NHS WEST LANCASHIRE CLINICAL COMMISSIONING GROUP

PRIMARY CARE COMMISSIONING COMMITTEE

9 July 2019, 1.30 – 3.00 pm

Boardroom, Hilldale, Wigan Road, Ormskirk, L39 2JW

Item Time Agenda item Paper / Verbal

Action Presenter

1. 1.30 Welcome and apologies Chair

2. 1.30 Declaration of Interests Verbal I All

3. 1.35 Minutes from the previous meeting Paper DR Chair

4. 1.40 Update on actions from the previous meeting Paper D Chair

STRATEGIC ISSUES

5. 1.45 Finance update

• Month 12 budget statement Paper I Jenn Greenhalgh

OPERATIONAL ISSUES

6. 1.55 Primary Care and NHS England update

• Practice relocation template

• Quarterly contractual changes report (Q1) Paper

Paper

DR

I

Sarah Bloy

7. 2.10 Workforce and education update Verbal I Nic Baxter

8. 2.20 Primary Care Networks Verbal I Jackie Moran

9. 2.30 Primary Care Quality Update Paper I Allison SathiyanathanFOR INFORMATION

Date and Time of Next Meeting – 10 September 2019, 1.30 – 3.00 pm, Boardroom, Hilldale

I – Information D-Discussion DR – Decision Required

Primary Care Commissioning Committee – 12 March 2019 Page 1 of 4

Minutes

Primary Care Commissioning Committee

Venue: Boardroom, Hilldale, Ormskirk

Date & Time: Tuesday 12 March 2019 at 1.30–3.00 pm

Attendees: Mr S Gross – Chair Mrs C Heneghan – Chief Nurse Mr M Maguire – Chief Officer Mr D Soper – Lay Member

In attendance: Dr J Caine – West Lancashire CCG Chair Mrs J Charnock – Primary Care Development Manager Ms J Greenhalgh – Finance Manager Mrs J Moran – Head of Quality, Performance and Contracting Mrs S Bloy – Senior Primary Care Manager Ms C Ashcroft – Executive Assistant (minute taker)

Apologies: Dr A Robinson – Secondary Care Doctor Mr P Kingan – Chief Finance Officer Mrs N Baxter – Head of Medicines Optimisation

Agenda Item

Summary of Discussion Lead

1. Welcome and apologies for absence Steve Gross introduced himself and welcomed the members of the Primary Care Commissioning Committee (PCCC) to the meeting of the committee. The apologies above were relayed. No members of the public were present.

2. Declaration of interest Steve Gross reminded committee members of their obligation to declare any interest they may have on any issues arising at committee meetings which might conflict with the business of West Lancashire CCG. Declarations declared by governing body members are listed in the CCG’s Register of Interests. The register is available either via the secretary to the governing body or the CCG website at the following link: Register-of-interests-Governing-Body-August-2018.pdf As with previous Primary Care Commissioning meetings John Caine again declared a general interest in all items as he is employed as a sessional GP. As John Caine is a non-voting member the chair considered the declaration of interest and deemed this to be significant and not fundamental for all items under consideration today.

3. Minutes from the previous meeting The minutes from the 29 January were approved as a correct record.

4. Update on actions from previous meeting The action sheet was updated.

Primary Care Commissioning Committee – 12 March 2019 Page 2 of 4

Agenda Item

Summary of Discussion Lead

STRATEGIC ISSUES

5. Finance update Jenn Greenhalgh presented the month 10 budget. The full year forecast continues to show an underspend against the full year original budget. The budget statement detailed a forecast of £165,000 underspend. The QoF full year forecast is now showing slightly over budget, due to Viran Medical Centre closing and therefore unavoidable duplicate payments (i.e. to Viran and other practices that take on their patients). Enhanced services are slightly over budget. Charges for the Viran closure, including redundancy, are recorded under miscellaneous expenditure. The rate rebate analysis by GL Hearn is now completed and the £8,000 benefit is now included on the budget statement resulting in a small underspend against Premises. Any benefit pre-delegated commissioning will be retained by NHSE. Jenn Greenhalgh to raise at the next Primary Care Co-commissioning meeting as to why the full value is not passed over to the CCG. The month 11 statement has been published and the forecast is slightly improved. The £70,000 in contingency has been released, which results in a forecast of c. £250,000 under budget. Following the completion of the premises’ analysis, final charges are c.£100,000 more than anticipated which is a pressure for this year. A meeting will take place with George Hurst and Paul Jones about the significant increase of 2017-18 costs compared with the previous year. The 2018-19 plan is a lower value to the previous year’s plan. The underspend in primary care overall will help the pressure. There is a general issue with delays in NHSPS resolving financial issues. The Primary Care Commissioning Committee: noted the financial position.

OPERATIONAL ISSUES

6. Primary Care and NHS England update

• Application for practice merger Sarah Bloy reported on the application to merge the contracts for Parkgate Surgery and County Road Surgery from 1 April 2019, following the sudden retirement of the GP at the County Road Surgery. This will result in the termination of the practice code for County Road Surgery. Both practices will continue to offer full services to patients. Following the plan being publicised and feedback being sought, no issues have been raised by patients. The boundary change had been agreed at the previous meeting. The merger is in line with primary care delivery at scale.

The Primary Care Commissioning Committee: approved the termination of contract P81727 allowing both practices to operate under GMS contract P81041.

• GP contract reform NHS England and the BMA GP Committee published a five-year framework for the GP services contract on 31 January 2019. This reflects the commitment in the NHS Long-Term Plan and the direction primary care will travel in the next ten years. Sarah Bloy presented the summary of the five-year framework including nine keys points, for information. The recruitment of physiotherapists or clinical pharmacists on a higher pay scheme was

Primary Care Commissioning Committee – 12 March 2019 Page 3 of 4

Agenda Item

Summary of Discussion Lead

raised. Existing clinical pharmacists will be given the opportunity to apply to the new pay scheme, but physiotherapists will not. There are very few physiotherapists in the practices, however the change could cause some discord. The CCGs have been asked to write a primary care strategy to demonstrate their alignment to the direction of the ICS. Details are still awaited for the primary care network DES, clinical director job role etc. In the five-year framework, 4.38 ii states that a contribution to the cost of a clinical director will be made based on the network list size and, combined with the cash payment of £1.50 per registered patient for network effectiveness, to create a £2.19 per head fund each year. Discussion continued around the different needs from each clinical director, salary and level of funding expected. It has been agreed that the clinical director does not need to be a GP, and can come from social services, nursing etc.

The Primary Care Commissioning Committee: noted the report.

7. Workforce and education update The new roles for clinical pharmacists had already been discussed in item 6. In terms of employing Irish GPs, agreement from Health Education England has been received and confirmation that some of the expenses related to the scheme will be covered by the International Recruitment Programme. There is a need to identify which GP practices are interested in taking the Irish GPs.

8.

Extended Access Jan Charnock confirmed that a letter had gone to OWLS CIC to agree the contract. Some issues require discussion, but the contract will commence on 1 April 2019 for 2 years.

9. Primary Care Networks The report provides an overview of Primary Care Networks, as detailed in the NHS Long-Term Plan and how they fit in West Lancashire. The report details the current progress of developing the networks and follows the long-term plan to work collectively. The practices within the primary care networks are listed. Beacon Primary Care sits across all three networks, but will need to fit into one single network. Each primary care network must complete the annual plan template by the end of March 2019, to demonstrate their development priorities and support requirements over the next 12 months. An extension for submission may be required from NHS England of 5 April, to allow the template to be taken to the neighbourhood meetings. It is anticipated the CCG will need to carry out an initial evaluation and feedback to Lancashire and South Cumbria. There is a concern that some documents have been produced locally before, although it is now known if they will be provided nationally eg job descriptions, Apex tool. The template will be shared with Drs Mittal, Jaidka and Gregory to discuss for neighbourhoods. The 15 May is the submission date for the CCG to approve the local sign up to the primary care networks.

10. Estates Update The refurbishment at Burscough Health Centre commenced yesterday and work will start at Tarleton Health Centre in a month or two. The work will be carried out with as little disruption to patients as possible. The draft plans are available.

Primary Care Commissioning Committee – 12 March 2019 Page 4 of 4

Agenda Item

Summary of Discussion Lead

The portacabin used for Viran Medical Centre should be collected by the end of March. Once the refurbishment work at Burscough is complete a review will take place in 12 months as to the utilisation. The practices had requested additional rooms, however flexible usage of the existing offices will be offered before the review, which could result in the POD moving out, providing additional space. The work should be completed in 16 weeks. The planned hubs in neighbourhoods will bring together the staff associated with practices eg district nurses.

11. Primary Care Quality Update A few CQC visits are taking place and an update will return to future meetings.

FOR INFORMATION

Date and time of the next meeting – The next meeting of the committee will take place on Tuesday 14 May 2019 at 1.30 pm, Boardroom, Hilldale.

Page 1 of 1

West Lancashire CCG Primary Care Commissioning Committee Action sheet

12 March 2019 Action Lead Date required by Action completed

6. Medicines Management - Flu provision The cost of out of season flu provision was discussed and Virgin Care will come back to us. This will be discussed with Michelle Lee.

Jackie Moran 14 May 2019 (cancelled)

9 July 2019 Nic Baxter had received advice, to find

one single provider.

7. Workforce and education update A proposal will be prepared to consider HCA’s training to be nurses and this will be presented at the next meeting.

Alison Lumley 14 May 2019 (cancelled)

9 July 2019

West Lancashire CCG : Primary Care Co-Commissioning

Description

Annual Budget

£000

YTD Spend

£000

Variance

£000 Narrative

GMS Global Sum 10,173 10,221 48

GMS Mpig Correction Factor 6 6 (0)

GMS Additional Staff Payment 1 1 -

General Practice GMS 10,180 10,228 48

APMS Contract Payments 223 176 (47)

General Practice APMS 223 176 (47)

Quality Achievement 431 442 10

Quality Aspiration 1,108 1,115 7

QOF 1,539 1,557 17

DES Learning Disability Hlth Chk 34 60 26 Includes accrual for Q4 activity

DES Minor Surgery 167 154 (13) Includes accrual for Q4 activity

DES Avoiding Unplanned Admissions - - - Scheme Finished

DES Violent Patients - - - Scheme Finished

DES Extended Hours Access 91 91 (1) Monthly payments based on list size.

Enhanced Services 292 304 12

Seniority 106 106 0

Locum Adoption/Paternity/Maternity 100 43 (57)

Miscellaneous Expenditure - 37 37 Consultancy / Storage costs

CQC / Indemnity Fees 77 74 (3) Includes accrual for practices which haven't claimed in year

Prof Fees Prescribing 94 92 (2)

Other 377 352 (25)

Premises Rent 358 349 (8) Reduction in Notional Rent for P81112

Premises Rates 77 58 (18)

Premises Water Rates 13 10 (4)

NHSPS Healthcentre Charges 296 297 1

Voids & Subsidies 255 308 53

Contract - Refuse & Clinical Waste 38 15 (23)

Premises 1,037 1,038 1

Contingency 70 - (70)

Reserves 233 - (233)

Reserves / Contingency 303 - (303)

Grand Total 13,951 13,655 (296)

Includes accrual for achievement based on CQRS data 04/04/19

Proposed template business case for GP relocation applications

May 2019

1.0 Introduction 1.1 The purpose of this report is to present the proposed template business case

for use in all future GP relocation applications for all CCG areas across Lancashire and South Cumbria.

1.2 The template has been developed with the intention of providing commissioners

with the detailed information they require to consider the implications of a proposed relocation in relation to their commissioning intentions

2.0 Background and Summary 2.1 NHS England published the Policy Book for Primary Care in January 2016

providing commissioners with guidance on the processing of primary care contractual management and changes.

2.2 In 2017 NHS England released the Primary Medical Care Policy and Guidance

Manual (PGM) which expanded the Policy Book guidance and included templates for commissioners to use when considering a range of contractual changes.

2.3 Commissioners were advised that they could develop these templates further

to ensure that they are gathering the information they require to consider proposed contractual changes including boundary changes, list closures and practice mergers.

3.0 Template 3.1 Further to recommendations received at Chorley and South Ribble and Greater

Preston Primary Care Commissioning Committee in February 2019, in relation to Practice Mergers template, NHS England has reviewed the questions within the business case for practice relocations and is proposing the changes as follows, (Appendix A).

3.2 Changes as recommended: -

• Expanding on the Engagement and Consultation - who/methods and the responses to the feedback received.

• Transport details for patients reliant on public transport

• EIA assessment 3.3 Additional amendments to expand on patient consultation and engagement: -

• Building and Parking – does it confirm to building regulations and provision of parking spaces for the site i.e. disabled, service users and occupiers etc.

• Service Improvements (breakdown of sub headings) with a clear detailed plan on how the patient will benefit from the relocation?

o Access and Telephone etc.

• CCG’s view of relocation 3.4 These proposed changes provide further information and clarification in relation

to patient engagement and consultation and will enable the commissioners to assess the impact and implications of a practice’s proposal.

4.0 Policies 4.1 The underlying principle for CCGs and NHS England to consider when any

such proposal is made to them is what the benefit is for the patients and what the financial implications are.

4.2 The application meets all relevant regulatory requirements and is consistent

with the Policy Book for Primary Medical Services which requires consideration in relation to the benefits to patients and the financial consequences.

5.0 Recommendation(s) 5.1 The Primary Care Commissioning Committee is asked to approve the proposed

template business case for use in all future GP practice relocations applications.

5.2 The Primary Care Commissioning Committee is asked to approve the patient

engagement and consultation recommendations to be applied to the Practice Merger business care applications.

Lysa Hasler Primary Care Manager NHS England

Appendix A

Premises Relocation Business Case

The proposed relocation of a GP practice’s premises represents a significant change to the provision of services to patients. Accordingly, prior to applying to relocate, practices are required to consult on their proposal with the Clinical Commissioning Group (CCG), registered list of patients, Healthwatch, the Patient Participation Group (PPG), the Local Medical Committee (LMC), local Acute and Community Trusts, local practices/network, and partnership organisations (District Nurses, Health Visitors, School Nurses, etc). The detailed results of these consultations should be appended to this application. The minimum requirement of consultation is that a 5-10% cross section of the practice’s registered patient list is written to (either by letter or email) asking for their views on the proposed relocation. Details on the practice website, posters in waiting areas and information leaflets should also be utilised and will offer further opportunities for the surgery to capture the views of patients on the proposal.

Practice Details

Practice code

Practice name

Current practice address

Proposed practice address

Proposed relocation date

Engagement and consultation

What level of engagement has been undertaken with the following groups? Please provide detailed information and analysis of the feedback received from each group?

Clinical Commissioning Group (CCG) (If neighbouring practices are in a different CCG area, please ensure that their CCG is also contacted.)

Registered Patients – please detail the number of patients consulted, the methodology used and the responses received. Please also detail the reassurances given to specific queries/concerns raised by patients during this consultation exercise.

Patient Participation Group (PPG)

Healthwatch

Local Medical Committee (LMC)

Local Acute and Community Trusts

Local practices/network

Partner organisation’s teams e.g. District Nurses, Health Visitors, School Nurses, etc.

Transport Links/Services

Please provide details regarding how you intend to support patients who are reliant upon public transport to access the surgery.

Proposal

Please provide details regarding the primary reasons for the proposed relocation and how it is expected that the new premises would address these issues.

What would be the strategic benefits/service improvements to the Commissioner by them agreeing to the relocation? Provide details of what the improvements will be to:

Opening hours

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Range of services to be made available

Availability of appointments

Financial savings

I.T. (including telephony improvements e.g. number 4of patient line, dedicated prescription lines, etc)

Workforce capability

Patients

Please provide information regarding the support that the practice will make available to support displaced patients who may choose not to/not be able move to the new surgery location?

What would be the potential impact on groups protected by the Equality Act 2010?

Age

Disability

Gender reassignment

Race

Religion or belief

Sex

Sexual orientation

Marriage and civil partnership

Pregnancy and maternity

Premises

Will the relocation result in services being provided from premises that are fit for purpose in accordance with minimum standards set out in 2013 GMS Premises Costs Directions, or do you have an approved Business Plan to achieve this within no more than 12 months?

Details of the premises information for both the current and proposed sites:

Current site Proposed site

Neighbouring practices distance from both sites – specify name and practice code

Surgery 1…...……………………

Surgery 2…...……………………

Surgery 3…...……………………

Surgery 4…...……………………

Please detail the different room types specifying the number and m² for each

Number m² Number m²

Consulting rooms

Nurses rooms

Waiting areas

Reception

Medical records store

Practice manager’s office

Staff room

Library

Other, specify…………….……...

Car parking spaces (number)

Disabled car parking spaces (number)

Rent (notional or cost) costs £s

Service charge costs £s

Please provide details of references made in the GP Survey to the existing premises.

Please confirm that the existing agreed practice area will be retained if the proposed relocation is approved?

What are the risks associated with this proposed relocation for both if it is approved or not approved?

Is the proposed relocation supported by the CCG Estates Strategy and Commissioning Strategy? (CCG confirmation to be included in additional information appendices)

West Lancashire Clinical Commissioning Group

Primary Care Commissioning Committee

Quarterly Contractual Changes Summary

9 July 2019 Overview Detailed within this report is a summary of any Contractual Changes effective in the previous quarter (April 2019 – June 2019) where Contract Variations have been processed to reflect a change to a practice’s existing contract. Partnership Changes

• P81138 Burscough Family Practice - Dr Biswas joined the practice with effect from 29 April 2019.

• P81138 Burscough Family Practice - Dr Duddukuri resigned from the practice with effect from 30 April 2019.

• P81041 Parkgate Surgery - Dr Billington joined the practice with effect from 1 April 2019.

• P81045 The Elms - Dr Duddukuri joined the practice with effect from 1 May 2019.

• P81695 Aughton Surgery - Dr McGrath resigned from the practice with effect from 30 April 2019.

Practice Mergers

• P81041 Parkgate Surgery and P81727 County Road Surgery – On 12 March 2019 the CCG Primary Care Commissioning Committee considered an application to merge from P81041 Parkgate Surgery and P81727 County Road Surgery. The application was approved, with the merger being effective from 16 April 2019. The merged practice continued under P81041 with P81727’s code ceasing.

Open and Closed Lists No list closure applications were effective during this quarter. Boundary Changes No boundary changed applications were effective during this quarter.

Premises (Relocations) No premises relocations were effective during this quarter. Recommendation Members of the Primary Care Commissioning Committee are asked to note the content of this report. Steven Harris Project Officer Sarah Bloy Senior Primary Care Manager

May 2019

Primary Care Commissioning Committee

Report Title Primary Care Services Quality Highlight Report

Written by Allison Sathiyanathan, Quality Assurance Manager

Presented by Allison Sathiyanathan, Quality Assurance Manager

Meeting date 9 July 2019

Purpose of the Paper

To present a summary of quality issues relating to Primary Care services provided to residents in West Lancashire.

Context

This paper escalates quality related issues identified by the CCG’s Quality Team and Primary Care Lead in line with the Framework for managing general practice performance and quality.

This is the first paper to the Primary Care Commissioning Committee and therefore content and format is for discussion.

Key Points to Note CQC There are currently 3 practices rated as Requires Improvement following recent CQC reports. These practices are at a surveillance level 2 (minor concerns). One of these practices was visited in May and provided an updated CQC action plan and assurance that the requirements would be achieved within timescales. CCG visits to the other practices are scheduled. All other practices are at level 1 (routine monitoring). Infection Control The target for reducing the number of community cases of E. coli remains challenging. As the main focus of the bacteraemia is the lower urinary tract the CCG are working with practices to promote hydration with the aim of reducing urinary tract infections. Patient Experience 8 complaints were received by the CCG in Quarter 4 of 2018/19 all via the local MP. 6 were categorised as access & waiting and 2 related to care provision. For complaints submitted to NHSE, West Lancashire CCG displays the second lowest number of complaints per 1000 population within Lancashire & South Cumbria (Quarter 3). NHSE have developed a quality dashboard that will inform this report in the future.

Purpose/ Actions Required

The Group are requested to note the contents of this report along with actions being taken where concerns have been raised.