primary care commissioning committee agenda

Primary Care Commissioning Committee

A meeting will be held from 9.30am – 11.30am on Thursday 30 January 2020 CCG Committee Room, Portsmouth

AGENDA

1. Apologies for Absence and Welcome

Ms M Geary Verbal

2. Register and Declarations of Interest

Ms M Geary Paper

3. Minutes of Previous Meeting a) To agree the minutes of the Primary Care Commissioning

Committee meeting held on 29 October 2019 b) Matters Arising

Ms M Geary Paper

4. Primary Care Risk Register – summary of key high level risks.

Ms T Russell Paper

5. Section 96 Funding Policy – draft

Ms R Spandley Paper

6. Portsmouth Practice List Sizes

Mr S McInnes Paper

7. Personal Medical Service (PMS) contract changes

• Chair’s Action: GP Retirement at Derby Road Group Practice

Ms T Russell Paper

8. Primary Care Finance update

Ms R Spandley Paper

9. Axe the Fax Campaign Mrs C Horan Paper

10. Additional General Medical Services (GMS) Space Application for Trafalgar Medical Group

Ms S Macey Paper

11. Date and Time of Next Meeting in Public The next Primary Care Commissioning Committee meeting to be held in public will take place on Thursday 26 March at 10.00am, Conference Room A, Civic Offices, Portsmouth

12. Meeting Close

Distribution:

Members Margaret Geary - Lay Member (Chair) Mark Compton - Deputy Director of Transformation Simon Cooper - Deputy Director Medicines Optimisation Jason Eastman - Associate Director of IM&T Dr Helen Atkinson - Interim Director of Public Health, Portsmouth City Council Julia O’Mara - CCG Nurse Advisor

Jackie Powell - Lay Member Terri Russell - Deputy Director, Primary Care David Scarborough - Practice Manager Representative Andy Silvester - Lay Member Michelle Spandley - Chief Finance Officer Dr Clare Sieber - Medical Director Local Medical Committees Ltd Jo York - Director, New Models of Care In Attendance Roger Batterbury - Healthwatch Nikki Burnett - Deputy Chief Finance Officer Sylvia Macey - Primary Care Estates Programme Manager Dr Elizabeth Fellows - Chair of Governing Board (GP) Lisa Harding - Director of Primary Care Christine Horan - Primary Care Improvement Manager Justina Jeffs - Head of Governance Steve McInnes - Primary Care Relationship Manager Dr Nick Moore - Clinical Executive Stephen Orobio - Clinical Quality Manager Rebecca Spandley - Assistant Finance Manager Lisa Stray - Business Assistant (minute taker) Joanne Williams - Acting Deputy Director Medicines of Optimisation

PRIMARY CARE COMMISSIONING COMMITTEE

Date of Meeting 30 January 2019 Agenda Item No

2 Title

Register and Declarations of Interest

Purpose of Paper

In order to meet its statutory duty, the CCG has revised processes for managing conflicts of interests to reflect national guidance published by NHS England throughout 2016/17. • The Committee Register of Interest holds information on the

Committees, its members and regular attendees. • Members are also required to declare any conflicts of interest

against agenda items for each meeting. These conflicts are recorded as per the guidance.

Recommendations/ Actions requested

The Committee are requested to:

• note the Register of Interests and • declare any actual, possible or perceived conflicts against the

agenda items of the Committee.

Engagement Activities – Clinical, Stakeholder and Public/Patient

Not Applicable

Item previously considered at Governing Board, Audit Committee

Potential Conflicts of Interests for Committee Members

None

Author

Margaret Geary, Lay Member (Committee Chair)

Sponsoring member

Margaret Geary, Lay Member (Committee Chair)

Date of Paper

22 January 2020

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NHS Portsmouth Clinical Commissioning Group Register of Interests - Governing Board/Committee Members

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Karen Atkinson Registered Nurse Representative on Governing Board

Southern Health NHS Foundation Trust Indirect Niece works at Matron for MH Services

Current Declare conflict where appropriate in discussions relating to mental health services


Compass Independent Fostering Agency

Direct Looked after child in situ Current Declare conflict where appropriate


Nursing and Midwifery Council Direct Member Current Manage in line with CCG policy


Surrey and Borders NHS Trust Direct Bank employee Current Declare conflict where appropriate. Manage in line with CCG policy

Nicola Andrews Quality Improvement Manager

Nil

Roger Batterbury Chair, Healthwatch, Portsmouth

Healthwatch Portsmouth Direct Chair 2013 Current Manage in line with CCG policy Attendee


Rebound Carers Group Direct Director/Trustee 2014 Current Would step aside should a grant be discussed.

Attendee


Solent NHS Trust Direct Bank SIRI Investigator 2016 Current Should any discussion relate to this role I would declare my role

Attendee


East Shore Partnership Direct Vice Chair Patient Participation Group

2015 Current Manage in line with CCG policy. Attendee


Nursing and Midwifery Council Direct Member as RMN 1991 Current Would declare my membership if relevant

Attendee

Nicola Burnett Deputy Chief Finance Officer

Healthcare Financial Management Association

Direct Member 2016 Current Manage in line with CCG policy. Attendee Attendee

Nicola Burnett Deputy Chief Finance Officer

Association of Certified Chartered Accountants

Direct Fellow Member 2008 Current Manage in line with CCG policy. Attendee Attendee

Dr Linda Collie Chief Clinical Officer/Clinical Leader

East Shore Partnership Direct Partner Current Manage in line with CCG policy Chair from June 2017


Portsmouth Primary Care Alliance Ltd (PPCA)

Direct Practice is a Member Current Manage in line with CCG policy Chair from June 2017


Portsmouth Primary Care Alliance Ltd (PPCA)

Direct Sessional GP Work Current Manage in line with CCG policy Chair from June 2017

Mark Compton Deputy Director of Transformation

Nil

Simon Cooper Deputy Director Medicines Optimisation

Health Education England Indirect Wife works for Health Education England

Current Manage in line with CCG policy

Simon Cooper Deputy Director Medicines Optimisation

Specialist Pharmacy Services Indirect Wife works for Specialist Pharmacy Services


Michael Drake Director of Planning and Performance

Portsmouth Hospitals Trust Indirect Wife works in Human Resources Department

1999 Current Manage in line with CCG policy

Jason Eastman Associate Director of IM&T

Nil

Dr Elizabeth Fellows Chair/Clinical Executive East Shore Partnership Direct Partner Current Manage in line with CCG policy Chair

Dr Elizabeth Fellows Chair/Clinical Executive Portsmouth Primary Care Alliance Ltd (PPCA)

Direct Practice is a Member Current Manage in line with CCG policy Chair

CommitteeName Action taken to mitigate riskNature of InterestDeclared Interest- (Name of the

organisation and nature of business)

Current position (s) held- i.e. Governing Body, Member practice, Employee or other

Date of InterestType of InterestIs the interest direct or indirect?

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Dr Elizabeth Fellows Chair of Governing Board/Clinical Executive

Circle Health Direct Shareholder Current Manage in line with CCG policy Chair

Dr Elizabeth Fellows Chair of Governing Board/Clinical Executive

NHS Portsmouth Clinical Commissioning Group

Direct Designated Doctor for Looked After Children

01/07/2019 Current Manage in line with CCG policy Chair

Margaret Geary Lay Member Associate Member of Association of Directors of Adult Social Services

Indirect Associate Member Aug-17 Current Manage in line with CCG policy Interim Chair Chair

Margaret Geary Lay Member Age UK Portsmouth Indirect Chair Apr-15 Current Manage in line with CCG policy Interim Chair Chair

Margaret Geary Lay Member Roberts Centre Family & Children's Indirect Trustee Sep-13 Current Manage in line with CCG policy Interim Chair Chair

Margaret Geary Lay Member Action Hampshire Indirect Trustee Oct-13 Current Manage in line with CCG policy Interim Chair Chair

Meyrick Grundy Clinical Quality Manager Nil

Jo Hanswenzl NHS England - Assistant Contracts Manger (Acting)

Nil Attendee

Lisa Harding Officer of Wessex LMC Wessex Local Medical Committee Direct Local representative body for GPs and their practices

Present Manage in line with CCG policy Attendee

Christine Horan Primary Care Improvement Manager

Nil Attendee

Dr Jason Horsley Governing Board Member

Portsmouth City Council/Southampton City Council

Direct Director of Public Health employed jointly

07/01/2017 Current In decisions where there is a potential conflict of interest between the CCG and either or both Councils, I would be acting in an advisory capacity that would not vote on the Governing Board.

Left 22/11/19


Southampton City Clinical Commissioning Group

Direct Member of Governing Body 07/01/2017 Current If deemed necessary by the Chair, I will abstain from voting decisions on or taking part in discussions where Southampton CCG may be a beneficiary.

Left 22/11/19


Hampshire Healthcare Foundation Trust

Indirect Wife works as a doctor in Infectious Diseases and Microbiology

07/01/2017 Current In decisions related to commissioning of these services I would not be a voting member, but may still act in an advisory capacity.

Left 22/11/19


Genito-urinary Medicine, Portsmouth Indirect A close friend works as a consultant locally

07/01/2017 Current In decisions related to commissioning of these services I would not be a voting member, but may still act in an advisory capacity.

Left 22/11/19


Faculty of Public Health Direct Fellow 07/01/2017 Current Manage in line with CCG policy Left 22/11/19

Katie Hovenden Clinical Associate Portsmouth Hospitals Trust Indirect Sister is Senior Orthopaedic Secretary


Katie Hovenden Clinical Associate General Pharmaceutical Council Direct Registered Current Manage in line with CCG policy Alison Jeffery Governing Board

MemberNil

Justina Jeffs Head of Governance Nil Aug-17 Current None required. Attendee Attendee Attendee Attendee Attendee

Rochelle Kneller Assistant Director, HR, Portsmouth City Council

Nil Attendee

Dr Carsten Lesshafft Clinical Executive Trafalgar Medical Group Direct Salaried GP Current Manage in line with CCG policy

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Dr Carsten Lesshafft Clinical Executive NHS Portsmouth Clinical Commissioning Group

Indirect In a relationship with a Commissioning Manager

03/06/2019 Current Manage in line with CCG policy

Dr Carsten Lesshafft Clinical Executive British Medical Association Direct Member Current Manage in line with CCG policy

Dr Carsten Lesshafft Clinical Executive Fine-Line Medical Aesthetic Treatments

Direct Sole Trader Current Manage in line with CCG policy

Dr Carsten Lesshafft Clinical Executive NHS England/Wessex Direct Appraiser Current Manage in line with CCG policy

Graham Love Lay Member HR Business Partner, Western Sussex Hospitals NHS Foundation Trust

Direct Employee Dec-17 Present Manage in line with CCG policy Chair

Graham Love Lay Member Chartered Institute of Personnel and Development

Direct Member Jun-05 Present Manage in line with CCG policy Chair

Steve McInnes Primary Care Relationship Manager

Nil

Dr Nicholas Moore Clinical Executive Derby Road Group Practice Direct Salaried GP Aug-19 Current Manage in line with CCG policy

Dr Nicholas Moore Clinical Executive GP Trainer, Health Education England, Wessex

Direct Delivery of training to GPs Jan-12 Current Manage in line with CCG policy

Dr Nicholas Moore Clinical Executive Portsmouth Primary Care Alliance Ltd (PPCA)

Direct Shareholder Nov-11 Current Manage in line with CCG policy

Dr Nicholas Moore Clinical Executive Wessex GP Appraisal Service Direct Appraiser Jul-19 Current Manage in line with CCG policy

Dr Nicholas Moore Clinical Executive Craneswater Group Practice Direct Financial investment in practice (as previous partner) and wife is GP at the practice

Nov-11 01/07/2019 Manage in line with CCG Policy

Trevor Nicholas Senior Finance Manager

Trusted Numbers Ltd, Financial Consultancy Business

Direct Director of Trusted Numbers Ltd, financial consultancy business previously providing services to health sector.

Dec-15 Current Business not currently active. Left 30/10/19


Aspire Ryde Direct Trustee - community based charity

Feb-18 Current Manage in line with CCG policy. Left 30/10/19


ACCA (Association of Chartered Certified Accountants)

Direct Member 2001 Current None Left 30/10/19

Julia O'Mara Practice Nurse Advisor J2S Limited Direct Director in Nurse training company providing training locally

01/01/2011 Current Will always declare this interest if involved in discussions regarding the provision of nurse education and will not participate in decision making regarding the award of any funding.

Julia O'Mara Practice Nurse Advisor RCN Member 01/12/2016 Current No risk

Stephen Orobio Clinical Quality Manager Nil Attendee

Anna Plumbly Quality Improvement Officer

Nil

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Jackie Powell Lay Member Solent NHS Trust Direct Associate Hospital Manager 2013 Present Declare conflict where appropriate in discussions relating to Solent and Mental Health Services

Jackie Powell Lay Member Southern NHS Foundation Trust Direct Mental Health Act Manager 2013 Present Declare conflict where appropriate in discussions relating to Mental Health Services

Jackie Powell Lay Member Off The Record - a Young Persons Support and Counselling Service

Direct Director 2013 Present Declare conflict where appropriate in discussions regarding mental health and wellbeing of young peoples' services

Jackie Powell Lay Member Off The Record - a Young Persons Support and Counselling Service

Direct Counsellor 2013 Present Declare conflict where appropriate in discussions regarding mental health and wellbeing of young peoples' services

Jackie Powell Lay Member You Trust Direct Counsellor Jan-18 Present Declare conflict where appropriate in discussions regarding mental health and wellbeing of young peoples' services

Jackie Powell Lay Member Relate - Young Persons Counsellor Direct Counsellor Oct-17 Present Declare conflict where appropriate in discussions regarding mental health and wellbeing of young peoples' services

Innes Richens Chief of Health & Care Portsmouth

Portsmouth City Council Direct CCG role is dual role with Portsmouth City Council that includes statutory responsibility for Adult Social Care

Apr-16 Current CCG/City Council joint risk mitigation agreement is in place for this role

Attendee Attendee


Portsmouth City Council Indirect Father in Law is a service provider within the City Council commissioned Shared Lives scheme

Apr-16 Current Manage in line with CCG policy Attendee Attendee


Portsmouth City Council Direct Member of the Board for The HIVE, a not-for-profit company delivering services in Portsmouth

Sep-19 Current Manage in line with CCG policy. Where any decisions relating to The HIVE are required, consider exclusion from the discussion and

Attendee Attendee


Portsmouth City Council Indirect Partner is a self-employed IT and software developer working across the south coast, including supporting the community and voluntary sector in Portsmouth.

Apr-16 Current Manage in line with CCG policy Attendee Attendee

Suzannah Rosenberg Director of Transition Solent NHS Trust Direct Substantively employed by Solent NHS Trust

01.07.19 Current Declare interest and abstain from commissioning decisions relating to Solent NHS Trust

Suzannah Rosenberg Director of Transition Solent MIND Indirect Friends with Director Current Declare interest and abstain from any funding decision

Terri Russell Deputy Director (Primary Care)

Academic Health Sciences Network Indirect Mother has a temporary consultancy role delivering training for the AHSN

Apr-17 Current Alternative team member to manage interface between practices and this work.

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Tracy Sanders Managing Director Sandpiper Associates Direct Director 14.12.16 Current Approval provided via T&Cs of employment to undertaken work for other NHS organisations. Little activity undertaken by company at present but when identified will consider any mitigating actions required if necessary.

Attendee Attendee

Tracy Sanders Managing Director University of Portsmouth Indirect Husband is Lecturer 14.12.16 Current Unlikely to present a conflict but to remain alert when CCG dealing with the University.

Attendee Attendee

Tracy Sanders Managing Director Chartered Institute of Management Accountants and a Chartered Global Management Accountant

Direct Associate Member 14.12.16 Current Unlikely to present a conflict but to remain alert should the CCG ever be dealing with the CIMA/CGMA.

Attendee Attendee

Tracy Sanders Managing Director Sandpiper Associates Indirect Husband is a Director of Sandpiper Associates

14.12.16 Current Any conflicts when identified will be declared in line with CCG policy

Attendee Attendee

David Scarborough Practice Manager Representative on Governing Board


Indirect Wife is Deputy Director of Quality and Safeguarding

Current Not in report chain. Manage in line with CCG policy

David Scarborough Practice Manager Representative on Governing Board

Trafalgar Medical Group Direct Business Manager Current Manage in line with CCG policy

Tina Scarborough Deputy Director Quality and Safeguarding


Indirect Husband is Practice Management Lead

01.04.18 Current Manage in line with CCG policy.

Sarah Shore Associate Designated Nurse for Children and Looked After Children

Nil

Clare Sieber Medical Director, Wessex LMC

Wessex Local Medical Committee Direct Local representative body for GPs and their practices

Present Manage in line with CCG policy

Andrew Silvester Lay Member Portsmouth Civil Service Sports Council

Direct Chair and some CCG staff are CSSC members

1996 Current Manage in line with CCG policy Chair

Andrew Silvester Lay Member Portsmouth Hospitals Trust Indirect Spouse is an employee 2016 Current Manage in line with CCG policy Chair

Andrew Silvester Lay Member Unite Trade Union Direct Elected workplace rep within the Defence sector

2016 Current Declare any lobbying in Health related matters

Chair

Andrew Silvester Lay Member Portsmouth City Council Direct Chair of Portsmouth Event Safety Advisory Committee

2019 Current Manage in line with CCG policy Chair

Andrew Silvester Lay Member Office of the Police and Crime Commissioner (OPCC)

Direct Volunteer Independent Custody Visitor

Current Manage in line with CCG policy Chair

Simon Simonian Clinical Executive Simonian Medical Limited Direct Director 2014 Current Manage in line with CCG policy

Simon Simonian Clinical Executive Winbell Limited Direct Helps father with business Current Manage in line with CCG policy

Simon Simonian Clinical Executive Lola Alvarez Psychotherapist Indirect Clinical Trustee Current Manage in line with CCG policy

Simon Simonian Clinical Executive Portsmouth Primary Care Alliance Ltd (PPCA)

Direct Sessional GP Work Current Manage in line with CCG policy

Michelle Spandley Chief Finance Officer Chartered Institute of Management Accountants (CIMA) and Chartered Global Management Accountants (CGMA) designation.

Direct Member Current Manage in line with CCG policy Attendee Attendee

Michelle Spandley Chief Finance Officer Healthcare Financial Management Association

Direct Member Current Manage in line with CCG policy Attendee Attendee

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Michelle Spandley Chief Finance Officer NHS Portsmouth Clinical Commissioning Group

Indirect Daughter is employed in the Finance Department

Current Daughter does not report directly to Michelle. There are systems in place to ensure that segregation of duties is addressed.

Attendee Attendee

Michelle Spandley Chief Finance Officer Joint STP Director of Finance Indirect STP role in addition to CCG role - overseeing finances across the Partnership

Sep-17 Current The role should provide opportunities for the CCG in greater understanding of the STP including current priorities. There maybe times when Portsmouth CCG has an alternative view to decisions taken at STP level. I will need to agree on a case by case basis the stance to be taken, which may include declaring the interest and standing aside from decision making process

Attendee Attendee

Rebecca Spandley Finance Manager NHS Portsmouth Clinical Commissioning Group

Indirect Mother is Chief Finance Officer for the CCG

Current Rebecca and Michelle do not discuss CCG business outside of the workplace. Not involved in the same approval processes/approval hierarchy.

Tahwinder Upile Secondary Care Specialist Doctor on Governing Board

University Hospitals Southampton NHS Foundation Trust & Hampshire Hospitals NHS Foundation Trust

Direct Secondary and Primary Care Physician



Concordia Healthcare Direct Secondary and Primary Care Physician

Jan-17 Current Manage in line with CCG policy


Harley Street LMA Group Direct Consultant Aug-12 Current Manage in line with CCG policy

Nigel Watson Chair of Local Medical Committee

NHS England Direct Worked for DHSC Partnership Review reporting to Secretary of State and CEO of NHSE

Jun-18 31/01/2019 Manage in line with CCG policy

David Williams Governing Board Member

Portsmouth City Council & Gosport Borough Council

Direct Chief Executive 2007 Current None


Solent NHS Trust Direct Appointed Governor 2010 Current None


Portsmouth University Technical College (UTC)

Direct Founding Member Current None


Victory Energy Services Limited Direct Director 2019 Current None

Jo York Director (New Models of Care)

Nil

STAFF LISTMarcel Britton Executive Assistant Nil Minutes

Jayne Collis Business Development Manager

Portsmouth Hospitals Trust Indirect Sister in Law works at PHT Current Manage in line with CCG policy Minutes

Victoria Sexton Business Development Manager

Nil Minutes Minutes

Lisa Stray Business Assistant Nil Minutes

Elizabeth Taylor Executive Assistant Nil Minutes



3 Title

Minutes of Previous Meeting

Purpose of Paper

To agree the minutes of the Primary Care Commissioning Committee meeting held on 29 October 2019


Committee members are requested to Approve the minutes of the previous meeting.


N/A

Item previously considered at N/A


N/A

Author

Lisa Stray, Business Assistant

Sponsoring member

Margaret Geary – Lay Member (Committee Chair)

Date of Paper

22 January 2020

1

DRAFT

Minutes of the Primary Care Commissioning Committee meeting held on Tuesday 29 October 2019 at 10.30am – 12.30 pm in Committee Meeting Room, CCG HQ, Portsmouth

Summary of Actions

Agenda Item

Action Who By

5. GP Patient Survey results

Will set up a Task and Finish group to look at the results, particularly in relation to access. Engage with other local CCGs to share intelligence and discuss findings.

S McInnes

January

6. Personal Medical Services (PMS) Reinvestment – Commissioning Intentions

Share specific specifications outside of this Committee with group members as they become available

T Russell

Ongoing

7. Care Navigation update Work and support practices around areas of improvement. Look at ways of increasing utilisation of the locally developed SystmOne Care Navigation template. Provide training and develop a close working relationship with practices, one of the options would be individual practice visits. Liaise with Care Navigators and discuss how Primary Care can support them. Look at ways of embedding Care Navigators into practices. Identify super users in practices. Bring back an update every six months.

C Horan

March

8. Primary Care Finance M06 2019/20 Will clarify the current Primary Care financial position at the next meeting.

R Spandley

January

2

9. Ear Irrigation within Primary Care Will consult with the Local Medical Committee further regarding tariffs and prepare the specification.

S McInnes

See item 6 above

10. Review of Practice Merger Will share the results of the patient survey and provide an update at a future meeting.

S McInnes

January

Present: Margaret Geary - Lay Member (Chair) Mark Compton - Deputy Director of Transformation Dr Elizabeth Fellows - Chair of Governing Board (GP) Jackie Powell - Lay Member Terri Russell - Deputy Director of Primary Care David Scarborough - Practice Manager Representative Dr Clare Sieber - Local Medical Committees Medical Director (GP) Jo York - Director (New Models of Care) Apologies: Simon Cooper - Director of Medicines Optimisation Jason Eastman - Associate Director of IM&T Lisa Harding - Local Medical Committee Representative Dr Jason Horsley - Director of Public Health, Portsmouth City Council Andy Silvester - Lay Member Michelle Spandley - Chief Finance Officer Rebecca Spandley - Assistant Finance Manager In Attendance: Roger Batterbury - Healthwatch Representative Christine Horan - Primary Care Improvement Manager Justina Jeffs - Head of Governance Steve McInnes - Primary Care Relationship Manager Stephen Orobio - Clinical Quality Manager Lisa Stray - Business Assistant Jo Williams - Acting Director of Medicines Optimisation 1. Apologies and Welcome

Margaret Geary welcomed members to the meeting, noted the apologies as above and reminded those present of the following: • The meeting is not a public meeting and therefore no participation from members of the

audience would be allowed during the formal business of the Committee. • The CCG undertakes Primary Care Co-commissioning under delegated powers from

NHS England • In order to support the management of any conflicts of interests, the Chair is a lay

member of the CCG. • The Chair will determine action to be taken where members declare a conflict in line

with the CCG’s policies.

3

2. Declarations/Conflicts of Interest

Members working in General Practice declared a conflict of interest with agenda items 6, 9 and 10. Margaret Geary, as the Chair, agreed that the conflicted member could participate in the discussion but not in any decision-making. Justina Jeffs reported that the Register of Interests – Governing Board/Committee Members document will be updated accordingly with the following change: Delete ‘Dr Nigel Watson, Wessex Local Medical Committee Ltd (GP)’ and replace with ‘Dr Clare Sieber, Local Medical Committees Medical Director (GP)’

3. Minutes of Previous Meeting

The minutes of the Primary Care Commissioning Committee meeting held on Tuesday 27 August 2019 were approved as an accurate record. An update on actions from the previous meeting was provided as follows:

Agenda Item

Action Progress

7. Hampshire and Isle of Wight (HIOW) Primary Care Strategy Agreed Actions: • Take comments back to NHS England and will

provide an update as appropriate.

• Share any additional comments back to Terri Russell.

• Share with the board as a now a public

meeting. • Share with members of the Primary Care Board

circulation list.

All Actions have been Completed

8. Any Other Business • A straw poll will be conducted with Committee

members to ascertain the most suitable day that all members can to attend future Primary Care Commissioning Committee and Primary Care Commissioning Committee Part II meetings.

Completed

4. Risks

There were no new risks to report. The Primary Care Commissioning Committee noted the update.

4

5. GP Patient Survey results

Members were informed of the latest GP Patient Survey (GPPS) results. The report reflected that results were generally lower than both national and comparative CCG areas, and were declining against previous results. The range across practices was also noted and it was advocated that any learning points should be shared. The data had previously been shared at the CCG’s Quality and Safety Executive Committee where it was agreed that the Primary Care Team will work collaboratively to identify and try to address specific issues that may be relative to access. Results relating to perception of care were positive and the Committee agreed this reflected well on the Health Care Professionals.

Members raised the following:

• Educate patients on how to make use of available resources and allow them time to adjust to such changes within the practice.

• Review the results in more detail and discuss with practices to better understand the issues.

Steve McInnes will set up a Task and Finish group to look at the results, particularly in relation to access. Steve will also engage with other local CCGs to share intelligence and discuss findings.

Action: S McInnes The Primary Care Commissioning Committee noted the report.

6. Personal Medical Services (PMS) Reinvestment – Commissioning Intentions

David Scarborough the Practice Manager Representative working within Primary Care and Dr Elizabeth Fellows, Chair of Governing Board and GP of the Committee, declared an indirect conflict of interest with information contained with the paper. Margaret Geary, as the Chair, agreed that David Scarborough and Dr Elizabeth Fellows could participate in the discussion but not in any decision-making.

Terri Russell spoke to the PMS Reinvestment – Commissioning Intentions paper that included previously approved principles for reinvestment and additional proposed schemes. The additional proposed schemes would make use of further reinvestment monies both in this financial year and recurrently going forward. Members were provided with an explanation of the origins of each new scheme and the estimated funding requirements.

Additional schemes in 2019/2020

• Long action reversible contraception (LARC) for non-contraceptive reasons Local Commissioned Service - £40k

• Safeguarding Local Commissioned Service - £60k • Ear irrigation Local Commissioned Service - £90k

Agreed Actions:

• Share specification outside of this Committee with group members • Work out where practices have not been claiming and share with the group.

Action: T Russell

Committee members were asked to approve the outlined Commissioning Intentions.

5

The Primary Care Commissioning Committee will approve the final scheme outside of the meeting.

7. Care Navigation update Chris Horan provided an overview of the Care Navigation Programme which supports Care Navigators in identifying and actively signposting patients and carers to the most relevant healthcare service for them at that time.

Members raised the following:

• Roger Batterbury raised a concern that practices should be allowed adequate time to adjust to changes.

• Chris Horan highlighted that the data indicated that not all practices were using the locally developed SystmOne Care Navigation template; this did not mean that practices were not Care Navigating.

• Jo York said that this is a good opportunity to take to non-clinical TARGET. • Terri Russell suggested that to help embed Care Navigation into practice it is integral

that practice management is involved in supporting their staff in the development of new processes and ways of working within practices.

• Dr Elizabeth Fellows commented that it would be useful for The Lighthouse Group Practice who has the highest users of the template to share what they are doing with other practices, to help other staff members to understand the system and the process they have embedded.

• Further to a question by Jackie Powell, Chris Horan confirmed that You Trust is part of the Social Prescribing.

The following Actions were agreed:

• Work and support practices around areas of improvement. • Look at ways of increasing utilisation of the locally developed SystmOne Care

Navigation template. • Provide training and develop a close working relationship with practices, one of the

options would be individual practice visits. • Liaise with Care Navigators and discuss how Primary Care can support them. • Look at ways of embedding Care Navigators into practices. • Identify super users in practices. • Bring back an update every six months.

Action: C Horan

Committee members were asked to receive the information provided in the report.

The Primary Care Commissioning Committee received the report

8. Primary Care Finance M06 2019/20 Dr Clare Sieber raised a question around the tracked spending figure on the Primary Care Finance 2019/20 report. Rebecca Spandley will clarify the current Primary Care financial position at the next meeting.

Action: R Spandley The Primary Care Commissioning Committee agreed that the Finance report will be carried forward to the next meeting.

6

9. Ear Irrigation within Primary Care David Scarborough the Practice Manager Representative working within Primary Care and Dr Elizabeth Fellows, Chair of Governing Board and GP of the Committee, declared an indirect conflict of interest with information contained with the paper. Margaret Geary, as the Chair, agreed that David Scarborough and Dr Elizabeth Fellows could participate in the discussion but not in any decision-making. Committee members worked through the proposed Locally Commissioned Service (LCS) i for the removal of ear wax within Primary Care. The proposal considered a new LCS or adding to an existing Basket LCS with an estimated finance around £90k. In both cases, Personal Medical Services Re-investment monies could be utilised to secure recurrent funding. Steve McInnes reported that a recent survey of GP practices recognised that 9 practices in Portsmouth are currently providing a service, with 5 practices referring patients elsewhere. Due to difficulties in maintaining competencies and keeping equipment in good working order, there is at least 2 practices strongly considering withdrawing from this service in the near future. Members raised the following:

• Dr Elizabeth Fellows raised a concern regarding the on-going costs of replacing insufficient quality equipment on a yearly basis.

• Dr Clare Sieber suggested a buddy arrangement should be considered to enable practices to share equipment.

• Julia O’Mara highlighted an inequality for patients across the city that are currently unable to access this service, and explained that not enough nurses are adequately trained to inspect the ear.

• Julia O’Mara asked if the new LCS will cover house bound patients. It was advised this wold be a community care responsibility.

• Steve McInnes said that he felt the new service would make good use of PMS reinvestment funds in Primary Care.

Steve McInnes will consult with the Local Medical Committee further regarding tariffs.

Action: S McInnes The Primary Care Commissioning Committee agreed the proposal in principle.

10. Review of Practice Merger

David Scarborough the Practice Manager Representative working within Primary Care and Dr Elizabeth Fellows, Chair of Governing Board and GP of the Committee, declared an indirect conflict of interest with information contained with the paper. Margaret Geary, as the Chair, agreed that David Scarborough and Dr Elizabeth Fellows could participate in the discussion but not in any decision-making.

Steve McInnes provided an update on the recent Practice Merger between The Devonshire Practice and Southsea Medical Centre, now known as The Lighthouse Group Practice. The merger had helped ensure services were sustained for patients and both the practice and the CCG felt the merger had been very positive. The timing had co-incided with some new initiatives and changes to the workforce, which had a positive impact on services. Steve thanked Andrew Clarke, Practice Manager, for leading the merger and for his considerable

7

hard work and effort during the process. All of the staff had worked tirelessly to ensure the merger went as smoothly as possible. The practice will undertake a patient survey in November, in order to gauge patient’s opinions around the merger and the new processes in place. Steve McInnes will share the results of the patient survey and provide an update at a future meeting.

Action: S McInnes Committee members were asked to receive the report. The Primary Care Commissioning Committee noted the report.

11. Any Other Business The CCG offices will be completely closed on the 27 December 2019. All GP practices have their individual continuity plan and aware of CCG on-call arrangements.

12. Date of Next Meeting

The next Primary Care Commissioning Committee meeting to be held in public will take place on Thursday 30 January 2020.

- Present A – Apologies

Member Name Apr 2019

Jun 2019

Aug 2019

Oct 2019

Dec 2019

Jan 2020

Margaret Geary Mark Compton A A Simon Cooper A A Jason Eastman A Dr Jason Horsley A A A A Jackie Powell Suzannah Rosenberg

Terri Russell David Scarborough A Dr Clare Sieber Andy Silvester A A Michelle Spandley A A A A Dr Nigel Watson A A Jo York A



4 Title

Risk Register

Purpose of Paper

To share information regarding high level risks from the Primary Care Risk Register.


To receive the paper


N/A

Item previously considered at Primary Care Commissioning Committee


N/A

Author

Terri Russell, Deputy Director of Primary Care

Sponsoring member

Jo York, Director (New Models of Care)

Date of Paper

22 January 2020

1

Primary Care Team (collated) Risk Register Report - Portsmouth CCG

Primary Care Co-Commisioning Project Risk Register

Risk Ref Risk Title Description I L Original

Risk Score

Key Controls Assurance Actions I L Current

Risk Score

Latest Note

PRC.P.05e

Practice Viability

If current primary care pressures cause practices to become unviable or unsustainable then practice could give notice on their contract potentially impacting on patient care and destabilising other practices

4 4 16 Primary Care Team actively engaging with practices to understand risk and to put in place mitigating actions to support practices GP practices merging and changing how services are delivered to become more resilient and sustainable

Monitoring of quality of primary care delivery, engagement of practices and CQC inspections Minimal escalated SITREPs

Potential Utilisation for the short term Primary Care medical services framework to quickly secure and alternative provider if required Encouraging all practices to move to SystmOne Accessing resilience programme Develop suite of responses to escalated SITREPs

4 3 12

PRC.P.05h

Practice Closures

If there is inadequate engagement around any proposed practice closures there may be a risk to patient safety, adverse publicity and a decrease in patient satisfaction

3 4 12 Applications for practice or branch closure to be considered by PCCC

Patient satisfaction surveys and practice performance in terms of access Proactive engagement with the public regarding the future options for general practice

Robust process for managing requests for practice or branch closures including patient and stakeholder engagement.

3 3 9

PRC.P.05i

PMS Contract Variations

If the CCG is unaware of or practices do not sign and return PMS contract variations (where they is joint and several responsibility) there is a significant risk to individuals, should anything go wrong

4 3 12 Process of updating all PMS contracts completed and regular communication from the Primary Care Team

Authorisation of PMS contract changes at PCCC

Escalation process in place where practices are not returning signed contract variations

4 2 8

PRC.P05j

PMS practices

If the PMS premium reinvestment work, carried out over five years

4 3 12 Clear principles agreed for reinvestment back into

Investment plans developed and shared at PCOG and

Section 96 flexibilities available if necessary

4 2 8

2


Risk Score


Risk Score

Latest Note

start to have a significant financial impact on practices in the remaining 3 years they may become unviable

General Practice and additional support available through the resilience programme

PCCC

Primary Care Programme (Portsmouth Clinical Commissioning Group) Risk Register


Risk Score


Risk Score

Latest Note

PRC.P.LSP

Loss of Suitable Premises

If primary care leased premises come to the end of their term, or partners who own freehold premises wish to exit the partnership and sell their premise, then practices may lose access to suitable premises to deliver services which may compromise patient care

4 2 8 Contractual stipulations ensure that GP practices are responsible for delivering services within suitable premises. Local Estates Forum established which can monitor and manage primary care premises risk

CCG has strong ties to NHS Property Services who hold the majority of head leases for leased properties within the city Changes to partnerships are required to be notified to the CCG – practices would need to identify the risk of premise loss at this stage

CCG to support practices at risk of premise loss to devise a plan to mitigate the risk or to obtain alternative premise arrangements Links to the wider estates strategy

4 2 8

R.Ports.PrC.18

Premises Flexibility

If primary care estate in the city is not flexible and able to adapt to accommodate evolving models of care delivery then improvements in patient care may be inhibited and national and local strategic ambitions may not be realised

4 4 16 Annual Premise Improvement Grant monies identified to develop primary care estate Local Estates Strategy developed to provide strategic direction for primary care estate

Local Estate Forum established to oversee potential estate development Feasibility studies commissioned across Portsmouth identifying opportunities for virtual and physical hub development to support new models of care

Formalise processes to routinely review existing primary care estate and its ability to accommodate new delivery models Identify potential capital investment and develop robust business cases to invest in refurbishing / extended existing primary care estate to accommodate new models of care

3 3 9

Primary Care Team Risk Register (Only)


Risk Score


Risk Score

Latest Note

R.Ports.PrC.01

New models of care

If member practices do not engage in collaborative working

4 3 12 CCG fund an MOU with the Portsmouth Primary

MCP Partnership Agreement signed between the CCG,

CCG and PPCA to continue engaging with member

3 3 9 Consideration being given to making

3


Risk Score


Risk Score

Latest Note

with other providers then this will impact on the development of an MCP, the Portsmouth Blueprint, and potentially primary care sustainability

Care Alliance to progress integration and collaborative working CCG has established Health and Care Executive to oversee Blueprint implementation

PPCA, Solent, and the Local Authority MCP partners are holding weekly MCP meetings to facilitate the delivery of new models of care

practices on the MCP transformation work programme

resources available via primary care CQUIN to support MCP engagement

R.Ports.PrC.06

Access to Urgent Care

If demand for primary care services during the winter or bank holiday periods cannot be met, then there may be an adverse effect on ED and flow through the hospital

4 4 16 Acute Visiting Service in place to relieve pressures on demand GP Enhanced Access service in place to relieve pressures on demand

A&E performance and feedback via A&E Delivery Board Primary care SITREPS

Expansion of GP Enhanced Access service, including movement towards 24/7 primary care model Commission additional AVS and GP Enhanced Access provision during winter and Easter periods Practices requested to 'move' extended access DES sessions either side of bank holidays where possible

3 3 9

R.Ports.PrC.09

Transition of PCSE services

If delivery of PCSE services by Capita does not improve then practices may experience significant financial, workload and operational issues and patient services may be at risk

4 4 16 Contract managed by NHSE. LMC have been collating practice issues and meeting regularly with PCSE colleagues

Reduction of complaints and issues reported by practices PCSE colleagues to regularly attend Wessex Primary Care Network meetings.

Finance have emergency file that will act as proxy to enable payments to be made Transformation programme now being implement for PCSE systems and processes PCSE have appointed Debbie Rowe to support practices locally and issues should be escalated accordingly

3 4 12 If delivery of PCSE services by Capita does not improve then practices may experience significant financial, workload and operational issues and patient services may be at risk.



5 Title

Policy and Procedure for Discretionary Support (given under Section 96)

Purpose of Paper

The intention of this paper is to outline a policy for NHS Portsmouth CCG with regards to support given under Section 96 of the NHS Act. The policy will outline the circumstances in which it would be suitable to utilise Section 96, and when it would be appropriate to issue financial assistance under this support mechanism. It will also recommend the procedure to be followed when a request for discretionary support is received from a Primary Care provider.


The recommendations of this paper are:

• To provide a consistent and fair approach to all providers seeking support via Section 96 funding.

• To utilise Section 96 only in exceptional circumstances, when all other routes of support have been explored or where Section 96 funding is required to enable that to happen.

• To use the policy outlined in this document to aid in assessing eligibility for Section 96 support.

• To utilise the procedure outlined in this document when applications for Section 96 support are received by the CCG.

The Committee are asked to:

• Discuss the content of the paper, recommending any amendments if required.

• If in agreement, approve the policy and procedure for Discretionary Support (given under Section 96) as described in this paper.


N/A



There may be a potential conflict with members of the committee who hold posts within member GP Practices.

Author

Rebecca Spandley, Finance Manager

Sponsoring member

Michelle Spandley, Chief Finance Officer

Date of Paper

24 January 2020

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NHS Portsmouth CCG

Primary Care Commissioning

Policy and Procedure for Discretionary Support (given under Section 96)

Version Control

Name of document Policy and Procedure for Discretionary Support (made under Section 96)

Date of document 23/12/2019 Author Rebecca Spandley Approved by Version 1.2 Version date 24/01/2020

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1. Introduction 1.1 Under Section 96 of the NHS Act (2006), NHS commissioners may provide additional

assistance and support to providers of Primary Care services.

1.2 The type and level of support provided is down to commissioner discretion, and can include financial assistance.

1.3 This support mechanism should only be used in exceptional circumstances, usually when a provider of Primary Care services is facing crisis. The aim of the support is to identify and resolve current issues, to assist in formulating a long-term sustainable solution, and to help build long-term resilience.

1.4 The intention of this paper is to outline a policy for NHS Portsmouth CCG with regards to support given under Section 96 of the NHS Act. The policy will outline the circumstances in which it would be suitable to utilise Section 96, and also when it would be appropriate to issue financial assistance under this support mechanism. It will also recommend the procedure to be followed when a request for discretionary support is received from a Primary Care provider.

2. Background 2.1 Primary Care is facing unprecedented demands. Nationally, an aging population,

increasing workload and challenges in recruiting GPs pose significant challenges to the continued delivery of high quality Primary Care services.

2.2 These issues are being experienced locally, which poses significant risk to the provision of Primary Care services in Portsmouth.

2.3 There are programmes that offer assistance and support (including financial support) to GP Practices. The General Practice Forward View (GPFV) published by NHS England in April 2016, includes a General Practice Resilience Programme, which incorporates the previously announced Vulnerable Practices Programme. The GPRP aims to identify and support GP Practices in difficulty.

2.4 However, the GPRP does not cover or replace all circumstances where there is a need for support. Local intelligence may suggest a GP Practice is facing challenges, but they do not qualify for support through a national programme, or that support under this programme is not available to be able to respond to need in a timely way.

2.5 Section 96 of the NHS Act details a statutory provision to make support available to a GP practice.

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2.6 This statutory provision may include financial assistance. In this instance, principles of

transparency should apply, ensuring a precedent is not set, with consideration to the alternative likely consequences if financial assistance is not provided.

2.7 Any financial assistance awarded will be within the confines of commissioners’ budgets and allocations. Therefore, any award of financial assistance will entail the identification of necessary funding and may impact on the CCG’s ability to fund other commitments.

2.8 When an application for discretionary support is received, the approval process followed must be fair, transparent and must reflect the Scheme of Delegation, within NHS Portsmouth CCG’s Standing Financial Instructions. This document will outline the procedure to be followed.

3. Statutory provision 3.1 Section 96 of the National Health Service Act 2006 provides a route for awarding

financial assistance to providers of primary medical services. It states:

96 Assistance and support: primary medical services

(1) The Board may provide assistance or support to any person providing or proposing to provide–

- primary medical services pursuant to section 83(2),

- primary medical services under a general medical services contract, or

- primary medical services in accordance with section 92 arrangements.

(2) Assistance or support provided by the Board under subsection (1) is provided on such terms, including terms as to payment, as the Board considers appropriate.

(3) “Assistance” includes financial assistance.

Reference: http://www.legislation.gov.uk/ukpga/2006/41/section/96

http://www.legislation.gov.uk/ukpga/2006/41/section/96

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4. Local Application 4.1 When would this statutory provision be appropriate to use?

4.1.1 As detailed in paragraph 2.3, there are programmes that offer assistance and support (including financial support) to GP Practices. All other routes of support should be explored prior to considering use of Section 96.

4.1.2 Section 96 is a statutory provision designed to offer short term and immediate support to providers of primary medical services. The provision is not designed to offer long term financial assistance to providers of primary medical services.

4.1.3 Commissioners should not use this mechanism to circumvent other provisions within the NHS Act or the terms of a providers GMS/PMS contract. Any funding awarded should take note of the General Medical Services Statement of Financial Entitlements.

4.1.4 Funding must not contradict the intent of the NHS Forward View which requires equity of global sum for the delivery of general medical services.

4.2 What could the assistance be used for? 4.2.1 Within Section 96 of the NHS Act, there are no specifically defined

circumstances in which this support can be utilised. 4.2.2 A general principle guiding the use of this support mechanism is that it should

only be utilised when all other routes have been explored. It should also be the opinion of the commissioner that without this assistance the risk of a provider being unable to continue to deliver primary medical services is unacceptably high.

4.3 It should be noted that individual decisions to agree assistance for providers of primary medical care services do not set a precedent for the future.

5. Criteria for awarding assistance and support 5.1 Prior to considering the issuing of assistance and support under Section 96 GP practices

should demonstrate to commissioners that they have both looked out and looked in for alternative solutions to the challenges they are facing.

5.2 Looking out requires GP practices to explore opportunities for working together with others, for example in order to develop shared back-office services and to find collective ways of delivering primary care at scale. It also requires providers to consider accessing alternative routes of support, such as the previously described General Practice Resilience Programme.

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5.3 Looking in requires GP practices to consider whether they have explored options to improve the situation, for example; proposing closure of their list or, changes to their boundary. In extreme circumstances a practice may consider changes to provision from or even closure of a branch surgery site.

5.4 Diagnostic tools are available to assist practices with analysing the current situation from a variety of sources and the LMC or CCG Primary Care team can assist GP practices in this regard.

5.5 If looking out or looking in fails to produce solutions to assist GP practices in addressing the challenges they are facing, issuing of assistance, including financial assistance, under Section 96 may be considered by commissioners. Equally, if GP practices are unable or ill equipped to find internal or locality based solutions they may be eligible for Immediately Necessary Support (see section 6 below) prior to (and perhaps mitigating against) a Section 96 application.

5.6 Consideration must be made to the impact if support is not provided and the provider is unable to continue to deliver the service.

5.7 In order to assess eligibility for financial assistance, the following framework sets out

what will be considered in deciding on whether or not to issue funding. Each scenario will be addressed on a case by case basis using this framework for guidance.

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5.8 All financial assistance must be provided within the principles of openness, fairness, probity and accountability.

5.9 Financial Assistance must demonstrate value for money and be in the best interests of the commissioner and the patients.

5.10 Financial Assistance must be proportionate to the identified need and represent better value for the taxpayer than alternative solutions.

6. Immediate Necessary Support

6.1 There are times when GP practices find themselves in a crisis situation and require immediate support. This is often a clinical need but can also be related to managerial/operational responsibilities.

6.2 In these circumstances the CCG will consider funding resources that have been tried and tested for practices locally and proven to provide value for money immediate support for GP practices.

No Criteria Rationale 1 There must be evidenced extenuating circumstances within the

practice population related to: 1. Workload 2. Patient demographics 3. Significant change in service provision 4. Sudden or significant change to service requirements This evidence may include an IMD score of 35 or higher for the practice population, a sudden increase in list size or evidence that local demographics dictate workload is not adequately reflected in the Carr Hill funding formula. This is proven by evidence of the downward weighting applied through the funding formula.

Evidence of the consequential impact on a practice workload must be provided.

2 No doctor in the practice should have declared pensionable earnings in excess of £99,969 p.a. (apportioned as relevant for part time GPs). This figure will be reviewed every year in line with nationally-available data.

Support not designed to increase pensionable income of GP’s.

3 The practice has been unable to access support through the GP resilience programme, or the funding available was insufficient to develop or implement a recovery plan (if applicable)

Ensure only appropriate resilience or viability issues are funded through Section 96.

4 The funding must be non-recurrent, and the practice has a plan in place to recover the position.

As per the guidance.

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6.3 The support available for GP practices will be time limited, and still require the S96 short form to be completed, but can be signed off by the Director of New Models of Care, Deputy Director of Primary Care and Finance Lead (or refer to Scheme of Delegation). The CCG will aim to seek approval within 1 week.

6.4 Funding will predominantly be made available for the LMC PM and/or GP supporter programmes although other support may be considered, as long as it does not exceed £5,000 (for example specialist financial or legal advice).

6.5 Practices in receipt of Immediate Necessary Support are not excluded from making a

full Section 96 application if it is still warranted, but in many instances it is expected that further support will not be required.

6.6 Total support made available through this route should not exceed £25,000.

7. Procedure for Discretionary Support (given under Section 96)

Stage Action Actioned by

1 GP Practice raises its sustainability issue with the CCG.

CCG and GP Practice should verify contract payments are correct.

GP Practice, CCG Primary Care and

Finance Teams

2

GP Practice submits either an Immediate Necessary Support request or Section 96 application accompanied with level of support requested, for what period, and for type of expenditure, with evidence provided to support application.

For applications requesting financial assistance of £25,000 or less – Short Form Application to be used (Appendix 1)

For applications requesting financial assistance of over £25,000 – Long Form Application to be used (Appendix 2)

GP Practice

3

CCG Primary Care and Finance teams review submission, apply the policy as detailed in this document, and if necessary request for further information / supporting documentation in order to produce a Business Case. Practices can expect a response within 10 working days.

CCG Primary Care and Finance Teams

4

Following review and validation of the GP Practice information, a Business Case (see Appendix 3) for the proposed support must be completed. This must confirm:

- Name and reference code of the GP Practice for whom the

CCG Primary Care and Finance Teams

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discretionary request is being made. - Description of what precipitated the request for discretionary

support. - The level of support being requested and the level being

recommended. - Whether the GP Practice has applied for and/or received any

funding (whether from any NHS or government body, or commercially) that relates to same subject matter of the Section 96 application.

- Whether the GP Practice is already identified under any national or local programme providing support.

- Confirmation of what practical and financial support the GP Practice has already invested to resolve these issues.

- How long is the support anticipated to be needed (either to achieve a resolution or to prepare a business case for longer term support) generally no more than a maximum £200,000 or 3 months funding should be considered (apart from in exceptional circumstances).

- If financial support is being recommended, how this will be paid. - The GP Practice need for the financial assistance has been

validated. - The case represents value for money. - Financial assistance is a better option than any alternatives. - Whether the CCG will ‘clawback’ any financial support given under

Section 96, and how this will be actioned. - Confirmation that the GP Practice agrees to receive the support

and any conditions placed on the support including confirmation of any conditions.

- Performance Management arrangements in respect of the financial assistance.

- Details of the GP Practices plan to recover the position, and demonstrate that the short term support will deliver a sustainable solution in the long term to ensure that the support is non-recurrent.

- Confirmation that the expenditure is in the “normal course of business” for primary medical care.

- Confirmation that there is no reason why greater transparency is required in respect of the payment.

- With regards to financial assistance, confirmation that there is no additional obligation being placed on the CCG as a result of the financial assistance, that this financial assistance does not arise out

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of a dispute or claim nor is there any fault or issue which a court may hold requires a payment must be made.

5

Review of financial evidence including certified accounts for the previous year and management accounts for the current year, cash flow, declared earnings etc.

Consideration whether the financial assistance will be sufficient to achieve the objectives.

Consideration of value for money vs alternatives.

Total likely overall financial risk to the CCG.

CCG Finance Team

6

The completed application and Business Case should then be considered for support by the Primary Care Contract Review Group.

There should be at least the following members attending the Group:

- CCG Representative (with authority to approve the financial assistance, as per the CCG’s Standing Financial Instructions)

- CCG Primary Care team representative

- CCG Finance team representative

- CCG Lay member

- NHS England representative

- LMC representative

Where, in exceptional circumstances, the financial assistance is above £200,000 the business case must be endorsed by:

• The Finance team, to confirm the availability of funding within the existing budget.

• Budget holders for confirmation of use of this financial assistance, and

• Legal advice to confirm correct use of the Financial Assistance power.

Primary Care Contract Review

Group

7

Once the Primary Care Contract Review Group has agreed to support the application and Business Case (and both are signed by the CCG Representative with authority to approve the financial assistance), these should then be taken to Primary Care Commissioning Committee (Part II) for formal approval.

It is recommended that all applications, where financial assistance totals up to £100,000, should be taken to PCCC for approval.

All applications requesting financial assistance of over £100,000 should be taken to PCCC, and then to Governing Board for approval.

Primary Care Commissioning

Committee/

Governing Board

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8 Once approval is received from PCCC/GB, the GP Practice can be advised of the outcome.

CCG Primary Care Team

9

An MOU will be populated and signed by GP Practice and CCG.

The MoU must set out:

• Parties to the agreement • Reference code of GP Practice (the “practice code”) for whom

discretionary support is being made; • Support to be awarded; • Duration of the support; • Aims and objectives of the support; • Outputs agreed and longer-term outcomes are defined,

wherever possible, to enable active performance management;

• Clawback provisions included unless CCG confirms that they are not appropriate;

• Regular reviews and adjustments are included where deemed necessary;

• Where appropriate, regular checkpoint meetings to discuss progress against pre-agreed schedule; and

• Supporting documentation and other evidence required to be provided from the recipient as appropriate.

GP Practice, CCG Primary Care and

Finance Teams

10 Payment set-up on a non-recurrent basis CCG Finance Team

11 Review of MOU objectives mid-way through period of support GP Practice, CCG

Primary Care Team

12 Routine reporting via the Primary Care Contract Review Group Primary Care

Contract Review Group

13 Advise GP Practice of continuation or further review of support depending on MOU progress

CCG Primary Care Team

14 Final Review and reporting to Local Primary Care Contract Review Group (as required)

Primary Care Contract Review

Group

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8. Recommendations and Conclusion 8.1 Recommendations:

• To provide a consistent and fair approach to all providers seeking support via Section 96 funding.

• To utilise Section 96 only in exceptional circumstances, when all other routes of support have been explored or where Section 96 funding is required to enable that to happen.

• To use the policy outlined in this document to aid in assessing eligibility for Section 96 support.

• To utilise the procedure outlined in this document when applications for Section 96 support are received by the CCG.

8.2 The Committee is asked to approve the policy and procedure for Discretionary Support (given under Section 96) as described in this paper.

CONFIDENTIAL

AI05ii Appendix 1 S96 Application form - Short form Page 1 of 4 24/01/2020

1 Date of application:2 Practice Name:3 Practice Identifier Code:4 Contract type: GMS/PMS/APMS5 Member of GP Federation (formal/informal?) Yes / No Name:6 CCG Name:7 Practice Address (of all contract sites) 1

23

8 Practice Raw List Size - Last Quarter9 Practice Weighted List Size - Last Quarter

10

11 Purpose of support requested and itemised value (non-recurrent) - above the practice budgeted level

12 Period of support and profile of costs (taper-off) Period 1 insert dates insert £Period 2 insert dates insert £Period 3 insert dates insert £Period 4 insert dates insert £Period 5 insert dates insert £Period 6 insert dates insert £

TOTAL REQUESTED £013 Supporting information - required for ALL applications at the outset

13.1 Yes No An MOU will detail agreed actions13.2 Yes No State drawings for partners13.3 Evidence of recruitment attempts Yes No eg advertisement invoices13.4 Annual income (all sources) & expenditure analysis OR Practice Accounts Yes No to validate sustainability issue13.5 Cash flow forecast 12 months ahead Yes No to understand predicted trend

FORM REF: (NHSE/CCG use) Commissioner: Insert NHS England DCO / or Delegated CCG

eg. Support with cost of locums whilst further recruitment is attempted: eg Need X sessions per week covered with a premium of £X per week above budgeted cost of £Y per week. Difference of £Z for X weeks sought initially, TOTAL £X. (Practice has funded X weeks but cannot cover this cost much longer and may need to reduce service provision)

GP Practice Application for Discretionary Funding Support (Section 96 NHS Act 2006)

Reason for application (describe the issues to be resolved)

eg. May be a GP recruitment issue - IMPACT is high cost of locum support - What are the circumstances that led to the situation? eg retirement, partnesrship split etc. How long has the vacancy existed? Describe recruitment attempts with dates and salary offered. CONSEQUENCES: describe effect on practice staff, patient services & access

Current AND proposed staff establishment - budgeted with salary & WTEPractice Recovery Plan (with actions and milestones to track success)

CONFIDENTIAL


2 Practice Name:Sustainability analysis Support Rationale Practice Response

15

Does the practice have an 'atypical' population e.g. university, rural or new town which is not adequately reflected in the contract payment? Please explain:

'Atypical' criteria:Must evidence that local demographics dictate workload is not adequately reflected in Carr-Hill

Yes No Details required:

Yes NoNegative impact of Carr-Hill formula? (weighted list vs raw list)Atypical population: adverse impact of Carr-Hill

14 insert any comments

CONFIDENTIAL


2 Practice Name:Local Context Information Practice to complete Practice to complete

18 Practice Total number of GP sessions worked/week? Understand GP access X sessions/week

19 Number of patients per WTE GP Understand GP access XXXX patients/WTE GP

hrs/weekhrs/week

state eg Pharmacist hours/weekhrs/week

21Has the practice received any contract breaches since 1 April 2013?

Potential marker of poorer quality practice

Yes No Details not required

22Are any of the GP performers being investigated by NHS England Medical Directorate or GMC?



23 What was the Practices published CQC overall rating?Understanding of practice quality issues

Outstanding / Good / Requires Improvement / Inadequate?

24Has the practice applied for a formal list closure at any point since 1 April 2013?

Marker of demand/practice issues


24b If yes, was this granted? Yes No

24cIf application was approved how long was the list closed in total?

3 months / 6 months / 9 months / 12 months

25 Number of practices within a 1-mile radius of practice insert number

a) GPb) Nurse

Total

Total no. of clinical (GP & Qualified Nursing) hours offered per week (incl. concurrent hours)

Understand total clinical access20

GP sessions

Patients/GP

Please state

Please state

c) Other

CONFIDENTIAL


2 Practice Name:

Local Context Information NHS England complete NHS England complete26 Any previous S96 support received? Yes No Detail..27 Any GP Resilience funding received? Yes No Detail..

28 Overview of deprivation - IMD Score?IMD is a marker of deprivation with consequential impact on workload

Practice Area:CCG Area:County Average:England Average:

29Outlying Areas on Primary Care Web Toolkit - fewer than 5 outliers on the GPHLI summary?


Yes No

30 Annual contractual 'e-declaration' - non-compliance issues?Potential marker of poorer quality practice

Yes No

31 Patient satisfaction survey - outlier areas?Potential marker of poorer quality practice

Yes No Detail issues:

Please return to: xxxxxxxxxxxxxxxxx @nhs.net (ALL INFORMATION WILL BE HELD SECURELY)

Contractor name Practice signature (Contractor):

insert

CCG Support required in all cases:

CCG Lead Name insert CCG signature or attach CCG email of support

NHS England Contract Officer reviewer - NHSE insert name insert

To be completed by Commissioner - NHS England

CONFIDENTIAL

AI05iii Appendix 2 S96 Application form - Long form Page 1 of 4 24/01/2020

1 Date of application:2 Practice Name:3 Practice Identifier Code:4 Contract type: GMS/PMS/APMS5 Member of GP Federation (formal/informal?) Yes / No Name:6 CCG Name:7 Practice Address (of all contract sites) 1

23

8 Practice Raw List Size - Last Quarter9 Practice Weighted List Size - Last Quarter

10

11 Purpose of support requested and itemised value (non-recurrent) - above the practice budgeted level

12 Period of support and profile of costs (taper-off) Period 1 insert dates insert £Period 2 insert dates insert £Period 3 insert dates insert £Period 4 insert dates insert £Period 5 insert dates insert £Period 6 insert dates insert £

TOTAL REQUESTED £013 Supporting information - required for ALL applications at the outset

13.1 Yes No An MOU will detail agreed actions13.2 Yes No State drawings for partners13.3 Evidence of recruitment attempts Yes No eg advertisement invoices13.4 Annual income (all sources) & expenditure analysis OR Practice Accounts Yes No to validate sustainability issue13.5 Cash flow forecast 12 months ahead Yes No to understand predicted trend

Practice Recovery Plan (with actions and milestones to track success)

FORM REF: (NHSE/CCG use) Commissioner: Insert NHS England DCO / or Delegated CCG

eg. Support with cost of locums whilst further recruitment is attempted: eg Need X sessions per week covered with a premium of £X per week above budgeted cost of £Y per week. Difference of £Z for X weeks sought initially, TOTAL £X. (Practice has funded X weeks but cannot cover this cost much longer and may need to reduce service provision)

GP Practice Application for Discretionary Funding Support (Section 96 NHS Act 2006)

Reason for application (describe the issues to be resolved)

eg. May be a GP recruitment issue - IMPACT is high cost of locum support - What are the circumstances that led to the situation? eg retirement, partnesrship split etc. How long has the vacancy existed? Describe recruitment attempts with dates and salary offered. CONSEQUENCES: describe effect on practice staff, patient services & access

Current AND proposed staff establishment - budgeted with salary & WTE

CONFIDENTIAL


2 Practice Name:Sustainability analysis Support Rationale Practice Response

15

Does the practice have an 'atypical' population e.g. university, rural or new town which is not adequately reflected in the contract payment? Please explain:

'Atypical' criteria:Must evidence that local demographics dictate workload is not adequately reflected in Carr-Hill

Yes No Details required:

16Are practice expenses greater than 65% of primary medical services (including Local Authority/CCG and NHS England) income?

South East average ratio of expenses:earnings is 65:35

Yes No Please state expenses: .................%

16b If yes, can this be sufficently evidenced? Yes No insert any comments

1 insert £2 insert £3 insert £4 insert £5 insert £6 insert £7 insert £8 insert £9 insert £

Yes No

Please state individually declared pensionable earnings per GP within the practice (pro-rata'd for part time) for the YEAR [INSERT YEAR](It is noted this may include non-GMS/PMS/APMS income & 'non-NHS' income.)

(£112k / £96k figure derived from HSCIC 2013/14- South East GPMS Contractor/salaried averages plus 1%/yr)

17

Negative impact of Carr-Hill formula? (weighted list vs raw list)Atypical population: adverse impact of Carr-Hill

14

No doctor in the practice should have declared pensionable earnings in excess of Contractor = £112k.Or combined contractor & Salaried GP average not in excess of = £96kSupport not designed to increase pensionable income.

insert any comments

CONFIDENTIAL


2 Practice Name:Local Context Information Practice to complete Practice to complete

18 Practice Total number of GP sessions worked/week? Understand GP access X sessions/week

19 Number of patients per WTE GP Understand GP access XXXX patients/WTE GP

hrs/weekhrs/week

state eg Pharmacist hours/weekhrs/week

21Has the practice received any contract breaches since 1 April 2013?



22Are any of the GP performers being investigated by NHS England Medical Directorate or GMC?



23 What was the Practices published CQC overall rating?Understanding of practice quality issues

Outstanding / Good / Requires Improvement / Inadequate?

24Has the practice applied for a formal list closure at any point since 1 April 2013?

Marker of demand/practice issues


24b If yes, was this granted? Yes No

24cIf application was approved how long was the list closed in total?

3 months / 6 months / 9 months / 12 months

25 Number of practices within a 1-mile radius of practice insert number

a) GPb) Nurse

Total

Total no. of clinical (GP & Qualified Nursing) hours offered per week (incl. concurrent hours)

Understand total clinical access20

GP sessions

Patients/GP

Please state

Please state

c) Other

CONFIDENTIAL


2 Practice Name:

Local Context Information NHS England complete NHS England complete26 Any previous S96 support received? Yes No Detail..27 Any GP Resilience funding received? Yes No Detail..

28 Overview of deprivation - IMD Score?IMD is a marker of deprivation with consequential impact on workload

Practice Area:CCG Area:County Average:England Average:

29Outlying Areas on Primary Care Web Toolkit - fewer than 5 outliers on the GPHLI summary?


Yes No

30 Annual contractual 'e-declaration' - non-compliance issues?Potential marker of poorer quality practice

Yes No

31 Patient satisfaction survey - outlier areas?Potential marker of poorer quality practice

Yes No Detail issues:

Please return to: xxxxxxxxxxxxxxxxx @nhs.net (ALL INFORMATION WILL BE HELD SECURELY)

Contractor name Practice signature (Contractor):

insert

CCG Support required in all cases:

CCG Lead Name insert CCG signature or attach CCG email of support

NHS England Contract Officer reviewer - NHSE insert name insert

To be completed by Commissioner - NHS England

[Type text]

NHS Portsmouth CCG

Business Case Template

Discretionary Support Applications (given under Section 96)

Version Control

Name of document

Date of document Author

Supported by 1 Primary Care Contract Review Group 2 CCG Representative with authority to approve

financial support, if this is being recommended Version 1.0 Version date

[Type text]

GP Practice GP Practice Code Date Application received from Practice Summary of GP Practice’s application, and reasoning for applying for discretionary support

Summary of support being recommended

With regards to the above question, if the support recommended is financial, what value is being recommended?

Has the GP Practice applied for, and/or has the GP Practice received any funding that relates to same subject matter of the discretionary support application?

Is the GP Practice already identified under any national or local programme providing support? If so, please reference the scheme and the level of support provided.

What practical and financial support has the GP Practice already invested to resolve issues?

For what period of time is the support required?

How will the support be made available to the GP Practice? Comment on how the support will be made available to the Practice. For example, will the financial support be one payment, or funding split across 3 months, etc.

[Type text]

Has the need for financial support been validated by the CCG? Does the financial support being recommended offer Value for Money? What is the likely overall risk to the CCG? Yes/No Financial evidence including certified accounts for the previous year and management accounts for the current year, cash flow, declared earnings etc. need to be reviewed by the CCG. Explain why the recommendation represents VFM for the CCG, and why financial assistance is a better option than any alternatives.

Is part of the recommendation to ‘clawback’ any financial support made available? If so, please note the value to be recovered by the CCG.

Are there any conditions that the CCG will be placing on the support being recommended? Has the GP Practice accepted these conditions? Explain if there are any actions to be put in place and monitored as conditions to receiving the support, etc.

What is the GP Practice’s recovery plan? The plan should demonstrate that the short term support will deliver a sustainable solution in the long term to ensure that the support is non-recurrent.

[Type text]

Please summarise any other options that have been considered, with reasoning as to why they are not recommended in this business case.

Declaration with regards to financial assistance being recommended (Please check that this is applicable, and that it is true in this case)

The CCG confirms there is no additional obligation being placed on the CCG as a result of the financial support being recommended, that this financial support does not arise out of a dispute or claim nor is there any fault or issue which a court may hold requires a payment must be made.

PRIMARY CARE COMMISSIONING COMMITTEE Date of Meeting 30 January 2020

Agenda Item No

6 Title

GP Practice List Size Summary Purpose of Paper

To note historical GP Practice List Size movements for Portsmouth GP Practices.


For the Primary Care Commissioning Committee members to note Practice List Size changes for Portsmouth GP Practices.


Committee members working within Primary Care may have a perceived, potential or actual conflict with information contained within this paper.

Author

Victoria Smyth – Primary Care Commissioning officer

Sponsoring member

Steve McInnes, Primary Care Relationship Manager

Date of Paper

7 January 2020

GP Practice list size information sourced from NHS South, Central and West Commissioning Support Unit (SCWCSU)

GP Practice workforce headcount and whole time equivalent (WTE) information (September 2019), sourced from NHS digital - https://digital.nhs.uk/data-and-information/publications/statistical/general-and-personal-medical-services/final-30-september-2019

Total Patients per whole time equivalent (WTE) Calculations in the table below are based on the SCWCSU list size information for October 19 and NHS digital workforce statistics for September 2019

Total Patients per (WTE) Craneswater Group

Derby Road Practice

East Shore Partnership

Guildhall Walk Healthcare Centre

John Pounds Surgery

Kirklands Surgery

Lake Road Health Centre

North Harbour Medical Group

Portsdown Group Practice

Queens Road Surgery

Sunnyside Medical Centre

The Drayton Surgery

The Hanway Group Practice

The Lighthouse Group Practice

Trafalgar Group Practice

University Surgery

Portsmouth CCG TOTAL

All GPs WTE 1564 1931 3225 3517 2286 1206 3188 1432 2263 0 1910 1948 2394 2256 1812 5347 2184

GP Partners WTE 2508 2574 9258 0 3528 1799 4855 1442 4034 0 8532 4524 3972 3164 5705 8084 3985

All Nurses WTE 5388 3109 1527 3940 6242 6115 2171 4463 3155 0 2338 2221 5829 4553 4702 5396 3273

All GPs and Nurses WTE 1212 1191 1036 1858 1673 1007 1292 1084 1318 0 1051 1038 1697 1508 1308 2686 1310

Note - List sizes are based on merged practice patient lists

Raw Population

Craneswater Group

Derby Road

Practice

East Shore Partnership

Guildhall Walk

Healthcare Centre

John Pounds Surgery

Kirklands Surgery

Lake Road Health Centre

North Harbour Medical Group

Portsdown Group

Practice

Queens Road

Surgery

Sunnyside Medical Centre

The Drayton Surgery

The Hanway Group

Practice

The Lighthouse

Group Practice

Trafalgar Group

Practice

University Surgery

Portsmouth CCG TOTAL

2016/2017 Apr 10623 11536 15303 6252 4015 8012 14812 8982 42031 5448 13213 17925 11710 13482 22322 17458 223124

2016/2017 Jul 10651 11569 15156 6235 4004 8089 14853 9001 42103 5437 13319 17985 11753 13330 22359 16746 222590

2016/2017 Oct 10703 11707 15071 6874 4098 8174 14862 9038 42290 5417 13356 18120 11820 13299 22595 16748 224172

2016/2017 Jan 10722 11755 14911 7231 4153 8256 14930 9075 42313 5438 13410 18242 11846 13266 22753 18961 227262

2017/2018 Apr 10826 11769 14597 7320 4157 8317 14957 9100 42533 5416 13455 18292 11868 13271 22889 18997 227764

2017/2018 Jul 10992 12340 14484 7359 4193 8584 15361 9144 43770 1570 13671 18393 12752 13398 23061 18392 227464

2017/2018 Oct 11080 12483 14335 7696 4218 8512 15342 9201 43951 0 13748 18509 14117 13455 23135 18138 227920

2017/2018 Jan 11132 12582 14165 7742 4277 8460 15346 9205 44045 0 13803 18548 14123 13517 23251 19936 230132

2018/2019 Apr 11129 12700 13879 7800 4300 8532 15381 9242 43909 13847 18589 14094 13577 23333 20231 230543

2018/2019 Jul 11240 12765 13720 7785 4325 8598 15412 9270 43926 13880 18623 14118 13594 23306 19700 230262

2018/2019 Oct 11095 12907 13614 7847 4344 8652 15548 9290 43934 13681 18631 14126 13712 23356 19991 230728

2018/2019 Jan 11461 12960 13602 8124 4341 8726 15564 9339 44010 13634 18552 14218 13716 23246 21122 232615

2019/2020 Apr 11542 13022 13478 8049 4333 8811 15594 9409 43996 13628 18650 14241 13622 23232 20961 232568

2019/2020 Jul 11593 13126 13392 7944 4326 8890 15602 9458 44025 13625 18612 14289 13503 23324 20169 231878

2019/2020 Oct 11639 13180 13331 8090 4328 8969 15601 9520 43998 13651 18638 14300 13415 23429 20216 232305

Total Population Change 1016 1644 -1972 1838 313 957 789 538 1967 -5448 438 713 2590 -67 1107 2758 9181

https://digital.nhs.uk/data-and-information/publications/statistical/general-and-personal-medical-services/final-30-september-2019

https://digital.nhs.uk/data-and-information/publications/statistical/general-and-personal-medical-services/final-30-september-2019



7 Title

Record of Chair’s Action

Purpose of Paper

For the Primary Care Commissioning Committee members to note retirement of Dr Andrew Richardson on 31st March 2020


To receive and note the approved Chair’s Action


N/A



Committee member working in GP practices may have an perceived or actual conflict relating to items in the paper

Author

Terri Russell – Deputy Director of Primary Care

Sponsoring member

Jo York – Director (New Models of Care)

Date of Paper

7 January 2020

RECORD OF CHAIR’S ACTIONS

Background and Summary: The Primary Care Commissioning Committee Chair is asked to consider the proposed GP partnership changes for the Personal Medical Services Contract for Derby Road Group Practice.

Dr Andrew Richardson – retirement on 31st March 2020 Total number of GP Partners after change 4 Remaining WTE GP Partner after change 3.125 Remaining WTE Salaried GP after change 1 Total number of GPs after change 7 Total WTE Clinical staff excl GP’s/Partners 2 Total WTE GP after change Total average patients per WTE GP 4.125 This equates to 4200 patients per WTE GP Partner This equates to 3182 patients per WTE GP This equates to 2143 patients Per WTE GP and WTE additional workforce

If the CCG cannot approve Dr Andrew Richardson’s retirement application until the next scheduled Primary Care Commissioning Committee meeting on the 30th January 2020, this will cause a delay to the GP receiving his pension payments.

Action: Chairperson’s action to approve the GP partnership change for PMS Contract for Derby Road Group Practice, following an application of GP retirement (Dr Andrew Richardson) on 31st March 2020. Action authorised by:

Signed: ……………………………………………………… Date: 2 January 2020 Margaret Geary Chair of Primary Care Commissioning Committee NHS Portsmouth Clinical Commissioning Group Prepared by: Terri Russell, Deputy Director of Primary Care



8 Title

Primary Care Finance M09 2019/20

Purpose of Paper

To inform the committee of the current primary care financial position.


The Committee are asked to note the position.


N/A



N/A

Author

Rebecca Spandley, Finance Manager

Sponsoring member

Michelle Spandley, Chief Finance Officer

Date of Paper

21 January 2020

Portsmouth CCG Reporting Period 9

Budget Manager

Annual Budget

YTD Budget

YTD ActualYTD

VarianceForecast Outturn

Forecast outturn variance

Budget Manager

Annual Budget

YTD Budget

YTD ActualYTD

VarianceForecast Outturn

Forecast outturn variance

£000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000Commissioning Schemes Delegated Commissioning

Basket Scheme T Russell 530 398 398 0 530 0 GMS - Main General Practice Contract/OOH T Russell 8,387 6,290 6,277 (13) 8,380 (7)Phlebotomy T Russell 195 147 147 0 196 1 MPIG T Russell 71 53 53 0 71 0Diabetes T Russell 144 108 108 (0) 144 (0) PMS - Main General Practice Contract/OOH T Russell 9,517 7,138 7,083 (54) 9,441 (76)Respiratory T Russell 222 166 166 0 222 0 PMS Premium T Russell 366 274 274 0 366 0Leg Ulcers T Russell 189 142 142 0 189 0 APMS - Main General Practice Contract/OOH T Russell 1,369 1,027 1,014 (12) 1,365 (3)LARC (Non Contraceptive use) T Russell 40 30 0 (30) 40 0 QOF Aspiration/Achievement T Russell 2,775 2,081 2,081 0 2,775 0Leg Group LCS T Russell 25 19 0 (19) 25 0 DES - Minor Surgery, Learning Disabilities T Russell 344 283 283 (0) 344 (0)Ring Pessary T Russell 15 11 11 0 15 0 DES - Primary Care Networks T Russell 1,032 648 603 (45) 1,032 (0)Glaucoma T Russell 9 7 7 0 9 0 Seniority T Russell 114 85 84 (1) 113 (1)Low Vision T Russell 19 15 15 0 19 0 Retainers T Russell 85 64 64 0 85 0CQUIN T Russell 462 346 211 (135) 281 (181) Maternity / Paternity / Adoptive / Sickness T Russell 327 245 87 (158) 327 0Worforce Development T Russell 395 297 297 (0) 395 (0) Needles & Syringes T Russell 12 9 9 0 12 1Pharmacy T Russell 164 123 123 (0) 164 (0) Collaborative Fees T Russell 151 113 113 0 151 0Flu Incentice Scheme T Russell 20 15 15 0 20 0 Professional Fees - Prescribing T Russell 190 143 139 (3) 186 (4)Special Allocation Scheme (SAS) T Russell 13 10 10 0 14 1 Premises - Rent T Russell 2,088 1,566 1,558 (8) 2,088 (0)Other T Russell 4 3 5 3 7 3 Premises - Business Rates T Russell 547 410 410 0 547 0

Total Commissioning Schemes 2,447 1,836 1,655 (181) 2,271 (176) Premises - Water/Sewerage/Clinical Waste T Russell 80 60 60 0 80 0Minor Improvement Grants T Russell 93 70 106 36 92 (1)

Primary Care Network Support 0 0 0 0 0 0 CQC Fees T Russell 143 107 0 (107) 141 (2)Network payment (£1.50 Per Head) T Russell 347 260 262 1 349 2 Section 96 T Russell 0 0 63 63 0 0

Total Primary Care Network Support 347 260 262 1 349 2 Target T Russell 84 63 0 (63) 84 0Life Channel T Russell 0 0 9 9 0 0

Integrated Primary Care Service 0 0 0 0 0 0 MJog T Russell 12 9 0 (9) 12 (0)Integrated Primary Care Service T Russell 1,377 1,033 1,033 0 1,377 0 Pathology Consumables T Russell 10 8 8 0 10 0In Hours Clinical Assessment Service (CAS) T Russell 105 79 79 0 105 0 PMS Premium to be reinvested T Russell 130 98 98 0 130 0

Total Integrated Primary Care Service 1,482 1,111 1,111 0 1,482 0 Other/Contingency funds T Russell 301 326 621 295 301 (1)Total Delegated commissioning 2019/2020 28,226 21,169 21,098 (71) 28,132 (95)

GP Forward View 0 0 0 0 0 0Integrated Primary Care Service T Russell 1,390 1,043 1,042 (0) 1,390 (0)STP - Training and Clerical T Russell 27 20 0 (20) 27 0STP - Resilience scheme T Russell 48 36 36 0 48 0STP - PCN Development T Russell 168 126 126 (0) 168 0Retained Doctors Scheme T Russell 8 6 0 (6) 0 (8)

Total GP Forward View 1,641 1,231 1,204 (26) 1,633 (8)

Total Primary Care Budget M08 1920 34,144 25,607 25,330 (277) 33,867 (277)

PRIMARY CARE BUDGET 2019/2020

Budget Holder - Terri Russell



9 Title

‘Axe the Fax’ Campaign

Purpose of Paper

To update Primary Care Commissioning Committee members on the ‘Axe the Fax’ campaign, where we are on a local level and an overview of the activity carried out so far.


To receive the information contained within the attached briefing paper and as part of the verbal update at the Primary Care Commissioning Committee meeting.


Numerous engagement activity has taken place, please see the attached briefing paper for information.



N/A

Author

Chris Horan, Primary Care Improvement Manager

Sponsoring member

Terri Russell, Deputy Director of Primary Care

Date of Paper

21 January 2020

‘Axe the Fax’ Campaign From 31st March 2020 all fax machines will be banned across the NHS under plans to overhaul outdated technology and IT systems, from this date all NHS organisations will be required to use modern communication methods such as secure email, to improve patient safety and cyber security. A national campaign ‘Axe the Fax’ has been created in order to support this initiative. The CCG Primary Care team have been working with practices and services to review current working processes and ensure alternative secure communication methods are put in place. In order to prepare for switch off the following services have been or are being engaged with:

• Local GP practices • F&G & SEH Clinical Commissioning Group • Portsmouth Hospitals NHS Trust • Solent NHS Trust • Southern Health NHS Foundation Trust • Care UK • Portsmouth City Council • Portsmouth Community Pharmacies • Dentists • Optometrists • Portsmouth Care Homes

A range of activity has taken place locally to support the national campaign, which includes: GP Practices:

• All practices have an action plan in place in preparation for the 31st March 2020 • Each practice carried out an audit during October 2019 of all incoming and outgoing

faxes over a 1 week period, their findings were shared with the CCG • Practice contact information has been shared with the relevant services

Services:

• Engagement has taken place with the above services • Ardens and the Primary Care team have been contacting services with fax as their

referral method and requesting an alternative (i.e. NHS.net email addresses) • Referral methods updated on relevant forms and Ardens template • NHS.net addresses received have all been added to the CCG Contacts SystmOne

Address book On a local system level, we are on track to meet the deadline of fax switch off on 31st March 2020.



10 Title

The Trafalgar Medical Group Practice request for additional GMS space

Purpose of Paper

The Trafalgar Medical Group Practice has worked out of its own Osborne Road premises and the Eastney Health Centre for over 30 years. Following the merger with the Ramillies Practice in 2016 the Ramillies Practice site in Victoria Road South closed and services moved into either Osborne Road or Eastney Health Centre. Additional GMS space was agreed at both sites, which is now at capacity. The loss of clinical and administrative space from the closure of the Ramillies Practice did not meet the total additional space acquired in 2016 at Osborne Road or Eastney Health Centre. This is limiting the scope for additional clinics and services. Eastney Health Centre has vacant space throughout the health centre. On the 1 April 2018 Trafalgar Medical Group Practice merged with the Eastney Practice to form a larger more sustainable Practice. The Eastney Practice was located in Eastney Health Centre, which was collocated within the same area of Eastney Health Centre as the Trafalgar Medical Group Practice. Trafalgar Medical Group Practice is requesting additional GMS reimbursable space in the void space that is within the Practice area. This will allow the Practice to provide services and be managed in a much more efficient manner. Security for the Practice can also be improved, for both patients and staff, as Trafalgar Medical Group Practice will be the sole user of this wing of Eastney Health Centre. Trafalgar Medical Group Practice currently consists of 6 GP Partners and 8 salaried GPs. It also has a growing nurse and HCA team. The additional space is required to enable additional clinical sessions to be provided increasing access and for storage and admin support. The practice is requesting 5 additional rooms with a total NIA of 43m2

and a share of the common areas which increases the request to 66.6m2. The cost of rent for these rooms is £9,660 per annum. As this space is currently void the CCG is already paying for the space and additionally service and management charges at a cost of £22,444. If approved there would be a saving to the CCG as the practice would pay the service and management costs of the currently void space. It should be noted that the two clinical rooms will require funding of approximately £9k for each room to be refurbished to the required standard which will be requested via a Minor Improvement Grant.


The Primary Care Commissioning Committee is requested to recommend approval for the additional 66.6m2 of GMS space at a reimbursable rental cost of £9,660 for the Trafalgar Medical Group at Eastney Health Centre. .


Not applicable

Item previously considered at None

Potential Conflicts of Interests for Review Group Members

Committee members working within Primary Care may have a perceived, potential or actual conflict with information contained within this paper.

Author

Sylvia Macey

Sponsoring member

Terri Russell

Date of Paper

27 January 2020

Revision 18th June 2019 Review Date: April 2020 Page 1 of 14

APPLICATION FORM Changes To General Medical Services (GMS) Approved Space

FOR OFFICE USE ONLY PRACTICE DETAILS Name: Practice Contact: Contact Details: OUTCOME OF NHS PORTSMOUTH CCG REVIEW Reviewed by Primary Care Commissioning Committee / Contract

Review Group on:

Application to Change General Medical Services (GMS) Space Recommended for approval:

Change To General Medical Services (GMS) Space application rejected:

If the application has been rejected, please state the reasons below:


PURPOSE OF APPLICATION Practices should use this application form to notify NHS England of all changes, or increases requested, to the approved reimbursable General Medical Services (GMS) space; this includes space outside of the Practice. For example: Changes in room usage i.e. a Meeting Room being converted to two Consulting Rooms. External Changes i.e. existing Parking Space being used for other purposes, planned extensions etc. Redesign of the Reception potentially leading to the loss of GMS Space i.e. a smaller waiting area

for patients, creation of further Administration space via the decrease in Reception Area space. Approval is required in advance for any changes made that may potentially impact on the actual or notional rent reimbursement the Practice receives as defined within the NHS (GMS – Premises Costs) Directions 2013 and to ensure a complete record of changes is available to support future current market rent assessments for reimbursement purposes. COMPLETION OF APPLICATION FORM This application form should be completed by a representative of the Practice i.e. Senior Partner, Practice Manager or other delegated member of staff. Exceptionally, it may be completed by a third party contracted to provide premises advice and support to the practice. It is the responsibility of said representative to provide NHS England with this completed application form and any further requested information in a timely fashion. Representatives of NHS England will only help to facilitate the completion of the form and cannot complete the application form on behalf of the Practice. Once completed, this application form should be submitted electronically to the following for processing.

Email: [email protected]

mailto:[email protected]


NOTES Please read and digest the Premises Costs Directions 2013 document prior to completing this

application form. The document contains information relating to the responsibilities of NHS England (the “Board”) and a Practice (the “Contractor”); and also the costs which can potentially be reimbursed by NHS England.

NHS Cost Directions 2013

Any and all potential changes to General Medical Services (GMS) space should be brought to the

attention of NHS England prior any changes being undertaken. NHS England will not commit to any level of retrospective funding for unauthorised changes made to General Medical Services (GMS) space, therefore the GP Practice will be held liable for any and all associated costs.


Please complete all of the sections below. Incomplete application forms or application forms not completed with a satisfactorily level of detail may be rejected by the NHS Portsmouth CCG Primary Care Commissioning Committee / Contract Review Group. DATE APPLICATION FORM COMPLETED 23rd December 2019 PRACTICE DETAILS Name: Trafalgar Medical Group Practice

Practice Code: J82028 Address Line 1. 25 Osborne Road Address Line 2: Southsea Address Line 3: Hampshire

Post Code: PO5 3ND CONTACT DETAILS (Representative of Practice to liaise with in regards to this application form)

Name: David Scarborough Telephone: 023 92892950

Mobile: 07855533098 Email Address: [email protected]

CHANGE(S) TO GENERAL MEDICAL SERVICES (GMS) SPACE REQUESTED Change Effective From: ASAP For TMGP to take on the following additional rooms at Eastney Health Centre (EHC): Room 41 – Currently Unoccupied Room 43– Currently Unoccupied Room 47– Currently Unoccupied Room 53– Currently Unoccupied Room 57– Currently Unoccupied The above will provide 2 additional clinical rooms + office space for EHC manager and additional much needed administrative and storage space.


REASON FOR THE CHANGE The Trafalgar Medical Group Practice (TMGP) has worked out of its own Osborne Road premises and the Eastney Health Centre (EHC) for over 30 years. Following the merger with the Ramillies Practice (RP) in 2016 it closed the RP old site in Victoria Road South and moved all its services into either Osborne Road or EHC. In doing so it acquired additional GMS space at both sites, but immediately this was used at capacity. The loss of clinical and administrative space from the closure of RP did not meet the total additional space acquired in 2016 at Osborne Road or EHC. This is limiting the scope for additional clinics and services. Significant savings were made in rent for GMS services following the closure of RP. EHC currently has spare space throughout. On the 1st April 2018 TMGP merged with the Eastney Practice to form a larger more sustainable Practice. The Eastney Practice was located in EHC, which was collocated within the same area of EHC as TMGP. If TMGP is successful with this bid it will take up the redundant space within the area the Practice is currently located. This will allow the Practice to provide services and be managed in a much more efficient manner. Security for the Practice can also be improved, for both patients and staff, as TMGP will be the sole user of this area of EHC. Since the 2018, TMGP has had considerable success in recruiting GPs and other clinical staff. Therefore this is allowing the Practice to provide more GP sessions than it did prior to that merger. This has placed considerable pressure on its clinical space at both Osborne Road and EHC. As the Practice has grown the administration of services and the Practice as a whole has had to grow to keep up with the development of the Practice and initiatives to free up clinician time e.g. workflow redirection and use of online services. The additional administration and management space will allow this part of the Practice to function more efficiently. TMGP currently consists of 6 GP Partners and 8 salaried GPs. It also has a growing nurse and HCA team. FINANCIAL IMPLICATIONS Current Rent (£): Last Rent Review Date: The diagram below provides details of the rent, service and facilities management costs associated with these additional rooms:

Eastney Additional Room Costings.pdf


ALTERNATIVE OPTIONS CONSIDERED Yes No There are no alternative options. TMGPs Osborne Road site is at capacity.


Supporting Information Please complete all of the sections below. Incomplete application forms or application forms not completed with a satisfactorily level of detail may be rejected by the NHS Portsmouth CCG Primary Care Commissioning Committee / Contract Review Group. PRACTICE DETAILS Name: David Scarborough

Practice Code: J82028 Address Line 1. Trafalgar Medical Group Practice Address Line 2: 25 Osborne Road Address Line 3: Southsea

Post Code: CURRENT SPACE LIMITATIONS TMGP GMS space across both its site is working at capacity. There is no space options for increasing the level or type of service the Practice provides

FUTURE SPACE UTILISATION Clinical Admin Patients Other Room 41 – Currently Unoccupied This room will be utilised for storage of medical and non-medical items. Lots of space is being taken up in clinical rooms for storage. We may also use this area to house the photocopier and ancillary stationary / paper Room 43– Currently Unoccupied This small area will be used to house a post room. This will free up valuable space in a cluttered reception area


Room 47– Currently Unoccupied Likely to be used for an HCA, it will become a clinical room This room will need to be converted from its current fit out Likely projected cost for this room will be £9000 Room 53– Currently Unoccupied Likely to be used for an GP / Nurse, it will become a clinical room This room will need to be converted from its current fit out Likely projected cost for this room will be £9000 Room 57– Currently Unoccupied This room will be converted to a non-clinical room. Likely to become a Managers’ Office and be used for hot desking amongst the management team CURRENT SERVICES DELIVERED BY THE PRACTICE CQC Statement of Purpose Part 3 attached.

20191014 - Statement of Purpose

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


DEMOGRAPHICS (e.g. growth list size, health of the local population, health inequalities, etc.) PLEASE PROVIDE SPECIFIC EVIDENCE Current list size = 23,538 (as of 23 Dec 19). Local knowledge of local primary care provision within the Practice catchment area indicates that our list size is likely to grow throughout the medium term future.

IT IMPLICATIONS (please detail any infrastructure changes necessary and associated costs) IT Rooms 43, 47, 53 and 57 will also require IT infrastructure. Bid for the works will be submitted to the CSU. TELEPHONE Rooms 47, 53 and 57 will require telephone extensions. Our current telephone provider will be able to undertake this work for us. Our current system is sufficiently modern that it can easily be extended to take on this additional requirement. The Practice is likely to submit a Premises Improvement Grant bid to refurbish the additional clinical rooms and it may include this work depending on the time frame within which this application may be approved.


Room Utilisation Schedule – Prior to change

• Please complete the room utilisation schedule below using one line per room based on current utilisation. Include extended hours and Saturday opening and any non-GMS services.

• If the Practice operates across several sites, please complete one room schedule per site.

• Please add start and end times for each session and include all clinical and non-clinical rooms (including meeting rooms). E.g. Dr Smith (08.30-11.30).

• Ensure all rooms are fully and effectively utilised before proceeding with the application.

• Add lines as necessary.

Rooms – Ground Floor Monday Tuesday Wednesday Thursday Friday Saturday

Osborne Road Waiting Room 0800 - 2000 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1200

Osborne Road - Reception 0800 - 2000 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830 0800 – 1200

Osborne Road – Room 1 (Clinical) 0830 - 1230 0900 - 1830 0900 - 1830 0900 - 1830 0900 – 1400

1400 - 1830

Osborne Road – Room 2 (Clinical)

0830 – 1230 1400 - 1600

0830 – 1230 1400 - 1630 0800 - 1230 0830 – 1400

1400 - 1630 0800 – 1230 1400 - 1630

Osborne Road – Room 3 (Clinical) 0900 - 1300 0900 - 1830 0900 - 1830 0830 – 1230

1400 - 1830 0900 - 1830

Osborne Road – Room 4 (Clinical)

0800 – 1230 1400 - 1630 0830 – 1730 0830 – 1400

1400 - 1600 0730 – 1230 1400 - 1530 0800 - 1230


Osborne Road – Room 5 (Clinical) 0900 - 1830 0830 – 1230

1400 - 1830 0900 - 1830 0900 – 1400 1400 - 1830

0900 – 1400 1400 - 1830

Osborne Road – Store Room 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1200

Osborne Road – WC 1 (Pts) 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1200

Osborne Road – WC 1 (Pts) 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1200

Rooms – First Floor Monday Tuesday Wednesday Thursday Friday Saturday

Osborne Road – Room 6 (Clinical) 0900 - 2000 0900 - 1830 0830 - 1230 0900 - 1830 0900 - 1830

Osborne Road – Room 7 (Clinical) 0900 - 2000 0900 – 1400

1400 - 1730 1400 - 1830 0900 - 1400 0900 - 1830

Osborne Road – Waiting Room 0800 - 2000 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830

Osborne Road – WC – (Staff) 0800 - 2000 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830

Rooms – Second Floor Monday Tuesday Wednesday Thursday Friday Saturday

Osborne Road – BM Office 0830 - 1830 0830 - 1830 0830 - 1830 0830 - 1830 0830 - 1830

Osborne Road – Secretaries 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830

Osborne Road – WC (Staff) 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830

Osborne Road – Kitchenette 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830

Rooms – Third Floor Monday Tuesday Wednesday Thursday Friday Saturday


Osborne Road – Admin Room 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830

Osborne Road – Notes Storage 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830

Osborne Road – Alt Therapy 1200 - 1600

Rooms – Ground Floor Monday Tuesday Wednesday Thursday Friday Saturday

Eastney – Waiting Room #4 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830

Eastney – Reception #74 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830

Eastney – Admin Office #75 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830

Eastney – Admin Office #73 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830

Eastney – Room 1 (Clinical) #42 0900 - 1830 0900 – 1400

1400 - 1830 0900 - 1830 0900 – 1830 1400 - 1830 1400 - 1830

Eastney – Room 2 (Nurse) #44 0800 - 1230 0830 - 1230 0800 - 1400 0830 - 1230 0800 - 1230

Eastney – Room 3 (Clinical) #71 0900 - 1830 0900 - 1400 0900 0 1400

1400 - 1830 0900 - 1830 1400 - 1830

Eastney – Room 4 (Clinical) #70 1400 - 1730 0900 - 1400 0900 - 1830 0900 - 1830 0900 - 1400

Eastney – Office #72 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830

Eastney – Store Room #69 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830

Eastney – Room 5 (Nurse) #45 0830 - 1230 0830 - 1230 0830 - 1230 0800 - 1400 1400 - 1730

Eastney – Room 6 (Clinical) #66 1400 - 1830 0800 - 1400 0830 – 1230

1400 – 1830

0930 - 1230


Eastney – Store #67 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830

Eastney – Room 7 (Clinical) #65 0900 - 1830 0900 - 1830 0900 - 1830 0900 - 1830 0900 - 1830

Eastney – Office #64 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830

Eastney – Room 8 (Nurse) #46 0830 - 1230 0800 – 1230

1400 - 1600 1400 - 1800 0830 – 1230 1400 - 1730

Eastney – Room 9 (Clinical) #62 0900 - 1830 0900 – 1400

1400 - 1830 0900 - 1830 0900 - 1400 0900 - 1400

Eastney – Room 10 (Nurse) #58

0830 – 1230 1400 - 1730

0800 – 1230 1400 - 1730 1400 - 1630

Eastney – Admin #61 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830

Eastney – Admin #60 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830

Eastney – Notes Room #52 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830

Eastney – WC1 #48 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830

Eastney – WC2 #49 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830

Eastney – Secretaries #54 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830

Eastney – Room 11 (Nurse) #55 1400 - 1730 1400 - 1630 1400 - 1700

Eastney – Staff Room #56 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830 0800 - 1830

NB Please note, these room numbers are generated using the plan below issued by Property Services

primary care commissioning committee agenda

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