primary care commissioning committee · audit results have been sent through and this is being...

HELD IN PUBLIC SESSION ON FRIDAY 20 OCTOBER 2017 1:00pm – 3:00pm THE BOARD ROOM, 3RD FLOOR, BRIERLEY HILL HEALTH AND SOCIAL CARE CENTRE,

VENTURE WAY, BRIERLEY HILL, DY5 1RU QUORACY A meeting of the Committee will be quorate provided that at least 4 members are present of which: • one must be either the Chair or Vice-Chair of the Committee • one must be the Chief Finance Officer/Deputy Chief Finance Officer or Chief Nursing Officer

PUBLIC AGENDA

Time Item Attachment Presented by

1.00 pm 1 Apologies Mr S Wellings 1.00 pm 2

Declarations of Interest 2.1 To request members to disclose any interest they have, direct or indirect, in any items to be considered during the course of the meeting and to note that those members declaring an interest will not be allowed to take part in the consideration or discussion or vote on any questions relating to that item. 2.2 This meeting is being held in public and is being recorded purely to assist in the accurate production of minutes, decisions and actions. Once the minutes have been approved the recording will be destroyed. All care is taken to maintain your privacy; however, as a visitor in the public gallery, your presence may be recorded. Should you contribute to the meeting during questions from the public, you agree to being recorded.

Mr S Wellings

1.00 pm 3 Questions from the Public Mr S Wellings 1.05 pm 4 Minutes of last meeting held on Friday 29 September 2017 Enclosed Mr S Wellings 1.05 pm 5 Matters Arising/Action Log Enclosed Mr S Wellings

1.10 pm 6 Primary Medical Services Report – Winter Pressures LIS 2016/17 Evaluation Enclosed Mrs R Gretton

1.20 pm 7 Contractual 7.1 Report from the Primary Care Operational Group 7.2 Internal Audit Report 2017/18 – Primary Care

Commissioning Contracting Arrangements

Enclosed Enclosed

Mrs J Robinson Mrs J Robinson

1:50 pm 8 Risk Register Enclosed Mrs C Brunt

2:00 pm 9 Dudley Practice Managers Alliance (DPMA) training budget evaluation 2016/17 Enclosed Mrs J Taylor

2.10 pm 10 Quality 10.1 Report from the Quality and Safety Team

Enclosed

Mrs C Brunt

2.20 pm 11 Finance 11.1 Finance Report

Enclosed

Mr P Cowley

12

Date and Time of Next Meeting Friday 17 November 2017 1pm – 3pm The Board Room, Third Floor, Brierley Hill Health and Social Care Centre

PRIMARY CARE COMMISSIONING COMMITTEE

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MINUTES OF THE MEETING HELD IN PUBLIC ON FRIDAY 29 SEPTEMBER 2017 THE BOARD ROOM, 3RD FLOOR, BRIERLEY HILL HEALTH AND SOCIAL CARE CENTRE,

VENTURE WAY, BRIERLEY HILL, DY5 1RU

Quorum: A meeting of the Committee will be quorate provided that at least four members are present of which one must be either the Chair or Vice Chair of the Committee and one must be the Chief Finance Officer/Deputy Chief Finance or Chief Nursing Officer. ATTENDEES: Members Mr S Wellings Non-Executive Director for Governance, Dudley CCG (Chair) Mrs C Brunt Chief Nurse, Dudley CCG Mrs J Jasper Non-Executive Member for Patient and Public Involvement, Dudley CCG In Attendance Mr P Cowley Senior Finance Manager, Dudley CCG Ms H Codd Engagement Manager, Dudley CCG Mr B Dhami Contracts Manager, NHS England Mrs J Emery Chief Executive, Healthwatch Dudley Mrs J Robinson Primary Care Contracts Manager, Dudley CCG Mr D Stenson Patient Opportunity Panel Representative Mrs J Taylor Commissioning Manager for Primary Care, Dudley CCG Mr T Thomik Dudley LPC Representative Minute Taker: Ms D Gilbert Personal Assistant, Dudley CCG 1. APOLOGIES FOR ABSENCE Apologies were received from: Dr C Handy, Non-Executive Director, Quality and Safety, Dudley CCG (Vice Chair) Dr T Horsburgh, Clinical Executive for Primary Care, Dudley CCG/LMC Representative Ms S Johnson, Deputy Chief Finance Officer, Dudley CCG Dr V K Mittal, GP Representative Mrs A Nicholls, Interim Deputy Head of Commissioning (Primary Care) NHS England (West Midlands) Dr D Pitches, Consultant in Public Health, Dudley MBC 2. DECLARATIONS OF INTEREST To request members to disclose any interest they have, direct or indirect, in any items to be considered during the course of the meeting and to note that those members declaring an interest would not be allowed to take part in the consideration or discussion or vote on any questions relating to that item. Mrs Jasper declared her standing interest as NED for Sandwell and West Birmingham CCG. Mr Stenson declared his standing interest as Non-Executive Director for Black Country Partnership NHS Foundation Trust.

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Mr Thomik declared his standing interest as representative for Dudley LPC, although he does not have a voting position on the Committee. Declarations of Interest were distributed at the meeting and will be appended to the Primary Care Commissioning Committee (PCCC) agenda and papers in future. 3. QUESTIONS FROM THE PUBLIC Mr Wellings had received no questions from the public and no public were in attendance. 4. MINUTES FROM THE PREVIOUS MEETING HELD ON 11 AUGUST 2017 The minutes of the Committee held on Friday 11 August 2017 were accepted as a true and accurate record with the following exceptions: It was agreed that on Page 5 it had not captured what the Committee agreed and it should have read: “That the future provision of a primary medical service to the patient population registered with the High Oak practice be included within the scope of services to be provided by a MCP and procured as part of the current procurement exercise.” The Committee agreed to:

1) Approve the proposed solution to meet the practice’s requirements. 2) Approve the required capital expenditure and increased revenue cost of the proposed solution.

5. MATTERS ARISING/ACTION LOG MATTERS ARISING The action log was discussed and updated accordingly with the following points noted: PCCC/JAN/2017/9.1(a), (b) Performance Report Action to be closed.

ACTION: MR FRANKLIN

PCCC/JAN/2017/9.1(c) Performance Report – Children’s Attendance Audit results have been sent through and this is being followed up. This is being tied in with Healthwatch. It looked at ten children attending the Urgent Care Centre (UCC), 30% at the Paediatric Assessment Unit (PAU). 40% were inappropriate presentations to both UCC and PAU. A report will follow to be presented to Committee in February 2018.

ACTION: MRS BRUNT PCCC/MAR/2017/7.1(b) Quality and Safety Immunisations Report

This item will be discussed in the Quality and Safety section and a detailed report will follow. To be deferred to November 2017.

PCCC/MAR/2017/11.0 DPMA Training Budget Business Plan

DPMA to be advised that if they don’t provide the requested evaluation report the Committee will cease to support funding. To be deferred to December 2017.

ACTION: MRS TAYLOR PCCC/APR/2017/13.0 Supporting Professional Decisions

This item was omitted from the agenda; a report was presented at the meeting. It was recorded that regular meetings are to be held to look into protocol/procedures/coding. An update would be provided at the December

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meeting unless anything arises that the Committee should be made aware of prior to this.

PCCC/JULY/2017/9.0 Dementia Local Improvement Scheme Review of dementia diagnosis evaluation to take place in six months’ time to

evaluate whether numbers are continuing to increase and the target has been met. The information should include individual practice performance. The diagnosis rate has continued to improve and now the CCG are over 64%.

ACTION: MR HINDLE

PCCC/JULY/2017/9.0 Clinical Peer Review

Dr Horsburgh, Dr Gee and Mr Curran have met to discuss how to approach this project, which will be brought back to a future Committee for discussion and approval. Detailed guidance is still awaited from NHS England. The BMA have written to practices stating this is not a legal requirement. The Commissioning Development Committee (before the CCG were advised about the BMA correspondence) made a decision to incentivise practices due to the additional work involved. To be deferred to October 2017 for an update.

ACTION: DR HORSBUGH

PCCC/AUG/2017/6.1 PPGs This item was included in the agenda and can be closed from the action log. PCC/AUG/2017/6.2 High Oak This item was included in the agenda and can be closed from the action log.

Mr Thomik arrived Committee agreed that for future action logs the date completed column would be removed in line with other Committees and Groups. When the action is completed and agreed it will be minuted and there is no need for the action to be discussed the following month. 6. CONTRACTUAL 6.1 PATIENT PARTICIPATION GROUP UPDATE Mrs Codd spoke to this item to update the Committee on the current situation and future plans regarding Patient Participation Groups (PPGs). A second PPG event was held in August, the first one having been well received. The event was opened positively. As well as the CCG, Three Villages had a stall. Moss Grove held a fish and chip supper at New Bradley Hall Care Home and Feldon Lane held a quiz night. Patient on-line was promoted and there was some uptake. The recommendations were that practices contact the Primary Care Team if they do not have a PPG; the Communications & Public Insight team continue to support PPGs and practices. That the CCG develop a new approach towards practices, their PPGs and volunteers. That the CCG work with practices, patients and groups as opposed to a challenging approach towards practices of concern. It was suggested that a champion may be beneficial and also to try and get a slot on the DMPA to help to spread the message.

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Resolved:

1) The Committee noted the report for assurance 2) The Committee agreed the recommendations

Mrs Codd left the meeting 6.2 REPORT FROM THE PRIMARY CARE OPERATIONS GROUP Mrs Robinson spoke to this item to update the Committee following the Primary Care Operational Group (PCOG) meeting held on 15 September 2017. The group received initial proposals for discussions around the merger of two practices in Dudley and the group supported the initial proposals. There was a serious IT issue at a practice that forced the closure of a branch surgery. The CMS contract was breached however due to the circumstances and action taken, PCOG recommend to Committee that a breach notice should not be issued. The CCG IT Manager will be formally addressing the escalation process with the IT supplier through the contract review. Resolved:

1) The Committee noted the report for assurance 2) The Committee agreed that a breach notice against the GMS contract should not be

issued. 6.3 PRIMARY MEDICAL SERVICES REPORT Mr Cowley spoke to this item to present to the Committee an update on the Dudley Quality Outcomes for Health (DQOFH) Framework 2017/18. The phase three pilot continues for this financial year with 42 of the 45 practices taking part. Feedback is awaited regarding review of the indicators and relating templates for next contractual year. The next phase of evaluation is currently in progress and feedback will be provided next month.

ACTION: MRS TAYLOR

Mrs Brunt arrived

Over the last couple of months the CCG has invested resource to assist other practices in setting up their systems and processes efficiently to run the DQOFH framework. This resource has been targeted at the moment at practices which appeared to need help in accordance with current performance. Practices who have been received assistance have stated that the visits were positive. It was re-enforced that people with learning disabilities should be encouraged to have a health check. Feedback had been received from a carer who felt that the benefit from having the annual health check and the continuity of care provided by the GP had been really beneficial. The Committee is asked to note for assurance the DQOFH framework update. Resolved: 1) The Committee noted the report for assurance

7. 0 RISK REGISTER Mrs Brunt spoke to this item to provide the Committee with an updated Board Assurance Framework and Risk Register for those risks assigned to Primary Care Commissioning Committee. This was the first time the register had been produced in the new format. The purpose of the register is to align this with contractual issues and having much more generic risks rather than looking at issues and specific risks.

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There were a couple of updates in terms of the actions especially around the workforce, Risk 136. The CCG in collaboration with the Black Country STP partners are developing a joint workforce strategy in response to the GP Forward View. The rating of this Risk was debated and it was felt that the rating was appropriate at this moment in time. In terms of Risk 135 where NHS England have the regulatory responsibility around individual performer issues, the concern here has been communication between the CCG and NHS England. This has been acknowledged and there is a fortnightly route whereby Quality and Safety and/or the Primary Care Contracts Manager feed in concerns to that group. NHS England have acknowledged that there are some difficulties and they are putting on a workshop so a more robust process can be put in place. In respect of risk 137 there was an outstanding action for a log to be maintained of alternative service locations for practices. It was noted that to date the CCG have received responses from approximately two thirds of practices to the request for information, and that of those there are a small number who have no alternative service location included in their Business Continuity Plans and another small number where the response given is inadequate. Once a more detailed response has been received the responses will be assessed and suggestions will be made to practices as to how they can be improved, and a report on this will be presented to Committee for assurance in November. It was suggested that if there is difficulty obtaining the information then the issue is included in Members News and raised at a future Members Event, to ensure GPs are aware of the requirements.

ACTION: MR COWLEY Resolved:

1) The Committee noted the report for assurance INANCE REPORT

8.0 QUALITY 8.1 FINANCE REPORT 8.1 REPORT FROM THE QUALITY AND SAFETY TEAM Mrs Brunt spoke to this item to provide on-going assurance to Committee regarding primary care quality and safety in accordance with the CCG’s statutory duties. A more detailed discussion regarding PCAT was to take place in the Private Committee. There are improvements around infection prevention and control and particularly our C Diff position. Dudley has proved to be the highest improved area in the country in terms of C Diff. There is one SI that continues to have Quality and Safety team support. Three practices are now using the live Datix system as well as the Urgent Care Centre. The CCG now have the PCAT tool which is helping to inform our decisions about Primary Care support. There is one practice at the moment that has an inadequate rating. The Chief Nurse of the CCG has had a conversation with the Chief Nurse at the CQC. A records audit has been undertaken and practice has confirmed that their practice nurses are not seeing women who are presenting for breast and gynaecological examinations. There had been a focus on mortality data following what had happened with Shipman and a query was raised as to whether this was still happening. The Committee were informed that the focus is now on having mortality reviews in Primary Care and the end result is for all deaths to be reviewed. This is already being done in Acute Trusts and they achieve 93% of those reviews. The one area that will be systematically reviewed regardless of the place of death will be patients with learning disabilities. This will come into place on 1 October 2017 where all learning disability deaths from the age of four onwards will be reported to a central point in Bristol and the CCG will have a process in the Black Country for reviewing those deaths.

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Resolved:

1) The Committee noted the report for assurance

8.1 FINANCE REPORT 9.0 FINANCE 9.1 FINANCE REPORT Mr Cowley spoke to this item to provide an overview of financial performance against budgets delegated to Committee. The financial report was presented for the period of August. There has been one allocation change since June with the quarter 2-4 allocation for the GP Forward View Extended Access being made to the CCG. The CCG had previously received quarter 1. The CCG are forecasting a break even position against co-commissioning and GP Forward View allocations and there is a small underspend forecast against the core CCG budgets, although the report highlights that a significant level of reserves remain uncommitted, and plans to commit these funds will be developed for presentation to a future Committee. It was also noted that there has been an underspend in payments for GP Forward View Extended Access in the period April-August, and that proposals to utilise this to fund additional access improvements on a non-recurrent basis would be brought to Committee.

ACTION: MR COWLEY Resolved:

1) The Committee noted the report for assurance

10.0 HIGH OAK PREMISES DEVELOPMENT Mr Cowley spoke to this item to seek approval for costs involved in an extension to the premises of High Oak surgery. Following a discussion at the previous meeting around the adequacy of the current premises, detailed proposals have been drawn up to extend High Oak Surgery and extend the lease on the site until March 2022. The premises are currently significantly undersized and this is to be addressed by the provision of two extra consulting rooms and extra administration space for the practice. The non-recurrent development cost for the proposed solution is £115,000 and the recurrent revenue cost approximately £60,000. The Committee were asked to approve the proposed solution to meet the practice’s requirements and to approve the required capital expenditure and increased revenue cost of the proposed solution. The Committee agreed to the proposed solution and approved the expenditure required to meet this. Committee also wished to thank NHS Property Services and the architects involved in pulling together the proposal, who had worked hard to pull this project together in time for Committee. Resolved:

1) The Committee received the report for assurance 2) The Committee approved the proposed solutions

11.0 DATE AND TIME OF NEXT MEETING Friday 20 October 2017 1pm – 3pm The Board Room, Third Floor, Brierley Hill Health & Social Care Centre MINUTES ACCEPTED AS A TRUE AND CORRECT RECORD Name Title

Signed Date

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PRIMARY CARE COMMISSIONING COMMITTEE OUTSTANDING ACTION LIST – 29 SE[TE,NER 2017

MEETING REFERENCE

ACTION LEAD STATUS

DEADLINE DATE

PCCC/JAN/2017/1(c) Performance Report – Children’s Attendance Report to be presented to Committee regarding findings of children’s attendance.

Mrs Brunt In Progress February 2018

PCCC/MAR/2017/7.1(b) Quality & Safety Immunisations Report The Committee requested a detailed report from Public Health for further details on the immunisation landscape.

Mrs Brunt In Progress November 2017

PCCC/MAR/2017/11

DPMA Training Budget Business Plan DPMA to provide the information by the end of December or the Committee will not support the re-procurement of their services.

Mrs Taylor In Progress December 2017

PCCC/APR/2017/13.0 Supporting Professional Decisions The Committee requested further detail around the membership of the panel and how that would work.

Dr Horsburgh In Progress

December 2017

PCCC/JUNE/2017/9.0 Dementia Local Improvement Scheme Review to take place in six months’ time. Mr Hindle In Progress December 2017

PCCC/JULY/2017/9.0 Clinical Peer Review Following discussions this will be brought back to the Committee for an update

Dr Horsburgh In Progress October 2017

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MEETING REFERENCE

ACTION LEAD STATUS

DEADLINE DATE

PCCC/SEPT/2017/6.3 Primary Medical Services Report Feedback and discussion regarding phase 3 pilot to be brought back to next meeting.

Mrs Taylor In Progress October 2017

PCC/SEPT/2017/7.0 Alternative Service Locations Report on practice Alternative Service Locations to be presented to Committee.

Mr Cowley In Progress November 2017

PCC/SEPT/2017/9.0 Finance Report Plans for expenditure against reserves, and commitment of GPFV Access underspends, to be produced.

Mr Cowley In Progress November 2017

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Date of Report: 20 October 2017 Report: Primary Medical Services Report – Winter Pressures LIS 2016/17 Evaluation

Agenda item: 6.0

TITLE OF REPORT: Primary Medical Services Report – Winter Pressures Local Improvement Scheme (LIS) 2016/17 evaluation report

PURPOSE OF REPORT: To present to the Committee the Winter Pressures LIS 2016/17 evaluation report

AUTHOR OF REPORT: Mrs R Gretton, Primary Care Commissioning Support Officer

MANAGEMENT LEAD: Mrs C Brunt, Chief Nurse CLINICAL LEAD: Dr T Horsburgh, Clinical Lead for Primary Care

KEY POINTS:

The scheme was offered to practices in two components:

Component One: Participation in collaborative working by the implementation of EMIS remote consultation

• 100% compliance following audit

Component Two: Weekend Extended Access

Option A – Extended weekend access to practices own registered population

Option B – Extended weekend access to practices own and other practices registered population

• 23 out of 46 practices (50%) opted in to provide option A • 10 out of 46 practices (22%) opted to provide option B in addition

to option A • A total of 9,812 additional primary care appointments were

available with an uptake rate of 81% and a DNA rate of 8% • A 1.4% reduction in A&E attendance was demonstrated with an

increase of 2.5% in UCC attendance

RECOMMENDATION: The Committee is asked to accept • The winter pressures LIS 2016/17 evaluation report

FINANCIAL IMPLICATIONS: Component one - £2,300 Component two - £347,000 Total - £349,300

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WHAT ENGAGEMENT HAS TAKEN PLACE:

• Locality meetings • CCG Clinical Executive Team • Practice Managers Steering group

ACTION REQUIRED: Decision Approval Assurance

DUDLEY CLINCAL COMMISSIONING GROUP

PRIMARY CARE COMMISSIONING COMMITTEE – 20th October 2017 PRIMARY MEDICAL SERVICES REPORT – WINTER PRESSURES LIS 2016/17 EVALUATION 1.0 PURPOSE OF REPORT 1.1 To present to the Committee the evaluation report for Winter Pressures Local Improvement Scheme

2016/17 for assurance. 2.0 BACKGROUND 2.1 The CCG commissioned a Winter Pressures Local Improvement Scheme (LIS) from 1 November 2016

to 31 March 2017. The aim of this LIS was to enable practices to improve patient access during the winter season by offering additional routine weekend appointments at times outside of core contracted hours and NHS England commissioned Extended Hours (if currently provided).

2.2 This LIS facilitates practices to respond to patient demand and capacity pressures during the winter period and also allows patients to attend the practice at a time when it is more convenient for them. The scheme is designed to be flexible so that providers can respond to their practice population requirements and offer variable hours;

2.3 The scheme was offered to practices in two components:

• Component One: Participation in collaborative working by the implementation of EMIS remote consultation

• Component Two: Extended Weekend Access:

- Option A – Extended weekend access to practices own registered population - Option B – Extended weekend access to practices own and other practices

registered population 3.0 KEY FINDINGS

3.1 44 of the 46 practices originally participated in component one, with sign up and activation of the Data Sharing Agreement for EMIS remote consultation. Subsequently, full practice coverage has now been achieved;

3.2 23 out of the 46 practices (50%) opted in to provide option A of component two;

3.3 10 out of the 46 practices (22%) opted to provide option B in addition to option A – extended weekend access to their own and other practices registered population. Although provision of this option was available, there is little evidence that this arrangement was utilised by other practices;

3.4 A total of 9,812 additional primary care appointments were made available with an uptake rate of 81% and a DNA rate of 8%;

3.5 In line with evidence from the Prime Minister’s Challenge Fund, demand is higher on Saturday mornings, with very low demand for Saturday afternoon and Sunday appointments. Of those practices offering extended weekend access, the most common type of offer, with 21 of the 46 practices (46%), provided Saturday morning appointments. Sunday was the least common day for practices to offer

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extended weekend access with 2 of the 46 practices (4%) providing Sunday opening. 1 of the 46 practices (2%) provided both Saturday and Sunday appointments;

Figure 1 – Proportion of Saturday and Sunday Utilisation and DNA’s

3.6 21 of the 23 practices demonstrated achievement of component two as per the monitoring requirements, with submission of appointment data;

Table 1 – Locality extended weekend access appointment utilisation

81%

9%

60%

12%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Utilisation DNA %

Perc

enta

ge U

tilis

atio

n an

d DN

A's

Saturday

Sunday

Locality Number of Practices Providing Extended

Weekend Access per locality

Hours available per weekend

by locality

Utilisation of

Appointments per locality

Dudley, Netherton 6 52.5 77% Halesowen, Quarry bank 2 6 88% Kingswinford, Amblecote, Brierley Hill 6 26.5 80% Sedgley, Coseley, Gornal 3 27 75% Stourbridge, Wollescote, Lye 4 45 82%

3.7 168,674 patients (53% of the registered Dudley population) are registered at one of the 23 practices

that provided extended weekend access. Identified is a need to ensure equitable access to additional appointment slots for non-host GP practices; Figure 2 – Proportion of register population covered by practices offering extended weekend access

3.8 Some capacity issues were reported from practices offering the extended weekend access, which

would need to be taken into consideration for a more substantive scheme;

3.9 A small impact on the A&E position for the whole of Dudley of 1.2% was demonstrable between November 2015 to March 2016 and November 2016 to March 2017;

3.10 Practices included within the LIS recorded a reduction of 1.9%, with a 0.5% reduction recorded for those practices not included. This would suggest that the impact of the scheme is around a 1.4% reduction in A&E attendance;

3.11 Urgent Care Centre (UCC) activities show an overall increase of 0.7% across Dudley between the years;

3.12 For those practices taking part in the LIS there is a 2.2% reduction in UCC attendance. Practices not partaking in the LIS show an increase of 4.7% attendance between the years. This would suggest the scheme did not have any impact on the UCC position, with an increase in activity of 2.5% in attendance;

3.13 The Winter Pressures scheme ran during the Urgent Care Centre’s second winter. At this time UCC activity had increased to beyond comparable activity for 2015/16 and may well mean that any reduction in A&E attendance could be coincidental of this scheme.

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

Dudley, Netherton Halesowen, Quarrybank

Kingswinford,Amblecote, Brierley

Hill

Sedgley, Coseley,Gornal

Stourbridge,Wollescote, Lye

Perc

enta

ge o

f reg

iste

red

popu

latio

n co

vere

d

4.0 RECOMMENDATION 4.1 The Committee is asked to accept the winter pressures LIS 2016/17 evaluation report for assurance.


Date of Committee: 20 October 2017 Report: Update from the Primary Care Operational Group

Agenda Item: 7.1

TITLE OF REPORT: Update from the Primary Care Operational Group

PURPOSE OF REPORT: To update the Committee following the Primary Care Operational Group meeting held on 4 October 2017

AUTHOR OF REPORT: Mrs J Robinson, Primary Care Contracts Manager

MANAGEMENT LEAD: Mrs C Brunt, Chief Nurse CLINICAL LEAD: Dr T Horsburgh, Clinical Executive for Primary Care

KEY POINTS:

• The group provides assurance that there are no contractual

breaches to be issued for any Dudley practice • The group considered and recommends the contractual changes

set out below in the recommendations • The group considered the quality and safety issues that are set

out in the quality and safety report

RECOMMENDATION:

Committee is asked to:

• Note the actions of the primary care operational group for

assurance • Approve the contractual changes recommended by the group as

follows: o Removal of three partners at Dudley Wood Surgery with

effect from 25 October 2017

FINANCIAL IMPLICATIONS: Not applicable

WHAT ENGAGEMENT HAS TAKEN PLACE: Not applicable


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DUDLEY CLINICAL COMMISSIONING GROUP – PRIMARY CARE COMMISSIONING COMMITTEE UPDATE FROM THE PRIMARY CARE OPERATIONAL GROUP 1.0 INTRODUCTION

1.1 This report provides an update from the Primary Care Operational Group (PCOG) following its

meeting held on 4 October 2017.

2.0 CONTRACTING ISSUES

2.1 PRIMARY CARE CONTRACTUAL CHANGES 2.2 The group considered one request from Dudley Wood surgery for the removal of three partners,

resulting in a single handed practice effective from 25 October 2017. 2.3 The GP attended PCOG and was able to assure the group by presentation of a comprehensive

business plan followed by questions and answers that plans are in place to continue to deliver and develop the full range of Primary Medical services.

2.4 Although currently a partnership, clinical services are not provided by 2 of the partners and only one

session is provided by the third resigning partner. An ANP has already been recruited to cover 6 sessions per week with a detailed plan to review the clinical skill mix in December.

2.5 PCOG agreed to review the practice performance in 6 months. 2.6 PCOG recommends to the Primary Care Commissioning Committee that the application satisfies

the conditions to enable the GMS contract to continue with an individual with effect from 25.10.2017.

3.0 PRIMARY CARE QUALITY & SAFETY 3.1 The group considered the quality and safety issues that are set out in detail in the Quality and

Safety report to the Primary Care Commissioning Committee.

3.2 There are no issues in the quality and safety report that require contractual actions to be taken against any practice.

4.0 RECOMMENDATION

The Committee is asked to: • Note the actions of the primary Care Operational Group for assurance • Approve the contractual changes recommended by the group as follows:

o Removal of three partners from Dudley Wood Surgery with effect from 25 October 2017

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Date of Committee: 20 October 2017 Report: Internal Audit Report 2017/18 – Primary Care Commissioning Contracting Arrangements

Agenda Item: 7.2

TITLE OF REPORT: Internal Audit Report 2017/18 – Primary Care Commissioning Contracting Arrangements

PURPOSE OF REPORT: To present to Committee the findings of an Internal Audit review for Primary Care Commissioning Contracts


MANAGEMENT LEAD: Mrs C Brunt, Chief Nurse CLINICAL LEAD: Dr T Horsburgh, Clinical Executive for Primary Care

KEY POINTS:

• Final report attached • Assurance level - Significant • 2 recommendations

o Obtain GMS Contracts from NHS England o Develop Dudley Quality Outcomes for Health monitoring

framework

RECOMMENDATION:

Committee is asked to:

• Note the report and actions

FINANCIAL IMPLICATIONS: Not applicable

WHAT ENGAGEMENT HAS TAKEN PLACE: Not applicable


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Dudley Clinical Commissioning Group Internal Audit Report 2017/18 Primary Care Commissioning (GMS Contract Arrangements)

FINAL

October 2017

cw audit internal audit services

Contents

Section Page

1. What we found in summary........................................... 1

2. The context for our review ........................................... 2

3. What we agreed to do .................................................. 4

4. Our findings and how management has responded ...... 5

Appendix 1: Definition of our assurance levels and risk rankings

Appendix 2: Responsibility statements

CW Audit Services Page 1

Dudley Clinical Commissioning Group | Primary Care Commissioning (GMS Contracts Arrangements) | 2017/18

1. What we found in summary The review has identified that the CCG has robust primary care commissioning monitoring and assurance arrangements in place which ensure

accurate and consistent monthly reporting to the Primary Care Committee and the Governing Body.

Assurance levelAssurance levelAssurance levelAssurance level The key The key The key The key issues that management must addressissues that management must addressissues that management must addressissues that management must address

• Contract variations for nationally agreed changes for 2016/17 and 2017/18 are not in place.

• Dudley Outcomes for Health Framework (DQOH) monthly activity monitoring is not discussed at

the Primary Care Operational Group (PCOG).

Individual control objectives Individual control objectives Individual control objectives Individual control objectives Key control objective Level of assurance

Full Significant Moderate Limited No

1. The CCG has signed GMS/APMS contracts in place for all its member practices in relation

to activity for 2017/18. �

2. GMS Contracts are in place for all material in-year spend on primary care commissioned

activities and highlight their roles, responsibilities, performance measurement and reporting

requirements. �

3. Controls are in place in relation to budgeting and assessing material variations to existing

GMS contracts. �

4. Appropriate mechanisms exist to evaluate and monitor the performance of GP GMS

activity. �

5. The Governing Body and relevant committees are updated on a regular basis in relation to

GMS Contract monitoring and management. �

Our assurance level and risk rankings are defined in Appendix 1.

Significant assurance



2. The context for our review

BBBBackgroundackgroundackgroundackground An internal audit review of the arrangements for Primary Care Commissioning (GMS Contracts) has recently been completed. This review was carried

out as part of the 2017/18 internal audit plan agreed by the Audit & Governance Committee. We last undertook a review on Primary Care

Commissioning - Payments to Practices in 2016/17, when significant assurance was given on the system controls in place.

The systemThe systemThe systemThe system All GPs have primary care contracts for the medical services they provide and these have been obtained from NHS England. All practices have signed

contracts and copies of these have been obtained from NHS England. Of the 45 practices 44 are on GMS contracts with 1 on an APMS contract. In

addition to this contract, the CCG has developed a Dudley Outcomes for Health Framework (DQOH) with 42 of the 45 practices signing up to it.

The Primary Care Committee (PCC) approved the development of a new contractual framework in August 2015 based on the components of access,

continuity and coordination. The new framework is a key component of the new model of care being commissioned by the CCG as a National

Multispecialty Community Provider (MCP) Vanguard.

Budgets have been delegated to the PCC for the financial year 2017/8 totalling £41.4m, with £40.6m delegated to Co-Commissioning Primary Care

and £800k delegated to Primary Care Development. A Finance report is produced monthly for the PCC and the Finance, Performance & Business

Intelligence Committee (FP&BI) which shows how the CCG is performing against the budget.

A timetable is in place for processing payments, some of the payments to be processed were set up at the beginning of the year and calculations

were carried out by NHS England and provided to the Primary Care Services. MS global sum payments are automatically generated from the list sizes

on the Exeter system. When the schedules are received from NHS England these are sense checked for values and against previous payments. Any

new items on the list are checked to confirm that they are appropriate and for any backing information. This is also used to check that all payments

requested relate to Dudley Practices, and that there are no payments to Practices which have closed or are suspended for any reason.

The Dudley Outcomes for Health Framework (DQOH), which was paid as a ‘block contract’ in 2016/17, is now partly paid upon achievement against

indicators, monitored through the extraction of data from GP systems. The majority (between 75% and 80%, depending on the GP practice) is still

paid as a block. A dashboard has been developed allowing practices to see their achievement against the DQOH framework, which is updated on a

monthly basis.



The Primary Care Contracting team undertake contract compliance reviews and report any issues to the Primary Care Operational Group (PCOG). The

PCOG is a forum for the CCG to review and monitor contractual performance and quality and safety in primary care. The Group provides a written

summary of the key matters covered by the meeting, including any actions and decisions taken to report to the PCC and Quality and Safety

Committee where necessary. After the ledger is closed for the month, a monthly Finance report is produced and submitted to the PCC. Minutes from

the PCC show that a finance update and PCOG reports are standing agenda items. A PCC report is presented to the Governing Body on a bi-

monthly basis to give them a summary of the issues discussed at the Committee. The financial aspects are also incorporated in the CCG monthly

Finance report to the Governing Body.



3. What we agreed to do The overall objective in undertaking this review was to ensure, through a process of systems evaluation and compliance testing, that there is an

appropriate control framework in place to manage the following key risks and to deliver the key system control objective:

The key risksThe key risksThe key risksThe key risks • Contracts do not reflect 2017/18 changes.

• If there is insufficient resource CCGs may need to direct other key CCG staff to pick up functions, for example

transactional contract issues, and may put pressure on CCGs’ ability to deliver on the range of responsibilities.

• The CCG staff may be unable to gain access to the national CQRS scheme used to administer the Quality

Outcomes Framework (QOF) incentive scheme and may impact on the CCG's ability to deliver its Primary Care

Contracting responsibilities adequately.

SSSSystem control ystem control ystem control ystem control

objectivesobjectivesobjectivesobjectives

• The CCG has signed GMS/APMS contracts in place for all its member practices in relation to activity for

2017/18.

• GMS Contracts are in place for all material in-year spend on primary care commissioned activities and

highlight their roles, responsibilities, performance measurement and reporting requirements.

• Controls are in place in relation to budgeting and assessing material variations to existing GMS contracts.

• Appropriate mechanisms exist to evaluate and monitor the performance of GP GMS activity.

• The Governing Body and relevant committees are updated on a regular basis in relation to GMS Contract

monitoring and management.

The results of this review have been discussed with the Primary Care Contracts Manager. Actions to resolve control weaknesses have been agreed

where necessary. We have delivered this review in accordance with the statements made in Appendix 2. The assistance and co-operation of

management during the course of this exercise is gratefully acknowledged.



4. Our findings and how management has responded

System Control ObjectiveSystem Control ObjectiveSystem Control ObjectiveSystem Control Objective 1111:::: The CCG has signed GMS/APMS contracts in place for all its member practices in relation to activity for 2017/18.

Area Audit Finding Risk Risk

Ranking

Recommendation Response Who and When

1.1

Contract

Variations

Testing during our previous audit confirmed that all

practices had agreements in place and those which

were previously PMS are now GMS. The contracts are

still with NHS England as they are all electronically

stored and there is an unresolved information

governance issue whereby NHS England are unable at

present to share. This means that variations for changes

to national contracts for 2016/17 to 2017/18 are still

outstanding.

Contract variations have been implemented by the CCG

where GP practice membership has changed due to

retirement, an addition or the departure of a GP.

All but three practices have signed up to the Dudley

Outcomes Framework and we confirmed that signed

agreements are in place for a sample of practices

tested.

Contract

documents not

in place to

support services

from

contractors.

4 The CCG should consider

liaising with NHS England on

an approach to take to obtain

copies of contracts.

We will continue to talk

with NHS England in

relation to the

outstanding GMS

contracts.

Julie Robinson

Primary Care

Contracts Manager

Update status 31

December 2017

System Control Objective 2:System Control Objective 2:System Control Objective 2:System Control Objective 2: GMS Contracts are in place for all material in-year spend on primary care commissioned activities and highlight their roles, responsibilities, performance measurement and reporting requirements. System Control Objective System Control Objective System Control Objective System Control Objective 3333:::: Controls are in place in relation to budgeting and assessing material variations to existing GMS contracts.

There are no issues to report relating to the above control objectives.



System Control Objective System Control Objective System Control Objective System Control Objective 4444:::: Appropriate mechanisms exist to evaluate and monitor the performance of GP GMS activity.

Area Audit Finding Risk Risk

Ranking

Recommendation Response Who and When

4.1

DQOH

Activity

monitoring

The Primary Care Operational Group (PCOG) review and

monitor contract performance of all GP practices within

the CCG and report to the Primary Care Committee.

The Dudley Outcomes for Health Framework, which was

paid as a ‘block contract’ in 2016/17, is now partly paid

upon achievement against indicators, monitored

through the extraction of data from GP systems.

For the LIS payments activity information is extracted

from EMIS on a monthly basis. CCG staff have a 14 day

turnaround to send the data to the Practice to confirm

details and confirm with the Finance team if they agree

with detail captured.

Audit noted that this information extracted is not

discussed at PCOG as part of the review and

monitoring.

Lack of regular

oversight on

contractor

activity.

3 The PCOG should consider

reviewing activity information

on a regular basis.

The live DQOFH

indicators are now

embedded in the

Primary Care Analysis

Tool and are now

reviewed monthly by

the Primary Care

Operational Group as

part of overall practice

performance. In

addition, a monitoring

framework is being

developed which is due

to be presented to the

Primary Care

Commissioning

Committee at a

forthcoming meeting.

Julie Robinson

Primary Care

Contracts Manager

31 December 2017

System Control Objective System Control Objective System Control Objective System Control Objective 5555:::: The Governing Body and relevant committees are updated on a regular basis in relation to GMS Contract monitoring and management.

There are no issues to report relating to the above control objective.



Appendix 1: Definition of our assurance levels and our risk rankings

Opinion Assessment rationale

No

The audit highlighted weaknesses in the design or operation of controls that have not only had a significant impact on the delivery of key system

objectives, they have also impacted on the delivery of the organisation's strategic objectives. As a result, no assurance can be given on the

operation of the system's internal controls to prevent risks from impacting on achievement of both system and strategic objectives.

Limited

The audit highlighted some weaknesses in the design or operation of control that have had a serious impact on the delivery of key system

objectives, and could also impact on the delivery of some or all of the organisation's strategic objectives. As a result, only limited assurance can

be given on the operation of the system's internal controls to prevent risks from impacting on achievement of the system's objectives.

Moderate

The audit did not highlight any weaknesses that would in overall terms impact on the achievement of the system's key objectives. However, the

audit did identify some control weaknesses that have impacted on the delivery of certain system objectives. As a result, only moderate assurance

can be given on the design and operation of the system's internal controls to prevent risks from impacting on achievement of the system's

objectives.

Significant

The audit did not highlight any weaknesses that would materially impact on the achievement of the system's key objectives. The audit did find

some low impact control weaknesses detailed in section four of this report which, if addressed, would improve the overall performance of the

system. However these weaknesses do not affect key controls and are unlikely to impair the achievement of the system's objectives. As a result,

significant assurance can be given on the design and operation of the system's internal controls to prevent risks from impacting on achievement

of the system's objectives.

Full

The audit did not highlight any weaknesses that would impact on the achievement of the system's key objectives. It has therefore been

concluded that key controls have been adequately designed and are operating effectively to deliver the key objectives of the system. As a result,

full assurance can be given on the operation of the system's internal controls to prevent risks from impacting on achievement of the system's

objectives.

Risk ranking Assessment rationale

1 The system has been subject to high levels of risk that have, prevented the system from meeting its objectives and also impacted on the delivery

of the organisation's strategic objectives.

2 The system has been subject to high levels of risk that has, or could, prevent the system from meeting its objectives, and which may also impact

on the delivery of some or all of the organisation's strategic objectives.

3 The system has been subject to medium levels of risk that have, or could, impair the system from meeting its objectives.

4 The system has been subject to low levels of risk that has, or could, reduce its operational effectiveness.



Appendix 2: Responsibility statements

Disclosure statement

We have prepared this document solely for your use and, therefore, we believe that it would not be appropriate for it to be made available to third parties. If such a

third party were to obtain a copy, without our prior written consent, we would not accept any responsibility for any reliance that they might place upon it. In the

event that, pursuant to a request which you have received under the Freedom of Information Act 2000 you are required to disclose any information contained in this

report, then you will notify CW Audit Services promptly and consult with us prior to disclosing such report. You agree to pay due regard to any representations

which we may make in connection with such disclosure and apply any relevant exemptions which may exist under the Act. If, following consultation with us, you

disclose this report or any part thereof, it shall ensure that any disclaimer which we have included, or may subsequently wish to include in the information, is

reproduced in full in any copies disclosed.

Compliance with applicable standards statement

Our review of compliance against the applicable audit standards has confirmed that this engagement has been conducted in accordance with the International

Standards for the Professional Practice of Internal Auditing. In conducting this assignment we can confirm that there have been no impairments to our

independence or objectivity, either as an organisation or as individual auditors involved in delivering this service.

General statement

This report highlights findings on an exception basis and does not therefore include detail of controls that the audit found to be operating satisfactorily. Our opinion

provides an overall assessment regarding the level of assurance we can provide regarding the controls operating in the system. The review will feed into the Head of

Internal Audit Opinion which in turn forms part of the assurance for the Annual Governance Statement. Implementation of recommendations will be monitored by

the Audit Committee.


Date of Committee: 20 October 2017 Report: Board Assurance Framework & Risk Register

Agenda Item: 8.0

TITLE OF REPORT: Board Assurance Framework (BAF) & Risk Register (RR) for Primary Care Commissioning Committee

PURPOSE OF REPORT: To provide the Committee with an updated BAF & RR


MANAGEMENT LEAD: Mrs C Brunt, Chief Nurse

CLINICAL LEAD: Dr T Horsburgh, Clinical Executive for Primary Care

KEY POINTS:

• Enclosed is the BAF & RR as at 10 October 2017 • Highlights changes made at the last Committee on 29 September

2017.

RECOMMENDATION: • The Committee is asked to note the changes and review the current status of risks.

FINANCIAL IMPLICATIONS: n/a

WHAT ENGAGEMENT HAS TAKEN PLACE: n/a


1 | P a g e

Dudley CCG Combined Board Assurance Framework and Corporate Risk Register 2017/1810-Oct-17 MASTER Document with full Risk Review Information

ID Original Date Last Review (Committee

Date)

Last Update (Risk

Amended)

LIN

K T

O

CO

RPO

RA

TE

OB

JEC

TIVE

(SEE

K

EY A

BO

VE)Risk Description Accountable

CommitteeAccountability Sponsor & Owner

Management Lead

P I

Initial Risk Score (PxI)Score

before any controls are in

Key ControlsWhat controls/systems are in place to assist in securing delivery of ourobjective. Such as strategies, policies and procedures

Gaps in ControlWhere are we failing to put controls/ systems in place. / Where are we failing in making them effective. For example lack of training or no regular review of

Gaps in Assurance Where are we failing to gain evidence that our controls/ systems, on which we place reliance, are effective. Such as no assurance a strategy or policy is effective

Internal AssurancesBoard Reports, Minutes of meetings

External AssurancesInternal and External Audit Reports, CQC Reports (R) P (R) I

Residual Risk Score

(PxI)Score

following controls put

in place

Risk Trend ActionsTo improve control, ensure delivery ofprincipal objectives, gain assurance

TimescalesDate action will be completed

COMMENTS

135 21/07/2017 29/09/2017 29/09/2017 4B

There is a risk that the provision of Primary Care Medical Services are adversely affected partially or fully due to either quality or individual performer issues

PCC Steve Wellings Caroline Brunt 3 4 12

Work regular with CQC & NHS England (Via PPIGG) to ensure that any concerns are addressed early.

Primary Care Team visits with practice to obtain soft intelligence

Receiving timely information from NHSE, There is no robust mechanism in place for the CCG to be informed of issues early on eg. Complaints, GMC investigations etc.

Gaps in reporting to Committee needs to be clarified as some of the soft intelligence is not suitable for a public meeting.

Report to PCCC regarding formal performance issues

Feedback from individual practices is reported through PCOG

Appraisal process for individual GPs carried out by NHS England (Moved from Key controls)

3 4 12 =1) Contribute to the review of the PPIGG structure and function

2) Discuss with NHSE regarding better ways of receiving timely complaints information

1) August 2017

2) November 2017

1) Fed back initial comments to PPIGG.

2) Pilot process agreed with NHSE for timely complaints information to be provided

136 21/07/2017 29/09/2017 29/09/2017 4B

There is a risk that the provision of Primary Care Medical Services are adversely affected partially or fully due to insufficient workforce


Annual Workforce Audit for clinical and non-clinical staff carried out

Recruitment Fayres/ Joint working and raising profiles in Primary Care

Training needs and skills set assessment

Primary Care Team visits with practice to obtain soft intelligence

Engagement with NHS England, Health Education England and Local Workforce Advisory Board committed to training and professional development.

Joint working with local Community Provider Education Network (CPEN) to maximise opportunities for Primary Care Workforce development

Enabling practices to improve and change (EPIC Programme)

Workforce plan to be developed

No current model of care available to address the workforce gaps

Gaps in reporting to Committee needs to be clarified as some of the soft intelligence is not suitable for a public meeting.

CCG do not currently receive notification from NHSE in respect of outstanding appraisals

Report to PCCC regarding training needs and workforce analysis

Feedback from individual practices is reported through PCOG

Report to PCC regarding EPIC Programme progress

2 3 6 =

1) Develop and implement the new model of care - Dudley Multispecialty Community Provider (MCP). As part of the new model, developing and investing in the clinical and non clinical workforce

2) Develop a joint action plan with external partners (eg. HEE) to establish future workforce needs moving into an MCP provider.

1) April 2019

2) 2017/18 TBC

137 21/07/2017 29/09/2017 29/09/2017 4B

There is a risk that the provision of Primary Care Medical Services are adversely affected partially or fully due to unplanned loss of Estates or infrastructure


CCG Estates Strategy in place

Rent Reviews in place

Review of Leases

Regular contact with practices to highlight premises issues

Alternative suitable space is not readily available in the event of an unplanned loss.

The CCG has no power to compel the relocation of practices from unsuitable premises.

There is no requirement upon practices to report issues with premises to the CCG.

GMS Contract responsibilities in respect of premises are not robust.

No assurance regarding Business Continuity Plans include alternative locations

Feedback on individual practice issues is provided to PCOG.

Issues are discussed at the monthly Estates Operational Group

None 2 3 6 =

1) Develop and implement the new model of care - Dudley Multispecialty Community Provider (MCP). As part of the new model, developing infrastructure and estate to deliver the model

2) Develop and maintain a log of the alternative service locations included in Business Continuity Plans

1) April 2019

2) November 2017

138 21/07/2017 29/09/2017 29/09/2017 4B

There is a risk that the provision of Primary Care Medical Services are adversely affected partially or fully due to Financial issue


GPFV related increases in investment in Primary Care

General Practice Resilience Programme

Reinvestment of PMS Premium

As independent businesses, the CCG have no oversight of financial issues

Primary Care Strategy Group

Report To PCCC re investment in DQOFH

GPFV Transformation Board

2 4 8 =Develop and implement the new model of care - Dudley Multispecialty Community Provider (MCP). As part of the new model, developing and investing in the back-office efficiency of practices

Apr-19

139 21/07/2017 29/09/2017 29/09/2017 4B

There is a risk that there is insufficient workforce within the primary care team to deliver the delegated Primary Care Commissioning functions and projects such as the GP Forward View Plan


PCCC will monitor the capacity of the PC team following restructure due to MCP development.

Work allocation, work plans and capacity is discussed at 1:1 and primary care team meetings

No additional resources have been identified to support the PC team on delivery of the GP Forward View

Monitoring has not been reported back to PCCC None None 3 3 9 =

Review capacity and inform PCCC and agree a way forward.

Establish a robust process for monitoring capacity issues on an on-going basis


Date of Report: 20 October 2017 Report: DPMA training budget

evaluation 2016/17 Agenda item: 9.0

TITLE OF REPORT: Dudley Practice Managers Alliance (DPMA) training budget evaluation 2016/17

PURPOSE OF REPORT: To present to the Committee the evaluation of the training schemes funded through the DPMA training budget in 2016/17

AUTHOR OF REPORT: Mrs. J Taylor, Primary Care Commissioning Manager

MANAGEMENT LEAD: Mr. C. Brunt, Chief Nurse CLINICAL LEAD: Dr. T Horsburgh, Clinical Executive for Primary Care

KEY POINTS:

• The collective evaluation on all training schemes is presented and evaluates positively

• The practice nurse conferences which took place in April and September 2016 are presented

• The individual 7 updates in 1 day for Practice Managers and Reception/Administration staff are presented

RECOMMENDATION: The Committee is asked to accept for Assurance

• The evaluation of the training schemes funded through the DPMA training budget 2016/17

FINANCIAL IMPLICATIONS: The allocation of this training budget was £69,000

WHAT ENGAGEMENT HAS TAKEN PLACE:

• Dudley Practice Managers Alliance


1 | P a g e

DPMA TRAINING EVALUATION FORM 2016-17 - Overall response: Based on 31 evaluation responses

Evaluation of training provided from DPMA training budget for the year 2016-17

Would you kindly complete the following questions to enable us to fully evaluate the training session. Could you please mark from 1 – 6 for each question . 1 = poor to 6 = excellent Practice Name: 31 DPMA Practice Replies Training Event

Question 1 Overall Impression?

Question 2 Met your /your Staffs’ expectations?

Question 3 Quality of Speakers?

Question 4 Quality of

Venue? Greens (G) St James(SJ)

Question 5 Quality of content/ handouts?

Question 6 Repeat again 2017-18? YES OR NO

Any comments:

ACAS Employment Law

31 x 6 29 x 6 2 x 5

31 x 6 31 x 6 (G) 28 x 6 3 x 4

YES - 31 Excellent - Sharing ideas across Pmgrs very useful

Infection Control

31 x 6 31 x 6 31 x 6 31 x 6 (G) 31 x 6 YES - 31 Very good – Well presented - like variety of dates-excellent

CPR – (in-house) Manual Handling Anaphylaxis

31 x 6 31 x 6 31 x 6 On site Training In surgery

31 x 6 YES - 31 Very informative and keeps us Upto date – Flexibility of being in surgery and can chose date

Fire Safety Training (in-house)

27 x 6 4 x 3

31 x 6 27 x 6 4 x 3

31 x 6 (G) 31 x 6 YES – 27 Same company change speaker x4

Great training speaker a bit annoying – Can we use same company different speaker?

7 updates in 1 day Practice Nurse conference (1&2)

81 x 6

81 x 6 81 x 6 81 x 6 (Village Hotel)

72 x 6 9 x 4

YES – 81

Always excellent and upto date Great towards revalidation

7 Updates for Practice Managers Conference

31 x 6 31 x 6 31 x 6 31 x 6 (G) 28 x 6 3 x 4

YES -31 Can we have this twice per year as per Nurse 7 updates x 11

Wound Care (HCAs)

8 x 6 6 x 6 2 x 5

6 x 6 2 x 5

8 x 6 (G) 8 x 6 YES - 8 12 places – 8 responses Good learning- enjoyed it

Ear Syringing Update (PNs/HCAs)

12 x 6 12 x 6 12 x 6 12 x 6 (G) 12 x 6 YES – 10 2 – alternate years

16 places – 12 responses

Cytology Update

16 x 6 16 x 6 16 x 6 16 x 6 (G) 16 x 6 YES - 16 16 places – 16 responses Excellent speaker- relevant

Chaperone Training 36 x 6 36 x 6 36 x 6 36 x 6 (G) 36 x 6 YES- 36 42 places – 36 responses First Aid in workplace(full cert)

42 x 6 42 x 6 42 x 6 42 x 6 (SJ) 42 x 6 YES– recommended x 42

42 places – 42 responses Excellent –CQC impressed!

http://uk.wrs.yahoo.com/_ylt=A0WTf2rDd5lN2UsAQ0ZNBQx.;_ylu=X3oDMTBqMjBybWU5BHBvcwM3NARzZWMDc3IEdnRpZAM-/SIG=1kg1ada76/EXP=1301932099/**http:/uk.images.search.yahoo.com/images/view?back=http://uk.images.search.yahoo.com/search/images?p=joining+together&b=61&ni=20&ei=utf-8&xargs=0&pstart=1&fr=yfp-t-702&w=600&h=280&imgurl=www.togethertoday.com.au/wp-content/uploads/2009/02/feature_join-the-dots_300dpi.JPG&rurl=http://www.togethertoday.com.au/&size=57k&name=feature+join+the...&p=joining+together&oid=6ef4e816c8ae11f0&fr2=&no=74&tt=31641&b=61&ni=20&sigr=110hoaop6&sigi=12kh0vql5&sigb=13k4f42h5&.crumb=VgaXGmARjVb

Training Event

Question 1 Overall Impression?

Question 2 Met your /your Staffs’ expectations?

Question 3 Quality of Speakers?

Question4 Quality of Venue?

Question 5 Quality of content/ handouts?

Question 6 Repeat again 2017-18? YES OR NO

Any comments: Page 2

Phlebotomy Training/ Update

6 x 6 1 x 5

6 x 6 1 x 5

7 x 6 7 x 6 7 x 6 YES 12 Places – 7 responses Good theory & practical

Flu Training/ Update (HCAs/PNs)

32 x 6 32 x 6 32 x 6 32 x 6 32 x 6 YES 36 places – 32 responses Excellent & informative

B12 Training/ Update (HCAs/PNs)

6 x 6 6 x 6 6 x 6 6 x 6 6 x 6 YES 12 Places – 6 responses Thanks for arranging this

Shingles Training/ Update (HCAs/PNs)

17 x 6 2 x 5

17 x 6 2 x 5

17 x 6 2 x 5

19 x 6 17 x 6 2 x 5

YES 24 Places – 19 responses Enjoyed it –right level

ECG Training/ Update (HCAs/PNs)

6 x 6 6 x 6 6 x 6 6 x 6 6 x 6 YES 12 Places – 6 responses Gave me good undertanding

Diet, Nutrition & weight mgt Training/ Update (HCAs/PNs)

11 x 6 3 x 5

11 x 6 3 x 5

11 x 6 3 x 5

14 x 6 11 x 3 3 x 5

YES 20 Places – 14 responses 11 comments – very informative

Medical Terminology-staff for Practice Staff

59 x 6 59 x 6 59 x 6 59 x 6 (G) 59 x 6 43 x 6 – Definitely 11 x 5 – YES – 5 - Not answered

Excellent speaker All makes sense now! -Learnt loads-all staff should do it

Subscriptions Have you found them useful?

YES NO Repeat again 2017-18? YES OR NO

COMMENTS

First Practice Management?

31 31 YES Couldn’t work without it – Excellent value for money – Great to use as a guide – Keeps us up to date on changes – Definitely need this every year

Medeconomics? 5 26 no log in ?? Problems with initial log-ins – extended 1st year contract at no cost/re-issued log-ins Any other comments/ ideas for 2017-18

Comments/Ideas Feedback from DPMA members requested 7 updates for practice staff who appear to be left out of training – Asked for this to be included as pilot for 2017-18 business plan – (SC & KD left room whilst 7 updates courses were discussed – this discussion was led by Joanne Green – Chair)

** These evaluation outcomes formed the foundation of DPMA full membership discussion at our February 2017 DPMA meeting where it was agreed our Training Plan for 2017-18 submitted to CCG in March 2017 **

http://uk.wrs.yahoo.com/_ylt=A0WTf2rDd5lN2UsAQ0ZNBQx.;_ylu=X3oDMTBqMjBybWU5BHBvcwM3NARzZWMDc3IEdnRpZAM-/SIG=1kg1ada76/EXP=1301932099/**http:/uk.images.search.yahoo.com/images/view?back=http://uk.images.search.yahoo.com/search/images?p=joining+together&b=61&ni=20&ei=utf-8&xargs=0&pstart=1&fr=yfp-t-702&w=600&h=280&imgurl=www.togethertoday.com.au/wp-content/uploads/2009/02/feature_join-the-dots_300dpi.JPG&rurl=http://www.togethertoday.com.au/&size=57k&name=feature+join+the...&p=joining+together&oid=6ef4e816c8ae11f0&fr2=&no=74&tt=31641&b=61&ni=20&sigr=110hoaop6&sigi=12kh0vql5&sigb=13k4f42h5&.crumb=VgaXGmARjVb

PRACTICE NURSE CONFERENCE – 21ST APRIL 2016 – EVALUATION SUMMARY

MODULE 1

1.

2.

3.

4.

Very Dissatisfied Dissatisfied Satisfied Very Satisfied How satisfied were you with the registration process?

6 7 34 45

Extra Comments… • Not on list despite having email confirmation of booking.

Very Dissatisfied Dissatisfied Satisfied Very Satisfied How satisfied were you with the conference materials provided?

3 5 59 25

Extra Comments… • Would like copy of slides in front of me for the presentation. • Never get emailed the presentation slides even though I ask and give

my email address.

Very Dissatisfied Dissatisfied Satisfied Very Satisfied Overall, how satisfied were you with the speakers/ presenters?

3 0 41 49

Extra Comments… • Informative & concise. • Speakers were all very passionate about their subjects.

Very Dissatisfied Dissatisfied Satisfied Very Satisfied Overall, how satisfied were you with the conference facilities?

4 7 46 35

5.

Too Long Just About Right Too Short Did you feel the length of conference sessions were too long, just about right, or too short?

82 10

Extra Comments… • Too short on some speakers. • Too short however I do like the short sharp approach to cover lots

of issues. • MCA needed more time.

6.

7.

Extra Comments… • Very hot. • Cramped & too close to next person. • Needs bigger venue with either seats changing or speaker & slides on a

platform to improve visibility. • Room too hot. • Coffee queue too long. • Need a larger venue now it is more popular. • Need a bigger venue ideally. • Overcrowded. • Food poor- better off with sandwiches. • Too small for the number of people. • Neither satisfied or dissatisfied- did not get coffee or pastries on breaks.

Strongly Disagree Disagree Agree Strongly Agree The content of conference sessions was appropriate and informative.

54 38

Extra Comments…

Strongly Disagree Disagree Agree Strongly Agree The conference was well organised.

3 56 33

Extra Comments…

8.

9.

Yes No Don’t Know Would you recommend this conference to others?

88 4

Extra Comments…

Strongly Disagree Disagree Agree Strongly Agree Conference staff were helpful and courteous.

52 40

Extra Comments…

EVALUATION PRACTICE NURSE CONFERENCE 22.9.16

1.

2.

3.

4.


3 1 40 51

Extra Comments… • No signs at reception x2 • Nobody to meet 7 greet x2


1 3 56 35

Extra Comments… • Handouts of presentations would like before x 4


27 68

Extra Comments… • “Excellent as always” • All speakers were excellent


4 23 54 14

Extra Comments… • Coffee queue too long x4 • Poor organisation of drinks break & lunch x 8 • Food cold x 2 • Noise from rooms either side x2 • Hotel unorganised x2 • Catering organisation was very poor • Not enough toilets • Poor food service • No sign posting at reception to say where to go

EVALUATION PRACTICE NURSE CONFERENCE 22.9.16

5.


89 6

Extra Comments… • A lot to take in in such a short time but all excellent

6.

7.

8.

9.


94 1

Extra Comments…


1 2 37 54

Extra Comments… • Speakers were all very good


4 59 32

Extra Comments… • Apart from hotel facilities x3 • Easy access, friendly team and relaxed atmosphere with relevant

updates • Not enough room


52 43

Extra Comments…

Feedback from 7 Updates for Practice Managers

THURSDAY 17th NOVEMBER 2016

144 – practice managers attended 106

107 – practice managers completed evaluation feedback 66

1.

2.

3.

4.


2 1 11 52

Extra Comments…


1 0 12 53

Extra Comments…


2 0 9 55

Extra Comments…


2 1 9 54

Extra Comments… • Seating too cramped – would’ve prepared tables

5.


4 56 6

Extra Comments… • Could be over 2 days?

6.

7.

8.

9.


66 0 0

Extra Comments…


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Continuing the Learning Journey ……. 7 Updates in half a day 2017

For: FRONT-LINE PRACTICE STAFF THURSDAY 30TH MARCH 2017

AFTERNOON SESSION: 1.30pm – 4.30pm THE VILLAGE HOTEL - DUDLEY

‘Join us for a programme covering the latest updates for General Practice Staff – Also an opportunity to network with staff from other Practices ’

UTLINE rat

1-15 – 1.30 R E G I S T R A T I O N

Welcome & Introduction to the afternoon

1.40 Update 1: ‘The changing face of General Practice’ – How skill sets have had to change? Speaker: TBC (to include time for any questions)

2.00 Update 2: ‘Information Governance’ – Anything new? Speaker: Paul Couldrey Information Governance Officer (to include time for any questions)

2.20 Update 3: ‘Its not what you say it’s the way that you say it!’ – Customer Service skills’ – Dealing with the individual who is always right! Speaker: tbc (to include time for any questions)

2.40 Update 4: ‘Body Language – Goes both ways’ – Looking out for the warning signs!... Speaker: tbc (to include time for any questions)

3.00 BREAK FOR REFRESHMENTS & NETWORKING

3.20 Update 5: -‘3 things you wish you could change about General Practice’ (interactive around the table discussion)

3.40 Update 6: ‘On-line Services’ – Meeting the challenge of 50% sign up by March 2018! Speaker: Tristan Stanton Implementation Lead Patient Online Programme NHS England

(to include time for any questions)

4.00 Update 7: Signposting patients effectively from the front-line Speaker: Deb Attwood – Healthwatch Dudley

4.20 Summary of the day and any final questions

DUDLEY CLINICAL COMMISSIONING GROUP


Date of Meeting: 20 October 2017 Report: Quality & Safety Report

Agenda Item No: 10.1

TITLE OF REPORT: Quality and Safety Report

PURPOSE OF REPORT: To provide on-going assurance to the Primary Care Commissioning Committee (PCCC) regarding quality and safety in accordance with the CCG’s statutory duties

AUTHOR(s) OF REPORT: Mr J Young, Quality and Patient Safety Manager

MANAGEMENT LEAD: Mrs C Brunt, Chief Nurse

CLINICAL LEAD: Dr Ruth Edwards, Clinical Lead, Quality & Safety

KEY POINTS: • There have been two CQC visits carried out since the last meeting

RECOMMENDATION: The Primary Care Commissioning Committee is asked to:

• Note this report for assurance

FINANCIAL IMPLICATIONS:

None to report

WHAT ENGAGEMENT HAS TAKEN PLACE: N/A

ACTION REQUIRED: Assurance

Page 1 of 1

Primary Care Analysis Report

Primary Care Analysis Report PCCC, 20/10/2017 Produced : 12th October 2017 Robert Franklin – BI Developer & Analyst (Dudley CCG) Jim Young – Head of Quality Assurance (Dudley CCG)

Primary Care Analysis Report – Summary

• There have been two visits completed : • Quincy Rise Surgery have had a full inspection following a change of registered

manager • Three Villages Surgery have had a focussed follow-up re-inspection following a

previous requires improvement rating for the safe domain • Support continues to be provided to Bath Street Medical Centre following their

inadequate rating

Care Quality Commission (CQC)

• No audits have been completed since the last meeting • The special sepsis edition of The Tablet newsletter has been circulated • An approach has been agreed for a number of audits including methicillin-sensitive

staphylococcus aureus (MSSA) infections; these will be supported by Office of Public Health and CCG Pharmaceutical Public Health colleagues

Infection Prevention & Control (IPC)

Service Developments

• A number of practice visits have been completed or are scheduled following review of the Primary Care Assurance Tool (PCAT) dataset at recent PCOG meetings

• The October PCOG included a focussed analysis of NHS Choices data and identified 3 further practices as potentially requiring further review and/or support; on review these do not require any immediate action and so will be reviewed again in six months time

Performance Indicators – actions taken

• Datix –Three practices are now using the live system as well as the UCC. Further meetings / demos have been arranged with two other practices.

• Currently, there is one SI open. Support is continuing to be provided by the Q&S team to ensure a robust RCA is carried out and documented.

Serious Incidents (SIs)

Primary Care Analysis Report

DUDLEY CLINICAL COMMISSIONING GROUP


Date of Report: 20 October 2017 Report: Finance Report

Agenda item No: 11.0

TITLE OF REPORT: Primary Care Commissioning Finance Report

PURPOSE OF REPORT: The report provides an overview of financial performance against budgets delegated to Committee.

AUTHOR OF REPORT: Mr P Cowley, Senior Finance Manager

MANAGEMENT LEAD: Mr M Hartland, Chief Operating and Finance Officer

CLINICAL LEAD: Dr T Horsburgh, Clinical Lead

KEY POINTS:

• There has been one allocation change in June, with an allocation of £32,000 being received following a successful application to NHS England’s GP resilience Programme.

• A break-even position is forecast against co-commissioning and GP Forward View Allocations, and a small underspend is forecast against core CCG budgets.

• The report highlights the current position in respect of the non-recurrent reserves, with £670,000 remaining to be committed.

• There is the potential to achieve recurrent savings of £20,000 by spending £50,000 non-recurrently to convert the Netherton Health Centre Reconfiguration into an application under the Premises Costs Directions

RECOMMENDATION:

Committee is requested to: • note the reported financial position for assurance. • Approve the utilisation of non-recurrent reserves totalling

£60,000 to support the reconfiguration of Netherton Health Centre, allowing conversion of the scheme into an application under the Premises Costs Directions.

FINANCIAL IMPLICATIONS: Recurrent saving of £20,000 from proposed change to funding route for Netherton Health Centre reconfiguration

WHAT ENGAGEMENT HAS TAKEN PLACE: None

ACTION REQUIRED: Decision Approval Assurance √

1 | P a g e

Finance Report (September 2017) This report submitted to Dudley CCG Primary Care Commissioning Committee provides a provisional breakdown of financial performance for Co-commissioned Primary Care and other budgets within the remit of the committee during the month of September.

Contents Financial Overview p2 Financial Detail p3 Utilisation of Reserves p5

Budgets reported to the committee have an annual value at September 2017 of £43,615,000, including both the delegated co-commissioning allocation and core CCG budgets. There has been one allocation change in September; an allocation of £32,000 in respect of a successful bid for funding from the national GP Resilience Programme.

Primary Care Co-

Commissioning £41,058k

CCG Core Commissioning

£548k

GP Forward View

£2,009k

Financial Overview

2

Budget Allocations

Allocation Breakdown

Delegated Co-Commissioning

3

Summary Position The forecast expenditure level against delegated budgets continues to reflect a break-even position. There are small variances in respect of the following areas: • GP Contract – the underspend of £8,000 represents the value of

PMS transitional payments to Bilston Street which are no longer payable following the practice closure.

• QOF and Enhanced Services – an underspend of £13,000 is reported against the Minor Surgery LIS scheme.

• Dispensing/Prescribing Drs – a small underspend of £24,000 is forecast in respect of fees payable to practices in respect of personally administered drugs, based upon July data. It should however be noted that the majority of these payments are due over autumn/winter in respect of Flu vaccinations, and that the forecast is therefore still volatile at this stage of the year.

• Other GP Services – Excluded Patients – an overspend of £15,000 is forecast, mainly due to a significant level of home visits for one patient on the scheme following surgery.

• Other GP Services – Interpreting – based upon the latest data an overspend of £4,700 is forecast against this budget

• Reserves – a £20,000 overspend is being forecast against reserves, anticipating the commitment of any residual underspends against additional non-recurrent programmes

Area

Annual Budget (WTE)

Annual Budget (£'000)

Forecast Variance (£'000)

GP Contract 27,333 (8) QOF and Enhanced Services 6,441 (13) Premises Costs 4,731 (0) Dispensing/Prescribing Drs 273 (24) Other GP Services 1,004 25 Development and Training Funds 0.80 263 - Non-Core GPIT 143 - Reserves 870 20 Total - 41,058 (0)

CCG Core Commissioning and GP Forward View

4

Core Commissioning

• Small underspends are forecast against both the GP with Special Interest and Practice Engagement LIS budgets.

GP Forward View As reported above, the CCG have this month received an allocation of £32,000 in respect of the GP resilience Programme. A break-even position was reported at month 5 against all allocations. The final underspend in respect of the ‘legacy’ Extended Access scheme for April to August is £235,000, and plans are being drawn up to invest this funding in additional schemes to provide additional access improvements in the period to March 2018.

Area

Annual Budget (WTE)



GP with Special Interest 0.50 64 (8) Practice Engagement LIS 484 (8) Total 0.50 548 (16)

Area

Annual Budget (WTE)



Reception and Clerical Staff Training 54 - Online Consultation Software - - GP Resilience Programme 32 - GPFV Extended Access 1,923 - Total 2,009 -

Utilisation of Reserves

5

Introduction

As reported to Committee at Month 5, the delegated budget currently includes reserves totalling £870,000, including a £406,000 non-recurrent reserve, and a contingency reserve of £203,000 to be released in January, subject to the overall CCG financial position. Although a number of commitments have now been made against these reserves, a balance of £670,000 is available to be committed now, and plans must also be drawn up to commit the contingency reserve from January, should this be available.

Current Commitments

The tables opposite highlight the available reserves and the current commitments against those reserves. These commitments are: • Costs associated with the Bilston Street Dispersal Programme • An estimate of the total cost of the relocation of Links Medical

Practice into Netherton Health Centre, including legal and stamp duty costs, removal expenses and IT costs not covered by ETTF funding, as well as a provision for costs should the practice not achieve the guaranteed minimum sale price

• The cost of the High Oak Premises Development, as approved at Committee in September

• Costs of IRIS implementation

Available Reserves

Funding Source Funding (£'000)

1% Non-recurrent Reserve 406 0.5% Contingency Reserve** 203 Uncommitted Reserve 261

Total Reserves 870

** not to be released until January 2018

Current Commitments

Budget Forecast (£'000)

Bilston St Dispersal Programme 5 Links Medical Practice Relocation* 50 High Oak Premises Development 115 IRIS System Implementation 30

Total Reserves 200

*Estimate

Available Resources 670

As shown opposite, these commitments leave a balance of £670,000, of which £453,000 is currently available to commit., and further proposals are currently being worked up and will be presented to Committee in November. One proposal, however, has provided the opportunity to invest some of the non-recurrent reserves to provide a recurrent saving, and is considered overleaf.

Reserves Utilisation - Continued

6

Netherton Health Centre Reconfiguration Ccosts

Committee will recall that an application has previously been made to relocate Links Medical Practice into the Netherton Health Centre, which is to be reconfigured using funding from the Estates and Technology Transformation Fund to accommodate the practice. The current intention is for NHSE to transfer the funding for the Netherton Health Centre reconfiguration directly to NHS Property Services (NHS PS), which will result in an additional annual depreciation charge to the CCG of approximately £20,000, in addition to the rental value of the premises. There is however an opportunity for the CCG to avoid this additional charge by transferring the funding to NHS PS via the practice under the Premises Costs Directions instead of through direct transfer to NHS PS. This would require the CCG to fund one-off costs of approximately £60,000, to fund costs that are unable to be recovered under the Directions, but would result in a net saving to the CCG of £240,000 over the 15 year period. NHS England have indicated that this proposal is acceptable in principle, and that the approvals process for this change should not lead to any delay in the commencement of works and relocation of Links Medical Practice. Links Medical Practice have been consulted on the proposal, and are also happy to agree to this route. The opportunity to save a recurrent cost of £20,000 for 15 years, by making a one off payment of £60,000 from the available non-recurrent reserves, represents good value for money to the CCG, and this approach is therefore recommended to Committee as the first call on the reserves.

Recommendations: Committee is requested to: • note the reported financial position for assurance. • Approve the utilisation of non-recurrent reserves totalling £60,000 to support the reconfiguration of

Netherton Health Centre, allowing conversion of the scheme into an application under the Premises Costs Directions.

primary care commissioning committee · audit results have been sent through and this is being...

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