nhs blackpool clinical commissioning group nhs fylde and

NHS Blackpool Clinical Commissioning Group NHS Fylde and Wyre Clinical Commissioning Group

Primary Care Commissioning Committees in Common Meeting

Tuesday, 6 April 2021 at 1.00pm – 2.30pm Via Microsoft Teams Videoconference

AGENDA

No

Agenda Item Report Requirement

Attached/ Verbal/

Presentation

Presenter

1. Welcome, Introductions and Apologies for Absence

Noting

Verbal R Fisher

2. Declarations of Interest/Conflicts of Interest Relating to the Items on the Agenda

Noting Verbal R Fisher

3. Minutes of the Previous Committees in Common Meeting Held on 2 February 2021

Approval

Attached

R Fisher

4. Matters Arising/Review of Action Sheet

Noting

Attached

R Fisher

5.

Chair’s Communications Noting Verbal R Fisher

Items for Approval

6. Draft Committee Workplan 2021/22

Approval Attached J Harrop

7. Estates Update: a) Ansdell Medical Centre Expansion b) Newton Drive Health Centre Expansion

Approval Approval

Attached Attached

P Hargreaves/

L Andrews

Items for Discussion

8. COVID-19 Vaccination Programme: a) General Update

b) £120m Funding for Primary Care

Noting Noting

Presentation

Verbal

M Ashton M Ashton

9.

Primary Care Financial Update – Month 11

Noting

Attached J Gaskins

10. Integrated Care System and Primary Care Network Update

Noting Attached J Harrop

11. Integrated Care System – IT Update

Noting Verbal P Kelly

12. Quality Contract Update Noting Attached M Ashton

13. Quality and Outcomes Framework Update Noting Verbal S Danson

14. Practice Closures Report - Nil Noting Verbal J Harrop

15. Quarterly Contractual Changes Summary

Noting

Attached S Danson

16. NHSE/I Update Noting Verbal S Danson

17. Risks: a) Corporate Risk Register Update – Primary Care b) Any Issues Identified in the Meeting that Require Risk Assessment/Adding to the Risk Register

Noting Noting

Attached Verbal

J Harrop R Fisher

2

No

Agenda Item Report

Requirement Attached/

Verbal/ Presentation

Presenter

Items for Information

18. Extended Access Service Provision Noting Attached M Ashton

19.

Agenda Items/Areas to Highlight for the Next Governing Body Meeting – 1 June 2021


20.

Any Other Business Noting

Verbal R Fisher

21.

Dates, Times and Venues of Future Meetings:

• Tuesday, 27 April 2021 at 9.30am via MS Teams

• Tuesday, 1 June 2021 at 9.30am via MS Teams


Exclusion of the public: “To resolve that representatives of the press and other members of the public be excluded from the remainder of the meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest” (Section 1(2) Public Bodies (Admission to Meetings Act 1960).

Subject to ratification at the next meeting

1

Minutes of the Primary Care Commissioning Committees in Common Meeting NHS Blackpool Clinical Commissioning Group and

NHS Fylde and Wyre Clinical Commissioning Group Held via Microsoft Teams on Tuesday, 2 February 2021

Part I

Present: Mr R Fisher, CCG Chairman (Chaired the meeting) Mr C Brown, Lay Member Mr D Edmundson, Lay Member Mrs H Williams, Lay Member Dr I Stewart, Secondary Care Doctor Dr B Butler-Reid, Clinical Director Mr A Harrison, Chief Finance Officer (Due to IT issues, was not present during Items 3-8 and

Item 11. Mr Gaskins assumed Executive responsibility in line with previously agreed and documented arrangements)

Mr J Gaskins, Acting Chief Finance Officer

In attendance: Mr K Toole, Lay Member, Fylde and Wyre CCG Mr M Nuttall, Lay Member, Fylde and Wyre CCG Mrs B Goodman, Deputy Director of Commissioning Mrs J Harrop, Head of Commissioning - Primary Care, PCNs and Community Pathways Mrs M Ashton, Senior Commissioning Manager, Primary Care Mrs A Bate, Head of Communications and Engagement Mr D Clough, Communications and Engagement Officer Mr P Hargreaves, Head of Estates (Item 12) Mrs F Ollis, Executive Lead, Lancashire Coastal Medical Committee (LMC) Mrs S Danson, NHS England/Improvement Mrs B Martin, Healthwatch Mr R Hodskinson, Patient Participation Group (PPG) Representative Mrs G Jackson, Patient Participation Group (PPG) Representative Miss L J Talbot, Secretary to the Governing Body, Blackpool CCG Mrs P Bowling, Secretary to the Governing Body, Fylde and Wyre CCG

The Chairman welcomed everybody to the ‘virtual’ meeting of the Primary Care Commissioning Committees in Common meeting for Blackpool CCG and Fylde and Wyre CCG explaining that it was a Part I meeting and whilst under normal circumstances the public can attend the meeting, Government social isolation constitute special reasons to avoid face to face gatherings as permitted by legislation. The papers for the meeting had been published on the CCGs’ websites.

The Chairman also welcomed Mr Hodskinson, PPG Chair at Garstang Medical Practice, Mrs Jackson, PPG Chair at Thornton Medical Practice and Ms Martin from Healthwatch.

1. Apologies for Absence

Apologies for absence had been received from Ms Scattergood.

2. Declarations of Interest/Conflicts of Interest Relating to the Items on the Agenda

RESOLVED: That the following declarations of interest be noted:

• That some members are patients of GP practices on the Fylde Coast.

• Dr Butler-Reid declared an interest as the GP practice he is employed byhas and is undertaking COVID-19 vaccinations to patients.

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3. Minutes of the Previous Committees in Common Meeting Held on 6 October 2020 RESOLVED: That the minutes of the meeting held on 6 October 2020 be approved as a

correct record.

Decision-making Schedule (Governance Review)

RESOLVED: That members of the committee receive the decision-making schedule for information.

4. Matters Arising/Review of Action Sheet including Updates

Mrs Harrop advised that the majority of actions listed had been paused due to COVID-19 (shaded orange on the schedule). Mr Toole referred to the action relating to the Hambleton Branch Surgery and had been given assurance that whilst the action had been paused, activity had not been paused. An issue had arisen that the former practice at Hambleton had not been made available for vaccinations. Mrs Harrop assured members that whilst actions had been paused, the primary care team continued to oversee the actions. Members noted that the action shaded green had been completed. Mrs Harrop would ensure that where relevant, the Executive sponsor is amended to Dr Butler-Reid. ACTION: J Harrop - Completed

RESOLVED: That members of the committee note the matters arising and receive the

action sheet, noting the current position. 5. Chairman’s Communications

On behalf of the committee members, the Chairman conveyed his thanks to all CCG staff along with the wider Fylde Coast NHS staff for their continued support in relation to the pandemic. In particular, he conveyed thanks to the primary care team for their support, in addition to their current roles. Excellent feedback had been received from the GP practices which was testament to the joint working across organisations. The Chairman also commented that some members of staff from the CCGs have also been carrying out vaccinations. A huge amount of work was taking place and it was gratifying to hear the tremendous effort of all staff involved.

Mr Toole also conveyed his thanks to Mrs Harrop and Mr Ashton for the regular updates he had received from them in respect of the work being undertaken across primary care. He also thanked the PPG Chairs, Mr Hodskinson and Mrs Jackson, for their input into the committee meetings which was greatly appreciated. Due to the rotation process of PPG Chairs attending the committee meetings, it was their last committee meeting. He also thanked them for their involvement in the vaccine roll out.

6. Confirmation of Chairs’ Action - GP Quality Contract Mrs Ashton provided a verbal update and had recently had a conversation with the Committee

Chairs (Mr Fisher for Blackpool CCG and Mr Toole for Fylde and Wyre CCG) seeking their agreement to step down some elements of the GP quality contract in line with other CCGs in Lancashire and South Cumbria due to the pressures relating to the pandemic. This was with the exception of the following two areas:

• GP practices to ensure their business continuity plans are updated in light of the COVID-19 pandemic

• GP practices continue to monitor the Eclipse patient safety alerts relating to medicines management.

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RESOLVED: That members of the committee approve the Chair’s Action taken in respect of

the GP quality contract. 7. GP Quality Contract – Update

Mrs Ashton provided a verbal update advising that as part of the Integrated Care System (ICS) guidance, the CCGs were not in a position to reintroduce the GP quality contract for the remainder of the financial year. She also explained that they may introduce an action to support the COVID-19 vaccinations in the wider sense as there had been other providers assisting. She would discuss it further with Dr Butler-Reid and Dr Hartley-Smith with a view to asking primary care to undertake this in a more co-ordinated way. Mrs Ashton advised that the ICS was looking at having a system-wide approach however, it had been delayed due to the pandemic. She explained that a local contract would need to be in place for at least six months from April to September 2021 and work was taking place in reviewing the draft contract that had been produced for 2020/21 which had not been formally put in place. Areas such as access and IT would need to be reviewed. Mrs Williams asked if the GP quality contract would be consistently applied across both CCGs and Mrs Ashton confirmed that it had been in place for the last two years. Dr Stewart sought further clarification as to when the new GP quality contract would be implemented, whether it would be from 1 April 2021 and if so, he was unsure whether it was acceptable for the practices to be paid for services they are not providing. As the next committee meeting is scheduled to meet on 6 April 2021, he asked how it would be updated and implemented. Mrs Ashton anticipated that we would be in a position to implement the GP quality contract by the timescale and that there may be a requirement to hold an Extraordinary committee meeting prior to 1 April 2021. She would liaise with Mr Fisher and Mr Toole. Mr Gaskins advised that detailed guidance was awaited which would take effect from 1 April 2021. He anticipated that it would be issued over the coming weeks and would likely give a national steer as to what can and cannot be undertaken in terms of contracts. He advised that the NHS contracts planning had been paused. Mr Gaskins informed committee members that the primary care contract sits separately, and we await the national steer. ACTION: M Ashton – Since advised, not required. Mr Brown referred to priority areas and asked if there were services tangential to COVID-19 such as mental health services. He also asked about non-COVID-19 related areas but those that are serious such as cancer as he would not want them to be lost. Mrs Harrop advised that priority areas would be discussed further in the next item on the agenda “COVID-19 Vaccination Programme Update” which should provide reassurance as a letter had been issued regarding four priorities.

RESOLVED: That members of the committee receive the update in respect of the GP

quality contract and note the ongoing work. 8. COVID-19 Vaccination Programme - Update

Mrs Harrop gave a presentation in respect of the COVID-19 vaccination programme which covered the following:

• Primary Care Network designated vaccination sites – Assurance processes – every site had to be assured from cold chain, security and patient flow then reviewed prior to sign off.

• Vaccination priority areas for primary care – Four cohorts, over 80s, care homes, front line staff, housebound, then by age and then an update on completion.

• Initial issues relating to vaccine deliveries, consumables, limited shelf life of vaccine and data availability.

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4

• CCG support to the vaccination programme – GP practices welcomed the support from CCG colleagues.

• Thanks were conveyed to a number of colleagues across the Fylde Coast from primary care, the Hospitals Trust, community pharmacies, CCG staff along with patient groups, volunteers and the wider ICS, NHSE/I and Local Medical Committee. Mrs Harrop conveyed her personal thanks and advised the committee that a lot of positive feedback had been received from patients. Mrs Ashton also commented that staff had worked tirelessly, over weekends and evenings contacting patients.

Dr Butler-Reid commented that we cannot underestimate how quickly the Fylde Coast and the rest of Lancashire and South Cumbria have moved in terms of the rest of the country. It demonstrated a true system working which provided a phenomenal response. Not all practices signed the Enhanced Service and Dr Butler-Reid commented that there had been concerns as to why two practices had not signed up to deliver the vaccine at the beginning of the process. He advised that there was a huge amount of uncertainty at the beginning of December as they could not commit to staff availability to deliver the vaccine on Boxing Day, so the two practices were advised not to sign up at that point. This was by no means a failure to support as the practices have provided support in other ways. Dr Butler-Reid further commented that after only eight weeks into the programme, 55,000 people had been vaccinated and whilst there are areas to improve, the programme continued. The Chairman asked Mr Hodskinson and Mrs Jackson asked for their comments from a PPG and front-line perspective. Mr Hodskinson commented that from the patient’s point of view, particularly at Garstang Medical Centre where a number of patients were vaccinated from outside of the area, he fully understood why patients from the Kirkham and surrounding areas attended Garstang and the staff at the practice were able to manage the additional caseload. He informed committee members that although he did not have the latest figures, he would be attending a PPG meeting to receive an update from the practice. On behalf of the patients at Garstang Medical Centre, Mr Hodskinson conveyed his thanks to the staff at the practice for providing a first class service. Mrs Jackson commented that the staff at The Thornton Practice had been amazing and she conveyed her congratulations to them all. Whilst there were difficulties with transport including taxis in light of the rules around COVID-19, the “bubble” rules, the weather etc, there has been a positive atmosphere. Information was available via the website or word of mouth and information received from the CCGs had been included on the practice website. The practice was able to continue providing services without being distracted by the vaccinations being carried out. Thornton Little Theatre was also being used as a vaccination site. The Chairman conveyed his thanks for the positive feedback. Mrs Harrop made reference to the transport issues and had previously raised with public health colleagues about voluntary car schemes and helping with social isolation. She was looking for this to be pursued from a primary care point of view. Mr Hodskinson commented that one of the main issues in the rural Fylde population was patients attending their GP practice such as Garstang and Catterall and a significant number of people live in remote areas and are elderly. A piece of work had taken place, via Lancashire County Council’s (LCC) community transport, in looking at having volunteer drivers who take people to their doctor, to the shops, the bank etc. The PPG or the wider community could also look at ways of addressing these problems. Mrs Bate referred to Preston Community Transport who receive funding from LCC however, it did not cover Blackpool at the current time. She provided a link to access the website. Mrs Bate and Mr Hodskinson would liaise further outside of the meeting.

ACTION: A Bate/R Hodskinson

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In terms of providing other support to patients, Mrs Ashton advised that consideration was being given in setting up a telephone hotline for patients where they would be provided with a range of options to access primary care services. An IT solution was being explored. In terms of data, Mrs Harrop would share up to date information with committee members when available. ACTION: J Harrop – Confirmed that the hot line had commenced and an update would be provided at the next meeting. Mrs Williams made reference to the most vulnerable patients in care homes and asked if there was a percentage uptake figure on care homes. Mrs Harrop commented that it would not be far from 100% uptake however, she would obtain the information and circulate to committee members.

ACTION: J Harrop – To be provided at the next meeting. Mrs Williams referred to the second dose and sought clarification on the message to patients. Mrs Harrop advised that for the Wave 1 sites, patients had received the second dose. In line with national guidance, all other patients would be contacted with a date for the second dose. Dr Butler-Reid commented that there had been some contentious issues in respect of the second dose. Mr Edmundson commented that whilst the process of vaccination had gone well personally, he asked if there was sufficient communication in terms of questions asked prior to and after having the vaccination. Dr Butler-Reid commented that the national communications state the question requirements and they are part of the consent process. It is an issue with the vaccinator and is part of the training. Mrs Harrop explained that national communications had produced a leaflet for patients and which were available at each Primary Care Network (PCN) site. Mrs Bate would review and re-share the information on the media forum. ACTION: A Bate Dr Stewart made reference to the flu update attached to the action sheet commenting on the poor uptake at GP practices. Mrs Ashton advised that the NHSE/I data available was up to the end of November and that the December data was awaited. She acknowledged the uptake locally and one practice that had a particularly low uptake commenting that it was likely to be a coding issue however, it was being picked up. Mrs Harrop advised that patients appear to prioritise the COVID-19 vaccination over the flu vaccination and Mrs Jackson commented that it came at the wrong time. Dr Butler-Reid advised that historically, flu vaccination uptake is not very high with 60-75% uptake in a normal year.

In respect of the messages about complying with the COVID-19 vaccine process and for patients waiting to be contacted by their GP, Mr Nuttall sought assurance to ensure patients are not being missed. He further commented that since commencement of the programme, nationally patients were receiving letters informing them to book a vaccination. He asked what checks and balances were in place to ensure nobody was waiting for a vaccination. Also, as we move forward for patients having their second vaccination and moving on to other cohorts, he asked how the ICS will manage the process and how it will be managed efficiently. The Chairman also commented that whilst the cohorts of patients had been prioritised via an age-related process, he asked how people will be picked up if in the meantime, their age moves up and they could potentially be in a different cohort. Dr Butler-Reid advised members of the committee that the data is captured on a separate system called Pinnacle and he explained the coding and capture process which is undertaken via a search as either “done” or “declined so not recalled”. He explained that everybody else is brought in unless they are in hospital, unwell or have had COVID-19 in the last four weeks. Those people will stay on that list and there will be recalls at each cohort. The data is captured centrally and he gave assurance that there are checks and balances in the system. In terms of the roll out, Dr Butler-Reid referred to the mass vaccination sites such as the Winter Gardens which is geared up for more agile people whilst the more fragile would want to go to their primary care site. He advised that there did not appear to be a capacity issue but more of an issue around availability of the vaccine.

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Mrs Ashton advised that a communication had been sent out advising the over 80s that if they had not yet had their vaccine, to contact their GP practice. Both Mrs Ashton and Mrs Bate would ensure that the message was sent out again. ACTION: M Ashton/A Bate – Action complete Mr Nuttall thanked colleagues for the update in respect of contacting their GP and the cross check but he sought clarification as to whether this had been undertaken across the ICS suggesting that a local communication would be useful without affecting the national approach as we step through the vaccination programme. Mrs Harrop had raised the issue around local communications and had been advised that all forms of communication are required to go through the ICS. Mrs Bate advised that very early on in the process there was a requirement to have a very generic approach. However, as the programme progressed, discussions had since been held with the ICS, regional and national teams and Mrs Bate would raise at the ICS communications meeting to see how it could be worked locally. It was recognised that as it progresses, there is a requirement for more nuanced messages locally. It was noted that the Local Resilience Forum has been working on uptake and barriers to uptake so they should be able to target people more specifically. Mrs Jackson suggested using community Facebook sites as they had been very successful at passing information on. ACTION: A Bate RESOLVED: That members of the committee receive the update on the COVID-19

vaccination programme. 9. Integrated Care System Primary Care Sub Cell - Update

Mrs Harrop gave a presentation on the Integrated Care System (ICS) primary care sub cell which provided an update on the primary care programme and workplan. The ICS had written to primary care asking that they focus their resources on managing four key functions required to support the health of our populations which were:

• Delivering the COVID-19 vaccination programme

• Providing an Acute COVID-19 Assessment and Triage Service, supporting virtual wards and oximetry at home

• Support to maximising safe hospital discharges

• Maintaining access for acute and undifferentiated general practice presentations Mr Brown asked what the undifferentiated general practice presentations were and Mrs Harrop commented that it was more around urgent access as concern had been expressed that patients were not attending the practices. She explained that there was more detail behind this and that it was likely to include mental health. Mrs Harrop advised that the feedback from GPs has been that the majority of presentations related to mental health issues and it was important to monitor whether services are able to manage this. Mrs Williams referred to support maximising safe hospital discharges and asked what the position was in respect of discharging COVID-19 positive patients back to care homes. Mrs Harrop made reference to the ARC where patients are taken for 14 days prior to going back to the care home. She further commented that all 33 beds are being used for this which is an ICP approach. Mr Edmundson asked if more information could be made available as it was not just around access into primary care but could also be referral on to Lancashire and South Cumbria NHSFT or to Blackpool Teaching Hospitals NHSFT. Dr Butler-Reid made reference to the four key areas of primary care advising that colleagues nationally were required to look at how we can best use sparse resource. He commented that all practices are offering a same day assessment or review whether physical or a mental health problem which is very different to what they were offering 12

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months previously. It was recognised that there has been a sea change in the way primary care is now working and the Local Medical Committee is also supporting practices. Dr Butler-Reid advised that in the short term over the next month or so, primary care is moving away from long term monitoring of conditions whilst vaccinations are being rolled out. Mrs Harrop advised that there is also support for mental health services in terms of support for referral on for patients and the impact of this. She referred to Togetherall and the Supporting Minds Service which are available. Reference was also made to IAPT which has been running very well with group workshops held. Mrs Harrop advised that they were looking at patient contact within one to two weeks of referral in. The crisis team continued to provide a service. Mr Brown thanked colleagues for the update around mental health services commenting that patients may have understandable fears in engaging with services and that it was about engaging with them to understand those fears and how we can allay them. RESOLVED: That members of the committee receive the update on the ICS primary care

sub cell.

10. Month 9 Primary Care Financial Update

Mr Gaskins spoke to a circulated report which provided an update on primary care spend to month 9 (31 December 2020) and highlighted the risks and mitigations to primary care budgets for the remainder of the 2020/21 financial year. Mr Gaskins advised that both CCGs were forecasting delivery of a breakeven position for 2020/21 in line with the plan when all budget areas of the CCGs are considered. It was noted that at present, a Fylde and Wyre CCG overspend against primary care budgets was forecast. Mrs Williams referred to the area of spend in respect of the local enhanced services and sought clarification as to whether they related to different schemes across both CCGs given that the GP enhanced contract was now equalised. Mr Gaskins made reference to the note within the report that for Blackpool CCG, £4m of the GP Quality Plus contract was within co-commissioning. Mr Gaskins further explained that there were a couple of anomalies within the local enhanced service which were outside of this at the current time and would be revisited when the CCGs move out of the current financial arrangements. It was also noted that the Blackpool CCG local enhanced service annual budget currently reflected some Lancashire hosted items.

RESOLVED: That members of the committee receive the month 9 primary care financial update.

11. Primary Care Networks - Update

Mrs Harrop provided a verbal update in respect of the Primary Care Networks (PCNs). One area that had continued was the PCN direct enhanced service and that appointment of additional roles continued to be undertaken. Moving into the financial year 2021/22, funding would be available for paramedics and mental health workers and work was taking place in co-ordinating PCN monies and developing ideas. Other areas of development were being reviewed in respect of the integrated care partnership and the integrated care system for the Fylde Coast.

Mrs Harrop advised committee members that mental health remains as the priority area and agreement had been reached to co-ordinate mental health services into the neighbourhood care teams and PCNs.

RESOLVED: That members of the committee receive the update on Primary Care Networks.

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12. Estates – Update

Mr Hargreaves provided a verbal update in respect of estates:

• Adelaide Street Practice - Due diligence process currently being undertaken and discussion with Blackpool Council taking place. A further update report would be provided at the April meeting of the committee in terms of the process relating to committee approval for sign off, detailed drawings then being prepared followed by the tendering process.

ACTION: P Hargreaves

• New Build - Wesham - Demolition complete and the site totally cleared. Half of the land would go up for sale. Discussions taking place with NHS Property Services in respect of the land valuation. A further update report would be provided at the April meeting of the committee in terms of the final figures and agreement to go out to tender. ACTION: P Hargreaves

Mr Toole asked how the patients affected were being kept aware of the changes and Mr Hargreaves advised that once the detailed plans were available, it was intended to take them to a public meeting. He further advised that it was part of the ongoing design team work that would be undertaken with all partners prior to any public presentation.

• New Build – Proposed New Accommodation at Great Eccleston - A large site had been identified which was currently at outline planning stage (approximately 1¼ acres identified). Mr Hargreaves advised that commitments against the scheme had been identified. The land owner has stated that they prefer to transfer the land and the building fully serviced and Mr Hargreaves was currently liaising with them to ensure there is a “like for like” comparison. An access road would be required to develop the site and planning permission was some time away. Mr Hargreaves advised that it was likely to be approximately 18 months before the building would commence.

• Section 106 Funding – Other sites where funding would be used towards approved developments were Harris Medical Centre (former Premium Bond site, Preston New Road), Queensway Medical Centre to support alterations and both Thornton Practices towards extensions. Mr Brown asked that when the detail of the schemes come back to the Primary Care Commissioning Committee, whether there would be any financial issues and Mr Hargreaves advised that he did not see any issues as Section 106 funding relates to improvement grants. Alteration works were also being considered at Garstang.

• Vaccination Programme – On the Fylde Coast, there were currently 14 fully operational sites made up of one mass vaccination site at the Winter Gardens, four community pharmacy sites and nine PCN sites. Mr Hargreaves advised that lessons learned have been undertaken and routine unannounced visits take place. Teething problems were being addressed and all sites were working well.

• Whyndyke New Village – Mr Toole asked for an update in respect of the new village however, Mr Hargreaves did not have any further information. Mr Harrison commented that as arrangements are in place in terms of Section 106 funding, as and when any housing development is put through, the CCGs/committee will be alerted to it immediately. He recommended, therefore, for this particular development to be stood down and await any further update from Mr Hargreaves as and when it was available.

RESOLVED: That members of the committee receive the estates update noting the actions being taken forward.

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13. Practice Closures Report

RESOLVED: That members of the committee note there had been no practice closures during the last quarter.

14. Quarterly Contractual Changes Summary

Mrs Danson spoke to a circulated report which provided a summary of contractual changes effective in the previous quarter (October – December 2020) where contract variations had been processed to reflect a change to a practice’s existing contract across both Blackpool CCG and Fylde and Wyre CCG. This included retrospective reporting in respect of an application from Over Wyre Medical Centre to close the Hambleton Health Centre branch site which had been approved and the closure effective from 7 August 2020. Mrs Williams asked what the impact of the Hambleton Health Centre branch site closure had been to date. Mrs Ashton advised that the practice was currently looking into having a voluntary car scheme and had been engaging with the community. A flu clinic had been held in the local church to ensure provision was met. She had not received any comments from patients about not being able to access the site. Mr Toole commented that the patients were aware that the practice was looking at accessibility and they appeared to be more understanding of the changes. Mrs Jackson advised that there had been problems with the vaccinations, there was an hourly bus service which does not stop near enough to the surgery and that people were required to walk three quarters of a mile. She had asked for the figures in relation to the number of patients who had transferred along with the number of patients who had left the practice, the figures were awaited. In addition to access in connection with the poor bus service, Mrs Jackson advised that car sharing was also problematical due to social distancing and also the age demographic of patients. Mr Toole would pick up the issues outside of the meeting. ACTION: K Toole

RESOLVED: That members of the committee receive the quarterly contractual changes

summary.

15. NHSE/I – Update Mrs Danson provided a verbal update and informed members of the committee that there continued to be a focus on the vaccination programme which had been discussed earlier in the meeting.

Mr Harrison referred to the reliance of financial processes and staff managing contracts and sought clarification on the transition of a different format in arrangement of commissioning across Lancashire and South Cumbria. He asked when the provision of service would be discussed to ensure continuity in terms of information provided to the committee in going forward. In summary, Mr Harrison asked how NHSE/I was responding to the changes in the provision of information and ongoing support across Lancashire and South Cumbria post 2020/21. Mrs Danson was not aware of the arrangements at the current time but would raise the issue outside of the meeting and would report back at a future committee meeting.

ACTION: S Danson – Confirmed that the action has been flagged in relation to ongoing support from NHSE/I and how this would work moving forwards as this is applicable to all CCGs across the Lancashire and South Cumbria locality.

RESOLVED: That members of the committee receive the NHSE/I update.

16. Winter Plan 2020/21

Dr Butler-Reid reminded members that due to timings of meetings, the Winter Plan 2020/21 had been circulated to the committee at the beginning of December for information.

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RESOLVED: That members of the committee receive the Winter Plan 2020/21 for

information. 17. Risks

a) Corporate Risk Register Update – Primary Care – As part of an action from the Chairs, Mrs Harrop gave a summary presentation on the risks associated with primary care commissioning which had been extracted from the Corporate Risk Register. She advised that Mr Medway, Interim Deputy Director of Nursing is the CCG lead for the Corporate Risk Register with both Mrs Harrop and Mrs Ashton having responsibility for the primary care commissioning risks. She would be liaising with Mr Medway regarding the process for reviewing and updating the risks and advised that a meeting would be arranged with the Chair of the Quality Improvement and Engagement Committee and quality and engagement leads to discuss the process between the two committees. Dr Stewart advised that it is the individual committee responsibilities to ensure that their risks are adequality supervised and the Fylde and Wyre CCG Governing Body Secretary had agreed to ensure each committee would undertake that role. It was noted that Mr Medway and the Quality Improvement and Engagement Committee have overall responsibility. The committee Chair had also liaised with Dr Stewart and Ms Scattergood regarding the risks and process. Mr Harrison commented that it is the responsibility of the Primary Care Commissioning Committee to endorse the mitigation and course of action in terms of risks and then escalate up to the Governing Body. Members were advised that the committee has a responsibility for monitoring the primary care commissioning risks to ensure there is assurance, ie, the full extent of the risk and what is being undertaken so that the committee is being assured or not assured and understand what plans are in place to ensure assurance. Mrs Williams commented that there was insufficient information provided and Mrs Harrop was mindful of this at the current time as she wanted to clarify processes. More detailed and meaningful information would be provided at the next meeting. ACTION: J Harrop – Process in place to bring detailed primary care risks to committee meetings. b) Any Issues Identified in the Meeting that Require Risk Assessment/Adding to the Risk Register – It was highlighted that there was a lack of clarity as to how the primary care commissioning risks were being managed and mitigated and further work was required to clarify the process and escalate as appropriate. Mr Brown commented that for future meetings, it would be more beneficial for written reports to be provided to include mitigations rather than a presentation at the meeting and this was noted.

RESOLVED: That members of the committee note the presentation and the work to be

undertaken in providing members with more detailed information in respect of primary care commissioning risks in order to be able to provide assurance or for them to be escalated accordingly.

18. Agenda Items/Areas to Highlight for the Next Governing Body Meeting

RESOLVED: That members of the committee note there were no items or areas to highlight.

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19. Minutes Primary Care Commissioning and Quality Forum (NHSE/I) – 24 September 2020

RESOLVED: That members of the committee receive the minutes of the meeting.

20. Any Other Business Patient Access – Dr Stewart advised that he had reason to change his personal details with his GP

practice and whilst he assumed that the amendment would be updated on the patient access platform, this had not been the case. He advised that the patient is required to update their personal information on patient access as the GP practice is unable to update these details. He expressed concern about personal details not being up to date on both systems. Mrs Bate would pick up the issue with the CCGs’ Head of IT to ensure a communication is cascaded to practices. She would also pick it up in terms of other applications such as the MyGP app etc. ACTION: A Bate

21. Date, Time and Venue of Next Meeting

The next meeting would be held on Tuesday, 6 April 2021 at 9.30am via Microsoft Teams. EXCLUSION OF THE PUBLIC

“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). The meeting closed.

Minutes approved as a correct record. Committee Chairman ………………………… Date …………………………

Item 3

PPRRIIMMAARRYY CCAARREE CCOOMMMMIISSSSIIOONNIINNGG CCOOMMMMIITTTTEEEE -- AACCTTIIOONN SSHHEEEETT –– 66 AAPPRRIILL 22002211

No. Meeting Date:

Agenda Item No.

ACTION POINT ACTION BY:

DEADLINE: PROGRESS:

1 3/12/19

14/7/20

12

4b

Quality and Outcomes Framework (QoF) Update That a presentation on Nexus Intelligence (expected prevalence based on demography) be provided at a future meeting.

BI Team work diverted due to COVID-19 pandemic. A presentation will be given to the committee in due course.

A Harrison/ S Bond

A Harrison/ S Bond

Ongoing

Ongoing

2 Discussed outside the committee

Primary Care Quality Principles between how quality concerns will be shared between the Chairs of the PCCC and the QI&EC.

I Stewart / K Toole

Ongoing

Item 4

Primary Care Commissioning Committees in Common

Report Details Meeting Date 6 April 2021

Report Title Draft Primary Care Commissioning Committee Workplan 2021/22

Presenter Jeannie Harrop

Prepared By Jeannie Harrop / Louise Talbot / Pam Bowling

Report Requirements Approve

Committee Discussion Date

Senior Management Team

Clinical Commissioning Committee

Quality, Improvement and Engagement Committee

Finance and Performance Committee

Audit Committee

Primary Care Commissioning Committee 6 April 2021

Remuneration Committee

Recommend to CCG Governing Body – Part I or Part II

Internal Assurance Process (indicate if not applicable) Clinical Lead -

Senior Lead Manager Jeannie Harrop

Finance Manager -

Has a Quality Impact Assessment been completed?

-

Has an Equality Impact and Risk Assessment been completed? If not, please explain why.

-

Patient and Public Engagement completed

-

Financial Implications -

Are there any associated risks? If so, are the risks on the Risk Register? If yes, please include the risk descriptor and current risk score.

-

Report Authorised by Executive Lead

-

Item 6

March 2021

Primary Care Commissioning Committee Workplan April 2021-March 2022

Agenda Items Apr 2021

Jun 2021

Aug 2021

Oct 2021

Dec 2021

Feb 2022

Standard Items

Core Contract Issues – Report as required MA √ √ √ √ √ √

Enhanced GP Quality Contract – Update position MA √ √ √

Finance Update JG √ √ √ √ √ √

Enhanced GP Access LA √ √ √ √ √ √

NHSE/I Update SD √ √ √ √ √ √

Primary Care Quality Report EP √ √ √ √ √ √

PCN Update JH √ √ √ √ √ √

Summary of Practice Contract Changes SD √ √ √ √ √ √

Risk Areas - To highlight: - Receive primary care risks periodically- Identify any issues raised at the meeting for

potential inclusion on the risk register

DB √ √

√ √

√ √

√ √

√ √

√ √

GP Annual Visits Update (Annually) MA √

GP Patient Survey Briefing (Annually) AB √

End of Year Quality Contract MA √

Agenda Items/Areas to Highlight – CCG Governing Body Meetings

√ √ √ √ √ √

Review Committee Terms of Reference PB/ LJT √

Ad Hoc Items

Estates and Technology Transformation Fund Update – NHSE/I

MA/ PH/ PK

√

National Contract Updates/Contract Variations SD

Update/Progress Reports (including CQC)/Action Plans

MA

Other Committee Business

Part II – To be convened as necessary MA/

JH

Item 6



Report Title Estates – Ansdell Medical Centre Expansion

Presenter Phil Hargreaves / Michelle Ashton

Prepared By Louise Andrews



Senior Management Team Not required

Clinical Commissioning Committee Not required

Quality, Improvement and Engagement Committee Not required


Audit Committee Not required


Remuneration Committee Not required

Recommend to CCG Governing Body – Part I or Part II Not required

Internal Assurance Process (indicate if not applicable) Clinical Lead Dr Neil Hartley Smith


Finance Manager John Gaskins


No


No


No

Financial Implications No


No


Dr Neil Hartley Smith

Item 7a


1

Ansdell Medical Centre Proposed Room Expansion

Introduction Ansdell Medical Practice is a well-established GP Surgery that has operated in this locality for many years. There are 9425 patients registered with the practice and it currently operates with five partners, two salaried GPs, 1 Advanced Nurse Practitioner (ANP) and another ANP in training. The list size is continuing to grow, and they are expecting this trend to continue with the development of new houses and Care Homes within the local area. They are a proactive training practice and have the ability to train medical students and have had confirmation from University of Central Lancashire that students can be placed with them to obtain training. Due to the increase within the team and the expanding Primary Care Network the practice is

struggling to accommodate the extra staff.

The practice is also expecting a surge in new patient registrations due to new surrounding housing

developments and neighbouring GP practices considering reducing their practice boundaries due to

GP recruitment issues.

To allow the practice to grow and support the number of trainees and PCN staff working in the

practice the attached proposal highlights the issues and investment required to expand the practice.

This business plan explains in further detail the requirements needed for the practice to increase its workforce. The practice is looking to increase capacity within the building by utilising the current Podiatry wing which equates to 3 rooms located on the ground floor, the current District Nursing room, Seminar Room, and School Nursing rooms located on the first floor of the building.

Changes in the practice over the past 15 years

• All original GP’s and Practice Manager have retired

• Practice growth >50% to 9700 with scope to grow further

• New housing developments

• New nursing home being built locally/already have most of the patients from the Hamptons and have good relationships due to early communications with management.

As a result of additional workload, the practice has moved work from reception staff to trained teams.

We have developed our Medicine Management Team to deal with all prescription queries resulting in

4 extra staff that liaise with pharmacies/care homes and hospitals.

The current admin team has increased from 1 staff member to 5, the admin team deal with all

paperwork coming into the building medicals / scanning / read coding / summarising / safeguarding

plus 1 care co-ordinator for end of life care / cancer patients and Electronic Palliative Care

Coordination System (EPaCCS) this in total is 6 extra staff.

Item 7a


2

These roles were previously covered in the jobs of other departments – Secretarial, Assistant

Practice Manager and Reception Team.

A triage system to review all same day urgent requests with a nurse practitioner (1 extra staff

member) to ensure adequate provision is in place. especially for children. We have developed our

training availability (previously only 1 GP trainer who supervised I GP trainee) We now have 3 GP

trainers. Other GP’s have completed Foundation Year 2 & medical student supervision and have the

capability to take trainees from Manchester/Liverpool and University of Central Lancashire.

The Nursing teams has also grown to improve chronic disease management and to facilitate

secondary care i.e. bloods & ECG requests from 2 nurses and 1 HCA to 3 nurses 2 phlebotomists

and 2 HCA’s.

Current Situation As a result of these changes the practice require a room to house the Medicine Management Team of 4 extra staff plus a pharmacist when recruited, which would be a total of 5 extra staff. There would also be a requirement to include another room to house 5 admin staff an increase of 4 to the team. We currently have our Care Co-ordinator working from a cupboard with no window/heating or air conditioning to action admin work, the Care Co-coordinator is also the cancer champion and actions all the EPaCCS. Part of this work is to supports the carers which they are currently unable to do as they do not have the facilities to see any patients for support face to face due to working in the cupboard. The Health Care Assistant also has no allocated room when doing her duties. An administrator is currently working in our library as BAME and high risk, the library would normally be dedicated to the trainees to use for any study work they wish to do. There is also currently no room space for Trainees or medical students (the practice has always been highly commended for as they allow them their own clinics to see their own patients). Due to COVID the practice has had to use the Podiatry wing within the building (as these rooms were the only non-carpeted rooms available in the building) to allow the GP’s to assess patients face to face. Planned Proposal – Additional Rooms Required The Podiatry wing would be 3 training rooms to be used by Medical Students. Seminar Room - Currently Unoccupied located on the first floor The Medicines Management Team has grown in numbers to meet the ever-increasing demand on the surgery, due to this the room they are currently working in is too small. The practice is looking to move the team into the currently vacant Seminar room on the first floor of the building. The practice has developed their own Medicines Management Team and now employ, 2 pharmacy technicians, a prescriptions administrator and a Medicines Optimisation Co-ordinator. This room would allow the team to work comfortably, and to allow the flexibility for further expansion.

Item 7a


3

School Nurses Room

This small area with adjoining storage cupboard on the first floor will be used to home our extensive administrative support team who deal with coding, scanning, workflow etc on behalf of the GPs. These roles have previously been carried out by nursing staff and so the need for office space has not been required. Due to an increase in workflow we have now taken on two members of administrative staff to fulfil these roles. This role has reduced the workload for the GPs and allows them to concentrate on patient care. This room would allow the team to work comfortably, and to allow the flexibility for further expansion.

District Nursing Room

This room would be used for the Nurse Practitioner, the Nurse Practitioner currently does not have a

room allocated to her and is a key member of our team. We have developed our workforce to meet

the ever-changing demands on our services and employed Advanced Nurse Practitioners. Due to the

above we now have restrictions on working space for our Nurse Practitioners. So, the practice

proposes to take over the old District Nurses room on the ground floor.

Approval of this application will provide the Practice with greater flexibility and ability to increase the number of clinical sessions it provides.

Records Room

There are currently 2 small record rooms, unfortunately once these rooms become empty after the

digitisation of all paper records, we would not be able to utilise these rooms for staff/office use due to

the size of the rooms. These rooms have no windows/heating or air-conditioning. The rooms also

don’t have any computer or electric points.

PCN Staff

The Pharmacist Team and Social Prescribing Link Worker now require a clinical room twice a week

for medication reviews. The practice is currently struggling to accommodate these members of staff

due to lack of room capacity. The practice has also had a recent request for the Social Prescribing

Link Worker to use a room in the practice for group meetings for face to face appointments,

bereavement groups and webinars.

Further expansion/opportunities

• Increase in patient growth

• New housing developments

• New nursing home being built locally/already have most of the patients from the Hamptons and have good relationships due to early communications with management.

• Pharmacist

• PCN staff requesting use of rooms for structured medication reviews

• Extended hours/access using our rooms

• Outreach workers requesting use of our rooms to help and support vulnerable patients

• Physicians associate trainees (PCN)

Item 7a


4

List Size Growth

Date List Size

Apr-13 8806

Jul-13 8834

Oct-13 8812

Jun-14 8937

Sep-14 8979

Dec-14 9015

Jun-15 9208

Sep-15 9265

Dec-15 9308

Jun-16 9366

Sep-16 9425

Dec-16 9313

Jun-17 9021

Sep-17 8946

Dec-17 8969

Jun-18 8977

Sep-18 8961

Dec-18 8983

Jun-19 9048

Sep-19 9177

Dec-19 9389

Feb 21 9735

Costs associated with proposal and identify increases

Total Rental Value ex VAT £24, 268.756

Reimbursable Rent provided by NHS E is £ per quarter £29,122.50

Reimbursable Rent provided by NHS E is £ per annum £116,488.00

With increase of floor space transferred from NHSPS lease to the practice (m2)

An increase of £ per annum Current Cost

Per Quarter = £29,122.50

Per Annum = £116,488.00

Item 7a


5

Cost for new rooms


Per Annum, - £68,875.68

Total New Cost


Per Annum = £185,365.68

NHS PS Service Charge budget is £2,887.00 for 2020/21

The Landlord is responsible for external repairs and maintenance under the lease, so NO extra service charge would be required from Assura. No legal costs currently Engagement The practice has discussed this proposal with the Patient Participation Group who are in support of

the practice’s application to increase it’s floorspace. We have discussed the risks and benefits and

they feel that the benefits significantly outweigh the risks. It would allow the practice to increase

services to both our registered patients and local community.

Risks

1. External services would bot be able to deliver care in this locality which would reduce

accessibility and quality of service to the local population.

2. Health Care Assistant has no allocated room.

3. Trainees/Medical Students have no allocated room. The practice has had to turn down a

trainees and medical students who were due to start in April due to there being no room

availability. BTH cross sector Pharmacy Technician student due to attend the practice for 6

months which the practice may need to decline due to lack of room capacity.

4. Library is currently being used for a BAME staff member (this room is meant to be used for

trainees and students to have quiet study time).

Item 7a


6

Table below shows room usage

Monday Tuesday Wednesday Thursday Friday

Room 1 Dr Butler-Reid Dr Holland Dr Holland Dr Butler-

Reid Dr Butler-

Reid

Room 2 Jane Jane Jane Jane Jane

Room 3 Dr Grant Dr Grant Dr Grant Jenny (PA) Dr Grant

Room 4 Dr Holland Dr Parkes

(ST3) Dr Parkes

(ST3) Dr Parkes

(ST3) Locum (mat

cover)

Room 5 Michelle Michelle Michelle

Room 6 Dr Norcross Dr Norcross Dr Norcross Dr Norcross Dr Norcross

Room 7 Dr Palmer Dr Palmer Dr Palmer

Room 8 Dr Carey Dr Carey Midwife Dr Carey Locum (mat

cover)

Room 9 Margaret Margaret Brenda Brenda

Room 10 Melanie Melanie Melanie Melanie Locum (mat

cover)

Room 11 Hannah Hannah Hannah Hannah

Room 12 Debbie Debbie Debbie Debbie Debbie

District Nurses

Ann (NP) Jenny (PA) Ann (NP) Jenny (PA) Ann (NP)

Cupboard

Pod 1 Dr Singh

(ST3)

Dr Singh (ST3)

Dr Singh (ST3)

Pod 2 Dr Saha (ST2) PCN (splw) PCN

pharmacist Dr Saha

(ST2) Dr Saha

(ST2)

Pod 3 RED CLINIC RED CLINIC RED CLINIC RED CLINIC RED CLINIC

• Room 2 – Currently housing Jane Health Care Assistant (HCA) Would be Dr Meehan permanent

room currently on maternity leave due back this year

• Room 5 – Currently housing Michelle (HCA) would be Dr Salmon permanent room current on maternity leave due back in July

Recommendation The Primary Care Commissioning Committee is asked to approve. Louise Andrews Commissioning Manager – Primary Care

Item 7a



Report Title Estates – Newton Drive Health Centre Expansion

Presenter Phil Hargreaves / Michelle Ashton

Prepared By Louise Andrews







Audit Committee








No


No


No



No



Item 7b

Newton Drive Health Centre Floor Space Expansion Business Case March 2021

Summary

Newton Drive Health Centre would like to request an increase to the floor space domain to help

expand the practice, improve patients’ services and establish new working arrangements to secure

the long-term effectiveness of the practice. The practice list size has grown significantly since we

moved to the premises in August 2011. With that, our clinical and administrative infrastructure has

also increased. The proposal is to expand into the administration office on the second floor of the

building that is currently occupied by Blackpool Teaching Hospitals. This area is part of the sub lease

agreement between the practice and NHS Property Services. NHSPS have indicated that they would

be happy to amend the lease and forgo this space back to the practice.

Background

The practice has requested consideration for this previously, but this is the first time we have put

forward a formal proposal. Approximately 12 months ago we met with the CCG to discuss how we

could expand the practice floor space as we had reached full capacity in our clinical rooms. However,

the discussion and plans involved substantial structural work to redesign the administration office on

the first floor. On consideration the practice felt the expense that would have had to be incurred was

not cost effective.

The current pandemic has shown that remote working and ‘hot desking’ is an effective way for clinical

staff to work. Up until now, clinicians have been allocated their own room. However, lessons learned

from a total triage model have proven that clinical staff can be effective at consulting over the phone

for the majority of their clinical contacts (up to 90% are currently completed over the phone). We are

proposing that clinical staff utilise the administration space, rather than clinical space to carry out

telephone triage, as they do not require a clinical room for telephone assessments. This would then

free up availability in the clinical rooms.

List Size Growth

The practice list size has increased every year since we relocated to the

health centre. The average yearly increase is 4%. This is set to continue

with new local housing developments including;

Applewood Grange, Poulton – 30 homes

Moorfield Park, Poulton – 136 homes

Oldfield Park, Poulton – 106 homes

Date List Size

01/04/20 11000+

01/10/20 10644

01/10/19 10233

01/10/18 9715

01/10/17 9123

01/10/16 8689

01/10/15 8434

01/10/14 8193

01/10/13 8154

01/10/12 8037

01/10/11 7582

01/10/10 7346

Item 7b

In addition to new housing we have seen a shift in patient registrations due to a number of reasons.

Recent GP retirements in the local area have caused patients to move practice as well as local branch

closures e.g. Staining Branch. Local services appear stable at present and despite this, list size

continues to grow. We currently serve the practice boundary below but also recognise that we serve

many hospital staff who register with us for convenience. These patients can now register with an ‘out

of area’ registration status.

Case for change

Due to the continued growth in list size we are now utilising our clinical space to capacity. We no

longer have available rooms for external community services such as Ophthalmology and

Dermatology. We have no space to expand our own clinical team and no scope to support PCN staff

or facilitate third party or community services staff e.g. Citizens Advice, District Nursing.

Increasing the practice’s available space means that clinical staff can relocate to an administration

room which is essential, due to lack of clinical space. This is possible due to the new ways of working

learned through adapting to the Covid-19 pandemic. Our face-to-face appointment ratio has dropped

from 1:3 to 1:10 for clinical triage. The experience gained and new methods of consulting such as

video and text are set to stay, as both clinicians and patients have seen benefits to this approach.

This remote triage can be done from any office and does not require a clinical room. This means our

clinical staff can share an administrative space and carry out clinical triage. They can then share rooms

for assessment purposes in the clinical space on the ground floor.

Current situation Room occupancy has been a growing issue for a number of years, as list size has grown, so has practice

infrastructure to accommodate new patients and services.

The practice currently has 12 clinical rooms and 3 specialist rooms (Minor Ops, Treatment Room and

Health Education Room).

Item 7b

Our room usage is running at 91% of capacity, having already had to ask several services to move out

during Covid. Including Ophthalmology, Dermatology, Citizens Advice and Community Staff (District

Nurses and Midwives). We no longer have capacity for all these services and no space to expand the

practice team or help support PCN staff. (Annex 1)

You may be aware of the Lloyd George Digitisation Project. The project aims to convert all patient

paper records to electronic records. This means the practice would no longer be required to physically

store paper notes, thus freeing up space in the practice. We already plan to utilise the existing storage

space, which is in the practice administration office, for additional workstations for staff. Some staff

will be returning to the office following the end of the covid restrictions and we are also in the process

of recruiting additional administration / reception staff to support the growing infrastructure of the

practice.

Proposed solution Increasing the practice floor space and taking on an additional administration office would ensure the

practice can work in a different way.

Instead of each member of the clinical team being assigned a room they could ‘hot desk’ and remote

triage from the administration base.

This would free up a number of essential clinical rooms which could then be shared and used for

clinical assessment when face-to-face appointments are required. This would continue to work after

the Covid pandemic as the practice has always run a GP triage system and other members of the team

are becoming increasingly competent at telephone triage, instead of having full face-to-face clinics.

In addition to this there are some cost benefits involved for the NHS family. The space is currently

being charge at NHS PS sublease rates to Blackpool Teaching Hospitals, which includes substantial

management fees. If the lease was rearranged and the room rented directly from the property

landlord, these fees would not be applicable. It would therefore, cost less to fund the same room

space. There is a detailed explanation of the funding below.

Costs associated with proposal and identify increases

Total Rental Value ex VAT £237,500.00

Reimbursable Rent provided by NHS E is £32,450 per quarter

Reimbursable Rent provided by NHS E is £129,800 per annum

With increase of floor space transferred from NHSPS lease to the practice (102.61m2)

Reimbursable Rent provided by NHS E is £37,703.13 per quarter

Reimbursable Rent provided by NHS E is £150,812.50 per annum

An increase of £21,012.50 per annum

Area m2 % NET P/A

PCT / NHSPS 423.95 36.50% £ 86,687.50

GPs 737.57 63.50% £ 150,812.50

Totals 1161.52 100% £ 237,500.00

Item 7b

FM Charges may need to be rebalanced – currently NHSPS are charged 42.5% Vs 45.33% rent NHSPS Currently charge BTH 35,362.00 per annum + 5% management charge = £37,130.00 per

annum.

Engagement We have discussed this proposal with our Patient Participation Group who are in support of the

practice’s application to increase it’s floorspace. We have discussed the risks and benefits and they

feel that the benefits significantly outweigh the risks. It would allow the practice to increase services

to both our registered patients and local community. I have included some of their comments below;

“As a member of the NDHC PPG, I wholly support the business proposal to expand the floor space of

the surgery. This expansion would enable creation of a hub for triage calls without taking up valuable

clinical rooms. These rooms could then be deployed to increase clinical capacity and introduce the

number and type of services offered to patients and the local community.” Victoria Greenwood –

Newton Drive Health Centre PPG Member

I'd like to say that as a patient (and member of PPG if that's appropriate to include) I fully back this

proposal.

I have been so impressed with how the practise has adapted to Covid with forward thinking and

careful thought. I understand that if we had more admin space, we could increase our team of triage

clinicians and house them in a secure and confidential setting.

I accessed the triage system recently and was really impressed to be offered a phone appointment

the same afternoon. I had a long chat and reassuring with a GP and it was lovely to not feel hurried

for time. Often when you saw a GP prior to Covid, they may be running late and with a waiting room

full of people; it can difficult to relax and take your time. To have more options for phone or video

appointments would seem viable and prudent. I also really appreciated the follow up call a week

later from my GP, something which may not have happened prior to Covid, but something that made

a huge positive impact on my recovery. – Jane Berry

NDHC Letter of

Support 26.11.20.docx

I have also received supportive comments from the Dermatology Service who are keen to move back

into Newton Drive;

“The Community Dermatology Service has pre-Covid-19 provided clinics at Newton Drive Health

Centre. This was pivotal to the community living in this area. Since Covid-19 we are limited to

undertaking clinics at only two sites across the borough which for patients is not ideal from a travel

perspective. Moving forward it is vital for our service to recommence undertaking clinics at Newton

Drive Health Centre so that the Blackpool, Fylde and Wyre community is serviced in all areas that

patients need to be seen.” Sharon Stansfield – About Health (Dermatology) Service Manager

Engagement is also required from NHS PS who agreed in principle on 8th September 2020 that their

sublease could be amended subject to the usual business plan and board approval process. The

Item 7b

practice understands that as per the terms of the lease we would be liable for any legal costs incurred

to amend to the leased domain.

Benefit / Risks

1. Practice unable to accommodate increasing list size if floor space is not increased, this may

negatively impact on service delivery and access, as the practice could not increase the size of

the clinical team. If the list was to close it would affect patient choice.

2. The NHS PS is classified as high burden, due to its high cost. This would continue if this domain

is not transferred.

3. Transferring the domain to the head lease would mitigate additional charges currently being

incurred by NHS PS managing the area under their sub lease.

4. External services would not be able to deliver care in this locality reducing accessibility and

quality of service to the local population.

Item 7b

Annex 1

Day/Session Ground Floor HCA ROOM

Ground Floor PN ROOM

G/Floor Interview

1st Floor PN ROOM

Treatment Room

Specialist Room

Health Ed Room

Specialist Room

Minor Surgery

Specialist Room

1st Floor Mgt office 1 2 3

Monday am MW HOT CLINIC AR GH [CC] AT [MS] CB ET

Monday pm MW HOT CLINIC AR GH [CC] AT [MS] CB ET

Tuesday am CH HOT CLINIC AR GH PAS AT PAS CB ET

Tuesday pm CH HOT CLINIC AR GH PAS AT PAS CB ET

Wednesday am CH HOT CLINIC AR GH Baby Vacc CB ET MR

Wednesday pm CH HOT CLINIC AR GH AT CB ET MR

Thursday am MW HOT CLINIC AR GH DN AT PAS CB ET MR

Thursday pm MW HOT CLINIC AR GH DN AT CB ET MR

Friday am CH HOT CLINIC AR GH AT CB MD MR

Friday pm CH HOT CLINIC AR GH AT CB MD MR

Day/Session Cons Room 1 Cons Room 2 Cons Room 3 Cons Room 4 Cons Room 5 Cons Room 6 Cons Room 7 Cons Room 8 Cons Room 9

Monday am HC AJ SGG SJG LOCUM JSM FUH RW AG

Monday pm HC AJ SGG SJG LOCUM JSM FUH RW AG

Tuesday am HC AJ SGG RW DKB JSM FUH DF AG

Tuesday pm HC AJ SGG RW DKB FUH DF AG

Wednesday am HC AJ SGG SJG MW JSM RW DF LOCUM

Wednesday pm HC AJ SGG SJG MW RW DF LOCUM

Thursday am HC AJ LOCUM RW DKB CH FUH DF AG

Thursday pm AJ LOCUM RW DKB CH FUH DF AG

Friday am HC AJ LOCUM RW DKB JSM FUH DF AG

Friday pm HC AJ LOCUM RW DKB JSM FUH DF AG

Item 7b


1


Report Title Primary Care Financial Update – Month 11

Presenter John Gaskins, Acting Chief Finance Officer

Prepared By Chris Keenan, Senior Finance Manager and John Gaskins, Acting Chief Finance Officer

Report Requirements Noting





Audit Committee



Internal Assurance Process (indicate if not applicable) Clinical Lead N/A

Senior Lead Manager N/A

Finance Manager Chris Keenan, Senior Finance Manager


N/A


N/A


N/A

Financial Implications N/A


Risk associated with primary care budgets and spend is already included on the risk register as part of overall financial risk


John Gaskins, Acting Chief Finance Officer

Item 9

Primary Care Financial Update

Month 11

Primary Care Commissioning Committee

Tuesday 6th April 2021

Item 9

Context • The Primary Care Commissioning Committee receive regular

financial updates on primary care budgets and expenditure

• This report

– Updates on primary care spend to month 11 (28th February 2021)

– Highlights risks and mitigations related to primary care budgets in

closing the 2020/21 financial year

Item 9

Primary Care Month 11

Blackpool CCG

• £4m of the GP Quality Plus contract is within co-commissioning

• GP Forward View budget of £2.8m includes £1.5m of hosted ICS resource

Covid expenditure within year to date position

• Blackpool £1,367k (includes £278k Fylde Coast costs for FCMS provision)

• Fylde and Wyre £1,244k

Item 9

Risks and mitigations

• These remain consistent with the position described in the previous report to committee at month 9 and are consistent with pressures identified in month 7-12 planning.

– Co-commissioning

• Fylde and Wyre CCG baseline spend and forecast out turn is above the allocation. Note that this is a continuation of the underlying position from 2019/20

– Prescribing

• In both CCGs these costs are circa 10% higher than 12 months ago

• Note in both CCGs additional budget has been put into this area of spend

• Month 7-12 planning forecast values for these risks, and other areas of primary care spend. The value of system top up received by the two CCGs was derived from these forecasts and this provides the mitigation

– Note the system top up is not within the Primary Care budgets

• Both CCGs are forecasting delivery of a breakeven position for 2020/21 in line with plan when all budget areas of the CCGs are considered. It should be noted that Fylde and Wyre CCG primary care budgets remain forecast to overspend.

Item 9

Recommendations

• The committee are asked to note

– current position and forecast out turn on primary care budgets

– risks and mitigations in respect of primary care budgets

Item 9



Report Title Integrated Care System / Primary Care Network Update


Prepared By Jeannie Harrop

Report Requirements Receive



Clinical Commissioning Committee Date to be agreed

Quality, Improvement and Engagement Committee Date to be agreed


Audit Committee




Internal Assurance Process (indicate if not applicable) Clinical Lead Dr Neil Hartley-Smith




Not required


Not required


Not required



Included in the report


Dr Neil Hartley-Smith

Item 10


Integrated Care System and Primary Care Network Update

Integrated Care System (ICS) – Primary Care

COVID

Until recent all meetings and work programmes priorities for the ICS Primary Care Sub cell have related to the COVID vaccine programme in primary care. In the last month the ICS Primary Care Sub Cell Strategic group has re-started and is currently reviewing the work programme for the next year and agreeing projects moving forward.

Various meetings are continuing for the COVID programme in primary care and the ICS Primary Care Sub Cell operational group is still mainly COVID related.

The CCGs are currently in the process of drafting a scope for the COVID programme for primary care to return to business as usual where possible.

Work Programme

Most of the primary care and Primary Care Network (PCN) related work for the CCGs is led by the ICS Primary Care Sub Cell.

The ICS Primary Care Sub Cell Strategic group agrees an ongoing work plan for the group which identifies commissioning and GP leads from each Integrated Care Partnership areas to lead on key pieces of work. A summary of the April plan is shown below:-

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The majority of PCN Direct Enhanced Service and national primary care requirements are coordinated via the ICS Primary Care Sub Cell.

Recent pieces of work include: -

• Primary Care Digital Strategy – Fylde Coast leads - Pete Kelly, Michelle Ashton and Dr John Miles.

• PCN additional roles – community mental health transformation / mental health practitioners – leads - Dr Mark Dziobon (East Lancs), Jeannie Harrop and Lesley Tiffen

• Primary care Workforce overview – Leads - Dr Mark Dziobon and Wayne Kirkham (NHSE)

• Rebuilding primary care – leads – Peter Tinson and Dr John Miles

• System Reform – leads - Vicky Elleraby and Dr Geoff Joliffe

• PCN Development

• Primary care recovery

• Development of the ICS quality contract – due to start shortly

Other areas that feed into the ICS Primary care Sub cell include: -

• PCN Development monies Oversight group

• National primary care guidance – NHSE/I i.e. QOF updates

• National primary care network guidance – NHSE/I

• Primary Care comms

• Primary care and PCN finance

Meetings

ICS Primary Care Sub Cell

There are two main meetings for the ICS Primary Care Sub Cell – Strategic Development and Operational. Jeannie Harrop attends both and Michelle Ashton attends the operational meeting.

Dr John Miles and Dr Neil Hartley-Smith also attend the strategic group and operational group. Dr John Miles is one of the ICS PCN GP leads.

The terms of reference for this meeting are shown in Appendix 1.

ICS Primary Care Board

An ICS Primary Care Board meets monthly and the ICS Primary Care Sub Cell reports items into this group.

The terms of reference for this meeting are shown in Appendix 1.

Informal ICP Primary Care Leads

This is a weekly meeting that Jeannie Harrop attends along with Peter Tinson and the ICP Heads of Primary Care.

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Primary Care Network Direct Enhanced Services Update

Additional roles Summary PCNs are continuing to recruit the following professionals in addition to those identified in 2019/2020 Clinical Pharmacist, Social Prescribing Link Worker, Physician Associate and First Contact Practitioners.

• Pharmacy Technician

• Health and Wellbeing Coach

• Care Coordinator

• Dietician

• Podiatrist

• Occupational Therapist

In 2021/22 they will be able to recruit paramedics and most PCNs have indicated they will employ 1 or 2 paramedics. Some of the PCNs are in discussion with NWAS regarding a rotation of the role between the ambulance service and primary care.

The PCNs were also supposed to include mental health practitioners but due to the risk of destabilising mental health services, these posts will now be recruited via a local mental health Trust.

Access – Primary Care Extended Access As part of national guidance due to the COVID programme, the review of Extended Access for PCNs has been put back until 31.3.22. A CCG lead has been identified to work with the PCNs to complete this review and a paper will be agreed at the Fylde Coast Network of Networks and the CCG Clinical Decisions Oversight Group, Finance and Performance Committee and this Committee.

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Activity has continued to be monitored and this is reported to this Committee. Extended hours As part of the PCN Directed Enhanced service, PCNs have to provide Extended hours for their patients and this access is in place for all PCNs. This is either completed by the PCNs themselves or subcontracted to other providers i.e. FCMS.

PCN Development monies 2021/22 The Fylde Coast PCN Development monies plan for 2021/22 has recently been agreed by the ICS PCN Development Oversight Group. A summary is shown below: -

National service specification Enhanced health in care homes

• Care home alignment

• Care home MDT payment CVD / Anticipatory care / Personalised care / Structured medication reviews

• Paused due to COVID

Early cancer diagnosis CCG colleagues Katie Rimmer and Daniel Baines lead on this national service specification and liaise closely with secondary care and the PCNs. Some PCNs now have cancer care coordinators as additional roles.

Community Integration Recently we developed a Standard Operating Procedure for Neighbourhood Care Teams. Due to the COVID vaccine programme this has been paused. We are now looking to agree a re-start date for community services, and we have agreed to review the Standard Operating Procedure with the PCN Clinical Directors.

CCG Structured support for PCNs The CCGs Primary Care, PCN and community integration team are supporting the PCNs in their development priorities. Their current priorities include elements of the PCN Direct Enhanced Service (DES) that aren’t paused i.e. additional roles, PCN Development monies and community integration.

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PCN – Clinical Priority Community mental health transformation These meetings are now being held on an ICS footprint. An ICP lead GP has been identified to attend along with myself and Lesley Tiffen (commissioning lead mental health). The meeting will focus on the integration of community mental health services into PCNs along with the recruitment of mental health practitioners as part of the PCN additional roles.

Population Health Management and Health Inequalities As CCG lead for PHM and health inequalities, Pete Smith and Stuart Bond are working closely with the PCN CDs to develop a dashboard for each PCN. This will provide the basis for future PCN priorities.

Meetings Fylde Coast Network of Networks The PCN Clinical Directors meet monthly and the Chair is Dr Mark Spencer. Dr John Miles is the ICP GP lead for the Integrated Care System Primary Care Sub Cell. PCN Update The CCG and PCN Managers meet every two weeks to provide updates on all matters relating to the PCNs. PCN Clinical Directors and Blackpool Teaching Hospitals Monthly meetings are in place to discuss the development of the ICP under System Reform and develop a provider alliance which Dr Mark Spencer and Dr Jim Gardiner are leading on.

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Appendix 1

Primary Care Sub Cell Terms of Reference

Document Control

Title Terms of Reference for the Lancashire and South Cumbria

(L&SC) Primary Care Sub Cell

Responsible Person Peter Tinson – L&SC Director of Collaborative Commissioning

Date of Approval

Approved By

Author Sarah Squires / Peter Tinson

Date Created 24.03.2020

Date Last Amended 29.07.2020

Version 0.09

Review Date 30.09.2020

Publish on Public Website Yes No

Constitutional Document Yes No

Requires an Equality Impact Assessment Yes No

Amendment History

Version Date Changes

0.04 25.06.2020 Amended to reflect change from GP Services COVID 19 Group to the

Primary Care Sub Cell, which incorporates the former L&SC Out of

Hospital COVID-19 Pharmacy, Dental and Optometry Sub Cell

0.05 29.06.2020 Amended to reflect feedback from the Primary Care Sub Cell on

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25.06.2020

0.06 29.06.2020 Amended to reflect feedback from Stephen Gough

0.07 06.07.2020 Amended to reflect feedback from Primary Care Sub Cell on 30 June

2020 and subsequent feedback from Peter Higgins and Collette Walsh

0.08 13.07.2020 Amended to reflect feedback from Peter Higgins

0.09 29.07.2020 Section 6 amended to remove the days of the different meetings and

replace them with the meeting titles.

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1 Scope and purpose

1.1 These Terms of Reference (ToR) relate to the L&SC Primary Care Sub Cell and set

out its purpose, membership and reporting arrangements.

1.2 The Primary Care Sub Cell forms part of the working arrangements for the Out of

Hospital Cell outlined in joint letter from Dr Amanda Doyle and Kevin McGee dated

18 June 2020 (Appendix 1).

The aims of the Out of Hospital and Hospital Cells are summarised below:-

• Support the wider development of the L&SC system as it moves through Phase 3 and towards Phase 4 in April 2021

• Lock in positive changes in care models, operational processes and data sharing

• Safely restore the delivery of frontline clinical services

• Mitigate risks using mutual aid where necessary

• Agree and accelerate a consistent offer of integrated place based care in each neighbourhood, implemented by ICP collaborations

• Reset the approach to population health management, tackling unwarranted variation and addressing inequalities

The Primary Care Cell will draw general practice and other community practitioners

together to enable a continued focus both on the operational response to Covid and

the wider development of PCNs.

1.3 The scope of the Primary Care Sub Cell is therefore twofold:-

• The operational response to Covid for General Practice, Dental, Optometry and Pharmacy

• The strategic development and planning of primary care and the development of PCNs within this context

For the avoidance of doubt, NHSE/I remain responsible for Dental, Optometry and

Pharmacy contracting and performance. Similarly NHSE/I and CCGs (through

delegated arrangements) remain responsible for General Practice contracting and

performance.

1.4 The purpose of the Primary Care Sub Cell is to:-

Operational response to Covid

Facilitate and enable:-

1. Issues to be escalated and responses communicated 2. Mutual aid between partners 3. Problem solving by partners (especially common problems requiring common solutions) 4. Implementation of national and regional guidance 5. Development of system guidance 6. Care models/pathways to be collectively designed where its beneficial to do so

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7. Sharing of best practice between partners 8. Provision of operational delivery assurance 9. Effective communication between partners 10. Delivery of specific pieces of work agreed by partners 11. Engagement with other Sub Cells and partners including delivery of shared priorities

Strategic development of primary care/PCNs

1. Agree collaborative working principles 2. Identify collaborative working priorities 3. Design a collaborative work programme, including clinical and managerial leadership and

support arrangements, programme management and reporting arrangements 4. Oversight of the delivery of the programme 5. Engage with other Sub Cells and partners including delivery of shared priorities

2 Membership

2.1 The Sub Cell will be chaired by Peter Tinson, L&SC Director of Collaborative

Commissioning and the Co-Chair will be rotated on a 3 month basis between the

ICP member clinical leads. The Co-Chair will take an active role in the leadership

of the strategic development of primary care/PCNs.

2.2. The core membership of the Sub Cell is as follows:-

Chair – Peter Tinson, L&SC Director of Collaborative Commissioning

• Co-Chair – ICP member clinical lead rotated on a 3 month basis

• ICP Clinical Leads o John Miles – Fylde Coast o Lauren Dixon – Morecambe Bay o Mark Dziobon – Pennine Lancashire o Lindsey Dickinson/Sumantra Mukerji – Central Lancashire o Peter Gregory – West Lancashire

• ICP Primary Care Leads o Jeannie Harrop – Fylde Coast o Kate Hudson – Morecambe Bay o Collette Walsh – Pennine Lancashire o Donna Roberts – Central Lancashire o Jan Charnock – West Lancashire

• NHSE&I Leads o Gareth Wallis, Deputy Medical Director o Jackie Forshaw, Head of Primary Care o Stephen Gough, Primary Care Network Manager o Tricia Spedding, Head of Public Health

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• LMC – Peter Higgins

• Other primary care contractor professional representatives – to be confirmed

• Programme Management – Sarah Squires

• Administration Support – Debbie McCann

The following Subject Matter Experts will be routinely invited to the Sub Cell:-

• Medicines management

• Business Intelligence

• Digital

• Workforce

• Communications

• Finance

• Estates

3 Governance

3.1 The Group will report to L&SC Out of Hospital Cell.

The schematic below outlines the current governance arrangements.

It is acknowledged that work is progressing to develop a ‘consistent governance

diagram to connect ICPs into the wider structures of the ICS/Cells’ which ‘aims to

ensure colleagues in local organisations can see how participation in the leadership

and decision making arrangements of the ICS/ICP/Cells is taking place.’

(Reference L&SC Joint Committee of CCGs 2 July 2020)

Accordingly this section is subject to change.

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4. Relationships with other groups

4.1 The Primary Care Sub Cell will have a close working relationships with other

groups, including:-

• North West Region Primary Care, Public Health and Health & Justice Covid19 Subgroup whose members include the Chair and Vice Chair alongside the L&SC NHSE&I leads.

• All L&SC Out of Hospital Cell Sub Cells

5 Access and attendance

5.1 Sub Cell meetings will be held in accordance with the prevailing Covid guidance

regarding infection prevention and control. These arrangements will be continually

reviewed.

5.2 Other colleagues may be invited to join meetings for specific items.

6 Meeting arrangements

6.1 The Primary Care Sub Cell will hold two meetings per week; an operational meeting

and a developmental meeting:

Primary Care Sub Cell Operational Meeting:

o Operational response to Covid

Primary Care Sub Cell Developmental Meeting:

o Strategic development of primary care/PCNs o One in every four meetings will operate as the L&SC Primary Care Programme

Board (terms of reference appended).

6.2 Primary Care Sub Cell Operational Meeting:

In recognition of the frequency of meetings a standing agenda will be developed.

Sub Cell members will be offered the opportunity to add any additional agenda

items by agreement at the start of the meeting or in advance via e-mail.

Minutes and an action log will be produced for all meetings. A risk log will be

maintained for all the Sub Cell activities (operational and developmental) and

routinely reviewed on a monthly basis.

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6.3 Primary Care Sub Cell Developmental Meeting:

A forward plan of development items will be agreed which will be partly shaped by

the collaborative work programme, requests from Sub Cell members and other Sub

Cells and partners.

The Programme Board will operate in accordance with its agreed terms of

reference (Appendix 2).

7 Review

7.1 In recognition of the evolving Covid situation, these terms of reference will be kept

under continual review but there will be a formal review in September 2020.

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Appendix 1

Letter from Amanda Doyle & Kevin McGee - Out of Hospital & Hospital Cell, L&SC.pdf

Appendix 2

Programme Board Terms of Reference 1 Introduction

1.1 These Terms of Reference (TOR) relate to the Primary Care Programme Board.

1.2 These TORs set out the purpose and scope, membership, objectives, remit, responsibilities

and reporting arrangements for the group. The group shall operate within these TORs reporting to the Lancashire and South Cumbria Integrated Care System (ICS) Board via the L&SC Primary Care Sub Cell and Out of Hospital Cell.

2 Purpose & Scope

2.1 The Programme Board has been established on behalf of the 8 CCGs and NHS England /

Improvement North West region in L&SC ICS to provide a decision-making forum for co-operation and collaboration across the footprint. Its overarching purpose is: -

• To provide a structure through which the strategic oversight and leadership of Primary Care can be managed and discussed, with a view to implementing the principles of co-operation, co-ordination and collaboration across the L&SC footprint.

• The strategic oversight and leadership of delivering transformational sustainable change in primary care through the delivery/implementation of the GP Five Year Forward View, key national strategies, the L&SC Primary Care Delivery Plan, relevant NHS Planning Guidance and the NHS Long Term Plan.

• Embed a population health management approach across the programme.

• Maximise opportunities to support and accelerate the transformation of primary care.

• Empower primary care to take its place in the wider health and social care system as central to integrated care systems and partnerships, delivering services to patients in collaboration with partners in the health and social care system, through PCNs.

• Support primary care networks in their development and maturity in line with the NHSE Maturity Matrix. This will include PCNs making progress towards having integrated care models and workforce models across primary care, mental health, community, voluntary sector and local authority services.

• Supporting ICPs move towards place based commissioning, and integrated models of care.

• Support the ICS to achieve the “triple aim” of addressing the wider determinants of health and wellbeing and tackling inequalities; improving the quality of care and supporting people to lead more independent lives; managing NHS resources more efficiently and effectively.

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• Identify resources required and develop appropriate investment plans.

• Identify key risks and mitigations for the programme.

• Ensure effective approach to communication across partners and key stakeholders. 2.2 Delivery of the GP Forward View commitments provides systems and partnerships with the

opportunity to transform the model of care delivered to patients, building capacity and services in local communities, integrating primary and community services to support a local population, enabling a shift in care, with a greater emphasis on population-based interventions – prevention, self-care and pro-active management of frail and vulnerable patients within their local community.

3 Status and Authority 3.1 In order to ensure the Programme Board is effective, each CCG/ICP will need to ensure that

its representative has sufficient delegated authority/seniority to enable the Programme Board to function effectively its duties within these terms of reference.

3.2 Equally to ensure appropriate clinical leadership each CCG/ICP will need to ensure it has a

clinical lead representative and NHS England/Improvement ensure Local Professional Network representation for Dental, Pharmacy and Eye Health Services.

4 Membership and Quoracy 4.1 The core membership mirrors the Sub Cell membership with the following additions:

o Lay Member o Local Professional Network Chairs for Dental, Eye Health and Pharmacy o Health Education England o Local representative committees (Medical, Dental, Pharmaceutical and Optical) o Voluntary Sector representative o Community Service Provider representative

4.2. Co-opted stakeholders as and when required. 4.3 Where core members are unable to attend a deputy is asked to attend in their absence. 4.4 Where appropriate, Sub-Groups and Task and Finish groups may be established with

delegated decision-making authority and corresponding budgets. The outcomes from any approved Sub-Groups and Task and Finish groups will be reported back to the group for consideration. Any Task and Finish Groups and Sub Groups established will formally report and make recommendations to the group will only take decisions within the remit specified by the group.

4.5 It is anticipated that each CCG/ICP will decide who is best placed to participate in the

Programme Board on a meeting by meeting basis. However, representatives must be of sufficient seniority to enable the Programme Board to function effectively.

4.6. The Programme Board may invite additional members that it considers necessary to achieve

its objectives. The intention is to retain a degree of flexibility in membership, ensuring that established and emerging clinical leaders have the opportunity to participate.

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4.7. The Programme Board will be quorate if three out of the five ICPs/MCPs are represented, either by a clinical lead or senior managerial lead, the chair and a senior commissioner from NHSE/I and ICS, subject to the members present being able to represent the views and decisions of the members who are not present at any meeting.

4.8. The Programme Board will be chaired by the Sub Cell Co Chair, and the Deputy Chair will be

the Sub Cell Chair. 4.9. Where the Chair is absent, the Deputy Chair shall take on the role of the Chair. 5 Objectives & Responsibilities 5.1 In recognition of and response to the Covid situation, the Board will determine the key

priorities to be progressed in the remainder of 2020/21 (the collaborative work programme). 5.2 Responsible for developing and overseeing the implementation of the primary care work

stream of the L&SC ICS including updating the ICS monthly highlight report and reporting requirements.

5.3 Promote and champion Primary Care within the L&SC system and partnerships, as well as

regionally and nationally. 5.4 Provide strategic management over the workstreams and allocations delegated to the sub

committees and task and finish groups. 5.5 Support ICPs and PCNs in the move towards place-based commissioning through the

delivery of an agreed work programme including the following priority areas and enablers:

• Building sustainable and resilient General Practice and wider primary care enabling a greater focus on prevention and personalisation.

• Extending access and enhancing services offered to patients in a primary care setting.

• Support the development of integrated care and workforce models across primary care, mental health, community, voluntary sector and local authority services.

• Embed a population health management approach across the programme.

• Oversee the development of a local workforce recruitment and retention plan which supports the development of an expanded workforce and multidisciplinary teams.

• Support and increase capacity within the primary care workforce facilitating the upskilling of the workforce ensuring training is future-proofed.

• Increase investment in primary care and ensure investment is connected across the ICS.

• Development of PCNs as the foundation of integrated care at the neighbourhood level ensuring PCNs are supported in the maturity journey and that all PCNs have annual development plans in place to support the transformation and integration agenda.

• Ensure effective communications across partners and key stakeholders.

• Adopting and championing a Digital First approach to primary care

5.6 Oversee implementation of the GP Forward View, the NHS Long Term Plan in relation to primary care and any other key strategy/planning guidance on behalf of the ICS through system wide resources within NHSE/ICS and ICPs.

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5.7 For each proposal/project clearly identify the scope and reporting arrangements, including progress reports. Responsibility to share best practice across the 5 ICPs, removing duplication and ensuring connection with other programmes.

5.8 Responsible for agreeing any changes and amendments to the agreed work programme and

accountable for the agreed work programme and deployment of associated resource.

5.9 Identify, resources required, develop appropriate prioritised investment plans and make recommendations of investment proposals which reflect strategic priorities.

5.10 Risk management of the primary care transformation programme through the identification of key

risks and mitigations.

5.11 Responsibility for ensuring integration with wider primary care including work programmes via

the Local Professional Networks. 5.12 Maximise the links and intelligence available through NHS England Primary Care and Direct

Commissioning Teams, at national, regional and local levels. 5.13 Ensure appropriate communication, engagement and consultation with the public, patients,

partners and stakeholders. 5.14 Will ensure compliance with equalities legislation.

5.15 Will invite other work programmes to the Programme Board to enable alignment and support

of the broader ICS Out of Hospital Work stream.

6 Frequency and Conduct of Business

6.1 Meetings will be held monthly. 6.2 The agenda will be developed in discussion with the members of the Programme Board and

its work programme. Circulation of the meeting agenda and papers via email will take place approximately one week before the meeting is scheduled to take place. If members wish to add an item to the agenda, they need to notify the Chair accordingly.

6.3 At the discretion of the Chair a decision may be made on any urgent matter within these

Terms of Reference through the written approval of every member. Such a decision shall be as valid as any taken at a quorate meeting but shall be reported for information to, and shall be recorded in the minutes of, the next meeting.

7 Decision Making and Voting

7.1. The Programme Board will aim to achieve consensus for all decisions of the members.

Where this cannot be achieved decisions will be made based on a simple majority and in the event of an equal vote the Chair will take the final decision.

8 Investment Decisions

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8.1 The Programme Board will oversee budgets and investments relevant to its responsibilities.

This includes those identified in Appendix A to secure key GPFV deliverables in 2020/21, which are subject to confirmation and it is anticipated the agreement of an MoU between the ICS and NHSE/I.

8.2 This may include considering investment proposals relating to primary care and making recommendations as to whether these should be supported. This may include prioritisation where necessary. Where budgets are within the remit of NHS England, decisions will be made within NHS England governance processes, informed by recommendations from the group.

8.3 Where investments relate to CCG budgets, these will be taken within the relevant CCG

governance processes, including the Joint Committee of CCGs. 9 Accountability and Reporting 9.1 The Primary Care Programme Board will report formally to the ICS Board via the Primary

Care Sub Cell and Out of Hospital Cell.

9.2 It is anticipated that members of the Programme Board will ensure that their respective Boards within their organisations or equivalent are regularly briefed on discussions and decisions taken at the Programme Board.

9.3 Update reports will be provided to the ICS Board and the CCG Joint Committee and the

Regional Management Team of NHS England/Improvement North West, for information only, as and when required.

10 Declarations of Interest

10.1 Individuals who are members of the group will comply with the group’s standard of business

conduct policy including the requirements for declaring conflicts of interest.

10.2 In order to facilitate this process “Declarations of Interest” will be a standing item on all agendas and copies of the minutes will be sent to the Corporate Programmes and Governance Manager for the purpose of maintaining the register of interests.

10.3 All new declarations of interest must be notified to the “Chair” within 28 days of a member taking office of any interests requiring registrations, or within 28 days of a change to a member registered interest. Copies of these notifications should be sent to the Corporate Programmes and Governance Manager.

11 Confidentiality 11.1. Members of the Programme Board are expected to protect and maintain as confidential any

privileged or sensitive information divulged during the work of the Programme Board. Where items are deemed to be privileged or particularly sensitive in nature, these should be identified and agreed by the Chair. Such items should not be disclosed until such time as it has been agreed that this information can be released.

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12 Review These terms of reference will be reviewed at least annually at the end of each financial year.

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Appendix A

GPFV FUNDING ALLOCATION

Healthier

Lancashire

and South

Cumbria

19/20 20/21

allocation

ring-fenced allocation

Practice Resilience £246,305 £259,600

GP Retention £390,960 £389,400

Reception and Clerical £295,283 £294,056

Online Consultation £481,712 £467,250

Practice Nursing £129,800

Total £1,414,260 £1,540,106

There are plans to include Practice Nursing in the new funding methodology for 2020/21.

The budgets for 2020/21 may change.

Item 10



Report Title Quality Contract Update

Presenter Michelle Ashton

Prepared By Michelle Ashton




Clinical Commissioning Committee April 2021



Audit Committee








No


No


No



No



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Healthy Fylde Coast Contract – 21/22

Introduction The Primary Care Commissioning Committee agreed to the Healthy Fylde Coast Contract (HCF) being re-introduced in a phased approach in 2020/21 effective from July 2020. Subsequently the contract was suspended again due to the second phase of the COVID Pandemic. Current Position The HCF contract has been drafted for 2021/22 and will be taken to the CCGs Clinical Commissioning Group in April 2021 for sign off on the clinical components of the contract. The draft contract will then be brought to the Primary Commissioning Committee in June 2021 for agreement with a planned implementation date of the 1 July 2021. This is in line with the financial information that the CCGs currently have from NHS England. At this stage the contract will be introduced and the financial KPIs will be applied as in previous years. The contract has been amended to reflect the changes that have been brought about by the pandemic for example, recognising the complexities that patients may have that are suffering from long COVID. The financial values will remain the same as 2020/21 with the only exception to this being any adjustments that are required for list size changes. The KPIs will continue to be paid at 100% for Apr-June 2021. The Integrated Care System is also looking to standardise the Quality Contracts across Lancashire during 2021/22. Recommendation The Primary Care Commissioning Committee is asked to note the current position and the plan for 2021/22. Michelle Ashton Senior Commissioning Manager – Primary Care

Item 12


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Report Title Quarterly Contractual Changes Summary

Presenter Sarah Danson – NHS England and Improvement

Prepared By Steven Harris – NHS England and Improvement


Committee Discussion

Date




Audit Committee



Internal Assurance Process (indicate if not applicable) Clinical Lead

Senior Lead Manager

Finance Manager




Financial Implications



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Quarterly Contractual Changes Summary

Overview Detailed within this report is a summary of any Contractual Changes effective in the previous quarter (January – March 2021) where Contract Variations have been processed to reflect a change to a practice’s existing contract. Partnership Changes Blackpool CCG

• P81115 Bloomfield Medical Centre - Dr Walker retired from the practice with effect from 28 February 2021.

Fylde and Wyre CCG No partnership changes were effective during this quarter. Practice Mergers Blackpool CCG No partnership changes were effective during this quarter. Fylde and Wyre CCG No partnership changes were effective during this quarter. Open and Closed Lists Blackpool CCG No applications to open or close lists were effective during this quarter. Fylde and Wyre CCG No applications to open or close lists were effective during this quarter.

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Boundary Changes Blackpool CCG No boundary changed applications were effective during this quarter. Fylde and Wyre CCG No boundary changed applications were effective during this quarter. Premises (Relocations) Blackpool CCG No premises relocations were effective during this quarter. Fylde and Wyre CCG No premises relocations were effective during this quarter. Recommendation Members of the Primary Care Commissioning Committee in Common are asked to note the content of this report.

Item 15



Report Title Primary Care Commissioning Committee - Risk Register


Prepared By Donna Bamber




Clinical Commissioning Committee To be advised

Quality, Improvement and Engagement Committee Date to be agreed


Audit Committee




Internal Assurance Process (indicate if not applicable) Clinical Lead


Senior Lead Manager

Jeannie Harrop

Finance Manager

John Gaskins


Not required


Not required


Not required

Financial Implications

No


Included in the report



Item 17a

BCCG & FWCCG Commissioning Risk Register

Risk Number & Committee

Risk Description Risk Owner Initial Score

Current Score

Target Score

Direction of Travel (between

previous & current score

Page No.

Fylde Coast Objective 1

• Blackpool -Through better commissioning, improve local health outcomes by addressing poor outcomes and inequalities.

• Fylde & Wyre – Commission high quality, safe and cost-effective services which reduce health inequalities and improve accessto healthcare.

COMM 01 formerly IPCC01 SPAC01

PCCC & CCC

Commissioning Decisions Assurance (Note: Shared risk with SPAC) Beth Goodman 16 12 4

COMM02 formerly IPCC02 PCCC

Safe Prescribing of DOAC Melanie Preston 9 9 6


Risk to Continuity of Care for Patients within Over Wyre boundaries Potential risk of legal challenge to the CCGs decision(s) Reputational risk to FWCCG

CLOSED

Michelle Ashton 20 4 4


Fylde Coast CCGs may not be sufficiently delivering the requirements contained within the SEND code of practice.

Sarah Camplin 15 12 6

COMM20 PCC

Lack of co-ordinated response by GP practices to the challenge of COVID-19 will not deliver a resilient, co-ordinated, and effective primary care for patients across the Fylde Coast.


Item 17a




Current Score

Target Score



Page No.

COMM27 PCCC

The Fylde Coast Clinical Commissioning Groups (FCCCGs) could see practices begin to struggle due to staffing shortages if staff were unable to work due to COVID-19 or need to isolate. Practices may not be able to assess patients and may not be able to operate if staffing shortages persist. RISK CLOSED AND MERGED WITH RISK COMM20


COMM36 PCCC

Risk of a lack of compliance from the homeless cohort

Pete Smith 12 9 9

COMM37 PCCC

Risk of symptomatic discharges from Prison; currently no testing in place for those on a planned release. One case already identified in the South of England

Pete Smith 9 6 6

COMM38 PCCC

Risk of failing to deliver response or risk of un-coordinated response to the homeless COVID response requirement

Pete Smith 16 6 4

COMM40 PCCC

Cases presenting for children’s continuing care continue to be assessed and approved, but due to COVID 19 families have either chosen not to commence the package or where a package is in place, are declining input due to concerns about contracting the virus. There is a risk that families may reach crisis point leading to breakdown of care delivery and potential for a hospital admission

Karen Gallagher 9 9

Fylde Coast Objective 2

• Blackpool -To work collaboratively to deliver safe, high quality health and care services.

• Fylde & Wyre – Develop excellent working partnerships which lead to improved health outcomes.

Item 17a




Current Score

Target Score



Page No.


Mental health pathways Lesley Tiffin 20 16 8

COMM06 formerly IPCC 05 PCC

Failure to redesign and commission Community diabetes services delivered in Fylde and Wyre that meet the needs of the population

Jeanne Hayhurst 16 9 6


There is a growing deficit in the clinical and medical workforce



Management of Opioid medications

Melanie Preston 9 9 6

COMM09 formerly IPCC09

New Risk Jul 19 PCCC

LD Psychiatry RISK CLOSED

Tracy Callahan Hayes 12 8 6

COMM31 QI&EC

Information for patients, the public and stakeholders is inconsistent and/or unclear resulting in a loss of impact for issuing advice and guidance.

Amanda Bate 16 8 4

COMM44 PCCC

Increased stock holding of controlled drugs in the community following recommendations on access to medicines for COVID-19. Such interim changes in guidance/legislation relating to availability, may lead to inappropriate use for patients outside of current regulation and misappropriation

Melanie Preston 9

Item 17a




Current Score

Target Score



Page No.

Fylde Coast Objective 3 – To ensure financial balance and improve efficiency and productivity

Fylde Coast Objective 4 – To deliver a step change in the NHS preventing ill health and supporting people to live healthier lives

COMM32 PCCC

Communications capacity and capability in primary care is inadequate leading to inconsistent patient messaging, lack of confidence and reputational damage and low patient compliance for appropriate use of services.

Amanda Bate 16 8 4

Fylde Coast Objective 5 – To maintain and improve performance against core standards and statutory requirements

COMM30 F&PC

There is a risk that decisions will be made during the period of the COVID-19 emergency that may not be in line with the requirements of the Fylde Coast Clinical Commissioning Groups’ (FCCCGs) constitutions and previously agreed internal processes.

Howard Naylor 8 8 6

Fylde Coast Objective 6 - To commission improved and effective out of hospital care

Item 17a




Current Score

Target Score



Page No.


New Models of Care. Jeannie Harrop 12 12 8

COMM26 PCCC

Primary care may not be able to segregate patients with potential COVID-19 that need to be seen face to face from patients that are non-COVID-19 symptomatic.

Michelle Ashton/ Phil Hargreaves

16 8 8

Fylde Coast Objective 7 - To support research, innovation, and growth

Fylde Coast Objective 8 – Develop & maintain an effective organisation

COMM33 QI&EC

Governing Body and its committees have ultimate responsibility for making decisions affecting the Fylde Coast Clinical Commissioning Group (FCCG) and services across the Fylde Coast. To ensure decisions are made by informed individuals, particularly in a time when information is changing constantly, mechanisms must be in place to keep the Governing Body up to date

Amanda Bate 16 4 4

COMM34 QI&EC

Staff working remotely may not have immediate access to information and may feel disconnected or isolated resulting in processes not being followed and operational disparity, as well as potential for poor health and wellbeing.

Amanda Bate 16 4 4

Item 17a




Current Score

Target Score



Page No.

Additional risk that lack of clarity of information could result in inaccurate information being shared outside of the organisation

Fylde Coast Objective 9 – Effectively engage patients & the public in decision making

COMM35 QI&EC

The CCG does not meet its legal duty to involve due to a lack of appropriate consultation with stakeholders, providers patients and public on service changes in response to COVID-19 .

Amanda Bate 16 12 4

Risk Matrix

Item 17a


CORPORATE OBJECTIVE 1

Through better commissioning, improve local

health outcomes by addressing poor outcomes

and inequalities.

Item 17a


Corporate Objective Corporate Objective 1: Through better commissioning, improve local health outcomes by addressing poor outcomes and inequalities

Risk COMM02 (IPCC02)

Inappropriate prescribing, dosing, and lack of sufficient monitoring for patients who are prescribed Direct Oral anti-coagulant (DOAC) medications in Primary Care. (Note: This will also be suggested as an ICS risk).

Initial Previous Current Target Risk Owner Melanie Preston

Executive Lead David Bonson

Likelihood Possible Possible Possible Unlikely Financial / VFM ✓

Severity Moderate Moderate Moderate Moderate Compliance / Regulatory ✓

Level 9 9 9 6 Innovation / Quality / Outcomes ✓

Date May 19 Sept 2020 Dec 2020

Mar 20 Reputation ✓

Controls Assurance FWCCG Practices have been given individual feedback on Audit findings in Practice meeting (towards the end of 2018-19). Audit only undertaken in FWCCG, but findings are likely to be pertinent to all Fylde Coast Practices. Audit only represented 20% of patients in F&W area (440 patients). The Medicines Optimisation Team are currently auditing the remaining 1200 patients) Lancashire and South Cumbria - Task and Finish group established outputs will come via the Lancashire Medicines Management Group (LMMG). (The BVH lead pharmacist for cardiology sits on this T&F group to take the risks to the acute trust also) The EMIS template has been changed to ensure actual weight is used in calculations (not ideal weight). Updated guidance from Lancs and South Cumbria

Clinical Commissioning Committee Fylde Coast Prescribing Group Commissioning Delivery Oversight Group Lancashire and South Cumbria Medicines Management Group recommencing July 2020

Gaps in Controls Gaps in Assurance Problems with insufficient data on discharge and co-ordination across the interface. Education to prescribers. Less than effective monitoring patients on DOACs

None identified Some meetings have been suspended temporarily due to COVID 19

Item 17a


ACTION PLAN

Action Assigned to

Due Action Description Progress to Date Date Completed

Melanie Preston 30/9/19 Await then adopt any products / recommendations from the LMMG T&F group

RB sits on the T&F group. On further actions at present (18/07/2019). Dec19: Updated guidance agreed at LMMG requires ratification at JCCG (Jan 20) April 2020 – Elementary advised guidance does not go to JCCG – website all up to date

Completed

Melanie Preston 31/3/21 Engagement with consultants, who prefer to use DOACs due to perceived lack of monitoring requirements, around appropriate usage of anti-coagulants

Dec 19: Audit results presented to Cardiology Team in Sep 19with recommendation to utilise ADAS Service – however this has received a negative response. MP to update CCC and identify next steps – this will be presented in March 2020 April 2020 – Due to COVID 19 the output has not yet been presented to CCC – this will be picked up post COVID 19 May 2020 – as above Sept – See below – action linked

Melanie Preston 31.03.2021 Work with primary care to improve patient safety (Consider presentation to BCCG GPs)

Audit results presented to FWCCG CoMs on 11/6/19 Recommendation from CoMs to present the same to the clinical senate and for BPCCG pharmacists to undertake the same audit – Dec 19: Audit to be progressed in Blackpool via GP enhanced contract April 2020 April 2020 – Due to COVID 19 the final contract has not yet been finalised -this will be picked up post COVID 19 – Audit on patient safety to be carried out by BCCG 01/04/2020 Action planning meeting with CSU team to move Fylde Coast DOAC process forward with ADAS. To pick up post COVID May 2020 –We are now progressing arrangement of the meeting Sept 20 clarifying ICS role and subsequent ICP impact December – this is now paused due to the vaccination programme

Melanie Preston ongoing Usage of Eclipse to identify patients at risk – patient weight needs adding into search criteria

Eclipse is now being used across the Fylde Coast (June 19)

Completed June 9

Item 17a


Jeannie Hayhurst, Melanie Preston,

ongoing The Anticoagulation Dosing and Advisory Service (ADAS) is aware of the issues and concerns and are looking to pilot a Monitoring, Dosing and Usage service for GP practices

Ongoing discussion (Jul19) Dec 19: discussion remains ongoing with BTH to agree process Jan 2020 – progress further discussions with BTH April 2020 – confusion around progress with this action – being looked into May 2020 – as above Sept 20- proposal to CCC 15.9.20. CCC agreed to progress pilot upon clarification of a few points. On-going (MP to pick up with ADAS) December 2020 – PCNs to identify one practice to participate in the pilot for commencement in January 2021 (CCG comms to go out this month)

M Preston

July 19 Fylde Coast Practices are encouraged to allow their practice pharmacist to attend PINCER (Pharmacist-led IT-based intervention to reduce rates of clinically important errors in medicines management in general practices) programme

Training opportunity and encouragement circulated to Practices w/c 24/6/19 - Trg (3 x sessions over 12 weeks) to start July 19. List of all eligible pharmacists/technicians for training sent to Gemma Byrne on 10/07/2019.

Completed July 19

R Chand 31.03.2021 BCCG practices to undertake the same DOAC audit. This was not specifically in the BCCG 19/20 GP+ contract but we have asked for this to be considered for the 20/21 GP+ contract. Currently the final version of the contract has not been agreed due to the sudden COVID19 activity taking priority. We hope to have an update on whether this is in the contract post Covid19.

May 2020 – ongoing – potentially being picked up in July Sept 20 safe prescribing of DOACs is included within the GPEC & practices will be asked to review their prescribing. Dec 2020 – most elements of the GPEC are paused including this audit – however the ECLIPSE radar alerts will still be actioned to pick up areas of risk relating to DOAC.

Item 17a


Corporate Objective Corporate Objective 1: Through better commissioning, improve local health outcomes by addressing poor outcomes and inequalities


Closure of a GP Practice Risk to Continuity of Care for Patients within Over Wyre boundaries. Potential risk of legal challenge to the CCGs decision(s). Reputational risk to FWCCG

Initial Previous Current Target Risk Owner Michelle Ashton


Likelihood Certain Rare Rare Rare Financial / VFM ✓

Severity Major Major Major Major Compliance / Regulatory ✓


Date May 19 JAN 20 April2020 tbc Reputation ✓

Controls Assurance Any Correspondence / Challenge to be answered in the light of legal advice Cut off period for challenge 26/9/19

Primary Care Commissioning Committee New Partnership making positive efforts to buy out former partners – ongoing Risk of any procurement challenge has been assessed and is LOW based on expert legal advice

Gaps in Controls Gaps in Assurance 2 previous partners still part-own the Practice Premises

2 previous partners still part-own the Practice Premises

ACTION PLAN

Action Assigned to


Michelle Ashton On-going Monthly Senior CCG Manager support meetings with OWMC

NO Longer required – ad hoc meeting to be convened if required

July 19

Michelle Ashton On-going CCG continue to manage pertinent correspondence / requests

On- going as at Sep 19

11 Nov 10

Item 17a


NOV 19: No Pertinent correspondence received – Legal advice suggest Low risk of this happening therefore action closed pending any need to review

Michelle Ashton Continuous CCG monitor any Patient complaint activity On-going as at Nov 19

Michelle Ashton Continuous CCG monitor any Patient complaint activity Continuing to liaise with new partnership to understand the premises issue

On-going as at Jan 20

Michelle Ashton Risk closed – the original decision was made in March 2019 – the six month period for potential litigation ended September 2019 as we are now six month further in we believes now is the right time to close this risk - any risk is now sits with practice partnership around premises

RISK CLOSED

Item 17a


Corporate Objective Corporate Objective 1: Blackpool -Through better commissioning, improve local health outcomes by addressing poor outcomes and inequalities. Fylde & Wyre – Commission high quality, safe and cost-effective services which reduce health inequalities and improve access to healthcare


Fylde Coast CCGs may not be sufficiently delivering the requirements contained within the SEND code of practice.

Background

There are core elements the CCGs need to develop in order to enact its responsibilities to meet the Special Educational Needs and Disability (SEND) Reforms agenda / Code of Practice. The Children’s and Families Act 2014 introduced the requirement for joint working between organisations that work with and support CYP with Special Educational needs – the SEND Code of Practice provides statutory guidance for Education, social, care, health and other services in how to meet this requirement and improve outcomes for children with SEND The Joint OFSTED & CQC SEND Inspection (Nov 2017) in Lancashire identified key areas of non-compliance in delivery of Reforms. A revisit (March 2019) recognised the improvements made and particularly that in seven of the twelve areas progress has been sufficient to mean that monitoring of these areas is no longer required. For those areas where further improvement is required, the inspectors also recognised the good work that has taken place. An ‘Accelerated Progress Plan’ has been devised to address the remaining issues, and this will be monitored by the DfE SEND Intervention Unit and NHSE/I, to address the five areas which continue to require improvement. Monitoring of this plan will commences on 18th November 2020. (Note BCCG will be inspected imminently)

Initial Previous Current Target Risk Owner S Camplin

Executive Lead D Bonson

Likelihood 5 4 4 2 Financial / VFM Severity 3 3 3 3 Compliance / Regulatory

Level 15 12 12 6 Innovation / Quality / Outcomes Date 16 Aug 19 May 2020 Nov

2020 Mar 2022 Reputation

Controls Assurance .

• Lancashire SEND Accelerated Progress Plan

• Established processes are in place for “Preparing for Adulthood” (Transition) at Strategic, Service and Local levels

• SEND Co-Ordinator funded by CCGs (CSU Employed)

• Designated Clinical Officers (DCO) Funded across ICS to support Health

• SEND Joint Commissioning Strategy in Place for Lancashire

• SEND Joint Commissioning Strategy now in place for Blackpool

• Revised Governance structure for Blackpool SEND from Jan 2020

• Defined KPIs / performance dashboard in place monitored monthly

• Fylde Coast SEND Offer Group

• Area Partnership Boards engages with parents / carers

• Audits of Education health and Care Plans (Lancashire only)

• Results of Lancashire SEND Revisit

Item 17a


• COVID 19 has impacted on the progress of this agenda, however, SEND governance structures are now in place as virtual forums.

• All services related to SEND are now back in place after the initial COVID response, with appropriate alternative appointment arrangements such as video or telephone contacts. There is of course some back log of referrals and waiting lists to be worked through

• Blackpool self-evaluation framework (SEF) took place on 20.11.2020 – this will lead to a revised SEF which will identify our gaps and priorities for progress

Gaps in Controls Gaps in Assurance

• Capacity issues identified in the Fylde Coast Neuro Development Pathway and case made for investment to be considered against Fylde Coast investment priorities 2019/20. However due to COVID 19 progress was unable to be made. The case is being refreshed and update in readiness for the new financial year 2021/22.

• A non-recurrently funded waiting list initiative for the Fylde Coast ND pathway has made good progress during 20 with COVID work arounds.

• There is no joint funding with Blackpool Council for SaLT and OT

• Joint Packages for Children and Personal Health Budgets significantly under developed in Lancashire, a proposal is being considered at an ICS level to address this

• Real time monitoring for KPIs

• Demand (on DCO) is greater than expected (responsible to 2 x LAs)

• ‘System’ understanding of improved outcomes (being addressed by the SEF workshop )

• Blackpool currently developing processes for EHCP Audits

ACTION PLAN

Action Assigned to


Head of Children’s Community Services

30 Sept 19 6/12 retrospective review of local Neuro development pathway compliance with ICS and NICE – this will inform an Action Plan

Nov 19 Review Completed (Oct 19) – a number of gaps were identified and a Multi- Agency IMPROVEMENT PLAN to address these is currently being finalised

3/12/19

Head of Children’s Community Services

31 March 2021

Delivery of Multi- Agency IMPROVEMENT PLAN for Neuro development pathway Plan will prioritise needs of those waiting outside of NICE timeframes for diagnosis (to be addressed by 31 Jan 20)

Nov 19: Early stages and will be on-going Jan 2020: Multi agency improvement plan ND pathway received. Paper describing capacity shortfall in ND pathway received at CCC 21.01.2020. May 2020 – commenced delivery of action plan, however the current COVID situation may delay the time frame

Item 17a


NOV 2020 – case for investment was presented to joint CCGS in Oct 2020 and a reduced investment amount was agreed

Send Co-Ordinator 13 August 19

Workshop to be held to consider how we can improve Joint POC / PHB arrangements for children

Identified gaps in current process 13.8.19

Julia Westaway tbc Programme of work planned to look at IPA processes for children including PHBs

Nov 19: Monthly meetings in place – New Children’s Commissioner has recently been appointed for Fylde Coast CCG Jan 2020 Monthly meetings ongoing – FCCCG children’s commissioner now attending May 2020 - a proposal is being considered at an ICS level to address this NOV 2020 – SC to email me with the update

Sarah Camplin 30 Sept Continue to complete Self-evaluation framework in preparation for Blackpool SEND Inspection

Nov 19: Additional areas have been identified including: CAMHS 0-19 developments PHB and CHC for Children Gaps in Children’s Equipment pathway Final document to be signed off by the SEND Board in Jan 2020 Jan 2020 As above – SEND board meets 23.01.2020 May 2020 – Self-evaluation complete and will be presented through CCG governance process in June NOV 2020 – CCG GB approved in June however joint SEF workshop took place in November to assure it was fit for purpose

Complete

S Camplin / LAH 31 Jan 20 Review Joint Commissioning arrangements for Blackpool Nov 19: Updating Joint Comm Strategy Jan 2020 New joint commissioning strategy in 1st draft May 2020 – new joint commissioning strategy complete and will be presented through CCG Governance process in June Nov 2020 – agreed by GB in June 2020 – SC to email LAH for further update

LAH Continuous Ensure that a Continuing Care Checklist is carried out for each individual for whom an EHC plan is initiated to

AUG 19 - Identified gap in current process. Meeting with Phil Thompson BCC to be arranged to define proposed process.

Item 17a


determine whether full Continuing Care Assessment is required.

NOV 19 May 2020 – Sarah Camplin to chase update Nov 2020 – SC to chase LAH for update

Item 17a


Corporate Objective

Corporate Objective 1: Blackpool -Through better commissioning, improve local health outcomes by addressing poor outcomes and inequalities. Fylde & Wyre – Commission high quality, safe and cost-effective services which reduce health inequalities and improve access to healthcare.

Risk COMM20 aligned to PCCC

Lack of co-ordinated response by GP practices to the challenge of COVID-19 will not deliver a resilient, co-ordinated, and effective primary care for patients across the Fylde Coast. Background

Challenges of pandemic will impact all practices. Sustained provision of Primary Care services in the Fylde Coast may necessitate sharing of resources and safe introduction of alternative working practices/interpretation of national direction (e.g. virtual consultation, identification, and management of shielded patients) require consistent support and co-ordination .


Executive Lead Dr Ben Butler-Reeves/Dr Neil Hartley Smith

Likelihood 3 2 2 2 Financial / VFM Y Severity 3 3 3 3 Compliance / Regulatory Y

Level 9 6 6 6 Innovation / Quality / Outcomes Y Date 03.03.2020 02.06.2020 Sept

2020 March 21 Reputation Y

Controls (What you have put in place to mitigate the risk) Assurance (What tells you that the control is in place / working) CCG led Command and Control established to support Practices in the forms of:-

• Three x weekly PM telecon (to deliver info, centralise and answer questions from Practices) – call primarily addresses Business and logistics

• Weekly GP Call – re-enforce PM messaging and facilitate clinical discussion to promote uniform response to clinical management – promote Standard operating procedure for G/Practices

• Regular liaison between CCG Clinical Directors and the Chair of ‘Network of Networks’

• Production of daily Covid-19 Specific Practice Bulletin

• Primary Care Commissioners maintain list of all changes to commissioned activity in primary care

• System in place for staff and family testing

• Notes of PM telecon

• Copies of Daily Comms bulleting

• Positive feedback re: CCG support for P/Care from: o LMC o CQC o Individual PM Feedback

• Incident chronology

• “Test and Adjust” exercise in progress

Gaps in Controls (What still needs to be put in place if possible – if not possible might generate an action)

Gaps in Assurance (What else might be required to inform you that the controls are working or what further can you do to get assurance)

Item 17a


• Challenge when independent activity (by practices, GPs, PCNs and /or commissioners) is not shared with ICC / Primary Care Commissioners

ACTION PLAN

Action Assigned to


ICC / PC Commissioners

Continuous in incident response

PM telecon Well established Positive Feedback Provides shared intelligence

Clinical Directors Continuous in incident response

Established Weekly telecon Well attended

Clinical Directors Continuous in incident response

Providing Clinical Leaderships including ensuring compliance with SOP / Guidance on managing Procedures / EOL Care etc Work with commissioners and Community services

All well understood, seeking further information as required. Clin Dir involvement in national Networks and feeding back to colleagues

ICC Continuous in incident response

Establishing a mechanism for Staff testing in Primary care

System in place – PC workers and families able to access testing

complete

PC Commissioners P Tinson

Continuous in incident response

Working with ICS out of hospital cell to manage primary care issues

Well established

PC Commissioners Clinical Directors

Plan for and enact recovery phase

Work with and support Practices to identify good practice and New practice (e.g. enhanced digital) to establish a phased return to normal and embed new Normals for the future

Still in planning stage – awaiting national guidance

ICC Establishing a mechanism with primary care for antibody testing

Due for completion 05/06/2020

Item 17a


Corporate Objective Corporate objective 1 Blackpool -Through better commissioning, improve local health outcomes by addressing poor outcomes and inequalities.

Fylde & Wyre – Commission high quality, safe and cost-effective services which reduce health inequalities and improve access to healthcare.


The Fylde Coast Clinical Commissioning Groups (FCCCGs) could see practices begin to struggle due to staffing shortages if staff were unable to work due to COVID-19 or need to isolate. Practices may not be able to assess patients and may not be able to operate if staffing shortages persist.

Background In line with national guidance, Primary Care has a number of clinicians and admin staff that are unable to work due to illness, having to isolate as a family member is symptomatic or have been instructed to shield as they fall into the vulnerable category.

The FCCCGs have undertaken daily calls to keep a track of the practices situation and fed back to the Incident room.


Executive Lead

David Bonson

Likelihood Almost Certain

Possible Possible Possible Financial / VFM

Severity Major Major Major Major Compliance / Regulatory

Level 20 12 12 12 Innovation / Quality / Outcomes

Date March 2020 June 2020 September 2020 March 2021 Reputation

Controls (What you have put in place to mitigate the risk) Assurance (What tells you that the control is in place / working)

• Calls with practices 3x weekly to get timely information

• Daily sitreps which detail staffing levels and the ability to flag if they feel the practice is vulnerable using a rag rating

• Supply IT to staff that need to isolate or shield that are well enough to work. VPNs were re-configured and additional number bought to support working from home

• The CCGs have created a database of staff that could be re-deployed to support Primary care if the situation is critical

• All practices dial in at least 3 times a

week to the practice manager call • Practices submit the sitrep by 9.30am

every day. Allows situational awareness for CCG

• Connection to system has greatly improved with additional VPNs

Item 17a


• Well established system in place now for primary care staff to be tested for COVID • System for Primary Care to request resource from CCGs is in place but has not been required yet

Gaps in Controls (What still needs to be put in place if possible – if not possible might generate an action) Gaps in Assurance (What else might be required to inform you that the controls are working or what further can you do to get assurance – might generate an action)

• System is currently working but a second wave of infections could prove difficult to maintain staffing levels

• PCNs are being asked to think about how they could work together to support each other if staffing is duly affected

• Unable to predicate if a second wave will have a larger impact on staffing levels

ACTION PLAN

Action Assigned to Due Action Description Progress to Date

Date Completed

Primary Care March 3x weekly calls set up

Completed and ongoing as at 28th April

March

Primary Care April Set up daily sitreps that record staff levels and PPE level

Completed and ongoing as at 28th April

April

IT March Purchase more VPN capacity to support Primary Care working at home

Completed

March

orporate team

April Database of CCG staff created that could be deployed to support Primary care

Database completed- No requests have been received from PC as at 28th April

Ongoing

Item 17a


RISK CLOSED – MERGED WITH COMM 20

Item 17a


Corporate Objective Corporate Objective 1: Blackpool -Through better commissioning, improve local health outcomes by addressing poor outcomes and inequalities. Fylde & Wyre – Commission high quality, safe and cost-effective services which reduce health inequalities and improve access to healthcare.

Risk COMM36 PCCC

Risk of a lack of compliance from the homeless cohort Background

Challenges of pandemic for this particular high-risk group, given health risks and lifestyle and potential risk to wider health and care system. Need to deliver nationally mandated response. Guidance issued at the end of March 2020. Multi agency response required incorporating, LA Housing, Public Health, community health response, primary care, drug and alcohol support services, Mental Health provision, voluntary sector, and others

Initial Previous Current Target Risk Owner Pete Smith


Likelihood

4

4

3

3

Financial / VFM

Severity

3

3

3

3

Compliance / Regulatory

Level 12

12

9

9

Innovation / Quality / Outcomes

Date 04.05.20 04.05.20 04.05.20 Reputation


• Provision of an enclosed outdoor area at Fylde Coast COVID Care site to allow safe outside space for cohort to use.

• Northern Security commissioned, through the Blackpool Borough Council contract, to help support and manage patients admitted to COVID Care.

• Daily MDT calls

• Response Cell calls/action log

Item 17a


• Advice sought from the Lived Experience Team

• Advice sought from Blackpool Borough Council Legal Team to understand the best form of legislation that can be applied to help manage compliance

• Police representation on daily response cell calls; LA patient status lists provided to police daily


Gaps in Assurance (What else might be required to inform you that the controls are working or what further can you do to get assurance – might generate an action)

ACTION PLAN

Action Assigned to


Item 17a



Risk COMM37 PCCC

Risk of symptomatic discharges from Prison; currently no testing in place for those on a planned release. One case already identified in the South of England Background




Likelihood 3

2

2

2

Financial / VFM

Severity 3

3 3

3


Level 9

6 6

6


Date 04.05.20 04.05.2020 Sept 2020

March 2021 Reputation


• Probation Service representation on daily response cell calls

• Acton log in place; updated daily

• Probation Service working 3 weeks in advance of planned release dates to ensure timely information is provided to local authorities; case flagged in daily patient status lists to instigate discussion at daily MDT

• Potential risk flagged with the Fylde Coast HHRC and Incident Control Centre

• For wider discussion on the HHRC call (Arif Rajpura) 05.05.20

• Ongoing dialogue outside of calls with Probation Service colleagues

• Daily MDT calls


Item 17a




No systematic testing in place for those on a planned release.

ACTION PLAN

Action Assigned to


Item 17a



Risk COMM38 PCCC

Risk of failing to deliver response or risk of un-coordinated response to the homeless COVID response requirement Background




Likelihood 4

2

2

2

Financial / VFM

Severity 4

3 3

2


Level 16

6 6

4


Date 04.05.20 04.05.2020 Sept 2020

March 2021 Reputation


• Deployed Commissioning Manager to develop and lead Fylde Coast COVID-19 Homeless Health Response Cell (HHRC)

• Deployed Commissioning Support Officer to support the project and ensure continuity of approach

• Daily cell calls/action log instigated to coordinate approach and direct action

• COVID additionality paperwork completed and submitted to inform of commission actions and activity and cost implications

• Daily MDT calls


Item 17a


• Cell lead acts as a single point of contact for the Fylde Coast HHRC and links to the wider ICS forum

• Daily MDT calls set up for service providers to manage daily work tasking and issues and to address patient need

• Detailed provider protocols worked up to manage operational aspects

• Daily local authority patient status lists issued to all providers/support services



Not yet had a symptomatic patient to test the model in place. We are assured that in theory the model is robust but until tested cannot be certain.

ACTION PLAN

Action Assigned to


Item 17a


Blackpool CCG Corporate Objective Fylde & Wyre CCG Corporate Objective

Commission high quality, safe and cost-effective services which reduce health inequalities and improve access to healthcare.

Risk

Cases presenting for children’s continuing care continue to be assessed and approved, but due to COVID 19 families have either chosen not to commence the package or where a package is in place, are declining input due to concerns about contracting the virus. There is a risk that families may reach crisis point leading to breakdown of care delivery and potential for a hospital admission

Initial Previous Current Target Risk Owner Karen Gallagher


Likelihood Possible (3) Possible (3) Financial / VFM

Severity Moderate (3) Moderate (3) Compliance / Regulatory

Level 9 9 Innovation / Quality / Outcomes

Date 8/6/20 13/12/20 Reputation

Controls Assurance

• Any case that has been assessed are in contact with the Children’s community nursing service who are in regular contact with the families and will escalate in circumstances change.

• There may be other services involved in the cases such as social care and education who are also monitoring the home situation and would be able to respond to a change in circumstances

• The CCG has regular multi-agency meetings for Blackpool cases led by the Lead nurse for continuing healthcare where all children’s cases are reviewed. Contingency plans are also being put in place for each case should a problem arise with care delivery.

• It is clearly documented in records that family have paused commencement or delivery of the care package because of potential risk of COVID19

• Where packages are in established but parents are declining input, this will be jointly monitored by the CCG and children’s community nursing team and discussed at the multi-agency meetings.

• Escalation process agreed with CSU and children’s community nursing team for Fylde and Wyre cases

Blackpool cases:

• All cases RAG rated and reviewed regularly at MDT

meeting

• MDT meeting action plan

• MDT meeting notes

Fylde and Wyre Cases

• All cases regularly reviewed and monitored by CSU

caseload holders and will escalate to CCG as required


ACTION PLAN

Action Assigned to Due Action Description Progress to Date Date Completed

Karen Gallagher 30th June 2020

To develop escalation process to the CCG with CSU should there be a change in circumstances for any case where care has been approved but is not being delivered because of COVID 19

CSU contacted awaiting response 15/6/20

Item 17a


Karen Gallagher 30th June 2020

Explore with CSU what assurance is currently in place that cases are regularly reviewed and what actions will be taken should there be a change in family circumstances

CSU contacted awaiting response 15/6/20

Item 17a



To work collaboratively to deliver safe, high

quality health and care services.

Item 17a


Corporate Objective 2 To work collaboratively to deliver safe, high quality health and care services


• Current ‘all age’ Mental Health pathways across acute and community settings are not managing demand effectively resulting in unacceptable levels of Out of Area placement (approx. 50 OOA placements as at Feb 2020) that is impacting negatively on patient experience and levels of safety and CCG Financial Control total

• Mental health workforce challenges in Crisis Home Treatment / Community MH / MH Liaison Teams results in an inability to provide community capacity as an alternative to in-patient care.

Initial Previous Current Target Risk Owner Lesley Tiffen

Executive Lead David Bonson Likelihood Likely Likely Likely Unlikely Financial / VFM ✓



Date NOV 2018 June 2020 Sept 2020 Mar 2020 Reputation ✓

Controls Assurance • A range of deflection schemes to enable patients to be safely treated outside of a psychiatric

hospital setting, including crisis beds, Acute therapy service, assessment beds.

• The Core 24 Service for the Fylde Coast in order to enable an increase in capacity for MH assessments in A&E

• A daily Status Report (SITREP) is produced by LSCFT to maintain a current and accurate picture of Community and In-Patient resources (including bed availability)

• The LSCFT Bed Hub capacity and flow team provides time sensitive system oversight and identifies patient placements. This has been further developed through the resourcing of an enhanced bed management team

• Focussed Mental Health Investment (Crisis and Community Teams)

• ICS level MH Improvement Board ongoing (post NTW Recommendations) to oversee delivery of the MH Improvement Plan. Paused during COVID replaced with cell arrangements to oversee mental health pathways and demand

• “Super Stranded” pathway in place with weekly flow meetings including flow manager, Integrated Discharge Team, complex cases team and Mental Health commissioner to support active discharge.

• Crisis/home treatment team are now gatekeeping all admission requests in order to enable alternatives to be offered

• Monthly reporting into the Fylde Coast A&E Delivery Board, Lancashire and SC ICS MH steering Group and Operational Resilience Group and the Fylde Coast IPCC Community MH Pathway Review workstream.

• Daily system wide LCFT Telecons

• NHSE / I intervention where required.

• MH Improvement plan in place and Monthly MH System Performance report

• Operational Resilience Group (ICS Level) although stood down due to COVID monitors performance around bed usage and the underpinning community & Crisis Pathways remotely via the sharing of reports

• Adult Mental Health cell as part of command and control cell arrangements reviews OAP numbers and provision.

• Performance framework included within Mental Health Improvement Board monthly meetings.

Item 17a


• Home treatment team and liaison team are now fully staffed to commissioned model to enable robust community alternative where appropriate

Gaps in Controls Gaps in Assurance • Fluctuating demands on MH acute beds

• Increase in number of patients presenting as acutely unwell as a first-time presentation during Covid.

• Patients with complex Mental health / LD/Autism being admitted to MH beds and becoming “Super Stranded” as insufficient move on capacity available.

• Difficulties in recruiting to key positions e.g. psychiatrists and psychology- this is likely to become more of an issue as we grow teams in line with long term plan requirements

• Risk of serious incidents where patients are waiting to be admitted.

• Crisis House provision not yet in place on Fylde Coast • Investment required for mental health pathways including long term plan asks not sufficient to

address all elements required. • In-patient commissioned capacity reduced due to COVID requirement to convert dormitory

provision into single usage rooms

• Lancs / S Cumbria considered one of the worst performing ICS Nationally in relation to MH 12 Hour Breaches and OAPS (out of area placements)

• The Contract processes – we currently do not have a formal contract due to COVID so assurance is reliant on cell arrangements

• During COVID performance has only been provided at an ICS level which makes it difficult to understand Fylde Coast unique pressures

ACTION PLAN

Action Assigned to Due Action Description Progress to Date Date Completed Lesley Tiffen MH Commissioning Team

Continuous To monitor the situation on a daily basis and at all relevant forums re MH/LD and report into the meetings/ Committees/ Executive Team.

Ongoing monitoring and liaison in place Nov 19: Daily Monitoring continues June 2020: Current OAPS position is15 across the ICS at 8th June. Sept 2020: Current OAPS position is 45 across the ICS at 1st Oct. This rise is due both to demand but also a reduction in bed stock

ICS Ongoing Action plan to be agreed by LCFT & CCGs to recover position. Target is to reduce OAPS to zero by March 2021

LCFT have developed an Action Plan that was presented to the ICS Board on the 3rd July and Mental Health Commissioners on the 10th July 2018 The CCGs have agreed a range of schemes and funding to improve the home treatment service and crisis response. Delivery of the action plan is being monitored by a joint meeting between CFOs and Mental Health Commissioning Leads on a monthly basis.

Ongoing

Item 17a


A copy of the presentation to the ICS Board

is attached.

ICS Board Mental Health Update

Paul Hopley, Deputy Director – Mental Health

06 Aug 19 – MH Improvement plan developed and further refined to include specific actions to address closure of MH Decisions Units Nov 19: Feb 2020: MH Imp BD continue to monitor implementation of the plan on a monthly basis. OAPs are reducing. April 2020: Weekly system flow meetings are in place to focus on super stranded patients and expedite onward plans where appropriate. Additional Rehab beds have been purchased utilising OAPS monies, which is contributing to a reduction in OAPS (currently 27). Work to repatriate OAPs continues which is expected to reduce numbers further. Work on EUPD pathway has been paused due to Covid 19 which will impact negatively on OAPS. September 2020 – Rehab pathway continues to be utilised and additional capacity is progressing via contract with Newton House Capital monies agreed for dormitory conversion, progress to be monitored to ensure bed capacity increases to normal levels as soon as possible. National funding for OAPS as a result of the above has also been requested and LSCFT have developed contracts with OAP providers to ensure adequate provision which is as close to home as possible. Performance reporting at ICP level has now recommenced.

Item 17a


CCB Nov 2018 A full external capacity review of Mental Health services across all pathways will be carried out in November 2018

Report Received May 2019 Complete (See action below *)

Lesley Tiffen March 2020 Increased investment in Home Treatment Teams to boost community provision as an alternative to In-Patient care

Fylde Coast Home treatment Team has been enhanced – but requires further growth following Clinical Model Presentations NOV 19: Investment for htt TO BE INCLUDED WITHIN Financial planning for 2020/21 Feb 2020: HTT investment has been increased in 19/20 plan however recruitment is challenging and this is challenging service development objectives – recruitment continues. Fin Plan for 20/21 needs to consider deliverability around workforce. June 2020: Recruitment into HTT successful with LSCFT reporting teams to be nearly fully staffed as per extended model.

Completed Aug 2020

Lesley Tiffen Complete by March 2020

Fylde Coast Pathway Group established to review and redesign pathways (Co-Production)

First meeting April 2019 NOV 19 – Co-Production strategy in place – Crisis Café development has been informed by this co-production – Closed as an Action

03 Dec 19

Lesley Tiffen Continuous Developing improved Crisis Pathways (Co-Production) (IPCC MH Group)

First meeting April 2019 Nov 19: Multi Agency Group (MAG) to review frequent attenders / crisis plans (meets monthly Crisis Café (as alternative to A&E) Dec 19 Frequent Attenders Team (not before Jan 2020) Crisis HTT visiting people out of area to look at re-patriating ‘Crisis House’ – step-up step-down model under consideration (Jan 2020) FEB 2020: Crisis House model planned to be operational by August 2020 Crisis café opened Jan 2020 – referrals are initially low but increasing as wider referral pathways are put in place e.g. Police and NWAS

Item 17a


June 2020: Crisis house development delayed due to Covid and queries from Blackpool Council on the planning application. This is now resolved but new timeline for implementation is October 2020 September 2020 – Frequent attender team now in place providing targeted support and utilising the SIM model for higher intensity users in addition to the monthly Multi agency group (MAG) Crisis Café fully operational and Police and NWAS pathways have been reviewed to increase usage. Crisis House development delayed due to Renovation works required. Now due to open Jan 2021.

Lesley Tiffen Complete by March 2020

Introduction of ‘Peer Support Workers’ in CMHT to augment ability to prevent escalation of known Service Users into A&E

Workers in place as at April 19 (To be reviewed as part of IPCC pathway for Community Mental Health – aimed at defining a changed model for MH provision) Nov 19: Continued Funding – looking at ways to complement rather than duplicate other pathways Feb 2020: PSWs are working within CMHTs – PSW Specification to be developed for inclusion in 2021 contract in line with National Framework for Integrated Community MH. June 2020: LSCFT looking to extend the peer support contract until end of financial year, while future model designed as part of LTP requirements. September 2020 –Contract now extended to the end of the year redesign of model is underway and will form part of integrated primary and secondary community mental health model linked to PCNs.

ICS and Local responsibility L Tiffen

Mar 2020 Work collaboratively to ensure the implementation of MH Improvement plan at both ICS and ICP placement levels

Collaboration is happening in every dimension therefore specific action closed

Nov 19

Item 17a


ICS and Local responsibility L Tiffen

October 2019

Implementation of the agreed Mental Health Investment Strategy up to 2024 Confirm short term injection of additional resource and associated monitoring

Nov 19: Remains ongoing however it is challenged by ICS financial pressures Feb 2020: - Not yet achieved BWD DoF is leading on this development – There is significant national pressure for completion by end March 2020. If not achieved this presents a further financial risk to the CCG. April 2020: Work on investment strategy along with ICS operating model have been paused due to Covid 19, however as plans move into recovery phase this will be re-established. June 2020: Financial gate way work has re-commenced . Current resource required to meet LTP requirements as well as to fund additional schemes put in place as part of improvement plan is higher than MHIS increase. This is without any additional schemes put in place through the mental health cell arrangements in response to Covid. Group established to understand current position and develop proposal for ICS/CCGs consideration. Sept - September 2020 – Finance agreed as part of Phase three planning and additional resource agreed by JCCCG to support community areas in line with LTP. Additional capacity for the crisis pathway, has also been included within Covid pressures in response to the evidenced increased demand, but is subject to prioritisation at the ICS

Item 17a


Blackpool CCG Corporate Objective Fylde & Wyre CCG Corporate Objective 2 Develop Excellent Working Partnerships which lead to Improved Health Outcomes


Failure to redesign and commission Community diabetes services delivered in Fylde Coast that meet the needs of the population will result in poor outcomes for patients and ongoing delivery of inefficient services.

Background

Specific examples of inefficiencies include: • High A&E and non-elective admission rates because of diabetic complications • High amputations rates as a result of diabetic complications

Initial Previous Current Target Risk Owner Jeannie Hayhurst /Jeannie Harrop


Likelihood Likely Possible Possible Unlikely Financial / VFM ✓

Severity Major Moderate Moderate Moderate Compliance / Regulatory ✓


Date Apr 17 August 2020

November 2020


Controls Assurance

• Additional diabetes staff in post supporting improved foot care pathway and in-patient services are in place in both Community and Inpatient settings

• Two six-month Community Diabetes pilot programmes established as of 3/12/19 in WIN and Central West neighbourhoods – recommenced 01/08/2020 – evaluation incomplete due to a typical data on account of COVID – pilot extended until end of December 2020 and will possibly continue until end of March 2021 to allow for a more comprehensive evaluation to be completed and for financial and clinical modelling to be undertaken in preparation for roll out of the service.

• Review of Consultant Job plans and commitment by Trust that Diabetes Consultants will support the Community Diabetes Pilot – ongoing support for the clinic by unscheduled care division is under discussion

• Working with providers to develop business cases to secure funding for clinical staff to continue to support the clinic – this is currently paused due to COVID

• The service is working with the new EPR Team to establish how the two EMIS systems can work together to facilitate clinic reporting communication and audit.

• Fylde Coast Clinical commissioning committee • Fylde Coast Diabetes Steering Group • Fylde Coast Commissioning Delivery Oversight Group • Fylde Coast Execs


• Some tensions between Provider operational work and delivery of transformational changes i.e. due to COVID demands

• Concerns around availability of DISN’s to support clinic – some DISN positions still vacant following recent retirements – recent recruitment drive has not resulted in any permanent appointments

• Evaluation of pilot is awaited and is delayed due to the inconsistency of the data on account of COVID

Item 17a


• There are significant challenges in relation to the admin function for the community clinic being managed by the adult long-term condition directorate

• ongoing support for the clinic by unscheduled care division and their agreement to the extension of the pilot until March 2021 is under discussion

ACTION PLAN


Jeannie Hayhurst / Trevor Morris

Recruited DSN’s and podiatrists to be incorporated into the development of the new community pilot.

Community diabetes pilot project group established

2018

Jeannie Hayhurst / Trevor Morris

July 2019 Community Diabetes pilot to be established May 19 Community diabetes pilot project group established, and Lead GPs identified.

May 2019

Jeannie Harrop May/ Aug/Sep 2019

Lack of operational staff buy and / or assurance in Consultant support in to be escalated to Execs

Escalated to Fylde Coast Execs (1st escalated May 19) Dec 19: Consultant supporting Community Pilot

Oct 19

Jeannie Hayhurst 31.03.2021 Encourage buy-in and support from Diabetes in Patient Specialist Nurses for Pilots and Consultant support of roll out of community Service from April 2020

DEC 19: Highlighted in DISN action plan for them to be involved in the pilot from Jan 2020 And Phase 2 of Consultant job plan review to support roll out of Service is ongoing Feb 2020: DISNs attending Community Clinics as of Jan 2020 – Longer term commitment to this support is still under discussion April 2020 – Longer term commitment to the clinic by DISNs remains unresolved June 2020 – availability of DISNs to support the clinics is still restricted due to half of the team being redeployed, however two new DISNs have been recruited and will be in post later in the summer August 2020 – One DISN appointed due to commence in September, the other appointment has now been reversed and is out to advert again. Nov 2020 - recent recruitment drive has not resulted in any permanent appointments – positions are out to advert again.

Item 17a


Jeannie Hayhurst 31/02/2021 (Rolling Issue)

Phased roll out to PCNs - some localities are known to have limited space availability Suite of Clinical rooms required to site the Clinics (currently 1 x venue is unsatisfactory and short term )

Feb 2020 Estates Manager now attending Diabetes T&F Group April 2020 – This now paused due to COVID 19 June 2020 – Roll out still paused but discussions around delivery of the clinic remotely moving forward could result in the risk around estates being reduced August 2020 – Preparations for roll out are underway but will require the completion of the evaluation November 2020 - Preparations for roll out are underway but will require the completion of the evaluation

Jeannie Hayhurst 31/03/2021 Use and Monitor the Dashboard to evaluate clinical outcomes and actual savings

Feb 2020 Dashboard in place being monitored by T&F group April 2020 – Dashboard continues to be monitored but data flow will be interrupted due to pausing of pilot due to COVID 19 May 2020 – unchanged August 2020 – remains unchanged November 2020 – COVID has caused he data to be atypical

Jeannie Hayhurst 31.03.2021 Move diabetes as a speciality from the adults long term conditions directorate to community services

Aug 2020 – Stakeholder group to be established – summit to be held in September November 2020 – paper being presented to obtain commitment from unscheduled care division to support the extension of the pilot and will be further supported by a case for change document which is currently in development.

Jeanne Hayhurst 31.03.2021 Formalise how the service is funded August – ongoing November 2020 - case for change document will consider the financial modelling for the service going forward.

Item 17a


Blackpool CCG Corporate Objective Fylde Coast CCG Corporate Objective 2 Develop Excellent Working Partnerships which lead to Improved Health Outcomes


There is a growing deficit in the Primary Care clinical and medical workforce, that is potentially exacerbated by the direction of travel for Primary care i.e. the Out of Hospital agenda Clinical Professionals are difficult to recruit and retain especially as 1/3rd of the total workforce can potentially retire over the coming 5 years (i.e. by 2023)



Likelihood Likely Possible Possible Unlikely Financial / VFM ✓

Severity Catastrophic Major Major Major Compliance / Regulatory ✓


Date Jul 18 June 20 Sept 20 Mar 20 Reputation ✓

Controls Assurance

• IPCC Delivery Unit (incl Primary care re-design sub programme) • CCG representation on NHS E led Workforce groups / initiatives at ICS; ICP and CCG levels • GP Bursary Scheme – Fylde Coast – Paused • APEX support in place CCGs now being asked to fund this as NHSE funding ceases at end of September • National funding for 10 x New Practice roles, e.g. Clinical Pharmacists etc as per Primary care Network

DES – PCNs can now claim 100% reimbursement for these roles • ETP Hub at Fernbank for Fylde Coast & Preston • Practice Nurse forum (Quarterly) – GPN 10-point Action plan – virtual during COVID 19 • Formalised Process for the utilisation HEE CPD funds within Fylde Coast CCGs (each CCG has a

separate allocation and therefore separate process) • National incentive payment for GPs to become partners in practices

• SMT/ Governing Body • ICP Steering Committee • Programme Board – overseeing ICS PC strategy) • Practices submit Quarterly “Workforce” update (HEE) • Dedicated workforce subgroup as part of NHSE

programme of work • Nurse forums previously funded through CPD allocation.

PCN Clinical Directors have been asked to consider top slicing PCN allocations (from the Fylde Coast TH) to continue in future

• PCN clinical directors have been provided with their funding allocations for 20/21 on a fair shares basis. Further allocations will be made in 2022 & 2023. Guidance on which AHP are eligible has been issued

• Plans are then submitted to the STP TH via the Fylde Coast TH for approval. Once approved, funds released to PCN


• FC CCGs do not have direct control over NHS E initiatives and resources (timelines are often not manageable)

• Limited collaboration between Practices – leading to disparity in remuneration offers / packages and uptake of development offers e.g. GP resilience Scheme

• Transition process to ICP working presents risk

• Transition risk whilst developing collaborative working processes across Fylde Coast CCGs.

• Assurance from PCN and Fylde Cast TH that spending allocations will be fully utilised. Liaison between and CCG and TH necessary

Item 17a


• Process for HEE CPD funds have changed. Fylde Coast TH has issued guidance on allocation which must be spent by end of March 2021. O

• CCG reviewing workforce initiates to determine what can be brought back on line in light of the CCGs financial position

ACTION PLAN


Michelle Ashton

Continuous Collaborate further with BCCG on equity of schemes (e.g. GP retention, Pharmacy Integration fund, Nurse Rotation Schemes)

On Going April – Paused due to COVID September – under review

Tracy Riddick April 19 Greater promotion / Utilisation of GP retention scheme April 19

Steve Gornall April 19 Implementation of workforce workload APEX / INSIGHT tool Apex installed in all practices on the Fylde Coast. COVID limited the training support and utilisation in practice. NHSE region have confirmed the decision to fund licences for APEX is a local decision. (c.28k to March 2021) CCG’s/ICS to take a view on funding by end of September 2020

September 2020

Emma Phillips Neighbourhood / PCN Utilisation APEX in order to forward plan / model for the future

Virtually complete Sep 19 NOV 19 – all Practices are live with APEX – CSU has been commissioned to train Practices on how best to use to identify future workforce requirements April – Training still to be undertaken – paused due to COVID September 2020 – This work not restarted as CCGs are reviewing the financial position and taking advice from the clinical directors

Mark Britton Oct 2020 Fylde Coast Recruitment Campaign / Portal Requires development Not open as at Nov 19 – Is there a need for this portal? NOV 19 All vacancies are advertised on NHS Jobs and CCG Social Media is used to promote vacancies. ‘Next Steps Blackpool’ website in existence – has potential to hold all vacancies for FC CCGs – needs updating April – paused due to COVID September 2020 – paused

Item 17a


L Anderson Hadley Continuous GPN Nurse Collaborative CCG Officer responsible for signpost and guidance about available resources and opportunities

Nov 19 L&SC PCN Lead Nurse Collaborative in place Monthly Pan Lancs meetings held (LAH to attend for FC CCGs)

Completed

Michelle Ashton Oct 2020 Continuing to develop the workforce plan but understand than NHSE are to publish a document called people and places which will outline some initiatives which will help outline national support to address workforce shortages.

Jan 2020 Overview of the plan taken to Primary Care Commissioning Committee in Dec 19 – Primary Care Commissioning Committee were supportive of the plan and asked that any barriers to implementation were escalated to them. April – Following the primary care commissioning committee plan was updated and further works undertaken – now paused due to COVID19 September 2020 - This work not restarted as CCGs are reviewing the financial position and taking advice from the clinical directors

October 2020

Work has begun to collate workforce plans from the PCNS in both CCGs

Item 17a


Corporate Objective 2

To work collaboratively to deliver safe, high quality health and care services


Poor management of opioid medicines in treating pain resulting in long term over-use and possible dependence. Patients’ pain may not be effectively managed and there is a risk of serious adverse effects. Fylde Coast CCGs are identified among the higher prescribers of all opioids and specifically high dose opioids. Media activity is focussed on inappropriate prescribing of high dose opioids.



Likelihood Possible Possible Possible Unlikely Financial / VFM ✓

Severity Moderate Moderate Moderate Moderate Compliance / Regulatory


Date April 2019 Sept 2020 December 2020


Controls Assurance

• Pilot project in 2016 to address appropriate opioid initiation & follow-up – part of 100-day development collaborative which has now finished but the learnings carried forward to current project plan mentioned below.

• Resources produced to support future roll-out of project.

• Education sessions held as required

• Allocated to the pharmacist’s work-plan included in GP Quality Contract.

• Project plan in place with input from practice pharmacists.

• CCGs datasets produced to benchmark & monitor performance.

• Lancashire-wide guidelines have now been agreed and are in place

• Liaison with regional accountable officer for controlled drugs to improve oversight locally.

• Benchmark performance - monitored via CCGs Prescribing Group.

• Performance reports to Clinical Commissioning Committee/Quality Committee.

• Production of LMMG Guidelines for treatment of non-cancer pain.

• Provision of protocols for management of opioid prescribing.


• Confidence of practice staff in providing appropriate support to patient

• Lack of alternative pain-management options to offer/refer to.

• Capacity issues to maintain local oversight due to COVID response

Item 17a


ACTION PLAN

Action Assigned to Due Action Description Progress to Date Date Completed Melanie Preston/Rukaiya

End April 2019 Define dataset for benchmarking reports Discussion with Eclipse to develop the format of the dataset. Completed June 19 Eclipse module under development, requires implementation of VISTA module for which authorisation is currently being progressed. Dec 19: to be completed by 31/12/19 Jan 2020 – Documentation still requires completion with IG April 2020 – still ongoing – expected completion May 2020 May 2020 – still ongoing – expected completion June 20 Completed Aug 2020

Completed Aug 2020

Omar Seedat End April 2019 Identify available resources for practice support Complete April 19

LMMG Jan 20 Production of updated Lancs guideline for treatment of non-cancer pain.

Lancs work is ongoing, update due in September Dec 19: Guidelines to be presented to LSCMMG Jan 20 - this has now been delayed date to be confirmed April 2020 – Guidelines were due to be finalised but this is now on hold due to COVID 19 May 20 – Guidelines due to be finalised in September 2020 Sept 20 - need to clarify current position, work in progress-awaiting ratification December- guideline now completed

Melanie Preston End May 2019 Arrange further education sessions for practice staff. Education sessions completed in May Practice Pharmacists meetings.

Complete May19

Melanie Preston July 2019 Develop CCG position statement on prescribing recommendations to support current/future work in practices.

Draft completed to go to Fylde Coast Medicines Group in July/August prior to CCC agreement. DEC19: Paper taken Nov 19 at CCC – agreed subject to minor amendment – to be distributed to all Prescribers by end Dec 19

Completed Dec 19

Melanie Preston 31 Jan 2021 Arrange meeting for OPIOD project group to agree implementation of Eclipse Module & prescribing resources in Practices

Dec 19 – new action Jan 2020 – Date to be confirmed

Item 17a


April 2020 – This action has been halted due to COVID 19 and will be picked post COVID May 2020 – This action has been halted due to COVID 19 Sept 20 Training date being agreed currently with Eclipse December 2020 – Training dates scheduled for December 2020/January 2021 This work is embedded in GPEC which is currently paused but remains under review.

R Chand Some concern re the inappropriate storage of controlled drugs (CDs) in care homes/mixed messages asking care homes do not dispose of stock due to risk of shortages of critical End of Life drugs. Also, aware possible change in legislation is being considered that may allow care homes to hold on to dispensed stock from deceased patients/other during COVID19 pandemic ONLY.

April 2020 Await guidance then consider course of action. In any event post COVID19 guidance will likely revert to current legislation therefore need to ensure stocks of CDs are not help inappropriately MELANIE TO CONSIDER NEW RISK IN RELATION TO THIS ACTION- TO FEED BACK TO DB ASAP Sept 20: to discuss at FCMG to understand need for intervention. December 2020 – Liaising with medicines in care home team to assess stock holding in care homes currently (taking account of requirements for COVID second wave)

Item 17a


Corporate Objective Corporate Objective: 2 To work collaboratively to deliver safe, high quality health and care To maintain and improve performance against core standards and statutory requirements

COMM09 (IPCC 09)

Intermittent Community LD Psychiatry provision in the BTH provided LD service (due to locum leaving) leading to no Consultant oversight of patient care and treatment (this is a singleton post with no cover arrangements in place)

Initial Previous Current Target Risk Owner Tracy Callahan Hayes



Level 12 8 8 6 Innovation / Quality / Outcomes Date 29/07/19 Feb 2020 April

2020 Reputation

Controls Assurance • Locum psychiatrist in post week beginning 12th August (until June 2020)

• Risk is recorded on BTH / ALTC Risk Register

• Collaborative model across the ICS for all community services being developed, led by the ICS TC team

• Community operational psychiatric interface meetings scheduled with primary care and secondary mental health for complex cases where indicated. Monthly TC meetings with LD commissioners to review situation.


• Locums can leave with short notice.

• Singleton Post - no formalised cover arrangements

LCFT have declined to provide a stand-alone psychiatrist to BTH – discussions required at Executive level between providers.

ACTION PLAN

Action Assigned to


Provider BTH ASAP Recruitment to a substantive post July 2019: Recruitment in progress with job description at Royal College Psychiatrists approval prior to advertising Aug 19 – see note below

ongoing

Item 17a


Nov 19: Plan to advertise once RCP approval obtained

BTH ASAP Agency staffing (Locum Consultant) is being sought, August 2019: locum now (from 12/8) in post from this week and recruitment is underway to a substantive post.

12/8/19

BTH ASAP Options being explored with neighbouring trusts in the interim.

Aug 19 – Locum in place – substantive recruitment underway therefore action suspended Nov 19: currently as stable locum in place (to June 2020) negotiated cover discussed as required Feb 5, 2020 – Locum remains in place April 2020 – Locum remains in place & ICS developments for model of Psychiatry across all areas continues (collaboration discussions between BTH & LSCFT)

RISK RECOMMENDED FOR CLOSURE - I’ve checked in with the provider and the risk is not in place anymore as there is psychiatry in place and have

recruited a substantive post with plans in place.

RISK CLOSED

Item 17a


Corporate Objective Corporate Objective 2: Blackpool -To work collaboratively to deliver safe, high quality health and care services. Fylde & Wyre – Develop excellent working partnerships which lead to improved health outcomes. Corporate Objective 9: Effectively engage patients & the public in decision making

Risk COMM31 aligned to QI&EC

Information for patients, the public and stakeholders is inconsistent and/or unclear resulting in a loss of impact for issuing advice and guidance.

Background

The Fylde Coast Clinical Commissioning Groups (FCCGs) has a responsibility to ensure clear and consistent messages for patients, public and stakeholders in order to:

• Encourage appropriate use of services so that services are not overwhelmed and have capacity to deal with demand.

• Give people sufficient information to protect themselves and others from COVID-19, and to protect their health and wellbeing.

Achieve high levels of patient, public and stakeholder confidence leading to high compliance with measures to reduce infections rates.

Initial Previous Current Target Risk Owner Amanda Bate



Level 16 8 8 4 Innovation / Quality / Outcomes Date 30/04/2020 June 2020 September

2020 March 2021 Reputation

Controls (What you have put in place to mitigate the risk) Assurance (What tells you that the control is in place / working) .

• Implementation of national messaging for patients and public across a range of media.

• Three times weekly team updates to monitor social media interaction and soft intelligence

• Daily monitoring of CCG and primary care social media accounts for soft intelligence

• Daily monitoring of NHS England communications bulletin for updated material

• Links to the ICC and system calls

• Daily communications lead telephone call with BTH, Blackpool Council, FCMS, Trinity Hospice (now stood down to twice weekly).

• Updated internet content

• Monitoring of reach for public messaging. • Services report patient activity is appropriate. • Soft intelligence indicates a high level of support for messages • Feedback from weekly Governing Body bulletin • Feedback from weekly stakeholder bulletin • Monitoring of primary care social media activity • Test and adjust survey

Item 17a


• Remote updating of patient facing materials on GP website where available and provision of content to all GPs

• GP Practice social media content issued

• Monitor media cuttings



Effective reach for people who do not have access to the internet

Survey conducted online only not representative of whole population

ACTION PLAN

Action Assigned to


Head of communications

Continuous within incident timeline

• Establish daily mechanism to collate national messaging for sharing

• Daily monitoring of national and regional briefings are in place and actions discussed and delegated at daily team meetings.

completed



• Establish daily team briefings

• 9am team call to discuss daily actions and requirements



• Establish consistent monitoring of social media activity

• Social media is monitored and queries responded to as appropriate.



• Establish appropriate sign off process for bulletins to ensure information is accurate

• Bulletins go through a robust process of sign off via executive lead and/or clinical directors and review regularly



• Establish regular comms leads calls with partners across the Fylde Coast to agree actions and ensure consistency of messaging.

• Twice weekly call with Fylde Coast communications leads is established.


July 2020 • Review results of survey and make recommendations for development of comms and engagement

•


Sept 2020 • Establish a virtual public and patient engagement group •

• •

Item 17a


Corporate Objective 2

To work collaboratively to deliver safe, high quality health and care services

Risk COMM44

Increased stock holding of controlled drugs in the community following recommendations on access to medicines for COVID-19. Such interim changes in guidance/legislation relating to availability, may lead to inappropriate use for patients outside of current regulation and misappropriation.



Likelihood 3 1 Financial / VFM

Severity 3 3 Compliance / Regulatory X

Level 9 3 Innovation / Quality / Outcomes X

Date June ‘20 March 2021

Reputation X

Controls Assurance

• Care homes team in place to liaise with all Fylde Coast Care Homes on medicines use & storage.

• Greater input of clinical pharmacy support due to C-19 and GP DES will allow closer scrutiny.

•

• Fylde Coast Medicines Group to give oversight to any audit supported by the care homes team.

• Updates to QEIC.


• Regular audit of medicines management in some care homes. •

ACTION PLAN

Action Assigned to Due Action Description Progress to Date Date Completed Review of interim guidance to ensure it is still required.

End Aug ‘20 1. Review of C-19 position and current levels of stock-holding in community pharmacy/wholesalers.

2. Review of process for care home to access pharmaceutical supply in a timely manner.

Draft audit for care homes

September ‘20

Item 17a



To ensure financial balance and improve

efficiency and productivity

Item 17a



To deliver a step change in the NHS preventing

ill health and supporting people to live

healthier lives

Item 17a


Corporate Objective Corporate Objective 4: To deliver a step change in the NHS preventing ill health and supporting people to live healthier lives

Risk COMM32 aligned to or PCCC

Communications capacity and capability in primary care is inadequate leading to inconsistent patient messaging, lack of confidence and reputational damage and low patient compliance for appropriate use of services.

Background

Primary care is at the forefront of patient care and has direct access to communicate with public, be it face to face or virtually via websites and social media. As such primary care must be kept up to date with latest key messages to ensure consistency both locally and nationally.




Level 16 8 8 4 Innovation / Quality / Outcomes Date 30 April

2020 June 2020 September

2020

March 21 Reputation


• Provide content for social media and website

• Ensure consistent messaging for patients in line with national materials is available to primary care colleagues

• Update Primary care websites with appropriate information remotely via the CCG where this is available. Where GP websites are managed wholly by the practice provide comprehensive ‘copy’ and offer advice and guidance.

• Provide advice and guidance to primary care settings on appropriate messaging

• Monitor primary care social media activity for soft intelligence in order to respond to misinformation and/or issues.

• Monitor media cuttings

• PPG network meeting

• Monitoring of reach for public messaging across primary care channels • Services report patient activity is appropriate. • Soft intelligence indicates a high level of support for messages • Feedback from daily primary care bulletin • Monitoring of primary care social media activity • Minutes from PM teleconference • Minutes from GP teleconference

Item 17a




• General practices are independent businesses and as such we cannot force compliance with CCG/national messaging

• CCG does not have access to all the primary care websites

• PPG network meeting currently not taking place due to COVID

None identified

ACTION PLAN

Action Assigned to




Establish daily primary care bulletin which collates all relevant information into single communication

• Bulletins go through a robust process of sign off via executive lead and/or clinical directors.



Establish single point of information on CCG intranet as a resource for primary care colleagues



Establish daily teleconference with practice managers Call is established and supported by comms



Establish twice weekly teleconference with GPs Call is established and supported by comms

Head of communication

Sept 2020 Establish virtual PPG network meeting

Item 17a



To maintain and improve performance against

core standards and statutory requirements.

Item 17a



To commission improved and effective out of

hospital care.

Item 17a

57

Corporate Objective 6: To commission improved and effective out of hospital care

Risk New Models of Care.

COMM10 (IPCC08)

Initial Previous Current Target Risk Owner Jeannie Harrop / Sarah Camplin Cc Emma Phillips


Likelihood Possible Unlikely Possible Unlikely Financial / VFM ✓



Date Apr 17 August 2020

Nov 2020

Aug 21 Reputation ✓

Controls Assurance

• Performance dashboard and minutes of the PCC committee reported to Governing Body • PCN Network of Networks have developed an optimal neighbourhood care team model for the Fylde

Coast. • Integrated Neighbourhood care teams in place for BCCG to support primary care for housebound and care

home patients and plans in place Fylde and Wyre. • Fylde Coast Care home model review completed and elements of model commenced on 01.10.2020

as agreed by the PCNs • Contracts and service specifications with KPIs in place for commissioned services, use of contractual levers

to ensure receipt of information, implementation of remedial action plans as required and sanctions imposed for continued non-delivery, including healthy Fylde coast contracts

• Individual work stream meetings established at a health economy or local level (i.e. PCN Network of Networks; Primary Care Commissioning meeting; A&E Delivery Board; Learning disabilities; Children and Young People)

• Dedicated commissioning leads for individual services and named leads for individual indicators • Monitoring and feedback reported to the relevant CCG meeting / Board regularly • Fylde Coast Integrated Care Partnership structure and processes developed to oversee the model and

complete risk reporting. • Community clinical roles agreed to be funded as part of winter planning • Mutual aid documentation developed ICS wide • Rehabilitation Beds across the Fylde coast •

• Primary Care Commissioning committee, Integrated Care Partnership work

• PCN Network of Networks meeting • Primary Care, PCN and community pathways work streams • NHSE&I Single Oversight Framework dashboard and exception

reporting • Minutes from provider contract and performance meetings • NHS England assurance meetings and minutes • KPI and activity reports being developed • Recent CQC inspection confirmed Adult Community Services as

Outstanding • Bi-weekly meetings with senior BTH community colleagues • Bi-weekly meetings with ICS Community Services Operational

Group • Review of rehab beds being discussed on Fylde Coast System

calls to determine pressure areas and assist where able and appropriate

• Current review of Clinical cover for Thornton House Residential Rehab beds ongoing


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• Some performance measures not directly attributable to CCG commissioned services and therefore reliant upon partners to deliver (i.e. public health; linked services to the neighbourhood care team model i.e. drug and alcohol)

• Concerns regarding restoration of community services and on-going workforce issues • The standardised Fylde Coast Neighbourhood care team model is not yet fully embedded across

the Fylde Coast due to staffing measures • The standardised Fylde Coast Care Home Team model is not yet fully embedded across the Fylde

Coast due to staffing measures

• Resilience of neighbourhood care teams due to vacancies and sickness absence across the Fylde coast – business continuity plans have been enacted which has resulted in a limited service offering from the NCTs. Some NCTs across the FC are reporting staffing capacity at below 50% at present. Staff are being reassigned where possible – however this will have an impact on wider

community services teams such as rapid response, IV therapy etc . • Potential impact on primary care due to limited service offering - i.e. non urgent dopplers; ear

syringing; palliative care support where appropriate; chronic disease management and non-urgent

bloods are being paused therefor will fall back to GP colleagues to provide – this is reviewed on a

4 weekly basis • Additional community clinical roles agreed to be funded as part of winter planning may be

problematic due to potential failure to recruit to posts • Rehabilitation beds across the Fylde Coast have been repurposed during COVID pandemic –

therefore not readily available to support commissioned service – patients not getting the rehabilitation required

Current gap in service provision for TH rehab beds, no clinical model in place to cover these needs at TH. Liaising with LCC and Quality colleagues to decide on level of cover required and form a plan to initiate a new service. Current cover being held by Thornton Practice will cease in imminent future

ACTION PLAN


Jeannie Harrop Continuous Concerns regarding some workforce issues in some of the community services.

Staff are being reassigned where possible Additional funding secured to recruit additional staff over winter period.

Ongoing

Jeannie Harrop Continuous PCN additional roles are currently being recruited to by PCNs November – ongoing Ongoing

Jeannie Harrop Continuous Explore opportunities with neighbourhoods to merge and work collaboratively. Dec19: Primary care Network Development on-going Aug 20 Primary care networks overseeing neighbourhood models November 20 – ongoing

Ongoing

Jeannie Continuous Development of a Standard Operating Framework for Neighbourhood Care Teams to ensure consistency of Model across the Fylde Coast.

Dec 19: New Action This has been completed. It has been approved via the

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Roll out will commence from April 2020 – as part of NHS Long term Plan appropriate governance routes. Roll out is delayed due to Covid-19 but the SOF has been shared with general practice and PCNs Aug 2020 – standard operating framework completed and working with community services to continue due to COVID delay November 20 – ongoing

Jeannie Harrop Continuous Planning and priorities plan in place for Primary Care, PCNs and community pathways aligned to corporate, ICP, ICS and national objectives.

Aug 2020 - Aligned to individual work plans with process for updates to Commissioning Delivery Oversight Group November 20 – ongoing

Ongoing

Gemma Dexter Ongoing Explore options for clinical cover required for Thornton House 18 beds Residential Rehabilitation side

Feb 21 – Meeting held, action plan agreed to explore option on FCMS, BTH and LCC cover and interim plan

Ongoing

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Corporate Objective

Fylde Coast Objective 6 - To commission improved and effective out of hospital care


Primary care may not be able to segregate patients with potential COVID-19 that need to be seen face to face from patients that are non-COVID-19 symptomatic. Background Primary care has been asked to identify rooms or parts of buildings to segregate patients to protect patients and staff from risk of infection. If this is not possible within their existing premises, they have been asked to identify other possible alternatives.

Initial Previous Current Target Risk Owner Michelle Ashton / Phil Hargreaves

Executive Lead Andrew Harrison

Likelihood Likely Possible Possible Possible Financial / VFM

Severity Major major major Major Compliance / Regulatory

Level 16 12 12 12 Innovation / Quality / Outcomes

Date March 2020 June 2020

Sept 2020

March 21 Reputation


• Primary Care have been asked to identify rooms / areas to segregate patients with potential COVID

• Practices have tried to find rooms close to entrances / exits to minimise patients mixing with non- COVID patients

The CCGs have supported the following practices to provide additional capacity:- • Great Eccleston – have a porta cabin • Kirkham / Ashtree - are utilising Kirkham Health Centre as a COVID

site • Glenroyd / North shore - using Ashfield as a COVID site • Lytham HC - Marque set up as a COVID site • Highfield and Stonyhill - using additional rooms in South Shore PCC

to see COVID patients



• CCGs are reliant on practices to determine if they can see patient’s safely and segregate potential COVID patients

• If CCG had concerns about a practice premise, they could ask to virtually assess what has been put in place

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ACTION PLAN

Action Assigned to


Practice April Order Porta cabin for Great Eccleston Completed April 2020

Phil Hargreaves April Relocation of community service from Kirkham Health Centre to free up the site for Ashtree and Kirkham HC to see COVID patients

Completed April 2020

PH/ PC March Set up Ashfield to be used as a potential hot site across the ICS. North Shore and Glenroyd begin to use the site as a hot site with potential expansion for FCMS if required at a future date


Phil Hargreaves April Relocation of some Extensive Care Service staff to free up capacity in South Shore PCC. Site is used as a hot site for Stonyhill and Highfield.


Michelle Ashton June All practices to confirm what arrangements they have in place to segregate patients

ongoing

Michelle Ashton June CCGs have produced a checklist for practices to complete to determine if they require additional support to segregate patients

• Sep 2020 Facilities manager has supported Practice Staff to ensure Practices have been made as safe as possible installing screens etc

• Need are being kept under RV

Completed

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To support research, innovation, and growth.

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DEVELOP & MAINTAIN AN EFFECTIVE

ORGANISATION

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Corporate Objective Corporate Objective 8: Develop & maintain an effective organisation


The Governing Body are uninformed about the activity being undertaken by the CCG in response to COVID-19 emergency leading to a loss of confidence in accountability.

Background

Governing Body and its committees have ultimate responsibility for making decisions affecting the Fylde Coast Clinical Commissioning Group (FCCG) and services across the Fylde Coast. To ensure decisions are made by informed individuals, particularly in a time when information is changing constantly, mechanisms must be in place to keep the Governing Body up to date.




Level 16 4 4 4 Innovation / Quality / Outcomes Date 30/04/2020 June 2020 September



• A weekly bulletin is produced with contributions from executive team and senior service leads. The bulletin also includes wider system and national high-level updates.

• A patient and public engagement paper is submitted to the Governing Body

• Communications and engagement strategy and reporting structure

• Feedback on weekly bulletin

• Minutes of Governing Body meeting

• Feedback from Governing Body members



• None identified

None identified

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ACTION PLAN

Action Assigned to




Establish weekly bulletin for Governing Body members that brings together relevant COVID-19 information as a single resource

Bulletin established and goes out each Monday. Evaluation of report being considered to establish how useful the information is and how it can be improved



Governing Body report


July Review test and adjust survey results

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Corporate Objective Corporate Objective 8: Develop & maintain an effective organisation


Staff working remotely may not have immediate access to information and may feel disconnected or isolated resulting in processes not being followed and operational disparity, as well as potential for poor health and wellbeing. Additional risk that lack of clarity of information could result in inaccurate information being shared outside of the organisation

Background

The Fylde Coast Clinical Commissioning Group (FCCG) has a responsibility to ensure that staff are provided with enough information to ensure:

• Staff are aware of new operational processes

• Staff follow correct HR procedures

Staff are supported to look after their own health and wellbeing.




Level 16 4 4 4 Innovation / Quality / Outcomes Date 30 April

2020 June 2020 September



• Increase frequency of weekly bulletin to daily

• Ensure teams are enabled to maintain regular contact with their line managers and each other by disseminating information from the IT team on how to use new systems.

• Created a staff intranet page detailing service changes updated as information from services is received

• Provide regular ad hoc information about HR issues and processes e.g. annual leave

• Regularly update the intranet with information for staff

• Establish a virtual team brief facility so that staff can access live exec team updates and/or watch these at a later date.

• Staff newsletter system analysis shows receipt of, and active interest in, daily newsletter bulletin

• Staff report usefulness of bulletins

• IT teams show staff utilisation of new systems

• All new HR processes being followed

• Information on intranet is kept up to date

• Good attendance to the virtual staff briefing

• Limited number of questions during the team briefing shows good uptake and understanding of information provided.

• Staff keeping in touch with each other through the WhatsApp group.

• Lack of reporting of poor staff morale

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• Provide consistent and regular signposting to a range of health and wellbeing support offers

• Proactively promote the five ways to wellbeing via a staff focussed campaign with daily themes

• Implement virtual fundraising events to replace regular activities previously held face to face to lift morale.

• Support staff social group chat using WhatsApp application



ACTION PLAN

Action Assigned to



Ongoing Established regular meetings with operational leads Meetings progress

Establish links with service leads to obtain regular updates Head of Communications meets with various heads of service

Seek out and receive national daily updates for dissemination to staff

Regional and national updates are being received

Ensure communications team member receives hospital trust staff newsletter for cross reference and sharing where appropriate

Trust bulleting received and shared with communications team and discussed during team meeting

Set up process for receiving information for daily staff bulletin

All communications team participate in various meetings and share learning from those meetings with the rest of the team. Service leads send extra information and article requests to central Communications team email inbox

Set up process for updating staff intranet Intranet is updated daily immediately following the release of the staff newsletter.

Set up process for approval of staff bulletins to ensure accuracy

Bulletins approved by Head of Communications daily before 2.30pm

Ensure communications team are using Microsoft Teams to enable accurate sharing of information

Microsoft Teams now being used and file storage system has been implemented for ease of sharing

Establish daily communications team updates for sharing information from various sources to share information

Communications team meet daily at 9am using a set agenda and updating a team action plan

Set up all staff team meeting Team meeting held on Wednesday 29 April with presentations from each service lead.

Source suitable social media posts aimed at health and wellbeing

National ‘Every mind matters’ information shared at least once a week

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Research Five Ways to Wellbeing and adapt these for staff working in isolations / social distancing / shielding

Daily bulletin highlights each of the five ways with examples and advice on how to implement them

Organise staff social event Staff quiz planned for Wednesday 6 May

Create dedicated health and wellbeing information page on staff intranet

Page now created.

Set up service change section on intranet so staff are aware of changes to services

Page now live

Assist with the preparation of NHS worker letter signed by Dr Amanda Doyle for use by staff as evidence of essential worker status.

Letter issued to staff and Trinity Hospice

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Effectively engage patients & the public in

decision making

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Corporate Objective Corporate Objective 9: Effectively engage patients & the public in decision making


The CCG does not meet its legal duty to involve due to a lack of appropriate consultation with stakeholders, providers patients and public on service changes in response to COVID-19 .

Background

The CCG has a legal duty to involve. The National Health Service Act 2006 sets out the legislative framework for public involvement: · Sections 13Q (NHS England), · 14Z2 (updated by the 2012 Health and social care act – introducing duties on CCGs) and · 242 (NHS Trusts and FTs)). NHS England guidance from ‘Planning, assuring and delivering service change’: Changes can be made temporarily under regulation 23(2) of the s.244 Regulations because of a risk to safety or welfare of patients or staff. In these circumstances it may not be possible to undertake any public involvement or consultation with the Local Authority. The local NHS should try to undertake as much engagement as possible in the time available and discuss with NHS England and NHS Improvement how this can be assured. However, when a decision is proposed to make a temporary change permanent, the full process must be followed.




Level 16 12 12 4 Innovation / Quality / Outcomes Date April 2020 June 2020 Sept


Controls (What you have put in place to mitigate the risk) Assurance (What tells you that the control is in place / working) .

• Website information

• Press releases

• Primary Care Daily Bulletin

• Staff Daily Bulletin – operational/HR/wellbeing content

• Governing Body weekly bulletin

• Influence newsletter – stakeholder bulletin distribution – patient volunteers and influence scheme members

• Social media

• Social media and website activity • Reader statistics from bulletins • Soft intelligence

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• ICS led MP briefings (external control)



• An approved process for stakeholder engagement

• EIRA

• Distribution of stakeholder bulletin to include providers

• Facility for virtual and online engagement

• Formally recorded stakeholder feedback on service change and additionality

• Approved EIRA

ACTION PLAN

Action Assigned to



Ongoing Establish robust communications via a variety of media which are regularly updated to inform stakeholders of any service changes or ways in which to access services.


Ongoing Increase frequency of information to staff, primary care, and providers


Ongoing Review social media and publications for reader statistics and reach and monitor soft intelligence.


SEPTEMBER Establish a process and key communications for engagement June – ongoing

Equality and inclusion team MLCSU

Ongoing Support the completion of EIRA assessments for service changes

June ongoing


SEPTEMBER Scale up capacity and capability for virtual engagement and/or consultation with a range of stakeholders.

June - ongoing

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Risk Matrix Likelihood

1 2 3 4 5

Rare Unlikely Possible Likely Almost Certain

Co

nse

qu

en

ce

5 Catastrophic 5

(Moderate) 10 (High) 15 (Extreme) 20 (Extreme) 25 (Extreme)

4 Major 4

(Moderate) 8 (High) 12 (High) 16 (Extreme) 20 (Extreme)

3 Moderate 3 (Low) 6 (Moderate) 9 (High) 12 (High) 15 (Extreme)

2 Minor 2 (Low) 4 (Moderate) 6

(Moderate) 8 (High) 10 (High)

1 Negligible 1 (Low) 2 (Low) 3 (Low) 4 (Moderate) 5(Moderate)

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1


Report Title Extended Access Service Provision

Presenter Michelle Ashton – Senior Commissioning Manager – Primary Care

Prepared By Louise Andrews - Primary Care Commissioning Manager


Future Committee Discussion Date

Clinical Commissioning Committee Not required

Quality, Improvement and Engagement Committee Not required

Finance and Performance Committee Not required

Audit Committee Not required

Primary Care Commissioning Committee 6.4.21

Recommend to CCG Governing Body – Part I or Part II Not required

Internal Assurance Process (indicate if not applicable) Clinical Lead Dr Ben Butler-Reid

Senior Lead Manager Michelle Ashton



N/A


N/A


N/A

Financial Implications N/A


None


Dr Ben Butler-Reid

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2

Extended Access Service Provision Introduction In November 2020 NHSE/I advised all Primary health care systems to repurpose all extended hours

and access capacity to support the COVID-19 vaccination programme. Locally it was agreed that, in

order to support the system, existing provision, including access to urgent and pre-booked

appointments over the Winter months, should be maintained.

The service continues to be fully operational and is delivered from 4 locations:

• Urgent Treatment Centre, Whitegate Drive, Blackpool

• Freckleton Health Centre

• Urgent Treatment Centre, Fleetwood

• Garstang Medical Practice/Over Wyre Medical Centre

The table below details the opening times of the services across the Fylde Coast footprint:

Day Blackpool UTC Freckleton

Health Centre Fleetwood UTC

**Garstang

Medical

Practice/Over

Wyre

Monday 18:30-20:00 18:30-21:30 18:30-20:00

Tuesday 18:30-20:00 18:30-21:30 18:30-20:00

Wednesday 18:30-20:00 18:30-21:30

Thursday 18:30-20:00 18:30-21:30 18:30-21:30

Friday 18:30-20:00 18:30-21:30

Saturday 08:00-20:00 08:00-14:00 08:00-12 noon 08:00-14:30

Sunday 08:00-20:00 08:00-14:00 08:00-12noon

** Provision at the Garstang and Over Wyre Medical Centres is rotated on a weekly basis.

Patients across the Fylde Coast are able to access routine/same day appointments at any of the four

locations.

Appointments can be booked via the GP practice during core GMS hours and via a dedicated

telephone number during service delivery hours noted in the table above.

Appointments are a combination of GP, Nurse and Health Care Assistant appointments.

GP practices can also make use of the nurse time for chronic disease / smears etc as we move to

recovery in primary care or consider repurposing some nurse appointments to GP appointments.

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Utilisation

The chart below outlines the combined service utilisation at all four locations to date: -

The table below outlines utilisation at each individual location: -

Sum of Field6 Column Labels

Row Labels Fleetwood Freckleton Garstang Over Wyre

Whitegate Drive

Grand Total

2020 62.20% 70.52% 76.12% 61.97% 43.03% 53.81%

Sep 43.80% 59.39% 62.79% 42.55% 34.52% 41.77%

Oct 72.11% 72.06% 84.35% 66.92% 44.16% 56.73%

Nov 67.09% 81.83% 83.33% 64.93% 44.43% 58.19%

Dec 62.82% 65.08% 64.39% 67.65% 47.45% 55.46%

2021 69.50% 78.44% 68.24% 72.64% 42.41% 56.47%

Jan 60.70% 74.50% 70.23% 66.17% 38.22% 51.92%

Feb 73.55% 80.19% 61.90% 80.60% 46.22% 59.71%

Mar 78.13% 82.05% 72.58% 76.12% 43.77% 59.19%

Grand Total 65.25% 73.86% 72.50% 66.74% 42.77% 54.94%

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4

The charts below highlight the appointments booked at each Fylde Coast for BCCG and FWCCG

Practices respectively (from 1/10/2018 to date):

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5

The chart below highlights the appointments booked by GP for BCCG and FWCCG Practices respectively (from 1/4/2018 to date): -

The chart below highlights the appointments booked by HCA for BCCG and FWCCG Practices respectively (from 1/4/2018 to date): -

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6

The chart below highlights the appointments booked by Nurse for BCCG and FWCCG Practices respectively (from 1/4/2018 to date): -

DNA rates are (1/4/2018 – date):

Row Labels Booked Total DNAs

%DNAs of total booked

Fleetwood 15528 2548 16.41%

Freckleton 18507 1916 10.35%

Garstang 2469 222 8.99%

Over Wyre 1216 106 8.72% Whitegate Drive 28403 4339 15.28%

Grand Total 66123 9131 13.81% Communications & Engagement As a reminder to the General Public the CCG Communications Team have recently re-advertised this service in terms of the located sites and opening times on offer. Recommendation The Primary Care Commissioning Committee is asked to note the contents of this paper Louise Andrews Primary Care Commissioning Manager

Item 18

nhs blackpool clinical commissioning group nhs fylde and

Documents