virtual primary care commissioning committee …€¦ · virtual primary care commissioning...

VIRTUAL PRIMARY CARE COMMISSIONING COMMITTEE (PUBLIC) To be held on Thursday 10 September 2020 at 12.30pm – 2.30pm

A G E N D A

Ref Time Item Enclosure Led By Action

Required 1. 12.30 Apologies for Absence

Verbal Chair Noting

2. Declarations of Interest Verbal Chair Consider / Discuss

3. Notification of Any Other Business

Verbal Chair Noting

4. 12:35 Minutes of the meeting held on 9 July 2020

Enc A Chair Approval

5. 12:40 Matters arising not on the Agenda and from papers circulated in August 2020

Verbal Chair Consider / Discuss

6. 12:45 Action Tracker Enc B Chair Consider / Discuss

7. Finance & Contracting

12:50 7.1 Interim Exception Report

Verbal H Tingle Noting

7.2 Primary Care Estates Strategy Implementation Plan Update

Enc C S Barnes / H Tingle

Noting

13:00 7.3 Barnburgh Contract Extension

Enc D K Roberts Approval

8. Quality

13:10 8.1 Interim Exception Report

Verbal Z Head/ A Ibbotson

Noting

13:20 8.2 Flu Plan 20/21 Update Verbal

E Serfozo Noting

9. Strategy & Planning

13:30 9.1 ICS Primary Care Strategy

Enc E N Alsindi /J Pederson

Approval

13:40 9.2 GP Patient Survey 2020

Presentation K Roberts/ G Munce

Consider/Discuss

13:50 9.3 Primary Care Cell Update

Enc F K Roberts Approval/Noting

14:00 9.4 Primary Care Networks Update

Enc G N Alsindi Approval/ Consider / Discuss

14:10 9.5 GP Forward View Update

Enc H K Roberts Consider/Discuss

14:20 9.6 Primary Care Delivery Plan 20/21

Enc I K Roberts Noting

10. 14:30 Forward Planner Enc J Chair Consider / Discuss

11. Risk Register

Enc K K Roberts Noting

12. Any New Potential Risks Verbal Chair Consider / Discuss

13. Any Other Business Verbal Chair Consider / Discuss

Date & Time of Next Meeting Thursday 8 October 2020 12.30pm

Noting

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Minutes of the Primary Care Commissioning Committee (Public)

Held on Thursday 8 July 2020 at 12.30 pm Via Microsoft Teams

Voting Members Present:

S Whittle Lay Member (Deputy Chair) J Pederson Chief Officer H Tingle Chief Finance Officer A Fitzgerald Director of Strategy and Delivery A Russell Chief Nurse

Non-Voting Members Present:

C Ogle Associate Director of Primary Care & Commissioning

K Roberts Primary Care Manager Z Head Lead Nurse Primary Care Quality Dr N Alsindi Clinical Lead for Primary Care & Long

Term Conditions P Barringer NHS England Representative Dr M Pande Locality Lead GP J Telford Healthwatch Representative

In Attendance:

K Smith Senior Officer, Digital Primary Care (Minutes)

Simon Barnes Interim Estates Director Nick Germain Primary Care Manager, NHS England

Meeting Start 12.33 pm

Action 1. Apologies for Absence

• L Tully – Lay Member (Chair)

2. Declarations of Interest The Chair reminded committee members of their obligation to declare any interest they may have on any issues arising at committee meetings which might conflict with the business of NHS Doncaster Clinical Commissioning Group (CCG). Declarations declared by members of the committee are listed in the CCG’s Register of Interests. The Register is available either via the secretary to the Governing Body or the CCG website at the following link: www.doncasterccg.nhs.uk The meeting was noted as quorate. Declarations of interest from sub committees / working groups: None declared. Declarations of interest from today’s meeting: Dr N Alsindi declared a financial interest in Agenda Item 7.2 Primary Care

http://www.doncasterccg.nhs.uk/

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Estates Strategy Implementation Plan Update, as a GP at Bentley Surgery. The Committee agreed that Nabeel could remain present for the item. Dr M Pande declared a financial interest in Agenda Item 7.3 QOF Settlement 19/20 to note virtual decision made, as a GP partner at Tickhill and Colliery Medical Practice. The Committee agreed that Dr Pande could remain present for the item as the decision has already been made and today’s item is to note the decision.

3. Notifications of Any Other Business

• Format of future Primary Care Commissioning Committee Meetings

4. Minutes From Previous Meeting held 11 June 2020 The minutes of the last meeting held on 11 June 2020 were approved as an accurate record.

5. Matters Arising not on the Agenda No matters arising.

6. Action Tracker The Committee discussed and updated each item on the Action Tracker. The latest updates can be viewed on the Action Tracker. K Smith agreed to provide an extract of the minutes from the 14 May 2020 meeting, to support items AP88 and AP89, and share with A Russell and Z Head.

K Smith

7. Finance & Contracting 7.1 Interim Exception Report H Tingle gave a verbal Finance update. The month 1 to 4 Primary Care allocation has been given, this will be reported in the full quarterly report at the August 2020 meeting, according to forecasting, it is expected there will be a £1m overspend, including prescribing. It is thought this is partly due to not receiving the full allocation that was expected however a variance top up is expected to meet the deficit; however this hasn’t yet been received. Further details are awaited from NHS England; a national call has been scheduled for 14 July 2020 where further clarity is expected. The CCG is in the process of submitting any GP Practice COVID-19 costs to NHS England. The Primary Care Team has sense checked the claims and only those that appear to meet the national guidance will be submitted for

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payment. As soon as the funding is released to the CCG, GP Practices will be reimbursed. The Primary Care Commissioning Committee noted the update. 7.2 Primary Care Estates Strategy Implementation Plan Update A paper was shared ahead of the meeting, S Barnes highlighted the following points: A South Yorkshire & Bassetlaw Estates Session was held on 1 July 2020 and was the second gateway review session. The aim of the session was to provide assurance on the progress of the project. Currently there are 5 projects underway in Doncaster and the Board was satisfied with the progress made so far. In addition to the 5 projects, the Mexborough GP led project is also ongoing, it was noted that this project will not be funded through the Capital Programme. The GPs of both Practices (The New Surgery and Mexborough Health Centre) are currently developing a business case, if the business case is successful, there will be a revenue consequence for the CCG in the future. H Tingle expressed the importance of understanding these costs in order for them to be played into future financial plans. The Committee noted the huge amount of work being undertaken by the team and noted that there are 6 Task and Finish Groups, one for each of the projects. The Primary Care Commissioning Committee noted the update. 7.3 QOF Settlement 19/20 to note virtual decision made A paper was shared ahead of the meeting for completeness. C Ogle advised the Committee that following discussions at the June 2020 Confidential Primary Care Commissioning Committee, further information had been sought from the Practices affected by the significant reduction in QOF points and a virtual decision was made outside of the meeting, to pay all 4 of the Practices based on the evidence provided which linked the shortfall to the impact of COVID. It was noted that Practice D identified coding issues and errors for their lower QOF points and agreed this could be a concern, Z Head agreed to investigate this further from a Quality perspective. However it was noted that the practice concerned had indicated that it had learnt from this experience and would be reviewing its processes. The Committee discussed the differences between the QOF and the newly released GP Survey results, in particular where patients feel they are not getting regular follow ups from their GP Practice for long term conditions, as QOF does not reflect his. The Committee noted that the GP Patient Survey

Z Head

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is only completed by a small percentage of the population however agreed that this needs to be discussed further, it was agreed to add GP Patient Survey Results to the forward planner for the September meeting. The Primary Care Commissioning Committee noted the update. 7.4 Proactive Care in Care Home Provision K Roberts gave an update on the recent changes to the Proactive Care specification to include Care Home provision. As per the new specification, it was agreed that Practices should focus on Care Home provision as a direct response to the COVID-19 pandemic, in place of the original Proactive Care specification with no changes made to the payment mechanism, however it was noted that not all Practices have Care Homes within their boundary and therefore the Primary Care Team are keen to seek assurance from those Practices that they are continuing to deliver the Proactive Care specification. The Primary Care Commissioning Committee considered the approach and agreed for the Primary Care Team to seek assurance from those Practices, that do not have Care Homes, that the Proactive Care specification is being delivered.

K Smith

K Roberts

8. Quality 8.1 Interim Exception Report The Primary Care Quality Report was shared as a paper, ahead of the meeting. Z Head highlighted the following:

• COVID-19 Pandemic – All GP Practices remain open with some Practice staff working remotely where necessary.

• COVID-19 Coordination Hub (CCHub) – While the CCHub has been a great resource and continues to support patients who are suspected or diagnosed as having the COVID-19 virus, parts of the service are now being stepped down due to a lack of demand. The service can be fully stepped up in a timely manner if demand requires.

• Primary Care Information Sub Group – The group was stepped down in light of COVID-19 however virtual meetings will begin to take place and discussion will resume in the coming weeks.

• Proactive Care / Care Homes – As discussed earlier in the Meeting, the Proactive Care specification was adapted for Practices to focus on Care Home provision, this will remain in place until the end of August when it is anticipated the new Enhanced Health in Care Homes Service will come into place.

• National Reporting and Learning System (NRLS) – Reports continue to be submitted by Practices, no themes or trends have been identified.

• Case Conference Reporting / Attendance – As detailed in the paper, the numbers of reports completed continues to fluctuate, it has been agreed that the Designated GP for Safeguarding Children, the

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Deputy Designated Nurse for Safeguarding Children and Z Head will meet to discuss this further and undertake a full review of processes once normal business resumes.

• Workforce – The General Practice Nurse (GPN) forum was set up at the beginning of the pandemic and continues to be used regularly by the nursing workforce for the sharing of best practice and peer support.

• Wound Care – Meetings have restarted and the group is looking at setting up Wound Care training again to ensure all staff are confident and competent once the service goes live.

• Care Quality Commission (CQC) – Is currently not undertaking routine face to face inspections. An Emergency Support Framework has been developed to support Practices by answering a series of questions. It was confirmed that this is not an inspection and ratings will not change following the discussion, unless any concerns become apparent.

The Primary Care Commissioning Committee noted the Report.

Z Head

9. Strategy & Planning 9.1 Primary Care Cell Governance Structure A paper was shared, ahead of the meeting outlining the governance structure of the Primary Care Cell. K Roberts highlighted the following:

• The governance structure set up is similar to that of the Health Cell. • Key members are listed within the paper along with the strategic aims

and objectives of the group. • The Risk Register is discussed and updated at each meeting and

escalated where appropriate. It was agreed for the Risk Register to be shared at the next Primary Care Commissioning Committee meeting.

• Action Notes are recorded at each meeting. • A flow diagram of the Primary Care Cell was included within the paper

and detailed other organisations that are involved in the Cell. The Committee questioned how long the Primary Care Cell is expected to run, it was confirmed that the group will work towards an exit plan however no end date has been agreed while the CCG remains in Phase 2 of the COVID-19 response. The group are keen to maintain the close working relationships that have been formed. The Primary Care Commissioning Committee noted the Primary Care Cell Governance Structure. 9.2 Primary Care Cell Decision Log A paper was shared ahead of the meeting, K Roberts shared the key updates:

K Roberts

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• There has been a shift in focus to evaluation and recovery, and therefore discussions have begun to step up any areas that were initially stepped down, such as Enhanced Services with review dates being updated accordingly.

• Standard Operating Procedures (SOPs) for Track and Trace and Face Coverings have been worked up and discussed with the Primary Care Cell, A detailed set of FAQs will be released to Practices, in the coming week.

• Risk Assessments for all Black, Asian and Minority Ethnic (BAME) staff members have been circulated to Practice staff, discussions are ongoing at the Primary Care Cell.

• It has been agreed to pull together a Primary Care Daily Situation Report to better understand system pressures.

• Latest guidance for Clinical Leads with Care Homes was released 8 July 2020.

• Conversations have begun and Flu and Winter Pressures alongside COVID-19, work on this is ongoing.

The Committee discussed potential ways in which Flu and COVID-19 will be managed in Primary Care, it is expected that guidance will be released by NHS England in the coming weeks. It is anticipated that Flu will have an impact on School Nursing with Year 7 children put forward for the vaccine. A Flu Plan is being developed and is expected to be drafted by the end of July 2020. It was agreed that the Primary Care Cell should discuss the Flu Plan at the next Meeting with the anticipation that Primary Care Networks will develop a model for vaccinations at scale for Doncaster. It was also agreed that a broad and draft Flu Plan should be included as part of the next Quality Report to be presented to the Committee. The Primary Care Commissioning Committee noted the Primary Care Cell Decision log and update. 9.3 Primary Care Networks Update The Primary Care Networks (PCNs) Update was shared as a paper, ahead of the meeting. C Ogle gave the following updates:

• As discussed at the last meeting, a request was sent to the PCNs for a breakdown of how the £1.50 per head had been used. 4Doncaster used the funding for additional equipment. Central, North, East and South used the funding to support staffing costs, training and additional equipment. It was agreed that the responses should be shared with H Tingle.

• The Head of Medicines Management will attend the next PCN Clinical Directors meeting to discuss the transfer of Medicines Optimisation in Care Homes staff to PCNs.

• As part of the Enhanced Health in Care Homes Services, each PCN is required to inform the CCG of which Care Homes they are responsible for by 31 July 2020, each Care Home will also have a Clinical Lead assigned to them. Discussions are underway with

K Roberts

Z Head

C Ogle

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Bassetlaw CCG to understand the implications of taking over Care Homes on the border and work is being done to develop a reciprocal agreement.

• A set of draft principles for the Additional Roles Reimbursement Scheme (ARRS) was included within the paper for consideration and sets out the following: - Priority is given to the PCN identifying the underspent funds, where possible. - Funding is used for additional roles over and above the March 2019 baseline. - Unclaimed funds are linked to the recruitment or support for the additional role. - Unclaimed funds are a one off cost; no recurring costs will be supported. - Areas of support could include: bringing forward recruitment of additional roles from the following year, advertising costs, costs for recruitment campaigns, induction and training as a one off costs, clinical supervision.

The draft principles will be discussed with PCN Clinical Directors in the coming weeks. The Primary Care Commissioning Committee approved the draft principles as written in the paper. In addition to the paper, C Ogle gave an update on the development of PCNs, in particular additional roles in the North PCN. Dr N Alsindi declared an interest in this item before the discussion began, as a GP at Bentley Surgery, The Nelson Practice and a member of the North PCN. The Committee agreed that Nabeel could remain present for the item but should not participate in the discussion. The North PCN has requested to recruit an additional 3 MSK First Contact Practitioners. C Ogle confirmed that though the Network Direct Enhanced Service (DES) gives a recruitment threshold, CCGs are able to approve additional roles. The PCN has undertaken a review of their patient demand and feel the roles are required, they believe this will ensure they have a well-rounded and diverse workforce. The Primary Care Commissioning Committee agreed to approve the request on the basis that they have an integrated MSK service and the service does not stand alone.

10. Forward Planner The Forward Planner was shared as a paper, ahead of the meeting. It was noted that an Extended Access update was scheduled to be

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discussed in August 2020, however it was felt there should be a focus on Access at the September 2020 meeting, therefore it was agreed to add the following items to the Forward Planner for September 2020:

- GP Patient Survey Results - Digital Primary Care Access Survey Results - Extended Access Update

It was also noted that further guidance relating to Phase 3 of the COVID-19 response will likely be released and therefore this should be added to the Forward Planner for the next meeting. The Primary Care Commissioning Committee noted the Forward Planner.

K Smith

K Smith

11. Any New Potential Risks

No new risks were identified at today’s meetings.

12. Any Other Business Format of future Primary Care Commissioning Committee Meetings It was noted that the last CCG Governing Body Meeting was held using Zoom and was recorded, the group discussed whether the Committee Meetings should also move to this format. It was agreed to investigate this further outside of the Meeting. A number of Committee members are thought to be on annual leave for the August 2020 meeting and therefore C Ogle agreed to raise this with L Tully. It was also agreed to refer to the Terms of Reference to check the required frequency of meetings.

A Fitzgerald

C Ogle

K Smith

13. Date and Time of Next Meeting Thursday 13 August 2020 at 12.30 pm

Meeting Closed 14:04 pm

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PUBLIC Primary Care Commissioning CommitteeOpen Action Tracker: 10 September 2020

Meeting DateAction/

Agenda RefAction Lead / Action For Timescale

Completed (RAG) and Date

13 February 2020 AP81 Consider inflationary uplift for Local Enhanced Services . UPDATE: Item to be discussed at the September Meeting. Hayley Tingle Sep-20 In Progress

14 May 2020 AP89It was also felt we need to consider some of our GP needs in terms of Level 3 Safeguarding Training as this was due tobe completed in March 2020 but was suspended so need to consider as a must do and look at how we manage that.UPDATE, extract of the minutes sent to A Russell and Z Head to support this item on 10.07.2020

Andrea Ibbeson Jun-20 Complete

11 June 2020 AP94It was noted that a Development Session is due, L Tully agreed to explore this further outside of the meeting. UPDATE: Currenlty exploring the possibility of holding the Development Session in October 2020.

Linda Tully Oct-20 In Progress

9 July 2020 AP96K Smith agreed to provide an extract of the minutes from the 14 May 2020 meeting, to support items AP88 and AP89 of the Action Tracker, and share with A Russell and Z Head.

Kelly Smith Aug-20 Complete

9 July 2020 AP97 Z Head to investigate coding errors and issues at the Practice identified as Practic D in the QOF Setllement paper. Zara Head Aug-20 Complete

9 July 2020 AP98GP Survey Results to be added to the Forward Planner. UPDATE GP Patient Survey Results added to the September 2020 meeting (links with AP105)

Kelly Smith Aug-20 Complete

9 July 2020 AP99K Roberts to see assurance from Practices that do not have Care Homes within their boundary, to ensure they continue to deliver the Proactice Care Specification.

Karl Roberts Aug-20 Complete

9 July 2020 AP100Z Head, the Designated GP for Safeguarding Children and the Deputy Designated Nurse for Safeguarding Children to undertake a full review of processes once normal business resumes.

Zara Head Dec-20 In Progress

9 July 2020 AP101 K Roberts to share the Primary Care Cell Risk Register for discussion at the next Committee meeting. Karl Roberts Sep-20 Complete

9 July 2020 AP102K Roberts to add Flu Plan for discussion, on the next Primary Care Cell Agenda with the anticipation that Primary Care Networks will develop a model for vaccinations at scale for Doncaster.

Karl Roberts Jul-20 Complete

9 July 2020 AP103 Z Head to include the broad draft Flu Plan within the next Quality Report to be presented to the Committee. Zara Head Aug-20 Complete

9 July 2020 AP104 C Ogle to share the PCN responses to the requests of how the £1.50 per head was used, with H Tingle. Carolyn Ogle Jul-20 Complete

9 July 2020 AP105Focus of the September Meeting to include; GP Patient Survey Results, Digital Primary Care Access Survey Results, Extended Access Update. K Smith to add to the Forward Planner. UPDATE: GP Patient Survey Results on September Agenda, other items to be brought to a future meeting once available.

Kelly Smith Oct-20 In Progess

9 July 2020 AP106Phase 3 of COVID-19 Response Guidance to be added to the Forward Planner for discussion at the next Committee meeting. UPDATE: Item discussed as part of the September Primary Care Cell Update.

Kelly Smith Sep-20 Complete

9 July 2020 AP107 A Fitzgerald to further investigate holding the Primary Care Commissioning Committee in public using Zoom. Anthony Fitzgerald Aug-20 Complete

9 July 2020 AP108C Ogle to discuss the August 2020 meeting (a number of members on AL) with L Tully and inform Committee members of any alternative arrangements.

Carolyn Ogle Aug-20 Complete

9 July 2020 AP109 K Smith to share extract of the Terms of Reference (Meetings Frequency) with L Tully and C Ogle Kelly Smith Aug-20 Complete

To be actioned but date not yet due

KEY

Completed / Closed

In Progress

To Action

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Meeting name Primary Care Commissioning Committee Meeting date 10th September 2020

Title of paper

Estates Implementation Plan Update

Executive / Clinical Lead(s) Hayley Tingle, Chief Finance Officer

Author(s) Simon Barnes, Interim Estates Programme Director, Carolyn Ogle, Associate Director of Primary Care & Commissioning

Status of the Report To approve To consider/discuss To note Purpose of Paper - Executive Summary The purpose of this paper is to provide a monthly update to the Committee on the implementation of the CCG Estate Strategy

Recommendation(s)

• The Primary Care Commissioning Committee is asked to note the contents of this report.

Report Exempt from Public Disclosure Yes No

Impact analysis Quality impact Support to improve the quality of the primary care infrastructure

Equality impact

Not applicable

Tick relevant box

An Equality Impact Analysis/Assessment is not required for this report. √ An Equality Impact Analysis/Assessment has been completed and approved by the lead Director for Equality and Diversity. As a result of performing the analysis/assessment there are no actions arising from the analysis/assessment.

√

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An Equality Impact Analysis/Assessment has been completed and there are actions arising from the analysis/assessment and these are included in section xx in the enclosed report.

Sustainability impact To secure sustainability of the primary care estate

Financial implications

Recurrent revenue consequences are a consideration with each scheme. Capital funding comes through ICS or NHS England

Legal implications Premises Cost Directions

Management of Conflicts of

Interest Will be preserved through the Committee’s constitution

Consultation / Engagement

(internal departments,

clinical, stakeholder and public/patient)

To be undertaken as plans emerge

Report previously

presented at Not applicable

Risk analysis

The ICS Programme Business Case isn’t approved and or funding is withdrawn.

Corporative Objective / Assurance Framework

CO3 ensuring that the primary care element of the primary care system is sustainable.

Primary Care Statutory

Duties (only)

[Complete this section if submitting a report to Primary Care

Commissioning Committee / Primary Care Delivery Group. For any other committee, delete this row on the report template.]

Statutory Duty Section Tick Relevant Box

Management of Conflicts of Interest

14O

Duty to promote the NHS Constitution

14P

Duty to exercise its functions effectively, efficiently and economically

14Q

Duty as to improvement in quality of services

14R √

Duty in relation to quality of primary medical services

14S √

Duties as to reducing inequalities 14T Duty to promote the involvement of each patient

14U

Duty as to patient choice 14V Duty as to promoting integration 14Z1 Public involvement and consultation

14Z2

GMS, PMS and APMS contracts (including the design of PMS and APMS contracts, monitoring of contracts, taking contractual

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action such as issuing branch/remedial notices, and removing a contract) Newly designed enhanced services (“Local Enhanced Services” and “Directed Enhanced Services”)

83

Design of local incentive schemes as an alternative to the Quality Outcomes Framework

83

Decision making on whether to establish new GP practices in an area

83

Approving Practice mergers 83 Making decisions on ‘discretionary’ payment (e.g., returner / retainer schemes)

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To plan, including needs assessment, primary medical care services in Doncaster

To undertake reviews of primary medical care services in Doncaster

To co-ordinate a common approach to the commissioning of primary care services generally

To manage the budget for commissioning of primary medical care services in Doncaster

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Primary Care Commissioning Committee

10th September 2020

Doncaster CCG Estates Implementation Update for

August_September 2020

Overview

The Doncaster Primary Care Estate Strategy Implementation and Improvement Plan was published in May 2019 and progress has now commenced delivering the plan.

The following sets out activities that have been undertaken in month and will be progressed in the following month.

Outputs and update for July_August 2020

1. Bentley Hub Project - The project start meeting was held in early August with

representation from the DEP, DCCG, DMBC and the involved GP practices. Project progressing with active involvement from stakeholders.

2. Rossington Health Centre – Follow up meeting held with the West End clinic

who are very keen to be involved in the new development.

3. Mexborough GP led project – T&F group met to update on progress. Land searches complete with input from public sector landowners. Unfortunately, the search has not identified any suitable public sector land available for the new scheme. Project progressing with a target of October 2020 for submission of the OBC to the CCG.

4. PCN/Practice Expansion Schemes The CCG attended the T&F group

meetings with the 4 Doncaster Estate Reconfiguration project, the Scott Practice extension project and the Petersgate Practice expansion project. All projects are progressing, and the CCG is supporting where requested / required.

5. The CCG attended the Doncaster Strategic Estates Group which met in

August.

6. SYB Estates Programme Board - The CCG attended the August SYB Estates Programme Board and updated on progress for the Bentley, 4Doncaster, Scott Practice, Petersgate Practice and Rossington projects.

7. The Programme Business Case is now expected to be submitted to the

October meeting of the Primary Care Commissioning Committee for sign off.

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8. A NHSE sponsored GP premises data collection pilot programme has

commenced and the CCG is actively involved in supporting the project. The project is ongoing.

Focus for September 2020

1. Bentley Hub Project – progress the next phase of the design development

work.

2. Rossington Project - progress the project, make further enquires with

stakeholders.

3. Mexborough GP led Project – continue working with the project team

progressing the project.

4. Continue progressing the 4Doncaster PCN, Scott Practice and Petersgate

practice projects.

5. Progress the Thorne Moore feasibility study with CHP.

6. Continue responding to the ICS Programme Board requests.

7. Attend estates meetings with key partners.

8. Respond as required to BAU requests.

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Meeting name Primary Care Commissioning Committee Meeting date 10 September 2020

Title of paper

Barnburgh Surgery Contract Extension

Executive / Clinical Lead(s)

Anthony Fitzgerald, Director of Strategy and Delivery

Author(s) Carolyn Ogle, Associate Director of Primary Care & Commissioning

Status of the Report To approve To consider/discuss To note Purpose of Paper - Executive Summary The purpose of this paper is to request approval for the contract extension to the Barnburgh Surgery contract for two years for the period ending 8 May 2023.

Recommendation(s) The Primary Care Commissioning Committee is asked to:

Approve the contract extension to 8 May 2023.

Report Exempt from Public Disclosure Yes No

Impact analysis Quality impact Continuity of care for the practice population

Equality impact

Not applicable

Tick relevant box


√

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Sustainability impact

Provides continuity of provision for the registered patients


Contract value

Legal implications

APMS Directions and GMS/PMS Regulations






Practice meetings, consultation engagement undertaken as part of the procurement exercise in 2017/2018. GP survey results included in paper

Report previously

presented at Not applicable

Risk analysis As per the report




Duties (only)





14O


14P


14Q


14R √


14S √


14U


14Z2

GMS, PMS and APMS contracts (including the design of PMS and APMS contracts, monitoring of contracts, taking contractual

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action such as issuing branch/remedial notices, and removing a contract) Newly designed enhanced services (“Local Enhanced Services” and “Directed Enhanced Services”)

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10 September 2020

Barnburgh Surgery Contract Extension

Introduction Following a procurement exercise the APMS contract for Barnburgh Surgery was awarded to the New Surgery and commenced on 9 May 2018 for a three year period ending 8 May 2021. The contract requires the Commissioner to serve nine months’ notice on the Contractor to extend the contract for a maximum of two years, such extension commencing on the day after the expiry date. This means that notice should have been served by 8 August 2020. A conversation has been held with the practice to explain that a renewal notice is required and the practice has indicated that it does wish the contract to be extended for the full term. There are no further extension provisions in the contract beyond May 2023. Considerations The partners of New Surgery practice in Mexborough were awarded the Barnburgh Surgery contract in May 2018 following the departure of the previous single handed provider on six months notice. An options appraisal was undertaken following the termination notice and dispersal of the patient list was considered but after stakeholder engagement and consultation it was felt that retaining a practice in the Barnburgh area was the best course of action. The practice has a list size of 2,689 as at July 2020 which is a reduction of 240 patients since April 2018. The New Surgery has seen an increase of 183 patients over the same period. The primary care matrix is attached for information comparing Barnburgh Surgery with Deprivation Tier 2 and the South PCN average. The CQC information is being updated as the surgery was rated as good following re-inspection in January 2020 after a March 2019 inspection which rated the practice as requires improvement for staffing and recruitment. This was mainly due to the evidence not being available at the Barnburgh Surgery as both practices are being run under one management structure. The January 2020 report recognised that action had been undertaken in all areas identified for improvement previously and rated the practice as good overall and in all population groups. In terms of the GP Patient Survey results for 2020 the practice performs largely in line with the Doncaster averages but exceeds the Doncaster rate of 57% in relation to telephone access (85%). The main area for improvement following the survey results relates to the timing and making of appointments. There are no concerns relating to the practice and there is no reason to suggest that the contract term should not be extended. The practice was visited in March 2019 as part of the Director of Strategy & Delivery’s round of visits and concerns were raised at that point

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about premises developments and the due diligence process in taking over the contract which it felt could be improved with support from the CCG. It is recommended that the contract be extended for the full term allowable and that there is a virtual practice visit to discuss areas of focus following the extension period.

Barnburgh Surgery Matrix Information C86606

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Title of paper

South Yorkshire & Bassetlaw Strategic Plan for Primary

Care 2020 - 2024

Executive / Clinical Lead(s) Jackie Pederson, Chief Officer


Status of the Report To approve To consider/discuss To note Purpose of Paper - Executive Summary The draft strategic plan for primary care 2020 – 2024 has been developed by the ICS Primary Care Steering Board and is attached as a working draft for the approval of the Committee. LMCs are meeting separately to consider the draft and will feed in comments accordingly. It has also been suggested that the Governing Body or Executive Committee have sight of this draft and is to be shared with the PCN Clinical Directors in advance of the Committee meeting. Members are asked to consider the content of the strategy and to make any contributions felt to be relevant. Written examples of any changes suggested are requested rather than just observations on the slides in their present form. It should be noted that some slides do need further work in order to ensure that we retain the original intent which is that the strategy is high level but real enough to resonate with stakeholders, built on principles and sighted on outcomes but with no prescriptive “what” or “how”. The Strategic Plan is to be finalised for the ICS Primary Care Steering Board meeting in October 2020.

Recommendation(s) The Primary Care Commissioning Committee is asked to:

• Approve the draft Strategic Plan for Primary Care as part of the consultation process.

• Consider whether any further circulation or approval is required.

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Report Exempt from Public Disclosure Yes No If yes, detail grounds for exemption:

Impact analysis Quality impact Quality improvement, reducing inequalities and learning from covid run

through the document

Equality impact

Not applicable

Tick relevant box




The strategy defines layers of scale to ensure sustainability of primary care within the wider system


The strategy will identify the priorities against which resources can be targeted

Legal implications Not applicable






Partner organisations across South Yorkshire & Bassetlaw

Report previously

presented at Primary Care Steering Board in August 2020

Risk analysis None identified




Duties (only)





14O


14P

Duty to exercise its functions 14Q

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effectively, efficiently and economically Duty as to improvement in quality of services

14R


14S


14U


14Z2

GMS, PMS and APMS contracts (including the design of PMS and APMS contracts, monitoring of contracts, taking contractual action such as issuing branch/remedial notices, and removing a contract)

83

Newly designed enhanced services (“Local Enhanced Services” and “Directed Enhanced Services”)

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83


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Title of paper

Primary Care Cell Briefing Paper



Author(s) Karl Roberts – Primary Care Manager

Status of the Report To approve To consider / discuss To note Purpose of Paper - Executive Summary The purpose of this paper is to provide committee members with an overview of the decisions taken at the Primary Care Cell that has been put in place as a response to COVID-19 and its effect across Doncaster Primary Care provision. Via the virtual update in August committee members were provided with the latest overview, this paper provides the detail of the decisions & main conversations that have taken since the last PCCC meeting. We have also included the Primary Care risk register as part of this update at the request of committee members. In addition for September committee we are asking members to consider the reduced guaranteed Local Enhanced Service (LES) payments until the end of Quarter 3 which have been discussed at the Primary Care Cell to come to PCCC for decision. The paper below provides further narrative in relation to this area. Finally the paper asks committee members to consider extending the standing down of the Primary Care Delivery Group whilst the PC Cell meetings are still running and to give time for both meetings to be reviewed.

Recommendation(s) To note the information provided in relation to the PC Cell update To approve the guaranteed 50% funding in support of the LES payments to Doncaster General Practices for quarter 3 2020. To agree for Primary Care Delivery Group to remain stood down until at least October 2020 whilst the PC Cell and PC Delivery Group meetings are reviewed.

Report Exempt from Public Disclosure

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Yes No If yes, detail grounds for exemption:

Impact analysis Quality impact Development of primary care networks supports the sustainability of

primary care

Equality impact

Tick relevant box

An Equality Impact Analysis/Assessment is not required for this report. x An Equality Impact Analysis/Assessment has been completed and approved by the lead Head of Corporate Governance / Corporate Governance Manager. As a result of performing the analysis/assessment there are no actions arising from the analysis/assessment.



Development of primary care networks supports the sustainability of primary care as a whole

Financial implications included in report

Legal implications described in the report


Interest None identified but managed within Committee constitution




Practice visits and practice manager discussions as well as monthly Clinical Director meetings

Report previously

presented at Regular updates provided to Committee

Risk analysis n/a


The report links to the following corporate objectives: • Commission high quality, continually improving, cost effective

healthcare which meets the needs of the Doncaster population • Work collaboratively with partners to improve health and reduce

inequalities in well governed and accountable partnerships.


Duties (only)

Statutory Duty Section Tick Relevant Box Management of Conflicts of Interest

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The Primary Care Cell Meeting Overview & Delivered Actions Author: Anthony Fitzgerald & Karl Roberts The Primary Care Cell was setup as a direct response to the COVD-19 outbreak, the rationale for the cell was to coordinate the Primary Care response for the Doncaster population. The cells principles are to enact a local response based upon national guidance and the local need. The Cell meets once a week and covers a multitude of different areas from PPE to new national guidance to new models of care and the input of the group ranges from general feedback and input to the creation of new services and implementation of new ideas. The cell has evolved and developed since implementation from a reactive group based upon the evolving situation that COVID-19 posed to a more proactive group ensuring that Primary Care services are prepared for ongoing care provision and the different expected COVID-19 phases. The Primary Care Cell links in closely with the other COVID-19 cells setup to ensure that there is consistency in delivery of key messages and to ensure that there are effective escalation routes across the wider Doncaster health community. Since the last Committee meeting the Primary Care Cell has continued to cover a range of key working areas, with the headline areas and work undertaken by the Primary Care Cell detailed below:

1. Evaluation & Recovery The PC cell have continued to look at the Evaluation & Recovery across Primary Care services and at the last meeting heard of the FAQ document circulated based upon the latest guidance. This has since been updated based upon new guidance and queries received and shared again with general practice. The Cell has continued to look at services and areas within Primary Care that need to be re-started and have looked at in more detail the local enhanced services (LES) with further detail and recommendations listed below.

2. GAP analysis on national guidance and reiterations of these (GP Preparedness letter,

Second phase of the NHS response and SOP etc.) The group continue to monitor and actions the areas identified via a GAP analysis document produced in light of the latest guidance/SOPS etc.

3. Continue to support activity and options for the CCHUB The PC Cell continues to discuss the role of the CCHUB model. Despite falling numbers and reduced staffing at present this remains a weekly agenda item and tweaks continue to be made. With the return to school and the start of flu season conversations have been had to ensure that the CCHUB has the ability to be stood back up if a second waive should occur.

4. Flu planning and Winter pressures

Flu and winter conversations continue to be a staple part of the PC agenda and have/are influential to the plans that will be put in place across Doncaster. The Primary Care supports the Flu meeting that take place and has recently agreed communications and a

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return to practices asking for extra detail and plans to support the extended flu vaccination campaign. Conversations around this area continue at pace and will continue via the Flu group and the Primary Care Cell.

5. Continue to review and agree a Risk Register in relation to key areas The group continue to add, update and maintain a log of all the risks discussed at the Primary Care cell and escalate as required. The group have recently added on new risks around the workload shift with in Primary Care and the risks and challenges that this is bringing. This now forms part of the agenda and will continue to be discussed, a copy of the latest PC cell risk register is also provided as part of this update.

6. Infection Prevention & Control (IPC) Guidance

The group have worked through some IPC guidance challenges and with the expert help of our quality colleagues have been able to provide assistance and assurance to the cell and wider Primary care in support of the recent FAQ documents. These discussions are ongoing and are likely to continue.

7. Verification of Death The primary care cell has discussed verification of death at the earlier stages of COVID but has recently discussed and agreed updated guidance in relation to the process around the why, who and when.

8. Care Home Specification extension (Use of Proactive Care Specification) It was previously agreed that the proactive care specification would be re-tasked to support care homes during the COVID outbreak in advance of the national Care Home DES coming in to force. This was originally agreed for 3 months ending in August 2020. However at the PC Cell agreed the extension of this for 1 month up to the end of September 2020 to ensure that there was a smoother transition to the DES and that there were no gaps in provision. This has been clearly communicated to practices and ALL practices are aware that Proactive Care in its original format will start again from the 1st October 2020.

Local Enhanced Service Funding Overview When COVID hit initially the CCG agreed that it would support the funding of the LES payments to practices until the end of July 2020 even if the practices were unable to complete any actual activity. This was based upon national guidance which stated that Primary Care funding should be protected and was also in line with payments for the DES’s as agreed with NHSE England. This was then extended until the end of quarter 2 (September 20). With national guidance now providing detail of how Primary Care and other services now shift back to the new ‘Business as usual’ the PC cell has held discussions about how this should happen, when this should happen and what are the enablers and blockages. It is recognised that with all the changes that were enforced that there are likely to be challenges around;

- Backlogs of work that need to be completed - The re-introduction of the more routine/normal - Looking at how these can be safely managed given the COVID precautions that are still in

place and are likely to remain. Additional factors such as workload shift and the need in some instances for some further clarity in guidance (e.g. minor surgery etc.) have indicated that it would be potentially unfair to expect practices to be able to just return to a model in place pre COVID and be able to provide the same levels of activity.

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Proposed course of action To support practices with a phased return but to also encourage practice to start ramping up activity PC Cell discussed continuing to support practices with 50% guaranteed funding for quarter 3 before returning to normal for quarter 4. These conversations were thought to give a good compromise in supporting practices but also ensuring activity re-commenced and services were stepped up for patients as needed. Although supported at the PC Cell it was explained that this was a decision that was needed by the Primary Care Commissioning Committee for further discussion and potential signoff. Discussions have taken place with the CCG finance leads as well as with other Primary Care leads across the patch in the run up to this committee meeting to ensure that everyone is sighted on this area. How this would work Practices are currently paid on twelfths based upon the last completed financial years activity with a reconciliation at the end of quarter 3 which would pay additional activity if the practices numbers were higher or reduce payments if practices activity was lower than then previous years. At present the CCG are providing practices with 100% activity based upon the last completed year and this would reduce to 50% as of the 1st October 2020 through to the 31st December 2020. After this there would no further guaranteed payments and it is expected that practice activity by then should better reflect normal. As before any practices that are exceeding the 50% activity will be paid the higher amount when reconciled at the end of the year. Primary Care Delivery Group When COVID first hit this committee gave permission to stand down the Primary Care Delivery Group until the end of July 2020 where this would be reviewed again. During COVID the PC Cell was setup to deal with immediate issues affecting Primary Care as a result of COVID and this group remains in place. As we now move back towards business as usual there is the intention to review both the Primary Care Cell and the Primary Care Delivery Group meetings in September and to formulate the best way forward. To this end we are asking committee to agree to continue the standing down of the Primary Care Delivery Group until October to allow these reviews to take place.

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Title of paper

Primary Care Networks Update




Status of the Report To approve To consider / discuss To note Purpose of Paper - Executive Summary The purpose of this report is to update the Committee of the work with Primary Care Networks and this month in particular to focus on workforce planning and the ICS assurance framework.

Recommendation(s)

• To consider the workforce plans for each of the five PCNs and how best they link to system workforce plans

• To approve the use of the 19/20 additional roles underspend. • To note the assurance template relating to PCNs

Report Exempt from Public Disclosure Yes No If yes, detail grounds for exemption: Impact analysis Quality impact Development of primary care networks supports the sustainability of

primary care Equality impact

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Tick relevant box




Development of primary care networks supports the sustainability of primary care as a whole

Financial implications included in report

Legal implications described in the report






N/A

Report previously


Risk analysis n/a




inequalities in well governed and accountable partnerships.


Duties (only)


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10 September 2020

Primary Care Networks Update Workforce Plans The Network Contract DES requires PCNs to complete and return a workforce plan, using an agreed national workforce planning template providing details of the recruitment plans for 2020/21 by 31 August 2020. This is to be followed by indicative intentions through to 2023/24 by 31 October 2020. The five plans attached (G1-G5) were all received by the August deadline. It should be noted however that Central PCN will be resubmitting their plan as two further physiotherapists are to be included. These are reflected in the summary below. The CCG has a role in supporting the implementation of the workforce plans and to ensure that NHS workforce plans for the local system are helpful in supporting PCN’s workforce plans. The CCG is required to share with the LMC and PCNs by 30 September 2020 an estimation of the amount of financial entitlement under the Additional Roles Reimbursement Scheme that the PCN is unlikely to claim by 31 March 2021. The figures included in the attached documents will require validation by the finance team to ensure accuracy of information to be shared and agreed with the LMC and PCNs. The approach to use of the underspend is to be finalised in line with the principles agreed for 19/20 and in the spirit of the Network Contract DES specification for 20/21. In summary the workforce plans show the following additional posts by end March 2021. Role Recruited 19/20

(wte) 20/21 Plan (wte) TOTAL (wte)

Clinical Pharmacist 9.64 14 23.64 Social Prescriber 6 0 6 Physiotherapist 11 11 Physicians Associate

11 11

Pharmacy Technician

4 4

Occupational Therapist

0 0

Dietitian 3 3 Podiatrist 1 1 Health & Well Being Coach

7 7

Care Co-ordinator 5.4 5.4 TOTAL POSTS 15.64 54.5 70

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Additional Roles Underspend 19/20

The draft principles for use of the underspend in relation to the Additional Roles Reimbursement scheme were agreed at a previous meeting of the Committee and with the PCN Clinical Directors and are included in the letter attached from Primary Care Doncaster Ltd.

The Clinical Directors were asked to submit their requests for use of the underspend in line with the principles by early September 2020. These were received as a composite request via Primary Care Doncaster and are attached as G6 and G7.

In essence the request for use of the underspend relates to recouping recruitment costs including the 30% non reimbursable amount for the pharmacists in year one (from 2020 all posts are funded at 100%); supervision and equipment costs.

The Committee is asked to consider and approve the use of the underspend as requested.

PCNs Assurance Template The following spreadsheet circulated by the ICS, details all of the key requirements in the Network Contract DES relating to PCNs as a way of tracking progress in each CCG area. Those that are greyed out are included as an aide memoire and are for information only. The completed spreadsheet will be taken to the ICS Programme Board as a way of sharing where we are collectively on implementing the Long Term Plan, sharing best practice and ideas and identifying where collective support to problems will help. The RAG rating agreed is : GREEN – done/implemented AMBER – on with it no problems being experienced RED – not started or experiencing problems that we could do with some help to sort It is not a good/bad rating. The Committee is asked to note the level of assurance required.

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Reference Requirement Source Deadline Doncaster

2020/21 Participation Process

Commissioner to ensure any patients of a practice not participating in the Network Contract DES are covered by a PCN

DES 4.1.3 01/04/2020 100% for 20/21


Commissioner to outline method practices must use to participate in the Network Contract DES (Form set out in Annex A)

DES 4.3.1 01/04/2020 Form submitted and PCCC sign off process


Practice to notify the commissioner of change / no change to PCN before 31/05/2020. Commissioner to confirm participation within 1 month

DES 4.4 - 4.8 31/05/2020 PCNs confirmed as per 19/20


Where change in details of previously approved PCN - commissioner must submit notice of ODS Change Instruction by 12/06/2020

DES 4.5.5 12/06/2020


Where PCN unwilling to accept a practice - practice to notify commissioner by 31/05/2020. Where commissioner requires inclusion of practice by a PCN, notice to be given by 30/06/2020

DES 4.9 30/06/2020


Auto-enrolment in 2021/22 Network Contract DES unless practices opt out by 31/03/21

DES 4.12.1 31/03/2021


Network Participation Payment - £1.761 x practice weighted population as at 01/01/2020.

DES 9.3.5 01/04/2020

PCN Organisational Requirements

Definition of PCN to cover populations of 30-50k, contiguous and sensible geographic boundary.

DES 5.1 01/04/2020 All PCNs are larger than 50k but makes sense to integrated working and Doncaster

place plan PCN Organisational Requirements

Continued provision of Extended Hours Access Service from 01/04/2020

DES 5.2.4 01/04/2020 Yes confirmed that this is the case with all 5 PCNs


Supplementary services to be contracted with a Core Network Practice or legal entity, cannot contract with a PCN directly

DES 5.2.7 01/04/2020


Clinical Director role accountable for strategic leadership, workforce planning and development, implementation of service changes

DES 5.3 01/04/2020 CDs confirmed, change to South PCN notified

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Non clinical data sharing between PCN members (and clinical data sharing where available) to understand population need, identify variation, manage capacity and demand etc

DES 5.4 01/04/2020 Aug 2020/21 Update – Data against a number of metrics is regularly refreshed in an online reporting system (PC Matrix), by PCN, with the ability to compare and identify variation. Project underway to begin to collate capacity and demand intelligence to form part of the full system analysis of pressures, as well as specifically within Primary Care and across PCNs. The broader Doncaster approach to PHM is being picked up again to develop additional products following work done during COVID19 to develop intelligence at neighbourhood and LSOA level. Further work also being progressed with the Federation to develop their analytical support offer.


PCN must act in accordance with requirements relating to patient engagement

DES 5.5 01/04/2020 Primary care event Feb 20 focused on this item and discussions ongoing about community participation forums


PCN to detail arrangements with local community services in Schedule 7 of the Network Agreement by 30/09/2020

DES 5.7.3 30/09/2020 On agenda for PCN CDs meeting 8/9/20


PCN to detail arrangements with community mental health providers and community pharmacy in Scehdule 7 of the Network Agreement by 31/03/2021

DES 5.7.4 31/03/2021 Not started but will pick up as part of discussion re above pharmacists already aligned


Core PCN Funding - £1.50 x PCN list size (£0.125 per patient per month)

DES 9.5.2 01/04/2020


Clinical Director Payment - 0.25 WTE per 50,000 PCN patients (£0.722 per registered patient per annum.

DES 9.4 01/04/2020


ICS 'PCN Development Support' to support implementation of Delivery Plans

PCN Development Support Prospectus

Local timeline

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ICS 'Clinical Director Development Support' to support implementation of Delivery Plans (nominally £3-4k per Clinical Director to be used collectively)

ICS Development Plan

Local timeline


Refresh of PCN Development Plans and Maturity Matrix (last submitted Sept 2019)

PCN Development - Guidance & Prospectus

Local timeline

On agenda for PCN CDs meeting 8th September 2020

Additional Roles Reimbursement Scheme

100% reimbursement to actual salary and defined on-costs for 10 PCN roles.

DES 9.10.1 01/04/2020


Additional Roles Reimbursement Sum calculated using £7.131 per PCN weighted population as at 01/01/2020.

DES 9.10.2 01/04/2020


From April 2020 following roles are reimbursable; Clinical Pharmacist, Pharmacy Technicians, SP Link Workers, HWB Coach, Care-Coordinators, Physician Associates, First Contract Physiotherapist, Dietician, Podiatrist, OT

DES Guidance 8.1.2

01/04/2020

Recruitment taken place


From April 2021 following roles are reimbursable; Paramedics, MH Practitioner

DES Guidance 8.1.3

01/04/2021

Need clarity on MH role please


Additionality measured from staffing baseline 31/03/2019 for 6 reimursable roles, fixed until March 2024. Clinical Pharmacist, SP Link Worker, First Contact Physio, Physician Associate, Pharmacy Technician, Paramedics.

DES 6.2.2 31/03/2019


No PCN baseline established for Care Coordinator, HWB Coach, Dieticians, Podiatrists, OT, however principles of additionality apply.

DES 6.2.6 01/04/2020


Equivalent reduction in ARR Sum back where staffing drops below the 2019 baseline.

DES 6.2.3 01/04/2020


Clinical Pharmacist and Pharmacy Technicians employed under MOCH scheme must transfer to PCN staffing by 31/03/2021 to become reimburseable

DES 6.2.10 31/03/2021 Head of Medicines Management in discussion regarding role of team and PCNs

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PCN to record information on Additional Roles via National Workforce Reporting Service (NWRS) in line with existing process

DES 6.4.3 01/04/2020


Commissioner must complete and return 6 monthly workforce report to [email protected]

DES 6.4.4 01/04/2020


PCN submission of Workforce Plans delayed until end August (see PCN Workforce Planning Template 2020/21)

DES 6.5.1 31/08/2020 Plans received by deadline


PCN submission of indicative plans for 2021/22 to 2023/24 delayed until end Oct (see PCN Workforce Planning Template 2020/21)

DES 6.5.1 30/09/2020


Commissioner to have shared and agreed an estimate amount that PCN are unlikely to claim under ARRS ("Unclaimed Funding") based on Workforce Planning returned 31/08/2020. Funding then open to bids and redistribution within 2020/21

DES 6.5.3 - 6.5.13

30/09/2020

Extended Hours Access

Provision of Extended Hours Access in accordance with Network Contract DES, regardless whether any practices within the PCN are providing any CCG Extended Access Service

DES 7.1.1 01/04/2020 All 5 PCNs are continuing with extended hours


Definition and minimum additional appointment minutes set out in Network Contract DES

DES 7.1.3 01/04/2020


Extended Hours Access Payment calculated as £1.45 x PCN list size (£0.121 per patient per month)

DES 9.6.2 01/04/2020

Enhanced Care in Care Homes

PCNs must agree with the CCG the Care Homes for which the PCN will have responsibility ("PCNs Aligned Care Homes")

DES 7.3.1a 31/07/2020 All care homes are aligned to a PCN


The CCG hold ongoing responsibility for ensuring that Care Homes in their area are aligned to a single PCN and may allocate a care home to a PCN if agreement cannot be reached.

DES 7.3.1a 31/07/2020 All care homes are aligned to a PCN.


PCNs need to have a simple plan in place with local partners (including community services providers) for how the service requirements will be delivered.

DES 7.3.1b 31/07/2020 RDaSH supporting MDT structure in place

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PCNs must support people entering, or already resident in the PCN’s Aligned Care Home, to register with a practice in the aligned PCN if this is not already the case.

DES 7.3.1c 31/07/2020 Update July PCCC - template letter used in other area shared with PCNs, ongoing patient choice given


PCNs must confirm a lead GP (or GPs) with responsibility for this specificaiton's requirements for each of the Aligned Care Homes. Transition COVID-19 support to EHCH amends requirement 7.3.1g so that lead may be non-GP clinical with relevant experience (change to DES later in 20/21 but to be operational immediately)

DES 7.3.1d

31/07/2020 Named lead identified for all care homes


PCNs to work with community service providers and other relevant partners to have an MDT and develop personalised care and support plans with people living in the PCN’s Aligned Care Homes.

DES 7.3.2 30/09/2020 Update July PCCC - 5 locality Care Home forums to oversee development of MDTs - phased plan with MDT for each home


PCN are to as soon as is practicable, and by no later than 31 March 2021, establish protocols between the care home and with system partners for information sharing, shared care planning, use of shared care records, and clear clinical governance.

DES 7.3.3 No later than 31 Mar 2021

Part of locality forum work as described above


PCNs to deliver a weekly ‘home round’ for the PCN’s patients in the Aligned Care Home, prioritised according to MDT clinical judgement and care home advice, provide consistency of staff in the MDT, except in exceptional circumstances. This must include appropriate and consistent medical input from a GP or geriatrician, when required and may use digital technology to support this.

DES 7.3.4a 01/10/2020 Weekly check ins being provided to care homes some LD homes this is not applicable for


The MDTs in the PCNs must refresh as required a personalised care and support plan with the PCN’s Patients who are resident in the PCN’s Aligned Care Home(s).

DES 7.3.4b 01/10/2020 In place as part of locality forum process and proactive care work


Care Home Premium calculated at £60 per bed for eight month period 01/08/2020 - 31/03/2021. Bed counted based on CQC data on beds within registered services. CCG to arrange payment on monthly basis from 01/08/2020.

DES 9.7.2 DES 9.7.3

01/08/2020

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Network DES defines minimum standard. Clarify NSHEI approach to Framework 'Best Practice' under Care Elements 1 to 7.

Framework for EHCH

??? Need clarity on this and what assurance is required

Structured Medication Reviews and Optimisation

A PCN to use appropriate tools to identify and prioritise PCN patients who would benefit from a structured medication review (SMR). This must include care homes, patients with complex and problematic pharmacy, medicines associated with medication errors, severe frailty (particulary housebound, isolated and recent hospital adms/falls) or using potentially addictive pain medication.

DES 7.2.1 01/10/2020 Update July PCCC - PCD letter confirming work underway to deliver Medicines Optimisation by Oct. MMT support to care homes phased withdrawal


PCNs need to offer and deliver a volume of SMRs determined and limited by the PCN’s clinical pharmacist capacity, and the PCN must demonstrate reasonable ongoing efforts to maximise capacity.

DES 7.2.1b 01/10/2020 Progress to be discussed with PCNs 8/9/2020


Staff completing SMRs must have prescribing qualification and advanced assessment and history taking skills, or be enrolled in a current training pathway to develop this qualification and skills

DES 7.2.1d 01/10/2020 Progress to be discussed with PCNs 8/9/2020


PCN to work with the CCG to optimise the quality of local prescribing of: i. antimicrobial medicines; ii. medicines which can cause dependency; iii. metered dose inhalers, where a lower carbon device may be appropriate; and iv. nationally identified medicines of low priority;

DES 7.2.1f 01/10/2020 MMT work with practices and PCNs to be agreed


PCN to work with community pharmacies to connect patients appropriately to the New Medicines Service which supports adherence to newly prescribed medicines

DES 7.2.1g 01/10/2020 Progress to be discussed with PCNs 8/9/2020

Supporting Early Cancer Diagnosis

PCNs are to review referral practice for suspected cancers against NICE guidelines , including recurrent cancers using clinical decision support tools and exploring local patterns on practice level data and where available the Rapid Diagnostic Centre pathway for people with serious but non-specific symptoms

DES 7.4.1 ai 01/10/2020 Update July PCCC - PCD letter confirming work underway to deliver Early Cancer Diagnosis by Oct

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PCNs to provide a consistent approach to monitoring patients referred urgently with suspected cancer or for further investigations to exclude the possibility of cancer inline with nice guidelines

DES 7.4.1 aii 01/10/2020


PCNs to ensure patients are signposted to or receive information on their referral including why they are being referred, the importance of attending appointments and where they can access further support.

DES 7.4.1 aiii

01/10/2020


PCNs need to contribute to improving local uptake of National Cancer Screening Programmes by working with Local system Partners including Public Health and Cancer Alliance and and must include at least one specific action to engage with a group with low-participation locally within timescales agreed with local partners

DES 7.4.1b 01/10/2020 Engaged with cancer alliance


A PCN must, through the community of practice conduct peer to peer learning events that look at data and trends in diagnosis across the PCN, including cases where patients presented repeatedly before referral and late diagnoses; and engage with local system partners, including Patient Participation Groups, secondary care, Cancer Alliance, and Public Health.

DES 7.4.1c 01/10/2020

Social Prescribing A PCN must provide their patients with access to a social prescribing service by directly employing Social Prescribing Link Workers or sub-contract provision of the service to another provider.

DES 7.5.2 01/04/2020 All PCNs have social prescribing support in place

Social Prescribing Where a PCN engages or employs a social prescribing link worker, that person must: a. have completed the NHS England and NHS Improvement online learning programme b. is enrolled in, undertaking or qualified from appropriate training as set out by the Personalised Care Institute; and c. attends the peer support networks run by NHS England and NHS Improvement at ICS and/or STP level;

DES Annex B B3.2

01/04/2020

Social Prescribing Whether employed or sub contracted the social prescribing link worker has the same responsibilities and these are outlined in PCN DES Annex B3.3.

DES Annex B B3.3

01/04/2020

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Social Prescribing Other wider responsibilities include woking collaboratively with local partners and engaging with local Voluntary, Community and Social Enterprise (VCSE) organisations and community groups to receive social prescribing referrals

DES Annex B B3.7

01/04/2020 South Yorkshrie Housing Employing Body

Social Prescribing A PCN must work in partnership with commissioners, social prescribing schemes, Local Authorities and voluntary sector leaders to create a shared plan for social prescribing which must include how the organisations will build on existing schemes and work collaboratively to recruit additional social prescribing link workers to embed one in every PCN and direct referrals to the voluntary sector.

DES Annex B B3.10

01/04/2020

Social Prescribing ICS Development Support for Social Prescribing Link Workers ICS Development Plan

Local timeline

N/A

Anticipatory Care Deferred to 2021/22

Proactive care commissioned locally

Personalised Care Deferred to 2021/22

Personalised care Steering Group in CCG new roles will support to embed

CVD Prevention and Diagnosis

Deferred to 2021/22

CCG Clinical Lead is ICS clinical lead for CVD update on progress required

Tackling Neighbourhood Inequalities

Deferred to 2021/22

Key element of commissioning via localities model

Investment & Impact Fund

Due to COVID-19, half the IFF value for 2020/21 (£16.25m) recycled into a GP support fund paid on PCN weighted population (27p per weighted patient) for 6 month period to 30/09/2020

DES Explanatory Note 31/03/2020

01/04/2020 - 30/09/2020


Remaining IFF funding to be discussed with GPC England once impact of COVID-19 clearer, and communicated before 01/10/2020


01/10/2020

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IFF data collection to continue as planned, but payment not contingent on performance up to 01/10/2020


01/04/2020


PCN performance against IFF metrics to be reported as planned against PCN dashboard


01/04/2020

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Title of paper

GP Forward View Update

Executive / Clinical Lead(s) Anthony Fitzgerald, Director of Strategy and Delivery


Status of the Report To approve To consider / discuss To note Purpose of Paper - Executive Summary The purpose of this report is to provide an update to the Primary Care Commissioning Committee on the implementation of the GP Forward View. The previous report was presented to the Committee in February 2020. The GP Forward View covers the five years April 2016 to March 2021, however a number of the areas included in the GPFV are now being taken forward through the NHS Long Term Plan as previously noted. Recommendation(s) The Committee is asked to:

• Consider


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Impact analysis

Quality impact Quality will be monitored through the Primary Care Quality Strategy and Quality Dashboard. The aim of the GPFV is to increase quality of general

practice across the board

Equality impact

[Summary of impact, if any, of CCG’s duty to promote equality and

diversity based on Equality Impact Analysis (EIA). All reports relating to new services, changes to existing services or CCG strategies / policies

must have a valid EIA and will not be received by the Committee if this is not appended to the report]. [Identify any equality impact – positive,

negative or neutral]

Tick relevant box




The aim of the GPFV is to invest in primary care to sustain services in to the future

Financial implications Any implications are set out in the paper

Legal implications

Covered nationally and through Federation


Interest Will be preserved through the Committee’s Constitution




All relevant departments impacting on delivery of the plan have been consulted through discussion at the Primary Care Delivery Group

Report previously

presented at Previous update to February’s Primary Care Commissioning Committee

Risk analysis Identified in the paper


CO3 – the workstreams in the GPFV ensure that the primary care element of the healthcare system is sutainable


Duties (only)



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GP Forward View Update

September 2020

Introduction The General Practice Forward View published in April 2016 commits to an extra £2.4 billion per year to support general practice services by 20/21. This paper serves to provide an update on progress made/activities undertaken since the last update in February 2020. Any overlap with the NHS Long Term Plan published in January 2019 and the new GP Contract Framework are highlighted as required. This report focuses on: Extended Access – Q4 19/20 and Q1 20/21 Quality Report from Primary Care Doncaster Ltd (PCD) Extended Access – Data report Extended Access – Planned re-establishment of the extended access service Apex Tool Online Consultation Funding 1. Extended Access 1.1 Quality Report

PCD Workforce Dashboard (Growth)

As the Covid-19 pandemic struck England and Government advised a lockdown to take affect min-March, PCD halted all face to face activity meaning that we no longer directly engaging with staff outside of PCD for any clinical activity. Halted: Saturday Morning GP Hosted Hubs Inclusion Health Clinics Same Day –Subcontracted to FCMS

The First2Physio Triage Service could remain in operation but in terms of staffing responsibilities those always lay with the sub-contractor Chapman’s Physiotherapy.

During the last six months PCD have overhauled HR recording systems and with the appointment of our HR administrator in April, is now able to report more clearly on the workforce dashboard and training matrix. However for the majority of the period this report covers PCD we were not running Extended Access in the traditional way, therefore full reports will be generated by the new recording systems in the next reporting period which will encompass the re-establishment of the full service. PCD expect the service to begin in its entirety in September.

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PCD EA Staff Training Matrix

Due to the improvements made to the HR tracker and particularly focusing on the EA Staff, this information is no longer available for that time frame. We can confirm though that the new process is in place for all staff waiting to start back in the service. As per the statement above. All the corporate team is compliant with all MAST training timescales.

CAS, MHRA and NICE Alerts PCD continue to work with clinical advice gained through the Q&R Committee and out GP lead for Target, to understand what we need to share with our EA Staff. Logging the ones we received with the date, saving them in the appropriate file and logging when and which group they were sent to. The process changed at this point to send out all alerts received. Since then this process has also been under review as a direct result of the CQC work. The process we currently follow is set out below:

PCD follow a Standard Operating Procedure for the dissemination of CAS, MHRA and NICE alerts. This procedure is set out below:

1. The Clinical Services Manager (CSM) receive alerts weekly via email 2. The CSM shares the alerts currently with the Education and Workforce

Lead (due to the office assistant finishing her apprenticeship) who records all alerts. This will change once PCDs new administrator is appointed.

3. The CSM is responsible for and oversees emailing the alerts as they are received

4. After the E&W Lead (CSM) has shared any relevant alerts, the E&W Lead records this. This includes the date shared and to which EA staff groups they went to. The email invites the reader to complete any relevant and appropriate actions.

5. The CSM will escalate any queries received from staff regarding the alerts to the PCD CL for discussion and appropriate action. This is then recorded.

Again this process will be reviewed once handed over to the new administrator and improvements made if it is felt necessary.

CAS/MHRA Alerts

Month Number alerts received

Number alerts relevant shared

January 46 46

February 71 71

March 52 52

April 1 0

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PCD Patient Questionnaires - Healthwatch

There has been some data collection for the period 1st Jan to mid-March but was not collated by HealthWatch prior to the Covid Pandemic as the period for the quarter had not ended. After consultation with HealthWatch it has been agreed that the responses that have been collected for this period will be analysed and put into report format. This will appear in the next report. There will have to be amendments made to some of the hubs’ questionnaire as the format of the clinic may change, questions will have to address those changes and reflect the new re-instated version of the service.

PCD General Communications

All comms and engagement was halted at the mid-March point due to lock down. However plans are that there needs to be specific engagement about the new version of the service, what patients need to be aware of and what booking practices have to be responsible for in terms of a Covid triage prior to booking. We continue to provide:

• Semi-frequent social media updates and regarding the service offer • Regular emails to practice managers informing of service availability

and service offer • Monthly updates to member practices at events and regular meetings

such as TARGET, Practice Managers Meeting, PCD Neighbourhood meetings, Market Place Events etc.

PCD continue to work with HealthWatch to produce on-line patient communications and surveys via an advertised QR code. Joint communications with Health Watch and the CCG will continue, again with more of a focus on directing patients in terms of guidelines with Covid regulations and how they will be in effect throughout the service. Evidence that the campaign which was launched in conjunction with the CCG at the latter part of 2019 is clear in the figures particularly in February 2020, as another push around the provision of the health bus as a drop in for minor illness proved popular with patients. Plans to work closer with partners to promote the Inclusion Health clinics are to be drawn up as PCD want to expand this area and be a valid presence alongside our larger partnership organisations. Some of this work in the early stages of the re-established service will be around flu vaccinations.

May 24 0

June 14 0

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Service Did Not Attend (DNA) Rates

To support understanding the effectiveness of the communication and engagement being undertaken PCD monitors the DNA rates of the different service elements. The work on this continues as we make improvements on the system. Data for the Jan to Mid-March period is not available at present which has pushed us to strive for a better way of extracting this information from the system. This element of the report will be reinstated from the start of the newly established service.

PCD Clinical Audit (Records)

PCD have recruited two sessional GPs and a sessional ANP to undertake an audit of the Extended Access Service. The Audit Template remains as set out below. These are scheduled to be undertaken in the next few weeks. Chapman’s Physio and FCMS have undertaken some audits of their own staff’s consultations under the EA service. Clinical Audit Template – As previously shared.

Number cases audited General Practitioner Nurse Practitioner / Emergency Care Practitioner Number of Clinicians audited this month General Practitioner Nurse Practitioner / Emergency Care Practitioner

Audit tool and questions used Scoring system criteria per question:

Clinical Audit tool Questions GP ANP

2 1 0 Blank Total 2 1 0 Blanks Total 1. Elicits reason for consultation. Clearly identifies reason for contact/patient concerns/health beliefs

2. Identifies EMERGENCY/SERIOUSNESS of situation. Asks appropriate questions to make assessment/exclude certain situations

3. Takes appropriate history. Relevant history e.g. PMH/ drugs taken/allergies and appropriate contextual information (e.g.; social problems, ability to collect prescription etc.)

4. Appropriate assessment of complaint. Surgery/visit: as above plus appropriate examination carried out

5. Draws appropriate conclusions. Makes appropriate diagnosis/differential diagnosis.

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6. Makes appropriate management decisions. Appropriate to diagnosis (e.g.: NICE/ prescription/self-care only)

7. Appropriate prescribing behaviour. Follows evidence-based guidelines (where appropriate) Uses generics/formulary & alert to drug availability/accessibility Adherence to formulary [including cephalosporin, co-amoxiclav & quinalones]

8. Displays adequate safety-netting. Clear, specific advice when/if to return and offers clear worsening advice

9. Documentation, use of IT. Adequate recording of data - Was clinical code used?

10. Consultation length. Was the time taken appropriate for the consultation

Clinical Audit Scoring Criteria

A score of 14 plus will indicate a pass mark (the minimum standard) - ‘A Grade consultation’ A score of 9-13 will indicate that there may be areas for professional development and FCMSNW aims to identify and provide appropriate training - ‘B’ Grade consultation’ A score below 8 may require support on a more personal basis - ‘C’ Grade consultation’ All consultations must be passed as ‘safe’

Compulsory Criterion. Was the GP consultation……………

Safe Safe but not best practice For reflection Unsafe Total

Compulsory Criterion. Was the ANP consultation…

Safe Safe but not best practice For reflection Unsafe Total

Overall GP Audit Scores Number of audits scoring 8 or below

Number of audits scoring 9-13

Number of audits scoring 14 and above

Unable to assess

Total

Overall ANP Scores Number of audits scoring 8 or below

Number of audits scoring 9-13

Number of audits scoring 14 and above

Unable to assess

Total

Overall GP Audit Percentages % of audits scoring 8 or below

% of audits scoring 9-13

% audits scoring 14 and above

Overall NP/ECP Percentages % of audits scoring 8 or below

% of audits scoring 9-13

% audits scoring 14 and above

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PCD Clinical Audit (Medicines Management) PCD are continuing to look at ways to audit antibiotic prescribing. PCD will work together with the CCG’s Medicines Management Team to gather any available prescribing and medicines management information based on our organisation code. If this information is not obtainable, a random audit of antibiotic prescribing will have to be undertaken similar to the above process that is used for the records audit process. The interruptions caused by the pandemic have meant that the service was not functioning at this time to be able to audit.

PCD Complaints Summary

The two complaints noted in Q3 have been dealt with and closed as no further requests from the complainant has come to fruition.

A) Patient complained they had not received details of a scan appointment. Letter sent to patient for further information. Nothing received. Recommend to close the complaint file.

B) Patient advised to buy over the counter medications. Pharmacist suggested was not suitable. Investigation took place, letter with report from the investigation sent. Nothing forthcoming from the complainant. Recommend to close the Complaint.

No complaints received in Qtr4 or Qtr1. Work is also ongoing to make improvements to the complaints process. Currently all complaints come to the CSM as this was potentially the main source of Complaints. This is set to change to become a business wide process including the Quality & Governance lead for PCD.

Antibacterial Prescriptions per 1000 Cases July August September No of Cases

Antibacterial Prescription Items issued

Items Issued per 1000 Cases

%age where Prescription issued

NB. RAG Status based on 17% national standard. The target has not been set by the

Antibiotic Usage (Co-Amoxiclav, Cephalosporins and Quinolones)

July August September No of Cases

Co-Amoxiclav Issued

Cephalosporins Issued

Quinolones Issued

Total Antibiotics Issued

Percentage Issued

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PCD Issues/Incidents

The last PCD Quality and Risk Committee sat virtually on the 23rd and 24th June and reviewed SEAs that had been investigated and discussed the format of the issues log. Work has been undertaken to ensure that issues are defined and the logging of system niggles that staff repeatedly report are not logged if it does not fit with the definition. We have now re-formatted the way in which we log these and have renamed this document as the Incident log, which comes with a clearly defined scoring matrix. Issues Log and Significant Event Analysis (SEA): Themes During this period there have been no new themes taken from the clinical audit or hub reception audit forms. Those logged on the new incident form covering this reporting period remain in keeping with what we would expect to see with the addition of Covid related incidents as we entered the month of March and lockdown. Incidents logged for the period: Task sent to incorrect recipient from hub. Staff member not arriving for shift. Inappropriate booking into nurse appointment. PPE unavailable at a Saturday am hub. Patient suspected of having Covid arriving at Saturday am hub for appointment. As we reopen there will be more opportunity for learning points taken from more meaningful incident recording. Review of Hub SLA Within the last quality report PCD made reference to the fact that a potential review of the SLA with hub host practices was being considered to realign and re-establish roles and responsibilities. As we go forward in the re-establishment we pick up this action and reflect any changes put in place in order to re-open.

PCD Urgent 2WW Referrals PCD continue to log and monitor all 2 week waits referrals that are produced within the service. In the last Quality Report it was noted that our sub-contractors are being asked to monitor 2WWs produced by their clinicians. Alongside the HR overhaul PCD have carried out a review of the 2WW process also, making sure that it is fit for purpose and in line with the CQC regulations and action plan we have in place. A number of changes have been made to the recording systems; as such PCD will gather the data from this system when the service is up and running. This data will appear in the next quality report.

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Using the original system, the numbers of 2WWs have been logged and shown here for the reporting period.

Total number of 2WW Referrals Recorded

Month Total January 2020 4

February 2020 8 March 2020 (Partial

Month) 1

April-June 2020 0 Recorded

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1.2 Data Report

Comparative Data Analysis for February 2020 for the Extended Access Service In February we oversubscribed the service and provided 21 additional hours the target number for the month. This was due to a number of factors but a large part of that was the provision of the Health Bus 7 days across February in three different locations. The provision of a GP or ANP with a HCA and accompanying administrator on most of the days meant that we could provide up to 13 hours of clinical time each day. Additionally more hours were added to the F2P service with the opening of the Bawtry hub in February.

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With the increase in the number of hours offered (against the target hours) it has pushed up the utilisation across the system. This has meant that we have seen utilisation against the target, hit 70% utilisation. This shows us that just over 200 hours in February were not utilised by Practices. Graphs later in this report should high-light where the gaps are, but without the FCMS data we cannot illustrate this for certain.

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The target hours for February was quite high with having five Saturdays within the month meaning that the hours to be provided in the Saturday hubs was high. Even though PCD provided an additional 95 hours in February from January, it was still 73hours short of the target. We continue to engage with Chase Medical and existing EA staff to promote bookings of shifts. SDHC remain consistent in the number of hours provided across January and February. The number of hours for IH here are massively boosted by the provision of the health bus in the Town Centre, Asda at Carcroft and Mexborough Market place on 7 full days in February, providing in most cases a GP or ANP with the support of an admin and HCA. F2P consistently provided 100% of the number of hours required. The addition of the Bawtry Hub hours and the Health Bus have both added to the overall provision of the 160 hours per week target.

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F2P continues to be a popular choice for practices reaching 97.5% utilisation against the target hours. The additional of the Bawtry hub hours will have contributed to the usage. The spike in utilisation in the IH clinics is due to the Health Bus being run as a drop like the Inclusion Health Clinics, the clinics were set up in the same way. The bus was very well attended, the date for which is shown later in this report. Thoughts are that this may become a regular part of the EA offer. Equally there has been a drive by the IH hubs themselves to try and increase footfall of patients, again the consistent booking of an admin has meant better recording of interactions. There has been a slight increase in the bookings in the Saturday hubs and no change in the utilisation in the SDHC; we can see the breakdown of bookings in the graphs to follow. LL continues to engage practices in site visits, communications directly to reception and admin staff and attending market place events across Doncaster organisations. Due to the consistent popularity of the F2P service and the effectiveness of the Health Bus through February, these two elements of the service have far excelled the target of 75% utilisation against the target number of hours offered.

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Across the board we have hit an average of 67% utilisation against hours actually offered. The massive increase in the number of hours offered in the Health Bus has meant that as a % we have used less that in January, we have actually used 62% of 350 hours in Feb, as opposed to 70% of 106 hours in Jan. The later graph shows the marked difference this increase has made. We see an increase in bookings into the Saturday hubs, again potentially due to the informative sessions carried out by LL.

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Bookings into F2P has been sporadic in terms of which practices were booking in. We expected to see more of an increase by practices who were relatively local to the new Bawtry hub this month, we will monitor this as it may need time to be embedded with the reception staff. We also may want to look at splitting this data out and looking at the bookings into the Bawtry hub specifically. Plans are to increase the capacity at SDHC of a few hours through the week, starting in March (staff availability permitting) increasing the availability in the central locality. There are no real surprises in the data, those practices who regularly use it continue to do so.

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The IH data has been increased by the addition of the health bus visits to the three areas of Doncaster – Town Centre, Mexborough Market Place and Asda at Carcroft. Once patients and practices were aware the bus was on site, many practices signposted their patients to us. The system was based on a drop in and no length of appointment time specified. We can see that the Scott Practice patients have dramatically increased their use of this element which would expect to be due the Health Bus activity, on speaking to the practice after, it was clear that once they knew of the town centre location they had sent patients to us. We know that some of our Inclusion Health regular visitors to the Wharf House and Changing Lives clinics visited the bus as they were comfortable and familiar with us. There is some drop in regular usage from Jan to Fab partly because it’s a shorter month with less clinics hosted and the half term means that often clinicians are on leave so we are unable to staff a session.

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We expected to see patients from a variety of practices in the town centre location as most people were in the centre for shopping, socialising etc. and we did find that to an extent. We also quickly found out that some practices were signposting their patients who wanted to be seen that day down to the bus. We expected to see a high number attending from the local practices to Carcroft and Mexborough which is evident in the graph. The unexpected occurrence was the 10 penitents from Field Road Surgery in Stainforth, which is not in close proximity to any of the locations. We did some communications out the practices and to the wider public in conjunction with the CCG which we feel had a massive impact on the attendees. We will be exploring the possibility of using the bus and this format on a more regular basis.

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The data illustrates that the same practices continue to use the Saturday hubs. The Hub Hosts remain the highest in utilisation with a little fluctuation from Jan to Feb but no real changes are apparent from 3 of the hub hosts. Thornemoor increased theirs by 31 appointments in February. Some significant changes to note are: Increase by 40 appointments for Great North. Increase by 20 for Scawsby. Increase by 20 by Field Road. We expected to see some increase in practice usage across the board after the visits to practice by Liz, intentionally advising the reception staff to ask the question of the patients about travel to other locations for a Saturday appointment. Promoting choice was the message we pushed. We feel that we may begin to see an effect from this direct communication.

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St Vincent’s has continued to be a high user of this element but has always fluctuated between 90and 40 appointments per month (taken from data from Oct 19 to Feb 20), showing that potentially the practice use it dependant on patient demand during that month. The Flying Scotsman has continued to increase their usage massively, followed by Mayflower Medical practice. These practices both received communication from Liz during this month so is potentially evident here. St John’s, Regents Square, Edlington and Sandringham saw an increase in February, Regent Square significantly so. Comms with all practices during this month focused on the need for further supply of Same Day appointments, practices reported struggling to get patients to take an appointment on a Sunday too. Work with FCMS continues to try and expand the provision in the right place at the most popular times.

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Key Theme Evidence & Work Done Plans/Actions An Increase in Attendance for Inclusion Health

This increase was due to the addition of the Health Bus clinics run over 7 days in February and three different locations. Well publicised to practices and to the general public.

Look to apply this as a regular fixture in the design of the service. Continue joint comms with CCG. Look at costings and the availability of the Health bus in terms of practicalities and feasibility.

Travel across the borough to hubs is evident but low.

Shown by practices booked appointments –evidenced in the pie charts. LL direct engagement with practices may have made some difference but not to the desired effect.

Consider the feasibility of the Sat am hubs. Cost Vs usage by practices other than the hub hosts.

Same Day still favoured by some practices over others.

Wild differences in numbers of appointments booked across Doncaster. Some outliers booking in but in smaller numbers. Anecdotally, practices want more same day provision – too few appointments available and seem to be snapped up by a few practices.

Look at the feasibility of increasing the Same Day availability. Look to when/how more appointments can be provided. Look at the Sunday provision – Need further detail from FCMS re the Adastra usage of those appointments turned over to NHS111.

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Quarterly Report of the Extended Access Activity Data for Quarter 1 2020-2021 This quarter (April to June) saw the continuation of the Covid-19 pandemic which began in mid-March and as such goes to tell the story of the massively reduced service that PCD maintained through this time. This information is brief in comparison to other quarters that have been presented but still shows the continued commitment to the service and the willingness for practices to use it. Two elements of the Extended Access service; First2Physio through the use of telephone appointments. Same Day (though reduced) through the turning over of appointments to the Adastra system for NHS111. Chapman’s physio continued to provide 30 hours per week of telephone appointments with a slightly longer appointment time to get around any technical difficulties and to allow extra consulting time. Patients were asked if they wanted to be emailed their suggested exercises and it worked well sending YouTube video clips rather than printed diagrammatical images. As part of FCMS’ originally agreement they continued to turn any of the unused Extended Hours appointments provided to Mayflower Practice and The Medical Centre on a Saturday, into Adastra appointments for the use of NHS111, which counted towards the Extended Access hours provided. This continued through this time period and so data shown below reflects the Adastra allocations. All Inclusion Health and Saturday Hubs were closed mid-March due to Covid-19 and therefore do not appear on this quarter1 report.

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As we can clearly see, there have been increased bookings throughout the time period and shows that patients are increasingly comfortable with a remote consultation and assessment and practices have become more familiar with this style as they have adopted it themselves. PCD added the message of the continued service to the wider PC Cell communications which go out to practices, so we feel that this also played a part in the increased uptake. Chapman’s have been able to maintain the provision of 30hours per week which is only 25 from the original provision. With this in mind we are satisfied that utilisation reached 90% in June.

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We continue to see a cross section of Doncaster practices continuing to book in, representing all 5 PCNs. Potentially removing the travel element to the appointments has been a factor in continued bookings from across the borough. However what is clear is the continued success illustrates it’s a favourite of practices and patients.

Burns Practice

Kingthorne

The Medical Centre

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It is no surprise that we see continued

bookings from most of the central practices, as this element of the service has been embedded in the central practices from the early pilot. Their continued bookings through this time has shown they value it’s input for their patients. Not all central practices are using the service. Notably the increase over the 3 month period of the bookings from Sandringham has greatly increased, partnered with this a similar story with Oakwood, though on a smaller scale.

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The East PCN practices appear not to follow any pattern in there utilisation of the service at this point. We can only hope to look into this further to see the reasoning behind it. Dunsville experienced an increase in bookings, Hatfield shows a decrease, TVG shows a spike in bookings in May and WHF 1 booking over the time period. Equally some East practices choosing not to use the service at all. With some East practices being a great distance away from the clinic itself, we expect a low number, however since the move to telephone consultations we would expect to see some increase in utilisation from this area. Further to this the inclusion of video consultations; again we expect a greater usage in the future. We would want to see more of an increase though after comms about the service come out prior to the full service being reinstated.

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South practices see a smattering of bookings across the time period, with low numbers of bookings maintained. Mexborough Health Centre however appears to have discovered the service was still running in June and made the most bookings. Again, the fact that there is no travel to the appointment has to be a consideration for the success in the utilisation here.

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It is clear that 4Doncaster continue to book a good number of patients into the system, maintaining the value in the service. The fact that this has gone to a telephone consultation generally should not affect the utilisation too much as the proximity to the clinic’s previous location was not far. We await the coming results when video consultations are in place and the Extended Access relaunch communications have gone out, to see if there is a further increase in utilisation.

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With the greatest numbers of bookings in the time period, it is clear that the North PCN has continued to see the value in this service. With encouraging numbers taking advantage of the telephone consultations, we hope that the addition of the video consultations will only serve to enhance their experience. Though not all practices have made bookings so it may be a question we put to those to see why; is there anything that we could put in place that would make this an attractive service to their patients and clinicians? What support can we put in place? Overall, very encouraging signs from the North.

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Themes and Next Steps Key Theme Evidence & Work Done Plans/Actions Medium to high usage by some practices in North and Central (4Donc included)

A high utilisation shown. Figures show that practices across the borough have made bookings in this time period. Practices & Patients still appreciated the service/contact even though this had reduced to telephone with no face to face.

• To continue with telephone consultations.

• To continue with emailing video clips of exercises.

• To add the provision of video consultations.

• To increase the number of available hours from the current 30 to the pre-existing 55.

• Plans to increase that further in the coming months.

• PCD Plans to re-launch with comms the whole PCD Service with specific information on the changes made to the existing service elements.

• Potential to provide further reception staff training in a Target session.

Some practices haven’t used the service at all Some practices do not register/appear on the graphs due to no engagement with the service. Some practices show tiny numbers of bookings compared to previous months. There is a concern that comms from the Primary Care Cell have not been received or disseminated throughout the practice staffing structure.

Anecdotal evidence given of high satisfaction by patients.

Patients aware that is remote consult via telephone – no expectation of hands on treatment, therefore no miscommunication and management of expectations. Patients find value in the emailing of video clips of suggested exercises over the printed diagrammatical form previously issued. Chapman’s have found that Monday appointments are seldom used at the moment – consideration to increasing the hours through the rest of the week, removing the Monday provision.

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1.3 The Re-establishment of the Extended Access Service Post Covid-19 Pandemic.

Purpose of the Paper: After a consultation period with partners, PCNs and Sub-Contractors, this paper sets out to describe the direction of travel for the service as we begin to emerge from the Covid-19 pandemic. We hope to illustrate the adaptations and improvements we intend to put in place to create a meaningful, well utilised service that fits the needs of all stakeholders. With reference to the two preceding papers presented to the CCG and the Primary Care Cell, we intend to show that we have completed the preliminary work we intended to do and gained a good understanding of the current landscape of primary care, in order that the redesign prove valuable, beneficial, safe and realistic in all its elements. Elements to the Service: There will always remain elements of the service that we have proved to be successful and popular both with practices and patients, so it would be remiss of us to remove these from the service. First2Phyio – This element of the service has remained throughout the pandemic at its peak though at a slightly reduced number of hours; it has quickly been able to adapt to provide a remote service that is still of value which practices have carried on utilising* Same Day – Since the start of the service practices have told us that appointments available on the same day are a valuable resource however up until now we have not had the opportunity to increase that offer. We aim to address this in the re-establishment. Inclusion Health – Although the numbers of patients seen has remained relatively low, we know from the Health Watch patient survey reports that they have great impact on the individuals. We have created excellent relationships with partner organisations that we feel can only be improved upon, creating a better outcome for their clients/our patients.

*Evidence collected and shown in paper ‘Quarter 1 2020-2021 Report- During Covid-19’ July 2020.

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The Design of the Hours by Service Element** Element of

Service Rota Design/Times, days etc. Number of hours per week Expected Start Date/Month Health Bus Wednesday, Thursday, Friday (9-12 & 1-5pm)

(Available from Jan 2021 onwards: Saturday (Potentially 9-12/2pm)) TBC

Between 21 x2 staff =42hrs (the potential of increasing 5hrs

Sat from Jan)

September 2020

Routine Appointments

Saturday Morning 9-12noon 3 x 3hubs currently (potentially x17 staff) = 51hrs

(Still awaiting Confirmation from Central & East proposal)

Central 17hrs East 15hrs

September 2020

Same Day Mon-Fri 7-8am, 6pm-9pm (x2 GPs) Sat 4pm-8pm (x1 ANP) Sun 8am-8pm (x1 ANP)

23hrs (There is also the arrangement in place for the Ex hrs provided to 2 practices being

turned over to NHS111 in addition to this but is not counted

in this calculation)

August 2020

First2Physio Tuesday to Saturday appointments ranging from 9am until early evening – exact design is TBC.

55hrs July 2020

Inclusion Health Wharf House Wed 1-4pm Changing Lives Thursday & Friday 1-4pm

Conversation Club Thursday 1-4pm Denaby Family Hub Friday 1-4.30pm

15.5hours September 2020

Flu Vaccinations (As Health Bus on line 1) (Health Bus Hours encompass the Flu Vaccs hours.)

September 2020

Total Number of Hours per week potentially: 186.5 hours per week. 218.50 incl East & Central’s allocation of routine hours

** Snapshot as at July 2020

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1.4 Apex Tool

The Committee will recall that NHS England procured the Apex Insight Workforce and Workload Tool on behalf of the North Region as an alternative to national tools in development. It was envisaged that the tool would be rolled out and fully operational in advance of the end of June 2020 when the NHS England licenses terminated. Unfortunately due to time constraints at the practices, the enormity of the task to roll out the tool across South Yorkshire and Bassetlaw and a national pause relating to a governance issue identified by another CCG progress was very slow. Sheffield CCG took the decision to discontinue the roll out and the focus has been on the other areas. The licenses were extended to end August 2020. After this point the license costs revert to CCGs, PCNs or local practices. Primary Care Doncaster undertook a survey of practices to which 8 responses were received. The majority of those responding indicated that they did not use the tool and would not wish to use it in the future. Conversations with practices indicated that they felt the tool was difficult to use and time consuming. From the latest deployment report received from Apex only one practice had completed all six stages of the process. Apex was configured at 71% of practices and 50% had attended the Insight workforce planning session. The practices had not therefore had the opportunity to embed the software in the practice and utilise it fully to enable a case to be made to support the funding of the licenses going forward. A message was sent to all practices as part of the primary care update to confirm therefore that neither Primary Care Doncaster nor the CCG would support the ongoing funding of the licenses. 1.5 Online Consultation The July useage report for Doctorlink is attached as Appendix A. Highlights:

• 3,589 Registrations • 2,731 Symptom Assessments started • 1,731 Symptom Assessments completed (report also includes the outcome

categories) Contact has been made with those practices with low registrations / no link on the websites. The feedback was that COVID had taken over and they had not had chance to resolve. A couple of Practices needed further support from Doctorlink. There are currently 3 Practices with no website, all 3 of them are in the process of building a website and confirmed they will contact the primary care team when this is done to include the Doctorlink information. The outcome of a recent Healthwatch survey is awaited which will help identify barriers to using online consultations.

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1.6 Funding A letter was received on 14 August 2020 outlining 20/21 funding allocations for primary care transformation in the North East and Yorkshire. This included those funding streams traditionally badged as GP Forward View funds which are now directed to the ICS (extended access funding comes direct to the CCG). This funding includes elements for GP Retention, GP Practice Resilience, Reception and Clerical Training and Online Consultation. It does not include practice nursing which was expected for the first time in 20/21. At the ICS Primary Care Programme Board it was evident that further work is required to understand the actual allocations an estimate that 50% of the funding identified would be made available. The priorities will be to continue those areas of work already in train such as online consultation and to review and evaluate those schemes funded previously such as VTS Nurse scheme before identifying new schemes for the use of this funding. It is not clear at this stage how much would be available for use in Doncaster. Any thoughts from members of the Committee about priorities in these areas would be welcomed. This could include sustainability of primary care at a wider system level for example or implementation of new ways of working as a result of covid.

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Title of paper

Primary Care Delivery Plan



Author(s) Karl Roberts – Primary Care Manager

Status of the Report To approve To consider / discuss To note Purpose of Paper - Executive Summary The purpose of this paper is to provide committee members an updated version of the Primary Care Delivery Plan for 2020/21. The delivery plan has been updated given the effects of COVID-19 and highlights any actions where amendments have been made in relation to the actions themselves, due dates and action owners. There will still need to be further updates made to the delivery plan and there are still some risks that continue to be associated as a result of COVID, winter and Flu etc. all of which could have some further impact. This will be brought back to committee at a future meeting. The highlights of the Delivery plan are:

- That unfortunately given current circumstances and as a result of the additional and/or shifting workload priorities some areas have been delayed resulting in the action due dates being amended (Noted by the highlighted Red text).

- Some areas are delayed due to CCG resource and the loss of key personnel to complete the identified tasks at this current moment in time or have been delayed and will need further review to assess when theses can/will be delivered (noted by entire lines highlighted in red or amber)

- The PCN work areas have continued although some timelines have had to be

slightly amended

- Primary Care digital work streams and some elements relating to GP access have been accelerated by the work as a direct result of COVID e.g. video and online consultations as well as the NHS 111 appointments (noted by entire lines highlighted in green)

A further paper will be available to PCCC in the near future that provides more detailed narrative in relation to the progress made against the key areas.

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Recommendation(s) To note the information provided on the 2020 Primary Care Delivery Plan specifically relating to the areas highlighted.


Impact analysis Quality impact Development of primary care networks supports the sustainability of

primary care

Equality impact

Tick relevant box




Development of primary care and the sustainability of primary care as a whole


Potential financial implications relating to delayed/stopped actions will require further discussion to understand possible financial implications

Legal implications Non identified






Discussed at DCCG managers and Senior Managers Team Meetings

Report previously


Risk analysis




inequalities in well governed and accountable partnerships. Primary Care

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Statutory Duties (only)


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Commissioning Delivery Plan

Ref.

Outcome References the Milestone will

Deliver

Joint/ CCG Only/ Council Only

Owned by: Name and Organisation

Strategic Milestone

1.1 QO3, AM2, FS5 Joint Joe Bloggs (DCCG), Jane Doe (DMBC) Yes/No (LW)

1.1 Stopped CCG Chris Empson

1.2 Delayed CCG Gemma Munce/Zara Head

1.3 Delayed CCG Zara Head/Karl Roberts

1.4 Delayed CCG Karl Roberts/Zara Head

1.5 Delayed CCG Gemma Munce

1.6 Same Joint Chris Empson /Jon Briggs

1,7 Same CCG Karl Roberts

2.1 Delayed CCG Carolyn Ogle/ Alex Molyneux

2.2 Same CCG Carolyn Ogle/Jo Forrestall

2.3 Same Joint Carolyn Ogle/PCD

2.4 Same Joint Carolyn Ogle/PCD/Karen Johnson Yes (LW)

2.5 Delayed JointClinical Directors/Carolyn Ogle/Karl Roberts/Tracy Wyatt/ Simon Barnes

2.6 Same Joint Alex Molyneux, Karen Tooley, Karen Leivers, Nabeel Alsindi

2.7 Complete CCG Carolyn Ogle

2.8 Delayed Joint Carolyn Ogle//PCD

2.9 Same CCG Paul Tarantiuk/Karen Leivers

2.10 Same CCG Stephen Emmerson Yes (AW)

2.11 Same CCG Carolyn Ogle/PCD

2.12 Same Joint Carolyn Ogle Yes (LW)

3.1 Same Joint Carolyn Ogle/Hayley Tingle/Simon Barnes

3.2 Same Joint Tracy Wyatt/Karl Roberts/Simon Barnes

3.3 Same CCG Wendy Lawrence/Gail Stones

3.4 Accelerated CCG Kelly Smith

3.5 Same Joint Katie Dowson

3.6 Delayed Joint Carolyn Ogle/Lisa Devanney

3.7 At Risk CCG Karl Roberts/Karen Leivers

3.8 Same CCG Carolyn Ogle


3.10 Delayed CCG Carolyn Ogle/Rory Brown


4.2 Same CCG Carolyn Ogle/Kelly Smith Yes (LW)

4.3 Delayed CCG Carolyn Ogle

4.4 Potentially Accelerated CCG Karl Roberts

4.5 Same CCG Paul Hemingway

4.6 Delayed CCG Karl Roberts/Ailsa Leighton

4.7 Same Joint Paul Tarantiuk

4.8 Same CCG Paul Tarantiuk

4.9 Same Joint Carolyn Ogle, Victor Joseph, Sarah Gill (PHE), Zara Head Yes (LW)

4.1O Delayed Joint Carolyn Ogle

Ref: Ref: Ref:

1MD7MD LivingWell

1LP North

1MD7MD LivingWell

2LP East

1MD7MD LivingWell

3LP South

1MD7MD LivingWell

4LP Central

2MD 5LP

3MD 6LP

4MD 7LP

VISION:

Living Well - Primary Care

Improve access to primary care

services

Must Be Dones

Improving access to Primary Care

1a.) increase in extended access appointments utilised . This target is still to be confirmed and agreed with Primary Care Doncaster (PCD).

Aug-20

Jul-20

Key Areas of Work to Deliver the Vision

Develop plans to utilise 100% of sustainability and resilience funding allocated in year 2 building on demonstrable outputs of investment from 19/20 (No allocation awarded yet) Mar-21

Develop Primary Care Networks

Ensure the appropriate allocation of resources and sharing of best practice approaches including finalisation of an escalation framework.Develop a practice visit proforma which enables an assessment of quality, contract compliance and performance in a consistent and supportive way. (Further discussions needed)Further develop the PCQ tool to ensure it is fit for purpose and meets the requirements of the wider CCG in terms of incident reporting and identification of risk. (Overtaken by COVID log - NRLS has continued)Provide monthly data on cost and activity for A&E attendances for PCN populations Work with PCNs to develop and interpret the Network Dashboard introduced in 2020/21 to identify areas of opportunity and reduce variation utilising existing systems in both health and social care. (Awaiting publication)

Mar-21

Mar-21

Mar-21

Develop a primary care digital strategy.

We will ensure the resilience and long term sustainability of primary care through the development of primary care at scale. This will:-● facilitate integrated working between partnership organisations at neighbourhood level, encouraging integration and collaboration;

● improve access to consistent high quality and holistic care that promotes health and wellbeing● increase the cost effective use of resources

● provide a focus for the prevention and management of long term conditions, including mental health, leading to improved health outcomes.

Continue to implement the communications and engagement strategy to ensure messages are published to patients at key points through the year and are targeted where necessary at specific populations and locations.

Develop a robust escalation framework for primary care and ensure business continuity plans are fit for purpose.

Mar-21

Due By:

Mar-21

Sep-20

TBC

TBC

Increase the utilisation of online consultation and direct booking from NHS 111 across all Doncaster GP Practices to increase access to local Practice services ; ensure that practices switch to "connected" mode and plans progress to offer video consultations by the end of March 2021

31st October 2019

Continue to develop an intelligence tool and evaluation process that identifies variation between Doncaster GP practices, highlights potential vulnerable practices and facilitates the management of risk.

Ensure that community partners and the provider alliance are engaged in the primary care workforce so that options such as rotational roles can be piloted and that the workforce development and training hub provide support to all staff in primary care

Support PCNs to develop workforce plans for 20/21 and longer term to ensure that 100% of allocated funding for additional roles is used in Doncaster. Plan to include redeployment of Pharmacist funded through Pharmacy Integration Fund

Develop CCG wide plan to use the available ARRS budget that is agreed by PCN clinical directors and the LMC, this will include a plan for use of any unspent money and will need to link to wider CCG plans with providers including therapy review.

Mar-21

Sep-20

Review the older age bed base across Doncaster and design new model to be agreed by all parties

Mar-21

Mar-21

Sep-20

Develop the neighbourhood delivery model, including "local solutions", ensuring that primary care networks are embedded into the approach, recognising that this action cuts across Starting, Living and Ageing Well. Once developed, deliver the actions agreed, with a focussed approach on the agreed neighbourhood outcome for Living Well.

Provide the basis for a Network estates plans to be developed to secure a joint vision of fit for purpose future estate and to maximise utilisation of the existing primary care estate to reduce void space.Facilitate delivery of the enhanced health in care homes, medicines optimisation and early cancer diagnosis national specifications and develop implementation plans for CVD diagnosis and tackling inequalities

Oct-20

Mar-21

Mar-21

Digital Maturity

By summer 2021 we will have 100% compliance with mandated cyber security standards across all NHS organisations in the health and care system.

RDASH

Financial Savings Metrics

Priorities currently being reassessed due to COVID19 pandemic. Expected Completion August 2020


Mar-21

Optimise the take up of population screening and immunisation programmes, including flu.

Work with practices and the ICS Diabetes Programme Board to Increase referrals to the National Diabetes Prevention Programme to ensure the trajectory is met.


1d.) Improvement from the 2019/20 baseline for the GP Patient Survey questions of:

- Percentage of respondents who find it easy to get through to there GP Practice by phone.- Percentage of respondents who were offered a choice of appointment when they last tried to make a general practice appointment.- Percentage of respondents who described there experience of making an appointment as 'good'.


1c.) implement the usage of video consultations by Doncaster GP Practices by ensuring 100% sign up and continual usage (i.e. baseline on usage still to be agreed).

Planned Care PlanMedicines Management Plan

Learning Disabilities and Autism Plan

Increase the availability and use of primary care appointments (through provision of and communication about extended access, on line consultations and direct booking from NHS 111) to ensure that the impact on the wider health and social care system is minimised

Sep-20

Sep-20

Mar-21

Nov-20

100% of Doncaster registered patients will have access to their care plan and communications from their care professionals via the NHS App by 2020/21.

LD Target 75% of patients on the QOF register to have a health check by March 2021.

To reduce xx% of number of A&E attendances (per Doncaster GP Practice) with no significant investigation or treatment from a 2018/19 baseline for patients who reside in a nursing home or residential home.


1b.) increase use of online consultations and encourage more GP Practices to move to a 'connected status' Awaiting further guidance from NHS England regarding a nationally set target. A locally agreed measure will be an increase in activity each quarter during 2020/21.

Identify practices with the longest routine appointment and work with PCNs and practices to make improvements.

Maximise opportunity for investment through the Investment and Impact Fund by agreeing reinvestment plans with PCNs.Support implementation of the national pharmacy contractual framework ensuring alignment with the local primary care strategy.Transition the emergency contractor framework to the national pseudo dynamic purchasing system or review in the light of revised national guidance on procurement.

Mar-21

Mar-21

Mar-21

Sep-20

Mar-21

Mar-21

Mar-21

Sep-20

Mar-21

Increase the use of online services for making appointments, ordering repeat prescriptions and repeat dispensing as well as patient access to clinical information and ensure a core digital service offer is made to all patients by April 2021.


Review non contracted activity such as wrist splints (carpal tunnel) and pathology packs

Review of pain management services in primary care?

Removal of duplication between national and local service specifications

Primary Care Delivery Group and Information Sub Group

Impact of planned care initiatives to move services from secondary to primary care, minor surgery review, robust LES monitoring

PCDLMC

Cancer Delivery Plan

Links to other plans

IT StrategyPlanned Care Board

Primary Care Estates Strategy & Implementation PlanPrimary Care Strategy

Dependencies

Ageing Well Delivery PlanLiving Well Delivery Plan

Increase number of routine appointments, thus reducing need to attend alternative services such as A&E

StakeholdersDoncaster CCG

DMBC

Und

er

Dev

elop

men

t

DBTH

3.) Some measures and actions maybe reviewed later on in year due to the current COVID19 pandemic.2.) Procurement has not being completed in regards to video consultations. Current usage is due to a COVID19 response and there is a risk no provider is available post COVID19.1.) Number of measures are still in development (indicated by red text) and these maybe subject to change.

DRAFT Health and Social Care Commissioning Delivery Plan: 2020/21

To meet the nationally set target of xx% for patients (per Doncaster GP Practice) registered to view their online clinical record.

To ensure all GP Practices deliver there agreed contracted amount of local enhanced services for 2020/21.

To increase the usage of Care Navigation (per Doncaster GP Practice) to equal or exceed the 2019/20 Doncaster average where the organisation is under the 2019/20 average.

Doncaster Local PrioritiesTo Deliver the following Outcomes/Monitored By:

Review of TeleDERM?

Eliminate duplication between extended access and other servicesReduce void space in LIFT and NHSPS buildings



To meet the nationally set target of xx% for patients (per Doncaster GP Practice) registered to book appointments online.

To meet the nationally set target of xx% for patients (per Doncaster GP Practice) registered to order online repeat prescriptions.

To reduce xx% of number of A&E attendances (per Doncaster GP Practice) with no significant investigation or treatment from a 2018/19 baseline for patients aged greater than 60 years old.

Category Name

GP Practice Inequalities and Risk

Management

Key Milestones

Neighbourhood Priorities

Support PCNs to refresh their Development plans building on outputs and investment in 19/20

Description of RiskKey Risks

e.g. Bed Base

Ensure practices act on feedback from an audit of accessibility in primary care for people with a learning disability

Supporting the primary care infrastructure

Mar-21

Improve uptake and quality of annual health checks for people with learning disability, through design of annual health check template and embed into primary care Mar-21

Eliminate dementia diagnosis and care planning variance within PCNs by co-producing best practice tools Mar-21

Mar-21

May-20Agree the local annual sign up process to continue to participate in the Network DES.

Work with Primary Care Doncaster to maximise the use of extended access appointments and to ensure a smooth transition to the new access arrangements from 2021 ensuring a combined access offer with general practice, 111 and integrated urgent care

Ensure workforce planning for primary care is aligned with wider workforce initiatives across the partner organisations that supports recruitment and retention of key staff.Seek opportunities to maximise delivery of core service requirements through sharing of good practice and develop further enhanced services that means patients access care closer to home including working collaboratively with the Planned Care Board on services to be delivered outside of a hospital setting that maximise value for money and access to high quality patient care.

Implement the findings of national and local surveys to ensure access routes are easy to navigate.

Mar-21

Facilitate the amendment to the Network Agreement to include community pharmacy, community providers and mental health providers, the Agreement to describe how they will work together through a collaboration agreement.

Support practices and PCNs to deliver the quality improvement modules relating to Learning Disability and Early Cancer Diagnosis.

Increase personalised care and support planning, personal health budgets and consider the future development of Social Prescribing, linking in with local Primary Care Networks.

Continue to develop estates plans to ensure that capital investment is maximised in Doncaster to meet the needs of the local population and the expanding workforce.Maximise utilisation of the existing primary care estate to reduce void space costs. Ensuring processes are established to facilitate this

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10 September 20 8 October 20 12 November 20 10 December 20 13 January 2021 11 February 2021 11 March 20201

Papers due by: 02.09.20 30.09.20 04.11.20 02.12.20 04.01.21 01.02.21 01.03.21Pre meet date: 03.09.20 01.10.20 05.11.20 03.12.20 07.01.21 04.02.21 04.03.21

Agenda & Papers circulated: 04.09.20 02.10.20 06.11.20 04.12.20 11.01.21 05.02.21 05.03.21

Agenda Items Lead Paper / Verbal

Apologies for absence Chair Verbal x x x x x x xDeclarations of Interest Chair Verbal x x x x x x xNotification of Any Other Business Chair Verbal x x x x x x xMinutes of the previous meeting Chair Paper x x x x x x xMatters Arising not on the Agenda, including progressing the Action Tracker

Chair Verbal x x x x x x x

Action Tracker Chair Paper x x x x x x xFinance & Contracting: Interim Exception Report Hayley Tingle Verbal x x xFull Quarterly Report Hayley Tingle Paper xPrimary Care Estates Strategy - Implementation Plan Update Carolyn Ogle / S Barnes Paper x x x x x x xEstates Program Business Case Carolyn Ogle / S Barnes PaperLocal Enhanced Services Update Hayley Tingle Paper xBarnburgh Surgery Contract Extension Karl Roberts Paper xQuality: Interim Exception Report Andrea Ibbeson / Zara Head Paper x x xFull Quarterly Report Andrea Ibbeson Paper xFlu Plan 20/21 Update Emma Serfozo Verbal x

Strategy & Planning: Primary Care Delivery Plan 2020/21 Carolyn Ogle Paper x xGP Forward View Update Carolyn Ogle Paper x xExtended Access Report Laura Sherburn / Jill Telford Paper x xPrimary Care Commissioning Committee Terms of Reference

Chair Paper x

Communication & Engagement Strategy Paul Hemingway Paper xPrimary Care Networks Update Carolyn Ogle Paper x x x x x x xProactive Care Karl Roberts Paper x xGPFV Funding Karl Roberts Paper xDRAFT Primary Care Delivery Group Minutes Carolyn Ogle Noting x x xGP Patient Survey Results Karl Roberts / Gemma Munch Presentation xPrimary Care Cell Risk Register Karl Roberts Paper xDigital Primary Care Access Survey Results Healthwatch Paper xPrimary Care Cell Update Karl Roberts Paper x x x x x x xICS Update / Minutes Carolyn Ogle Paper x x x x x xICS Primary Care Strategy Nabeel Alsindi / Jackie Pederson Paper xForward Planner Chair Paper x x x xRisk Register Carolyn Ogle Paper x x x xAny New Potential Risks Carolyn Ogle Verbal x xAny Other Business Chair Verbal x x x xDate and Time of the next Meeting Chair Verbal x x x x

PUBLIC Primary Care Commissioning Committee Forward Planner 2019/20

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Meeting name Primary Care Commissioning Committee Meeting date 10 September 2020 Title of paper Risk Register

Executive / Clinical Lead(s) Anthony Fitzgerald, Director of Strategy & Delivery

Author(s) Alison Edwards Corporate Governance Manager

Status of the Report To approve To consider / discuss To note

Purpose of Paper - Executive Summary The Primary Care Commissioning risk register comes to the Primary Care Commissioning Committee to make the members aware of current risks. The updated register was circulated in August 2020 however approval of the removal of a risk is required to be made and therefore has been circulated for consideration at September’s meeting.

The risks have been reviewed with the Head of Service and Corporate Governance Manager. There are currently three Primary Care risks (refer to Appendix 1 for the full details) on which the committee needs to be sighted: -

• CO3-PCP014 (Lack of workforce sustainability and Primary Care Workforce Strategy in Doncaster which clearly highlights current position and future plan). Update – Primary Care Network (PCN) recruitment plans are developed and recruitment to additional roles commenced. South Yorkshire and Bassetlaw Workforce and Training Hub representatives attended August meeting of PCD Clinical Directors to discuss the work plan and all five workforce plans have now been submitted.

• CO3-PCP015 (Lack of assurance that proactive care specification is being delivered in Primary Care). Update - All 39 practices are now delivering the proactive care specification. The specification has been reworked to allow for the COVID response to care homes for three months to end September 2020 when it will revert back to proactive care. It is recommended the removal of this risk from the register.

• CO3-PCP016 (Practice not registered under CQC requirements) New risk added following discussion at July Primary Care Commissioning Committee in confidential session

x

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Additions / Removals There has been the addition of risk PCP016 since the risk register was last reviewed.

Recommendation(s) The Primary Care Commissioning Committee is asked to

a) Review the Primary Care Risk Register to confirm all risks are appropriately scored and described.

b) Agree the recommendation to the removal of CO3-PCP015

c) Identify any potential new risks


Impact analysis

Quality impact None

Equality impact

Tick relevant box

An Equality Impact Analysis/Assessment is not required for this report. X An Equality Impact Analysis/Assessment has been completed and approved by the lead Head of Corporate Governance / Corporate Governance Manager. As a result of performing the analysis/assessment there are no actions arising from the analysis/assessment.


Sustainability impact Nil

Financial implications Nil

Legal implications Nil


Interest None Identified


(internal departments, clinical, stakeholder &

public/patient)

Consultation with Risk and Assurance Lead

Report previously presented at None

X

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Risk analysis Captured throughout the Assurance Framework

Assurance Framework CO2-2.2, CO2-2.3

Primary Care Statutory Duties

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To undertake reviews of primary medical care services in

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Doncaster To co-ordinate a common approach to the commissioning of primary care services generally


virtual primary care commissioning committee …€¦ · virtual primary care commissioning...

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