costs have been made payable. From the

outstanding items remaining, a review will continue to be undertaken to ascertain the required information need

and whether the costs can be paid or rejected.

1.3 Total Spend Breakdown of claims paid in June and July

A breakdown of the spend in each claim category is listed below:

Area of Spend Cost for June Cost for July

Cleaning Resources £9,284.94 £11,416.84

Equipment Costs £19,584.30 £26,068.25

Estates Costs £0 £0

Laundry Costs £0 £39.99

PPE £44,063.00 £45,898.96

Postage Costs £774.23 £2,396.65

Printing/Stationary £854.73 £284.32

Scrubs £710.10 £652.02

Telephony Charges £5,517.73 £10,103.96

Admin Staffing (Including Practice Manager Time) £22,681.42 £68,216.99

GP Partner and Salaried Staffing £14,328.82 £37,326.75

Nursing Staff Costs £6,314.33 £13,511.06

GP Locum Costs £43,614.36 £54,051.22

Cleaning Staff (Additional Expense) £2,545.84 £5,038.14

COVID Expenses - Other £30,129.25 £20,411.26

(N.B this table is based on the categorisation of items by individual practices).

Future submission and payment dates are as follows:

August 2020 Claim – Submission Date 3 September 2020, Payment Date 18 September 2020.

For the next submission there will be some slight changes to the acceptance of some items. This is due to the

recent correspondence from NHS England and NHS Improvement, dated 4 August 2020. Guidance for

practices will be released via TeamNet.


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2. Summary

The total amount approved for payment so far for June 2020 was £200,403.05, paid in July 2020. The total

amount approved for payment for July submissions is £295,416.41, which will be paid towards the end of

August 2020. The increased cost of this month’s submissions reflects the on-going work to resolve outstanding

claims.

The remaining sum of outstanding claims is £111,713.02.

£443,571.18 has already been reconciled from previous submissions between March and July.

On-going liaison is taking place with practices where deductions from their original claims have been made.

When practices provide further information and evidence, deeming the claim payable, they will be considered

for future payment with August submissions.

The maximum payable for this month’s claims would be £407,129.43.


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(Open Session)


Paper Title: GP vulnerable staff risk assessment

exercise outcome


Sponsor:

Presenter:

Joe Lunn – Interim Associate Director of

Primary Care

Attachments/

Appendices:

Lynette Daws – Head of Primary Care

Purpose: Approve ☐ Endorse ☐ Review


Assurance

Information

☒

Executive Summary


Delegated Function 1 - Planning primary medical care services, including carrying out needs assessments,

and undertaking reviews of primary medical care services

On 24 June 2020, a letter was sent to all Clinical Commissioning Groups (CCGs) and all practices from NHS

England and Improvement asking for assurance that practices had undertaken the relevant risk

assessments. The purpose of the risk assessments was to support all members of staff who were employed

by the practice.

The Primary Care Commissioning Team worked with practices to ensure that the return was completed.

The collection was sent to 127 practices across Nottingham and Nottinghamshire and a 100% response rate

was achieved. The findings have been included in the main body of this paper.




☐

Financial Management ☐ Cultural and/or Organisational

Development

☐





General Practice Vulnerable Staff Risk Assessment Exercise: Outcome

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Assessment (EQIA)



Assessment (DPIA)


Risk(s):

No risks identified

Confidentiality:

☒No

Recommendation(s):

1. NOTE that risk assessments have been undertaken for all staff members employed by all Nottingham

and Nottinghamshire practices.


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GP vulnerable staff risk assessment exercise outcome

1. Introduction

Following a request from NHS England and Improvement (NHSEI) the CCG supported all practices in

ensuring risk assessments had been undertaken for all staff members employed by the practices. The

purpose of this paper is to provide a summary of these findings.

2. Data collection and findings

NHSEI asked practices to complete a return including the questions below:

1. Have you offered a risk assessment to all staff?

2. What % of all your staff have completed a risk assessment?

3a. Does the practice employ staff who are known to be 'at-risk'?

3b. If answered 'Y' to Q3a; where accepted, what % of risk assessments have been completed for

staff who are known to be 'at-risk', with mitigating steps agreed where necessary?

4a. Does the practice employ staff who are known to be from a BAME background?

4b. If answered 'Y' to Q4a; where accepted, what % of risk assessments have been completed for

staff who are known to be from BAME background, with mitigating steps agreed where necessary?

A response was received from all 127 Nottingham and Nottinghamshire practices. The data collected

shows:

110 practices (87%) have undertaken risk assessments for 100% of their staff. Where practices

have not completed 100% rationale has been provided as to why.

121 practices (95%) confirmed that they employ staff members who are known to be “at-risk”.

Practices also confirmed that mitigating steps have been agreed.

117 (92%) shared that they employ staff of a Black, Asian and Minority Ethnic (BAME)

background. Practices also confirmed that mitigating steps have been agreed.

As part of the collection, some practices provided additional information on staff members who are part

of the “at-risk” and BAMEcategories. The additional information included rationale for staff members

working from home, number of BAME GPs and information on staff members shielding.

The return was submitted to NHSEI via the Situation Report (SitRep) on Friday 31 July.

3. Recommendation

The Primary Care Commissioning Committee is asked to note that risk assessments have been

undertaken for all staff members employed by all Nottingham and Nottinghamshire practices.


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Paper Title: Primary Care Support for Care Homes in South Nottinghamshire


Sponsor:

Presenter:

Lucy Dadge, Chief Commissioning Officer Attachments/ Appendices:

Appendix 1 -Enhanced Health in Care Homes (extract from PCN DES, March 2020)

Appendix 2 – Service Specification

Fiona Callaghan, Locality Director

Purpose: Approve ☒ Endorse ☐ Review ☐ Receive/Note for:


☐

Executive Summary

The purpose of the paper is to:∑ Outline the approach to ensure General Practice in South Nottinghamshire can effectively deliver the

Enhanced Health in Care Homes Specification (EHCH) part of the Directed Enhanced Service (DES)∑ Document proposed changes to the Local Enhanced Service (LES) in South Nottinghamshire ∑ Secure approval for a new contract model and associated financial redeployment

The Clinical Commissioning Group (CCG) has a range of commissioned contracts to support health care in care homes which reflect historical commissioning arrangements; the complexity across the three Integrated Care Partnerships (ICPs) covers a mix of core service provision, enhanced service provision and the GP LES.

City and Mid-Nottinghamshire both have a community-led enhanced service for care homes. South Nottinghamshire does not and has instead the evidence-based GP-LES. City and Mid Nottinghamshire practices do not have an LES payment for care home support.

The LES currently in place across South Nottinghamshire offers payment for practices to deliver primary care support to Care Homes until 30 September 2020. The total annual contract value is £303k. This GP-led service provision is variable across the South Nottinghamshire localities with differing take up and variable financial payments.

A meeting of the CCG Executive Management Team in July 2020 considered the position. They acknowledged the disparity of community service provision specifically for care home support and approved continuing to work with Nottinghamshire Healthcare NHS Foundation Trust (NHT) to review provision across the CCG. It was also agreed to continue providing the LES contract investment until March 2021 to help facilitate delivery of the EHCH specification in the interim during 2020/21.

Primary Care support for Care Homes in South Nottinghamshire

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The proposal is to terminate the LES with GP practices on 30 September 2020 and instead contract with the PCNs (via GP Federations using the NHS Standard Contract) to deliver enhanced support to care homes from 1 October 2020 to 31 March 2020; this will support PCNs to deliver the requirements of the PCN DES.

A specification has been drafted outlining the service delivery requirements and key performance indicators.



☒


☐

Performance Management ☐ Procurement and/or Contract Management ☒



☒ Conflict noted, conflicted party can participate in discussion, but not decision

As a practising GP Dr Richard Stratton is conflicted in relation to this item.



Yes ☐ No ☐ N/A ☒ No change to service offer to care home residents.


Yes ☐ No ☐ N/A ☒ No change to service offer to care home residents.

Risk(s):

South Nottinghamshire Primary Care Networks (PCNs) have a capacity gap to deliver the EHCH specification from 1 October meaning they may not be able to achieve the outcomes set out in the specification.

∑ DES implementation is delayed or unachievable given current approach∑ Care in care homes is compromised resulting in poorer outcomes for residents∑ Lack of care home support may result in increased East Midlands Ambulance Service (EMAS) call outs and hospital admissions∑ Engagement and relationships damaged across general practice and community services∑ Possible public reputational damage given the current high profile of the care homes sector

Confidentiality:

☒No

Recommendation(s):

1. ACKNOWLEDGE the requirement to support South Nottinghamshire PCNs to deliver the PCN DES as supported by the CCG Executive Management Team

2. APPROVE the redeployment of the LES investment

3. APPROVE the service specification and associated contracting model with South Nottinghamshire PCNs (via the GP Federations) from 1 October 2020 to 31 March 2021


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Primary Care Support for Care Homes in South Nottinghamshire

The purpose of the paper is to:

∑ Outline the approach to ensure General Practice in South Nottinghamshire can effectively deliver the Enhanced Health in Care Homes Specification (EHCH) part of the Directed Enhanced Service (DES)

∑ Document proposed changes to the Local Enhanced Service (LES) in South Nottinghamshire∑ Secure approval for a new contract model and associated financial redeployment

1. Local Enhanced Service (LES) in South Nottinghamshire

There is a LES currently in place across South Nottinghamshire which offers payment for practices to deliver primary care support to Care Homes until 30 September 2020. The total annual contract value is £303k. This GP-led service provision is variable across the South Nottinghamshire localities with differing take up and variable financial payments. When agreement to continue the LES was approved in February 2020 it was noted that it would be subject to a review alongside the anticipated Primary Care Network (PCN) DES; due to COVID-19 this has not happened in the way originally envisioned.

There is also a requirement of Clinical Commissioning Groups (CCGs), outlined in the update to the GP contract agreement (February 2020), which states that any historical investment which previously supported services now aligned to the PCN DES should be maintained.

The proposal is to continue to invest the LES contract value until March 2021 and redeploy it through PCNs as the delivery units to help facilitate delivery of the challenging EHCH specification during 2020/21.

The CCG will be required to notify the participating Practices of the termination of the existing LES on 30 September 2020.

2. Community Services Provision to Support Care Homes

The CCG has a range of other commissioned contracts to support health care in care homes which reflect historical commissioning arrangements; the complexity across the three Integrated Care Partnerships (ICPs) covers a mix of core service provision, enhanced service provision and the GP LES.

City and Mid-Nottinghamshire both have a community-led enhanced service for Care Homes. South Nottinghamshire does not and has instead the evidence-based GP-LES. City and Mid Nottinghamshire practices do not have an LES payment for care home support.

The South Nottinghamshire PCNs, supported by the CCG, have clarified with Nottinghamshire Healthcare NHS FoundationTrust (NHT) the level of support that community services can provide to help support the EHCH DES. NHT have confirmed that as part of their current core community services provision they can provide:

∑ A named clinician for each residential care home. This does not include Nursing Homes∑ Provision of a clinician to attend Multi-Disciplinary Teams (MDTs) and support home rounds.

This will not however be a dedicated named individual for every MDT or home round.


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This leaves South Nottinghamshire PCNs with a capacity gap to deliver the EHCH specification (Appendix 1) from 1 October meaning they may not be able to achieve the outcomes set out in the specification. The risks are:

∑ DES implementation is delayed or unachievable given current approach∑ Care in care homes is compromised resulting in poorer outcomes for residents∑ Lack of care home support may result in increased East Midlands Ambulance Service (EMAS)call outs and hospital admissions∑ Engagement and relationships damaged across general practice and community services∑ Possible public reputational damage given the current high profile of the care homes sector

3. Proposed Contract and Investment Redeployment across South Nottinghamshire

A meeting of the CCG Executive Management Team in July 2020 considered the position. They acknowledged the disparity of community service provision specifically for care home supportand approved continuing to work with NHT to review provision across the CCG. It was also agreed to continue providing the LES contract investment until March 2021 to help facilitate delivery of the EHCH specification in the interim during 2020/21.

The part year effect LES value of the funding is £151,484. Finance have confirmed that this investment has been included in the month one to four budget and if the GP-based LES ceases 30 September 2020 the associated funding would then be available for PCN redeployment in the second half of the year. The proposal means switching and continuing it to pay for a revised service offer for the latter half of the year (as opposed to not switching and making a saving).

Should a change to the contracting approach, as described below, be approved then the CCG should ensure that £151,484 is removed from the LES payment for the second half of the year to fund the proposed PCN payment. This means that the change is in effect, cost neutral.

PCN Proposed Rebasing* of the South Nottinghamshire LES Investment

Nottingham West £42,182

Rushcliffe £45,343

Arnold and Calverton £15,267

Arrow Health £18,612

Byron £16,662

Synergy £13,418Total – 1.10.20-1.3.21 £151,484

*Calculated from the number of beds per PCN. Further review required following conclusion of border homes alignment

The proposal is to terminate the LES with GP practices on 30 September and instead contract with the PCNs (via GP Federations) to deliver enhanced support to care homes from 1 October 2020 to 31 March 2020; this will support PCNs to deliver the requirements of the PCN DES. The CCG’s Director of Procurement has confirmed the viability of the approach as it is within the required procurement threshold and contractable as a direct award via the NHS Standard Contract (Short Version).

A specification has been drafted (Appendix 2) outlining the service delivery requirements and key performance indicators. The specification has been drafted for a six month service requiring notice to be served in January 2021. The option to extend the contract has been included, as it is intended that the parallel work with NHT to review the community services provision will provide an all-inclusive comprehensive service offer from April 2022.


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Performance management of the contract will be supported by the South NottinghamshireLocality and the Primary Care Contracting Teams.

4. Recommendations

The Primary Care Commissioning Committee is asked to:

∑ ACKNOWLEDGE the requirement to support South Nottinghamshire PCNs to deliver the PCN DES as supported by the CCG Executive Management Team

∑ APPROVE the redeployment of the LES investment ∑ APPROVE the service specification and associated contracting model with South

Nottinghamshire PCNs (via the GP Federations) from 1 October 2020 to 31 March 2021


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Appendix 1 - Enhanced Health in Care Homes (extract from PCN DES, March 2020)

By 31 July 2020, a PCN is required to:

∑ have agreed with the commissioner the care homes for which the PCN will have responsibility (referred to as the “PCN’s Aligned Care Homes” in this Network Contract DES Specification). The commissioner will hold ongoing responsibility for ensuring that care homes within their geographical area are aligned to a single PCN and may, acting reasonably, allocate a care home to a PCN if agreement cannot be reached. Where the commissioner allocates a care home to a PCN, that PCN must deliver the Enhanced Health in Care Homes service requirements in respect of that care home in accordance with this Network Contract DES Specification;

∑ have in place with local partners (including community services providers) a simple plan about how the Enhanced Health in Care Homes service requirements set out in this Network Contract DES Specification will operate

∑ support people entering, or already resident in the PCN’s Aligned Care Home, to register with a practice in the aligned PCN if this is not already the case

∑ ensure a lead GP (or GPs) with responsibility for these Enhanced Health in Care Homes service requirements is agreed for each of the PCN’s Aligned Care Homes.

By 30 September 2020, a PCN must:

∑ work with community service providers (whose contracts will describe their responsibility in this respect) and other relevant partners to establish and coordinate a multidisciplinary team (“MDT”) to deliver these Enhanced Health in Care Homes service requirements;

∑ have established arrangements for the MDT to enable the development of personalised care and support plans with people living in the PCN’s Aligned Care Homes.

As soon as is practicable, and by no later than 31 March 2021, a PCN must establish protocols between the care home and with system partners for information sharing, shared care planning, use of shared care records, and clear clinical governance.

From 1 October 2020, a PCN must:

∑ deliver a weekly ‘home round’ for the PCN’s Patients who are living in the PCN’s Aligned Care Home(s). In providing the weekly home round a PCN:

∑ must prioritise residents for review according to need based on MDT clinical judgement and care home advice (a PCN is not required to deliver a weekly review for all residents);

∑ must have consistency of staff in the MDT, save in exceptional circumstances; ∑ must include appropriate and consistent medical input from a GP or geriatrician, with the

frequency and form of this input determined on the basis of clinical judgement;∑ may use digital technology to support the weekly home round and facilitate the medical input;∑ using the MDT arrangements refresh as required a personalised care and support plan with

the PCN’s Patients who are resident in the PCN’s Aligned Care Home(s). A PCN must: aim for the plan to be developed and agreed with each new patient within seven working

days of admission to the home and within seven working days of readmission following a hospital episode (unless there is good reason for a different timescale);

develop plans with the patient and/or their carer;


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base plans on the principles and domains of a Comprehensive Geriatric Assessment49 including assessment of the physical, psychological, functional, social and environmental needs of the patient including end of life care needs where appropriate;

draw, where practicable, on existing assessments that have taken place outside of the home and reflecting their goals;

make all reasonable efforts to support delivery of the plan; ∑ identify and/or engage in locally organised shared learning opportunities as appropriate and

as capacity allows;∑ support with a patient’s discharge from hospital and transfers of care between settings,

including giving due regard to NICE Guideline 2750.

For the purposes of this section a ‘care home’ is defined as a CQC-registered care home service, with or without nursing.


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Appendix 2 - Enhanced Health in Care Homes PCN specification and Key Performance Indicators (KPIs)

SCHEDULE 2 – THE SERVICES

A. Service Specifications

Service Specification No. 01

Service Enhanced Health in Care Homes

Commissioner Lead South Nottinghamshire Locality

Provider Lead Partners HealthPrimary Integrated Community Services

Period 1st October 2020 to 31st March 2021

Date of Review January 2021

1. Population Needs

1.1 National/local context and evidence base

The NHS Long Term Plan (2019) contained a commitment as part of the Ageing Well Programme to roll out Enhanced Health in Care Homes (EHCH) across England by 2024, commencing in 2020. This reflects an ambition for the NHS to strengthen its support for the people who live and work in and around care homes.

The Enhanced Health in Care Homes (EHCH) model moves away from traditional reactive models of care delivery towards proactive care that is centred on the needs of individual residents, their families and care home staff. Such care can only be achieved through a whole-system, collaborative approach.

The EHCH model has three principal aims:

1. To deliver high-quality personalised care within care homes.

2. To provide, wherever possible, for individuals who (temporarily or permanently) live in a care home, access to the right care and the right health services in the place of their choosing.

3. To enable effective use of resources by reducing unnecessary conveyances to hospitals, hospital admissions, and bed days whilst ensuring the best care for people living in care homes.

In the EHCH model, care providers work in partnership with local GPs, Primary Care Networks (PCN), community healthcare providers, hospitals, social care, voluntary sector, individuals and their families, and wider public services to deliver care in care homes. Services are ‘wrapped around’ the individual and their family, who are connected to and supported by their local community. Proactive, personalised care and support becomes the norm.

This specification will support the delivery requirements and outcomes of the EHCH model. This will be achieved through the need for PCN collaboration, integration with community partners, GP federations, care home staff and ‘system’ working. This will


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allow the PCNs to work at pace and comprehensively deliver the requirements of the EHCH model to deadline, whilst also encouraging innovation that will complement and enhance the EHCH model outcomes.

2. Outcomes

2.1 NHS Outcomes Framework Domains & Indicators

Domain 1 Preventing people from dying prematurely X

Domain 2Enhancing quality of life for people with long-term conditions

X

Domain 3Helping people to recover from episodes of ill-health or following injury

X

Domain 4 Ensuring people have a positive experience of care X

Domain 5Treating and caring for people in safe environment and protecting them from avoidable harm

X

2.2 Local defined outcomes

∑ All work undertaken within this specification will compliment and support the delivery of the Primary Care Network Directed Enhanced Services Specification 2020-2021 and The Framework for Enhanced Health in Care Homes

∑ Improved PCN collaboration across the PCNs in South Nottinghamshire ∑ Improved integration of primary care, community services and the voluntary sector

into care homes∑ Improved working and partnerships with care home staff to deliver quality care

through jointly agreed processes to improve patient outcomes e.g. supporting the continual professional development, training and peer appraisal of the care home workforce

∑ Delivery of the EHCH service specification requirements at pace, with milestones met before deadline

∑ Improved Primary Care education around the needs of care home residents∑ Greater emphasis on preventative and proactive care for patients residing in care

homes∑ Reduced non-elective admissions from care homes into secondary care

3. Scope

Aims and objectives of service

The objectives of this specification are to:

∑ Improve the quality of care to patients.


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∑ Improve the relationship between primary care, community services and care homes to the benefit of patients.

∑ Increase the confidence and ability of care homes to deliver high quality and coordinated care.

∑ Minimise unpredictable acute events∑ Avoid unnecessary progression of long term conditions and the unnecessary

burdens of irrelevant treatments.∑ Offer care homes reliable access to familiar health professionals.∑ Reduce unnecessary non-elective admissions, out of hours contacts and

Emergency Department attendances.∑ Appropriate use and maximising the value of GP prescribing to ensure robust

medicines management within the care home.∑ Increase in number of patients dying at place of choice as measured by after death

analysis.∑ Develop a culture of partnership, support and shared clinical governance.

Service description/care pathway

This specification has been developed to support and compliment the delivery of the Enhanced Health in Care Homes Specification as directed within the Primary Care Network (PCN) Directed Enhanced Service (DES) 20-21 specification.

The provider will work with the PCN membership and its member practices to;

∑ Support the delivery of the Directed Enhanced Service (DES)∑ Support the collaboration with key providers and enhance working relationships∑ Encourage engagement across all providers to support the delivery of the

specification∑ Encourage learning across all partners to enhance delivery of care∑ Work constructively with care homes to support the improvement of quality of care

where required∑ Work with providers to collectively embed additional roles to complement and

enhance additional service provision across system partners∑ To creatively develop systems, partnership working and test new ways of working

Population covered

The aligned Care Homes as agreed by the PCN.

Patient Definition

This service specification is inclusive of all residents residing within CQC registered residential and nursing care homes that are aligned with the practices in the Primary Care Network.

Any acceptance and exclusion criteria and thresholds

All patients within the patient definition and registered with the aligned practice will be included in the specification.

Patients admitted for respite care are within the scope of this service only if the resident


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needs to register with the aligned practice.

The scope of the specification will not include activity required of general practice as part of the PCN DES and EHCH Framework. This includes;∑ Weekly multidisciplinary home rounds∑ Personalised Care and Support Plans (PCSPs)∑ Structured medication reviews (SMR)∑ Hydration and nutrition support as outlined in the DES∑ Oral health care∑ Access to out of hours/urgent care when needed

GP practices are already paid for this activity through the GP Contract and may also be additionally rewarded for performance through the Impact and Investment Fund (IIF).

Interdependence with other services/providers

∑ Care homes including care home managers, staff and owners∑ GP federations∑ PCN Additional Roles staff and their employing organisations∑ Medicines management team∑ Community nursing and therapy staff∑ Out of Hours providers∑ East Midlands Ambulance Service∑ Pharmacy services

∑ Hospital services∑ Community Geriatrician∑ Mental Health Services for Older People∑ Adult Health and Social Care∑ Care Quality Commission∑ Adult Safeguarding∑ Continuing Health Care∑ NHS Nottingham and Nottinghamshire Clinical Commissioning Group∑ South Nottinghamshire Integrated Care Partnership∑ Voluntary sector

4. Applicable Service Standards

4.1 Applicable national standards (e.g. NICE)

This service model takes consideration of the EHCH Framework from NHSE: https://www.england.nhs.uk/wp-content/uploads/2020/03/the-framework-for-enhanced-health-in-care-homes-v2-0.pdf

4.2 Applicable standards set out in Guidance and/or issued by a competent body (e.g. Royal Colleges)Not Applicable

4.3 Applicable local standardsNot Applicable


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https://www.england.nhs.uk/wp-content/uploads/2020/03/the-framework-for-enhanced-health-in-care-homes-v2-0.pdf

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5. Applicable quality requirements and CQUIN goals

5.1 Applicable Quality Requirements (See Schedule 4 Parts A-D)

Clinical Governance and Quality Contractors must ensure that they are aware of, compliant with and can provide evidence if required to demonstrate compliance with any of the relevant Fundamental Standards for CQC that apply to this service. Further information about them can be found http://www.cqc.org.uk/content/fundamental-standards

Serious Untoward Incidents / Safeguarding Concerns

The provider is required to have a robust incident reporting and investigation procedure in place for all clinical and non-clinical incidents. All SUIs should be recorded and reported to NHS CCG Quality and Assurance Team within the timeframes stated in the NHS East Midlands’ protocol for the reporting and handling of Serious Untoward Incidents in the East Midlands.

5.2 Applicable CQUIN Goals (See Schedule 4 Part E)

Not applicable.

6. Location of Provider Premises

The Provider’s Premises are located at:

TBC

Location(s) of Service DeliveryThe service will be delivered to all aligned care homes within the PCN.

Days/Hours of Operation The service will operate within usual GP practice core opening hours; 8am to 6.30pm.

TBC

The payment for the delivery of this specification is TBC

Claiming for the Service

Payments will be made as part of the contractual arrangements between the CCG and Provider organization.

Monitoring


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The service will be monitored through monthly reporting, contractual activity and the agreed defined outcomes.

Care Homes LES funding to support the EHCH Framework; Key Performance Indicators

Indicator Frequency TargetCare homes are actively supported in their flu vaccination campaign for residents and eligible staff. Promotion of vaccinations for families of residents and staff, and care home visitors is actively promoted using the Public Health England (PHE) flu campaign resources

Monthly 100%

Care home residents anticipated to be within their last 12 months of life have Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) forms completed as part of their Personal Care and Support Plan (PCSP)

Monthly 100%

The care home MDT is supported to put in place the process to ensure that Comprehensive Geriatric Assessments (CGA), including a Structured Medication Review and a Falls Risk Assessment, can be completed for care home residents

Monthly N/A

Care homes are supported in providing a diverse range of activities for residents to promote good physical and mental health and wellbeing

Monthly 100%

Care homes are supported to populate the ‘This Is Me’ documentation (or equivalent) for all residents with a diagnosed cognitive or communication impairment.

Monthly 100%

Care homes are supported in delivering optimum hydration and nutrition support to their residents through education and upskilling programmes

Monthly N/A

Number of referrals to Dietetics for care home residents with an up to date Malnutrition Universal Screening Tool (MUST) score of 3 and 4

Monthly 100%

Develop an action plan with community partners that results in reduced of ambulance conveyance to secondary care

N/A N/A

Relationships established with local community and voluntary support services, including bereavement support services, to identify ways of working collaboratively to support residents and their families through End of Life (EOL) care

N/A N/A

Relationships established with dental services to support best practice of oral health care for care home residents.

N/A N/A

Patient Experience Number of received;

∑ Complaints∑ Concerns∑ Compliments ∑ Comments

Collated across care homes, primary care and community services, with provision of evidence of shared learning that has

Quarterly N/A


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shaped and influence practice. Incident Reporting

a) Number of incidents, serious incidents and never eventsb) Number of Significant Event Audits (SEAs) accompanied

by audit report and action plan

Quarterly N/A


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Paper Title: Primary Care Workforce Update Paper Reference: PCC 20 088

Sponsor:

Presenter:

Stuart Poynor, Chief Finance Officer Attachments/ Appendices:

Appendix 1:

NHSE/I Workforce Funding Guidance 6th

August 2020

Andrea Brown, Associate Director Planning and Workforce Transformation



☒

Executive Summary

This paper seeks to provide the Primary Care Commissioning Committee with an update on the approaches and strategies in place to support workforce planning and development in primary care. It specifically advises of the most current workforce profile, the focus around workforce schemes in place and on the integrated approach to transformation planning.

The paper also seeks to advise on the current planning requirements around the recovery phase following COVID-19 and the approach to support on future planning for the Primary Care Networks given the increased responsibility in developing primary care and its delivery.

The paper advises on the risks to workforce development and advises on the mitigation of those risks.


NOTE the current workforce position and focus on retention strategies

NOTE the development of infrastructure and support to Primary Care Networks around workforce planning

COMMENT and ADVISE on the level of assurance gained from this update



☒


☐






Primary Care Workforce Update

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Yes ☐ No ☐ N/A ☒ Not required for this item


Yes ☐ No ☐ N/A ☐ Not required for this item

Risk(s):

This paper is for information and assurance and as such has no identified risk. The paper advises of risks around delivery of workforce planning and development and presents mitigations.

Confidentiality:

☒No

Recommendation(s):

1. To NOTE the current workforce position and focus on retention strategies

2. To NOTE the development of infrastructure and support to Primary Care Networks around workforce planning

3. To COMMENT and ADVISE on the level of assurance gained from this update


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Introduction

This paper aims to provide a current position against the delivery of the workforce plan within the Primary Care Strategy. The paper presents information as it is available to the system at this time and describes the approaches and strategies in place around workforce planning and workforce development. The Primary Care Commissioning Committees received in November 2019 a detailed presentation of the primary care workforce plan and impact of the schemes. This update seeks to build on that in presenting the activity taking place in the period December 2019 to current times, with an acknowledgement this period of time was impacted upon by the COVID-19 pandemic.

Current Workforce

The latest reported workforce position is as at December 2019. This is because the March 2020 data collection was stood down acknowledging the response to the COVID-19 pandemic. A submission was made by practices in June 2020 but NHS Digital has not yet published the data. This data will be published 28 August 2020.

The workforce profile as at December 2019 is detailed in Figure 1 below

Fig 1. Nottinghamshire Primary care Workforce Profile as reported December 2019 - *DPC refers to Direct Patient Care

The position reflects a positive position for all groups of staff when compared to the same period in 2018 with the exception of General Practitioners. The Registrar position evidences an increased uptake in


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placements and increase in the number of placements. The data does not provide any detail to determine staff turnover or number of vacancies at the time of reporting.

There has been a steady increase across each quarter for this period in the number of nursing posts including advanced practice roles as well as an increase in the numbers relating to direct patient care which includes pharmacists.

The recruitment and retention strategies have predominantly been to address the General Practitioner and General Practice Nurse roles informed further by the change to the GP Contract with 100% funding (via the Primary Care Network Directed Enhanced Services (PCN DES)) for additional roles. The local and national direction over this period has been on the new to practice or roles within the first five years after qualification. These initiatives have supported an increase in the number of newly qualified GPs staying in Nottinghamshire and seen 17 new General Practice Nurse appointments.The increase in General Practitioner numbers or head count however, has not comparable when looking at participation rates of salaried or partner General Practitioner roles of 0.67 w.t.e. and 0.9 w.t.e. respectively. The new roles have only contributed 0.4 w.t.e. in real terms.

An analysis of the age profile of this reported workforce provides an insight with 78.4% of the total workforce being over 35 years of age, 20.6% over the age of 55 years. Figure 2 presents this data with an analysis of the roles that make up that 20.6% over 55 years.

Fig 2. Age profile of reported Workforce December 2019

The analysis evidences a need to focus retention on mid and senior years in both General Practitioners and General Practice Nurses. The other aspect with regard to General Practitioners is the potential loss of partner roles. This position reflects a national picture and as such had prompted a national review of the partnership model.

Retention initiatives were put in place in 2019-20 with GP Forward View (GPFV) funding supporting mid and senior year’s programmes for General Practitioners along with joint work with NHS England (NHSE)on the General Practice Nurse development Programme. Another contributing aspect to retention of


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non-medical roles was securing funding from Health Education England (HEE) to support workforce development, enabling access to training and education beyond mandatory training.

In addition to targeted schemes the focus during January to March was on development of an infrastructure to support workforce planning and development for the Primary Care Networks. The Long Term Plan and Interim People Plan placed a real focus on the role of Training Hubs in providing this support. Nottinghamshire had previously supported HEE investment in four local hubs within the city and south county localities. These local hubs were operating under a Service Level Agreement with Health Education England. The training hubs had developed good connections within the system in supporting the development of training in urgent care for primary care and established an Urgent Care Faculty. They merged in 2018 to create a Nottinghamshire Alliance Training Hub. This meant Nottinghamshire was well placed and in a state of preparedness to respond to delivering an enhanced offer under an extended contract with Health Education England. Health Education England funds had not been agreed nationally so this development was not taken forward during 2019- 20 but NHSE funds had been provided that enabled system investment in the Training Hub of a workforce development manager, and a workforce analyst. This would allow for early engagement with the Clinical Directors, and their supporting infrastructure, to be able to plan future workforce needs in terms of role development, training and education requirements that supported service delivery and specifically skills that addressed services directed to population health need.

Workforce Planning 2020-21

The approach to workforce planning for 2020-21 and beyond was underway as part of the Operational Planning process for 2020-21. The workforce w.t.e. returns followed a similar line to previous years submissions with an added element of capturing the recruitment to the additional roles funded through the GP contract. Figure 3 provides the detail of the draft submission in March 2020.


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Fig 3. Workforce Trajectories (DRAFT) 2020 - 2024

Primary Care Networks were expected to submit more detailed workforce plans in April and July 2020. The planning process was halted as a result of COVID-19 management

As part of the Phase 3 recovery following COVID-19 workforce plans are being requested by NHSE/I. Primary Care Networks have been directed to submit returns to the CCG by 31 August 2020 for the additional role recruitment in 20-21 to be submitted by the CCG to NHSE/I on 9 September 2020. Further workforce plans are required to include the full workforce and trajectories up to 2024 by 9November 2020 with workforce plans being agreed between the Nottingham and Nottinghamshire system and NHSE/I by 30 November 2020. 1

Workforce Development 2020- 21

Workforce development planning required a better connection of the various initiatives to ensure that workforce development was linked to service provision (workload/activity) and ways of working, specifically to support the visions and requirements of the Primary Care Networks as they take up increased responsibilities of primary care delivery. Within this approach there is recognition that resilience is still an issue and therefore an alignment of development also linked to the focused schemes to be developed under the final delivery year of the GPFV.

A primary care transformation approach was agreed through the Integrated Care System (ICS) Primary Care Delivery Board that brought PCN development, GPFV and workforce development together focusing on agreed principles to ensuring we were using resources and allocating them to the priorities of transforming primary care. This process was underway but the COVID-19 pandemic and the need to focus resource on the system response meant this process was halted. In May the COVID-19 pandemic response moved into a ‘restore and reset’ phase and allowed discussions to continue. However, the funding regime had changed with system allocations reflecting a changed delivery model due to COVID management. This created an uncertainty about the transformation funding arrangements previously assumed that would be available to support the planning approach. In addition the significant change to the delivery model within primary care and the need to maintain COVID-19 management with safe practices maintained for the foreseeable future presented a need to ensure workforce development was in keeping with these changed ways of working that would remain such as virtual consultations.

1 NHSE/I letter – Expanding the Primary Care Workforce in 20-21, 12th August 2020


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Figure 4 below illustrates.

Fig 4. Illustration of revised approach to workforce planning and development post COVID-19

External funding Resource: NHSE/I and Health Education England

As previously stated the system has benefited from external resources to support workforce development with uncertainty around what resource would be made available and for what in 20-21.

Health Education England has confirmed commitment to both Continued Professional Development (CPD) and Workforce Development Funds (WDF):

∑ CPD funds of £155k: held in HEE with spending plans to be submitted by 31 August 2020 to inform. The Nottinghamshire Alliance Training Hub has been asked to coordinate this spending plan and return for Primary Care Networks. CPD funding base don head count as at April 2019 and includes a defined list of roles that each will receive £1,000 which covers a three year period with some flexibility on how this is spent in that period. Further guidance is expected from HEE

∑ WDF of £101k: To be released to the CCG to coordinate, supports training and education needs of non-medical clinical roles. The Nottinghamshire Alliance Training Hub has been asked to complete a training needs analysis and will coordinate future applications, ensuring they meet the set criteria. The CCG will hold the fund and release payments as courses are agreed and have commenced.

In addition to this the Training Hub infrastructure funding has now been agreed nationally with an allocation to the Nottinghamshire Alliance Training Hub of £300k with infrastructure bid submitted and awaiting final sign off from Health Education England.

Similarly NHSE/I have recently announced schemes to support workforce, predominantly for General Practitioner retention but includes previous support given via GPFV on reception and clerical training. Appendix 1 provides the full list of schemes, references and current position on funding.

The Nottinghamshire Alliance Training Hub, working in partnership with the Phoenix Programme has submitted an Expression of Interest to secure funding to support GP Trailblazers, a scheme established


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in South Yorkshire with capacity to offer out to other systems with an opportunity of funding of between 4 – 18 placements. These roles are targeted at supporting practices that have the highest level of deprivation. As we have a programme in place of PCN Fellowships we are piloting supporting Primary Care Networks around population health needs we are able to give confidence in our expression of interest of experience and support infrastructure.

Next Steps

As much as changed and only recently through the reset of regional primary care forums has the system been advised of the support it can expect there are a number of actions for the ICS Primary Care Workforce Group in the next coming month. These are:

∑ Review the June workforce position∑ Review the Primary Care Network submissions around the Additional Roles and submit to

NHSE/I∑ Establish greater support to the Primary Care Networks via the Nottinghamshire Alliance Training

Hub of support to embedding the additional roles∑ Implement those schemes where confirmed external funding resource has been allocated and

maximise the opportunities they offer∑ Develop the support to Primary Care Networks in completing workforce plans by November :

establishing workshop/focus groups to determine the recruitment, retention and transformation requirements Collate staff experience around COVID to enhance staff wellbeing and support, particularly picking up At Risk staff

∑ Support the BAME Network established during COVID

Risks

The Primary Care Workforce Group informs both the ICS People & Culture Board and ICS Primary Care Delivery Board of risks and issues. The current risks are around three areas of concern;

1. Certainty around funding, and reliance on short term and non-recurrent external funding to support workforce developmentMitigation: ∑ Workforce lead operating in the system and regional forums that ensures awareness of

opportunities and escalations of risk proactively seeking support from Health Education England and NHSE/I on our priorities.

∑ Integrated transformation planning to ensure no duplication and efficient use of any resource received to support primary care

2. Meaningful engagement with Primary Care Networks is limited due to the operational pressures and competing development pressures and expectationsMitigation: ∑ Close working arrangements between CCGs officers with lead roles on Primary Care, PCN

development and workforce

3. The loss of dedicated clinical leadership supporting Primary Care Workforce as it was created from non-recurrent funds that have not been replicated in the NHSE/I offer.Mitigation:∑ Discussion with ICS Primary Care SRO on continuation of the role and potential resource.


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The CCG risk reflects a need for changed workforce models and a risk around the pace of change. The update provided in this paper should give assurance that within the system there is infrastructure to support future workforce planning, there are on-going schemes to support retention specifically for General Practitioner roles and General Practice Nursing. There is recognition of a need to support change being directed through Primary Care Networks, informed by the networks and a commitment to deliver this support. This commitment stretches to:

∑ understanding and influencing future supply of the General Practitioner, nursing and Allied Health professionals working closer with the Health Education Institutes,

∑ supporting recruitment through partnership working in the system and creating employment models to support specifically the additional roles recruitment ,

∑ increasing access to training and education to up-skill the existing workforce∑ support the development of new roles

Recommendations


∑ NOTE the current workforce position and focus on retention strategies;∑ NOTE the development of infrastructure and support to Primary Care Networks around workforce

planning;∑ COMMENT and ADVISE on the level of assurance gained from this update


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Workforce Funding Guidance Document

The following outlines programmes and funding available to help grow, support and retain the primary care workforce, several of which are new for 2020/21. This guidance sets out the funding available, how it will be distributed, including where detailed guidance is still to be made available, and some parameters for how it may be used.

Additional roles and reimbursement scheme: Under the Network Contract DES, funding is made available to PCNs through the Additional Roles Reimbursement Scheme to recruit up to an additional 26,000 full time equivalent posts across twelve specific roles. Regions and systems should support PCNs to plan for and recruit a workforce which is responsive to local needs; and work with PCNs to create rotational working models which balance supply across the system. NHS England and NHS Improvement (NHS E/I) are providing a suite of guidance and tools which will soon be available through the Future NHS Collaboration platform.

Local GP Retention: To support areas in delivering local activities which retain their GP workforce, funding will be available to systems. Systems should hold action plans for retaining as many GPs as possible, contributing to the manifesto commitments of growing the GP workforce by 6,000. Systems should consider how they make use of the various national GP recruitment and retention schemes (below) to support their plans. NHSE/I published a toolkit last year which details ways in which systems can retain GPs, based on best practice. This full annual budget will be available to systems on a weighted capitation basis for spend in 2020/21.

Training Hubs: Funding will be available to systems to commission primary care workforce transformation activities from their local training hub. NHSE/I have drafted guidance for systems to utilise when engaging their local training hub, which can be found on the Future NHS Collaboration Platform. This full annual budget will be available to systems on a weighted capitation basis for spend in 2020/21.

Fellowships: Continuing the scheme that launched in December 2019, all systems are required to maintain delivery of the General Practice Fellowships scheme across their patch. This was a commitment in the Long Term Plan, and recently restated in the ‘Update to the GP Contract Agreement 2020/21-2023/24’. The scheme is two years of support, networking and learning that builds contextual confidence in newly qualified GPs and nurses working in general practice. Funding will be held regionally and refreshed guidance for 2020/21 will be published in early August.

New to Partnership Payment: A new commitment from ‘Update to the GP Contract agreement 2020/21-2023/24’, this scheme, administered nationally, aims to increase the number of partners working in primary care, stabilise the partnership model and help increase clinicians’ participation levels. The scheme gives eligible participants a sum of up to £20,000 plus a contribution towards on-costs of up to £4,000 (for a full-time participant) available to support establishment as a partner, as well as £3,000 in a training fund to develop non-clinical partnership skills. Further guidance has been published and applications are open currently. This full annual budget will be held nationally and drawn down on by practices (on behalf of individual participants) as per the guidance.


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Locum Support Scheme: Funding will be available regionally to support delivery of the

GP Contract Commitment to create an offer to those GPs who prefer to continue working on a more flexible basis. In return for the delivery of a minimum number of clinical sessions, GPs engaged through the scheme on a flexible basis will benefit from CPD sessions. National guidance can be expected in August, with an expectation that there is full coverage of the country by the end of 2020/21. We are currently reviewing locum support options given the impact of COVID on locum work in primary care. This funding will be held regionally and guidance for 2020/21 will be published by the end of August.

Supporting Mentors Scheme: Delivery of this scheme offers experienced GPs the opportunity to train as a mentor and receive reimbursement for mentorships sessions delivered to GP fellows participating on the Fellowship Programme, with the aim of supporting fellows and helping experienced GPs to continue to do clinical work. Funding will be held regionally and guidance for 2020/21 will be published in early August.

Reception & Clerical Training: £9.4 million is available for the fifth and final year of

this programme. This money has been made available to support the training of practice staff to implement the 10 High Impact Actions, including active signposting and document management and new consultation types. Delivery of this programme is tracked using the GPFV Monitoring Survey, to understand the number of practices which have accessed the programme. In addition, funding is tracked on a monthly basis via the Primary Care Toolkit which extracts data from the ledger, providing a month on month position of actual spend. This full annual budget will be available to systems based on a weighted capitation basis for spend in 2020/21.

Information as at 6 Aug 2020


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(Open Session)


Paper Title: GP Survey Results Paper Reference: PCC 20 089

Sponsor:

Presenter:


Primary Care

Attachments/

Appendices:


Primary Care



Assurance

Information

☒

Executive Summary

Arrangements for Discharging Delegated Functions Delegated function 2 – Planning the provider landscape Delegated function 4 – Decisions in relation to the commissioning, procurement and management of primary medical services contracts On the 9 July 2020 NHS England, together with Ipsos MORI, published the latest Official Statistics from the GP Patient Survey which took place from January to March 2020. This provides insight into patients’ experiences of general practice in the period prior to the Covid-19 pandemic. The survey consisted of around 2.3 million postal questionnaires sent out to adults registered with GP practices in England; around 740,000 patients completed and returned a questionnaire and the results provide information on patients’ overall experience of primary care services and access to these services. Data are weighted by age and gender so that results resemble the eligible registered list population of each practice and CCG. The results for Nottingham and Nottinghamshire GP practices are currently being analysed by the CCG Data Analyst Team and will inform a paper that will be submitted to the Primary Care Commissioning Committee in October 2020. Key headlines published by NHS England can be found on their website, and included below: https://www.england.nhs.uk/statistics/2020/07/09/gp-patient-survey-2020/ A detailed overview of the results, by GP practice, can be accessed via the GP Patient Survey website: https://gp-patient.co.uk/ Overall Experience

The majority of individuals (81.8%) rated their overall experience of their GP practice as good, with more than two in five (43.6%) rating their experience as ‘very good’. Compared with 2019, the proportion of patients who rated their experience as good has decreased by 1.2 percentage points from 82.9%.

Around two thirds of patients (65.5%) rated their overall experience of making an appointment as good, with over a quarter saying it was ‘very good’ (27.6%). Compared with 2019, the proportion of patients who rated their experience as good has decreased by 1.9 percentage points from 67.4%.

Around one in five patients (21.7%) say they tried to contact an NHS service in the past 12 months when

GP Survey Results

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https://gp-patient.co.uk/

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they wanted to see a GP but their GP practice was closed, either for themselves or for someone else. Of these, two thirds (67.3%) rated their overall experience of these services as good, with over three in ten (30.1%) saying it was ‘very good’. Compared with 2019, the proportion of patients who rated their experience as good has decreased by 2.1 percentage points from 68.7%.

Access

Of patients who had tried, around two thirds of patients (65.2%) said it was easy to get through to their GP practice on the phone, a decrease of 3.1 percentage points compared with 2019 (68.3%).

The majority of patients (88.9%) said the receptionists at their GP practice were helpful, a decrease of 0.4 percentage points from 2019 (89.4%).

Over six in ten patients (63.0%) were satisfied with the appointment times available to them a decrease of 1.7 percentage points compared with 2019 (64.7%).

Half of all patients (50.0%) have a GP they prefer to see for some or all of their appointments. Less than half of patients who have a preferred GP said they saw them always, almost always or a lot of the time (45.1%), a decrease of 2.9 percentage points compared with 2019 (51.8%).

Online GP services

The majority of patients (76.3%) said they had booked an appointment over the phone in the 12 months before completing the survey. Two in five (41.6%) had booked in person, and over one in ten (14.4%) had booked online (including on an app).

Almost half of patients (48.3%) were aware they could book appointments online, an increase of 4.2 percentage points compared with 2019 (44.1%). More than two in five patients (43.7%) were aware they could order repeat prescriptions online, an increase of 3.0 percentage points compared with 2019 (40.6%). Fewer patients (18.7%) were aware they could access medical records online, an increase of 3.3 percentage points compared with 2019 (15.4%).

Around one in three patients (35.9%) were unsure whether these services were available at their GP practice, while less than one in ten patients (7.0%) believed that none of these options were available (decreases of 3.8 percentage points and 0.4 percentage points respectively compared with 2019).

Almost one in five patients (18.8%) said they’d used online services in the last 12 months to order repeat prescriptions, an increase of 2.6 percentage points compared with 2019 (16.2%). A similar proportion had used online services to book appointments (18.1%), an increase of 3.2 percentage points compared with 2019 (14.9%). Fewer patients (5.8%) say they used online services to access their medical records in the past 12 months, an increase of 1.5 percentage points compared with 2019 (1.5%).

Just over two in five patients (42.0%) had tried to use their GP practice website to access information or services, an increase of 3.8 percentage points compared with 2019 (38.2%).

Of patients who had tried to use their GP practice website, around three in four (76.2%) found their GP practice website easy to use, a decrease of 0.7 percentage points compared with 2019 (77.0%).

Appointments

Over six in ten patients (60.4%) were offered a choice of appointment (choice of time/day, location, and/or healthcare professional), a decrease of 1.3 percentage points compared with 2019 (61.7%).

Over seven in ten patients (72.7%) were satisfied with the appointment they were offered last time they tried to make one, a decrease of 0.9 percentage points compared with 2019 (73.6%).

Overall, most patients (93.5%) said they accepted the appointment they were offered, a decrease of 0.4 percentage points from 2019 (93.8%).

Last Appointment

Around seven in ten patients (69.7%) waited 15 minutes or less after their appointment time to be seen, similar to 2019 (69.5%).

Over nine in ten patients (93.0%) felt involved in decisions about their care and treatment, a decrease of 0.4 percentage points from 2019 (93.4%).

Over four in five patients (85.4%) felt the healthcare professional recognised or understood their mental health needs, a decrease of 0.8 percentage points compared with 2019 (86.2%).

Most patients (95.3%) had confidence and trust in the healthcare professional they saw, similar to 2019 (95.5%).

Most patients (94.2%) felt their needs were met during their last appointment, similar to 2019 (94.5%).

Your Health

GP Survey Results

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Over half of all patients (53.4%) said they had one or more long-term physical or mental health conditions, disabilities or illnesses, 44.5% of patients said they have none of these, and 2.2% preferred not to say.

The most commonly reported conditions, disabilities or illnesses are ‘Arthritis or ongoing problem with back or joints’ (18.3%) and ‘High blood pressure’ (17.1%).

Of patients who said they have one or more long-term condition, disability or illnesses, 77.5% said they had support from local services or organisations to help them manage their condition(s), a decrease of 0.9 percentage points compared with 2019 (78.4%).

Over eight in ten patients (83.3%) with a long term condition felt confident they could manage any issues arising from their condition(s), similar to 2019 (83.6%).

Of patients who say they had a long-term condition, 40.3% have had a conversation with a healthcare professional about what is important to them when managing their condition(s), an increase of 0.8 percentage points compared with 2019 (39.5%). Of these patients, 60.7% had agreed a plan with a healthcare professional to manage their condition(s), an increase of 0.4 percentage points from 2019 (60.3%), and over nine in ten (94.1%) found this plan (very or fairly) helpful in managing their condition(s).

When your GP practice is closed

Just over one in five patients (21.7%) had contacted an NHS service when their GP practice was closed, similar to 2019 (21.7%).

Over three in five patients (63.4%) thought the time taken to receive care or advice on this occasion was about right, a 2.5 percentage point decrease compared with 2019 (66.0%).

Over nine in ten patients (90.8%) had confidence and trust in the people they saw or spoke to on this occasion, a decrease of 0.3 percentage points compared with 2019 (91.1%)




☐

Financial Management ☐ Cultural and/or Organisational

Development

☐







Assessment (EQIA)

Yes ☐ No ☒ N/A ☐ The information is in the public domain.


Assessment (DPIA)

Yes ☐ No ☒ N/A ☐ The information is in the public domain.

Risk(s):

No Risks Identified

Confidentiality:

☒No

Recommendation(s):

1. PCCC is asked to NOTE the latest GP Survey results published on 9 July 2020

GP Survey Results

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of 2



Paper Title: Primary Care Quality Report August 2020 Paper Reference: PCC 20 090

Sponsor:

Presenter:

Danni Burnett, Deputy Chief Nurse Attachments/Appendices:

Appendix 1 3-Year Rolling Dashboard Data (Q1 2017 – Q4 2019)

Danni Burnett, Deputy Chief Nurse



☒

Executive Summary

This paper provides an overview of Primary Care Quality for the Nottingham and Nottinghamshire Clinical Commissioning Group (CCG).

It includes:

•Primary Care Quality Dashboard - An overall summary of the quarter one quality dashboard ratings and actions identified to be taken with either individual practices or where an issue has been identified in relation to several practices or all practices.

•Primary Care Quality Groups / Primary Care Quality Team – An update on the activity of the Primary Care Quality groups and Primary Care quality team.

•Care Quality Commission (CQC) - An overall summary of current CQC ratings and actions being taken to support practices with either an overall rating of ‘Inadequate’ or ‘Requires Improvement’.

•An overview of any practices currently receiving an enhanced level of support from the Primary Care quality team and activity undertaken to support practices / remain assured of quality of services during the COVID-19 pandemic.



☐


☐






Equality / Quality Impact Yes ☐ No ☐ N/A☒ Not required for this item

Quarterly Quality Update

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of 2

Assessment (EQIA)



Risk(s):

No risks identified.

Confidentiality:

☒No

Recommendation(s):

1. Note the Primary Care Quality Report August 2020


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1

Primary Care Quality Report August 2020

1. Primary Care Quality Dashboard

The 2020/21 quarter on dashboard results were available for all Nottingham and Nottinghamshire practices at the end of July 2020. The majority achieved an overall ‘Green *’ or ‘Green’ rating – 83 out of 129. This was comparable with the previous quarter where 84 out of 130 practices achieved either ‘Green*’ or ‘Green’. 46 practices achieved an overall ‘Amber’ rating, also comparable to the previous quarter (46). No practices received an overall ‘Red’ rating.

It was however, acknowledged in the Primary Care Quality Groups that the overall ratings do not yet reflect the true impact that COVID-19 has had on service provision as some of the available data is from before the start of the pandemic.

Within the Clinical Outcomes domain it was identified that several practices (82) continue to struggle with achieving the 80% target for cervical screening and that this was an indicator which was likely to be severely impacted upon further due to COVID-19. The primary care quality team agreed to work with the performance team to establish if ‘real time’ data on the current cervical screening performance for each practice could be retrieved to enable a gap analysis to be undertaken. This information will then be used to identify specific ‘hot spots’ which may require additional support involving Primary Care Networks (PCNs) and the communications and engagement teams.

Within the Patient Experience domain, which has predominantly live data, improvement from quarter four in the number of practices achieving the ‘% of list size recorded as a carer’ was noted. A proposal will be made at the next Primary Care Quality Dashboard Development group that the threshold for this indicator should be increased from 0.5 to 0.75%.

Improvement in the ‘% of patients on the end of life register who have their preferred place of death recorded’ indicator was also noted.

It was evident however, that the volume of learning disability health checks (104 practices not achieving the indicator in comparison to 99 the previous quarter) and health checks for those with a mental health condition (93 practices not achieving the indicator in comparison to 90 the previous quarter) has decreased as a result of practices having to postpone all routine work.

0

5

10

15

20

25

30

35

40

Green * Green Amber Red

South Notts

Mid Notts

City


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The primary care quality team are developing presentations to demonstrate the indicators in graph format, and by PCN, so they can be shared with the locality teams and PCN clinical directors for discussion at PCN meetings.

A further piece of work (See Appendix 1) is in progress to plot twelve of the dashboard indicators for each practice over the last three years to enable identification of any significant gradual or sudden deterioration and where support may be required.

2. Primary Care Quality Groups

A quarterly meeting of a Primary Care Quality Group for each Integrated Care Partnership (ICP), including standardised terms of reference, membership, work plan and governance and reporting arrangements, is now established.

At the quarter one meetings, in addition to review of the dashboard and actions identified above, thequarter one Patient Experience and Primary Care Patient Safety Incidents reports were presented and reviewed by the group.

The Patient Experience report identified that during Quarter 1 there were 138 contacts received by the Clinical Commissioning Group CCG about a primary care issue. Of these 133 were enquiries which were handled by the Patient Experience team, and five were complaints which at the request of the complainant, were passed to NHS England and Improvement (NHSE/I) to investigate.

CCG Primary Care Enquiries

Locality Q2 19/20

Q3 19/20

Q4 19/20

April20/21

May20/21

June20/21

Q1 Total

Nottingham City 40 36 19 6 4 115 125South Notts 14 3 14 1 1 1 3Mid Notts 5 8 8 4 1 0 5TOTALS 59 47 41 11 6 116 133

Complaints passed to NHS England

Locality Q2 19/20

Q3 19/20

Q4 19/20

April20/21

May20/21

June20/21

Q1 Total

Nottingham City 8 7 3 0 0 1 1South Nottingham 19 0 1 2 1 0 3Mid Nottinghamshire 2 1 2 0 0 1 1TOTALS 29 8 6 2 1 2 5

The Patient Experience team received 105 calls and 8 emails following a letter from NHSEI being sent in error to patients concerning two practices, Radford Health Centre where Dr Phillips was retiring and the RHR surgery which was closing and re-opening as the Broad Oak Surgery. The letters caused some confusion about where the two sets of patients were being re-registered, but all the patient queries were addressed within 2 days and there have been no further issues.

Data is not yet available from NHS England about complaint handling during March 2020 or for Quarter One of 20/21 due to the COVID-19 Pandemic. It is anticipated that these figures will be released soon.

The Primary Care Patient Safety Incidents report provides a quarterly update on the patient safety incidents within primary care that have been reported to the CCG. The Primary Care Quality team review all patient safety incidents reported, which can be from a variety of sources (e.g. the practice itself, another provider, a healthcare professional, eHealthscope or the National Reporting and Learning System). Incidents are categorised as either a serious incident (SI) (meeting the national


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3

serious incident criteria) or are deemed ‘not an SI’. They are then logged and support/feedback is provided to the practice to ensure appropriate investigation and subsequent sharing of lessons learned facilitated by the Primary Care Quality team. Specialist advice and guidance from CCG colleagues is sought as required, for example, where an issue regarding safeguarding or medicines management has been highlighted.

During quarter one, 36 patient safety incidents were received by the CCG relating to primary care. Of these, 30 were stage three or four pressure ulcer alerts, one was regarding medication and fivemiscellaneous. None of the incidents reported met the national SI framework threshold.

The Primary Care Quality group did not identify any specific concerns in relation to a group of practices or an individual practice from review of the patient safety incident report.

3. Care Quality Commission (CQC)

The chart below provides a summary of the CQC’s overall rating of practices in Nottingham and Nottinghamshire as of 1 August 2020. 19 are rated ‘Outstanding’, 102 ‘Good’, 2 ‘Requires Improvement’, 2 ‘Inadequate’ and 5 ‘Not yet rated’ due to recent changes in provider.

In response to the Covid-19 pandemic, the CQC has paused its routine inspections and launched an Emergency Support Framework. Throughout the pandemic, a fortnightly meeting has taken place with CQC colleagues and the Primary Care Quality team to share intelligence and identify where support for practices / clarification on any issues from practices may be required.

The table below identifies practices with either an overall CQC rating of ‘Inadequate’ or ‘Requires Improvement’ as of 1 August 2020, and actions being taken to support each practice.

Overall Rating (May 2020)

Outstanding

Good

Requires Improvement

Inadequate

Not Rated


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4

Integrated Care Partnership

Practice Current Overall CQC Rating (Report Published)

Actions / Support In Place

Nottingham City

Queen’s Bower Surgery

Inadequate (11.02.2020)

Quality and contractual assurance meetings in progress and improvements being evidenced against an assurance matrix.

Nottingham City

Beechdale Surgery

Requires Improvement (07.08.19)

Quality and contractual assurance meetings are in progress and improvements being evidenced against an assurance matrix.

Nottingham City

Greenfields Medical Practice

Requires Improvement(10.07.18)

Re-inspection anticipated post-merger, CCG’s quality team to undertake pre CQC support visit.

Mid Notts Hounsfield Surgery

Inadequate(10.10.19)

Quality and contractual assurance meetings are in progress and improvements being evidenced against an assurance matrix.Re-inspection in relation to 2 warning noticeswas undertaken in January 2020 and the CQC have identified that the requirements have been met.Full re-inspection was due to take place by mid-April 2020, however this has been postponed due to the Covid-19 pandemic.

4. Updates

St. Peter’s Surgery (Mid Nottinghamshire)

St. Peter’s Surgery continues to receive support from the CCG’s primary care quality and locality teams as the lead GP remains on sick leave. The practice is taking all appropriate steps to ensure a safe and effective service is in place for patients during this time.

Covid-19 Pandemic

The Primary Care Quality team have continued to support the E-Healthscope issues log where practice colleagues are able to post issues / concerns. Recent posts have included concerns about 2 week waitand other referrals which the team have been able to action and provide a response back to.

During the pandemic each practice has been submitting a daily status report to the CCG. This Operational Pressures Escalation Levels (OPEL) reporting has continued to be reviewed by the qualityteam and links maintained with Primary Care and Locality team colleagues to identify any potential quality concerns and observe for correlation with any other sources of intelligence and information.

As part of the pandemic restoration and recovery phase, and in order to seek assurance that practices are compliant with the general practice standard operating procedure, an Infection prevention and control and operating preparedness assessment has been undertaken by each practice. These have been reviewed by the recovery group and where issues have been raised by practices or risks


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5

identified, mitigations have been developed / a request to address the risk processed through the appropriate governance route to support with the cost to ensure compliance, such as replacement of carpets in clinical areas.

5. Recommendations

The Primary Care Commissioning Committee is asked to note the Primary Care Quality Report August2020.


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6

0.75

0.981.091.091.020.961.031.01

0.931.021.051.1

0

0.2

0.4

0.6

0.8

1

1.2

Qu

arte

r 1

2017

Qu

arte

r 2

2017

Qu

arte

r 3

2017

Qu

arte

r 4

2017

Qu

arte

r 1

2018

Qu

arte

r 2

2018

Qu

arte

r 3

2018

Qu

arte

r 4

2018

Qu

arte

r 1

2019

Qu

arte

r 2

2019

Qu

arte

r 3

2019

Qu

arte

r 4

2019

Carers Target 0.5%

Carers Target 0.5%

1.22

1.561.39

1.591.761.69

1.551.721.69

1.881.891.74

00.20.40.60.8

11.21.41.61.8

2

Qu

arte

r 1

2017

Qu

arte

r 2

2017

Qu

arte

r 3

2017

Qu

arte

r 4

2017

Qu

arte

r 1

2018

Qu

arte

r 2

2018

Qu

arte

r 3

2018

Qu

arte

r 4

2018

Qu

arte

r 1

2019

Qu

arte

r 2

2019

Qu

arte

r 3

2019

Qu

arte

r 4

2019

EOL register Target 1 %

EOL register Target 1 % 1017 19 22

1524

2833

3742 42 45

0

10

2030

40

50

Qu

arte

r 1

2017

Qu

arte

r 2

2017

Qu

arte

r 3

2017

Qu

arte

r 4

2017

Qua

rter

1 2

018

Qu

arte

r 2

2018

Qu

arte

r 3

2018

Qu

arte

r 4

2018

Qu

arte

r 1

2019

Qua

rter

2 2

019

Qu

arte

r 3

2019

Qu

arte

r 4

2019

EOL Preferred Place of Death Target 50%

EOL Preferred Place ofDeath Target 50%

31 3341

3442 43

3947

51 4852 53

0

10

20

30

40

50

60

Qu

arte

r 1

2017

Qu

arte

r 2

2017

Qu

arte

r 3

2017

Qu

arte

r 4

2017

Qu

arte

r 1

2018

Qua

rter

2 2

018

Qu

arte

r 3

2018

Qu

arte

r 4

2018

Qu

arte

r 1

2019

Qu

arte

r 2

2019

Qu

arte

r 3

2019

Qu

arte

r 4

2019

Mental Health Checks Target 40%

Mental Health ChecksTarget 40%

8073

8289 88

7990 85

77

92 89 91

0102030405060708090

100

Under 2's Imms & Vaccs Target 90%

Under 2's Imms &Vaccs Target 90%

9077

89 95 93 92 89 93 96 8997 94

0

20

40

60

80

100

120

Qu

arte

r 1

2017

Qu

arte

r 2

2017

Qu

arte

r 3

2017

Qu

arte

r 4

2017

Qu

arte

r 1

2018

Qu

arte

r 2

2018

Qu

arte

r 3

2018

Qu

arte

r 4

2018

Qu

arte

r 1

2019

Qu

arte

r 2

2019

Qu

arte

r 3

2019

Qu

arte

r 4

2019

Preschool Imms & Vaccs Target 90%

Preschool Imms &Vaccs Target 90%

76

5562

6877

71 6978 75 70 75 77

0102030405060708090

Cervical Screening Target 80%

Cervical ScreeningTarget 80%

77 81 8168

76 7683 87

7185 87

77

0102030405060708090

100

LD Health Checks Target 75%

LD Health ChecksTarget 75%

8889

92

95

90

87

9192

89

87

90

88

82

84

86

88

90

92

94

96

Breast Screening Target 70%

Breast ScreeningTarget 70%

0.8

0.880.87

0.82

0.79

0.86

0.890.90.88

0.850.86

0.91

0.720.740.760.78

0.80.820.840.860.88

0.90.92

Antibiotics Target Below 0.94

Antibiotics TargetBelow 0.94

6765

72

7775

6871

65

78

7270 69

55

60

65

70

75

80

Bowel Screening Target 52%

Bowel ScreeningTarget 52%

14.5814.5

13.613.613.5313.6813.2413.1113.0913.0613.0813.04

12

12.5

13

13.5

14

14.5

15

Qu

arte

r 1

2017

Qua

rter

2 2

017

Qu

arte

r 3

2017

Qu

arte

r 4

2017

Qua

rter

1 2

018

Qu

arte

r 2

2018

Qu

arte

r 3

2018

Qua

rter

4 2

018

Qu

arte

r 1

2019

Qu

arte

r 2

2019

Qua

rter

3 2

019

Qu

arte

r 4

2019

Opiods Target Below 6.93

Opiods Target Below6.93

Appendix 1

3-Year Rolling Dashboard Data (Q1 2017 – Q4 2019)

Practice X

Quarterly Q

uality Update

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Paper Title: Primary Care Commissioning Finance

Report as at month four Paper Reference: PCC 20 091

Sponsor:

Presenter:

Stuart Poynor, Chief Finance Officer Attachments/ Appendices:

N&NCCG PC Commissioning Report – M4

Michael Cawley – Operational Director of Finance



Assurance

Information

☒

Executive Summary

This Primary Care Commissioning (PCCC) finance report is written in the context of a revised financial

regime implemented by NHS England and Improvement (NHSE/) I given the current COVID-19 pandemic

and resulting crisis.

This has resulted in a revised PCCC budget of £47.45m for months one to four, further details of how this

has been arrived at can be found in the introductory section of the PC Commissioning Finance Report.

The Clinical Commissioning Group (CCG) is reporting a breakeven position for Primary Care

Commissioning based on the assumption of allocation being provided by NHSE/I, as noted in the main body

of the report.



☐

Financial Management ☒ Cultural and/or Organisational Development

☐










Risk(s):

Finance Report

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At this point the £3.68m required allocation has not yet been reviewed and actioned by the NHSEI team.

Confidentiality:

☒No

Recommendation(s):

1. NOTE the contents of the Primary Care Commissioning Finance Report.

2. APPROVE the Primary Care Commissioning Finance Report as at July 2020.

Finance Report

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Primary Care Commissioning – Finance Report – JULY 2020

NHS Nottingham & Nottinghamshire CCG

Introduction

This Primary Care Commissioning (PCCC) finance report is written in the context of a revised financial regime

implemented by NHS England and Improvement (NHSE/I) given the current COVID-19 pandemic and

resulting crisis.

The original Clinical Commissioning Group (CCG) wide Revenue Resource Limit (RRL) for the financial year,

including the PCC allocation, has been removed by NHSEI. This has been replaced with a non-recurrent

budget to cover an initial revised reporting period, months one to four. NHSEI have calculated this budget

primarily by reference to 2019/20 outturn (further detail is given in the public Governing Body Finance Report

for month 2). NHSEI have then informed CCGs to report actual costs against this budget and any resulting

variances will be top-sliced or funded accordingly to allow the CCG to break-even and report an on plan

financial position for each reporting period.

The CCG wide, and also the PCC specific, budget set by NHSEI for the period has been assessed by the

CCG finance team to be below our expected costs, so the CCG will expect to overspend initially and require

an additional allocation adjustment. The key reason why the CCG expects the NHSEI initial budget to be

below requirements is because the 2019/20 outturn position included a number of non-recurrent benefits and

income in 2019/20 (which enabled the CCG to deliver its financial duties) that NHSEI budget setting

methodology then assumes are recurrent/on-going. As this is not the case, the budget is therefore under-

stated.

For PCC, NHSEI have set a budget of £47.45 million for the four month period, whereas the expected budget

requirement calculated by the CCG finance team is £50.49 million. This gives a budget shortfall of £3.04

million for the four month period. The CCG budgeting approach has been to set budgets, on a service by

service basis, to match our expected / required budget and to hold the difference between this and the NHSEI

budget (ie., the funding gap and thus expected overspend) on a separate reserves line.

The financial position, including the budget as describing above, and the month four actual costs for the initial

reporting period is set out below:

The financial position below shows the overall position for NHS Nottingham and Nottinghamshire CCG.

Finance Report

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Year to Date

The year to date financial position for the CCG is showing a year to date overspend position of £3.68 million.

Due to the current situation regarding the Coronavirus Pandemic, NHSE/I made a decision to determine the

level of budgets that feature within our General Ledger for Months 1-4 (Apr – Jul).

This has resulted in a negative budget being required described as ‘NHSEI Budget Balancing’ line and this

identifies the variation to what budget should feature as part of the Primary Care Commissioning position

against the value determined by NHSEI. This is showing a overspend position on this line of £3.04m of the

overall position of £3.68m overspend.

It is anticipated that NHSEI will provide an allocation in order to show a breakeven position and this can be

seen on the line ‘Anticipated NHSEI Budget Adj’ line.

The main drivers of the remaining £0.64m overspend are:

Enhanced Services – There are underspends relating to Minor Surgery, following a review in

Month 3 this has increased in relation Minor Surgery, by basing estimates on what has been

claimed so far in the year as well as what was claimed in 19/20.

Primary Care Network (PCN) – The overspend position here relates to the Additional Roles

commitments from 2019/20 that were agreed to be made available in 2020/21.

General Practice – Alternative Provider Medical services (APMS) – The increased variance in this

area from Month 3 totals £0.12m and is made of Caretaking costs of £0.07m and the Contract for

Broad Oak Medical Practice commenced from 01.07.20 and is an APMS contract (£0.05m). The

opposite impact of this is shown within the PMS contract line.

Co-Commissioning Category

4 Mths

Budget

(£m)

YTD

Actual

(£m)

YTD

Variance

(£m)

Dispensing/Prescribing Drs 0.64 0.38 0.26

Enhanced Services 1.45 1.25 0.20

General Practice – APMS 2.40 2.77 (0.37)

General Practice – GMS 22.83 23.15 (0.32)

General Practice – PMS 8.37 8.12 0.24

Other GP Services 0.40 0.57 (0.18)

Other Premises costs 1.02 1.06 (0.03)

Premises Cost Reimbursement 5.36 5.28 0.08

Primary Care Networks 3.73 4.21 (0.48)

QOF 4.29 4.33 (0.04)

Subtotal 50.49 51.13 (0.64)

NHSEI Budget Balancing Line (3.04) 0.00 (3.04)

Subtotal 47.45 51.13 (3.68)

Anticipated NHSEI Budget Adj 3.68 0.00 3.68

Grand Total 51.13 51.13 0.00

Finance Report

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General Practice – General Medical Services (GMS) – The variance has adversely increased this

month by £0.26m and this is due 5 PMS Contracts have transferred onto a GMS contract wef

01.07.20.

General Practice – Personal Medical Service (PMS) – The variance on this line has positively

increased due to the 5 contracts that have transferred to a GMS contract that were previously

PMS and also a PMS contract ending on 30.06.20 and being re-commissioned as an APMS

contract as mentioned above.

It is important note that any costs relating to the claims for Covid-19 expenditure do not form part of the figures

presented above as part of Co-Commissioning budgets.

This expenditure is presented as part of the CCG Core Primary Care budgets and at month 4 currently totals

£2.358m.

Section 96 Funding

This funding is a mechanism of providing discretionary payments to GP Contractors under Section 96 of the

NHS Act 2006 (as amended). The approval of this funding is delegated to the Primary Care Commissioning

Committee (PCCC).

To date there has been one approval of Section 96 funding in relation to patient reallocation and this totals

£0.01million year to date.

Forecast

At this stage, the months one to four period represents the full extent of the allocated budget by NHSEI,

therefore there is no additional forecast.

Risks.

The key risk, and this is also described in the main finance report, is that the CCG has not received funding for

the spend in excess of the originally allocated PCC budget (as with other budgets and costs with the exception

of the COVID cost claim). As such, an assumed breakeven position following additional resource/allocation is

currently a risk.

Recommendation

The Committee is asked to note and approve the contents of the Primary Care Commissioning Finance

Report as at July 2020.

Finance Report

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Paper Title: Risk Report Paper Reference:

PCC 20 092

Sponsor: N/A Attachments/ Appendices:

Risk Register (Extract) - Appendix A

Presenter: Siân Gascoigne, Head of Corporate Assurance

Summary Purpose:

Approve ☐ Endorse ☐ Review ☐ Receive/Note for:


☒

Executive Summary

The purpose of this paper is to present the Primary Care Commissioning Committee (PCCC) with risks relating to the Committee’s responsibilities. The paper provides assurance that primary care risks are being systematically captured across the Nottingham and Nottinghamshire Clinical Commissioning Group (CCG) and sufficient mitigating actions are in place and being actively progressed.



☐

Financial Management ☐ Cultural and/or Organisational Development ☐





Risk Report

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Risk(s):

Report contains all risks from the CCGs Corporate Risk Register which fall under the remit of the PrimaryCare Commissioning Committee.

Confidentiality: (please indicate whether the information contained within the paper is confidential)

☒No

Recommendation(s):

1. COMMENT on the risks shown within the paper (including the high/red risk) and those at Appendix A; and

2. HIGHLIGHT any risks identified during the course of the meeting for inclusion within the Corporate Risk Register.

Risk Report

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1

Primary Care Commissioning Committee

Monthly Risk Report

1. Introduction

The purpose of this paper is to present the Primary Care Commissioning Committee with risks relating

to the Committee’s responsibilities. It provides assurance that primary care risks are being

systematically captured across the Nottingham and Nottinghamshire CCG and sufficient mitigating

actions are in place and being actively progressed.

2. Risk Profile

There are currently five risks relating to the

Committee’s responsibilities (as detailed in

Appendix A). This is the same has was

presented to the last meeting.

Since the last meeting, risks have been

reviewed by the Head of Corporate

Assurance, in conjunction with the Chief

Commissioning Officer and the Associate

Director of Primary Care.

The table to the right shows the current risk

profile of the five risks.

There is one high / red risk in the

Committee’s remit as outlined below.

It was agreed at the previous meeting that a review of this risk would be undertaken at the August

Committee meeting to determine the continued appropriateness of the risk narrative and score given

it has been a high / red risk for over 12 months.

Risk

Reference Risk Narrative

Current Risk

Score

RR 032

Reducing workforce capacity within General Practice may impact the

sustainability of some GP Practices. In responding to these

challenges, Practices should consider adapting their workforce

models to enable the sustained delivery of core services, whilst also

ensuring sufficient capacity to deliver/contribute to system and

transformation requirements.

Lack of pace of change may present a risk that the CCG's population

access needs are not met, adversely impacting patient experience

and/or outcomes.

Overall Score

16: Red

(I4 x L4)

Risk Matrix

Imp

act

5 - Very High

4 – High 1 1

3 – Medium 3

2 – Low

1- Very low

1 -

Rare

2 -

unlik

ely

3 -

Po

ssib

le

4 -

Lik

ely

5 -

Alm

ost

Cert

ain

Likelihood

Risk Report

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2

3. Risk Identification

There have been no new risks identified since the last meeting.

4. Archiving of Risks

There are no risks proposed for archiving.

5. Amendments to Risk Score/Narrative

There have been no amendments to risk narrative or score since the last meeting.

6. Recommendations

The Committee is asked to:

COMMENT on the risks shown within this paper (including the high/red risk) and those at

Appendix A; and

HIGHLIGHT any risks identified during the course of the meeting for inclusion within the

Corporate Risk Register.

Siân Gascoigne

Head of Corporate Assurance

August 2020

Risk Report

151 of 15209:00 - 10:35, Zoom Webinar-19/08/20

Risk Ref Oversight Committee Directorate Date Risk

Identified Risk Description Risk Category Existing Controls Mitigating Actions Mitigating Actions Progress Update:

Last Review

DateTrend

(Relevant committee in the

CCG's governance structure

responsible for monitoring

risks relating to their

delegated duties)

(as per April 2020

CCG structure)

(Date risk

originally

identified)

(These are operational risks, which are by-products of day-to-day business delivery. They arise from

definite events or circumstances and have the potential to impact negatively on the organisation and its

objectives.) Imp

act

Like

liho

od

Sco

re

(The measures in place to control risks and reduce the likelihood of them occurring).

(Actions required to manage / mitigate the identified risk. Actions should support

achievement of target risk score and be SMART (e.g. Specific, Measurable,

Assignable, Realistic and Time-bound). Imp

act

Like

liho

od

Sco

re (To provide detailed updates on progress being made against any mitigating actions identified. Actions taken should bring risk to

level which can be tolerated by the organisation).

(Movement

in risk score

since

previous

month)

RR023 Primary Care Commissioning

Committee

Finance and

Resourcing

Jul-19 As practices have seen an increase in charges for non-reimbursable costs for premises from Property

Services and from CHP (Community Health Partnerships), there is a risk that (for some practices) this

may impact viability of providing primary care services from their current location.

This may, in turn, lead to service disruption, inability to invest and/or risks to patient access to primary

care services.

Finance

Stu

art

Po

yno

r

Lyn

ne

Shar

p

3 3 9 • CCG meetings with NHS Property Services and Community Health Partnerships

(quarterly).

• Engagement with NHS England Primary Care national and local teams

• LMC support to Practices

Action: To continue to work with local GP practices, the LMC and property

companies (NHSPS and CHP) to ensure management plans are in place.

Action: To escalate larger GP practice debts to NHSE/I for further national

support.

3 3 9 August 2020: An update was presented to the June 2020 PCCC meeting on Covid and non-Covid related Primary Care estate

activity (including debt management). A joint meeting between NHSEI, the CCG and the Practice(s) are being set up for those

Practices with the largest challenges regarding debt. It has been recognised that this needs to be re-prioritised as an area of focus

post Covid; a further update in relation to this risk has been requested from the Associate Director of Estates.

06/08/2020 ↔


Committee

Finance and

Resourcing

Jul-19 Reducing workforce capacity within General Practice may impact the sustainability of some GP

Practices. In responding to these challenges, Practices should consider adapting their workforce models

to enable the sustained delivery of core services, whilst also ensuring sufficient capacity to

deliver/contribute to system and transformation requirements.

Lack of pace of change (e.g. adaption of workforce models) may present a risk that the CCG's population

access needs are not met, adversely impacting patient experience and/or outcomes.

Commissioning

Stu

art

Po

yno

r

An

dre

a B

row

n

4 4 16 • Role and remit of the Primary Care Commissioning Committee (and supporting

governance structures - e.g. primary care quality / contracting teams)

• PCCC assurance reporting requirements.

• Establishment of Primary Care Cell, as part of CCG's Covid-19 incident response

• ICS Primary Care Workforce Strategy; ICS Primary Care Board

• Establishment of Primary Care Networks (PCNs) (and/or other

collaboration/federation activities)

• Ensuring the best use of funding via the GP Forward View, targeting resources to

areas of need e.g. GP Resilience Funding, Practice Manager training and development

funding.

• CQC Inspection Rating(s) / Report(s).

Action: Implement and embed PCCC supporting governance and reporting

requirements to ensure appropriate assurance is provided regarding primary care

services (e.g. quality of services, delivery of contract requirements, patient

experiences).

Action: To continue to deliver requirements of Primary Care Workforce Strategy:

to request further update regarding delivery of the Strategy to the CCG's PCCC.

4 4 16 August 2020: An update in relation to primary care workforce is scheduled for the August 2020 PCCC meeting. A review of this

risk will be undertaken at this stage.

It was highlighted by the Associate Director of Strategic Planning & Workforce Transformation that the ICS Primary Care

Workforce Group is an enabler to mitigate the risk. The Workforce Group reports to the Primary Care Programme Board, which is

recognised by the PCCC as a commissioner led oversight forum that recommends system wide development, use of resources,

addressing workload, ways of working and workforce. Workforce in terms of numbers and skills is part of the answer to quality

service delivery and performance.

Further mitigations are also being undertaken through PCN workforce planning and the Training Hub, both of which are in

development.

07/08/2020 ↔


Committee

Commissioning May-20 Covid-19 may present a risk to the sustainability of safe and effective delivery of primary care services

to members of the CCG's population.

This may be due to Primary Care workforce having to 'shield' or self-isolate, lack of PPE to ensure safe

working, or challenges with GP Practice estate not meeting infection, prevention and control (IPC)

requirements.

This risk may be exacerbated if/when there is a surge in primary care activity.

Commissioning

Lucy

Dad

ge

Joe

Lun

n

4 4 16 • Primary Care 'Cell' within the CCG's emergency response infrastructure

• Roll-out of IT infrastructure/technology to support virtual working (e.g. telephone

appointments, etc.)

• Routine OPEL reporting and escalation processes

• Establishment of CMCs and ability to step up/step down if needed

• PCN 'buddying' processes in place

• 'Roving' workforce support across Practices.

Action: To continue with incident response structures as described.

Action: To to produce, and share, guidance/FAQs following the Remote Working

Hazard Workshop.

4 3 12 August 2020: GP workforce capacity continues to be monitored daily via the Primary Care Cell. Daily Primary Care OPEL reports

are in place to monitor primary care workforce and service pressure, as well as concerns and issues (such as lack of PPE, for

example). All Practices have been required to complete risk assessments for BAME/clinically vulnerable staff. 100% of GP

Practices have now responded, providing assurance that appropriate mitigations are in place for their staff.

In addition, each Primary Care Network (PCN) has identified a business continuity plan to respond to workforce pressures. Joint

working through CMCs continues to be an option with 'step up' and 'step down' arrangements in place. This will build more

capacity and resilience to delivering core General Practice services.

The CCG held a Remote Working Hazard Workshop with GP colleagues to help identify the potential quality hazards/risks to

remote working and what mitigations need to be put in place to stop these materialising. This was fed back to the July PCCC

meeting, outlining next steps.

07/08/2020 ↔


Committee

Commissioning May-20 There is an increased risk of Covid-19 infection to clinically vulnerable (including BAME) primary care

workforce which may impact the provision of primary care services across the CCG's population.

This may particularly impact areas of Mid-Nottinghamshire and Nottingham City.

Workforce

Lucy

Dad

ge

Joe

Lun

n



appointments, etc.)





Action: To continue to seek assurance regarding the completion of risk

assessments and progressing any actions identified from these (or the IPC Estates

Reviews).

3 3 9 August 2020: The main mitigation to this risk is the digitalisation of Primary Care service provision. The CCG has sought assurance

from all GP Practices that risk assessments have been completed and any subsequent actions identified. Further actions have also

been identified following review of Primary Care Estate to determine whether it is compliant with new IPC requirements. 100% of

GP Practices have now responded, providing assurance that appropriate mitigations are in place for their staff.

Mitigations are also via the GP Practice business continuity plans and the ability to 'step up' and 'step down' CMCs.

07/08/2020 ↔


Committee

Commissioning Jun-20 The impact of Covid-19 test, track and trace on workforce may impact primary care service provision.

The likelihood of this risk materialising is greater for smaller/single-handed practices.

Workforce

Lucy

Dad

ge

Joe

Lun

n



appointments, etc.)





Action: To continue to seek assurance regarding the completion of risk

assessments and progressing any actions identified from these (or the IPC Estates

Reviews).

3 3 9 See update for risk RR 137 above. 07/08/2020 ↔

Current Risk RatingInitial Risk Rating

NHS Nottingham and Nottinghamshire CCG Corporate Risk Register (August 2020)

Exe

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Risk R

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152 of 15209:00 - 10:35, Z

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meeting agenda ( public session) primary care ... · agenda 2 of 152 09:00 - 10:35, zoom...

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