southeasternhampshireccgandfareham&gosportccg ... · deputy chief finance officer 1415 6...

South Eastern Hampshire CCG and Fareham & Gosport CCGPrimary Care Commissioning Committee in Public

Boardroom, CommCen Building, Fort Southwick, James Callaghan Drive, Fareham PO17 6AR5 December 2018 14:00 - 5 December 2018 15:10

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AGENDA

# Description Owner Time

1 Welcome and apologies Chair 1400

2 Register and declarations of interest

2 register of interests cover sheet.docx 5

2 Register of interests.pdf 7

Chair 1402

3 Minutes of previous meeting

3 minutes of previous meeting cover sheet.docx 9

3 180905 pccc draft minutes.docx 11

Chair 1405

4 Matters arising Chair 1410

5 Finance report

5 Finance coversheet.docx 17

5 Finance table for December 18 - Final.pdf 21

Deputy Chief Finance Officer

1415

6 Quality report

6 Quality cover sheet.docx 23

6 2018.11.19 PC Quality slide PCCC_QAC.pptx 25

Chair 1425

7 Communications and Engagement Report

7 PCCC Engagement Report cover sheet (Dec 201... 27

7 PCCC Engagement Report (December 2018).doc... 29

Head of Communicati

ons and Engagement

1435

8 Decision Log Associate Director of

Primary Care

1445

9 Any other business Chair 1455

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INDEX

2 register of interests cover sheet.docx..........................................................................................5

2 Register of interests.pdf...............................................................................................................7

3 minutes of previous meeting cover sheet.docx...........................................................................9

3 180905 pccc draft minutes.docx..................................................................................................11

5 Finance coversheet.docx.............................................................................................................17

5 Finance table for December 18 - Final.pdf..................................................................................21

6 Quality cover sheet.docx.............................................................................................................23

6 2018.11.19 PC Quality slide PCCC_QAC.pptx...........................................................................25

7 PCCC Engagement Report cover sheet (Dec 2018).docx..........................................................27

7 PCCC Engagement Report (December 2018).docx....................................................................29

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of 1Version 1 February 2018

FOR THE ATTENTION OF THE PRIMARY CARE COMMISSIONING COMMITTEE

IN PUBLIC

Title of Paper Register of InterestsAgenda Item 2 Date of meeting 5 December 2018Exec Lead Clinical SponsorAuthor Lesley Winter

For DecisionTo RatifyTo Discuss

Purpose

To Note x

Link to Strategic Objective Statutory requirement

Executive Summary

PCCC members and officers are required to declare any personal or business interests they may have which may affect, or be perceived to affect, the conduct of their role within the PCCC. This includes any interests that may influence their judgement in the course of conducting the business of the PCCC. Members must also declare any interests held by family members or persons or bodies with which they are connected.

Recommendations

The Primary Care Commissioning Committee is asked to: Receive and note the Register of Interests of Members Receive any oral updates on the Interests of Members Declare any interests relating to any item on the agenda

Publication Public Website

Please provide details on the impact of following aspectsEquality and Quality Impact Assessment

Patient and Stakeholder EngagementFinancial Impact, Legal implications and Risk

Governance and Reporting- which other meeting has this paper been discussedCommittee Name Date discussed Outcome

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Primary Care Commissioning Committee

29 November 2018

First Name Surname Declared Interest - Name and Nature of Business

Sarah Anderson Contractor for PwC

Sarah Anderson Director and owner of Hollybrook Associates Limited

Anna Bennett Wife is Partner at Liss and Liphook Surgery

David Chilvers Undertakes section 12(2) Mental Health Act assessments for Social Services

David Chilvers GP with Willow Group

David Chilvers Fareham & Gosport Alliance

David Chilvers SCAS Governing Body Member

Lucy Docherty Close relative is an employee of Portsmouth Hospitals NHS Trust

Lucy Docherty Spouse works for HCC Childrens services in a senior position

Lucy Docherty Chair of Portsmouth Diocese Council for Social Responsibility

Lucy Docherty Chair of Fareham Good Neighbours

Lucy Docherty Member of the Lighthouse Learning Trust

Lucy Docherty Patron of Fareham Community Hospital

Susanne Hasselmann Husband is trustee of Valley Leisure

Susanne Hasselmann Board Member, NHS Clinical Commissioners (Chair of CCG Lay Member Network)

Susanne Hasselmann Director & Owner of Scirum Ltd

Susanne Hasselmann Chair of Wessex PDLP (Performers List Decision Panel)

Susanne Hasselmann Husband is Director System Delivery, Southampton City CCG

Andrew Holden Dr Laly - partner at Swan Medical Group involved in Laly Pharmacies

Andrew Holden Partner at Swan Medical Group

Andrew Holden Local Medical Committee - Representative for Hampshire & IOW LMC

Andrew Holden Supporter - Friends of Petersfield Hospital

Andrew Holden Swan Medical Group is a member practice of South Eastern Hampshire Alliance

Andrew Holden Wenham Holt (Chase Hospital) Beds - medical cover provided by Swan Medical Group

Andrew Holden Swan Medical Group provides medical cover for Petersfield Hospital wards with L&L and Grange surgeries - subcontract from SHFT

Andrew Holden Liss and Liphook Surgery have contract for community ENT and audiology vial Alliance

Andrew Holden NICE GP reference panel - non-funded GP casual role to comment on draft NICE guidance

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First Name Surname Declared Interest - Name and Nature of Business

Andrew Holden Swan Medical Group holds a sub-contract for community dermatology contract

Sophie Perrio Friend with Practice Manager at Brune Medical Centre

Sophie Perrio Registered as a patient at Manor Way Surgery

Sophie Perrio Previously worked at Rowner Surgery and Brune Medical Centre

Barbara Rushton Member of Alliance

Barbara Rushton GP Principal at Liphook and Liss Surgery

Barbara Rushton CCG Clinical Chair South East Hants CCG

Barbara Rushton Co-Chair of NHS Clinical Commissioners

Margaret Scott Governor of University of Portsmouth

Pat Shirley Member of the Hampshire-wide Crisis Concordat Steering group

Pat Shirley Chair of the Portsmouth and South Eastern/Fareham & Gosport Crisis Care Strategic planning group

Pat Shirley Family member works for Solent Healthcare

Sara Tiller Working closely with South Hampshire GP Allicance, Southern Health NHS Foundation Trust and GP practices on the development of new care models

Nick Wilson Member of Portsmouth Hospitals NHS Trust

Nick Wilson Governor, Treloar School and College

Nick Wilson Champion for voluntary organisations including Community First, MIND HEH and Age Concern Hampshire

Nick Wilson Member of South East England Forum on Ageing (SEEFA) Executive Group

Nick Wilson Member of Southern Health Foundation Trust

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of 1Version 1 February 2018


Title of Paper Minutes of the previous meetings and Action LogAgenda Item 3 Date of meeting 5 December 2018Exec Lead Clinical SponsorAuthor Lesley Winter

For Decision xTo RatifyTo Discuss

Purpose

To Note x

Link to Strategic Objective Statutory requirement

Executive Summary

The minutes of the meetings held on 5 September 2018 are presented for consideration by the Primary Care Commissioning Committee

RecommendationsThe Primary Care Commissioning Committee is asked to approve the minutes of the meeting held on 5 September 2018, in public.





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1

Minutes of the meeting in public of the Fareham & Gosport CCG and South Eastern Hampshire CCG Primary Care Commissioning Committees

Wednesday 5 September 2018 2pmBoardroom, CommCen Building, Fort Southwick

PresentMargaret Scott (Chair) Lay Member Commissioning & Procurement – South Eastern

Hampshire CCGSarah Anderson Lay Member Governance and Audit – Fareham & Gosport CCGDavid Chilvers Clinical Chair - Fareham & Gosport CCGLucy Docherty Lay Member Commissioning & Procurement – Fareham &

Gosport CCGBarbara Rushton Clinical Chair – South Eastern Hampshire CCGPat Shirley Lay Member Patient and Public Involvement – Fareham &

Gosport CCGSara Tiller Managing Director, Fareham & Gosport and South Eastern

Hampshire CCGsNick Wilson Lay Member Patient and Public Involvement - South Eastern

Hampshire CCGAndrew Wood Chief Finance Officer

In AttendanceLisa Baker Primary Care IT Lead - Fareham & Gosport and South Eastern

Hampshire CCGsKate McCandlish Head of Quality for Primary Care and Community - Fareham &

Gosport and South Eastern Hampshire CCGsLesley Winter Governance and Committee Support Officer – Fareham &

Gosport and South Eastern Hampshire CCGs

ApologiesJulia Barton Director of Quality and NursingAlison Edgington Director of Development Keeley Ellis Head of Primary Care - Fareham & Gosport and South Eastern

Hampshire CCGsSusanne Hasselmann Lay Member Governance and Audit – South Eastern HampshireAndrew Holden Clinical Lead, Primary Care - South Eastern Hampshire CCGPaul Howden Clinical Lead, Elective – Fareham & Gosport CCG

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1 WelcomeThe Chair welcomed members to the scheduled meeting in public of the Primary Care Commissioning Committee.

Apologies had been received from:

Julia Barton Director of Quality and NursingAlison Edgington Director of Development Keeley Ellis Head of Primary Care - Fareham & Gosport and South

Eastern Hampshire CCGsSusanne Hasselmann Lay Member Governance and Audit – South Eastern

HampshireAndrew Holden Clinical Lead, Primary Care - South Eastern Hampshire

CCGPaul Howden Clinical Lead, Elective – Fareham & Gosport CCG

The Governing Body noted and accepted the apologies

2 Register and Declarations of InterestThe Register of Interests was presented to the Committee. Members were asked by the Chair if they had any interests to declare relating to specific agenda items being considered at the meeting or if they had anything more to add to the register.

Nick Wilson declared that he was now a Parish Councillor; it was noted that a Conflicts of Interest form should be sent to him.

The Primary Care Commissioning Committee noted the register of interests and the verbal update.

3 Minutes of the Previous MeetingThe minutes of the meeting held in public on 6 June 2018 were presented to the Primary Care Commissioning Committee.

The Primary Care Commissioning Committee agreed that the minutes presented were an accurate record of the meeting.

4. Action LogThe Action Log was presented and noted.

The Primary Care Commissioning Committee noted the register of interests and the verbal update

5 Finance Report The Chief Finance Officer provided an overview of the Primary Care budgets and forecasts summary for 2018/19.

The Committee was advised that the Chief Finance would report back on GP IT; a lack of clarity had been reported with regards to stock control, in particular in the Isle of Wight.


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It was noted that Transformation Managers and Assistants were in place however there was no long term plans for resourcing to ensure the delivery of NCM. Nick Wilson asked if any leftover monies could be reinvested in this. It was confirmed that a business case would be worked up for the continuation of these roles. .

The Primary Care Commissioning Committee noted the information set out in the Finance Report.

6 Quality Report The Head of Quality for Primary Care and Community Services presented this item and highlighted the following key issues:

The Quasar team has been covering complaints and looking at themes and trends;

CQC wishes to meet with Practice Managers. The Head of Quality for Primary Care and Community Services will speak with Primary Care to determine how to facilitate this request;

CQC will continue to have a monthly intelligence sharing phone call; Both CCGs remain at 97% good overall.

It was noted that all recent issues at Brockhurst surgery had been alleviated.

The Primary Care Commissioning Committee noted the information provided in the Quality Report.

7 Communications and Engagement ReportThe Managing Director gave an update on engagement activities which have taken place since the last meeting.

Patient Participation Groups (PPGS) are reporting difficulty in getting through to their practice on the telephone. PPGs have raised this concern with their individual practices who are considering how to address the concerns. The CCGs are aware that practices are working to resolve these issues, including southern Health NHS Foundation Trust investing to upgrade the Willow Group’s phone system

Patient representatives have raised concern about accessibility of phlebotomy services. The CCGs are currently procuring a GP led phlebotomy service which will improve accessibility; a contract is being developed which will allow all Phlebotomy services, except domiciliary care, to be provided by General Practice. This will be rolled out over autumn.

The CCGs held a workshop for practice managers and Locality Patient Group representatives in July. The purpose was to explore how practices and Patient Participation Groups (PPGs) can work together to help local people understand how local services are developing and that their GP doesn’t always need to be their first option. The workshop was an opportunity to share ideas, examples of best practice and learning from previous experience and was attended by 29 representatives with 17 from local practices and eight from the Locality Patient Groups. Hampshire Healthwatch also attended the event.


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Much time and effort has been spent on looking at options to for potentially relocation Emsworth Practice in the future. There are a number of options to be considered including developing the existing practice building, developing Emsworth Victoria Cottage Hospital and designing a new build at Redlands Grange. The practice, local community representatives and CCG will work together to look at the options to determine which are viable and sustainable to ensure the practice continues to provide the high quality services. There has been a great deal of criticism from local people stating that there has not been enough public consultation. This, however, seems to have calmed down a bit now that there is further public and MP engagement taking place.

The Primary Care Commissioning Committee noted the information in the Communication and Engagement Report.

8 Primary Care Risk RegisterIt was reported by the Primary Care IT Lead that there had been not amendments to the PC Risk Register since the last time it was presented. She further reported that due to sickness within the team and the Transformation roles, the team was being left short. It was confirmed that during October and November, focus would be given to those risks which were increasing.

The Chief Finance Officer asked about PC.20; he stated that this was due to charges on unpaid invoices etc. and the information coming from NHS Property Services being flawed. There was currently some engagement and negotiating taking place with all practices to determine the correct information.

The Primary Care IT Lead was asked to bring the risk register back to a future PCCC with risks scored at 12+ only. It was noted that in future, risks would be cut by Business Units, which would mean that Primary Care and New Model Risks would be brought together.

The Managing Director reported that Staunton Workforce Issues (PC.19) could be taken off the risk register as good progress had been made.

The Primary Care Commissioning Committee noted the information in the Risk Register.

9 Bi-annual Focus on GP Forward ViewThe presentation for this item sets out the expectations of CCGs for 2018/19 with regards to GP Forward View implementation. The following key points were highlighted;

One practice is currently not signed up to eConsult; the Primary Care IT Lead advised that she and a Practice Manager would attend the practice to encourage them to sign up.

The Primary Care IT Lead is working with the Communications Team to encourage Pharmacies to direct patients to eConsult. It was suggested that there could be an article for a local paper or patient group. The Managing Director confirmed that these conversations were taking place across the Partnership re engagement/advertising for winter and promoting eConsult.


5

The GP Extended Access Scheme is running well, however this also needs more promotion as feedback is showing that not all are aware of it and people are not being offered appointments. It was confirmed that often receptionists are not offering appointments. The Managing Director advised that training was needed to standardise the approach.

It was reported by the Managing Director that the ETTF Fund was one of the highest risks, with difficulties arising from dealings with NHS Capital and Estates.

The Managing Director confirmed that although workforce planning was taking place, more could be done to help plug gaps as we move forward; she advised that she would speak with the Associate Director of Primary Care and the Head of Workforce and Education.

The Primary Care Commissioning Committee noted the information in the GP Forward View and the progress made.

10 Decision LogThe Decision Log was presented for the Committee to note.

The Primary Care Commissioning Committee noted the information in the Decision Log.

11 Any Other BusinessPat Shirley informed the Committee that Suella Braverman (MP) was holding a Health Summit on 14 September. Sara Tiller confirmed she was attending, along with Maggie MacIsaac, David Chilvers and Tom Bertram.

The meeting closed at 4.00pm


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Title of Paper Primary Care Finance Report, M07 2018/19Agenda Item Date of meeting 05/12/2018Exec Lead Deputy Finance Officer Clinical SponsorAuthor


Purpose

To Note X

Link to Strategic Objective

Executive Summary

This report provides an overview of Primary Care Budgets and Forecasts for 2018/19.

RecommendationsPCCC is asked to:• Note/approve the information set out in the paper.





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CONTENT – MEETING PAPERS

1. Summary

1.1 Set out the purpose of the paper and what it is seeking to achieve. i.e [insert committee] is asked to [approve, note, endorse] [the proposal]

1.2 Identify and summarise a description of the key risks associated with the issue to be developed in the paper.

Risk one: Description of the risk and implication Risk two: Description of the risk and implication

1.3 Summarise what the paper will cover in bullet point form.

For example - This paper will:

Provide the political context Address each of the key risks Appraise potential options Recommend an option Set out next steps

2. Context

2.1 Brief outline of the historical, environmental, political and/or, technical context within which the subject of the paper is set.

3. Addressing issues and risks

3.1 Brief overview of main issues and risks related to the subject

3.2 Sub-Headings (for each risk or issue)

Each risk or issue should be clearly and succinctly described and proposed steps to mitigation outlined.

4. Options (if applicable)

Outline range of options and present rationale for preferred option if applicable to the content of the paper.

5. Recommendations

Set out recommendations regarding the preferred way forward.


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6. Governance

Set out the arrangements for monitoring progress and reporting back to the [insert committee].

7. Next steps

Set out key steps to implementation, timescales and who is responsible.

8. Decision Required

The [insert committee] is asked to:

Approve, note, endorse [insert the proposal] Note that an update will return to the [insert committee] [timescale]

Annex

To be avoided unless they add materially to the paper. Useful annexes may include

A An action plan

B Graphs and Diagrams

D Definitions or processes material to the content of the paper

Don’t forget to put your name (as the author) and the date of the report on the document.


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Annual Budget 18/19

£000's

Forecast Outturn 18/19

£000's

Variance

£000's

Annual Budget 18/19

£000's


£000's

Variance

£000's

26,990 26,973 (17) 24,943 24,892 (50)

1,300 1,300 (0) 1,264 1,282 18

642 646 4 589 593 4

641 641 0 614 614 0

1,558 1,559 1 1,403 1,403 0

71 71 0 68 68 0

36 36 0 35 35 0

31,239 31,226 (13) 28,915 28,887 (28)

Further detail - Further detail -

Delegated Commissioning Delegated Commissioning

GMS GMS Contract 9,611 9,635 24 GMS GMS Contract 15,462 15,442 (20)

PMS PMS Contract 9,281 9,289 9 PMS PMS Contract 1,588 1,591 3

PMS PMS Premium 288 288 0 PMS PMS Premium 97 97 0

QOF QOF 3,203 3,203 0 QOF QOF 2,913 2,913 (0)

DES Directed Enhanced Services 765 763 (2) DES Directed Enhanced Services 734 734 (0)

PCO PCO - Maternity/Sickness/Seniority 729 729 (0) PCO PCO - Maternity/Sickness/Seniority 541 565 23

Collaborative Collaborative fees 130 130 0 Collaborative Collaborative fees 117 117 0

Drugs Prescribing/Dispensing 327 320 (8) Drugs Prescribing/Dispensing 174 176 1

Premises Premises 2,302 2,263 (40) Premises Premises 2,968 2,912 (56)

Premises Premises Improvement Grants 18/19 134 134 0 Premises Premises Improvement Grants 18/19 127 127 0

Other Other - CQC fees/Other 219 219 0 Other Other - CQC fees/Other 220 218 (2)

26,990 26,973 (17) 24,943 24,892 (50)

Local Commissioning Schemes Local Commissioning Schemes

LCS Commissioning LIS 623 621 (2) LCS Commissioning LIS 592 589 (3)

LCS Block LCS 439 439 0 LCS Block LCS 419 419 0

LCS Phlebotomy 137 138 2 LCS Phlebotomy 198 198 0

LCS SMI Health Checks 65 65 0 LCS SMI Health Checks 24 42 18

LCS Low Vision/Stable Glaucoma 23 21 (1) LCS Low Vision/Stable Glaucoma 22 20 (2)

LCS Other 14 15 1 LCS Other 9 14 5

1,300 1,300 (0) 1,264 1,282 18

Local investment (£3.00 p/h)

Online Consultations

A&C Reception training

South Eastern Hampshire CCG Primary Care Commissioning Summary

Delegated Commissioning

Local Commissioning Schemes

GP IT

Services for Extended Access (£6.00 p/h)

Local investment (£3.00 p/h)

Online Consultations

A&C Reception training

Fareham & Gosport CCG Primary Care Commissioning Summary

Delegated Commissioning

Local Commissioning Schemes

GP IT

Services for Extended Access (£6.00 p/h)

Total

Summary Description

Total

Total

Summary DescriptionAnnual Budget 18/19

£000's


£000's

Variance

£000's


£000's


£000's

Variance

£000's

Annual Budget 18/19

£000's


£000's

Variance

£000's

Total


£000's


£000's

Variance

£000's

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Title of Paper Primary Care Quality Exception reportAgenda Item 6 Date of meeting 5 December 2018Exec Lead Julia Barton Clinical SponsorAuthor Kate McCandlish Head of Quality Primary Care Community Services


Purpose

To Note X


Objective 5: Patients using local health services will experience reduced variation in treatment and care standards; they will notice increasing consistency in the quality of services across all care providers

Executive Summary

This report provides an update on CQC, Improving Quality in Primary Care and QUASAR.

Recommendations The committee is asked to note the information given in the paper.




Governance and Reporting- which other meeting has this paper been discussedCommittee Name Date discussed OutcomePrimary Care Operational Group tbc

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Primary Care Quality – 19 Nov 2018CQC UPDATE Improving Quality in primary care

• New style of report. • Short and bullet points with a table of evidence.• CQC & CCG continue to have a monthly intelligence

sharing phone call.

• Both CCGs are 100% Good overall

However:2 x Draft reports awaited/ being reviewed1 x F&G inspection taking place week of 28 Nov 2018.

New Care Models team: Aim to reduce the burden of CQC prep and work together to move towards OUTSTANDING

1. Document showing a vision that will enable neighbourhoods to review what makes “outstanding”

2. Topics that require additional detail e.g. emergency kit.3. Checklists for practices to follow4. Draft CQC presentation template- what to include.

QUASAR used as learning- an example Quasar: Improving the Safety Culture in Primary Care.“This poster demonstrates how a tool developed by clinicians for clinicians is improving the patient safety culture in primary care across two CCGs and how feedback from healthcare professionals leads to changes in local health care systems.” The team was pleased to be able to showcase the delivery of the Executive Director of Quality and Nursing Julia Barton’s vision for CCG quality surveillance”

Relationships are the key to improving quality

Flexible to practice needs, build trust, openness, CQC, share concerns, escalate to senior team.

• Poster competition winnersAHSN Wessex Safety, Quality and

• Improvement Conference in SouthamptonPage 1 of 16 2018.11.19 PC Quality slide PCCC_QAC.pptx

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Title of Paper Transforming Primary Care – Engaging with our local communitiesAgenda Item Date of meeting 5 December, 2018

Exec Lead Sara Tiller, Managing Director Clinical Sponsor

Author Elizabeth Kerwood, Head of Communications and Engagement


Purpose

To Note X


Executive SummaryThis report provides the Primary Care Commissioning Committee with information on engagement activities with the public and patients that have taken place since the previous meeting.

Fareham and Gosport (F&G) and South Eastern Hampshire (SEH) CCGs engage with local people to support the development of primary care through a number of routes and this report provides the key themes from the feedback received.

The Committee is asked to note the three main issues raised during this period:

Micro-suction service waiting times – Concern has been raised about the waiting times for audiology, in particular micro-suction, which was a tier two service, and hearing aid services

Phlebotomy service promotion – Patient representatives have raised concern about the promotion of the new GP led phlebotomy service but recognise that the service is new and agree that the communications should be reviewed after the initial implementation period

Flu vaccine – Concern has been raised about the availability of the flu vaccine and reports of practices having to cancel clinics.

Details of action being taken are detailed in section three.

Recommendations The Primary Care Commissioning Committee is asked to note this report and the CCGs’ responses to the issues highlighted in section three.


Please provide details on the impact of following aspectsEquality and Quality Impact Assessment N/A

Patient and Stakeholder Engagement N/A

Financial Impact, Legal implications and Risk N/A

Governance and Reporting- which other meeting has this paper been discussedCommittee Name Date discussed OutcomeN/A

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Transforming Primary CareEngaging with our local communities

1. PurposeThe purpose of this report is to provide members of the Primary Care Commissioning Committee with information on engagement activities with the public and patients that have taken place since the previous meeting.

2. Engagement routesFareham and Gosport (F&G) and South Eastern Hampshire (SEH) CCGs engage with local people to support the development of primary care through the following routes:

Locality Patient Groups (LPGs) – Ongoing engagement with Patient Participation Groups (PPGs) through the Locality Patient Groups including representatives being members of the CCGs’ Community Engagement Committees

Neighbourhoods – Ongoing engagement in the neighbourhoods about the transformation and development of local services. This includes having representation from Patient Participation Groups and the voluntary sector on established Neighbourhood Boards

Changes to primary care services – Engagement programmes to support GP practices which would like to make changes to their current services.

3. Feedback received and action takenIn addition the CCGs have received feedback through a number of other ongoing routes and these are detailed in Appendix one.

The issues raised and the action taken, or being taken, by the CCGs are set out in Appendix two. Issues to which we would particularly draw the Committee’s attention to are:

Micro-suction service waiting times – Concern has been raised about the waiting times for audiology, in particular micro-suction, which was a tier two service, and hearing aid services. The provision of audiology will be subject to review in the near future

Phlebotomy service promotion – Patient representatives have raised concern about the promotion of the new GP led phlebotomy service but recognise that the service is new and agree that the communications should be reviewed after the initial implementation period. This has been raised with the project lead and further promotion work will be undertaken as required

Flu vaccine – Concern has been raised about the availability of the flu vaccine and reports of practices having to cancel clinics. NHS England is responsible for the distribution of the flu vaccine and is aware of the issues there have been. It is working to resolve these to ensure practices have the supplies they need.

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4. Engaging with local peopleThe CCGs are leading on communication and engagement programmes to either directly seek the views of local people on changes to primary care NHS services or support neighbourhoods to develop these approaches. Current programmes include:

Promoting new models of careGP practices are working together, with support, in neighbourhoods across the CCGs to develop new models of care. This includes support to plan to engage with and inform local people of the changes being made and supported with behaviour change.

Discussions are underway with the neighbourhood leads to understand the plans being developed and determine the communications and engagement work that needs to be undertaken and opportunities to adopt a common approach across neighbourhoods.

Your Big Health ConversationPhase one of Your Big Health Conversation was largely survey-based, and broad brush. Altogether there were 1,950 responses with over 20,000 individual comments.

Phase two was intended to be a more detailed discussion, and was aimed at four specific issues: mental health care, frailty, same-day services, and long-term conditions.

The primary method for gathering feedback was face-to-face discussions. Feedback was also collected via Facebook, and an online survey (answers were ‘free text’ rather than ‘box ticking’.

The overall approach was to set out a very loose outline of future NHS care, with a greater focus on integration and community-based care, and to examine what people felt to be positive about that outline, what concerned them, and what gaps there may be. The priority was to hear from people with direct experience of the relevant services – people with knowledge, rather than a perception.

There were more than 20 separate group discussions across all parts of the Portsmouth and east Hampshire, and there were an additional 112 online survey responses.

Early analysis has provided a number of key themes for each of the issue areas.

Key themes for mental health include: lack of out-of-hours access; gaps in the range of provision, for people who are struggling but short of full-blown crisis; inflexible support which requires people to fit into the service model, rather than fitting the service model to people’s needs.

Key themes for long-term condition support include: burdensome and inflexible systems which often put the onus on the patient to chase and organise; continued duplication, poor communication and inefficiencies between different services; easy access to clinicians – particularly specialist staff – was prized; the need for holistic care, not just specific symptom management.

Key themes for same-day care include: a focus on the importance of access to primary and community services, not just the Emergency Department and 999; the importance of stronger out of hours services; the potential for technology; the need for better information and signposting.


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Key themes for frailty include: the importance of non-medical services to promote mental/emotional wellbeing as well as physical health; the need for greater integration/ joining up of services; preference for ‘in-house’ provision as opposed to agency.

We will be continuing our analysis work and using this to determine phase three.

5. Changes to specific local Primary Care servicesIn addition, the CCGs are leading/supporting communication and engagement programmes to seek the views of local people on the following specific potential changes:

Emsworth PracticeSouth Eastern Hampshire CCG is supporting the practice to consider options for potentially relocating in the future. There are a number of options to be considered including rebuilding/developing Emsworth Victoria Cottage Hospital and designing a new build at Redlands Grange.

The practice, local community representatives and CCG are working together to look at the options to determine which are viable and sustainable to ensure the practice continues to provide the high quality services.

The practice and CCGs have been seeking the views of local people as the preferred option is determined, including two drop-in events. The first phase of the engagement sought people’s views on nine potential options. The themes from the feedback received were used at a non-financial options appraisal to help shortlist the options to three. A second phase of engagement is underway and the themes from the engagement will be included in a report that will be submitted with the business case to NHS England.

Manor Way Surgery and Lee Medical PracticeManor Way Surgery and Lee Medical Practice, both located in the Lee-on-the-Solent Health Centre, have informed Fareham and Gosport CCG that they propose to merge from April 2019. The CCG has been supporting the practices to develop their plans, including seeking the views of their patients.

6. RecommendationThe Primary Care Commissioning Committee is asked to note this report and the CCGs’ responses to the issues highlighted in section three.


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Appendix oneSince the last Committee meeting the CCGs have received feedback through the following routes:

Fareham and Gosport CCG Community Engagement Committee held on September 4 and November 6

Fareham and Gosport Voluntary Sector Health Forum held on September 6 South Eastern Hampshire Locality Patient Group held on September 20 and November

15 Gosport Locality Patient Group held on October 9 South Eastern Hampshire CCG Community Engagement Committee held on October 10 Fareham Locality Patient Group held on November 8.


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Appendix twoThe table below details the themes from the feedback received by the CCGs and the actions that have or will be taken.

Theme Feedback received Actions planned or takenAudiology waiting times Concern has been raised

about the waiting times for audiology, in particular micro-suction and hearing aid services

The provision of audiology will be subject to review in the near future

Phlebotomy service promotion

Patient representatives have raised concern about the promotion of the new GP led phlebotomy service but recognise that the service is new and agree that the communications should be reviewed after the initial implementation period

This has been raised with the project lead and further promotion work will be undertaken as required

Flu vaccine Concern has been raised about the availability of the flu vaccine and reports of practices having to cancel clinics

NHS England is responsible for the distribution of the flu vaccine and is aware of the issues there have been. It is working to resolve these to ensure practices have the supplies they need

Care navigators and surgery signposters

Some patient groups have reported confusion about the difference between care navigators and surgery signposters

The CCG has developed a guide for PPG members which has been shared with practices for patients

Doctors notes for minors Concern has been raised about GPs charging minors for letters related to their health for school, etc

GPs are entitled to charge reasonable costs for work that is outside of their General Medical Services (GMS) contract which includes letters to support applications to exam boards, etc. This work is additional to the services they are funded to provide and charges cover the professional expertise and administrative support required.

There are no set regulations for this area however professional bodies, such as the British Medical Association (BMA) and the Wessex Local Medical Council, do offer guidance for practices

Willow Group practice telephone lines

Following the upgrading of the phone system patient representatives have reported that it is easier to get through by phone

The CCG has shared this feedback with the practice


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