primary care commissioning committee in public

Primary Care Commissioning

Committee in Public

Thursday 21st May 2020

[Intentionally left blank]

Hertfordshire, Bedfordshire and Luton ICT Shared Services is hosted by NHS East & North Hertfordshire CCG Page 1 of 1

Video Conferencing Etiquette

1. Be on time to attend the meeting When you're connecting in to a video conference, it's especially important to be on time. Being late is far more visible in a video conference, as late people suddenly appear on everyone’s device unannounced.

2. Check your technology in advance, Check your device in advance, including power cables, your camera, speakers and microphone. External peripherals such as headsets of earphones will improve quality as they capture your voice better if you naturally move when you speak.

3. Video conference from home When conferencing from home, consider who else may by using your broadband/internet connection, if saturated, this will impact performance. If possible limit broadband usage during video conferences.

4. Avoid using VPN services There is no need to be connected to the corporate VPN service during video conferences. Having VPN connection will only reduce performance quality, as it competes for scarce network bandwidth for your device.

5. Reduce the number of open applications Reducing the number of open/active applications on your device will free up processing capacity, improve network bandwidth and limit opportunity for personal distraction.

6. Mute yourself when you are not speaking Even though you may not be speaking and think you're being quiet, most microphones can pick up minor background noises, like coughs, sneezes, typing, etc. These sounds can easily distract other video conferencing participants and potentially cause annoyance.

7. Frame your camera correctly When you're on video, make sure you frame your camera in a way that feels natural to you and allows you to look directly at the camera. Make sure that you are at the centre the frame and that there are no distracting objects behind you.

8. Display participants in grid format This will enable you to view all participants on your screen, making the meeting more inclusive.

9. Keep your self-view on your screen This is so that you can see how you are presented to other participants. What you can see in your self-view is what others can see.

10. Have the right lighting Think about lighting in the room. Poor lighting conditions have an enormous effect on the video quality that you send. You'll want to make sure that there is enough light in the room you're in so that your video isn't grainy and unwatchable.

11. Address the Camera When speaking, directly face the camera and minimise your physical movement. Looking down or away from the camera will distort your voice quality to the audience.

of 3

Primary Care Commissioning Committee Public Meeting

Thursday 21st May 2020: 09:00am – 12:30am

AGENDA

Item Time Subject Report Action

1. 09:00 Welcome and Apologies for Absence

Chair - Verbal

2. Declarations of Interest

To receive any new declarations of interest or declarations relating to matters on the Agenda.

To reconfirm current declarations on the Register of Interests are accurate and up-to-date.

Chair - Enclosed

3. Minutes of the Previous Meeting Held on 16th

January 2020 and Matters Arising Chair Approve Enclosed

4. Action Tracker

Chair Discuss Enclosed

5. 09:10 Matters not discussed arising from 19th

March 2020 meeting pack Chair Discuss Previously

circulated

6. 09:20 Virtual Decisions Since Last Meeting

Chair Note Verbal

7. 09:25 Consolidated Funding Framework 2020/21

Medical Director

Approve Enclosed

8. 09:45 Covid-19 Primary Care Cell and Care Homes Update Director for

Primary Care Development

Note Enclosed

of 3


9. 10:00 Overview of Primary Medical Care Contracts and Primary Care Networks Chief Finance

Officer Approve Enclosed

10. 10:15 HBL ICT Response to the Covid-19 Pandemic

Chief Digital Officer

Discuss Enclosed

11. 10:30 Primary Care Devolved Commissioning

Finance Report Month 12 2019/20 Chief Finance Officer

Discuss Enclosed

12. 10:50 Primary Care Delegated Commissioning

2020-21 Financial Plan Chief Finance Officer

Approve Enclosed

13. 11:10 Primary Care Quality Report

Director of Nursing and

Quality

Note Enclosed

14. 11:25 Premises

Chief Finance Officer

Note Enclosed

15. 11:45 PCNs & Hot Sites

Director for Primary Care Development

Note Enclosed

16. 11:55 Seasonal Influenza Report 2019/20 and Plans for 2020/21 Director for

Primary Care Development

Approve Enclosed

17. 12:10 Risk Assessment for Front Line BAME Staff in Primary Care Director of

Workforce Note To follow

of 3


18. 12:25 Questions from Members of the Public

To receive any questions from members of the public.

19. Any Other Urgent Business

To consider any other matters which, in the opinion of the Chair, should be considered as a matter of urgency.

All Discuss Verbal

20. Date of Next Meeting:

Thursday 2 July 2020

09:00am-11:00am

- -

Resolution to exclude members of the press and public

The Primary Care Commissioning Committee of the Clinical Commissioning Group resolves that

representatives of the press, and other members of the public, be excluded from this meeting having

regard to the confidential nature of the business to be transacted, publicity of which would be prejudicial

to the public interest, in accordance with the Public Bodies (Admissions to Meetings) Act 1960.

Page | 1

Agenda Item No: 2

Date of Meeting: 21 May 2020

Primary Care Commissioning Committee in Public

Paper Title: Declarations of Interest

Decision or Approval Discussion Information

Report author: Nakiya Jafferji, Corporate Governance Manager

Report signed off by:

Executive Summary: The purpose of this paper is to receive any new declarations of interest or declarations relating to matters on the Agenda, and to reconfirm current declarations on the Register of Interests are accurate and up-to-date.

Recommendations

to the members:

To review the Register of Interests of the Committee membership, and highlight any potential conflicts, which the Chair needs to manage:

http://www.enhertsccg.nhs.uk/declarations-interest

To declare those interests at the start of the meeting.

To complete a declaration form available from the secretariat.

Conflicts of Interest

involved:

There are none identified.

Conflict of Interest Definitions

The following table describes the sub-classifications of interests:

Type Description

Financial Interests This is where an individual may get direct financial benefits from the

consequences of a commissioning decision.

Non-Financial

Professional Interests

This is where an individual may obtain a non-financial professional benefit

from the consequences of a commissioning decision, such as increasing

their professional reputation or status or promoting their professional

career.

Non-Financial

Personal Interests

This is where an individual may benefit personally in ways which are not

directly linked to their professional career and do not give rise to a direct

financial benefit.

Indirect Interests This is where an individual has a close association with an individual who

has a financial interest, a non-financial professional interest or a non-

financial personal interest in a commissioning decision.

Locality GP Surgery (If

appropriate)

First

Name

Last Name Current position(s) held in the CCG

i.e. Governing Body member;

Committee member; Member practice;

CCG employee or other

Declared Interest

(Name of the organisation and nature of

business)

Financial Non-

financial

professional

Non-

financial

personal

Indirect

interest

Is the

interest

direct or

indirect?

Nature of Interest From: To: Action taken to mitigate risk Date most

recent form

received

LLV Director for Primary

Care Development,

ENHCCG

Denise Boardman Director for Primary Care Development Occupational Therapist

Royal College of Occupational Therapyy Direct As a registered Occupational Therapist and former

member of the Royal College of Occupational Therapy

Professional Practice Board, I receive “ad hoc” requests to

deliver presentations to specialist sections of the Royal

College of Occupational Therapy.

01/09/2017 Ongoing Any requests received are discussed in 1:1 meetings with

my line manager prior acceptance.16/04/2018

A/U A/U Fahim Chowdhury Independent GP GP Partner – Angel Surgery, Edmonton,

Enfield CCGy Direct As stated 01/04/2017 Ongoing To declare any interest at meeting 30/04/2019

A/U A/U Fahim Chowdhury Independent GP Clinical Vice-Chair, Enfield CCG y Direct As stated 31/10/2016 Ongoing To declare any interest at meeting 30/04/2019

A/U A/U Fahim Chowdhury Independent GP DUA GP Services Ltd: Locum GP Provider

for services in Enfield

Company: DUA GP services ltd

Company number: 09420763

Registered office: 18 Moreland Way, London,

E4 6SG

y y Direct and

indirect

I am the director (70%) and my wife is company secretary

(30%). I also locum for the service and my wife is

employed and shareholder as well.

01/09/2016 Ongoing To declare any interest at meeting 30/04/2019

A/U A/U Dianne Desmulie Lay Member - Co-Commissioning Pieve Solutions LtdCompany No, 5600186.

Registered address:Orchard House, Park

Lane, REIGATE, Surrey, RH2 8JX. Nature of

business: I have worked through this

company as a freelance Management

Consultant.

y Direct &

Indirect

Director of my own company: Pieve Solutions Ltd.I have

worked through this company as a freelance Management

Consultant.

My husband, Robert Pinkham, is a freelance management

consultant and also a director of this company

Nov-14 Ongoing Provide new declaration of interest in event of either myself

or my husband entering into a consultancy contract with a

supplier to the CCG

21/02/2018

A/U A/U Dianne Desmulie Lay Member - Co-Commissioning Hoddesdon Carers' Support Hub y Direct I am the Volunteer Hub Lead for the Hoddesdon Carers'

Support Hub. This is part of Carers in Hertfordshire, a

charity which contracts with Herts County Council and the

CCG and NHS locally. This particular project is funded by

the Big Lottery.

Feb-16 Ongoing Declare non financial personal interest at any meeting where

contract or performance of CinH (Carers in Hertfordshire) is

to be discussed

21/02/2018

A/U A/U Dianne Desmulie Lay Member - Co-Commissioning Hanscombe House Patient Participation Core

Groupy Direct I am a practice patient and a Member of Hanscombe

House Patient Participation Core Group. I am acting

secretary for the group.

Nov-14 Ongoing Declare non financial personal interest where funding or

performance of Hanscombe House practice is to be

discussed

21/02/2018

A/U A/U Linda Farrant Lay Member, Governance and Audit Non-Executive Board Member, Parliamentary

and health Service Ombudsman (PHSO)y Direct Non-Executive Board Member, Parliamentary and health

Service Ombudsman (PHSO)

Feb-20 Ongoing As appropriate to situation 02/01/2020

A/U A/U Beverley Flowers Accountable Officer East and North Herts

CCG and

Joint STP Lead for Herts and West Essex

Herts at Home Ltd. Company number

11360947. Registered office address County

Hall, Pegs Lane, Hertford, United Kingdom,

SG13 8DE. .

y Direct Non remunerated Non-Executive Director role with Herts

at Home Ltd a company established and fully owned by

Hertfordshire County Council to provide care and support

within the County.

01/02/2019 Ongoing Declare at meetings where relevant. 19/06/2019

A/U A/U Beverley Flowers Accountable Officer East and North Herts

CCG and

Joint STP Lead for Herts and West Essex

Hertfordshire Criminal Justice Board y Direct Member of the Hertfordshire Criminal Justice Board

representing the NHS

31/01/2017 Ongoing None 19/06/2019

A/U A/U Alison Gardner Lay Member for Public and Patient

Engagement

Herts Valleys CCG y Member of HVCCG Board (Lay Member – Public and

Patient Engagement)

01/08/2019 Ongonig Full transparancy with both organisations on both roles 02/08/2019

Stevenage CHELLS SURGERY Russell Hall GP Board Member / Locality Co-Chair

Stevenage

GP Practice, Chells Way, Stevenage, SG2

0NHy Direct GP Partner, Chells Way Surgery. GP Partner and

Provider - GMS Services.

May-00 Ongoing Declare at meetings 01/02/2018

Stevenage CHELLS SURGERY Russell Hall GP Board Member / Locality Co-Chair

Stevenage

Stevenage Health Ltd (Stevenage

Federation)y Direct Chells Practice is a member of Stevenage Federation, a

private company.

Jul-15 Ongoing Declare at meetings 01/02/2018

NH

ULV

WH

Chief Finance Officer,

ENHCCG

Alan Pond Chief Finance Officer GP Partner in Herts Valleys CCG (Haverfield

Surgery, Kings Langley) and Chair of

Dacorum Locality

y y Indirect Partner (Corina Ciobanu) 01/08/2010 Ongoing If ENHCCG ever seeks to procure services from GPs and/or

GP Surgeries outside the CCG, I will keep confidential any

information I receive that could be of benefit to Haverfield

Surgery and/or Corina Ciobanu. Should Haverfield Surgery

and/or Corina Ciobanu submit a proposal to undertake any

work for ENHCCG I will declare this interest and will not take

part in any discussions and/or decisions on any appointment.

11/12/2017

NH

ULV

WH

Chief Finance Officer,

ENHCCG

Alan Pond Chief Finance Officer Director of Assemble Community Partnership

Ltd (Company Number 06471276) and

associated companies

Assemble Fundco 2 Ltd (Company Number

08309498)

Assemble Holdco 2 Ltd (Company Number

08309495)

Wolverton Holdings (Company Number

08307564)

Wolverton Fundco 1 Ltd (Company Number

08306830

Assemble Fundco 1 Ltd (Company Number

06471659)

Assemble Holdco 1 Ltd (Company Number

06471233)

All of 128 Buckingham Palace Road, London,

SW1W 9SA.

y Direct These companies form the LIFT (Local Improvement

Finance Trust) for South East Midlands which was created

to develop community premises for the NHS. The shares

in the companies are held by Guildhouse Ltd and

Community Health Partnership, the latter being a company

wholly owned by the Department of Health.

The directorship is unpaid, nominated by Community

Health Partnerships and represents the interests of the

CCGs in the LIFT area, including East and North

Hertfordshire CCG.

Jul-08 Ongoing My role on the Board of the LIFT Company Group is to

represent the interests of the local public sector, provide

insight, but also to oversee the financial and governance

arrangements of the companies.

The Group of Companies was created to provide benefits to

the NHS locally and a conflict is highly unlikely to occur.

Should any conflict of interest arise, I would excuse myself

from both parties for the relevant matter and should an

Ongoing conflict arise would resign my director position with

the Group of Companies

11/12/2017

Full Names Type of interest: Date of Interest:

Stevenage Director of Nursing &

Quality, ENHCCG

Sheilagh Reavey Director of Nursing & Quality Daughter y Indirect Daughter has a permenant contract with Prior Approval /

IFR Team as of August 2019

01/08/2019 Ongoing Not a decision making post and line management and HR

issues etc. are through AD not Director. HR oversaw

recruitment and sat on interview panels.

11/11/2019

WH WRAFTON HOUSE

SURGERY

Ashish Shah Vice-Chair of ENHCCG.

GP Governing Body Member

representing WelHat Locality. Locality

Chair – WelHat Locality.

Wrafton House Surgery

9-11 Wellfield Road

Hatfield

AL1 OBS

y Direct Principal GP and GP Trainer

Wrafton House Surgery. Both provider and

commissioner.

01/11/2014 Ongoing Any conflict arising out of discussions regarding same at

meetings will be raised at the meeting.01/05/2019

WH WRAFTON HOUSE

SURGERY





Abhirush Limited.

Company registered address

5 Chedburgh

Welwyn Garden City

AL7 2PU.

Company No: 07998120

Nature of Business: I work through the

Limited Company as an Out of Hours GP at

Herts Urgent Care.

y Direct Director (Joined) of Abhirush Limited. I work through the

Limited Company as an Out of Hours GP at Herts Urgent

Care.



WH WRAFTON HOUSE

SURGERY





Ephedra Healthcare Ltd, Suite 3, Middlesex

House, Rutherford Close, Stevenage, Herts,

SG1 2EF. Company no: 06560722

y Direct Principal GP at Wrafton House Surgery. Practice is a

Shareholder of Ephedra Healthcare Limited, which is a

local federation for WelHat Locality.

Ephedra Healthcare Ltd.



WH WRAFTON HOUSE

SURGERY





Locality Lead for Workforce Planning and

Educational Network for Welwyn and Hatfield

Locality

y Direct I Work as a Locality Lead for Workforce Planning and

Educational Network for Welwyn and Hatfield Locality



WH WRAFTON HOUSE

SURGERY





Spouse y Indirect Spouse works a GP in Hertford and Corporate GP lead for

ULV on ENHCCG Governing Body.



ULV A/U Rupal Shah GP Governing Body Member

Representing ULV Locality.

Locality Co-Chair: ULV Locality

Hanscombe House Surgery, 52A St Andrews

Street, Hertford, SG14 1JA

Salaried GP – Hanscombe House Surgery. 01/05/2019 Ongoing None perceived necessary as I am a salaried GP and do not

perceive a conflict19/07/2019



Locality Co-Chair: ULV Locality

GENERATING HEALTHCARE LIMITED –

Upper Lea Valley

Company number 08830754

Registered office address

2 Tower House, Tower Centre, Hoddesdon,

Hertfordshire, England, EN11 8UR.

Hanscombe House is a shareholder of GENERATING

HEALTHCARE LIMITED

I am not a director or a shareholder

01/05/2019 Ongoing None perceived necessary as I am a salaried GP and do not

perceive a conflict19/07/2019



Locality Co-Chair ULV Locality

Abhirush Limited.

Company registered address

5 Chedburgh

Welwyn Garden City

AL7 2PU.

Company No: 07998120

Nature of Business: I work as a locum GP via

the limited company.

y Direct Director (Joined) of Abhirush Limited. 01/05/2019 Ongoing Any conflict arising out of discussions regarding same at the

meeting will be raised at the meeting. 19/07/2019




Upper Lea Valley Locality Provider Board y Direct I work as a GP Representative for Hertford on the

Provider Board at ULV Locality

01/05/2019 Ongoing Any conflict arising out of discussions regarding same at the





Spouse y Indirect Spouse works as a GP in Hatfield and Deputy Chair and

Corporate GP Lead on ENHCCG Governing Body.

01/05/2019 Ongoing Any conflict arising out of discussions regarding same at the


N/A N/A Philip Turnock ICT Shared Service Director Nil N/A N/A N/A N/A N/A N/A N/A N/A N/A 20/12/2017N/A N/A Philip Turnock Chief Digital Officer Nil N/A N/A N/A N/A N/A N/A N/A N/A N/A 12/11/2019

of 1

Agenda Item No: 3



Paper Title: Draft Primary Care Commissioning Committee Minutes


Report author: Tracey Middleton, Governing Body Clerk

Report signed off by: Nakiya Jafferji, Corporate Governance Manager

Executive Summary: To approve the draft Minutes of the Primary Care Commissioning Committee held on 16 January 2020

Recommendations

to the members:

To approve the Minutes


involved:

There are none identified.



Type Description

Financial Interests This is where an individual may get direct financial benefits from the consequences of a commissioning decision.

Non-Financial Professional Interests

This is where an individual may obtain a non-financial professional benefit from the consequences of a commissioning decision, such as increasing their professional reputation or status or promoting their professional career.

Non-Financial Personal Interests

This is where an individual may benefit personally in ways which are not directly linked to their professional career and do not give rise to a direct financial benefit.

Indirect Interests This is where an individual has a close association with an individual who has a financial interest, a non-financial professional interest or a non-financial personal interest in a commissioning decision.

1 | P a g e

Primary Care Commissioning Committee Public Meeting Thursday 16th January 2020: 09:00am – 10:15am

Meeting Room 2, Focolare Centre, Welwyn Garden City

MINUTES

Present:

Denise Boardman [DB] Director for Primary Care Development

Dianne Desmulie [DD] Lay Member, Patient and Public Engagement

Linda Farrant [LF] Lay Member, Governance and Audit

Beverley Flowers [BF] Chief Executive

Alan Pond [AP] Chief Finance Officer

Sheilagh Reavey [SR] Director of Nursing and Quality

Ashish Shah [SH] GP Lead, Welwyn Hatfield

Nabeil Shukur [NS] GP Lead, Stort Valley and Villages

Vacancy GP Lead

In Attendance:

Ozlem Cholak [OC] Head of Primary Care and Community Contracts

Sarah Feal [SF] Company Secretary

Sue Fogden [SFo] Assistant Director – Premises

Veronica Fraser [VF] Patient Representative

James Gleed [JG] Associate Director of Commissioning Primary Care

Cathy Harris [CH] Senior Contracts Manager, Primary Care

Nakiya Jafferji [NJ] Corporate Governance Manager

Tracey Middleton [TM] Governing Body Clerk

Philip O’Meara [PO] Senior Finance Manager

Gerry Moir- [GM] Associate Director Localities

Michael Taylor [MT] Healthwatch, Hertfordshire

Andrew Tarry [AT] Head of Primary Care Development

Nicky Williams [NW] Medical Director Bedfordshire and Hertfordshire Local Medical Committee

Kelly Young [KY] Primary Care Quality Manager

2 | P a g e

Item Subject Action by

1. WELCOME AND APOLOGIES FOR ABSENCE

The meeting opened at: 09.00The Chair welcomed all to the meeting.

Thanks were extended to Dr Peter Graves (former CEO Beds & Herts Local Medical Committee) for his valuable contribution to the meetings during his tenure.

Apologies were received from:

Dr Fahim Chowdhury [FC], Independent GP Karen Livingstone [KL], CEO Bedfordshire and Hertfordshire

Local Medical Committee Alison Gardner [AG], Lay Member, Patient and Public

Engagement

The Chair declared that the meeting is quorate.

2. DECLARATIONS OF INTERESTS

The Chair invited the members to reconfirm their current declarations on the Register of Interests and advise of any new declarations.

All members confirmed their declarations were accurate and up-to-date.

The Chair invited members to declare any declarations relating to matters on the Agenda.

1. Item 5 - PCCC High Level Work Plan 2019/20: Update - The CCG Governing Body GPs have a financial conflict of interest in any decisions relating to investment in primary care as they are shareholders in their GP federations and are also practising GPs in their localities

2. Item 8 - Primary Care Quality Report - GP Committee representatives’ practices are members of Locality federations which are private companies which may provide CCG commissioned services. N Williams is a GP in Ware, Practice member of Hertford and Rurals PCN, Practice member GHC federation and Medical Director Beds and Herts LMC

3. Item 9 - Overview of Primary Medical Care Contracts and Primary Care Networks (PCNs). N Williams is a Practice member of Hertford and Rurals PCN, Practice member GHC federation, Medical director Beds and Herts LMC

4. Item 11 - Hertfordshire and West Essex (HWE) STP Primary Care Strategy - STP primary care oversight group and PCCC GPs are local practising clinicians and are therefore likely to be personally affected by future developments in primary care.

3 | P a g e


5. Item 12 - Primary Care Networks Development Plan - CCG PCCC GPs are local practising GPs and therefore could be personally affected by the creation of new Primary care networks

6. Item 8 - Primary Care Quality Report - Veronica Fraser, Dianne Desmulie and James Gleed are patients at Hanscombe House Practice.

The Chair agreed that colleagues could remain in the meeting but not be involved in decision making where there is an actual conflict.

3. MINUTES OF PREVIOUS MEETING AND MATTERS ARISING

The Minutes of the meeting held on 07 November 2019 were approvedas an accurate record subject to the following amendments:

5.6 – the Care Homes report will be presented to the Committee in the March meeting

9.8 – one off set up of £10k per PCN

ACTION: The final minutes of the meeting held on 07.11.19 to be updated to reflect amendments

Matters Arising:

It was noted that the patient interaction at the PCN Clinical Director’s workshop held on the 12th December bringing their perspective was a positive experience and the Patient Participation Group (PPG) group will be involved in a STP meeting.

MT arrived at 09.07

NJ

4. ACTION TRACKER

The contents of the Action Tracker which was circulated in advance of the meeting were reviewed

The following actions were agreed to be closed:

Action 49 Action 63 Action 64 Action 66 Action 68 Action 69

The following updates were provided:

4 | P a g e


Action 65 - 7 - Primary Care Devolved Commissioning Finance Report Month 4 2019/20 – ongoing.

ACTION: The Action Tracker to be updated to reflect the updates. NJ

5. PCCC HIGH LEVEL WORK PLAN 2019/20: UPDATE

The report was circulated in advance of the meeting.

The Committee noted the update.

6. PRIMARY CARE DEVOLVED COMMISSIONING - FINANCE REPORT MONTH 8 2019/20

The Chief Finance Officer introduced the document which was circulated in advance of the meeting.

1. It was noted that the allocation for devolved commissioning as at Month 8 remains at £74.736m

2. As at Month 8, Primary Care Devolved Commissioning budget reported an underspend of £341k against allocated budget and is forecast to deliver an underspend of £501k

3. The CCG has uncommitted headroom of £1.014m and contingency reserve of £385k. It is still the intention that this headroom is released by the year end

4. Year 2019/20 is likely to be an underspend however there are anticipated pressures to consider

5. The intention is to agree a consistent arrangement across the three CCGs to recompense practices for their time regarding safeguarding reporting and attendance at meetings e.g. fixed price per activity back dated to September 2019. Colleagues challenged the associated risks and assumptions of good will with back dating the payment. ACTION: It was agreed that from 1st April 2019 to end of January 2020 a fixed payment of £45 per report is paid. From February 2020 it will be based on the time taken with a view to £90/hour or a fixed fee arrangement in the future.

6. The risks for Primary Care Networks (PCNs) associated with recruitment regarding the Primary Care Network specifications published on 23 December 2019 was debated. It was acknowledged that there are considerations regarding the £10k payment for recruitment costs being carried forward to when recruitment takes place.

JG left the meeting at 09.20-09.25

The Committee noted the month 8 position.

AP

5 | P a g e


7. REVIEW OF POTENTIAL FUNDING FLOW CHANGES

The Chief Finance Officer provided a verbal overview and further discussion included:

1. Risks and assumptions relating to funding and associated financial balance through localities and PCNs through CFF

2. Routing of funds from practices to PCNs in part or whole and the General Practice monies moving across the PCN which will include other providers

3. What elements of the CFF can be achieved by practices working together was considered

4. Colleagues agreed that the interaction of Primary Care with other providers requires Primary Care to be strengthened and more resilient to address the changes.

The Committee noted the discussion.

8. PRIMARY CARE QUALITY REPORT

The Primary Care Quality Manager invited discussion on the report which was circulated in advance of the meeting which included:

1. The Committee acknowledged the latest information available for a number of quality indicators relating to GP Practices in ENHCCG. It highlights the themes identified through the Care Quality Commission (CQC) visits that have already taken place to ENHCCG practices and outlines some of the actions taken to support practices to address these.

2. The overall ‘Inadequate’ rating of Stevenage Health Limited for Extended Access services (Kingsway Health Centre). The Committee was assured that learning has been taken from this report regarding to Extended Access services provided by Federations. Greater due diligence in setting up Federation schemes and offering services in other settings is required and it was acknowledged that purchasing of specialist expertise may be required.

3. Stockwell Lodge “Requires Improvement” although improvements had been evidenced.

ACTION: Link to the Primary Care website with the CCG and CQC conference slides to be circulated

The Committee noted the update. The Committee supported the course of actions proposed for supporting the CQC rated ‘Requires Improvement’ practices and CQC rated Extended Access Services.

KY

9. OVERVIEW OF PRIMARY MEDICAL CARE CONTRACTS AND

6 | P a g e


PRIMARY CARE NETWORKS

The Senior Contracts Manager and Head of Primary Care and Community Contracts introduced the report which was circulated in advance of the meeting.

1. The Committee reviewed the update on list closures, mergers, APMS contracts, Primary Care Networks and other contractual items for practices in East and North Hertfordshire.

2. It was noted that Hanscombe House is on the list closure (closed with conditions)

3. The joint CCG and CQC conference slides referred to are available on the Primary Care website and it was noted it was an effective meeting

4. It was noted that a second letter was sent to patients at Orchard Surgery and Ware Road in November, outlining the process for patient transfer. The feedback from patients was also noted.

5. The CCG is working through patient preferences and will also be meeting with GHC and receiving practices to agree the safest order to transfer patients. Patients will move across in February and March and all patients will have moved by 31st March 2020.

The Committee noted the update

10. HERTFORDSHIRE AND WEST ESSEX (HWE) STP PRIMARY CARESTRATEGY

The Director for Primary Care Development introduced the report which was circulated in advance of the meeting

1. The Committee discussed the executive summary which included: The separate slide deck provides the Primary Care Commissioning Committee (PCCC) with the proposed Hertfordshire and West Essex STP Primary Care Strategy; as developed by the STP Primary Care Oversight Group. As the HWE STP already had both a Clinical Strategy and a Primary Care Strategic Framework and Vision Statement, this document incorporates both of these

2. The original Primary Care Strategic Framework and Vision Statement presented to the PCCC in July 2019 were produced to articulate the STP primary care oversight group’s vision in response to the STP’s Draft Health & Care Strategy (b) outline the key work priorities for the STP primary care oversight group and (c) fulfil NHSE requirements

3. This strategy identifies the delivery of work streams that are required under national policy and guidance; GP Five Year Forward View, NHS Long Term Plan and the Long Term Investment and Evolution published by NHSE and the British Medical Association (BMA). It describes how the 3 CCGs in the

7 | P a g e


STP, Herts Valleys, East and North Herts and west Essex will collaborate to ensure the alignment of delivery and implementation of local and national priorities such as Online Consultations, Primary Care Network Developments etc

4. An earlier draft of the strategy was submitted to NHSE eastern region GP Forward View team during summer 2019; NHSE requesting a slide deck presentation. Feedback given stated the strategy covered all the key aspects with good background information and the journey to PCNs with work plans detailing how services will be integrated and delivered. However, it would also benefit from a reorder of information to ensure a logical flow. This was completed and the slide deck is the finished document

5. It was noted that the communication to patients and general public would require consideration as the detail is complex.

ACTION: A plain English version to be developed with the Communications Team for members of the public

6. The PCNs are able to set their own priorities however there are mandated national priorities for PCN delivery.

7. The relationship with the strategy and implementation plans was debated and it was recognised that the next stage will be more useful to the Committee.

8. It was suggested that practice resilience has been a focus for the CCG and the preservation of the strengths already in the system could be acknowledged.

9. Congratulations were extended to the team for the work undertaken to date.

The Committee approved the HWE STP Primary Care Strategy. The Committee supported the work of the STP Primary Care Oversight Group in relation to its 3 work stream priorities; forming part of the work in progress preparing a Strategy Implementation.

DB

11. PRIMARY CARE NETWORKS (PCN) DEVELOPMENT PLAN

The Associate Director of Commissioning Primary Care introduced the report which was circulated in advance of the meeting

1. The Committee reviewed the executive summary which provided the update on the CCG PCN Development Plan. This plan has previously been approved by the Director of Finance and the Director of Primary Care Development.

2. NHS England (NHSE) have provided new dedicated PCN support funding, released to STPs in June to support PCNs to develop in 2019/20; for ENHCCG this equates to almost £414,000. There is a commitment from NHSE for this funding to continue as ongoing support in subsequent years

3. This PCN development plan has been constructed utilising the CCG’s full share of the STP’s allocation, the plan is broadly

8 | P a g e


divided into the following areas: 4. CCG provided support:

CCG workshops to provide a forum for PCNs and wider system partners to meet and facilitate the development of PCNs Legal advice and support for recruitment under the ARR scheme Support to ensure PCNs have the appropriate IT infrastructure to enable data sharing and collaborative working Population Health Management (PHM) support CCG offer of training and education to meet needs identified by the majority of PCNs – relevant courses have been sourced with dates and venues provided Allocated funding per PCN: Individual Clinical Director development support Allocation for each PCN to use for development activities unique to their network e.g. service pathway pilots, projects and training. Support with non-recurrent recruitment activities e.g. preparing Job descriptions and liaison with potential service supplier.

5. It was noted that the current support is provided at a locality level and this will be considered when clarity provided regarding PCN level

6. The training requests received was debated and it was noted that the courses were identified at the workshop last year and take up at the courses will be addressed at the next workshop.

7. Assurance was provided that CCG welcomes training requests from colleagues and will facilitate providers to address requests if required.

The Committee noted the paper.

12. COMMITTEE VACANCY GP (NON VOTING)

1. The Committee Chair advised that Dr Tara Belcher has resigned from the Committee resulting in a vacancy.

2. It was noted that Dr Russell Hall has agreed to join the Committee from the next meeting.

3. The 12 Clinical Directors are being invited to nominate a representative to attend this committee. The representative will be remunerated for their attendance.

ACTION: Letter to be circulated to Primary Care Network Clinical Directors to ask who will represent them at this Committee. Dr Nicky Williams will support the process.

The Committee noted the update.

SF

13. ANNUAL CYCLE OF BUSINESS 2019/20

1. The Annual Cycle of Business was reviewed 2. A discussion regarding operating during the shadow year will be

9 | P a g e


included in the March agenda. 3. Controlled Drugs Report may no longer be required at this

Committee and may be removed from the May agenda.

The Committee noted the Annual Cycle of Business.

14. QUESTIONS FROM THE MEMBERS OF THE PUBLIC

1. No questions from the 1 member of the public.

14. ANY OTHER BUSINESS

1. None

15. DATE OF NEXT MEETING:

Thursday 19th March 2020 9:00am-11:00am Focolare Centre, Welwyn Garden City (Meeting Room 2)

The meeting closed at: 11.16

of 1

Agenda Item No: 4



Paper Title: Primary Care Commissioning Committee Action Tracker


Report author: Nakiya Jafferji, Corporate Governance Manager


Executive Summary: The purpose of this paper is to discuss the Action Tracker

Recommendations

to the members:

To discuss the Action Tracker


involved:

There are none identified



Type Description







Primary Care Commissioning Committee in PUBLICAction Tracker

No. Meeting Date Item No. and Title Action Responsible Manager Deadline Revised Deadline Current Position Status

65 12/09/2019 7 - Primary Care Devolved

Commissioning Finance Report Month 4 2019/20

To discuss how to fill the gap between access and availabilityto deliver for the population over the next 18 months

Associate Director for Primary Care

Development,

07/11/2019 13/11/2019 - Results of the National Access Review haven’t been

published yet which significantly impedes CCG’s ability to agree

new terms and conditions of any expanded service offers.

Contracts team will continue to work with North Herts and Upper

Lea Valley EA providers through the contract review process to

see how population coverage could be improved within current

funding arrangements

31/10/2019 - CCG Contracts Team have written to all Extended Access providers to understand their intent until PCNs take over Extended Access in 2021. In the meantime, all CCGs are awaiting the National Access Report to advise NHSE expectations on access going forward

Open

67 07/11/2019 PCCC High Level Work

Plan 2019-20: Update

The Care Homes report and updated actions will be brought to

this committee in January

Associate Director for

Primary Care Development,

16/01/2020 05/03/2020 - Work is progressing well, however CCG is now for

NHSE technical guidance for the GMS DES. Once this is released,

CCG officers will need to cross reference the care home work thus

far. Additional verbal update to be provided

07/01/2020 - Care Homes report to be deferred to a future meeting

Open

70 16/01/2020 6 - Primary Care

Devolved Commissioning Finance Report Month 8 2019/20

It was agreed that from 1st April 2019 to end of January 2020

a fixed payment of £45 per report is paid. From February 2020 it will be based on the time taken with a view to £90/hour or a fixed fee arrangement in the future

Chief Finance Officer 19/03/2020 12/03/2020 On-going Open

71 16/01/2020 8 - Primary Care Quality

Report Link to the Primary Care website with the CCG and CQC

conference slides to be circulated

Primary Care Quality

Manager

19/03/2020 05/03/2020 - Link circulated on 26/02/2020 To be closed -

19/03/2020

72 16/01/2020 10 - Hertfordshire and West Essex (HWE) STP

Primary Care Strategy

A plain English version to be developed with the Communications Team for members of the public

Director for Primary Care Development

19/03/2020 05/03/2020 - Due to competeing priorities, this has not been taken

forward as of yet

Open

73 16/01/2020 12 - Committee Vacancy GP (Non-Voting)

Letter to be circulated to Primary Care Network Clinical Directors to ask who will represent them at this Committee. Dr Nicky Williams will support the process

Company Secretary 19/03/2020 05/03/2020 - Email sent to PCN Clinical Directors on 25/02/2020

requesting expressions of interest in the position

Open

Page 1 of 1

of 2

Agenda Item No: 7



Paper Title: Consolidated Funding Framework 2020/21


Report author: Renna Bharania, Programme Manager and members of the PMO team

Report signed off by: Rachel Joyce, Medical Director

Executive Summary: The 2020/21 CFF has been developed by the CCG’s PMO team in

conjunction with the clinical leads for each area. All elements are

clinically based, supported by strong evidence and improve the quality of

patient care/ outcomes.

Due to the current situation the CFF was revised to include metrics to

support practices through Covid-19 and also includes elements to help

practices through the recovery process of Covid-19.

There are 5 sections in this year’s CFF:

1. Mandatory elements

2. Proactive management

3. Patient education

4. CCG intelligence

5. Additional services

The CFF document has received feedback from the CFF steering group committee (30/05/20), Quality & Safety committee (07/05/20) and Organisational Performance and Delivery Group (12/05/20). This feedback has been implemented into the attached paper. There is further feedback that needs to be worked up, however due to limited time the attached version will require further input on specific indicators. In particular the medicines optimisation indictor will require further input from the team to decide which elements of the metric will remain. This will be reviewed once medicines optimisation team receive data from the NHS business authority (due on 20th May 2020).

Feedback from the various groups meant some indicators have been removed from the proposed CFF, and there is £0.60 remaining. Subsequently, Sam Williamson from the PMO team (Public Health Consultant) is currently working up a metric to include into the CFF (equivalent to £0.60). This will be based on a public health management

of 2

approach.

We request the outstanding indicators, once worked up and completed are considered by the PCCC group virtually, later this month.

Please refer to the action tracker for information on feedback received from the OPD group and which actions are still outstanding.

Recommendations

to the members:

<delete as appropriate >

To approve

(please see information above with regards to further approval

required on the outstanding actions)


involved:

No Known Conflicts of Interest



Type Description







of 18

The finical balance element of the CFF (total of £1.50) has been

suspended this year due to Covid-19. The total equating to the

financial balance has been dispersed into specific metrics of this CFF

which supports covid-19 work. The intention is to remove these

covid-19 supportive metrics from the next CFF as they will no longer

be needed, and to reinstate the financial balance element into the

CFF for 2021/22.

1. Mandatory Elements - Practice Level

Metric Data Extraction through MedeAnalytics or other system (e.g. Apollo)

Payment None

What is required of Primary Care

Rationale for inclusion Guidance

Continuing from 2019/20: Pseudonymised data extraction to improve risk stratification and system data integration

In order to apply a population health management approach, the CCG needs to understand the characteristics, disease prevalence and risk factors identified for the patient population.

Allowing the data extraction enables this work to be undertaken without adding additional pressures to practices by requesting they undertake the reporting internally.

1. Mandatory Requirements - FINAL.docx

Metric Sign up and use of Ardens Manager Payment None



New/changes for 2020/21: Sign up to and upload data to Ardens Manager. Allow CCG access to reports within Ardens Manager

NB. Not yet an option for EMIS practices due to the different reporting system.

Most of the reporting required for the CFF can be undertaken using reports built within Ardens. Uploading to Ardens manager will allow practices to review progress at practice and PCN level.

Access for the CCG will reduce the amount of reporting required by practices as the CCG can extract from Ardens Manager. The data uploaded is directly from the GP system and they can review the metrics, update and re-run reports as frequently as they wish. The CCG will be reliant on practice upload.

Included in above

of 18

Metric Continued promotion of Summary Care Records with Additional Information

Payment None



As part of the COVID-19, NHSD & NHSX are temporarily removing the requirement to have explicit consent to share the SCR-AI, and this Additional Information will now automatically be included in all patient SCRs unless a patient has expressed a preference not to include it.

The decision for automatic upload of SCR-AI will be review in October 2020. If the decision is to cease the automatic upload then practices will reinstate the activity of:

Promotion & and gain consent to upload patient summary care record with additional information (SCR-AI)

When a patient gives permission to include additional information in their SCR, this means more information will be available to health and care staff viewing the SCR. This is a quick, cost-effective way to:

Improve the flow of information across the health and care system

increase safety and efficiency

improve care

respond to particular challenges such as winter pressures

It's particularly useful for people with complex or long term conditions, or patients reaching end of life.

Included in above

Metric Workforce and Skills data Payment None



Workforce and skills data - provide updates on staffing skills and training requirements

The workforce and skills data collection informs the CCG of pending staffing or skill gaps which allows for early priority for initiatives or intervention before patient care is affected.

Included in above

Practices will not receive any CFF payments if the four mandatory elements

are not met. All mandatory elements will need to be delivered at practice

level.

of 18

2. Proactive Management - Each metric will be delivered at Practice

Level apart from metric 2.6

Managing Risk Factors

Metric 2.1 Identifying, staging of disease and coding Payment £0.60

What is required of Primary Care Rationale for inclusion Guidance

Continuing from 2019/20:

Rockwood scale - identify frailty status using Rockwood assessment

COPD Gold classification

End of life patients to be coded against relevant Gold Standards Framework stage

New/changes for 2020/21:Additional LTCs included:

New York Heart Association classification

Chronic Kidney Disease stage coding

Diabetes - Pre-diabetes

Diabetes - data cleansing as a number of patients coded as both Type1 and Type2

Mild cognitive impairment

Identifying and coding patients enables:1) Risk stratification - supports better management of patients by identifying deterioration 2) Population health management - supports PCNs and CCG to understand health issues across the population 3) Pathway compliance - identifies appropriate pathways and support to identify end of life 4) Better care between multiple providers as there is a joint understanding of patient prognosis 5) Identifies who is appropriate for community services 6) Pre-diabetes - identifies cohort of patients for NDPP courses - helps the provider target specific areas to run course

2.1 Identifying staging of disease.docx

of 18

Metric 2.2 Support patients with Long Term Conditions to manage risk factors Payment £0.40


Patients with long term conditions to have recorded as part of their annual review:

Physical activity status

Anxiety and Depression screening

Goals should be agreed with patients and recorded within their notes

NB: All of the above must be undertaken to qualify for payment.

Most practices are now using online systems to carry out online consultations/digital triage, with non-digital users supported to go through the same system by practice staff. The expectation is for practices to undertake the listed 3 elements remotely if it is not possible to have a face-to-face review.

Weight, Height & BMI:

As the year progresses, circumstances may change which means methods of patient contact may transmute. In the event a patient presents at the practice, practices would be encouraged to measure, record and code the patient’s weight, height & BMI as a measure of good practice. If the patient is aware of their recent weight, height and BMI they can self-report this during their consultation and measurements should be recorded on the patient record.

If the patient is unaware of their recent BMI then video consultation methods should be utilised for the healthcare professional to ask the patient about recent diet/exercise changes in their lifestyle and utilise past history to identify and address any nutritional concerns and provide lifestyle guidance accordingly.

Lack of physical activity is one of the key risk factors related to long term conditions. It can also increase an individual’s risk of a fall as strength and stability decreases.

Many people with long-term physical health conditions will also experience poor mental health and it is estimated that 30% of all people with a LTC have a co-morbid mental health problem. These can lead to significantly poorer health outcomes and reduced quality of life.

The British Journal of General Practice notes that physical activity brief advice in health care is effective at getting individuals active. It has been suggested that one in four people would be more active if advised by a GP or nurse, but as many as 72% of GPs do not discuss the benefits of physical activity with patients.

Physical inactivity is common during periods of self-isolation, and for patients with LTCs, there are crucial benefits to be gained from maintaining an active lifestyle throughout the COVID-19 pandemic. Patients should be provided with support to maintain physical activity and avoid prolonged periods of time spent sitting.

Estimated that £1 in every £8 spent on LTCs is linked to poor mental health and wellbeing. Emotional and mental health problems can impact the patient’s ability and motivation in self-managing their condition.

2.2 risk factors - proactive management.docx

of 18

Disease Specific Requirements

Metric 2.3 Diabetes - Three Treatment Targets Payment £0.30



Delivery of the 3 treatment targets for diabetes

New/changes for 2020/21:

None

People with diabetes can live well with the condition if they manage the condition within the recommended targets.

Discussing and setting targets can help to identify patients who are struggling to manage their condition or lack an understanding regarding their condition.

The three treatment targets are part of the Integrated Assessment Framework to monitor CCG performance.

2.3 Diabetes - Three Treatment Targets - CFF 2020-21 FINAL.docx

Metric 2.4 Diabetes - 8 care processes Payment £0.40



Delivery of the 8 care process for patients with diabetes


Practices will be paid to measure 7/8 Care processes (BMI excluded)

In the event a foot check cannot be completed in a face-to-face review, a video foot check will need to be conducted. (See attached guide for information on READ codes & guidance on conducting virtual/telephone diabetic foot checks)

Data from 2019/20 has shown that the proportion of people receiving all 8 care processes is still lower than the national average - although the latest data is inaccurate as the codes for Urine Albumin were not picked up correctly during the data extraction.

The Royal College of Physicians, Association of British Clinical Diabetologists, and NHS have issued a clinical guide for the management of people with diabetes during the COVID-19 pandemic. The guide outlines considerations for “the best local solutions to continue the proper management of people with diabetes while protecting resources for the response to coronavirus.”

In light of this practices are requested to conduct 7 out of the 8 care process checks. BMI has been excluded however; it is encouraged to be measured as a method of good practice. There is an option for patients to self-report their weight,

2.4 Diabetes 8 care processes.docx

of 18

Weight, Height & BMI:

As the year progresses, circumstances may change which means methods of patient contact may transmute. In the event a patient presents at the practice, practices would be encouraged to measure, record and code the patient’s weight, height & BMI as a measure of good practice. If the patient is aware of their recent weight, height and BMI they can self-report this during their consultation and measurements should be recorded on the patient record.


height and BMI if they are aware of this.

In the event a patient is unable to attend a face-to-face review for their diabetic foot check, we recommend video consultations should be used as the alternative to achieve this. (See attached guide for information on READ codes & conducting virtual/telephone diabetic foot checks). This is supported by the NHS clinical guide which states, “In primary care the recommendation is to consider routine diabetes care delivered virtually in the context of broader LTC management and prioritisation.”

The 8 care processes are an opportunity to prevent patients from developing serious health complications which in turn puts additional cost pressures on the system.

Metric 2.5 Palliative and End of Life Patients Payment £0.40



Review Gold Standards Framework status

Record discussion re: DNACPR

Record discussion re: Preferred Place of Death

Record anticipatory medication


Removal of post death audits

Record discussion re: Preferred Place of Care

Use virtual meetings, where

COVID-19 has altered the way we care for the vulnerable patients in our community, especially those at end of life, now more than ever they require personalised care planning to ensure the health and social care system is aware of their situation and needs. Should such patients become unwell, from COVID-19 or non-COVID-19 conditions, having a plan in place to guide management in a crisis will enable better outcomes in line with the wishes of the patient.

Where patients have a preferred place of death identified and recorded within their care plan, they are more likely to achieve this. This results in a reduction in patients dying in hospital.

These discussions about care planning, anticipatory

2.5 EoL.docx

of 18

appropriate to ensure monthly GSF meetings can take place

medication, DNACPR and preferred place of care and death should form part of multidisciplinary Gold Standard Framework (GSF) meetings. These meetings can take place in person or virtually and this metric is designed to encourage use of virtual GSF MDT. Practices should use their preferred technology to ensure these meetings happen.

Metric 2.6 Additional home visits and welfare calls potentially required for shielded patients during Covid-19 (To be delivered at PCN level)

Payment £0.30


During Covid-19 the CCG has asked that practices contact all patients who are on the shielded patient list for a welfare conversation.

Patients on the shielded list who need to see a GP for a face-to-face appointment should not be bought into general practice premises, unless a designated site has been set up for such purposes.

As PCNs, develop plans to be able to safely see shielded patients either in their own home or in “cold sites”. As a PCN it will be up to you how you deliver this; the CCG will seek assurance that you have a plan in place, and we will ask our infection control team to assure us that they are happy with your processes

Shielding is a measure to protect extremely

vulnerable people from coming into contact with

coronavirus, by minimising all interaction between

them and others.

Those who are extremely vulnerable should:

not leave their homes

minimise all non-essential contact with other members of the household

The shielded patient list comprises patients

identified using national administrative datasets

and patients identified by hospitals or general

practice and flagged as high risk. Patients that have

been identified nationally have been selected by

using a national algorithm. The shielded patient

list is updated daily with hospital data, address

changes and where patients have passed away. It

is updated weekly with GP data.

Patients can also refer themselves using the

government service to get coronavirus support as a

clinically extremely vulnerable person. GP practices

will need to assess the records of patients who

refer themselves in this way.

On 27th April practices were sent a letter via the GP

bulletin consisting of this information. Where

practices have not already done so, we are

requesting that you make sure that you have

contacted all the people on the patient list who

are shielding as a follow-up to the letter. These

Ensure the situation is clearly flagged in the patient's record.

Review patients' care plans, adapting them where needed or appropriate, including undertaking any essential follow-up. This should be done remotely where possible.

Help patients receive their medicine supplies regularly by helping them to arrange electronic repeat dispensing and enlisting the support of local resource (this could be co-ordinated through your social prescribing link worker or equivalent) and voluntary sector partners to collect and deliver.

Speak to patients (remotely where possible) who have an urgent medical question relating to their health and/or pre-existing condition (they may also need to contact their specialist consultant directly).

Liaise with local community health services to review patients receiving mental health or learning disability

of 18

conversations should:

(a) discuss what shielding means,

(b) describe any changes to their ongoing care and

treatment, including home visiting wherever this is

clinically needed*

(c) confirm they have an arrangement in place for

receiving their medications, and

(d) check that they are aware of the government

support offer.

We asked you to review a specific list of people

who self-declared as clinically extremely vulnerable

before 28 March which should have been provided

as a task within your IT system. Going forward,

please review any new patients that contact you

self-declaring to be clinically extremely vulnerable,

adding them to the list if in your clinical opinion

they meet the criteria.

support who may need additional help or support.

As PCNs, develop plans to be able to safely see shielded patients either in their own home or in “cold sites”. As a PCN it will be up to you how you deliver this; the CCG will seek assurance that you have a plan in place, and we will ask our infection control team to assure us that they are happy with your processes

Metric 2.7 Frailty Payment £0.50



Review Rockwood score and record frailty status


Removed anxiety and depression screening as is now a standalone metric.

Added in Fall Risk Assessment (FRAT)

Appropriate referral to social prescribing link workers

Individuals suffering with frailty experience higher incidence of non-elective admissions and are at greater risk of deterioration in the event of being admitted to hospital.

Levels of avoidable harm among older people are considerably higher than in younger age groups. Proactive management of patients with frailty can support care by optimising treatment and

In 2018/19 it was estimated that there were currently 48,000 patients registered in East and North Hertfordshire CCG living with frailty (based on electronic frailty index). Approximately 12,000 of these were identified as being moderate or severely frail.

During the pandemic GPs can make use of social

2.7 Fraility 2.docx

of 18

prescribing link workers to support this cohort of patients in order to build resilience and take control of their health and wellbeing – both during this crisis and in the future. A recent paper in the Lancet Psychiatry highlighted how the pandemic could have a profound impact on people's mental health.

Social prescribing link workers are continuing to manage existing social prescribing caseloads as well as supporting patients from the practice who are shielding and other vulnerable patients, by:

Conducting welfare telephone and/or video calls.

Facilitating medication delivery/pick up with pharmacists.

Facilitating community support for patients via local COVID-19 response hub, NHS volunteers and other community support.

Helping patients to navigate the menu of support that meets their needs.

Acting as the link for NHS Volunteers and other support available to patients.

Giving people hope and a new mindset to see

new possibilities.

Supporting patients to use digital platforms to stay connected

of 18

Metric 2.8 Serious Mental Illness Payment £0.50



Undertake annual physical health checks for patients with SMI. This includes:

HbA1c

BP

Cholesterol

Alcohol status

BMI

Smoking status

GP Practices to proactively engage and offer every patient on the SMI register a consultation over the phone or online. This can be done by the primary care mental health worker/GP or Practice Nurse. practices to follow if

BMI: In situations where it is not possible to measure the patients, weight, height and BMI; the patient can self-report this to the GP if they are aware of their most recent BMI.


CCG has a target of 60% of SMI patients to have received their annual physical health check. This target has been set nationally, and NHS England has stated this target will not change in light of coronavirus and the social distancing measures currently in place.

ENHCCG data shows that 18% of people on the SMI

register had received a full physical health check in Q1

2019/20 which this had increased to 27% by Q4. Similarly

to diabetes there are a number of care processes to

complete but the number of patients having all 6 of the

identified care processes is well below the national

average.

2.7 SMI - Physical Health Check - FINAL.docx

Practices are requested to offer every patient on their SMI register a consultation over the phone. Attached is a guidance that the mental health commissioning team have provided for healthcare professionals to utilise when making phone calls

Guidance for telephone support services.pdf

of 18

3. Promoting Patient Education- To be delivered at Practice Level

Metric 3.1 Promoting Patient Education Payment £0.20


New/changes for 2020/21: Communication to patients:

Practices to identify a patient communications champion who will be responsible for sending out messages developed by the CCG communications team. These messages will align with national campaigns and will aim to promote awareness on various long term conditions.

CCG communications team to develop these messages and provide guidance on how messages should be sent to patients

Practices required to support patient engagement and education around Long Term conditions and national health campaigns provided by the CCG communications team

Patient Participation Groups:

Practices to support PPGs to meet virtually where possible (can use teleconference methods or virtually).

Cancel Out Cancer:

Practices are expected to continue with the ‘cancel out cancer campaign’ if this is restarted this financial year.

There are a number of potential benefits associated with using email and text messaging to communicate with patients/ service users. For example, providing health messages can encourage healthy behaviours such as adopting healthy lifestyles and seeking opportunities for early screening and diagnosis for serious health problems.

This is a resource aimed to provide information and support at a patient to patient level.

The ask of this metric is for practices or practices to engage and support the communications team to deliver these messages to patients. The delivery method will be varied for example; this may be via text messaging, patient letters and potentially Patient Participation Groups.

3.1 Cancer - Cancel Out Cancer - FINAL.docx

of 18

4. CCG Intelligence - Practice Level

Metric 4.1 Catheter Register Payment £0.10



Identify patients with a newly inserted catheter and record in the clinical notes.

Review patients with a newly inserted catheter

If no catheter management plan is in place, refer to community services for ongoing management.

Report instances where patients have been discharged without a plan for management of their catheter to the CCG.


None

NB: Practices are asked to review patient notes and are not required to call in the patient for a review.

The overall CFF requirement is for good catheter care management to be in place which will have the benefit of improving patients self -management as well as focus on the prevention of Urinary Tract Infection (UTI), which will lead to the more appropriate use of antibiotics and a reduction in the potential for health acquired infections and antimicrobial resistance.

The reporting so far in 2019/20 has identified a large number of patients discharged from secondary care with a catheter that have not been referred to HCT for ongoing support or care management.

However, there are a lot of practices that are not reviewing anywhere near the number of patients that are being discharged with a catheter. This means that these patients may not be getting the follow up support required and good catheter care management may not be in place. Practices need to be encouraged to pick up and review these patients.

4.1 Catheter Register - CFF 2020-21 - FINAL.docx

Metric 4.2 PCN COVID-specific Business Continuity Plans in place across all ENHCCG GP practices

Payment £0.30


All practices will be provided with a template to review against their current Business continuity plan which will include a COVID-19 section. Practices are requested to submit the BCP Plan every quarter or earlier if there is a critical change to demand or capacity to East and North Herts CCG.

COVID-19 is an unprecedented event due to the nature of this novel virus. Although current practices’ existing BCPs should account for how they would deal with loss of staff, IT failure, supplier failure, information loss and denial of access to premises, the far reaching and unknown nature of this incident means that the pace of change for services, patients and staff safety is under constant review and alteration during this national incident.

To provide assurance to the CCG that all practices have robust arrangements in place

This would be measured by confirmation that all practices have submitted a plan which

has been reviewed and confirmed by CCG as meeting

all core criteria.

Once submitted, ENHCCG will provide feedback on plans to

ensure they are robust

of 18

(that appropriately includes mutual aid and not rely solely on moving activity to NHS 111 in the long term), it will need to cover all potential eventualities for the remaining duration of the COVID-19 crisis and the recovery phase. This includes the event that a practice is unable to continue to operate due to Covid-19 (e.g. lack of staff due to illness) and a massive overwhelming surge in demand and LTC complications once public confidence is seeking help has been restored.

ENHCCG will provide feedback on plans to ensure they are robust

GP Business Continuity Template.doc

Metric 4.3 Compliance with Pathways Payment £0.40



Practices agree that clinicians

working for the practice comply

with the requirements of the

pathways, including conducting

appropriate tests prior to

referral, using referral criteria

and referring using appropriate

referral forms.


Priority Pathways – see guidance

Continue to comply with local and national covid-19 pathways

Covid-19 is an evolving situation and to meet demands a number of local and national pathways have been developed. It is essential that practices continue to adhere to these pathways to ensure consistent messaging and practice is met across all localities

Reduces delays in referral to treatment

Avoids inappropriate referrals

Ensures pathways are followed by practices

4.3 Pathway Compliance.docx

Metric 4.4 Medicines Optimisation Payment £0.40


1) Reducing the overall total prescribing of antibacterial prescription items per STAR PU Prescribing to be at or below 0.905 items/STAR-PU for the rolling 12 months to March 31st 2021 - £0.10 per registered patient

Antimicrobial resistance (AMR) is a global problem that impacts all countries and all people, regardless of their wealth or status. The scale of the AMR threat, and the need to contain and control it, is widely acknowledged. Three key ways of tackling AMR are: • reducing need for, and unintentional exposure to, antimicrobials; • optimising use of antimicrobials; and

4.4 Medicines Optimisation (1) - CCG Intelligence - FINALv2.docx

of 18

2) For Apr 20-Dec 20, reduce the cost of prescribing of items that are available for purchase over the counter by at least 15% compared to the period April –December 2017 Practices already exceeding this reduction at the start of the year will need to maintain this in order to receive -payments – £0.10 per registered patient

• investing in innovation, supply and access.

NB Update to the GP Contract Agreement 2020/21 to 2023/24 was published 6.2.20 and contains information relevant to this metric. Under the DES there is a requirement for practices to ‘’actively work with their CCG’’ to optimise the quality of prescribing in 4 key areas, including antimicrobial prescribing and resistance. This Quality Improvement module is still in development and no indication is given when it will be included

PMOT believe this to still be a priority area locally. For the period April-November 2019, the CCG’s total spend on items that are available for purchase over the counter was £2.38M, despite it being a metric area in the 2019/20 CFF. This has only decreased by 6.6% over the same period in 2018, and 10% over 2017. In contrast, HVCCG has decreased spend by over 13% since 2017, and our spend per 1,000 patients is above the average in our group of RightCare ‘’10 Closest’’ CCGs with similar demography.

NB Update to the GP Contract Agreement 2020/21 to 2023/24 was published 6.2.20 and contains information relevant to this metric. Under the DES there is a requirement for practices to ‘’actively work with their CCG’’ to optimise the quality of prescribing in 4 key areas, including nationally identified medicines of low priority. There are a number of indicators associated with the introduction of the Investment & Impact Fund – but these monies can only be spent on workforce expansion and services in primary care (as opposed to QOF which is practice income). One indicator relates to the reduction of spend per patient on 20/25 medicines on the national list of items that should not be routinely be prescribed in primary care. Achievement is measured against the PCN’s spending goal (no information given on who sets this). Maximum achievement is worth £6000 to the average sized PCN. The lower threshold for achievement is set at being 60%

4.4 Medicines Optimisation (2) - CCG Intelligence - FINALv2.docx

of 18

3) Increase Electronic Repeat Dispensing Uptake

4) Oral Anticoagulation: - To ensure the appropriate monitoring and dosage adjustment for patients who have been switched from warfarin, or initiated onto to DOAC treatment. This reduces the requirements for INR tests at a time when phlebotomy and anticoagulation services are under strain from the effects of the pandemic. Patients will need to be assessed to see that their dose is appropriate for their indication, co-morbidities and renal function.

over the spending threshold. PMOT do not understand this to include OTC medicines.

TBC (Meds op to provide further information)

Electronic Repeat Dispensing In order to provide a more efficient way to manage repeat prescriptions, in 2005 the government introduced Repeat Dispensing Services. Initially repeat dispensing was only available using paper based prescriptions but since July 2009 it has been possible to use repeat dispensing via Release 2 of the Electronic Prescription Service (EPS). This is called electronic repeat dispensing to differentiate it from paper based Repeat Dispensing, but uptake by practices has been low. The coronavirus pandemic has identified a need for face to face interactions to be minimised and replaced with digital alternatives wherever possible to protect the population, and NHSE have made this message clear to general practice.

of 18

Metric 4.5 Ensuring current remote consultation processes grow and become embedded as part of BAU beyond recovery.

Payment £0.30


GP practices to increase use of

remote digital consultation

process such as online and video

consultation where clinically

appropriate and safe to do so

Patient Engagement: Primary

care are developing a specific set

of patient engagement activities

that each practice will need to

action in order for patients to be

made aware of using digital

consultations – details to be

confirmed

Digital technology is transforming how patients

and health professionals interact. As a result,

NHS England is supporting primary care to

move towards a digital first approach, where

patients can easily access the advice, support

and treatment they need using digital and

online tools. These tools need to be integrated

to provide a streamlined experience for

patients, and quickly and easily direct them to

the right digital or in-person service. In practical

terms, this means patients should be able to

use online tools to access all primary care

services, such as receiving advice, booking and

cancelling appointments, having a consultation

with a healthcare professional, receiving a

referral and obtaining a prescription.

Recent baseline audit revealed that use of

eConsult, phone and video consults is highly

variable across ENHCCG.

Outcome measure to be based on reasonable usage levels vs either national/local usage levels or increase vs current levels (to be confirmed by primary care)

Patient Engagement:

Primary care are

developing a specific

set of patient

engagement activities

that each practice will

need to action in

order for patients to

be made aware of

using digital

consultations – details

to be confirmed

of 18

5. Additional Services - PCN level (only)

Metric: 5.1 Treatment Room Payment £2.00



Wound Management e.g. Suture Removal / dressings

Ear irrigation

Leg ulcer

Spirometry

12 lead ECGs

24hr BP monitoring (including at home)

Ring Pessary

To provide the above treatments in a primary care setting

A new service that will support the reduction in NEL activity, particularly attendance at A&E for suture removals and wound dressings, which could be carried out at PCN level.

The RCGP Guidance on workload prioritisation during COVID-19 lists ear irrigations and ring pessaries in the ‘red’ category. Red signifieslower priority routine work which could be postponed in the event of a high prevalence of covid-19 in your patient population, aiming to revisit once the Pandemic ends. Although ear irrigation and ring pessaries falls under this category, patients should not be referred to secondary care for these treatments and practices are expected to manage and advise these patient’s in primary care.

This metric will be measured by the number of new inappropriate referrals to secondary care for these procedures.

5.1 Primary Care Treatment Room Bundle FINAL.docx

Metric: 5.2 Non-Elective Activity Payment £3.00


1) Maintain reviews for patients with long term conditions in particular: (£1.40)

a) Asthma in adults > 12 years b) COPD c) Chronic Kidney Disease d) Heart Failure e) Hypertension

As the year progresses, circumstances may change which means methods of patient contact may transmute.

1. Long Term Condition Reviews: Disruption of care and diversion of healthcare resources can impact patients with LTCs during national emergencies. Despite the COVID-19 pandemic, patients of all ages are still living with LTCs which may be further exacerbated if left unmanaged or untreated which may lead to hospital admissions. To help mitigate this, practices are requested to continue to review their patients with LTCs.

1. Long Term Conditions

LTC guide.docx

of 18

Therefore, reviews can be conducted remotely or face-to-face when the opportunity presents.

2. Continue to adhere to Prevention of Admission Pathways (£0.80)

3. Increase access to same day urgent access in primary care. (£1.00) Practices should increase access to same day appointments; Use of digital technology can be utilised to support this

These reviews align with indicators that were embedded as part of the Quality and Outcomes Framework (QOF). In the event that QOF is reinstated, payments for this indicator will still continue.

2. Prevention of Admission Pathways:These pathways provide interventions to prevent avoidable admissions in particular for the housebound and care home patients.

3. Same Day urgent access in primary care: Increasing access to same day appointments means patients with urgent health related issues can be seen quicker, improves patient satisfaction and can reduce avoidable non-elective attendances. We will measure this as a comparison to practice performance in the previous financial year.

Metric Metric Title Feedback/Actions since OPD (12/05/21) Action To Be Completed RAG

1 Mandatory Elements

Alter information on summary care records in line with information from

NHS Digital Completed -Phil Turnock has provided wording for this

2.1

Identifying, staging of

disease and coding Guidance document to be reviewed and amended Completed

2.2

Support patients with Long

Term Conditions to manage

risk factors

Following feedback from NHSE we have included to state that BMI can be

self-reported by the patient Completed

2.3

Diabetes - Three Treatment

Targets

Following feedback from NHSE we have included to state that BMI can be

self-reported by the patient Completed

2.4 Diabetes - 8 care processes

Following feedback from NHSE we have included to state that BMI should

be recorded if patient knows this

Template for virtual foot checks to be completed Partially completed - diabetes footcheck template to be developed

2.5

Palliative and End of Life

Patients Create a template for GSF MDT meetings Marina to complete the Guidance document & creation of GSF template

2.6

Additional home visits and

welfare calls potentially

required for shielded

patients during Covid-19

Develop more specific guidance to understand how PCNs can develop

plans to ensure shielded patients are being seen

Working with primary care to develop further guidance for primary care

on how shielded patients can be bought to cold clinic sites

2.7 Frailty No changes Completed

2.8 Serious Mental Illness

NHSE have confirmed patients can self report weight, height BMI

MH commissioners requested to add a requirement that GP Practices need

to proactively engage and offer every patient on the SMI register a

consultation over the phone or online. completed

3.1

Promoting Patient

Education PPG groups to meet virtually completed

4.1 Catheter Register No changes Completed

4.2

PCN COVID-specific

Business Continuity Plans in

place across all ENHCCG GP

practices

Require further detail of the template and to liase with quality team to

gain their feedback on the covod-19 template

Liaised with Solomon Brown and Sharn Elton - agreed to include the BCP

into CFF and there is a covid specific appendix. Feedback from quality

team has been inputed into this

4.3 Compliance with Pathways No changes no changes

4.4 Medicines Optimisation

To be signed off externally - Meds op to retrieve data and work up which

elements of the metric they would like to keep into the CFF

Meds Op to receive data on 20/05/21 from NHSBSA - following this meds

op will anaylse data and decide which elements will go into the CFF

4.5

Ensuring current remote

consultation processes

grow and become

embedded as part of BAU

beyond recovery.

To incoperate two elements:

1) Making patients aware of the different methods they can consult with

their GP

2) Ensuring that we are promoting appropriate use of digital technology

across the CGG

Primary Care to provide further information

5.1 Treatment Rooms No changes no changes

5.2 A

Maintain Reviews with LTC

patients Create a guide LTC guide in progress

5.2 B

Continue to adhere to

Prevention of Admission

Pathways No changes no changes

5.3 C

Increase access to same day

urgent access in primary care Collect baseline data survey to provide to practices In process of collating baseline data

5.3 Public Health Management Sam williamson to work up an indicator - to be signed of externally SW to complete and submit work once data is retrieved

1 | P a g e

Agenda Item No: 8



Paper Title: Covid-19 Primary Care Cell and Care Homes Update


Report author: James Gleed, Associate Director Commissioning Primary Care

Andrew Tarry, Head of Primary Care Development

Report signed off by: Denise Boardman, Director of Primary Care Development

Executive Summary: The Primary Care Cell commenced in early April 2020 to support the CCG’s COVID-19 response. The cell has a dedicated senior lead and has agreed representation cross-directorate to deliver the required outcomes. The cell’s key objective is supporting general practice to ensure that patients’ health needs are met and that the primary care workforce is supported during the COVID-19 pandemic and beyond.

It was agreed that the virtual Primary Care Cell would meet on a daily basis commencing on Wednesday 8th April. From week commencing 4th May the regularity of the cell meetings was reduced to three times weekly. A cell tracker was developed to support the meetings, to record key actions, updates and decisions made. The tracker is updated and circulated following each cell meeting.

A weekly OPD Highlight Report is produced summarising key headlines/achievements, critical milestones/next steps, risks/mitigating actions and the key points for the weekly Governing Body report:

This report provides updates on 4 key work streams:

Care Homes:

Response to the immediate care provision requirements as set out in the NHS England letter Primary and Community support into Care Homes during the time of Covid19

Plan for producing a new Care Homes Local Enhanced Service (LES): A working group with representation from across the CCG and PCN Clinical Directors is being set up. This work will incorporate the previous review of the current CCG LES and the requirements and timelines of the Enhanced Health in Care Home

2 | P a g e

PCN DES.

Regular engagement with PCN Clinical Directors - providing a forum for key issues/concerns to be discussed, enabling the CCG to be able to provide assurance/further explanation.

Support for NHS 111/direct booking into general practice - planned and ad-hoc support provided to the NHS 111 COVID line call handling.

Personal Protective Equipment (PPE) - summary of the current process and support provided to primary care.

The CCG has been required to make two initial submissions regarding planning for the next phases of the pandemic and this will be the key focus for the Primary Care Cell going forward.

Recommendations

to the members:

To note the update.


involved:

There were no conflicts of interest in the preparation of this paper.

The CCG Governing Body GPs have a financial conflict of interest in any decisions relating to investment in primary care as they are shareholders in their GP federations and are also practising GPs in their localities.



Type Description




3 | P a g e




4 | P a g e

1. Executive summary

The Primary Care Cell commenced in early April 2020 to support the CCG’s COVID-19 response. The cell has a dedicated senior lead and has agreed representation cross-directorate to deliver the required outcomes. The cell’s key objective is supporting general practice to ensure that patients’ health needs are met and that the primary care workforce is supported during the Covid-19 pandemic and beyond.

It was agreed that the virtual Primary Care Cell would meet on a daily basis commencing on Wednesday 8th April. From week commencing 4th May the regularity of the cell meetings was reduced to three times weekly. A cell tracker was developed to support the meetings, to record key actions, updates and decisions made. The tracker is updated and circulated following each cell meeting.

A weekly OPD Highlight Report is produced summarising key headlines/achievements, critical milestones/next steps, risks/mitigating actions and the key points for regular Governing Body reports:

This report provides updates on 4 key work streams:

Care Homes:

Response to the immediate care provision requirements as set out in the NHS England letter Primary and Community support into Care Homes during the time of Covid-19

Plan for producing a new Care Homes LES: A working group with representation from across the CCG and PCN Clinical Directors is being set up. This work will incorporate the previous review of the current CCG LES and the requirements and timelines of the Enhanced Health in Care Home PCN DES.

Regular engagement with PCN Clinical Directors - providing a forum for key issues/concerns to be discussed, enabling the CCG to be able to provide assurance/further explanation

Support for NHS111/direct booking into general practice - planned and ad-hoc support provided to the NHS111 COVID-19 line call handling

Personal Protective Equipment (PPE) - summary of the current process and support provided to primary care.

The CCG has been required to make two initial submissions regarding planning for the next phases of the pandemic and this will be the key focus for the Primary Care Cell going forward.

5 | P a g e

2. Background

In order to discharge ENHCCG responsibilities as a Category 2 responder, an Incident Control Centre (ICC) was established during March in response to COVID-19. Single Points of Access (SPOCs) were established and key roles and responsibilities were established to operate the ICC 24/7.

The CCG’s Organisation Performance Delivery (OPD) group was tasked with managing oversight and decision making in relation to service transformation and changes in response to COVID-19, implementation of new guidance and the impact on current provision of core services. It was agreed that this would be managed through the development of key work streams/cells reporting into OPD with escalation into the Governing Body membership.

The Primary Care Cell was one of the initial cells agreed in early April 2020. The cell has a dedicated senior lead and has agreed cross-directorate representation to deliver the required outcomes. The cell’s key objective is supporting general practice to ensure that patients’ health needs are met and that the primary care workforce is supported during the Covid-19 pandemic and beyond.

It was agreed that the virtual Primary Care Cell would meet on a daily basis commencing on Wednesday 8th April. From week commencing 4th May the regularity of the cell meetings was reduced to three times weekly to allow more dedicated time for cell members to undertake key tasks and align the frequency of these meetings to other CCG cells.

A cell tracker was developed to support the meetings, to record key actions, updates and decisions made. The tracker is updated and circulated following each cell meeting with an expectation that any key updates are provided by action ‘owners’ between cell meetings. All actions that are AMBER or RED RAG rated are reviewed in full at cell meetings.

The tracker records appropriate actions under the following key headings:

Communications Pharmacy & Medicines Optimisation Team (PMOT) Contracts and Finance Extended Access / 111 Primary and Community Care PCNs *SOP/Pathways (*Standard Operating Procedures) Information Governance IT ( Information Technology) Vulnerable / Shielded patients PPE

A weekly OPD Highlight Report is produced summarising key headlines/achievements, critical milestones/next steps, risks/mitigating actions and the key points for the weekly Governing Body report: The latest OPD Highlight Report is provided as a separate attachment for the Committees information.

The Primary Care Cell reviews key information received and cascaded via the ICC, including publications from NHS England and Improvement; agrees the actions required to advise general practice and obtains assurance that any necessary action has been taken (and provide assurance or reports as required by NHS England and Improvement).

6 | P a g e

The main NHS England and Improvement publications reviewed and actioned since the inception of the Primary Care Cell have been:

General Practice preparedness letters and updates of 19th March, 27th March and 14th April

Standard Operating Procedures (SOP) – General Practice in context of coronavirus Preparedness letter/revised Primary Care SOP Identifying Highest Risk Patients & FAQs Advice on how to establish a remote ‘total triage’ model in general practice using

online consultations Second Phase of NHS response to COVID19 letter Primary care and community health support for care home residents.

3. Issues

As we are in a command and control Level 4 Major Incident, there has been the need for a very rapid response to NHSE guidance ensuring the salient points are distilled and shared and with General Practice colleagues to support their day-to-day work. Teams have worked hard to undertake this against tight deadlines supported by the multi-directorate Primary Care Cell.

Work streams

Information on each work stream is recorded in the Primary Care Cell Tracker. To provide a more detailed oversight for the Committee updates on key areas of work streams are provided in this paper:

3.1 Primary care and community health support for care home residents

The NHS England letter of 1st May outlined the “Primary and Community support into Care Homes during the time of Covid-19”. The expectation is that the outlined model should be established as soon as possible, and within a fortnight (of receiving the letter) at the latest in order to support residents as quickly as possible.

The CCG working with practices and community providers are required to have implemented for their registered care home population the following elements of the COVID-19 care home support model:

Weekly ‘check ins’ – to be delivered – primarily remotely wherever appropriate, by an Multi-Disciplinary Team (MDT) where practically possible, drawing on general practice and community services staff and expertise

Process for the development of personalised care and support plans Clinical pharmacy support, including structured medication reviews to care home

residents.

CCGs were encouraged to take immediate steps to support individual practices and community health services teams to organise themselves according to their local areas or networks. As part of this process, networks should identify a named clinical lead for each care home.

NHS England and NHS Improvement will collect regular weekly ‘SitRep’ data from CCGs, starting 13th May, to understand the support being provided to care homes and the coverage

7 | P a g e

achieved across the country. The SitRep includes the requirement to confirm that the model is in place for all care homes in the ENH CCG area, specifically confirming compliance with the three key aspects of the model and confirmation that a clinical lead is in place.

Progress to date Across ENH, many of the elements of the letter have already been implemented through the work undertaken as part of previous the Care Home Vanguard programme. This includes an aligned GP scheme, medicines management reviews and training.

Basic observation equipment, including pulse oximeters, blood pressure monitors and thermometers has been purchased and shared to older people care homes, this decision was based on stock availability for reliable equipment. NHSE have now purchased pulse oximeters and it has been agreed that these will be given to learning disability and physical disability homes. Basic observation training is being offered to the homes and Hertfordshire Community Trust (HCT) will be signing off competencies in the care homes.

We have been delivering infection control training over the last few months and are now further increasing these efforts, with CCG colleagues working closely with HCT, ENHT and Hertfordshire Care Providers Association (HCPA), to deliver infection control training to every home and supported living site.

Future work Further work is underway with partners to start to reduce the identified gaps in provision versus the requirement:

The letter states that all care homes should be covered. In ENH, the local enhanced service (LES) only covered 80 of the 133 homes, predominately learning disability and physical disability homes. ENHCCG has now agreed the local enhanced service will be expanded to cover all homes

MDT working. There are already examples of MDT working with care homes in our localities. Taking the learning from these models and best practice there is work underway to understand what a potential model could look like and how this would be best delivered. Engagement has begun with PCN Clinical Directors and with key partners, for example, HCT to understand what can be delivered.

A multi-directorate working group with relevant stakeholder representation (including PCN CDs) is being set up to develop a new LES for care homes. This will dovetail with the timeline on implementation of the Enhanced Health in Care Home requirement of the PCN Direct Enhanced Service (DES), as below:

Enhanced Health in Care Homes - every care home will be supported by a single PCN with a named GP or GP team. A delivery plan for the new service will be agreed with community provider partners

31/07/2020

PCN must detail the arrangements with its local community services provider(s) in Schedule 7 of the Network Agreement

30/09/2020

Enhanced Health in Care Homes - deliver a weekly ‘home round’ for the PCN’s Patients who are living in the PCN’s Aligned Care Home(s)

01/10/2020

The new LES specification will incorporate the recommendations from the previous review of care home support provision (undertaken by Gill Benveniste) and also the requirements of the PCN DES. The new LES will come to PCCC for review and sign off, within a timeline that is compatible with the milestones set out in the table above.

8 | P a g e

3.2 Regular engagement with PCN Clinical Directors

The PCN Clinical Directors have been actively and successfully leading a range of activities in response to the current pandemic and there has been some very good joint work with the CCG - the establishment and running of new primary care ‘hot sites’ (to see patients that have symptoms consistent with COVID-19 requiring a face-to-face assessment in the community setting) being noted as a particular achievement.

It was recognised that a forum for more regular engagement with the Clinical Directors could help foster greater joint planning, information sharing and problem solving. In response to this identified need, a weekly WebEx was established from week commencing 27th April involving CCG Executive colleagues, Governing Body members and PCN Clinical Directors. Although this group is still in its infancy, the early meetings have proved to be a useful forum where key issues/concerns have been discussed, enabling the CCG to be able to provide assurance/further explanation. This is also proving a valuable starting point for collaborative discussion on care pathway issues, such as the care homes work stream.

3.3 Support for NHS111/direct booking into general practice

During late March it was clear that the patient call volumes to NHS 111 were massively increasing due to COVID-19 related concerns, which was placing the service provider, Herts Urgent Care (HUC) under great pressure.

The CCG worked with the 6 Extended Access service providers in ENH to re-purpose the workforce that would normally provide Extended Access services, to instead provide extra 111 COVID line call handling. The requirement to bolster the 111 service coincided at a point when patient demand for usual Extended Access services had dramatically reduced (due to the pandemic) and therefore enabled this clinical time to be utilised in a really valuable way.

To facilitate this support, HBLICT was able to rapidly deploy the Adastra system across the general practice estate enabling EA GPs to take calls direct from 111 call queue. Training was arranged by HUC for clinicians unfamiliar with the system (although several GPs also worked for HUC and did not require this). Agreement was reached between HUC, the CCG and the EA providers on the contractual basis & governance arrangements for this rapid redeployment of clinicians.

This support was pivotal in meeting the growing patient demand at a crucial time and was a good example of the health system working collaboratively to meet patient need and support wider system pressures. By early May patient call volumes into 111 had reduced and it was agreed to stand down the ongoing support, however the process and infrastructure established provides scope for similar support in the future should this be required.

As part of the national COVID-19 response there have been enhancements in the direct booking process from 111 into general practice. This has involved the rapid enablement of GP Connect functionality nationwide and the requirement for GP practices to provide greater capacity for direct booking – increasing this daily capacity from 1 appointment per 3,000 patients (as it is currently) up to 1 per 500 patients (the actual number should be adjusted according to demand). This approach has required NHS Digital to produce an amended national standard operating procedure (SOP); however there has been a lack of clarity in some areas of the requirements. HBLICT are working closely with NHS Digital and revised guidance will be provided to GP practices very shortly to enable the process to be fully implemented.

9 | P a g e

3.4 Personal Protective Equipment (PPE)

The Primary Care Cell agreed the appointment of a primary care lead for Personal Protective Equipment (PPE) for ENH and they represent the CCG on the Hertfordshire County Council PPE Cell.

Reminders of PHE guidance and changes in ordering processes are regularly sent to primary care via circulation to practice managers.

We await an e-commerce solution for ordering PPE of which Hertfordshire have just been included as part of the pilot scheme. While we await this permanent solution, the interim process for primary care to order PPE is using their business as usual suppliers or other approved suppliers; if these options have been exhausted then an order can be placed via the Local Resilience Forum (LRF) and stock dependent, orders can be delivered within 7 days. There is also scope to contact the National Supply Disruption Response (NSDR) for an emergency supply pack if the practice does not have enough PPE for 7 days.

6th May saw the start of a new CCG primary care PPE Stock holding weekly SitRep, each PCN is being asked to confirm their stock holding for each item of PPE which Public Health England (PHE) recommends for primary care. This allows support to be offered and obtained across the system and necessary reporting to NHS England.

4. Options

For the care homes work stream, potential options are to be explored through further engagement with the PCN Clinical Directors, HCT and other local system partners. Through this multi-stakeholder work, clarity will be brought to the operational detail behind key areas of the service model such as the function of the MDT and any contractual or funding implications associated with fulfilling the national requirements.

5. Resources implications

CCG staffing – to support the response to the pandemic, CCG staff have re-focused their roles to support the response including where appropriate redeployment opportunities.

Funding routes - to support the response to COVID-19 NHS England confirmed they will ensure that funding does not influence clinical decision making by ensuring that all GP practices in 2020/21 continue to be paid at rates that assume they would have continued to perform at the same levels from the beginning of the outbreak as they had done previously, including for the purposes of Quality & Outcomes Framework (QOF), DES and LES payments.

The CCG confirmed to all practices details of the suspension of the originally planned Consolidated Funding Framework (CFF) for 2020/21 and the implementation of an interim CFF instead, for at least for the first 4 months of 2020/21. Under the interim CFF Practices will receive 100% of the monthly amount that was available – 89p per patient. Upon sign-up Practices will receive a single payment covering the 4 months, i.e. £3.56 per patient. This provides guaranteed income and a boost to practices’ cash flow.

Practices will also be reimbursed for any additional costs incurred as part of preparing for and managing the COVID-19 outbreak. Details of the claim process have been communicated to all practices.

10 | P a g e

Primary care and community health support for care home residents

The PCN DES includes a Care Home Premium of £60 per bed for the period 1 August 2020 to 31 March 2021 (please note this is for 6 months service delivery from October onwards, so equates to annual payment of £120). The CCG has previously stated that it would maintain the current level of reimbursement under the Care Home LES of £205 per bed and this commitment has been welcomed by PCN Clinical Directors. However the potential reinvestment into primary care of the difference i.e. £120 per bed has been raised as a query by PCNs in light of the previous NHSE instruction to CCGs - the update to the GP contract agreement 2020/21 - 2023/24 published in February 2020 states:

‘All funding previously invested by CCGs in LES/LIS arrangements, which are now delivered through the DES must be reinvested within primary medical care. LMCs should be engaged on reinvestment proposals and provided with an annual report – drawn from CCG annual accounts – of how the CCG has used its primary medical care funding allocation’

The requirement to now include all care homes under enhanced care arrangements will create an additional funding requirement as might the final MDT model that is established with other community services. These requirements (and any others associated with delivery of primary and community services in care homes) would need to be met before considering reinvestment in any other areas.

6. Risks/Mitigation Measures

Risks are recorded on the Primary Cell Tracker and key risks with mitigation measures are shown on the weekly OPD Highlight Report. In addition risks are in the process of being recorded and monitored through the Datix risk management system.

7. Recommendations

For the Committee to discuss the contents of this paper; and to support the work of the CCGs’ Primary Care & Localities Cell.

8. Next Steps

The Primary Care Cell is now predominantly concerned with planning for the next phases in the pandemic.

Phase 2 focuses on the next six weeks and beyond with the following key priorities for primary care:

Ensure patients have clear information on how to access primary care services and are confident about making appointments (virtual or if appropriate, face-to-face) for current concerns.

Complete work on implementing digital and video consultations, so that all patients and practices can benefit.

Practices to proactively contact their high-risk patients with ongoing care needs, to ensure that appropriate ongoing care and support plans are delivered through multidisciplinary teams. Particular focus on the ‘shielding’ cohort of patients

Care homes support – as previously noted.

11 | P a g e

Making two-week wait cancer, urgent and routine referrals to secondary care as normal, using ‘advice and guidance’ options where appropriate.

Deliver as much routine and preventative work as can be provided safely including vaccinations immunisations, and screening.

Phase 3 work is centred on capacity planning for the August 2020 – March 2021 period

Primary Care & Localities Cell: Highlight Report

Date: 13 May 2020

SRO: Denise Boardman Project Manager: Emily Perry & Jodie Rettie

Rag Status

Major Risks and Issues:Cell Objectives and Work streams

Key Objective: to ensure that Primary Care staff and primary care patients in East and North Hertfordshire are supported and their health needs safely met during the Covid-19 pandemic and beyond.1. Communications 7. SOP/Pathways2. PMOT 8. Information Governance3. Contracts and Finance 9. IT4. Extended Access / 111 10. Vulnerable / Shielded patients5. Primary and Community Care 11. PPE6. PCNs

Headlines (Achievements)

• Home visiting service - AiHVS is back in operation following a pause of the service in mid-February when it was redeployed to manage the IUC CAS COVID-19 (CV19)queues. The service is now at full capacity as of Monday 4th May 2020 and will visit both CV19 and non-CV19 patients. Referrals are under capacity so more comms to practices are required.

• Hot sites/Shielded Pts: All 13 hot sites where patients with CV19 symptoms will be seen in primary care, were live as of 27.04.2020. Practices have confirmed they are contacting Vulnerable and Shielded patients and this was included in the NHSE Phase 2 submission recently submitted.

• Early May Bank Hol – ensured GP Light arrangements were in place at the vast majority of practices• Phase 3 Plans - Capacity plan submitted to NHSE within required timescaleCritical Milestones and next steps

This Week’s Next Steps• Implementation of care home support model – weekly NHSE SitRep on the 3 elements of required

support - Weekly ‘check ins’; Process for the development of personalised care and support plans; Clinical pharmacy support, including structured medication reviews to care home residents.

• Business Continuity Plans- Plans received from practices have been reviewed by the PCSMs and feedback will be given in the coming week. This is proposed for inclusion in 2020/21 Consolidated Funding Framework (CFF) to ensure all practices have robust plans that cover the very exceptional circumstances that the COVID-19 pandemic has created.

• Video and Online Consultation-. Practices use of this will also be included in the 2020/21 Consolidated Funding Framework (CFF). Letter from PCD/Contracts to those practices yet to implement eConsult to encourage use / understand why they have yet to implement this.

• Business as Usual in Primary Care –PCSMs are working with practices to confirm services put on hold, those due to be re-instated (i.e. flu vaccine) and what support is required to do so. COVID-19 hot sites to continue; some PCN discussions to combine hot sites as currently use of these sites is low.

Risk RAG Controls

Phase 2 Recovery Actions – issues withengaging with patients about recovery. Primary Care to deliver as much routine and preventative work as can be provided safely, particular focus on proactive care for shielded patients.

Amber Engagement with other CCG cells, potentially via task and finish group. Establish key actions & timescales.

Issue Mitigating Actions being taken

Implementation of the care home support model

Contacting practices to ensure all CQC registered care homes are covered by the Care Home LES & ensure named clinical lead for all care homes.

GP Connect /Direct booking for CCAS/111 - All ENH GP practices are enabled as GP Connect endpoints. Delay on enablement of additional direct booking slots

HBLICT finalising local guidance to be agreed with NHS Digital to support practices with implementation. Practices need to make sufficient number of appointments available to meet demand and initially this may be less than 1 per 500 per patients. Practices need to review and regularly adjust the number of appointments made available

PPE - ensuring that key messages/requests regarding PPE are read, understood & complied with by general practice.

PCSMs to liaise with practices to ensure they have seen key information that requires action.

Primary Care & Localities Cell: Highlight Report

Date: 13 May 2020

SRO: Denise Boardman Project Manager: Emily Perry & Jodie Rettie

Rag Status

Key points for weekly Governing Body report:

1. Electronic Prescription Service (EPS)- Practices have been contacted by the HBLICT Implementation team to encourage switch on to ensure patients can access prescriptions without having to attend the practice. 34 Practices have Enabled EPS Phase 4 in total as of 11 May 2020. The PMOT are also working with HBLICT to ensure the EA hubs are EPS enabled – currently working to enable EPS at the Stevenage EA Hub.

2. Practice Business Continuity Plans – The Primary Care Support Managers had training to enable them to review the plans submitted by practices – plans received have been reviewed and feedback will be given to support practices to strengthen these where necessary. For those practices who have not returned a BCP, a CCG devised template document will be shared to support them.

3. Bank Holiday Opening hours- CCG is currently waiting on written guidance from NHSE as to whether the end of May bank holiday will be a working day for Primary Care or not.

4. Care Homes – NHSE letter re implementation of the care home support model, weekly SitRep required with evidence/assurance that CCG is compliant against a number of areas. Internal meetings have taken place to assess current status against standards – CCG is largely compliant due to Care Home LES, although previously ineligible care homes need to be included & further work on required on MDT approach. Anna Makepeace is leading this and will also discuss with the GB GPs, EXEC and PCN CD’s.

5. Referrals to secondary care- Information was included in the GP bulletin re national guidance, if any referrals are inappropriately rejected (i.e. does not provide any management plan/ advice) practices have been advised to raise this through the GP hot line. ENHT are accepting referrals and PAH have now confirmed that they are also accepting routine referrals and that Advice and Guidance remains available – PAH have advised that currently 95% of all consultations are taking place by phone – comms to go out in GP Bulletin 14.05.2020.

6. PPE- Weekly stock take of Primary Care PPE started on 6th May – this is fed back to the LRF. Comms went out to Primary Care on 11.05.2020 to ask for practices to return certain eye protection that had not passed quality tests.

7. NHSE Regional Phase 2 & Phase 3 Recovery Plan – PCS Team have submitted Primary Care return for phase 2. PC cell to drive plan forward & co-ordinate with other cells regarding key actions & responsibilities. PCS Team have submitted required phase 3 plan to NHSE 13.05.20.

8. NHSE Speciality Guidance – The Medical Directorate has summarised recent NHSE Speciality guidance. These guides are primarily aimed at secondary care but will be shared with primary care for information. This will ensure they are aware of changes that could happen in secondary care during Covid-19 that may impact the care they give to patients. For e.g. acute settings not admitting someone where they usually would have done and therefore more care may be required to be given by primary care to support the patient. In addition, any confirmed changes to local services will be confirmed by the Contracts team and communicated out to practices via the GP bulletin.

Recommendations and Requests for Decisions or Support:

• None currently.

of 17

Agenda Item No: 9



Paper Title: Overview of Primary Medical Care Contracts and Primary Care Networks


Report author: Ozlem Cholak, Head of Primary Care and Community Contracts, ENHCCG

Holly Fairhurst, AD Contracts, ENHCCG

Report signed off by: Alan Pond, Chief Finance Officer, ENHCCG

Executive Summary: Executive SummaryThe paper provides an update on list closures, APMS contracts, contract changes, primary care networks and other contractual items for practices in East and North Hertfordshire.

Recommendations

to the members:

For Information

CFF proposal for approval


involved:

GP Committee representatives’ practices are members of

Locality federations which are private companies which may

provide CCG commissioned services



Type Description







of 17

1.0 Introduction

This paper provides an overview and update from the Primary Medical Care Contracting Panel and from the Contracts team more widely. The paper also requires a decision and approval of the recommendations outlined in section 8 – CFF.

2.0 Primary Medical Care Contracting Panel

The ENHCCG Primary Medical Care Contracting Panel has moved to a virtual fortnightly ‘newsletter’ format. Key updates are gathered from all stakeholders, and circulated to the Panel members. There have been no decisions requested which would require the Panel to meet.

3.0 Audit of Primary Medical Care Contract Oversight and Management Functions

An internal audit focusing on the CCG’s contract oversight and management functions was undertaken in quarter 4, 2019-20. The audit reviewed a number of contractual areas including:

Policies, procedures and guidance Local processes Roles and Responsibilities Annual e-declaration GP opening times Patient lists Monitoring of quality indicators and GP visits Outlier management Mergers and closures Primary Care Commissioning Committee

The audit was supported by evidence provided by both the CCG Contracts and Quality teams. The internal auditors identified that no actions were required and substantial assurance had been received. The overall conclusion in the audit stated that “Taking account of the issues identified, the Governing Body can take substantial assurance that the controls upon which the organisation relies to manage the identified risk(s) are suitably designed, consistently applied and operating effectively.”

4.0 List Closures

As at 11th May 2020, there is one list closures in place across East and North Hertfordshire as detailed below:

Practice Area, Locality Date of CCG list closure

Re-open due date

Conditions

Nevells Road

Letchworth, North Herts

09.03.20 07.12.20 None – full list closure

Nevells Road Surgery was granted a 9 month list closure by the Primary Medical Care Contracting Panel (PMCCP) in March 2020.

of 17

With advice and support from the LMC, all Practices have been informed that ENHCCG will support them in only registering patients who are new to the area, and that inter-practice transfers are strongly discouraged at this time.

5.0 APMS Contracts

The details of the APMS contracts in East and North Hertfordshire are listed in the table

below:

Practice Area, Locality Provider Contract start date

Contract end date

The Limes Surgery

Hoddesdon, Upper Lea Valley

Lea Valley Health Federation

01.02.18 31.01.22

Sollershott Surgery

Letchworth, North Herts 12 Point Care. North Herts Federation

01.07.18 30.06.21

Spring House Medical Centre

Welwyn Garden City, Welhat

Ephedra, Welhat Federation

01.04.18 31.03.21

Please note that:

Sollershott and Spring House Surgeries APMS contracts were set up for an initial 3 years with the option to extend for a further 2 years.

The Limes was an initial 2 year contract with the option to extend for 2 years and then a further 1 year. East and North Hertfordshire CCG agreed to extend this contract for the 2 years.

Ware Road Surgery and Orchard Surgery Update

The Ware Road and Orchard Surgery APMS contracts ceased on 31st March 2020. The contracts team can confirm that all patients have transferred to their new practices, and the IT systems (SystmOne) at both sites have been made obsolete. The Q&A section of the CCG website has been updated – and remains live. The Feedback email is also still being monitored, but we have not received any emails from patients since 15th April 2020. The phone line is also still available, but due to social distancing, is monitored less frequently than originally intended. There are no new messages on the voicemail, and no outstanding calls to be returned as at 7th May. Both the phone line and email will be terminated at the end of May, with patients redirected to the CCG switchboard.

Local MP’s and the respective PPG leads have received updates on the final transfers, and it is hoped that the CCG will be able to hold a ‘lessons learnt’ session with key stakeholders, when priorities allow.

Some patients who were unhappy with their allocations (having not provided preferences, and then being allocated somewhere) had been advised that they could move themselves after 1st April, if they so wished. In light of Covid-19, the CCG and receiving practices are in agreement that patients shall remain where they were allocated, for the time being.

of 17

6.0 Practice Changes

Haileybury College The incumbent GP’s contract ceased on 30th April 2020. Hailey View Surgery has successfully registered all GMS patients at the College, and NHSE/I have been made aware of the new registrations. The College site is currently a ‘hot site’.

Castlegate Surgery and Church Street (Ware) The merger of these two practices is now complete, and the new practice is known as New River Health. The Church Street site will serve as the main branch of the practice, with the Castlegate site being considered the branch surgery.

7.0 Extended Access Contracts

To support Herts Urgent Care (HUC) and 111 call volumes in the initial weeks of the lockdown, ENHCCG requested that Extended Access (EA) providers use their Extended Access hours to support the call queue. EA providers worked with the CCG and HBLICT to ensure required IT solutions were in place to help support HUC. This clinical input was invaluable and supported HUC in reducing the call waiting times for patients. The call volumes have now stabilised and are manageable for HUC, so the EA support has been removed for now, with the condition that it may be required again if call volumes peak.

8.0 PCN DES

The deadline for PCN registration, and sign up to the PCN DES is 31st May. NHSE/I have requested weekly progress updates, but there is no requirement on PCN’s to indicate their intentions sooner than the 31st May, and a number are awaiting further guidance from the BMA. Informally, 5 of the 12 PCN’s have indicated that they will continue on in their current form.

9.0 CFF 2019-20

Further to discussions with the PCCC members, it was agreed that the CCG’s proposals for revising performance assessment of the 2019-20 CFF, in light of corona virus, would be shared with Practices for their feedback. The key themes from the feedback received are discussed below for the Committee to review and confirm the final approach.

Key Themes We note that a number of practices wrote in to confirm their achievement to date/request their eligibility figures for the Care Planning element, without providing feedback on the proposals. Feedback on the proposals is included in its entirety at Appendix 1. It is requested that the Committee review the full feedback to understand the content of emails received on this matter.

Theme CCG ViewA number of practices felt that everyone should be paid in full for the year, despite the effects of Covid only impacting on March data. Others noted that last year’s achievement could be used to award payments.

It is not reasonable to expect full payment for the year, when only March was affected by Covid and not a single Practice achieved 100% in 2018/19. It is not possible to apply last year’s achievement for each element because the not all of the elements have carried through and some practices have done better this year in those elements that have carried through.

of 17

Reference has been made to QOF where NHS England has agreed in principle that in aggregate Practices will be paid based on the higher of the QOF points achieved in 2018/19 and 2019/20.

The CCG could do something similar, with financial balance and engagement elements being measured as per the original proposal (appendix 2), but with the remaining £s per patient being based on the higher of:

That achieved in 2018/19 That achieved through application of the original

CFF requirements That achieved through the application of the

revised proposals (Appendix 2)

This is possible because the remaining £s per patient are the same in 2018/19 and 2019/20,

A number of practices noted that activity through the year is not ‘straight-line’ and felt that they would have undertaken a greater level of work in March, had they had the opportunity

The CCG holds that the CFF schemes should be undertaken throughout the year to support good patient care. March is a notoriously busy month with QOF etc. and it would not be reasonable for the CCG to anticipate a sharp increase in CFF activity in March.

Indeed, the CCG has reviewed all practice delivery month-by-month over the last three years, and finds limited evidence to support the argument that practices undertake a significantly larger proportion of their CFF work in March. The chart below shows at most 10% in March rather than 8.33% if activity was even. However, this may not pick up improved coding undertaken at the year end.

Some practices wanted to know if there would still be an appeals process

The CCG will consider appeals where practices can demonstrate administrative errors e.g. an incorrect payment amount was sent for processing. However, the CCG will not consider individual practice circumstances for specific CFF schemes, as the guidance must apply to all equally.

Some concern was raised about the accuracy of MEDE data, and the respective perceived issues between

These perceived issues have been dealt with continuously throughout the year – and guidance can be found on the CCG’s website, including in the CFF FAQs detailing the

of 17

EMIS and SystmOne practices solutions to issues raised by the practices.

QOF codes were used where possible, and when the CCG asked EMIS practices to support with testing, only one practice came forward in June 2019 – so solutions could not have been implemented any sooner.

Some questioned how achievement would be assessed.

This was detailed in all of the original CFF paperwork and guidance; was supported in year with reminders in the FAQs and was detailed in the final proposal sent for their consideration.

The largest concern expressed was the Care Planning element

Care Planning detailed further below.

Care Planning Most of the feedback received from Practices focused on the Care Planning element of the CFF. Below is the key information for the element, and the CCG’s view on the feedback.

CFF Element

Value per Patient

Original Measure of Achievement

Proposed Measure of Achievement

Q4 Reporting Required

Care Planning

Maximum £3.25

Care plans will qualify for payment if they incorporate all of the relevant components Practices will receive £125 for each complete new care plan and £75 for each complete review of a care plan. The change in reimbursement reflects the work that has been undertaken by Practices over the last two years to develop care plans for their complex patients.

Process for paymentAlthough there are no targets for care planning, there is a maximum amount the practice can claim as the overall practice allocation for care planning is capped at £3.25 per practice list size. This is expected to be split over the year as follows: 50% of care plans to be new and 50% care plan to be reviews.

Practices receive £125 for each complete new care plan and £75 for each complete review of a care plan. The CCG identifies the number of care plans undertaken and has agreed that any care plan will be counted if it was for an eligible patient. Subject to the maximum payment of £3.25 per registered patient, the CCG will pay the higher of the total of all claims made by Practices and the total as at the end of February 2020 plus 27p per registered patient (being 1/12th of £3.25).

None required

Practice View: Practices assert that the number of plans required, and the content of those plans has not been verified, and so they contend that they have not been sure throughout the year if they are completing as many as they should, and if they are completing them correctly.

CCG View: All Practices were informed through the CFF guidance how to identify patients that qualify for new and review care plans. This was communicated as early as February 2019, and repeated at Practice Manager meetings, through the FAQ distributions and to individual and

of 17

in November provided individual patient lists of eligible patients to each practice, despite the practice having been informed of how to generate these lists themselves.

In year, the CCG discovered some issues with individual components of the care planning scheme not being reported as complete. A decision was taken to pay for all new care plans completed and reviewed care plans for eligible patients; and to not look at the individual components of these plans. This was communicated to Practices in an email on 11th March 2020.

Recommendation on Care Plans: The Committee is asked to agree that Care Plans should be counted for eligible

patients only.

Recommendation on overall CFF measurement: The Committee is asked to agree that the original proposals as set out in

Appendix 2 should not be changed.

The CCG is asked to discuss and agree whether the QOF like protection to income should be introduced for 2019/20 only so that, other than for financial balance and engagement, no Practice will earn less £s per patient in 2019/20 than they did in 2018/19.

Alan Pond May 2020

of 17

Appendix 1 – Practice Feedback

Practice No. Feedback Received 1. Can you confirm whether the email of 11th March regarding Care Planning will still

apply.

2. Thank you for the email below. I discussed this with Senior Partners this morning and generally we agreed with the proposal. We just wanted to check about what the position was with care plans and if practices would still be paid as per the email received on 11 March. If I am really honest, I think practices would appreciate it if the CCG paid the full CFF and did not embark on a another round of complex and uneven assessments which will continue to soak up time over the next couple of months.

3. Practices really value you reducing the reporting burden by not requiring further reports for Q4. If I am really honest, I think practices would appreciate it if the CCG paid the full CFF and did not embark on another round of complex and uneven assessments which will continue to soak up time over the next couple of months.

Reading through the detail of the proposed measures, on first glance most seem reasonable. But it will not be until the CCG does its data extractions can a practice determine if there are any issues with data quality or reporting. The frailty and care plan elements ignore that most practices carry out a good deal of tightening up on reviews and assessment coding in the last month of the year and that workload may not appear straightline. I have been querying how care plans will be measured for months and have never had a response from the contracts team. There are no Ardens reports in this area and only EMIS practices have been asked to submit data for care plans. You state that practices will be paid on basis of higher of total claims made (we were not asked to make any claims) and the total at the end of February (it should be at the end of March).

4. I would be grateful for the following to be taken into consideration when calculating our payment please: PPG Engagement & Patient Communication [Our Practice] was unable to complete the second part of this element because despite asking for help many times, the screen in the waiting room was never set up properly. We were therefore unable to participate fully in the patient survey. Much time was unfortunately wasted chasing the set-up and we have highlighted to the CCG on more than two occasions. Considerable work has gone into patient communication despite this. We have an established facebook page and a virtual PPG group. Record Sharing [Our Practice] achieved this element however in Q3 made a submission that was advised as "incorrect submission". No further clarification was given as to what was incorrect - therefore we would be grateful to be paid for this element. Respiratory [Our Practice] made submissions for this element despite not receiving the baseline list of patients. Cancer [Our Practice] made submissions for this element and following the Q2 submission I was advised you had not received it. It was sent to you again. Peer Review The peer review element was difficult for us to achieve as we only have one GP partner supported by locums of which we have had many different ones during the last year.

5. We have made specific comments below regarding the CFF proposal, and would like to note that since the start of the CFF 19-20 we have made numerous requests for clarity on how the reporting was going to work. Concerns have been raised over how

of 17

we would be able to monitor our own performance benchmarked against your report, which in turn has meant that we have put a considerable amount of effort in this year in trying to achieve targets whilst not knowing how we were performing against your reports. We have been aware that Mede has not been working and in our locality we have not been able to access specific data throughout the year. EoL - How are the CCG collecting monthly data, we have never been made aware of performance. CFF guidance says MEDE however this has not proven to be correct in past and we have had lots of issues with this system. Catheter Register - How is this being measured from our quarterly returns submitted? Frailty - We have been undertaking frailty checks based on our reports, but have not been sent quarterly updates to compare against. Where are you collecting the monthly updates from? Care Planning - How are you identifying the number of care plans completed, we have been asking for this information to audit against our own reports? Can we submit our figures? Diabetes - How are you measuring performance, we sent figures in a few months ago is this the basis for the performance Cancer Audit - We completed cancer audits and returned for Q1-Q3 does this mean we have met the criteria? CCG Pathways - How do we know if we met criteria in Q1-Q3 Peer Review - We completed peer reviews and sent quarterly returns does this meet requirements of Q1-Q3 IFR/PA - We have kept a report of our referrals sent to ensure compliance, how do you measure our achievement?

6. The practices across [this] PCN acknowledge the intention of the CCG to mitigate the impact of COVID-19 on practice achievement levels, and are grateful for this.

Whilst there are positives within the proposal and a stated endeavour to allow for the impact on practices of the COVID pandemic, we disagree with the assumption that the 12 month period is a flat curve of activity within practices, which appears to be the basis upon which the suggested adaptations to thresholds and any estimated calculations of achievement are planned.

The early part of the year is invariably void of activity from practices as we are generally awaiting finalisation of the criteria and awaiting the final version of the specifications and claim form during Q1. The end of the year, and March in particular, is a very busy month. A lot of time is spent checking performance to date against the required targets and chasing the required numbers, both by means of targeting patients themselves and also reviewing the accuracy of coding throughout the year to ensure that work actually done is rewarded. All of this work in March 2020 was effectively side-lined due to COVID, and cannot be measured as a simple additional 1/12th of achievement up to the end of February. This year end work in relation to coding would have been particularly relevant in relation to the care planning section of this years CFF where there have been numerous reported problems throughout the year regarding coding discrepancies, completed care plans not being recognised, and the required codes not all being highlighted on Ardens templates.

It is our feeling, therefore, that some relevance has to be placed on practice performance in previous years, and where this was higher than the achievement gained via the CCG's suggested formula for this year, comparable achievement to previous years should be awarded. This suggestion is also in keeping with national guidance on this matter, in relation to both QoF and local funding schemes of a similar nature. Please see attached a copy of a letter sent to General Practice from NHSE in March (Preparedness Letter 19th March 2020). I have highlighted to relevant sections on pages 3 and 5 which clearly indicate the above rationale will/should be used. Of course, if a practice has managed to perform better across a certain area within

of 17

2019/20 than in previous years, despite the difficulties presented by COVID, no adjustment based on previous years should be applied.

We request that the above mechanism is added to the proposed methodology to fully protect practices income and stability at this most difficult time.

7. having considered the proposed amendments to the CFF payment schedule for 2019-20 with my colleagues, it appears to us that it would be fairer and, in the light of current circumstances, justified to honour the CFF contracts as they exist and just pay the practices for the full amounts. Undoubtedly we have all done a significant amount of work towards achieving the aims of the CFF this year, we have submitted as requested our quarterly monitoring forms along with numerous attachments, we have put considerable effort into care planning and all the other aspects of this past year's CFF and it seems somewhat begrudging of the CCG to back out of full payment at this time. it almost seems like one of those occasions when you go out for a group meal and someone starts arguing about the bill because they didn't have a starter !

8. Many thanks for advising us of the planning. In general terms we are very appreciative of your approach - thank you. However we have some areas of concern that we would like to bring to your attention that apply to our EMIS practice. I have attached correspondence* related to serious coding issues experienced when completing EMIS work as compared to SystmOne for your consideration. Also there has been work done for the collaborative area which was completed by our practice in Q4 but related to earlier periods and we trust that this can also be taken into consideration.

*nb: Correspondence has been removed from this paper to maintain anonymity of the practice, but has been reviewed by the contracts team.

9. Thank you for setting out the proposal for the CFF 19/20 and recognising the time lost to Practices in delivering the CFF. I am happy with your proposal in principle for all elements with the exception of Care Planning. Before agreeing the care plan element I contacted [the contracts team]… to establish the number approved by the CCG and reconcile this against what I believe we achieved. we are miles apart (37% difference) and the resultant effect will be a significant reduction of expected income.

On further investigation with [CCG colleagues], they believe we have undertaken care plans on patients that do not meet the eligibility criteria and hence the discrepancy. I dispute this for a number of reasons:

As an Emis practice we have had a number of issues throughout the year which I have brought to the attention of the CFF team. There was no Emis template for care planning at the start of the CFF year. [CCG colleagues] visited our practice in September last year to discuss this in detail and review the plans we had completed. [They] approved the majority of care plans achieved at this point and we assisted… with an Emis template for use with other practices. There were delays by QMasters/Ardens providing the new template for use. [They] understood the issues for Emis practices and gave assurances that this would be considered and allowances made at the end of year. In fact, we were told not to worry and carry on doing what we were doing. [They] could see how thorough the care plans were being completed using the Emis unplanned admissions template as a temporary measure and additional read codes.

To assist us with identification of appropriate patients, a case finding list of patients was requested but it was never provided by the CCG and this was hindered as Emis did not have a Rockwood Scale for frailty rating. We used the Emis EFI index for frailty and undertook care plans on patients who had a moderate or severe rating.

Issues with care plans were consistently raised with the CFF team at the quarterly

of 17

practice manager meetings and promises were made to give practices ongoing achievement totals. The team failed to deliver on this promise.

In summary, we feel there have been significant failings in the process of administering care planning criteria to practices which has subsequently resulted in loss of expected income. We acted in good faith and undertook 201 care plans covering all the elements requested (Medication reviews, Advance Care Planning, Wellbeing Goals, Sharing information and supporting patients with information). The patients have benefitted significantly from the time spent with the GP and indeed many were saved a hospital admission with the support from the practice. I accept care plans have always been a thorny issue but I do feel we alerted and worked with the CCG to ensure a fair outcome.

I request that you review the above issues and reconsider your numbers. We would also like a breakdown of those care plans that were completed and not eligible for payment with clear reasoning for your decision so we can review these and use this as learnings for the future.

10. In principle, all areas with the exception of care planning make sense, and deliver a fair approach.

I understand that individual practices have provided similar feedback about the care planning metric, principally concerned with the lack of information from the outset, which led to inconsistency of approach at practice level - the very opposite of the intended outcome.

For our part…. we achieved 100% target for care planning the previous year, but only c50% ytd for yr 19/20, and even then, there are discrepancies in calculation between the CCG and the practice regarding eligibility, which has already tied up many hours of admin work trying to unravel.

It would be easy to get drawn in to a time consuming argument about what is or isn't eligible, or what the outturn would have been if March represents 8% of the year's care planning activity as proposed, or 25% of the year as it was for us last year, or even the month that brings most practices in line with their target, regardless of their starting point at the beginning of the month. The bigger point to consider, relates to the purpose of CFF.

At its inception, CFF was proposed as a means of incentivising good practice to improve patient outcome. Because practices embrace the concept and the scheme is largely successful in driving these behaviours, CFF now forms a very significant portion of annual income - c8.4% for our practice. Across the PCN, we delivered against the set targets in good faith.

When, on 4th March, we held an emergency Covid 19 planning meeting to galvanise the PCN into concerted activity to protect our workforce and patients, whilst providing business continuity as a single body rather than individual practices; we abandoned all individual targets and put patient outcome first. We had to innovate daily, often leading the way locally and nationally. We had to relinquish many of our income streams, and at the same time spend additional on service provision, and we did this, because it was the right thing to do. We did not let the fact that our income would suffer, dictate a more conservative approach. We worked entirely collaboratively, pooling resources and skillsets to deliver the best outcome for everyone.

If we operated in the private sector, we would already be making plans for redundancies, based on projected income. If we do not receive the income for care planning, having already relinquished other income streams (-minor ops, LARCs, some immunisations, NHS health checks, learning disability reviews), the financial impact at practice level will not be sustainable. Surely that's the bigger point. If not

of 17

rewarding for a failed set of targets on care planning, perhaps a complementary figure recognising the level of innovation and collaboration that has become a core part of primary care delivery over the past couple of months? A gesture to reflect the enormous strain that leads to the levels of innovation currently in place seems appropriate.

To summarise; we believe the care planning process, although approached in good faith, has not been deliverable for a number of reasons, largely administrative. The resulting number of queries will take an onerous amount of time to remedy, and is unlikely to reach a satisfactory outcome for practices. Income not received for care plans, along with other income streams drying up, will have significant financial consequence at practice level - particularly as infrastructure was in place to deliver the targets. The level of innovation and collaboration across our PCN reflects the real purpose of CFF and should be recognised financially. Our suggestion therefore, is that these figures are fully compensatory so that the impact of care plans not achieved, is negated.

11. We are extremely concerned about the process for assessing achievements for the 2019/20 Consolidated Funding framework. There have been numerous problems during the year with communication and quality of data.

We will not achieve our patient engagement monies as we had in April 2019 done a patient survey and reported on it at our annual patient meeting (over 100 people attended) and produced an action plan arising. Despite asking on several occasions if this would be sufficient as we did not want to duplicate and we had arranged this years meeting again for May I did not receive an answer until November 2019, too late for us to achieve the 2%.

Care planning is of great concern to us as we could not access the eligible patients reports from medeanalytics until the new year., due to a problem with the way the report had been done. This has caused severe problems, we had set up searches using the criteria for eligibility but results are vastly different to the patients identified on medeanalytics.

We lack confidence in the quality of the data obtained from medeanalytics and this has substantially increased the burden on us as we seek to reconcile the CCG data with ours.

We so feel that given the circumstances and the impact on Practice finances which could cause destabilisation of Practices that the CCG should reconsider it requirements for achievement so that practices can focus on new ways of working knowing that they have are financially secure.

12. In response to the email from [the CCG]… in respect of performance assessment for the 2019/20 CFF, we feel that this is a fair approach.

The one area that we may wish to be reviewed for Q4 is Frailty & Care planning as we under took a significant piece of work during the last quarter of the year.

We have assumed that as with previous years, once the results are published to practices, there will be an appeals process?

of 17

Appendix 2 – CFF Assessment 2019-20

Below is a summary of each element of the 2019/20 (CFF), together with the proposal for assessing

achievement of each element, taking into account the consequences of COVID-19, and minimising

any reporting requirements relating to Q4. In almost all cases the CCG is not requiring Q4 reporting

by Practices. Where the CCG is responsible for reporting, it will measure performance excluding the

month of March 2020. In both cases the target performance required need to be adjusted to

recognise the shorter time period Practices had to reach the target.

In recognition that some Practices may have performed well in Q4 and/or March 2020, the CCG will

allow Practices to report on Q4/year-end outturn if they wish to. Where the CCG is responsible for

reporting, it will also measure performance including the month of March 2020.

Practices choosing to submit Q4 reports will not have to submit reports for all elements, i.e. the CCG

will allow Practices to choose which elements they wish to provide reports for. This will allow a

mixed approach where some elements may be assessed based on the full year and others based on

part-year and the revised targets set out below.

Through this full year/part year measurement of performance, the CCG will ascertain for each

element independently which method of measurement would give each Practice the highest

financial award and pay on this method. In this way the CCG will seek to fairly reward every Practice

for its efforts and neutralise the impact COVID-19 would otherwise have on their income.

CFF Element Value per Patient

Proposed Measure of Achievement Q4 Reporting Required

Financial Balance £1.50 Calculation will be undertaken at year end as usual. Recognising that costs may have increased because of COVID-19 the CCG will consider further the position of any Locality who is overspent at year-end.

Any Locality underspent at month 10 will be awarded financial balance regardless of its year-end position. Any Locality overspent at month 10 and at year-end, but within 0.5% of its budget at year-end will be awarded this element.

None required

PPG Engagement and Patient Communication

5p With the delay in the patient survey being finalised by the CCG, the activities Practices had to undertake were pushed back with some elements due in Q3 being pushed into Q4. Given the low value of this element, it is proposed that any Practice that met the requirements of Q1-Q2 will be awarded this element. Any Practice that did not meet the requirements of Q1-Q2 will not be awarded this element.

None required

Meeting Engagement

£3,798 fixed sum

Any Practice that met the requirements of this element as at the end of February will be awarded this element. Any Practice that would have met the

None required

of 17



requirements had they attended a planned event in March will be awarded this element. Any Practice that could not have met the requirements even if they had attended a planned event in March will not be awarded this element.

Locality Collaborative Working

55p Localities will be reimbursed the costs they have incurred. Any underspend from 2019/20 will be carried forward into 2020/21.

Delay reporting until at least 30 June

2020

Workforce and Skills data

5p Any Practice that submitted information for Q1-Q3 will be awarded this element. Any Practice that did not submit information for each of Q1-Q3 will not be awarded this element.

None required

Record Sharing 30p This element had 2 sub-elements both associated with Summary Care Record with additional information shared or dissent decision recorded. Full payment and half payment were set at achievement levels of 80% and 60% respectively. This element can be measured monthly using data held by the CCG. In light of COVID-19 the CCG will relax the percentage achievement to 70% and 55% respectively based on information to the end of February 2020. Any Practice exceeding these revised thresholds at the end of February 2020 will be awarded full or half payment as appropriate.

None required

End of Life 35p This element had 3 sub-elements. Full payment and a sliding scale partial payment were set at 80%, 60%, 40% and 25%. The CCG is able to collect monthly information on achievement, but in light of COVID-19 will relax the percentage achievement to 70%, 55%, 35% and 22% as at the end of February 2020.

Any Practice exceeding these thresholds as at the end of February 2020 will be awarded full or partial payment as appropriate.

None required

Catheter Register 10p The CCG will assess performance based on Q1-Q3 and will make payments in accordance with the original thresholds.

None required

Frailty 45p This element had 2 sub-elements. The first was for identification and undertaking Rockwood Assessments. The second was for full assessment and additional support. Practices were given a target number of patients for the year with payments based on the level of achievement.

The CCG is able to collect monthly information on achievement, but in light of COVID-19 will add onto the numbers reported to February 1/12th of the annual target, i.e. effectively assuming that the Practice would have achieved all of these in the final month. This adjusted total will be compared to the annual target to identify percentage achievement

None required

of 17



and the CCG will make payments in accordance with the original thresholds.

Care Planning Maximum £3.25

Practices receive £125 for each complete new care plan and £75 for each complete review of a care plan. The CCG identifies the number of care plans undertaken and has agreed that any care plan will be counted if it was for an eligible patient. Subject to the maximum payment of £3.25 per registered patient, the CCG will pay the higher of the total of all claims made by Practices and the total as at the end of February 2020 plus 27p per registered patient (being 1/12th of £3.25).

None required

Respiratory 30p The CCG was supposed to provide Practices with a baseline list of patients, but was unable to do this for the majority of Practices. Practices were therefore unable to comply with this element and it is proposed that the 30p is paid in full to all Practices.

None required

Diabetes 60p This element had 2 sub-elements both requiring 70% to be achieved for full payment and with thresholds for partial payment. Given this is a longstanding CFF element and payment was associated with continued improvement up to and beyond 70%, the CCG will measure performance as at both Q3 and Q4, taking the higher performance and will relax all performance thresholds for full and partial payment by 2.5 percentage points.

None required

Cancer - improve screening uptake

70p Performance information is provided by NHSE after the year-end from information supplied by Public Health England. Payment thresholds for this element were set depending on whether a Practice’s starting position was above or below the national target.

For practices below the national target at the beginning of the year, the achievement thresholds will all be relaxed by 2.5 percentage points.

For practices above the national target at the beginning of the year, but whose performance worsens, 2.5 percentage points will be added onto their actual performance and achievement will be measured based on this adjusted performance.

None required

Cancer audit 45p This element required Practices to report quarterly providing evidence of practice meetings, identification of issues or themes, and showing actions that the locality has taken and the outcomes, as well as areas of learning and best practice.

Any Practice that met the requirements of Q1-Q3 will be awarded this element. Any Practice that did

None required

of 17



not meet the requirements of Q1-Q3 will not be awarded this element.

Compliance with CCG Pathways

10p This element required year round compliance with pathways and was measured centrally by the CCG. Any Practice that met the requirements of Q1-Q3 will be awarded this element. Any Practice that did not meet the requirements of Q1-Q3 will not be awarded this element.

None required

Peer Review 25p This element required Practices to produce a plan in Q1 describing how they will undertake peer review and then the submission of quarterly reports from Q2 providing sufficient evidence of meeting the Practice’s plan. Any Practice that met the requirements of Q1-Q3 will be awarded this element. Any Practice that did not meet the requirements of Q1-Q3 will not be awarded this element.

None required

Implement thresholds/ IFR referrals/ Prior approval

35p This element required Practices to seek prior approval in primary care for referrals for:

Hip replacement Knee replacement Cataracts Tier 3 obesity services Correction of Dupuytren’s contracture and

ganglion procedures Cosmetic treatments (non-skin)

Achievement was awarded to a Practice where 85% or more of its patients referred to services and receiving care had prior approval in place.

With routine elective activity suspended and so prior approval also suspended during March, the CCG will assess performance based on April to February.

None required

Medicines Management

40p This element had 3 sub-elements being: reduction in prescribing of antibacterial

prescription items per STAR PU broad spectrum antibiotics Over the counter medicines

All reporting is undertaken by the CCG and there is no reporting burden for Practices.

Performance on the first 2 elements is assessed over the 12 months to 31st March 2020. This includes a short period of time coinciding with the planning for and response to COVID-19 and there may be a small impact on a Practice’s performance. In considering payment for these elements the CCG will consider near misses and the extent to which this may have impacted by COVID-19.

None required

of 17



On the 3rd element performance was assessed on the 2019 calendar year so COVID-19 will not have impacted on this element. Achievement will be assessed as per the original CFF.

In setting out the proposals above, the CCG has attempted to recognise the time Practices will have

lost in delivering the CFF and the impact of this on reported outcomes. The CCG has also sought to

reduce the reporting burden on Practices by requiring no further reports on 2019/20.

1

Agenda Item No: 10



Paper Title: HBL ICT Response to the Covid-19 Pandemic


Report author: Phil Turnock, Chief Digital Officer

Shane Scott, Head of Informatics, HBL ICT

Report signed off by: Phil Turnock, Chief Digital Officer

Executive Summary: The purpose of this paper is to share with the committee the accelerated digital activities in response to the Covid-19 pandemic

Headline Covid-19 Deliverables: Increased support capacity Increased VPN capacity for both corporate & GPIT Rapid deployment of circa 1,000 laptops to HCT, HPFT &

GPIT Enabled Video Conferencing for patient consultations and

for Corporate meetings Provided multimedia screens and cameras for video

conferencing in practices Deployment of Microsoft Teams to all laptops and desktops Installed Adastra to all GP devices Set-up 111 service in Charter House Deployment of SystemOne Hubs for 10 of 12PCN’s Technical enablement of Primary care Hot Sites Additional functionality for GP Connect in practices EPS Phase 4 in 75% of practices On-Line consultations at 42 practices SCR-AI being enabled centrally for all practices

GPIT Project Progression: Windows 10 HSCN Migration – July 2020 N3 to HSCN Migration – Aug 2020

Futures: Investigating virtual smartcards Inclusion in the new national N365 Microsoft Office Suite

Recommendations

to the members: 1. To gain an understanding of

2


involved:

The GPs on the PCCC declare and manage conflicts of interest on a case by case basis where decisions could impact on their role as providers of healthcare.

The CCG’s policy on management of conflicts of interest has been reviewed and updated to ensure alignment with the recently published guidance from NHS England

3

1. Executive Summary

The purpose of the report is to advise the Primary Care Commissioning Committee on the extensive digital advancement in response to the Covid-19 pandemic.

During the unprecedented times that all of our services are experiencing with Covid-19, the digital agenda has moved forward significantly and has been able to add value to service delivery throughout the HBL Partnership, including Primary Care.

The report focusses on two phases to the Covid-19 digital response:

Phase 1 – Digital Deliverables (Enabling) Phase 2 – Digital Renewal (Sustaining – the new norm)

The digital response to Covid-9 has been as direct result of the extensive investment technology investment within the HBL Partnership at both a core infrastructure and end user device levels, which has put the Partnership in a unique position to deliver at scale and pace throughout the Partnership.

A further key enabling factor, has been the availability of funding at a national level from NHSE/I and new digital initiatives from NHSD which will further advance the digital agenda.

1. Phase 1 – Digital Deliverables (Enabling)

Supporting Member Organisations The following are the key deliverables that are within the enabling phase of the Covid-19

response.

Operational Support

The operational support teams in HBL saw a 100% increase in demand for support calls

during the initial 5 weeks from the point of ‘lock-down’, the primary reason being saturation

of VPN services and advice and guidance for flexible working. To manage the increase

demand, the following actions were taken:

Redeployment of non-operational ICT staff to the Service Desk

Prioritised support across the ‘Live-Chat’ communication channel

Developed a new Service Support Portal focusing on supporting flexible working

Increased core support hours over the weekend period, including Public Holidays

Introduced Operational SitRep calls twice daily to focus on escalations/support

issues, with effect from 4th May, these have reduced to once a day.

Increasing Network Infrastructure Capacity across the Member Organisations

Following the official Government lockdown mandate on the 23rd March, the demand for the

VPN service across the HBL network increased by 500%. Due to the in-house technical

expertise, the HBL service was able to adapt swiftly with the following:

4

Developed a non-token VPN service to simplify VPN access, whilst maintaining two-

factor authentication.

Introduced split-tunnelling on the HBL VPN service to enhance performance, by

separating non-clinical network traffic off of the VPN service onto host service

provider.

Completed the HSCN migration at our two data centres, which includes increasing

the bandwidth from 100mb to 1gb at each DC.

Technically enabling re-opened sites for HCT and HPFT for their Covid-19 responses

Enabled and set-up the HCT infrastructure at Farnham House (HCC site) for the

POA service

Mobile Devices ICT End Users Services

In addition to the core infrastructure, there has been a significant increase in demand to

support NHS staff within the Partnership. Over 500 additional laptops and mobile devices

have been issued to staff to ensure that the technology supports the new agile working

model; the number of deployments has increased by approximately 125% on normal levels.

We continue to have a good stock of devices and any requests can now be delivered within

2 3 days.

Video Conferencing for Meetings & Patient Consultations

The introduction of video conferencing (VC) has been achieved at pace and has been well

received by all member organisations who are now routinely using VC where it is

appropriate. HCT & HPFT are using a number platforms for patient consultations including

the national platforms of Attend Anywhere and Accurx together with WhatsApp as a back-up

option.

To assist in the wider collaboration agenda, Microsoft Teams which has been centrally

funded for the Covis-19 response has now been made available to all staff within the HBL

Partnership, including Primary Care. As the use of MS Teams grows it is evident that this

will allow a different way of working and allow the HBL Partnership to become more agile in

how we work, reducing the dependency on staff working in the office.

For larger meetings and committees within ENHCCG, Webex has been provided as a VC

solution, as this allows greater visibility and control of the meetings.

Herts Urgent Care 111 Service

In the last four weeks, mobile devices have been set-up in Charter House which are then

connected by to HUC installed with their EPR (Adastra) and phone systems so that CCG

staff are able to be deployed to support the 111 service. Likewise at Kingsway Health Centre

and Cheshunt Community Hospital.

Within Primary Care, the Adastra software has also been installed on every GP laptop to

enable GP’s to access the 111 service. In total this exceeds 2,000 instances of the

software.

5

Supporting Primary Care Within Primary Care there has been a rapid response to digitally enable Practices in

response to the pandemic. The realisation of this response has been to flexibility of

resources within HBL & ITS Digital and the significant funding that has been made available

centrally from NHSE/I and NHSD.

Operational Support

Working with ITS Digital, additional support has been provided to Primary Care including

extended hours support at weekend and public holidays.

In addition, regular communications have been issued to all practices to support their uptake

of the new technologies and systems that have been provided.

Video Conferencing for Patient Consultations

IG tested and validated video consultation systems (Accurx & Clinic.co.uk) for use in

practices.

MS teams installed on all primary devices

Procurement, delivery and installation of 150 multi-media monitors to enable video

conferencing and 400 webcams and headsets to enable video conferencing

Increase Virtual Private Network (VPN)

Across Primary Care in the four CCGs we support we have increased the capacity of the

remote access solution (VPN) from 1200 user licences to 3,200 and the number of

concurrent instances has increased from 100 to 2,250, making the service far more available

and responsive.

Although the increase in VPN licences was not made available by RedCentric until 16th April,

HBL deployed a tactical VPN solution from the HBL data centre’s to mitigate the elapsed

time from the start of lock-down to the 16th April.

Provision of Additional Laptops to GP’s

One of the key deliverables for facilitate flexible working within Primary Care has been the

rapid deployment of a laptops to all practices, with allocated volumes geared to population

size.

Procurement, build and delivery of 416 additional laptops

Bringing back into service of 115 laptops, these are laptops that were deployed

sometime ago and needed refreshing.

This key deliverable was dependent upon centralised funding from NHSE/I

Primary Care Systems

From a systems perspective, there has been a significant advancement in progressing

national and local systems, the development of these systems was already in train, but due

6

to Covid-19 has now gathered momentum at pace. This also includes the technical

enablement of 13 hot sites across the ENH Primary Care.

SystemOne Hubs

Ordered, received and configured additional SystmOne hubs to enable collaborative

working. The plan is to have 12 hubs, one for each PCN, to date there are 10 operational

SystemOne hubs.

GP Connect

Additional functionality has been rapidly deployed across GP Connect to give GPs, NHS 111

clinicians, and those in urgent and emergency care settings providing direct care, access to

all primary care medical records through the GP Connect solution.

improve GPs ability to treat patients outside of their registered practice, giving

patients easier access to a GP when they need one, regardless of demand or staffing

levels in their own practice, for example within a network or a federation hub. If your

Federation/PCN wish to use GP Connect Appointment booking functionality, please

e-mail [email protected] to initiate contact.

give authorised health and care professionals working in primary care, NHS 111 and

the COVID Clinical Assessment Service (CCAS) - and other appropriate direct care

settings, access to the GP records of the patients they are treating, regardless of

where they are registered

allow remote organisations such as NHS 111 to book appointments directly with the

patients GP practice including the ability to manage referrals from the COVID Clinical

Assessment Service (CCAS). This will enable healthcare professionals to provide

more timely care and provide flexibility for the primary care system.

Electronic Prescribing Service (EPS) – Phase 4

During April, EPS Phase 4 become available from NHSD and is now being deployed across

all practices, within ongoing support on usage. This phase allows electronic prescriptions to

be issued without the patient having a nominated pharmacy on their record, therefore the

patient can then attend any pharmacy to obtain their prescription.

To date circa 75% of ENH practices has EPS Phase 4 enabled.

EPS in non-GP SystmOne hubs enabled

On-Line Consultations

Supported the further rollout of OnLine Consultations to practices across the CCG. To date,

42 practices have gone live with the service.

Summary Care Record – Additional Information (SCR-AI)

Following a national directive from NHSD & NHSX, the additional information patients will

now be included in the SCR across all practices. The system changes will be enabled by the

7

system providers (TPP & EMIS) and will be made available over a 4 week period

commencing 23rd April.

The additional information included in SCR-AI (Formally known as Enhanced Summary Care

Record) includes the following and is a significant step forward in formation sharing and

interoperability.

Significant medical history, past and present.

Details of the management of long-term conditions

Medications

Immunisations

Care plan information

There will also be a temporary change made to SCR_AI to include COVID-19 specific codes

in relation to suspected, confirmed, Shielded Patient List and other COVID-19 related

information.

Patients who have opted-out of having a Summary Care Record or chosen to have a core

Summary Care Record only by declining to provide consent for additional information to be

shared will continue to have their preferences respected.

The decision to enable SCR-AI will be reviewed after three months.

2. Phase 2 – Digital Renewal – (Sustaining – the New Norm) COVID-19 has presented a need and opportunity to advance the digital agenda across the

NHS, and therefore Phase 2 needs to put in place procedures and investment to sustain this

momentum, whilst embracing further opportunities.

As we move to the “new normal” we will need to reflect on and evaluate all of the digital

responses we have delivered and propose to deliver in the response to COVID:

Adopt - accept the digital implementation and transition to BAU

Adapt - amend the digital implementation and then transition to BAU

Abandon - do not continue with the digital implementation

One of the key successes has been the usage of video conferencing for both clinical

consultations and corporate business meetings. Moving forward we need to embrace this as

a new norm and not just a tactical response to the pandemic

Some of the solutions, whilst appropriate as a tactical solution for the Covid-19 response

may not be functionally and financially viable as a solution moving forward.

In addition, there are new technologies which will need to be considered and evaluated.

These include:

Virtual Smartcard

Physical smartcards and readers can be a barrier in PPE and sterile environments and can

be logistically complex to manage where the cards need to be deployed across a wide

geography as is the case for the HBL Partnership. Working with a 3rd Party Supplier

8

(Isosec) NHSD has now approved a virtual smartcard solution which can replace the need

for a physical card which still maintaining 2 factor authentications.

Therefore, moving towards a virtual smartcard will remove this barrier and will improve

opportunities for robotics and automation within clinical systems. HBL will be working to

investigate opportunities for using virtual smartcards as this will simplify authentication onto

systems and speed up initial registration process.

N365 (NHS Microsoft Office Suite of Services)

NHSD are in the process of agreeing a national contract for Microsoft licencing to allow the

continued use of MS Office suite of services (Word, Excel, etc) and migration to an Office

365 platform which will include greater collaboration options and system security. This

agreement known as N365, will allow NHS organisations including primary care to access

Microsoft office suite of services across various care setting and organisations enabling

greater collaboration, joint working and sharing of documentation.

The proposed new contract will allow NHS organisations to have a choice of shared or local

tenancy options so that they can maintain local controls of system policies and procedures.

Windows 10 Migration for Primary Care

Work on the Windows 10 rollouts has been impacted by Covid-19 pandemic and the need to urgently deploy large numbers of laptops to support remote working. Whilst these laptops are built to Windows 10, the work on the existing desktop estate has slowed accordingly. For practices in ENH, 94% have been migrated and the remaining 6% will be completed to meet the extended deadline of end of June 2020.

HSCN Migration

The HSCN migration has also been significantly impacted by the impact of Covid-19. To

date 19 of the 51 practices have migrated to HSCN, with the remaining 32 practices

scheduled to be migrated by the end of July.

Remaining Practice Migration to HSCN

Month No. Practices

May 17

June 10

July 5

1

Agenda Item No: 11



Paper Title: Primary Care Devolved Commissioning

Finance Report Month 12 2019/20


Report author: Philip O’Meara, Senior Finance Manager

Sunday Adeniyi, Deputy CFO


Alan Pond, Chief Finance Officer

Executive Summary: This paper provides details of the finance position at the end of the financial year - March 2020.

The allocation for devolved commissioning as at the end of March remained at £74.718m for the full year.

At year-end Primary Care Devolved Commissioning expenditure was £72.589m, with a reported underspend of £2.129m against the allocation received.

At month 11 the CCG had forecast spend of £72.570m and still held unallocated resources (£1.014m) and contingency reserves (£0.385m) neither of which were utilised in month 12.

Recommendations

to the members:

To note the year-end position.


involved:

There are no conflicts of interest

Conflict of Interest Definitions The following table describes the sub-classifications of interests:

Type Description




2




1. EXECUTIVE SUMMARY

This paper provides details of the finance position at the end of the financial year - March 2020.

The allocation for devolved commissioning as at the end of March remained at £74.718m for the full year.

At year-end Primary Care Devolved Commissioning expenditure was £72.589m, with a reported underspend of £2.129m against the allocation received.

At month 11 the CCG had forecast spend of £72.570m and still held unallocated resources (£1.014m) and contingency reserves (£0.385m) neither of which were utilised in month 12.

2.0 PRIMARY CARE DEVOLVED COMMISSIONING ALLOCATION & BUDGETS

The table below shows a summary of 2019/20 CCG devolved commissioning allocation and planned spend as approved by the Primary Care Committee Board.

Summary of 2019/20 Allocation vs Planned Spend

2019/20 High Level Financial Plan E&N Herts

£'000

Published 2019-20 Allocation 76,951

Less: Clinical Negligence Centrally Managed Less: 'GP at Hand patient transfers

(2,215) (18)

Resources Available for Commitment 74,718

Planned Spend 73,319

Uncommitted 1,014

0.5% Contingency 385

Total Commitments (Inc.: Contingency) 74,718

2.1 PRIMARY CARE DEVOLVED COMMISSIONING EXPENDITURE OVERVIEW

The Primary Care Devolved Commissioning reported position at year end is an underspend of £2.129m, made up of £0.730m on the allocated budgets, £1.014m on the uncommitted

3

headroom and £0.385m on the contingency reserve. The table below shows a summary of the financial position as at end of March 2020.

GMS Contracts The reported year end spend for GMS contracts is £46.5m with an overspend of £211k. This overspend is due to the list size difference between the plan and the outturn.

APMS Contracts The reported year to date spend for APMS contract is £3.2m with a slight overspend of £34k.

Enhanced Services This budget includes: Extended Hours of £1.45 per weighted population, learning disability DES, minor surgery DES, Special Allocation Scheme (formerly violent patients) DES, translation fees LES and the Safeguarding children & vulnerable adults - General Practice Reporting budget of £120k.

The reported year end spend for enhanced services is £1.3m, with a slight underspend at year end of £28k. Learning disability DES for quarter 4 has yet to be received but is accrued and still reported an underspend of £121k which offset overspend within Extended Hours LES, Translation fees and Minor Surgery.

Primary Care – Other This budget includes: doctors retainer scheme, locum/maternity cover, locum sickness cover, seniority. The reported year end spend is £1.9m, representing an overspend of £277k compared to budget. The most significant driver of this overspend was increased use of locums within primary care, a variance of £284k overspent. The support costs for the Upper Lea Valley practice closures and patient dispersal costs were fully utilised by year end.

DescriptionAnnual budget

(£'000)

Forecast Outturn

(£'000)

Annual Budget

Variance

(£'000)

GMS Contracts 46,239 46,450 211

APMS Contracts 3,127 3,162 34

Enhanced Services 1,315 1,287 (28)

Primary Care - Other 1,652 1,930 277

Prescribing/Dispensing 1,501 991 (510)

QOF 7,463 7,463 0

Premises 7,491 7,752 260

Primary Care Networks 2,810 2,232 (578)

Winter Resilience/Flu 875 875 0

Primary Care Workforce Education

Network 436 150 (286)

Primary Care Support 410 299 (111)

Sub Total Allocated Budget 73,319 72,589 (730)

Uncommitted Headroom/Reserve 1,014

Contingency 385

Total 74,718

PRIMARY CARE DEVOLVED COMMISSIONING POSITION AS AT MARCH 2020

4

Prescribing/Dispensing This budget includes: dispensing and prescribing fees for both GMS and APMS contracts. The reported full year position is an underspend of £510k, the majority of which is reduced level of prescribing fees compared to budget and a lower level of prescribing than expected over winter.

QOF is reporting breakeven against budget for the full year.

Premises The budget allowed for full year effect of new premises in 2018/19, rent reviews 1% per annum increase on all premises, rent on new premises in 2019/20 compared to old premises. Regular rent reviews are still to be completed and the CCG has prudently accrued to meet these potential liabilities. The outturn reflects an overspend of £260k primarily as a result of increased vacant/void space charges from NHS Property Services.

Primary Care Networks The reported year to date spend for PCNs is £2.2m with an underspend of £578k. Allocated funding of £120k was previously released from the uncommitted budget to support PCNs to train and equip staff or for similar non-salaried support to help with further mobilisation. A significant number of the posts available for funding under the national Additional Roles Reimbursement Scheme are yet to be recruited into.

Winter Resilience/Flu The reported full year spend is £875k and has achieved a breakeven position.

Primary Care Workforce Education Network The reported full year spend for PCWEN is £150k with an underspend of £286k at year end. The CCG was holding accruals for a number of training schemes and events which did not materialise by year end and the accrual had to be released.

Primary Care Support This budget is made up of a number of previously approved support functions of Safeguarding and Data Protection Officer (DPO). There is an underspend of £111k for the year.

Contingency The CCG contingency provision of £385k was not utilised.

5

3.0 TOTAL ENHANCED AND LOCALLY MANAGED SERVICES EXPENDITURE OVERVIEW

The following section reports the total CCG Primary Care Enhanced and locally managed services.

3.1 CFF, Enhanced Services and other Primary Care Funding

CONSOLIDATED FUNDING FRAMEWORK (CFF) CFF Components have been accrued to budget with some minor variances where practices have opted out of the service since evidence of achievement can only be established in the coming months.

ENHANCED SERVICES CLAIMS Expenditure reflects actual claims with CCG accruals for practices who have not submitted their claims yet. The month 12 accrual is based on the average of M1-M11 actual spend. There is a full year underspend of £34k.

OTHER FUNDED LOCAL SCHEMES Primary Care Network (PCN) Core budget of £1.50 per patient (£905k) is paid to practices for participation in PCNs. There is a slight underspend as it is paid on actual patient numbers.

Service DescriptionAnnual Budget

(£'000)

Month 12 Outturn

(£'000)

Forecast Variance

(£'000)

Consolidated Funding Framework (CFF)

£1.50 Frailty £1,084 £1,084 (£0)

£3.25 Capped Frailty £1,957 £1,957 (£0)

Cancer £692 £692 (£0)

Engagement £596 £596 (£1)

Financial Balance £903 £903 £0

Planned Care £662 £662 (£0)

Record Sharing £181 £176 (£5)

PMS Premium £0 (£200) (£200)

Consolidate Funding Framework (CFF) Total £6,075 £5,869 (£205)

Enhanced Services Claims

Anti-coag £446 £413 (£33)

Dementia £148 £146 (£2)

Near Patient Testing £137 £137 £1

Enhanced Services Claims Total £730 £696 (£34)

Other Funded Local Services

£1 Per Patient £603 £603 (£0)

Care Homes £857 £830 (£28)

Care of Homeless £4 £4 (£0)

PCN Support £905 £902 (£3)

Phlebotomy £0 £0 £0

Unallocated Funding £0 £3 £3

Other Funded Local Services £2,370 £2,342 (£28)

Grand Total - Enhanced and Locally Managed Services £9,174 £8,907 (£267)

Total Enhanced and Locally Managed Services as at March 2020

6

3.2 GPIT Budget Statement March 2020

The financial position of the GP IT budget is as shown in the table below. GP IT budget is showing a small full year overspend of £21k.

4.0 CCG Update on specific Primary Care allocations

The following section reports on specific Primary Care allocations under General Practice Five Year Forward View (GPFV):

4.1 GPFV Transformation Funds (£1.50)

The CCG had an underspend of £754k which was brought forward into 2019/20. A total of £628k expenditure has been incurred to date. Other than GPIT support, the balance remaining is committed against existing schemes.

GPITSum of Annual

budget

(£)

Sum of YTD

Actual

(£)

Sum of YTD

Variance

(£)

Total Pay £327,632 £346,383 £18,751

Computer Hardware Purch £201,000 £63,993 (£137,007)

Computer Software/License £160,000 £174,847 £14,847

Computer Network Costs £36,039 £34,160 (£1,879)

Computer Maintenance £160,000 £184,150 £24,150

Telecom £128,935 £115,651 (£13,284)

Data Lines £271,052 £264,433 (£6,619)

Travel Costs £500 £0 (£500)

Training Expenses £500 £1,319 £819

Other ICT Costs-IT Security Costs £10,000 £48,163 £38,163

Miscellaneous Expenditure £0 £83,334 £83,334

Total Non-Pay £968,026 £970,049 £2,023

Total Expenditure £1,295,658 £1,316,432 £20,774

Recharge : Received £663,342 £663,342 £0

Total Income £663,342 £663,342 £0

Total (Under)/Overspend £1,959,000 £1,979,774 £20,774

7

Localities Annual B/F

(£)

Month 12 Outturn

(£)

Month 12 Variance (£)

Lower Lea Valley £13,351 £13,350 (£1)

North Herts £167,020 £145,370 (£21,650)

Stevenage £193,993 £189,601 (£4,392)

Stort Valley & Villages £40,838 £29,248 (£11,590)

Welhat £205,511 £160,105 (£45,406)

Upper Lea Valley £113,963 £92,114 (£21,849)

GP IT Support £18,993 (£2,203) (£21,196)

Grand Total £753,669 £627,584 (£126,085)

4.2 Practice Staff Training – Care Navigation and Workflow Optimisation

The CCG had an underspend of £91k which was brought forward into 2019/20. The allocation for 2019-20 of £101k transferred from STP resources in month 6. Full Year expenditure and accruals for outstanding commitments is £192k hence the budget has reported a breakeven position.

4.3 Online Consultations

The project to implement Online Consultation is ongoing. Allocations were received in 2017/18 and 2018/19 and unspent funds carried forward into 2019/20. The allocation for 2019/20 of £165k, transferred from STP resources. This funding is fully committed to date. A further £139k is expected in 2020/21.

The expenditure and commitments are set out below.

£000

Allocations received and proposed

17/18 & 18/19 Allocations 346 Held by CCG

19/20 Allocation 165 STP Capitated Share

20/21 Allocation 161 STP Capitated Share

672

Expenditure and Commitments over the project period

Senaca Phase 1 (36)

Senaca - additional phase 1 (24)

Senaca - phases 2 & 3 (84)

Seneca - Phase 4 (80)

HBLICT Support costs (50)

19/20 Pilot costs- eConsult (14)

Pilot practice support (78)

Implementation- eConsult (18 mths) (135)

Practice support/backfill (150)

Total Spend and Commitments (651)

Residual Balance 21

Online Consultations plan and commitments

8

4.4 Extended Access

Total allocation increased from £4.00 to £6.00 per patient and is £3.398m. Expenditure of £2.3m was incurred as the current price is £4.08 per patient including inflation for 19/20.

4.5 GPFV GP International Recruitment

The CCG received separate income for a project lead to undertake the work. Outturn and income received means the project achieved a breakeven position.

GPFV International Recruitment Project to March 2020

Description Annual Budget

(£)

Outturn (£)

Outturn Variance

(£)

Forecast Outturn

(£)

GPFV Int GP Recruitment Allocation

63,625 63,625 0 63,625

Total 63,625 63,625 0 63,625

Income from NHSE (63,625) (63,625) 0 (63,625)

Over/(under) 0 0 0 0

4.6 GPFV GP Retention Scheme

The allocation was retained by West Essex CCG to be centrally managed by the STP.

Extended Access By Locality to March 2020

LocalityAnnual budget

(£)

Outturn

(£)

Variance

(£)

LLV 299,120 299,120 (0)

North Herts 433,587 433,587 0

Stevenage 384,279 384,279 0

SVV 233,530 233,530 (0)

ULV 450,306 451,298 992

Welhat 465,806 467,911 2,106

HUC Locality Cover 33,604 0 (33,604)

Other Support Costs 65,460 65,471 11

Total 2,365,693 2,335,197 (30,496)

Centrally Held 1,032,307 0 (1,032,307)

Total 3,398,000 2,335,197 (1,062,803)

Allocation received 3,398,000

Underspend against allocation (1,062,803)

9

4.7 GPFV Practice Resilience

The allocation for 2019-20 of £75k originally sitting within STP resources was fully spent at year end.

4.8 GPFV PCN Support

The allocation for 2019-20 of £413k originally sitting within STP resources was transferred into the CCG’s own allocation to manage directly from Month 6. It was fully committed by year end.

5.0 RECOMMENDATIONS

To note the report.

Alan Pond Chief Finance Officer May 2020

1

Agenda Item No: 12



Paper Title: Primary care Delegated Commissioning 2020-21 Financial Plan


Report author: Sunday Adeniyi – Deputy CFO


Alan Pond, Chief Finance Officer

Executive Summary: NHS England has published the primary care allocations and planning assumptions for 2020-21.

This paper sets out proposed budgets for Delegated Commissioning. The budget has modelled all the changes as published in the planning guidance. It has also allocated funding to local schemes as approved by the Primary Care Commissioning Committee (PCCC).

Recommendations

to the members: To approve the delegated primary care commissioning budget for 2020-21 and to note the risks identified


involved: There are no conflicts of interest

Conflict of Interest Definitions The following table describes the sub-classifications of interests:

Type Description







2

2019-20 Operating Financial Plan

1.0 Introduction

NHS England has published delegated primary care allocations and planning assumptions for 2020-21.

This paper sets out proposed budgets for Delegated Primary Care Commissioning. The budget has modelled all the changes as published in the planning guidance. It has also allocated funding to local schemes as approved by the Primary Care Commissioning Committee (PCCC).

2.0 Allocation

The 2020-21 allocation to East and North Hertfordshire CCG for delegated primary care commissioning is £79.241m after taking account of the published allocation, adjustment for the centrally funded state backed indemnity scheme, loss of funding for patients rewgistering with digital primary care providers and increased allocations for changes NHSE/I have made to the primary care contracts in 2020/21.

The guidance requires CCGs to hold a contingency reserve of 0.5% of initial allocation and after allowing for this, the resources available for spending are £78.849m. The calculated budgets total £77.283m leaving uncommitted funds of £1.565m, as shown in the table below.

Summary of 2020/21 Allocation vs Planned Spend

2020/21 High Level Financial Plan E&N Herts

£'000

Published 2019-20 Allocation 80,739

Less: Clinical Negligence Centrally Managed (2,319)

less: Emerging digital delivery model (25)

Additional Expected Allocation 846

Resources Available for Commitment 79,241

Planned Spend 77,284

Uncommitted 1,565

0.5% Contingency 392

Total Commitments (Inc: Contingency) 79,241

3

3.0 Control Total

NHS England expects CCGs to spend the delegated budget on Primary Care Commissioning. However, in 2020/21 NHS England is also requiring the CCG to deliver an in-year underspend against its total allocation of £4.1m. The required underspend is being achieved by the CCG drawing down £4.1m from its accumulated underspend, meaning in-year resources can be committed in full.

The £1.565m uncommitted funding shown in the table above is therefore available to be spent.

4.0 2020-21 Financial Planning Assumptions

The CCG delegated commissioning plan assumes the following:

Weighted list size has been updated to April 2020 as published and list size

growth of 0.25% is assumed for each of the subsequent three quarters.

Increase in Global Sum – In line with the guidance, global sum price per weighted

patient increased from £89.88 to £93.46 (4% or £3.58). GMS Out of Hours Opt

Out deduction changes from 4.82% in 2019/20 to 4.77% or £4.46 in 2020/21. The

net global sum price is therefore £89 per weighted patient.

Seniority payments and Minimum Practice Income Guarantee (MPIG) payments

have now come to an end however they are reinvested into the global sum price

set out above.

APMS budget updated to maintain existing contract agreements with a 20%

premium on the Global Sum.

Increase in the value of Quality and Outcomes Framework (QOF) points from

£187.74 to £194.83 (3.8% or £7.09), resulting from the updated Contractor

Population Index (CPI). Number of QOF points has increased by 8 from 559 to

567. The budget assumes 100% achievement. 70% is usually paid monthly as

aspiration and the remaining 30% is paid based on achievement.

Enhanced Services:

o Learning disability is estimated from the total patients on the learning

disability register multiplied by £140 per health check.

o Minor Surgery – Cohort list size updated to reflect latest populations;

injections will be paid for at £43.79 while invasive (incision/excisions) will be

paid for at £87.60.

o Violent patient management is a joint scheme with Herts Valley CCG. ENH

CCG has a case of one violent patient requiring more support hence has

provided more funding into this service.

o Funding provided for doctors to write safeguarding reports. This is a

continuation of the commitment made in 2019-20 to pay £45 per report. The

price will be reviewed once further detail is received on the level of resource

input required, to enable the CCG to confirm an appropriate payment rate

going forward.

4

Prescribing/Dispensing - Based on previous year spend with a 5% uplift.

Business Rates – updated to coinfirmed values

Premises Rent budget is based on actual rents to be paid in 2020-21, with

estimates made for new/expanded premises and a 3% allowance (£200k)

provided for in-year rent reviews

Funding was allocated to Primary Care Networks (PCNs) largely based on the

ready reckoner as shown in the table below, but with the following exception:

o Additional Roles Reimbursement – CCG allocations only include 60% of the

£7.13 with CCGs able to claim the balance only upon evidence of additional

spending so the budget only allows for 60% of the cost

5.0 Expenditure Plan

After applying the above assumptions, there remains unallocated headroom of £1.565m. A comparison of the 2019/20 budget, 2019/20 outturn and the 2020/21 proposed budget is shown in the table below.

The key movements are explained as follows:

GMS budget is up and APMS budget is down because of the closure of Ware Road and Orchard Surgeries and the transfer of their patients to GMS providers

Enhanced Services budget is down because of the move of Extended Hours to PCNs

Primary Care Other budget is down because of the cessation of seniority payments and removing the budget for GP Practice reliance and transformation because we receive a separate in-year allocation for this from NHSE.

Annual funding stream

Funding available per

registered patient

(unless otherwise stated)

Basis of calculation

i. Core PCN funding 1.50

total number of registered patients for the

practices across the Network at 1 January

2020

ii. Clinical Director contribution 0.72



2020

iii.Additional Roles Reimbursement sum

(funding figure per weighted patients)7.13

total number of weighted patients for the


2020

iv.

PCN Care Home Premium: £60 per bed, based

on CQC data on beds within services

registered as care home services with nursing

(CHN) and care home services without nursing

(CHS) in England *

60.00

the estimated number of CQC registered care

home and nursing home beds within the PCN

from October 2020

v. Extended Hours Access 1.45



2020

vi.Impact & Investment Fund (assumes 100%

achievement)0.67



2020

Total indicative net effect

2020-21 Primary Care Network - Maximum Network Funding

5

Prescribing/dispensing budget is down to reflect the large underspend in 2019/20 QOF budget is down reflecting lower than national average deisease incidence Premises budget is up because of new premises, rent reviews, increased rates,

increased NHSPS voids PCN budget up because of the full year effect and expansion in additional staff

roles Primary Care support budget up because of the transfer of costs previously

charged to CCG running costs, but actually support primary care Winter budget is down to take out the non-recurrent funding rolled over from

2018/19 to 2019/20 to provide support for April 2019.

6.0 Financial Risks and Opportunities

The operating financial plan has not included the potential impact of the following risks: Growth in list size may be different from the assumption in the plan.

Current assumption on uptake of enhanced services could change.

Recruitment to the PCN new workforce posts may be slower than budgeted for.

Ongoing impact of COVID-19 and additional National directives.

The CCG has funding set aside as available headroom and contingency to enable it respond to these risks should they materialise.

Description2019-20

Budget

2019-20

outturn

2020-21

Annual

budget

GMS Contracts 46,256,260 46,450,044 49,245,297

APMS Contracts 3,128,343 3,161,841 2,465,091

Enhanced Services 1,314,900 1,287,007 1,024,368

Primary Care - Other 1,652,414 1,929,617 1,134,245

Prescribing/Dispensing 1,500,632 990,829 1,070,812

QOF 7,462,968 7,462,968 6,849,552

Premises 7,491,361 7,751,539 8,352,415

Primary Care Networks 2,809,590 2,231,740 5,327,421

Primary Care Workforce Education

Network (PCWEN) 436,254 150,003 421,917

Primary Care Support 409,616 298,884 628,553

Winter Resilience/Flu 874,907 874,907 764,263

Uncommitted Headroom/Reserve 1,014,000 0 1,565,091

Contingency 384,755 0 391,975

TOTAL 74,736,000 72,589,379 79,241,000

PRIMARY CARE DELEGATED COMMISSIONING

6

7 Summarised Financial position

A slightly more detailed analysis of the budget is set out in the table below.

CCG Primary Care delegated Commissioning 2020-21 Budget

Description

Annual Budget

2020-21

Global Sum 49,245,297

C&M-GMS Global Sum 51,674,664

C&M-GMS OOH Opt Outs -2,478,021

C&M-GMS Other FDR Payment 48,654

APMS Contract 2,465,091

C&M-APMS Contract Value 2,327,091

C&M-APMS OOH Opt Outs -111,000

C&M-PMS Baseline Adjustment 249,000

Enhanced Services 1,024,368

C&M-APMS DES Learn Dsblty Hlth Chk 9,240

C&M-APMS DES Minor Surgery 21,720

C&M-GMS DES Learn Dsblty Hlth Chk 353,484

C&M-GMS DES Minor Surgery 504,924

C&M-GMS LES Translation Fees 15,000

C&M-GMS Safeguarding children & vulnerable adults 120,000

Primary Care - Other 1,134,245

C&M-APMS PCO Locum Sickness 10,000

C&M-APMS PCO Other 14,040

C&M-GMS CCG Transformational Support 0

C&M-GMS DES Violent Patients 62,400

C&M-GMS PCO Locum Adop/Pat/Mat 350,000

C&M-GMS PCO Locum Sickness 75,000

C&M-GMS PCO Other 364,405

C&M-GP PRACTICE REVENUE - PCTF 120,000

Dispersal Costs 28,400

Sterile Products 10,000

Suspended GP's 100,000

Prescribing 1,070,812

C&M-APMS Prof Fees Prescribing 19,710

C&M-GMS Dispensing Quality Sch 49,848

C&M-GMS Prof Fees Dispensing 796,339

C&M-GMS Prof Fees Prescribing 378,711

C&M-GMS PrscChrgsCll&RmttdbyGPCntra -173,796

QOF 6,849,552

Premises 8,352,415

Primary Care Networks 5,327,421

Primary Care Workforce & Education 421,917

Primary Care - Support 628,553

Winter Resilence/Flu 764,263

Uncommitted 1,565,091

Contingency 391,975

Grand Total 79,241,000

7

8.0 RECOMMENDATIONS

To approve the delegated commissioning budget for 2020-21 and note the risks identified.

Alan Pond Chief Finance Officer May 2020

of 9

Agenda Item No: 13



Paper Title: Primary Care Quality Report


Report author: Kelly Young- Primary Care Quality Manager, ENHCCG

Report signed off by: Sheilagh Reavey – Director of Nursing and Quality, ENHCCG

Executive Summary: From the 1st April 2018, ENHCCG was formally delegated responsibility for commissioning Primary Care from NHS England.

This report reviews the latest information available for a number of quality indicators relating to GP Practices in ENHCCG, it highlights the themes identified through the Care Quality Commission (CQC) visits that have already taken place to ENHCCG practices and outlines some of the actions taken to support practices to address these.

Recommendations

to the members:

To note the current CQC updates.

To support the course of action proposed for supporting the

CQC rated ‘Requires Improvement’ practices and CQC rated

Extended Access services

of 9


involved:

GP in attendance may have an interest in Practices discussed in the paper-to be declared



Type Description







of 9


As described on page 1.

2. Background

The Care Quality Commission (CQC) is part of the Information and Risk Sharing Group with

information shared regarding any concerns or issues. The risk sharing meeting is attended

by the CCG (quality, contracts, safeguarding, premises and commissioning), the Care

Quality Commission, the Local Medical committee and representation from the practitioner

performance team at NHSE. At each meeting a risk log containing a number of key quality

indicators/metrics including General Practice High Level Indicators (GPHLI), complaints,

friends and family test, serious incidents, practitioner performance and CQC inspection

ratings are presented and discussed.

Of the reports that have been published, the following outcomes have been achieved: 53

practices are rated as ‘Good’, 1 practice rated ‘Inadequate’, 1 practice rated ‘Requires

Improvement’ and 1 practice has had their inspection archived.

2.1. Table of CQC ratings

* Ware Road Surgery. Please refer to section 2.4.

** 2 practices have now closed (Ware Road surgery and Orchard surgery) but for the purpose of the report and update provided they are included in the total.

COVID-19 update – Primary Care summary

The points below summarise the support to practices in relation to CQC and ongoing

monitoring of quality and patient safety.

The CCG are continuing to support practices however due to current circumstances,

the Quality Assurance Visits (QAV) to practices have been temporarily stopped.

Instead regular contact is being maintained with these practices and support is

continuing to be offered remotely.

Locality Outstanding Good Requires Improvement

Inadequate Inspected awaiting

publication

Archived inspection

Comments

North Herts 0 11 0 0 0 0

Stevenage 0 7 0 0 0 0

WelHat 0 9 0 0 0 0

ULV 0 14 0 1 0 0

LLV 0 7 1 0 0 0

SVV 0 5 0 0 0 1 Sawbridgeworth MC

CCG Area 0 53 1 1* 0 1 TOTAL = 56**

of 9

The Primary Care joint contract and quality visits have been temporarily stopped. The

year 1 cycle has been completed. Over half of the practices have been visited. Year

2 will commence when appropriate.

Planned Extended Access (EA) joint contract and quality visits have been postponed.

Instead, all EA services have been emailed with useful resources/templates to use

going forward. Please see section 2.3.

The CQC have suspended routine inspections but will continue to monitor services.

Weekly calls between the primary care quality team and the CQC have been

established to ensure regular updates of any urgent issues.

The CCG continues to maintain regular oversight of practices through the risk and

information sharing meeting. This is to ensure any urgent issues from both a quality,

contracts and premises perspective are monitored.

The CCG continues to follow its internal whistleblowing process to respond to any

concerns that may arise.

To ensure the management of patient safety in primary care and minimising the ongoing

impact on Covid-19, the CCG has contacted practices to highlight the need for practices to

continue to develop systems and processes including:

Ensuring patients have clear information on how to access primary care services,

including mental health help, and are confident about making appointments (virtual or

if appropriate, face-to-face) for current concerns.

Implementing digital and video consultations.

Contacting high-risk patients with ongoing care needs, including patients that are

‘shielding’.

As Primary Care Networks (PCN’s), develop plans to safely see patients at ‘hot’ and

‘cold’ sites.

Making urgent and routine referrals to secondary care as normal.

Stressing to patients the importance of attending any tests and appointments.

Delivering as much routine and preventative work as can be provided safely,

including vaccinations, immunisations and screening.

2.2. CQC inspections/publication since last report

Inspection CQC Rating &publication date

Ware Road Surgery Inadequate 09/03/2020

The Sollershott Surgery Good 30/03/2020

Ware Road Surgery - the practice was rated ‘Inadequate’ Overall, ‘Inadequate’ for Safe and Well Led domains and ‘Requires Improvement’ for Effective, Caring and Responsive domains. Please refer to section 2.4 for further details.

The Sollershott Surgery- the practice was rated ‘Good’ Overall and across the domains.

of 9

2.3. Extended Access service

CQC inspection outcomes for EA services:

EA Inspection date CQC Rating &publication date

Stevenage Health Limited- Kingsway Health Centre

Inadequate 06/11/19

Lea Valley Health- The Maples Health Centre

Requires Improvement 20/12/19

Stevenage Health Limited (Kingsway Health Centre) - received a CQC rating of

‘Inadequate’ Overall, ‘Inadequate’ for Safe and Well-led, ‘Requires Improvement’ for

Effective and ‘Good’ for Caring and Responsive domains.

Areas highlighted by the CQC for improvement included:

o Improvements in the management of risk, oversight of safety assessments

(such as fire safety and legionella), recruitment checks and staff training.

An action plan has been developed based on the CQC published final report.

The CCG have completed regular QAV’s to Stevenage Health Limited to go through

the action plan and progress.

The service closed on 31/03/20 and is now being led by Stevenage South and

Stevenage North Primary Care Networks.

The CCG have been in contact with the new provider to offer support going forward.

Lea Valley Health (The Maples Health Centre)- received a CQC rating of ‘Requires

Improvement’ Overall, ‘Requires Improvement’ for Safe and Well Led and ‘Good’ for

Effective, Caring and Responsive domains.

Areas highlighted by the CQC for improvement included:

o Improvements in the management of risk, oversight of safety assessments

(such as fire safety and legionella), recruitment checks and staff training.

The CCG has shared resources (based on best practice and learning from CQC

inspections) to help support the service.

The CCG will keep in contact to offer support going forward.

Other EA services

The Quality team have produced resources based on best practice to help support EA

services. The CCG had originally planned to complete physical joint contract and quality

support visits however due to Covid -19 this support has now been offered remotely and

resources have been shared with all EA services in ENHCCG. The Quality team will

continue to offer support where required going forward.

of 9

2.4. Practices with ‘Inadequate’ or ‘Requires Improvement’ CQC ratings since last

report

Updates since previous PCCC meeting:

Ware Road Surgery– received an Overall CQC rating of ‘Inadequate’ (Date of publication: 09/03/2020).

The Practice breached on Regulation 12 - Safe care & Treatment and Regulation 17 - Good Governance

The CQC identified : o The practice did not have clear systems, practices and processes to keep

people safe and for appropriate and safe use of medicines o The systems and process for the ongoing monitoring of infection prevent and

control required strengthening. o The overall governance arrangements were ineffective. o The provider did not have clear and effective processes for managing risk,

issues and performance. The CQC confirmed that the practice provided assurance on the immediate actions

identified. The practice closed on 31st March 2020. Patients have been transferred to other

primary care services.

Stockwell Lodge Medical Centre - received an Overall CQC rating of ‘Requires Improvement’ (Date of publication: 18/12/2019).

The CQC inspected the practice in October 2019 and the practice was rated ‘Requires Improvement’ Overall (and across the domains).

The CQC identified a number of areas for improvements including; risk assessments (for Legionella, Health and Safety and Fire), emergency medicines, staff training and appraisals.

Following the inspection, the practice has been addressing many of the issues raised.

The CCG visited the practice on 7th February 2020 to review progress and progress is being made in some areas. The practice is continuing to work on their CQC actions.

The CCG will continue to support the practice going forward and will monitor progress and provide specialist support where required.

A meeting to review CQC actions / progress is currently being arranged. This will be carried out remotely.

2.5. Complaints and Serious Incidents

Serious Incidents There have been no primary care serious incidents reported since the previous PCCC report.

of 9

National Reporting and Learning System (NRLS) There have been two notifications reported on NRLS since the previous report. The CCG have been in contact with the practice to seek assurance on actions and learning.

The reporting of serious incidents is an important part of quality and provides an opportunity for learning and for continual improvements in patient safety. Overall, the number of serious incidents reported by ENHCCG practices remains low. This is not an unusual trend, for example during 2016/17 there were 2 SIs reported for ENHCCG. In June 2018 the CCG contacted all practices to clarify the reporting process and examples of serious incidents were shared.

NHS England and NHS Improvement have recently published the NHS Patient Safety Strategy (2019) which describes how the NHS will continuously improve patient safety, building on the foundations of a safer culture and safer systems. Going forward, the CCG will be supporting practices with primary care patient safety and delivering the patient safety strategy.

Updates since previous PCCC meeting There have been no further updates since the previous report.

Complaints

There have been no further complaints data received since the previous PCCC report. The CCG are currently liaising with NHS England and NHS Improvement.

Figure 1: complaints per quarter

0

5

10

15

20

25

30

Q1 Q2

Nu

mb

er

Quarter

Complaints per Quarter 2019/20

of 9

2.6. Friends and Family Test (FFT)

Q1 2019/20

Q2 2019/20

Q3 2019/20

Q4 2019/20

April 2019

May 2019

June 2019

July 2019

August 2019

Sept 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

England recommend % 90% 90% 89% 90% 90% 90% 91% 93% 90% 90%

CCG recommend % 90% 90% 89% 90% 91% 90% 91% 90% 90% 91%

Practices submitting no data (‘no data’)

20 24 29 25 27 20 23 24 26 24

Practices submitting data

36 31 26 30 28 35 32 31 29 31

Nil returns (‘0’) 4 3 3 3 2 2 5 5 2 4

Practices submitting <10 patient responses

17 18 12 17 12 18 17 15 10 16

Practices submitting =>10 patient responses

19 37 14 13 16 15 15 16 19 15

Of those submitting- range of responses

0-764 0-568

0-587

0-605 0-525 0-688 0-663 0-631 0-473 0-583

The CCG % recommended is in line with the National average. Overall, there are more

practices submitting data than not submitting. Across quarter 1 and 2, approximately half of

those practices that submit data, submit less than 10 responses.

The CCG is requiring improvements in both the response rates and the number of patients

recommending their surgery. The data is reviewed regularly and practices are contacted to

raise their awareness regarding their lack of data submission and provide support / links to

useful resources.

As part of the support visits to practices, the Friends and Family Test (FFT) is discussed.

This includes reinforcing submission requirements, highlighting available FFT resources and

encouraging practices to capture FFT patient feedback for example, sharing the ‘you said,

we did’ feedback posters. The CCG has recently seen that five practices that had previously

not submitted data for over 6 months are now submitting monthly data.

Forthcoming changes to the FFT

In July 2019 NHS England and NHS Improvement (NHSE/I) communicated to providers detailing that following extensive consultation and research, there will be several changes to the way the FFT is carried out across England. The updated guidance has been circulated to practices and changes were due to take effect from 1st April 2020. However, due to the Covid-19 pandemic, there has been further information given on this - please see below.

Update since the previous PCCC meeting

NHS England and NHS Improvement (NHS E/I) have provided the following advice about reducing burden and releasing capacity to manage the Covid-19 pandemic:

Practices will not be required to report to commissioners about FFT results. The requirement to implement the FFT changes by 1 April 2020 has been postponed.

of 9

Patients and carers can be directed to PALS, NHS.uk or Care Opinion (where feedback reviews can be posted online); they can also leave feedback with the CQC or contact Healthwatch.

NHSE/I will advise when to restart submitting FFT data later in the year.

The CCG continues to share relevant FFT communications and updates with practices.

3. Issues N/A

4. Options N/A

5. Resources implications N/A

6. Risks/Mitigation Measures The practice with a CQC rating of ‘Requires Improvement’ and the EA service CQC rated ‘Requires Improvement’ has been offered support by the CCG as detailed in the report.

7. Recommendations To note the current CQC rating updates, the CQC rated ‘Requires Improvement’ practice and CQC rated EA services.

8. Next Steps ENHCCG to continue to monitor quality and report progress related to the ‘Requires Improvement’ practice and the EA service.

of 6

Agenda Item No: 14



Paper Title: Premises


Report author: Sue Fogden – Assistant Director - Premises

Report signed off by: Alan Pond – Chief Finance Officer

Executive Summary: This paper provides an update on Premises Projects during March/April and May 2020.

Recommendations

to the members:

The Committee is asked to note the contents of the report.


involved:

Potential Conflicts of Interest should be considered by all parties at all times and any potential issues raised with the meeting Chair prior to the meeting.



Type Description







of 6

1. Executive Summary

This paper provides an update on all premises projects during March, April and up to 11 May 2020.

2. Background

Capital is funded by NHSE, landlords or Third Party Developers. On projects supported by NHSE

Estates Technology Transformation Fund (ETTF) all eligible professional fees are funded via that

fund. On non ETTF projects, the eligible professional fees are funded by ENHCCG from the delegated

Primary Care Budget. In all projects the additional revenue will be met from CCG’s delegated Primary

Care Budget. On projects that have received PCCC approval, PCCC also approved the additional

revenue. PCCC will also be asked to consider and approve the revenue consequences on future

business cases presented. Since August 2019 and following NHSE/I’s restructure, approval from

NHSE’s Capital Investment Oversight Group (CIOG) is required; these meetings are held monthly.

Update ETTF Projects

1. Puckeridge

The surveyor acting for the Practice completed the second independent drainage survey requested

by East Herts District Council (EHDC) to satisfy one of the planning conditions to prove adequate

drainage discharge. The survey and request to discharge the planning condition has been submitted

to EHDC who advised that they will aim to respond by 3 June 2020 but also advised that under

statutory timeframes they have up to 17 June 2020 to respond.

Due to the revisions on the drainage scheme, the surveyor has also requested a revised tender price

from the lowest tenderer. No increase on cost is expected but cost neutral or perhaps a small saving.

When these two pieces of work have completed, the CCG will submit the tender report to CIOG and

is aiming for CIOG on 25 June 2020.

2. Dolphin House, Ware

Legals completed and the third party developer completed the tender and appointed Conamar as its

contractor. Virtual pre site meeting held via TEAM on Thursday 23 April 2020. Site works start on 18

May 2020 with practical completion scheduled for 16 May 2020. The contractor has attended to all

pre site mobilisation and preparation works.

3. Herts and Essex, South Street and Parsonage

Scheduled project calls every two weeks continued with a full complement of attendance. Final

design was met in accordance with the programme. Tenders will be invited on 23 May with a

request for returns by 3 July 2020. NHS PS/Imagile spoke to contractors to test their interest in

tendering and all were interested; they will be invited.

NHS PS/Imagile are also taking forward the variation under the PFI contract.

of 6

When the tenders are back and have been evaluated, the CCG will upgrade the OBC to FBC and

present it to CIOG along with the exceptionality paragraph 6 exceptionality score sheet that the CCG

completed. EoE CIOG confirmed that NHSE National will be required to give final approval on

exceptionality.

4. Stanmore Road Medical Centre

Scheduled project calls every two weeks continued with a full complement of attendance. Four

tenders were returned in accordance with the programme. One tender was considerably high and

automatically ruled out. When evaluated the lowest tenderer was considerably lower than the other

two and the surveyor acting for the Practice entered into discussions to clarify the accuracy of the

return. This piece of work increased the tender sum but remained the lowest.

The CCG will upgrade the OBC to FBC and present it to CIOG with the tender evaluation and the

exceptionality paragraph 6 exceptionality score sheet that the CCG has completed. EoE CIOG

confirmed that NHSE National will be required to give final approval on exceptionality.

Update CCG Projects

5. Knebworth

Regretfully BT Open Reach did not install the data line despite reporting that they had and this

created a host of problems with completion of the new surgery premises, impacting on when the

Practice terminated its occupation of their existing leased premises and arranging the move into the

new premises. HBLICT worked daily to resolve this finding a solution that facilitated completion.

On site practical completion took place on Wednesday 1 April with limited attendance having regard

to social distancing rules with the contractor, Practice manager, surveyor representing the Practice

and CCG in attendance. Minor snagging and a final clean were outstanding, these were not

significant enough to deny practical completion, but a further problem arose as the contractor’s staff

are based in northern England and they were unable to attend site. These works are arranged to be

completed by 12 May in time for the Practice to move between 16-18 May 2020.

To ease pressure on the Practice on the timing of ending its’ lease arrangements on their existing

premises and the un-confirmed date when the BT data issue would be resolved, the CCG agreed to

rent reimbursement on the existing premises until the end of May 2020 whilst also reimbursing the

new premises costs from 27 April 2020. Note that the lease on the new premises started on 9 April

but the developer agreed to a rent free period until 27 April 2020.

6. High Street, Chesthunt

Site works commenced prior to the COVID lockdown and the Practice had moved into a porta cabin

in the surgery car park. On 27 March 2020 the contractor, in agreement with the landlord who is

funding the works, the Practice, advisors and the CCG agreed that the site would close as it was

proving difficult to maintain social distancing. The contractor reviewed the programme and

workforce and re-opened the site on 29 April 2020. All note the impact of delay on programme but

the contractor has agreed to do all he can to recover lost time.

of 6

7. South Street, Stortford Fields

The relocation to HEH, provides a part solution for South Street and PCCC on 4 November 2019

approved an OBC to relocate the remainder to Stortford Fields. The CCG has challenged the Practice

on the size of the premises proposed at Stortford Fields and reached agreement to maintain all

clinical areas but reduce the administration area on the second floor by 38sqm. The District Valuer

provided his valuation report which didn’t meet the developer’s expectations, but agreement was

reached resulting in an annual rent of £262,400. The November 2019 PCCC paper reported an initial

rent of £262k. As soon as the adjusted second floor plan is provided the DV will be asked to provide

his final valuation.

The Practice, supported by the CCG will complete the FBC and the CCG will present this to a future

CIOG.

8. Thorley Park, branch of Church Street, Bishops Stortford

Scheduled monthly project calls continued.

The managing agent for the landlord withdrew his interest to extend the surgery premises as a

landlord’s scheme based on funding reasons. The Practice has started discussions with Assura with

the aim of appointing them as a third party developer. Assura has started to make land enquiries.

The Practice is getting three quotes for legal advice and considering who to appoint as its monitoring

surveyor. These costs are reimbursable to the Practice from the CCG’s Primary Care Delegated

budget in accordance with the Premises Cost Directions.

9. Hertford, Wallace House, Bircherley Green

Scheduled fortnightly project calls continued with the Practice, their chosen third party developer

and the CCG.

Assura arranged a site visit with Chase Homes to assess the area allocated for health and were

satisfied. They produced an initial layout plan which underwent minor changes following discussion

with the Practice and CCG.

Chase put an opening offer forward to Assura but the offer is significantly above market value,

Assura are now in negotiations with Chase.

Chase submitted its planning application which allows for an area for health but the concern is

reaching a commercial agreement that the DV will support. The CCG has approached EHDC for its

support and a call is being arranged.

10. Letchworth: Garden City, Nevells Road, Birchwood and Sollershot

After months of negotiation agreement was reached between the DV, agent acting for the landlord

and the valuer that the CCG funded. The landlord’s managing agent was ready to submit the terms

of the agreement with her retail client when the COVID lock down was announced. The managing

agent advised that whilst COVID created further pressures on the retail sector, they would not be in

of 6

a position to give further consideration to the health project. The Practices also confirmed that they

had other priorities. Work had begun on the OBC, but this work is currently paused.

11. Spring House, Welwyn Garden City

During the lock down period terms were agreed on a new head lease between HPFT and NHS PS that

resulted in a rent that reflected market value and discounted any value on the porta cabins; an

annual revenue saving of £34,843. NHS PS and the APMS provider are now agreeing terms for the

under lease; the rent will be a straight pass through cost but the aim is to reduce the tenant’s repair

obligation and ensure a break option to facilitate a relocation or development having regard to the

aged porta cabins and capacity issues.

The calls also included discussions with HPFT, NHS PS, the APMS provider and the CCG to plan for

permanent premises. Options have been tabled and are being looked into.

12. Hoddeson

Hertfordshire Community Trust (HCT) and the CCG discussed provision of primary and community

health care. HCT agreed to scope options for the redevelopment of its clinic in Hoddeson.

13. Buntingford

Following a site visit in January with the Practice and CCG, emails subsequently exchanged and a call

took place on 5 May with the Practice, the agent appointed by the joint landlords and the CCG to

scope increasing primary care infrastructure in Buntingford. Options discussed, a further call is

arranged in June.

Hertfordshire County Council and its development arm Herts Living have temporarily paused their

residential development plans for Nevetts Care Home which has re-opened to provide additional

care home bed capacity.

14. Northdown

The Practice appointed an advisor to produce an initial design for the branch surgery in the new

development. Welwyn Hatfield Council confirmed that they will be the development landlord and is

taking the project forward.

15. Astonia House

Nothing to report.

16. COVID – HOT

13 sites set up, 10 of which used surgery premises but there were three areas that were challenging:

Letchworth, Hertford and Hatfield. On all three sites the CCG worked well with HCT to secure Nevells

Road, Bull Plain Clinic and Queensway Clinic. Many of HCT’s services had been suspended, or

arrangements were made for patients to be seen at other locations including the patient’s homes.

Under mutual agreement HCT held onto the running and operational costs and also agreed that

of 6

occupational agreements would not be required. HCT arranged additional cleaning as required for

COVID purposes and provided the access arrangements to all sites.

The CCG approved an Improvement Grant for £15k at Stockwell Lodge to bring into use the surgery

annex as the single COVID HOT site for Lower Lea Valley. Smaller sums of money were spent in

Letchworth and Ware to provide portable shower units.

The footfall isn’t as high as initially anticipated and talks have started on consolidating some sites.

The CCG is in discussion with HCT to understand its plan for how and when it will re-commence its

services as that will impact on the availability of Nevells Road, Bull Plain Clinic and Queensway.

3. Recommendation

The Committee is asked to note the contents of this paper.

of 1

Agenda Item No: 15



Paper Title: Hot Sites Update


Report author: Gerry Moir, Associate Director Primary Care Support

Report signed off by: Dee Boardman, Director for Primary Care Development

Executive Summary: The table provides the detail around the hot sites that are currently up and running in East and North Herts

Recommendations

to the members:

To note


involved:

No conflicts of interest



Type Description







ENHCCG COVID-19 HOT SITES

Locality PCN Hot site locationFull address including

PostcodeStart date

Opening Hours

Mon -Fri

Opening Hours

Weekends

Stevenage

NorthSt Nicholas Health centre

Canterbury Way,

Stevenage SG1 4LH30/03/2020 09:00 - 17:30

Not at the

moment

Stevenage

SouthKing George

135 High St, Stevenage SG1

3HT06/04/2020

Practice opening

times

Not at the

moment

Hitchin and

WhitwellCourtney House, Hitchin

30 Bancroft, Hitchin SG5

1LH31/03/2020 8.30 - 18:30 Daily

Not at the

moment

Icknield Ernest Gardiner Treatment CentrePearsall Cl, Letchworth

Garden City SG6 1QZ03/04/2020 8.30 - 18:30 Daily

Not at the

moment

WGC and

VillagesHollybush Lane

141 Hollybush Lane

WGC

AL7 4JS

30/03/2020Practice opening

times

Not at the

moment

WGC A Hall Grove

4 Hallgrove

WGC

AL7 4PL

Up and

running

Practice opening

times

Not at the

moment

Hatfield Queensway

Queensway

Hatfield

AL10 0LF

23/04/2020 09:00 - 18:30Not at the

moment

Hoddesdon and

BroxbourneHaileybury College Health Centre

Hertford Heath

Hertford SG13 7NU08/04/2020 16:00 - 17.30 daily

Not at the

moment

The Maltings, Ware

Dolphin House, Branch Surgery

15 Amwell End, Ware

SG12 9HP

Up and

running08:00 - 18:30 daily

Not at the

moment

Stevenage

North Herts

Welhat

Puckeridge

Standon & Puckeridge

Surgery

Station Road

Ware

SG11 1TP

Up and

running08:00 - 18:30 daily

Not at the

moment

Hertford and

RuralsBull Plain Clinic

27 Bull Plain

Hertford

SG14 1DZ

27/04/2020 13:00 to 17:00Not at the

moment

Lower Lea

Valley

Lea Valley

HealthStockwell Lodge annex

Rosedale Way

Cheshunt

EN7 6HL

06/04/202012:00 to 18:00

Mon to Fri

Not at the

moment

Stort Valley

and villages

Stort Valley and

villagesHaymeads

Haymeads at Herts and

Essex Hospital, Bishop’s

Stortford, CM12 5JH.

30/03/202015:00 to 18:00

Mon - Fri

Not at the

moment

Upper Lea

Valley

Ware and

Rurals

1

Agenda Item No: 16



Paper Title: Seasonal Influenza Report 2019/20 and Plans for 2020/21


Report author: Monica Wright – Project Officer, Primary Care Development

Report signed off by: Denise Boardman – Director for Primary Care Development

Executive Summary: This paper has been produced to appraise the Primary Care

Commissioning Committee on:

Information on the 2019/20 flu season, including

information on vaccines and issues faced that year

The uptake figures from the 2019/20 flu season

To discuss PCN level funding for the 2020/21 flu season

and how this could be used to improve vaccine uptake

levels.

In 2019/20, ENHCCG flu vaccine uptake levels were up in the over

65s group (73.4%). However, uptake levels were down in the under

65s at-risk (40.9%) and in pregnant women (39.5%) groups. These

results followed the national trends.

ENHCCG flu vaccine uptake levels were down in the 2 year old

(51.3%) and 3 year old (49.8%) groups compared to 2018/19.

These results also followed the national trend, although ENHCCG

achieved higher uptake rates in these groups than the national

figures.

There were national delays with the delivery of the QIVe vaccine

(manufactured by Sanofi Pasteur), which was recommended for the

under 65s at-risk (adults aged 18 to 64) and pregnant women.

There were also national delays with the delivery of the childhood

nasal spray flu vaccine (manufactured by AstraZeneca). This

resulted in some delays to the start of the flu vaccination campaign

for some practices, which could have contributed to lower uptake

levels among these affected groups.

2

The Primary Care Commissioning Committee is asked to consider

the future plans for funding at PCN level to support the flu season –

two options are outlined within the paper.

Recommendations

to the members:

To discuss and approve option 2.1 in section 5 of the paper.


involved:

There were no conflicts of interest in the preparation of this paper.

The CCG Governing GP leads have a financial conflict of interest

as they are shareholders in their GP federations and are also

practising GPs in their PCNs.



Type Description

Financial Interests This is where an individual may get direct financial benefits from the

consequences of a commissioning decision.

Non-Financial

Professional Interests

This is where an individual may obtain a non-financial professional benefit

from the consequences of a commissioning decision, such as increasing

their professional reputation or status or promoting their professional

career.

Non-Financial

Personal Interests

This is where an individual may benefit personally in ways which are not

directly linked to their professional career and do not give rise to a direct

financial benefit.

Indirect Interests This is where an individual has a close association with an individual who

has a financial interest, a non-financial professional interest or a non-

financial personal interest in a commissioning decision.

3


The purpose of this paper is to inform the Primary Care Commissioning Committee of the

results from the 2019/20 National Flu Immunisation Programme for East and North

Hertfordshire CCG. ENHCCG flu vaccine uptake levels were up in the over 65s group (73.4%).

However, uptake levels were down in the under 65s at-risk (40.9%) and in pregnant women

(39.5%) groups. These results followed the national trends.

ENHCCG flu vaccine uptake levels were down in the 2 year old (51.3%) and 3 year old (49.8%)

groups compared to 2018/19. These results also followed the national trend, although ENHCCG

achieved higher uptake rates in these groups than the national figures.

There were national delays with the delivery of the QIVe vaccine (manufactured by Sanofi

Pasteur), which was recommended for the under 65s at-risk (adults aged 18 to 64) and

pregnant women. There were also national delays with the delivery of the childhood nasal spray

flu vaccine (manufactured by AstraZeneca). This resulted in some delays to the start of the flu

vaccination campaign for some practices, which could have contributed to lower uptake levels

among these affected groups.

The paper also looks at the benefits of once again offering an additional specific Flu Planning

funding across the PCNs. The Primary Care Commissioning Committee is asked to consider

the future plans for funding at PCN level to support the flu season – two options are outlined

within the paper.

1.1. Terms/Acronyms Used in the Report

ENHCCG: East and North Hertfordshire Clinical Commissioning Group

CCG: Clinical Commissioning Group

FPTG: Flu Planning Task Group

PHE: Public Health England

NHSE NHS England

LPC: Local Pharmaceutical Committee

LMC: Local Medical Committee

HCC: Hertfordshire County Council

aTIV: Adjuvanted Trivalent Vaccine

QIV: Quadrivalent Vaccine

2. Background

Background and recap of 2019-20 flu vaccination programme

Flu vaccine uptake ambitions in 2019/20 were the same as for previous seasons and were set

nationally as outlined in Table 1:

4

Table 1:

Main eligible group National target set by NHS England (2019-20)

65 and over 75% Under 65s at risk 55%

All pregnant women 55%

School years R, 1, 2, 3 & 4 and 5 65%

(Herts Community Trust commissioned Vaccination UK to deliver this programme in schools)

Children aged 2 & 3 48%

2.1 Planning for the flu season

The CCG continues to attend the Flu Planning Task Group (FPTG) which is led by Public

Health England (PHE) and is also attended by representatives from the LPC, the LMC, HCC

and a number of other CCGs from the Midlands & East (Central Midlands) region. During the flu

season (September – March) the FPTG meets monthly and out of season meets bi-monthly and

works together to share best practice with the aim of supporting GP practices and pharmacies

to help increase seasonal flu vaccine across the region.

2.2 Communications

Practices have been kept up to date on flu developments via the CCGs Bulletin, as well as

urgent information being sent directly to practices via email. As the 2019/20 season was

particularly difficult due to vaccine supply issues, an increased amount of telephone contact

was also made with practices during this season. Practices were also kept up to date via

Practice Managers meetings. PCN level flu data from Immform was shared regularly with

practices and PCN flu leads.

2.3 Local funding

In 2019/20, ENHCCG provided extra funding to PCNs to support the development of a joint

local plan with community pharmacies with the aim of increasing vaccine uptake levels. The

funding (£30k in total) was broken down as shown in Table 2 on a capitated allocation basis.

Funding was allocated on PCN rather than Locality basis as previously, to promote

development of PCN working. PCNs were however given the option of collaborating with other

PCNs on their plans; the 3 Upper Lea Valley PCNs chose to work together,

Table 2:

PCN Maximum capitated allocation

Two thirdsof

allocation

Remainingthird of

allocation

Hatfield £2,530.29 £1,686.86 £843.43

Hertford and Rurals £2,581.91 £1,721.27 £860.64

Hitchin and Whitwell £2,351.55 £1,567.70 £783.85

Hoddesdon and Broxbourne £2,071.76 £1,381.17 £690.59

Icknield £2,847.68 £1,898.45 £949.23

Lea Valley Health £3,802.85 £2,535.23 £1,267.62

Peartree Group Practice & Bridge Cottage £1,832.82 £1,221.88 £610.94

5

Stevenage North £3,030.77 £2,020.51 £1,010.26

Stevenage South £2,443.47 £1,628.98 £814.49

Stort Valley and Villages £3,091.96 £2,061.31 £1,030.65

Ware and Rurals £1,641.36 £1,094.24 £547.12

Welwyn Garden City A £1,773.57 £1,182.38 £591.19

Total £29,999.99 £19,999.99 £10,000.00

Two thirds of the funds were initially allocated to PCNs. To receive this funding, PCNs

were required to develop a plan on how they would work with other local services

including community pharmacies, to increase vaccine uptake levels. The plan also

required details on the additional staffing costs to run out of hours appointments and

how funding would be used for advertising and promotional materials. Whilst not all

PCNs were able to outline tangible actions and measurable outcomes, a pragmatic

approach was adopted to ensure all PCNs submitted flu plans and to encourage their

involvement.

The remaining third of the funding was to be allocated on an outcomes basis.

Following the end of the flu season, this funding was allocated to PCNs that met either

the national targets or who made a 2% or more increase on vaccine uptake compared to

the 2018/19 season in the three key eligible groups (over 65s, under 65s at risk and

pregnant women). Section 2.11 provides information on which PCNs achieved this.

2.4 Extra funding for practices that immunise ‘super at-risk’ groups

In 2019/20, PHE/NHSE offered extra funding to practices that focussed on immunising three ‘super at-risk’ groups (under 65 with chronic liver disease, chronic neurological disease or chronic neurological disease) and pregnant women, with a view to increasing uptake rates among these groups.

Due to the increased mortality risk in these groups, an extra 75 pence per patient immunised was offered to practices. This required practices to agree to calling and recalling these patients throughout the flu season via letter, text or telephone, to encourage uptake in these groups.

2.5 2019/20 Vaccines

In 2019/20, it was recommended that priority groups receive the following vaccines:

Over 65s: Either an adjuvanted trivalent injected vaccine grown in eggs (aTIV) or a cell-

grown quadrivalent injected vaccine (QIVc) – both vaccines were considered to be

equally suitable

Under 65s at-risk (adults aged 18 to 64) and pregnant women: A quadrivalent

injected vaccine – the vaccine offered will have been grown either in eggs or cells (QIVe

or QIVc), which were considered to be equally suitable

Children aged 2 to 17 (in an eligible group): A live attenuated quadrivalent vaccine

(LAIV), given as a nasal spray

6

A range of flu vaccines were available in 2019/20. This includes the ‘adjuvanted’ vaccine which

was offered to those aged 65 years and over for the first-time last year and provided a higher

level of protection compared to the standard non-adjuvanted vaccines in this age group.

A key supplier of the QIVe vaccine Sanofi Pasteur had to phase the delivery of the vaccine, due

to manufacturing hold-ups that were caused by a delay from the World Health organisation

(WHO) to provide a final recommendation for vaccine manufacturers. There were also delays in

the delivery of the childhood nasal spray flu vaccine manufactured by AstraZeneca. These

delays resulted in a later start to the 2019/20 vaccination campaign, with some practices and

primary schools having to reschedule flu clinics, as some vaccines were not received until

November 2019. Further information on these issues is elaborated in section 3.

2.6 Pharmacy

Community pharmacies were once again commissioned nationally to vaccinate eligible patients

aged 18 and over. NHS England locally commissioned PharmOutcomes software for the

2019/20 season to enable fast electronic transfer of vaccination information to GP practices. As

part of the PCN flu funding practices were asked to work with community pharmacies to

encourage better working relationships and ensure that between them more people were

offered flu vaccinations. Compared to 2018/19, the percentage of patients vaccinated in

pharmacies increased in all three of the key eligible groups, these figures can be seen in Table

3.

Table 3:

Eligible group 2018/19

vaccinated in pharmacy

2019/20 vaccinated in

pharmacy

Percentage difference

Over 65 13% 14% Up 1%Under 65s at-risk 11% 14% Up 3%Pregnant women 10% 12% Up 2%

2.7 Midwifery

PHE worked with East and North Herts Trust (ENHT) to ensure that midwives were set up to

deliver the flu vaccination to pregnant women during the 2019/20 season.

In 2019/20, 10.4% of pregnant women were vaccinated by ‘other healthcare providers’

(excluding pharmacists), however, the data does not give specific details of the profession of

the clinician. For pregnant women it can be assumed to largely be midwives. The percentage

of those pregnant women who were vaccinated by this group in 2018/19 was 9.8%, thus there

was a slight increase an (0.6%) observed in this setting in 2019/20.

2.8 Circulating virus

Whilst seasonal flu has been circulating in the community, it has remained at a low level.

2.8 Vaccine uptake figures 2018/19 vs 2019/20

In 2019/20, flu vaccine uptake levels were up nationally in the over 65s group, but down

nationally in the under 65s at-risk, pregnant women groups and 2 year old and 3 year old

groups, compared to 2018/19. ENHCCG uptake levels can be seen in Table 4.

7

Table 4:

2.10 Flu vaccine uptake levels by PCN

A comparison of vaccine uptake levels for 2019/20 vs 2018/19 at PCN level can be seen in

Table 5, which shows the following results:

Over 65s: 8 out of 12 PCNs achieved higher uptake levels in 2019/20 compared to

2018/19

Under 65s at-risk and pregnant women: All 12 PCNs recorded lower uptake levels in

2019/20 compared to 2018/19.

For Table 5: please refer to next page.

Category/National end of

season ambition

2018/19 - Final figures

(February 2019)

2019/20 - Final

figures (February

2020)

%increase/

decrease from

18/19 to 19/20

65 and over (75%) 72.5%

Practice coverage ranged

from 45.5% to 82.5%

73.4% Practice coverage ranged

from 49.6% to 81.6%

Up 0.95%

Under 65s at risk (55%)

46.8%Practice coverage ranged

from 31.4% to 58.9%


from 25% to 54.7%

Down 5.98%

All pregnant women (55%)


from 25.0% to 80.0%


from 20.8% to 60.6%

Down 13.97%

Children aged 2 (48%) 53.8% 51.3%Down 2.50%

Children aged 3 (48%) 51.3% 49.8% Down 1.50%

8

Table 5:

PCN

Over 65s Under 65s at-risk Pregnant women

2019/20 2018/19 2019/20 2018/19 2019/20 2018/19

Hatfield 74.0% ↓ 75.2% 42.5% ↓ 46.4% 45.8% ↓ 46.7%

Hertford and Rurals 70.4% ↓ 70.6% 39.7% ↓ 43.9% 41.8% ↓ 54.8%

Hitchin and Whitwell 77.3% ↑ 72.9% 41.3% ↓ 46.2% 45.7% ↓ 59.8%

Hoddesdon and Broxbourne

72.5% ↑

72.0% 40.7% ↓

46.9% 37.7% ↓

49.0%

Icknield 77.4% ↑ 76.7% 48.9% ↓ 53.3% 44.5% ↓ 61.3%

Lee Valley Health 70.7% ↓ 70.8% 37.7% ↓ 46.8% 29.6% ↓ 43.2%

Peartree Group Practice & Bridge Cottage

72.4% ↑

70.1% 39.2% ↓

46.3% 37.4% ↓

49.5%

Stevenage North 70.1% ↓ 70.4% 37.9% ↓ 43.0% 32.4% ↓ 54.3%

Stevenage South 73.5% ↑ 73.0% 42.2% ↓ 48.4% 41.1% ↓ 50.5%

Stort Valley and Villages 74.5% ↑ 72.2% 39.0% ↓ 44.7% 38.1% ↓ 54.1%

Ware and Rurals 73.5% ↑ 71.1% 38.1% ↓ 45.1% 45.7% ↓ 59.1%

Welwyn Garden City A 76.2% ↑ 76.0% 45.4% ↓ 52.5% 50.3% ↓ 63.1%

Total (ENHCCG) 73.4% ↑ 72.5% 40.9% ↓ 46.8% 39.5% ↓ 53.4%

National figures 72.4% ↑ 72.0% 44.9% ↓ 48.0% 43.7% ↓ 45.2%

2.11 Outcome of PCNs and 2% vaccine uptake increase ambition

As outlined in section 2.3, the remaining third of funding was allocated to PCNs that met either

the national targets or who made a 2% or more increase on vaccine uptake compared to the

2018/19 season in the three key eligible groups (over 65s, under 65s at-risk and pregnant

women).

In 2019/20, four PCNs achieved a 2% or more increase in vaccine uptake levels in the over 65s

group. These PCNs were Hitchin and Whitwell, Peartree Group Practice & Bridge Cottage, Stort

Valley and Villages and Ware and Rurals. 3 PCNs achieved the national uptake target for this

group – Icknield, Welwyn Garden City A and Hitchin and Whitwell; However, no PCN achieved

national target or the 2% increase in either the under 65s at-risk and pregnant women

categories.

2.12 ENHCCG’s performance against other CCGs in the area

Immform, the system that captures flu vaccine uptake data, allows CCGs to extract anonymous

comparison reports against other CCGs in the region (Midlands and East). Unfortunately this

does not allow us to compare directly with the other CCGs in the STP. Using this data we can

compare ENHCCG’s vaccine uptake rates in the three priority groups with other CCGs in the

region:

Over 65s: ENHCCG came 5th out 20 CCGs, achieving 73.4%. The uptake for the

region ranged from 65.5% to 75.2%.

Under 65s at-risk: ENHCCG came 7th out 20 CCGs, achieving 40.9%. The uptake for

the region ranged from 37.7% to 48.2%.

9

Pregnant women: ENHCCG came 11th out 20 CCGs, achieving 39.5%. The uptake for

the region ranged from 31.2 % to 57.1%.

3. IssuesThe WHO delayed its recommendation on one of the strains of the virus by a month. This

resulted in manufacturing delays for Sanofi Pasteur, a supplier of the inactivated quadrivalent

influenza vaccine (QIVe), which is suitable for the under 65s at-risk group and pregnant women.

This supplier anticipated that some surgeries would receive the first deliveries from 7 October

2019. However, others would have to wait a few more weeks to receive first deliveries. In

addition, second and third supplies were not due to be delivered until late October and mid-late

November 2019, respectively.

Ahead of the flu season, the CCG advised practices to order vaccines from more than one

manufacturer, to help ensure a reliable supply of vaccine for the flu season. However, 39

practices ordered vaccines for under 65s at-risk from one supplier only, and 28 of these

practices had ordered from Sanofi Pasteur. As a consequence, the start date of the vaccination

campaign was delayed for some practices, as flu clinics had to be rescheduled to later dates.

There were also delays in the delivery of some batches of the childhood nasal spray flu vaccine

that was manufactured by AstraZeneca. As a result, some supplies were not received until

November 2019. This caused disruption to some planned flu vaccine clinics in primary schools,

where vaccine stocks were not already held by the teams delivering the programme.

At the end of each season, feedback is usually requested from PCNs on the overall flu

vaccination season, including what went well and any challenges/issues that may have affected

uptake levels. However, due to the COVID-19 pandemic and re-prioritisation of workloads it was

not possible to obtain feedback for this season.

4. Flu planning for 2020/21 PHE’s annual flu vaccination letter for 20/21 was published on 14th May 2020. PCNs are being

advised to continue to plan for the flu vaccination programme 20/21 as usual and practices

have ordered or are further ordering the required vaccines for the start of the programme in

September 2020. The letter acknowledges that delivering the flu immunisation programme is

likely to be more challenging because of the impact of COVID-19 on health and social care

services. In addition, further guidance is due to be issued on how to manage the immunisation

programme to reflect circumstances nearer the planned start of the campaign. It also notes that

discussions are underway to consider expansion of the flu programme for this autumn.

Some PCNs have started to discuss and formulate plans for the forthcoming season and it is

proposed that this will be further discussed with all PCNs and relevant CCG stakeholders.

The Investment and Impact Fund (IIP) element of the PCN DES for 20/21 is due to include an

incentive based on the percentage of patients aged 65+ who received a seasonal flu

vaccination; with an indicative value for average PCN (c45,000 patients) of up to £6,400 per

PCN. IIP funding for subsequent years will further focus on other flu targets.

10

5. Options

Looking ahead to the 2020/21 season, the Primary Care Commissioning Committee is asked to

consider whether funding at PCN level is offered again. Following internal discussions, there

are two options for consideration in relation to this for the upcoming season:

1) Funding is offered again and distributed across the PCNs again at either the same

amount £30k or an increased amount to further incentivise PCNs to increase vaccine

uptake levels. It is difficult to comment on the effectiveness of the funding provided to

support flu planning, however we would note that the encouragement to agree specific

outcomes with community pharmacy in the plans was largely unsuccessful. The amount

of funding available when split per PCN may be perceived as insufficient to make a

difference, particularly the case for the third of the funding based on uptake outcomes.

2) Separate Flu Funding is not continued as other PCN funding streams are available,

including the PCN Development Fund etc. It is fully recognised in the preparation of this

paper and against the backdrop of COVID-19 there will be additional costs due to the

expected new requirements to safely administer and provide a vaccination programme.

Flu planning and activity is increasingly part of the PCN remit as evidenced by the IIP

funding available to PCNs. PCNs have other funding streams which could be utilised to

support this activity, including the annual PCN Development Funding. This was provided

to the CCG by NHS England in 19/20 and much of this was passed directly to PCNs; we

anticipate a similar approach for 20/21. A year-end assessment of PCN spend of this

fund has been delayed due to COVID-19, however it is understood that for many PCNs

this funding has been largely under-utilised.

2.1 Amalgamate the separate flu funding of £30k in to option 2 recognising the fact that

additional costs that will be incurred to administer a flu programme against the

backdrop of COVID-19. This also supports the NHSE premise established during

COVID-19, of ensuring CCG monies remain invested in General Practice.

6. Resources implications If the Primary Care Commissioning Committee decides to move ahead with a funding approach

for 2020/21 a budget would need to be agreed.

7. Risks/mitigation measures Flu vaccination is one of the most effective interventions we have to reduce pressure on the

health and social care system and this coming winter we may be faced with co-circulation of

COVID-19 and flu. It is recognised that delivering the flu immunisation programme is likely to be

more challenging for the 20/21 season because of the impact of COVID-19. There will also be

implications resulting from the expected further guidance on how to manage the immunisation

programme to reflect the COVID-19 circumstances, the timing of which is as yet unclear.

Engagement and discussions with PCNs in terms of potential plans at this relatively early stage

are planned to mitigate against this risk and one PCN has already submitted an outline plan.

11

8. Recommendations We would conclude that the current flu planning funding has not been effective in delivering

appreciable improvements in flu uptake levels, so the justification for continuing such funding is

not clear. The major caveat however being the expected challenging circumstances explained

in this paper due to COVID-19. This is highly likely to necessitate a changed approach,

requiring more proactive planning and potentially to have a higher cost basis than previous flu

seasons. Therefore additional funding will be required to support this whether from the PCN

Development Funding or CCG delegated funding and option 2.1 in section 5 of the paper is

recommended to the Committee.

9. Next steps

1. Commence early discussions with PCNs regarding Flu planning for the 20/21 flu season.

2. Review further guidance once issued by PHE.

primary care commissioning committee in public

Documents