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Primary Care Commissioning Committee Part I - 2.30-3.30pm Wednesday 28 March 2018 Committee rooms, 4th Floor, Unex Tower, 5 Station Street, London E15 1DA
Statement of advice on declaring interests at NCCG meetings
Guidance • All attendees are asked to declare any interest they have in any agenda item before it is discussed
or as soon as it becomes apparent be that before or at the meeting. If during the course of a meeting an interest not previously declared is identified, this must be declared at that time.
• The record of a declared interest is the interest declared verbally at the meeting. Anattendee cannot refer to interests already declared on the register of interests or an interest already declared at a previous meeting. There is no such thing as an “ongoing” interest.
• The minutes of the meeting will detail all declarations made and any relevant responses and/oraction taken.
Direct Financial Interest • If you have a direct financial interest in any matter on the agenda you must not participate in any
discussion or vote on that matter. If you do so you may be committing a criminal offence, as well as a Breach of the Conflict of Interest Policy and the CCG Code of Conduct. The individual should leave the meeting (including any public seating area) during consideration of the matter.
Indirect Financial Interest • You are required to make a verbal declaration of the existence and nature of any Indirect Financial
Interest. Any Member who does not declare these interests in any matter when they apply may be in breach of the Policy and Code of Conduct.
Other Interest • You are required to declare an interest where a decision in relation to the business of the meeting
might reasonably be regarded as affecting your well-being or financial standing, or a member of your family, or a person with whom you have a close association with to a greater extent than it would affect the majority of the GPs or other Board Members.
If in doubt you should assume that a potential conflict of interest exists.
Action upon declaration of an interest at a meeting • For direct financial interests you must leave the meeting for that item• For indirect financial interests and for other interests the action required will vary dependent upon
the interpretation of the extent and influence of the interest and may involve;o leaving the meeting,o remaining at the meeting and not voting or speaking,o remaining at the meeting and both speaking and voting
Chairs ruling • For the avoidance of doubt the Chairs decision on a declaration of interest
and its management is final
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Primary Care Commissioning Committee Part I - 2.30-3.30pm Wednesday 28 March 2018 Committee rooms, 4th Floor, Unex Tower, 5 Station Street, London E15 1DA
Agenda
No Time Item Action Required Page Presenter
1. Administration and updates 1.1
2.30pm
Welcome, introductions and apologies
Chair
1.2 Declarations of interests Monitor
1.3 Minutes of the previous meeting Approve 4
1.4 Action log Monitor 9
1.5 Chair’s action - e-consult provider for Newham Note 10
1.6
2.35pm
Londonwide Operating Model for Co-Commissioning of Primary Care Services
Approve 15 A Goodlad/ L Hutchinson
1.7 GMS / PMS Update Note Verbal A Goodlad/ L Hutchinson
2. Strategic items 2.1 2.45pm GP access: expectations in respect of core and
extended hours 71 J Mazarelo
2.2 2.55pm Estates update 83 J Kelder
2.3 3.05pm Improvement academy proposal – update 89 A Shah
3. Patient and Public Engagement 3.1 3.10pm Questions from the public Discussion Chair
4 Performance 4.1 3.15pm Risk Register Information 101 J Mazarelo
4.2 3.20pm NCCG Finance & QIPP Report Monitor 106 L Wei
5. Any other business 5.1 3.25pm AOB Chair
Next meetings: Wednesday 25 April 2018 – business meeting Wednesday 30 May 2018 – discussion meeting
2.30-3.30pm Committee rooms 4th Floor, Unex Tower, 5 Station Street, London E15 1DA
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Primary Care Commissioning Committee Part I meeting: 2.30-3.30pm Wednesday 31 January 2018 Committee rooms, 4th Floor, Unex Tower, 5 Station Street, E15 1DA
Minutes
Voting members present: Present: Selina Douglas Acting Managing Director, Newham CCG
Ambady Gopinathan GP Board Member, Newham CCG
Ashwin Shah GP Board Member, Newham CCG
Fiona Smith Registered Nurse, Newham CCG
Non-voting members present: Alison Goodlad NHS England
Lorna Hutchinson NHS England
Andrea Lippett - Chair Lay Member Remuneration, NCCG
Jenny Mazarelo Associate Director Primary Care, Newham CCG
Meradin Peachey Public Health Member, LBN
Anil Shah GP Member, Newham CCG
In Attendance: Kate McFadden-Lewis (minutes) Board Secretary, Newham CCG
Ingrid McKitty Assistant Finance Director, NHS Newham CCG
Dr C M Patel GP, LMC
Chris Riley (item 2.1) IT Project Manager, Newham CCG
Apologies: Wayne Farah Lay Member Patient & Public Engagement, NCCG
Selina Rodrigues Healthwatch Newham
Lei Wei Interim Chief Finance Officer, Newham CCG
No Item
1.1
1.2
Welcome, introduction, apologies for absence and declarations of interest A Lippett welcomed attendees to the meeting and introductions were made.
Apologies were noted from Wayne Farah, Lay Member Patient & Public Engagement, NCCG, Selina Rodrigues, Healthwatch Newham and Lei Wei, Interim Chief Finance Officer, Newham CCG.
Declarations of interest were recorded for the GP attendees under items 2.2 and 2.3.
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1.3 Minutes of the previous meeting and matters arising The minutes of the business meeting held 29 November 2017 were accepted as an accurate record, subject to the addition of an interest declared for Dr Anil Shah under item 2.1, Primary Care access.
1.4 Action log The action log was reviewed and the Committee agreed to close actions PCCC92, PCCC96, PCCC97 and PCCC98.
2. Strategic items
2.1 GPIT update C Riley joined the meeting to present on Newham CCG’s progress on delivery of the commitments outlined in GPIT Operating Model (2016-2018).
The Committee noted the report. It was agreed that a strategy for ensuring all practices are taking up and using the available technology to its full capacity, such as iPLATO, would be actioned through the practice managers’ forum. (ACTION: JM)
2.2 Extended Primary Care Services and Local Incentive Scheme 2018/19 J Mazarelo presented on the EPCS and LIS for 2018/19, outlining NCCG’s financial position, the review of EPCS and LIS to inform the CCG’s commissioning intentions in 2018/19 and NCCG’s intention to continue to commission services in line with STP and CCG priorities.
Discussion points included: i. the need to ensure that the EPCS/LIS budget meets the QIPP target set for 2018/19ii. the importance of ensuring the effectiveness, and value for money, of each of the schemes
for next yeariii. the tight timescales on this programme, and that it is possible these plans may change once
the operating plans are published by NHS England.
It was agreed to discuss this again at the 28 February Committee meeting. (ACTION: JM)
2.3 Upper Road Medical Centre J Mazarelo reported to the group on the interim caretaking arrangements in place and the recommendation to disperse the patient list for Upper Road Medical Centre, following the retirement of Dr A Zakaria on 10 November 2017. Members approved the recommendation.
3. Patient and Public Engagement
3.1 Questions from the public: None
4. Performance
4.1 Risk Register J Mazarelo presented the risk register, highlighting the risks from NHS England’s risk register, in respect of delegated commissioning, that are now included (risks 15 and 16).
F Smith raised the recent announcement regarding Capita’s financial difficulties in relation to risk 16. The Committee were assured that the risks are mitigated at a national level, with an escalation process in place.
It was agreed that the Committee would see the detail on risks 15 and 16 at the next meeting, in order to ensure mitigations are in place, if necessary, for Newham residents. (ACTION: JM/LH)
4.2 NCCG Finance & QIPP Report Ingrid McKitty presented the year to date financial position to the Committee, reporting that Newham CCG remains on track to meet its financial targets for the year. The Committee noted.
5. AOB
5.1 None
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Next meetings: Wednesday 28 February 2018 – discussion meeting Wednesday 28 March 2018 – business meeting
2.30-3.30pm Committee rooms 4th Floor, Unex Tower, 5 Station Street, London E15 1DA
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Primary Care Commissioning Committee Part I discussion meeting: 2.30-3.30pm Wednesday 28 February 2018 The Plaistow Room (FO21), 4th Floor, Unex Tower, 5 Station Street, London E15 1DA
Minutes
Present: Wayne Farah - Chair Lay Member Patient & Public Engagement, NCCG
Clive Furness London Borough of Newham Alison Goodlad NHS England Dr Ambady Gopinathan GP Board Member, Newham CCG Lorna Hutchinson NHS England Jenny Mazarelo Associate Director Primary Care, Newham CCG Anil Shah GP Member, Newham CCG Ashwin Shah GP Board member, Newham CCG Fiona Smith Registered Nurse, Newham CCG In Attendance: Kate McFadden-Lewis (notes) Board Secretary, Newham CCG Apologies: Andrea Lippett Lay Member Remuneration, Newham CCG Dr CM Patel GP, LMC Selina Rodrigues Healthwatch Newham Lei Wei Interim Chief Finance Officer, Newham CCG
No Item
1.1
1.2
Welcome, introduction, apologies for absence and declarations of interest Wayne Farah welcomed attendees to the meeting and introductions were made. Apologies were noted from:
• Andrea Lippett, Lay Member Remuneration, Newham CCG• Dr CM Patel, GP, LMC• Selina Rodrigues, Healthwatch Newham• Lei Wei, Interim Chief Finance Officer, Newham CCG
There were no declarations of interest.
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Discussion - GP access: expectations in respect of core and extended hours J Mazarelo led a discussion around GP access: expectations in respect of core and extended hours to inform the basis of a paper for fuller discussion at the next meeting. It was agreed that the following should be included:
i. Benchmarking – a comparison on the number of practices not signed up to the extended hoursrequirements across Newham with our STP footprint and another comparable area, such as Brent CCG
ii. An explicit definition of ‘assuming responsibility for primary care’, for example, could this includehome visits and phone consultations if the practice is not open?
iii. Clarity on the services commissioned by NCCG versus the services deliverediv. How to ensure sustainable, and easy to navigate, primary care services for Newham.
(ACTION: JM)
Next meeting: 2.30-4.30pm Wednesday 28 March 2018 Committee rooms, 4th Floor, Unex Tower, 5 Station Street, London E15 1DA
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Action reference Meeting date Action Owner Deadline Update
PCC93 29/11/2017 Referral Pathway Scheme - a full update to be provided to March meeting J Mazarelo Mar-18 This has been deferred to May
2018 - on the planner
PCCC94 29/11/2017Review of Roma Community access to Primary CareThe proposal for roll out of this training across Newham GP practices to be discussed by the Committee early 2018.
S Sanghera May-18 On the meeting planner for May 2018.
PCCC95 29/11/2017 Improvement Academy - further assurance to be provided on the alignment with the CCG's primary care strategy A Shah Mar-18 On the agenda for March 2018
PCCC99 31/01/2018
GPIT A strategy for ensuring all practices are taking up and using the available technology to its full capacity, such as iPLATO, to be actioned through the practice managers’ forum.
J Mazarelo Mar-18
Opportunities and benefits of available digital technology promoted to practice staff on an on going basis at Newham EMIS User Group
PCCC101 31/01/2018
Risk Register Provide the detail for risks 15 and 16, from NHS England’s risk register, in respect of delegated commissioning, in order to ensure mitigations are in place, if necessary, for Newham residents.
J Mazarelo / L Hutchinson Mar-18 On the meeting planner for March
2018.
item 1.4 - 28 March 2018 Primary Care Commissioning Committee - Action Log Part I
Highlighted items represent a recommendation to remove from register
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Primary Care Commissioning Committee Part I - 28 March 2018 Committee rooms, 4th floor Unex Tower
Title Procurement of an e-consult provider for Newham
Agenda item 1.5
Author Lauren Sibbons, Newham CCG, Head of Commissioning & Transformation – Primary Care
Presented by Selina Douglas, Newham CCG, Interim Managing Director
Contact for further information
Lauren Sibbons, Newham CCG, Head of Commissioning & Transformation – Primary Care 0203 816 3858 or [email protected]
This paper is for Information
Action required The committee are asked to: Note for Information acknowledging the Chairs Action
Executive summary
As part of the GP Forward View, there was a commitment to invest significantly in Technology and Estates, part of this funding was a specific £45 million pounds to deliver a national programme to rollout of online e-consultation systems within GP practices.
In 2017/18 allocations were made nationally for the project. This funding came with an element of procurement support. Locally at an STP level it was agreed that the STP would collectively undertake a joint procurement and secure one provider.
City & Hackney and Tower Hamlets decided that they did not want to pursue this route from the outset so therefore BHR, Newham and Waltham Forest went out to procurement for a single provider.
Following the procurement exercise Newham CCG decided to withdraw and procure their own provider to enable a bespoke local solution that was in the best interests of Newham patients.
The paper addresses the process that was undertaken in terms of governance arrangements when withdrawing from the joint procurement process and; the steps taken in line with procurement regulations and the CCGs internal SFIs and Constitution when securing a local solution for Newham.
Attached is the chairs action that needs to be noted, assurance can also be provided as a single tender waiver has been completed and signed off internally for the cost of the project. This will be presented to the Audit Committee on 20th April 2018.
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Supporting papers Appendix A – Chairs Action
How does this fit with NHS Newham CCG strategy?
Values Transparency with our decision-making and leadership Accountability and responsibility
Aims Reducing inequalities and improving accessibility.
Where has the paper been already presented?
No previous presentation to any meeting.
Risk BAF.01 – Failure to meet NHS Constitutional standards.
Risk of non-adherence to procurement laws and regulations leaves the CCG open to the risk of legal challenge. In addition to this are the very real risks to the reputational of the organisation and risk of financial liability if proven in a court of law that the correct procurement procedures were not undertaken prior to contract award.
Equality impact This document relates to all Newham residents and therefore has assessed and taken into consideration the nine protected characteristics that are covered by the Equality Act 2010 and our organisational duties and obligations under the Act.
Stakeholder engagement
None
Financial Implications
Other than the risk covered in the risk section of this paper, there are no cost pressures to the CCG as this funding is provided to us by NHS England as part of an allocation under the Five Year Forward View funding programme.
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Operating Model
Co-Commissioning of Primary Care
Services
15
Document filename: Operating Model
Directorate / programme Primary Care Commissioning
Project Primary Care Commissioning
Document reference
Project manager Anne Whateley Status For Approval
Owner Primary Care Management
Board/ Primary Care Committees
Version 16.0
Author Patrick Newton Version issue date 08/03/2018
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Operating model: Co commissioning of primary care
Document management
Revision history
Version Date Summary of changes
1.0 22.04.15 First draft
2.0 23.04.15 Revision following Christina Windle review
3.0 30.04.15 Revision following Heads of Primary Care review
4.0 30.04.15 Draft for review by David Sturgeon
5.0 05.05.15 Review by Primary Care Commissioning and Primary Care Management
Board
6.0 03.06.15 Draft updated following comments
7.0 09.06.15 Updated to reference initial comments from CCGs (to be approved in
PCMB)
8.0 20.07.15 Draft updated to reflect agreed comments
9.0 14.08.15 Updated following discussion at co-commissioning meeting
10.0 09.09.15 Updated following discussion at co-commissioning meeting
11.0 22.09.15 Final draft for approval
11.1 02.10.15 Factual amendments post approval by SE London (Joint Status of SE London Committees. Some minor editorial changes
12.0 01.06.17 Updated to reflect the geographical assignment of NHSE staff at lead
CCGs for each STP footprint
13.0 30.10.2017 Updated to reflect comments from CCG leads
13.01 01.12.2017 Revised version endorsed by the December PCMB
14.0 26.01.2018 Updated to reflect amendments for BHR CCGs
15.0 14.02.2018 Updated to incorporate the arrangements for GP Quality Performance
reporting
16.0 08.03.2018 Updated to reflect amendments regarding Occupational Health arrangements and new Director of Primary Care Commissioning
Reviewers This document must be reviewed by the following people before being shared externally:
Reviewer name Title/responsibility Date Version
Anne Whateley Director of Primary Care Commissioning
Jill Webb Head of Primary Care
Julie Sands Head of Primary Care
William Cunningham-Davis Head of Primary Care
Alison Goodlad Head of Primary Care
Vanessa Piper Head of Primary Care
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Approved by This document must be approved by the following groups:
NHS England:
Name Signature Title Expected
Date
Version
David Slegg (in
recognition of approval at the Primary Care
Management Board)
Regional Director for Finance (London)
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Following sign off by NHS England (London), this document must be accepted by each of the co-
commissioning committees. These groups are therefore shown below:
Co-Commissioning Committees:
Area Signature Title Expected
Date
Version
Barnet CCG
Primary Care Committees In Common
Camden CCG
Haringey CCG
Enfield CCG
Islington CCG
Croydon CCG Primary Care Committee
Kingston CCG Primary Care Committee
Merton CCG Primary Care Committee
Richmond CCG Primary Care Committee
Sutton CCG Primary Care Committee
Wandsworth CCG Primary Care Committee
Bexley CCG Primary Care Committee
Bromley CCG Primary Care Committee
Greenwich CCG Primary Care Committee
Lambeth CCG Primary Care Committee
Lewisham CCG Primary Care Committee
Southwark CCG Primary Care Committee
Brent CCG Primary Care Committee
Ealing CCG Primary Care Committee
Hammersmith and Fulham CCG
Primary Care Committee
Central London CCG Primary Care Committee
West London CCG Primary Care Committee
Hounslow CCG Primary Care Committee
Harrow CCG Primary Care Committee
Hillingdon CCG Primary Care Committee
Tower Hamlets CCG Primary Care Committee
Waltham Forest CCG Primary Care Committee
Newham CCG Primary Care Committee
Barking & Dagenham, Havering & Redbridge
CCGs
Primary Care
Commissioning Committee (Committee
in Common)
City and Hackney CCG Primary Care Committee
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Related documents (to be updated)
Title Owner Location
NWL Terms of Reference Primary Care Committee North West London
NCL Terms of Reference for
Joint Committee v0.2
Primary Care Committees in
Common North Central London
SWL Terms of Reference Primary Care Committee South West London
Annex F – Delegated TOR Tower Hamlets v0.1
Primary Care Committee Tower Hamlets
Annex F – Delegated TOR
Waltham Forest v1.0 Primary Care Committee Waltham Forest
Annex F – Delegated TOR
Newham v final Primary Care Committee Newham
Barking & Dagenham, Havering and Redbridge –
Updated Annex F (TOR)
Primary Care Commissioning Committee (Committee in
Common
Barking & Dagenham, Havering and Redbridge
Document control The controlled copy of this document is maintained by NHS England. Any copies of this document held outside of that area, in whatever format (e.g. paper, email attachment), are considered to have
passed out of control and should be checked for currency and validity.
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Contents Document management ....................................................................................................3
Revision history ...............................................................................................................3
Reviewers........................................................................................................................3
Approved by ....................................................................................................................4
Related documents (to be updated)..................................................................................6
Document control.............................................................................................................6
1. Introduction ..................................................................................................................9
1.1 Purpose of this document ...................................................................................9
1.2 Operating model processes for individual committees......................................9
1.3 Defining co-commissioning .............................................................................. 10
1.4 Terminology:...................................................................................................... 11
1.5 Differences between Joint and Delegated Committees.................................... 11
1.6 Responsibilities remaining with NHS England ................................................. 11
2. Decision Making ......................................................................................................... 12
2.1 Decision making principles ............................................................................... 12
2.2 Decision making process .................................................................................. 12
2.3 GP Performance and Quality Reporting Requirements ........ Error! Bookmark not
defined.
2.3.5 Conflicts of interest ............................................................................................ 24
2.3.5 Other decision-making processes – finance and strategy.................................... 25
2.4 Other potential Committee responsibilities ...................................................... 27
3. Governance and people ............................................................................................. 28
3.1 Committee constitution ..................................................................................... 28
3.2 Committee resourcing ....................................................................................... 28
4. Processes & Capabilities ............................................................................................ 29
4.1 Meeting process: ............................................................................................... 29
4.1.1 Agenda contents ............................................................................................ 29
4.2 Meeting Papers .................................................................................................. 30
4.3 Meeting in private .............................................................................................. 30
5. Annexes..................................................................................................................... 31
Annex Introduction ...................................................................................................... 31
Annex 1: Detailed processes ....................................................................................... 32
Annex 2: Section 13Z - CCG statutory duties ............................................................. 42
Annex 3: Performer Contract Decision Making Process ............................................ 43
Annex 4 - Safeguarding – responsibilities at different levels of CCG co-
commissioning delegation .......................................................................................... 45
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Annex 5 – Pan London Responsibilities of NHS England STP Based Teams............ 47
Annex 6 – Pan London Fora ........................................................................................ 55
Annex 7 - Template for Future NHS Access………………………………………………………………………59
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1. Introduction
1.1 Purpose of this document This document sets out NHS England national and London region policy and guidance to
inform, the way that NHS England (London) primary care commissioning and contracting
teams will support CCGs which have moved to joint or delegated co-commissioning
arrangements (as of April 2017).
As this document provides the standard offer of NHS England in terms of supporting Primary
Care Commissioning activities, this document will need to be signed off by NHS England
(through the Primary Care Management Board) and then CCG Commissioning Committees,
before it is considered final.
It is important to note that some specific details (i.e. the contact points for different
committees/ areas) will differ per committee and these added details should be cross
referenced with committee terms of reference or other supporting documents.
Governance of this document and processes
Once this document has been signed off by both parties, any variance from the processes
described here will need to be agreed between the Committee and NHS England (through
the Primary Care Management Board) as:
Having no impact on support (for example changes to the contact to be involved in
urgent decision making) and can therefore be adopted for a specific Committee
Is an adjustment or improvement to the process which would be beneficial for all
Committees and therefore should be made as a change to standard processes (for
example reporting format or processes which makes the reporting cycle more
efficient or information more easily understood)
Is a required change for a specific Committee(s) and therefore a change request will
need to be logged (i.e. additional reporting).
Agreement of these changes will require sign off at the Primary Care Management Board
and then with Primary Care (Co) Commissioning Committees before it can be considered
confirmed. This may require resource and/ or cost implication assessments, and the
ownership for any impact of these would need to be discussed as part of the agreement
discussions.
Updates of and additions to working policies and guidance, referred to by this document,
may be approved by Accountable Officers and NHS England (London). Any changes would
be considered and approved by London Region’s Primary Care Management Board.
1.2 Operating model processes for individual committees As mentioned above, this document aims to provide a standardised version of the operating
model. However the below details will need to be discussed in each individual committee,
and therefore decisions relating to the below are seen as acceptable levels of customisation
within this standard model:
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Incr
easi
ng
CC
G c
on
tro
l
Standard policies to assist decision making should be reviewed and agreed by the
committee; the committee may wish to add others
The sub-committee structure is likely to be different per committee. This should follow
the principles defined here and be discussed and agreed with NHS England if
involved.
The CCG representative(s) to be contacted in the event of urgent decisions being
required.
These elements should be discussed and agreed as part of committee discussions, and
should be included as appendices or linked documents.
1.3 Defining co-commissioning Co-commissioning for primary care refers to the increased role of CCGs in the
commissioning, procurement, management and monitoring of primary medical services
contracts, alongside a continued role for NHS England. The scope for co-commissioning is
general practice services only. CCGs have the opportunity to discuss dental, eye health and
community pharmacy commissioning with their regional team and local professional
networks, but have no decision making role.
There are three co-commissioning models, and as of April 2017 there are London CCGs at
Levels 2 and 3:
Level 1: where CCGs have involvement in primary care decision making,
Level 2: which is where the CCG (or CCGs) participate in decision making with NHS
England in a Joint Committee
Level 3: delegates decision making regarding certain functions (see below) entirely to
the CCG (or CCGs)
A high level overview of responsibilities is shown below:
Figure 1: High level breakdown of co-commissioning responsibilities
Level 1*: Greater involvement in
primary care decision-making
Level 2*: Joint commissioning
arrangements
Level 3*: Delegated
commissioning arrangements
CCGs participate in discussions about primary care, but there is no
“committee”, or other new governance arrangements, required to take
on added responsibilities.
NHSE retains its statutory decision making responsibilities.
NHSE and the CCG(s) form a “joint committee” (or “joint committee in
common”) to support commissioning of primary care. Together they
vary/ renew existing contracts for primary care , make decisions on
contractual GP performance management and commission some
specialised services. Can also design local incentive scheme as an
alternative to the Quality and Outcomes Framework (QOF) or Directed
Enhanced Services (DES).
The CCG assumes full responsibility for commissioning GP services,
forming a committee on their own. Responsibilities are as above, but
includes budget management. NHSE retain legal liability for
performance of primary medical commissioning, and therefore retain
oversight of the committee.
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Figure 1: Co-Commissioning Levels
1.4 Terminology: At levels 2 and 3, co-commissioning decision making is conducted through a, or several,
‘committee(s)’, which is joint with NHS England, or delegated. The committee could either
consist of:
Committees of single CCGs (with or without NHS England)
Committees in common of more than one CCG (with or without NHS England)
For simplicity, throughout this document, the body which conducts decision making
for co-commissioning is referred to simply as “the committee”, and it may refer to any
of the parameters above. Where different processes are required for joint or delegated
committees, these are called out.
1.5 Differences between Joint and Delegated Committees The move to co-commissioning, means that certain decisions (see Figure 2) which were
previously conducted directly by NHS England, will now be made by the body constituted to
support the level of co-commissioning each CCG has applied for – i.e. committees with NHS
England (for joint commissioning) or without NHS England (for delegated commissioning).
Regardless of whether the CCGs are conducting Joint or Delegated commissioning, the
functions enacted will be for the most part the same; the main difference is whether NHS
England is part of the decision making process or not. It should be noted that there will be a
joint responsibility for ensuring quality, through the reporting of performance data
It should be noted that the CCG may ask NHS England to attend and/ or present papers at
delegated committees, but this should be done on request and NHS England will not be a
voting member.
1.6 Responsibilities remaining with NHS England At all levels of co-commissioning, NHS England will retain a role in supporting delivery of
commissioning and contracting functions. This will be discharged by NHSE teams that will be
accommodated by a lead CCG for each of London’s STPs. Also the following responsibilities
will remain with NHS England and will not be included in joint or delegated committees:
Continuing to set nationally standing rules to ensure consistency and delivery goals
outlined in the Mandate set by government.
The terms of GMS contracts and any nationally determined elements of PMS and
APMS contracts will continue to be set out in the respective regulations/ directions.
Functions relating to individual GP performance management (medical performers’
lists for GPs, appraisal and revalidation).
Administration of payments to GPs.
Patient list management will remain with NHS England.
Capital expenditure functions.
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2. Decision Making
2.1 Decision making principles One of the exceptions to this as a standard document across all committees is that there
may be some variation as to what and how decisions are made in the commit tees. Decisions
will be taken in line with the criteria set out in each committee’s Terms of Reference. In
addition to principles of good practice which are set out in the Next Steps in Co-
Commissioning document, conflicts of interest policy, terms of reference etc., the following
principles should be considered:
Any urgent decisions made outside of the committee should be based on what
is necessary to maintain patient care; wherever possible decisions will be taken
within the committee.
In the event that an urgent decision is required and action must be taken to
maintain patient care outside of a committee, NHS England will communicate
with the contact nominated in the committee’s terms of reference (via phone
and email) to ensure that an urgent unplanned decision is made to maintain
and safeguard patient care.
2.2 Decision making process Co-commissioning of Primary Care will enable committees to take full or partial responsibility
for many decisions which previously sat with NHS England. Any CCG functions which are to
be delegated into this committee are not included here.
Decisions have been classified into three types in order to help capacity in the committee.
These types are:
1. Decision making through policies which therefore require minimal/ do not require
discussion because there is a clear approved policy which provides clarity on the
action required
2. Urgent decisions which cannot wait until the committee. These decisions require
emergency processes (see below)
3. Decisions to be discussed in the committee. Other General Practice
commissioning decisions should be made within the committee. It is expected in
many cases recommendations will be made into the committee from pre-work or sub-
committees as appropriate.
These decision types and the related processes can be seen in the below processes:
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2.2.1 Decision Making through policies
The below diagram shows how decisions where policies which are already defined might be used to support the co -commissioning committee.
Please note, this process would be the same for both Joint and Delegated commissioning decisions:
Figure 2: Decisions made through policies
This policy shows that although the policies referred to here would be Nationally or Regionally agreed policies, and therefor e with limited scope for
change, it is proposed that these are discussed and agreed at one of the early committee meetings in order to confirm that the members are
comfortable with the scope and approach. The process also includes provision for addendums to the policy. If for example ther e are concerns
regarding the way a decision has been reached then the committee should talk about the way that this can be improved in the f uture. It is
important to note that the content of an agreed policy may not be able to be changed, and the impact of any material change would need to be
signed off at the Primary Care Management Board as well as the committee, but this is to illustrate the opportunity for continual improvement.
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The purpose of this process is to relieve agenda pressure in the committee. If there are any
decisions or elements of the report which the committee would like to discuss, this can be
done and should be offered by the chair at the start of the meeting.
2.2.1.1 Decisions with defined policies
The decisions which can be made through defined policies will be discussed and agreed by
each co-commissioning committee, however the expected decisions where policies are
expected to be used to make decisions:
List closure
Boundary changes
Discretionary payments
Contractual changes
There are several other areas where standard operating processes or policies exist, but it is
expected that decisions will still need to be made within the committee and therefore are not
included here. The full list of potential decisions with policies can be found in Figure 5.
2.2.2 Urgent decision making:
‘Urgent’ is defined in this document as a decision which cannot be made within a committee
because of timing and nature of the decision. The main co-commissioning committee is
accountable for all decisions, and should agree to the decision process for this and expected
circumstances where this would arise and these agreed arrangements should be reflected in
the relevant terms of reference. It is important to note that there are two types of urgent
decisions. These are described below, with suggested processes.
It should be noted however that the process and individuals involved should be decided and
agreed by the Primary Care Committee, and this should be reflected in their terms of
reference (either referring to this operating model and providing details of the individuals to
be involved or outlining any changes within the agreed principles).
2.2.2.1 Urgent unplanned decisions
An urgent unplanned decision arises when something unexpected occurs that requires
immediate action. For example if a practice goes bankrupt a decision will need to be made
immediately in order to support the patients on the registered list.
The below principles apply to urgent unplanned decisions:
o Wherever possible, only decisions necessary to maintain patient care should
be taken outside of the committee
o The terms of reference of co-commissioning committees should set out
member’s responsibilities for making urgent decisions The NHS England team
accommodated at the lead CCG will communicate with this contact (by phone/
email) to ensure a decision is made which will be:
A joint decision between the NHS England and CCG representatives if
operating in joint commissioning, or
The CCG is asked to make a decision in delegated commissioning
o In the event that the CCG is made aware of the need to make an urgent
decision, they are:
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Required to communicate with NHS England to make the decision
together if operating in joint commissioning
Able to communicate with NHS England if they require support/ advice
to make the decision in delegated commissioning
The below diagram shows how urgent unplanned decisions might be made. Please note,
these processes would be the same for both Joint and Delegated commissioning
decisions:
29
Figure 3: Urgent unplanned decisions
This process is also described below:
In the event that a situation occurs unexpectedly in which an urgent decision is made, the NHS England team accommodated by the lead
CCG will communicate with the relevant CCG contact (by phone/ email) in order to support the decision making process
o For joint commissioning CCGs, the decision will be made by NHS England and the CCG together
o Delegated commissioning CCGs will make the decision, supported by NHS England as required
These decisions will be reported back to the committee and discussed. Any further action will be agreed by the committee.
It should be noted that both NHS England and CCGs should aim to learn from and if able create processes for making decisions in these
circumstances. Also in the event that the CCG becomes aware of the decision that needs to be made, they will need to:
30
In joint commissioning – communicate with NHS England (the relevant Head of
Primary Care or Director of Primary Care) in order to jointly make the decision
In delegated commissioning, the CCG may wish to seek advice or support from NHS
England but is not obligated too. They should however inform them of the decision as
there may be impacts or other communications which should reflect the decision
made.
Some CCGs have outlined a process if the decision making window is longer (for example
two weeks), allowing them to bring together a slightly bigger group of people (e.g. Chief
officers, the chair of the committee and NHS England representatives). This enables
decisions to be more widely considered and tested however it is noted that it may be
challenging to gather a wider group at short notice, and it is suggested that virtual or
telephone discussions may be easier. CCGs are advised to make the process of planned and
unplanned urgent decision making clear in their committee TOR.
2.2.2.2 Urgent planned decisions
There may be some decisions which are expected, but:
Cannot be made at an earlier committee as, for example there is insufficient
information
Must be made before the next committee
This means that decisions do need to be made through an urgent process, but that some
planning can be undertaken ahead of the decision. Specific arrangements and decision
rights, for each CCG, should be referenced in their Terms of Reference. The principle of how
this should operate is shown below:
31
Figure 4: Urgent planned decisions
This process is also described below:
32
In the event that a decision cannot be taken in the committee because sufficient
information is not known, or there are some other inhibiting circumstances, planning
should be undertaken as much as possible to ensure the committee is able to input
into the decision making process
Therefore any elements of the decision or process relating to the decision should be
discussed, and if necessary a sub or working group may be set up to continue work
towards this decision
o Please note, there may be an existing group or sub-committee which would
undertake this work.
These decisions will be reported back to the committee and discussed. Any further
action will be agreed by the committee.
It should be noted that both NHS England and CCGs should aim to learn from and if
able create processes for making decisions in these circumstances. CCGs are advised
to make the process of planned and unplanned urgent decision making clear in their
committee TOR.
2.2.3 Main decision types required
2.2.3.1 Business as usual decisions
The table below sets out of the main formerly NHS England functions which will now be
decided in the committee. This includes a recommendation as to the type of decision the
committee will be asked to make (this is not confirmed until this document has been
approved by each committee).
Name Function Committee decisions
needed (section 2.2)
Decision possible
with approved policy (s 2.2.1)
Need for urgent
decisions (s 2.2.2)
Does a
national/London SOP/policy/report
exist?
Determin -
ation of
key
decisions
or
requests
List Closure Yes
List suspension Yes
Practice mergers/ moves Yes
Boundary Changes Yes
Securing services through
APMS contracts
Yes – options appraisal doc
PMS (review s etc) Yes
Discretionary Payments Yes (Appeal/ complaint SOP)
Remedial and breach
notices
Yes (Contractual issues of concern)
CQC Inadequate &
Requires Improvement
ratings
Yes – National (Inadequate)
Yes – London (Requires Improv ement) .
Contract termination-e.g.
Death/ Bankruptcy/ CQC
Yes (bankruptcy, and options)
Contractual changes
(contentious/ important)
Contractual changes
(transactional)
Yes (Contract signatory changes)
Locum reimbursements Yes Yes plus London FAQ, which is being considered f or national adoption
33
Locum cover or GP
performer payments for parental and sickness
Leave
Yes plus London FAQ which is being considered f or national adoption
Infection prevention &
control
SLA
GP Rent review process green green green Under dev elopment
Edec irregularities green green Under dev elopment
Financial
Processes
Ensuring budget
sustainability
Management Accounting
Strategy &
Policy
Securing quality
improvement
Request to issue breach ov er quality attached
Developing and agreeing
outcome framew ork e.g. LIS
Yes (f or LIS schemes)
Securing consistent
population based provision
of advanced and enhanced
services
As abov e
Premises plans, including discretionary funding
requests in accordance w ith
current NHS (GMS -
Premises costs) Directions
yes Yes, example PID attached Premises Directions Financial assistance towards premises running costs and serv ice charges –
Resilience & sustainability
of general practice
yes Section 96 agreement and MOU
Figure 5: Table showing former NHS England functions which will now be decided in the
committee
Relevant national policies and guidance can be found here
Extant London policies and guidance can be found here:
2.2.3.2 Strategic Discussion and decision making
The committee should also be used to support discussion on Primary Care strategies, such
as delivery of the General Practice Forward View, Five Year Forward View Next Steps
and Strategic Commissioning Framework and other strategic aims.
2.3 GP Performance and Quality Reporting Requirements
The following outlines the agreed principles which will underpin future GP Quality and Performance reporting arrangements
Collaborative working
London region, its STP primary care leads and constituent CCGs will work together todeliver, common approaches and shared protocols/operational procedures to enabletimely, reliable, meaningful and consistent quality and performance reportingarrangements across London.
Over time, collaborative working will enable the system to make comparisonsbetween practices against set standards in order to stimulate and motivate change.
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In recognition that there are further developments in quality and performance dataand information, a minimum of an annual review of the London quality andperformance offer will be undertaken with STP PC leads at the Primary CareManagement Board.
NHS England will: Provide standardised data reports, cut at different aggregated levels e.g. Practice,
CCG, STP, Regional, National
Adhere to a planned refresh and publication schedule.
Clarify what can and can’t be shared and/or what can be shared through the NHSEngland team, but cannot be accessed by CCGs/STPs directly, based on clearInformation Governance requirements.
Where NHSE governance allows, upload dashboards, data and analytical informationonto the FutureNHS platform, which is a single accessible work space, for namedSTP/CCGs users to access
Will enable comparisons to be made between practices and used by STPs/CCGsagainst set standards over time in order to stimulate and motivate change.
STPs and/or CCGs will:
• Develop capacity to support standard reporting and analysis at STP/CCG level,subject to local agreement
• Be responsible for presentation, analysis and the ‘so what? Subject to localagreement.
• Target areas where quality needs improving based on local needs, which will alsoenable focus on specific issues e.g. DNA rates.
• Determine what data they use from the NHS England repository and may choose touse more up to date information, subject to its availability
• Share dashboards/tools that have been developed or are under development topromulgate good practice/what works
• Make a clear differentiation between what is information/data provided to reviewquality standards and that which is used to monitor performance in respect ofcontractual obligations and compliance
• Offer training to practices to support improved completion of returns, where required
Dashboards, data and analytical information and frequency of reporting
Whilst recognising that STP/CCG access to some NHS England data had not yet been
authorised by the latter, the initial list of reports and information available will consist of:
Resilience & Sustainability Tool (see yellow cells in Annex 1 for data items andreporting frequency)
CQC ratings trend analysis (monthly)
GPPS (General Practice Patient Survey) trend analysis, focused on questionsrelating to accessing services, coordinated care and patient experience (annual)
London Complaints dashboard (monthly)
Under development:
HEE workforce data
FFT trend analysis
Awaiting NHS England authorisation clearance:
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Primary Care Activity Report (see red cells in Annex 1 including reporting frequency).NHS England STP contract management teams will provide information on itemssuch as list closures; temporary list suspension; breaches; contractual disputes in themeantime (most up to date information provided, based on report timing)
GPFV Dashboard (see white cells in Annex 1, including reporting frequency). A smallnumber of the extended access metrics will be shortly published externally. In time allof it will be and it will be gradually incorporated into reports.
Other information supplied by NHS England STP contract management teams:
Performer concerns being addressed by NHS England’s Medical Directorate that mayimpact on GP contracts (most up to date information provided, based on reporttiming)
Access to Dashboards, data and analytical information
FutureNHS will be the collaborative online resource that will allow NHS England London
region to host and share the latest iterations of dashboard reports each month. NHS England
will setup the workspace and invite delegates to join.
The list of delegates will include CCGs, STPs and primary care contracting team nominated
representatives across London.
As this process develops and governance requirements allow, additional dashboards/reports
will be included and shared as part of the Operating Model.
Attached is a template (Annex 7) that should be shared via STP leads with relevan t
stakeholders, and populated with the required information, following which it should be sent
back to Adrian Mccloskey [email protected] who will enable access.
Access to FutureNHS can take place from the beginning of January, subject to when STP
leads return their completed templates
36
Data sources and reporting frequency
Data Source Frequency
Active practices Quarterly
Branch practices Quarterly
Registered patients Quarterly
Practice size Annual
Delegation arrangements Annual
Contract type Annual
Dispensing practice Annual
Deprivation Annual
Patient demographics Annual
Workforce overview Quarterly/Bi-annual depending on measures
Workload reporting Frequency TBD
CQC ratings Monthly
Complaints Monthly
QOF Annual
GPPS Annual
FFT Annual
Average payments Annual
Patient online (POMI) Monthly
Extended access Bi-annual/Quarterly depending on source
Provider development measures for care redesign Monthly
Estates and Technology Transformation Fund Monthly
Secondary care measures (e.g. A&E attendance, elective admissions etc) Monthly
Care coordination (e.g. Care Navigators and Medical Assisstants) Quarterly
Online consultation systems Quarterly
Practice closures Annual
Procurement exercises Annual
Section 96 discretionary payments Annual
Patient list closures Annual
Patient and public participation planning and asssessment forms Annual
Contractual reviews Annual
Contractual disputes Annual
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2.3.5 Conflicts of interest
All committees must adhere to the conflicts of interest guidance1 and this must also be
adhered to for any sub groups set up to support the committee.
1 i .e. Managing conflicts of interest: Revised statutory guidance for CCGs and Code of Conduct guides
38
2.3.5 Other decision-making processes – finance and strategy
Finance
Joint Co-Commissioning Committees
For Joint Committees, NHS England Finance teams accommodated at Lead CCGs will
continue to do all financial and management accounting. However, it will produce monthly
financial reports (for instance, covering spending against forecast and narrative on variance)
which will be provided to each CCG. The CCG may then choose to add information to these
reports before they are submitted to the committee(s).
Delegated Co-Commissioning Committees
For Delegated Committees, transactions for delegated functions will be posted directly to the
CCG’s ledger., NHS England Finance teams accommodated at Lead CCGs will be
responsible for reporting, and management accounting of primary care costs. The CCG may
also make further queries of NHSE, to support this process. Management accounting
activities will likely include, but not be restricted to:
Month end procedures
Accruals, prepayments, and any payments additional to those in the financial plan
The production of monthly & quarterly CCG management reports at GP practice or
locality level to ensure robust financial forecasts and analyse variances to ensure
they are explained
Practice list size analysis by CCG locality for GM/system report downloads
Quarterly forecasting on CQRS
Additional year end tasks including working papers and support to AOB process
Liaise with internal and external audit as required.
39
Figure 7: Process map showing financial processes
40
2.4 Other potential Committee responsibilities In addition to the above standard processes, there are other Primary Care elements which
the Committee is expected to be involved in. Some of these areas are listed below however
it should be noted that further discussions are required as to how these would be enacted
and supported between NHS England teams accommodated at Lead CCGs and the CCGs
at different co-commissioning levels. Further delegation from NHS England to CCGs will not
be made without agreement, and without consideration of the resource implications of such
delegation.
Item Committee Requirement
Appeals and disputes
The committee is asked to note the standard operating procedure for managing appeals and disputes submitted by GPs in relation to their GP contract.
Counter Fraud Ensuring that proper processes are in place to prevent fraud within the NHS
Interpreting services Ensure that patients can access interpreting services when using GP practices.
Occupational Health The committee shall ensure that GPs have access to occupational health services in accordance with national guidance
Controlled drugs reporting
The Committee is responsible for ensuring that practices are complying with legal requirements for use of controlled drugs and that CCGs and NHSE have proper controls in place to maintain patient safety. The RT will carry out reporting, analysis and compliance that aids this.
Safeguarding To set policy and to set the expectation that GP Practices have effective safeguarding systems in place in accordance with statutory requirements, national guidance and Pan London Policy/ Procedures. CCGs will be responsible for ensuring that the GP services commissioned have effective safeguarding arrangements in place to improve the well-being of children and adults. The CCG will proactively support Primary Care through advising on training and good practice guidance and monitoring safeguarding issues, providing assurance to NHSE that there is compliance with safeguarding standards.
Further detail on responsibilities for safeguarding are provided under Annex 4.
Incident management
For both serious and non-serious incident management, the Committee is responsible for ensuring that there are proper processes in place for the reporting and review of incidents, so that they can be identified and managed. The CCG and NHS E will support and contribute to investigations, as required.
Domestic Homicide Reviews
The Committee will ensure that GPs contribute to domestic homicide reviews, where necessary. The CCG and NHS E will support this where their resources are appropriate.
Further detail on responsibilities for safeguarding are provided under Annex 4.
Communications For CCGs at level 3 delegation, lead responsibility will be determined by what is appropriate, on the merits of each communication.
NHS England remains responsible for communications for CCGs at level 2 delegation.
41
Figure 8: Other potential Committee responsibilities
3. Governance and people
3.1 Committee constitution While much of the decision-making processes will be determined by Committees/ Joint
Committees, the constitution of the Committees themes have been set by NHSE, as a
condition of co-commissioning. The following are the criteria for a Committee (for Level
Three co-commissioning), and for a Joint Committee (for Level Two co-commissioning).
Figure 9: Committee and Joint Committee constitution
Other Committee attendees
In the interests of transparency and the mitigation of conflicts of interest , other interested
local representative bodies have the right to join the joint committee as non-voting attendees,
such as LMC, HealthWatch and Health and Wellbeing members. Invitees should be
determined in line with national guidance, and local terms of reference. Attendees should be
agreed so as to support alignment in decision making across the local health and social care
system. Other organisations may be invited, and as the committee meets openly it is likely
that members of the public and others will attend.
3.2 Committee resourcing There will not be a nationally-determined model of resourcing for co-commissioning, and
there is a recognition of the additional workload these new ways of working will result in . We
Committee is made up entirely of CCG
members (NHS England will not be
members of the board).
The Chair and Vice/Deputy Chair of the
committee are CCG Lay Members.
There is a secretary, responsible for
minutes, actions, the agenda, and
reporting back Committee decisions to
the CCGs.
NHS England will also have access to the
minutes etc. from the board for
assurance purposes, and all of these
documents will also be publically
available on CCG websites.
Committee includes representation of
both CCG and NHS England members
and both bodies have equal voting
representation*
The Chair and Vice/Deputy Chair of the
committee are CCG Lay Members.
There is a secretary, responsible for
minutes; actions, the agenda, and
reporting back Committee decisions to
NHS England and CCGs; and these will
also be publicly available on CCG websites
Level Two: Joint Committee Level Three: Delegated Committee
42
expect, therefore, local dialogue between CCGs and their regional teams to determine how
the Committees can access the existing primary care team support, recognising that
CCGs are taking on significant responsibilities from NHSE, and therefore will require
access to a fair share of the regional team’s primary care commissioning staff
resources
Area teams need to retain a degree of this resource, in order to safely and effectively
continue with their remaining responsibilities.
Currently, there is no possibility of additional administrative resources from NHS England at
this time, but this will be kept under review.
4. Processes & Capabilities
4.1 Meeting process:
It is proposed that the method of operating the committee should follow processes already
established in CCG’s. The below illustrates a standard process for meeting setup:
Figure 10: Meeting process map
4.1.1 Agenda contents It will be important for engagement between NHS England and CCGs ahead of meetings,
particularly in cases where a particularly significant matter is on the agenda to be discussed.
This may involve the need for additional meetings, or for information from NHS England to
inform thinking. This will be particularly important for delegated commissioning, where NHS
England will not be participating in the committee discussion. Each Committee should set out
how this engagement will take place, as well as when, in the standard meeting process set
out above (Figure 10), submissions will be accepted for discussion at each meeting.
In general, clear and active engagement with NHS England, as well as the Committee sub
groups, will help inform the content of the agenda we expect that agendas are likely to have
the following components:
Standard agenda items, which might involve items that can be expected at each
meeting, such as an overview of finance and performance reports.
Work-plan items, such as a review of the annual budget or developing a Primary
Care Strategy, which is determined by the known upcoming work
Length of meeting cycle, and regularity of meetings, to be defined by Committee/ Joint Committee
43
Any other items, which could include submissions from NHSE, sub groups, and the
CCG.
There will also need to be a determination for whether part of the meeting needs to be in
private. The process for determining the privacy of meetings is set out in 4.2, below.
4.2 Meeting Papers As outlined in the reporting section on page 21, papers created by NHS England should be
submitted to the committee secretary 4 days before the papers are circulated in order to
allow time for them to be reviewed and comments and adjustments made.
It is expected according to standard meeting processes that papers may be circulated a
week before the meeting, although this should be determined by each committee and
referenced in their terms of reference.
It is important that requirements in terms of papers and presenters is made clear by the time
the agenda is finalised. Working groups and sub-committees should have clarity regarding
upcoming meetings and how work should feed into these boards, including the timelines
required.
Delegated CCGs should also ensure that where advice, recommendations or papers a re
required from NHS England, that this is sought and discussed in advance. The CCG may or
may not request NHS England presents the paper at the committee.
4.3 Meeting in private As standard, the Committee meetings will be held in public. However, the Committee may
require to close part of the meeting on account of the matters to be discussed. Only
members of NHS statutory bodies, that are bound by standard NHS confidentiality
agreements are expected to attend the closed part of meetings. Only attendees of the private
part of the meeting will receive the papers for that part of the agenda. If necessary it may be
important to redact names and other details from the minutes.
It may be appropriate for the committee to seek the views of the audit chairs once a definition
of this policy has been created for each committee. Below is some guidance which
Committees may wish to consider:
Whenever publicity would be prejudicial to the public interest by reason of the
confidential nature of the business to be transacted or for other special reasons
stated in the resolution and arising from the nature of that business or of the
proceedings; or
If the discussion is commercially sensitive; or
Where the matter being discussed is part of an ongoing investigation; or
For any other reason permitted by the Public Bodies (Admission to Meetings) Act
1960 as amended or succeeded from time to time.
The provision for private meetings should only be used where required (as per the criteria
above). Where the discussion is not as sensitive, other mechanisms could potentially be
used, such as anonymising the reports. Additionally, Members of the Committee shall
respect confidentiality requirements as set out in the CCG Constitution and Standing Orders.
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5. Annexes
Annex Introduction The annexes included with this document aim to provide further detail to elements of the
Operating model where it is too detailed to include in the main body of the text. These are
not meant to be read as continuous chapters, but are included as reference material if
required. A short description of the purpose of each annex is included in a table below:
Annex Reference/ Name Purpose Annex 1: Detailed processes – including differences in responsibility by delegation level
This is the detailed memorandum of understanding aiming to outline the relative responsibilities of the CCG, NHS England and “the committee”. The committee includes both joint and delegated committees. This can be used if more detail is required on process and ownership, however it is suggested that where activities are unclear it may be beneficial to discuss with an NHS England or CCG colleague.
Annex 2: 13Z – CCG Statutory duties This lists the duties which effect the CCG that NHS England does not have liability for under section 13Z. This is included for its reference to roles and responsibilities.
Annex 3: Performer Contract Decision Making Process
This process aims to outline the decision making process specifically related to contract decisions arising from performer issues. It links into the overall decision making process flows (section 2).
Annex 4: Safeguarding – responsibilities at different levels of CCG co-commissioning delegation
This annex provides a high level analysis of responsibilities related to safeguarding at different levels of co-commissioning:
Annex 5: Pan London Responsibilities of NHS England STP Based Teams
This annex provides a list of matters dealt with on a pan-London basis, with lead NHS England STP based team responsibilities
Annex 6: Pan London Fora This annex provides an overview of pan-London Primary Care for a, their remit and membership
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Annex 1: Detailed processes The tables below set out the key Co-Commissioning responsibilities and tasks of the Committee, the CCGs and NHS England.
Responsibilities Tasks/ Standard
Definition The Committee CCG NHS E The Committee CCG NHS E
1. Determination of key decisions/ requests
Determination to secure services through an APMS contract either a consequence of a practice vacancy, a finding that there are inadequate services in the area or following a contract expiration
To decide whether it is appropriate to undertake a procurement to appoint an APMS provider where there is a vacancy or a contract has expired. In making this decision the Committee must ensure that it is a viable and vfm service that will meet the needs of the current and future population, addresses inequalities, improves quality choice and access. The Committee is responsible for ensuring that appropriate engagement processes are in place to support decision making
To secure & provide, to the RT, local intelligence and feedback to support decision making. The CCG shall also provide relevant local strategic context to support decision making. The CCG may, if appropriate, agree additional resourcing for the service. To work jointly with the RT and local representative to identify new or alternative solutions to address the practice vacancy and additional local KPI requirements.
To secure & provide necessary information to support decision : - performance and service data; - equality impact assessment; - needs assessment; - available funding, including transitional funding; -service viability; - feedback from stakeholders and the CCG; -relevant guidance. To implement the decision of the Committee. To work jointly with the RT and local representative to identify new or alternative solutions to address the practice vacancy
Tasks: 1. Determine whether procurement is the best option in the interests of patients and the public and that no other options are viable to secure adequate services 2. Assure that correct processes have been followed, particularly in relation to patient and stakeholder engagement; 3. Confirm that the contract is affordable; 4. Confirm that the service is viable 5. Set tolerances for the cost and timeframe for implementation. 6. Ensure that an equality impact assessment has been undertaken 7. Ensure that the proposed procurement processes are undertaken in accordance with SFI's and regulations. Standard: Maintain a record of the decision, particularly in relation to potential conflicts of interest; Notify RT of decision with details of agreed funding and tolerances for implementation;
Tasks: 1. Provide local intelligence to the RT to support their report: 2. Provide relevant information about localstrategies to be included in the RT report: 3. Where necessary present paper to The Committee, with RT 4. Where appropriate, secure additional CCG funding to support a new service prior to the Committee's determination 5. Provide relevant specifications and data to support local KPI's. Standard: To provide relevant information to the RT within 15 WD's of the request. To ensure that the Committee has information to support their decision making, including confirmation of any funding the CCG intends to make available for the service.
Tasks: 1. Undertake required needs assessment, feasibility analysis, financial modelling and impact assessments to support the decision making process. 2. Implement an appropriate engagement plan.3. Work jointly with the CCG to identify any localKPI's or other commissioning opportunities. 4. Identify and secure any additional resources required to support options. 5. Establish a procurement project team to implement the Committee's decision, if required. 6. To maintain and update a database of fixed term contracts. 7. To procure the service in accordance with directions, regulations and guidance.
Standard: To process in accordance with regulatory requirements, Relevant SFI's and agreed procurement processes.
Procurement of new Services under APMS agreements
The Committee is responsible for approving a preferred provider following procurement process following the evaluation process
The CCG is responsible for providing local standards and specifications to address local issues of access, quality and choice
The RT shall develop and implement procurement policies & programmes aimed RT securing new APMS providers.
Tasks: Develop local standards and KPI's to be incorporated into APMS contracts. Support providers to ensure optimum delivery. Communicate with local stakeholders as required.
Tasks: Develop London standards and KPI's to be incorporated in APMS Contracts. Standard: Use standard frameworks to secure services and ensure good value for money - Support providers to ensure optimum delivery. Standard: Procure APMS in line with the agreed commissioning strategy - Initiate formal procurement activity for each APMS scheme, within terms of any national procurement support. - Sign off/ finalise contracts with preferred bidder. - Agree/ implement the local mobilisation plan. - Undertake appropriate checks prior to service commencement (for example, premises inspection). - Make provision for emergency primary medical care services in the event of an unforeseen circumstance.
Determination of a requests; - to close a branch practice; -for practice mergers; -PMS partnerships; -List Closures; -Rent Reviews
To consider and determine requests in a timely manner following appropriate consultation and in accordance with statutory requirements and agreed policy; ensuring that any decision will secure continuity of services and provide benefits for patients and the public. The Committee will pay due considerations to Strategic imperatives and Statutory
To secure & provide, to the RT, local intelligence and feedback to support decision making. The CCG shall also provide relevant local strategic context to support decision making.
To secure & provide necessary information to support decision: - performance and service data; - feedback from stakeholders and the CCG; -relevant guidance. To implement the decision of the Committee.
Tasks: 1. Determine request; 2. Assure that correct processed have been followed, particularly in relation to patient and stakeholder engagement; 3. Provide minutes and decision rationale 4. Ensure continuity services as a consequence of their decision: 5. Maintain records of all decisions; 6. Respond to questions and queries relevant to the decision, including FOI requests.. Standard: Provide decision and rationale within 5 WD of the meeting:
Tasks: 1. Provide local intelligence to the RT to support their report: 2. Provide relevant information about localstrategies to be included in the RT report: 3. Work jointly with RT to ensure patient benefit and service continuity; 4. Where necessary present paper to The Committee, with RT . Standard: All requested information to be provided within 10 WD: To make available relevant staff for meetings and case conferences pertinent to the decision
Tasks: 1. Processing the application; 2. Engagement/consultation with stakeholders and patients; 3. Notifying the CCG and The Committee secretariat ; 4. Preparing & presenting the report to the Committee, using agreed format; 5. Issue decision letters/ notices; 6. Support any practice closure using agreed protocol; 7. Updating databases and notifying 111 via CSU. Standard: To process in accordance with:
46
Responsibilities Tasks/ Standard
Definition The Committee CCG NHS E The Committee CCG NHS E
requirements to secure primary care services to meet the current and future needs of the population.
- Ensure that service continuity is not compromised as a consequence of their decision: - Ensure patient and public benefits are secured: - Acknowledge all queries within 5 WD offering full response within 20 WD: - Comply with FOI timescales
- National & London SOP; - Regulations- Contract and Patient Public engagement
GP Practices list maintenance
The Committee is responsible for decisions on any ad hoc list maintenance requests and for the setting of cleansing periods
NHS England is responsible for commissioning a process of practice list maintenance and will liaise with NHS Shared Business services and any other external partner as part of that.
Issue of Contract Breach Notice
To determine whether a provider has breached the terms of their contract and to make a proportionate decision as to whether: -a remedial or breach notice is warranted; -the practice should be asked to submit a improvement plan; -no action is required under the circumstances. To review outcome of remediation /improvement plans.
To identify & manage any resulting risk to services they commission as a consequence of an adverse finding. To provide support or facilitation for any relevant improvement plan/actions
To investigate concerns and provide evidence where a contract has been breached together with any mitigation offered by the provider using an agreed London template: To implement decisions
Tasks: 1. Review evidence and confirm that a contract has been breached; 2. determine the most appropriate and proportionate response to the breach taking account of relevant mitigation . Standard: Provide decision and rationale within 5 WD of the meeting: Ensure that service continuity is not compromised as a consequence of their decision: Ensure that there is a formal review of the outcome of all remediation and improvement plans.
Tasks: The CCG may be informed of concerns when a finding has been made, if it is relevant to any contract held between them and the provider. .
Tasks: 1. Identify concerns: 2. Investigate concerns: 3. Notify the provider of concerns and any evidence to support they have breached the contract: 4. Present evidence of the breach to the The Committee along with any mitigation provided by the provider: 5. Issue notices to the provider: 6. follow up remedial actions /action plans7. liaise with the CQC and carry out actions to support registration 8. Produce format for local notices and breaches. Standard: Contract Regulations; National SOP Local protocols
Contract Termination
Determine the appropriateness of contract termination
To identify & manage any resulting risk to services they commission as a consequence of an adverse finding. To provide support or facilitation for any relevant improvement plan/actions
To investigate concerns and provide evidence where a contract has been breached together with any mitigation offered by the provider using an agreed London template: To implement decisions
Tasks: 1. Review evidence and confirm that a contract has been breached; 2. determine the most appropriate and proportionate response to the breach taking account of relevant mitigation . Standard: Provide decision and rationale within 5 WD of the meeting: Ensure that service continuity is not compromised as a consequence of their decision: Ensure that there is a formal review of the outcome of all remediation and improvement plans.
Tasks: The CCG may be informed of concerns when a finding has been made, if it is relevant to any contract held between them and the provider.
Tasks: Develop contract termination documentation, systems and processes. - Prepare Reports and Evidence for the Committee, securing necessary legal advice. - Issue termination notices. - Develop action plans to manage termination of contracts and implement in consultation with and supported by stakeholders. Update the contractor database with sanction information.
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Responsibilities Tasks/ Standard
Definition The Committee CCG NHS E The Committee CCG NHS E
Contractual Payments
The Committee is responsible for assuring that systems and processes are in place to ensure accurate and prompt payments to GP Practices in accordance with Contracts, Agreements, The SFE and SFI's
The CCG is responsible for notifying the Committee of any systematic failure to promptly pay GP Providers in accordance with the Contract / Agreements and SFE, setting out how this is to be addressed
NHS E is responsible for notifying the Committee of any systematic failure to promptly pay GP Providers in accordance with the Contract / Agreements and SFE, setting out how this is to be addressed
Tasks: 1. Review evidence and confirm that a contract has been breached;2. determine the most appropriate and proportionate response to the breach taking account of relevant mitigation . Standard: Provide decision and rationale within 5 WD of the meeting:Ensure that service continuity is not compromised as a consequence of their decision:Ensure that there is a formal review of the outcome of all remediation and improvement plans.
Tasks: The CCG may be informed of concerns when a finding has been made, if it is relevant to any contract held between them and the provider.
Tasks: - Agree appropriate contract variations (for example, list size changes) including their input to payment systems. - Calculate any agreed local quality and outcomes framework arrangement. - Calculate the impact of key performance indicators on contractual payments (alternative provider medical services contracts). - Determine entitlements to personal allowances (for example, seniority/ locum reimbursement). - Calculate and pay enhanced services that are specified nationally.- Calculate payments for GP registrars in respect of salary, mileage and travel grants. - Calculate prescribing and dispensing drug payments. - Calculate entitlements under the GP retainer/ GP returner and flexible career schemes.- Calculate payments in respect of the dispensary service quality scheme. Administer superannuation regulations, including all deductions, in relation to joiners, leavers, retirements, increased benefits, adjustments and pay these to the pensions division. - Administer and validate GP annual certificates. - Administer GP locum and GP- Solo contributions. - Provide the NHS pension assurance statement.- For suspended contractors, ascertain the individual’s entitlements, advise the contractor, validate all documentation, and adjust payment accordingly.
Disputes and Appeals
The Committee is responsible for agreeing a policy and procedure for managing appeals and disputes submitted by GP's in relation to their GP Contract. This includes ensuring there is a local resolution process and that a Panel is established to consider disputes and appeals where local resolution is not successful.
Tasks: The Committee shall establish a Panel who will consider any appeal or dispute.. Standard: The Committee shall ensure that all decisions are made in accordance with the Contract Regulations, SFE, SOP and previous determinations.
Tasks: The RT shall : 1. Ensure that contractors receive a clear and concise notice setting out any determination under the contract; 2. Implement local resolution where a contractordisputes a determination; 3. Where Local Resolution is not successful notify the Committee of the need to establish a Panel; 4. Provide a report to the Panel setting out theirrationale and evidence in support of their decision; 5. Present evidence & representations to the Panel 6. Notify the contractor of the outcome; 7. Provide information as required by the Litigation authority in relation to any appeal
2. Financial processesDetermine total budget requirements for all primary care services, including premises and information technology
The Committee is responsible for ensuring that financial balance is secured and maintained.
Under Delegated Arrangements the CCG CFO will approve the financial plan plus any in year revisions
NHS England finance teams accommodated at lead CCGs will carry out the day to day financial management tasks, including the production of monthly reports showing spending vs the agreed budget and variance analysis.
Tasks: Ensure appropriate financial controls are in place to securely manage the budgets.. Standard: Operates in accordance with NHSE or CCG SFIs.
Tasks: a) Maintain control total for revenue and capital limits and agreement of RFTs
Tasks: b) Financial Planning & Reporting including input to monthly board report, external reports, financial plan submissions and in year review of plans, budget setting & team co-ordination, month end overview. non ISFE reports to region, QIPP reporting.
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Responsibilities Tasks/ Standard
Definition The Committee CCG NHS E The Committee CCG NHS E
Management Accounts
The Committee will: - review the financial reports; - Make decisions to address financial deficits; - Approve any payments additional to those in the financial plan
The CCG will scrutinise the financial reports prepared by the RT and will ensure that the appropriate decisions are brought to the attention of the Committee
NHS England finance teams accommodated at lead CCGs will provide appropriate monthly financial reports to enable budget holders to monitor and take decisions on the budgets,
Tasks: The production of monthly & quarterly CCG management reports at GP practice or locality level to ensure robust financial forecasts and analyse variances to ensure any variances are explained: Month end procedures a) complete regular task file b) variance analysis & narrative c) accruals & prepayments d) monthly year end forecasts at practice level orlocality level and input to system e) meet with budget holders f) Practice list size analysis by CCG locality forGM/system report downloads g) Quarterly forecasting on CQRS(inform forecasting h) additional year end tasks including workingpapers and support to AOB process i) liaise with internal and external audit as required..
Tasks: The production of monthly & quarterly management reports at GP practice or locality level to ensure robust financial forecasts and analyse variances to ensure any variances are explained: Month end procedures a) complete regular task file b) variance analysis & narrative c) accruals & prepayments d) monthly year end forecasts RT practice level orlocality level and input to system e) meet with budget holders f) Practice list size analysis by CCG locality forGM/system report downloads g) Quarterly forecasting on CQRS(inform forecasting h) additional year end tasks including workingpapers and support to AOB process i) liaise with internal and external audit . Standard:
Financial systems and BI
The Committee shall assure that appropriate systems and SOPS are in place to manage and maintain financial control in line with the relevant financial instructions
The CCG will ensure correct calculations and payments are carried out in line with the contracts by ensuring appropriate internal and external audit arrangements in place
NHS England finance teams accommodated at lead CCGs are responsible for the correct calculation of payments to all contractors in line with their contracts
Tasks: Ensuring compliance with central requests and timelines and utilising their system and BI reports to best effect: a) Financial System Management includingsetting up new ISFE reports, locality reporting, controls, exception reporting
Tasks: a) Ensuring compliance with central requests and timelines and utilising the system and BI reports to best effect: b) Set up new suppliers or amend existing suppliers on ISFE e.g changes to bank account details, and to reflect practice mergers c) Financial System Management including settingup new reports, locality reporting to CCGs, controls, exception reporting d)Liaison with SBS and central NHS England
3. Strategy and policy
Develop and agree a Primary Care Strategy (SPG)
The Committee to: - approve strategy and, - provide oversight to development and implementation
To contribute information & resources to: -support strategy development, -implement plans and strategies, - contribute resources to facilitate joint working To ensure primary care strategies are aligned to CCG strategies and plans To develop and implement engagement plans in line with primary care strategy.
To contribute information & resources to: -support strategy development, -implement plans and strategies, - contribute resources to facilitate joint working To develop and implement engagement plans in line with primary care strategy.
Standard: Engage and consult with key stakeholders, including patients, carers and the public in relation to priority areas for improvement, Ensure that the London Specifications / Framework is integrated into Local CCG and SPG Strategies, Ensure that primary care is integrated into local joint strategic needs assessment planning processes, Integrate and align primary care strategies with health and wellbeing strategies, Integrate and align primary care strategies with CCG and SPG strategies, particularly in relation to urgent care and collaborative care
Primary Premises Plan /Strategy
The Committee is responsible for reviewing and determining business cases for new premises developments in accordance with local CCG premises development plans, national guidance and primary care directions
The CCG is responsible for developing local Strategies and Development Plans in conjunction with NHS E and NHS property holding organisations (Trusts, NHS PS and CHP)
The RT is responsible for providing information to CCG's and other organisations to support the development of strategic premises plans
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Responsibilities Tasks/ Standard
Definition The Committee CCG NHS E The Committee CCG NHS E
W orkforce Audit and planning
The Committee shall ensure that appropriate workforce audit and planning is place to support service delivery
The CCG to undertake local audits as required
The RT shall implement the national workforce audit and is responsible for ensuring that all practices submit their return
GP Provider Development -Organisation Structures
The Committee is responsible for determining responses to requests to close or merge practices
To support the below : - performance and service data; - feedback from stakeholders and the CCG; -relevant guidance. To implement the decision of the Committee. The CCG will consult with local stakeholders to arrive at a final decision.
To secure & provide necessary information to support decisions : - performance and service data; - feedback from stakeholders and the CCG; -relevant guidance. To implement the decision of the Committee.
Standard: The Committee shall ensure that all decisions in relation to mergers, closures and procurement support the London and Local aims for provider development
Develop and agree outcome frameworks for GP Services
For Level 2 CCGs NHS E remain ultimately accountable
The Committee shall agree an outcome framework for GPs services that enables continuous quality improvement and that it is aligned to national and local strategies. The framework shall be based on the national primary care GPOS and High performance indicators plus any local outcome and indicators set by the CCG
The CCG shall make available performance against locally agreed outcome and indicators required under the framework as required
NHSE shall make available practice and CCG performance against national GPOS and High Level indicators via the Primary Care Web-Tool
Tasks: The CCG develop a local Outcomes Framework under the guidance of The Committee by -Collecting and validating performance data against locally agreed outcomes and standards - Providing locally agreed performance reports
Undertake Service reviews : LIS (or LES) Specifications.
Tasks: The RT will support the development of a local Outcomes Framework under the guidance of The Committee by -Collecting and validating performance data against nationally agreed outcomes and standards - Providing nationally agreed performance reports on an annual or quarterly basis via the Primary Care Web Tool
Undertake service reviews :GP Contracts, Advanced Services & DES. Standard:
Planning PMS Review
The Committee shall oversee the implementation of the national PMS review to ensure that all contracts are reviewed within the national timescales and that agreements are varied to reflect new prices and premium payments
CCGs shall lead on the development and implementation of Local PMS Premium specifications and payments.
NHS England may be asked to support the PMS review
Tasks: The CCG develop a local Outcomes Framework under the guidance of The Committee by -Collecting and validating performance data against locally agreed outcomes and standards - Providing locally agreed performance reports
Undertake Service reviews : LIS (or LES) Specifications .
Tasks: Financial Review, contract review, engagement (public and stakeholder), implementation of agreement changes
Securing Quality Improvement
For Level 2 CCGs NHS E remain ultimately accountable
The Committee is responsible for review and approval of all Local Improvement Schemes (LIS's). The Committee is responsible for review and approval of the use of APMS to secure quality improvement under collaborative arrangements
The CCG will develop and lead the implementation of local schemes /Local Enhanced Services aimed at improving the quality in primary care. This will include development of clinical leadership and of peer support for practices.
The RT shall make available information to support quality improvement, and will support the CCG in the implementation of local schemes.
Tasks: Develop and implement local improvement schemes /Local Enhanced Services aimed at improving quality in primary care. -- Procurement and implementation of collaborative services aimed RT quality improvement under APMS arrangements. - Support and develop peer support for practices and practice staff. - Support and develop clinical leadership Standard: LCSF
Tasks: The RT will incorporate any Local Incentive Schemes into the provider contracts as stated in Schedule 2 Part 1 Sections 2.11 The RT will negotiate, in partnership with clinical commissioning groups, quality improvement plan with each practice. Standard:
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Responsibilities Tasks/ Standard
Definition The Committee CCG NHS E The Committee CCG NHS E
Securing Directed Enhanced Provision
The Committee shall review uptake and performance of all national DES and where necessary direct CCG's and RT's to take action to improve uptake or develop alternative local schemes
To support implementation as directed within the specifications
To support implementation as directed within the specifications. To provide information to the Committee on uptake and performance
Tasks: The CCG shall support local implementation and training as required under the national specification.
Tasks: The RT will disseminate all national DES specifications to practices together with local implementation guidance and a sign up sheet in accordance with the national timetable/ MOU (KPI's).
Securing Advanced Service Provision
The Committee shall review uptake and performance of all additional service provision and where necessary direct CCG's and RT's to take action to improve uptake or develop alternative local schemes
To provide information to the Committee about uptake and performance of non GP providers, making recommendations where additional services should be commissioned
To provide information to the Committee about uptake and performance of GP (& Pharmacy) providers, making recommendations where additional services should be commissioned
Tasks: Where necessary to direct the CCG or RT to take action to improve service provision.
Tasks: Procure additional services from non GP providers where practices do not wish to undertake them.
Tasks: Agree opt outs from the general medical services contract. Discuss locally the provision of additional services (where practices wish not to undertake them) with clinical commissioning groups.
Development of Policies and Procedures
The Committee shall approve all Local and endorse all London policies procedures in line with regulations
Tasks: Develop and maintain policies and procedures in line with regulations.
Contract Maintenance
The Committee shall ensure that the RT and CCG maintain all GP contracts in line with national and local variations and that systems are place to implement material changes
The RT will be responsible for the carrying out of several responsibilities specifically highlighted in the Delegation Agreement, including:
1. Managing Contract Variations The RT shall report, by exception, any failure to properly maintain contract documentation and provide an action plan to address this oversight
Tasks: - Issue national standard contract variations in line with changes to regulations. - Produce and issue local contractor specific variations (including, partnership changes, relocations, and mergers). - Implement changes to relevant systems to contractor payments. - Raise contract variations which may have a significant impact on the delivery of patient services and finances with localities and commissioners. - Maintain the contractor data base, including hard copies of all signed contracts for primary care providers, pertinent to the geographical area covered by the local regional team (including contract variations and breaches).
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Responsibilities Tasks/ Standard
Definition The Committee CCG NHS E The Committee CCG NHS E
Quality Assurance GP Services
For Level 2 CCGs NHS E remain ultimately accountable
The Committee will review reports to ensure GP's services are safe and meet all national and local standards. This will be monitored through an annual report on performance and the use of exception reports as required or as a result of a critical incident - Monitor activity on performers lists alongside practice performance data to generate a complete picture of quality
The RT will provide a regular quality report, based on the national framework to The Committee to support locality-wide quality assurance of primary care. This will include exception reports as required.
Tasks: Support practices and performers in the achievement of their quality improvement plan.
Tasks: The RT shall, using the national GPOS, High Level indicators, practice E-Declarations & CQC reports: 1. Collate Compliance Reports2. Assess practice performance from analysed data and identify priorities for further interrogation 3. Provide an Annual Performance Report and any exception reports 4. Conduct contractual compliance and quality reviews, developing and agreeing action plans to address performance issues with contractors.. - Support each clinical commissioning group in the development of a primary medical care quality improvement strategy involving all practices . - The RT will support the CCG with information to establish any cause for concern and act accordingly, including a quality review where necessary and performance management arrangements for poorly performing practices. In particular the RT will ensure that: 1. It maintains regular and effective collaboration with the CQC and responds to CQC assessments 2. Ensure and Monitor Practice remedial action plans .
Develop processes and systems to ensure fair, open and transparent decision making
The CCG is responsible for implementing processes and systems as required by the Committee
The RT is responsible for implementing processes and systems as required by the Committee
4. OtherCounter fraud To ensure that proper processes
are in place to prevent fraud within the NHS
Where CCGs hold contracts with GPs in their own name, where they contract and fund the services e.g. Enhanced Services, CCGs would continue to be allocated these allegations for investigation.
Implementation of the Deloitte Counter-Fraud service Deloitte will need to liaise with primary care staff who would have performance information in relation to GP contracts or perform Post Payment Verification visits
Tasks: Issue notification of stolen prescription forms or persons attempting to obtain drugs by deception, to GPs, pharmacists, counter fraud, drug squads and other interested parties.
Interpreting Services To ensure that patients have access to interpreting services when using GP practices
FOI
For Level 2 CCGs NHS E remain ultimately accountable
Dependant on source of information as to owner of FOI responsibility Tasks: To provide any information that the CCG holds about GP services as requested under the FOI act. Standard:
Tasks: To provide any information that the RT holds about GP services as requested under the FOI act.
Occupational Health The Committee shall ensure that GP practices have access to occupational health services in accordance with national guidance
Tasks: To secure contracts and access to OH services in line with the national guidance.
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Responsibilities Tasks/ Standard
Definition The Committee CCG NHS E The Committee CCG NHS E
EPRR The Committee shall ensure that the RT and CCG develop strategies and plans to respond to rising tides, major incidents and service failure.
- Responding to local service disruption. - Responding to major service disruption. - Planning for major service disruption. - Flu Pandemic Planning. - Other Public Health Responses (e.g Ebola). - Issuing Communications to practices.
Implementation of Premises Directions
Approval of DV Rent Reviews, responding reimbursement appeals; Approval of discretionary payments for SDLT, Legal Fees and Development costs to practices; Procurement of Support for the Development of Strategic business cases; Approval of improvement grants; Approval of business cases for new premises / expansion; Approval of capital schemes; Approval of business cases for new premises /expansion
The RT shall bring to The Committee's attention as part of the regular reporting any matters requiring decision in relation to the Premises Cost Directions Functions including but not limited to: - new payments applications - existing payments revisions
Tasks: The CCG will respond to any requests from NHS England for relevant information to support the assurance of primary care commissioning.
Tasks: The RT will provide sufficient information to support The Committee's decision. Following decision from The Committee the RT is responsible for carrying out all subsequent payments. The RT must liaise where appropriate with NHS Property Services Ltd., Community Health Partnerships Ltd and NHS Shared Business Services.
Information sharing The Committee is responsible for ensuring that information relevant to assure the quality of primary care commissioning is shared in accordance with legislation and guidance.
The CCG is responsible for making available any information required to assure the quality of primary care commissioning as provided within IG rules
The RT is responsible for making available any reasonable and available information required to support primary care commissioning.
Tasks: The CCG will respond to any requests from NHS England for relevant information to support the assurance of primary care commissioning.
Tasks: The RT will respond to any requests from NHS England around information sharing as specified and will be responsible for auditing and ensuring that providers accurately record and report information.
Controlled drugs reporting
The Committee is responsible for ensuring that practices are complying with legal requirements for use of controlled drugs and CCGs and NHSE have proper controls in place to maintain patient safety
The RT will carry out any reporting, analysis, compliance or investigations involving controlled drugs.
Tasks: The CCG shall 1. Analyse prescribing data available 2. Complete the periodic self-assessments / self-declarations. 3. Report all incidents and other concerns to NHS England’s CDAO.
Tasks: The RT will support The Committee to comply with its obligations under Controlled Drugs regulations by Reporting all complaints
Safeguarding – children
To ensure that GP Practices have effective safeguarding systems in place in accordance with statutory requirements and national guidance and Pan London Policy and Procedures . Ensure appropriate response from primary care to safeguarding enquiries and serious case reviews (including approval of IMRs)
Support and facilitate Primary Care to proactively improve the safety and wellbeing of children registered within the practice setting, providing assurance to NHSE that practices are compliant with safeguarding standards.
To monitor and review compliance with safeguarding standards
Tasks: The RT will ensure that: 1. GP Contracts include requirements forsafeguarding; and 2. GP practices annually declare compliance; The CCG shall provide representation at the LSCB. The CCG shall support GPs in engaging with serious case reviews, safeguarding adult reviews and domestic homicide reviews. Would recommend that NHSE RT approve GP IMRs. NHSE shall approve GP IMRs.
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Responsibilities Tasks/ Standard
Definition The Committee CCG NHS E The Committee CCG NHS E
Safeguarding – adult To ensure that GP Practices have effective safeguarding systems in place in accordance with statutory requirements, NHSE national safeguarding guidance and Pan London Policy and Procedures Ensure appropriate response from primary care to safeguarding enquiries and serious case reviews (including approval of IMRs)
Support and facilitate Primary Care to proactively improve the safety and wellbeing of those adults most vulnerable registered within the practice setting, providing assurance to NHSE that practices are compliant with safeguarding standards.
To monitor and review compliance with safeguarding standards through CCG
Tasks: The RT will ensure that: 1. GP Contracts include requirements forsafeguarding; and 2. GP practices annually declare compliance; NHSE shall approve GP IMRs. CCG shall have oversight of training compliance relating to safeguarding, MCA and Prevent. CCG is a statutory member of the LSAB and shall agree appropriate representation from health services including primary care
Domestic homicide Ensure that GPs contribute to domestic homicide reviews – where relevant and where necessary take action to remedy any oversight, including sharing and embedding learning to improve outcomes for service users.
To support practices in undertaking DHR where resources are held by the CCG
To support practices in undertaking DHR where resources are not held by the CCG
Tasks: Provide funding and advice where resources are not held by the CCG Provide representation at DHR Panels.
Serious incidents The Committee shall ensure processes are in place to report and review incidents so that serious incidents can be identified and managed. This includes reviewing the outcome of SI investigations and where necessary making recommendations to improve patient safety
To support and contribute to investigations
To support and contribute to investigations. To monitor compliance
Tasks: The RT will ensure that: 1. GP Contracts include requirements for reportingincidents; and 2. GP practices annually declare compliance; -Provide Advice and guidance to primary care practitioners and practice staff who wish to report an incident; Co-ordinate SI case management, including evaluation of final report; Liaison with NHS England Performance and Revalidation team regarding performance concerns.
Incident management
The Committee shall ensure that there are proper processes in place for GP practices to report incident (subject to a national review) and shall review reports on incidents at least once annually or where necessary by exception. The Committee shall make recommendations where necessary as a consequence on incident reports
To support and contribute to investigations
To support and contribute to investigations. To monitor compliance
Tasks: The RT will ensure that: 1. GP Contracts include requirements for incident management; and 2. GP practices annually declare compliance; Regularly log into the NRLS site to access any eForms (reported incidents); Ensure reported incidents are assessed to determine if SIs – and manage accordingly; Provide expert guidance on NRLS form/function.
Central Alerting System (CAS) Alerts
The Committee shall ensure that processes are in place to ensure that CAS alerts are disseminated in accordance with guidance.
To monitor compliance Tasks: The RT will ensure that: 1. GP Contracts include requirements for incident management; and 2. GP practices annually declare compliance; Regularly log into the NRLS site to access any eForms (reported incidents); Ensure reported incidents are assessed to determine if SIs – and manage accordingly; Provide expert guidance on NRLS form/function.
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Responsibilities Tasks/ Standard
Definition The Committee CCG NHS E The Committee CCG NHS E
Engagement and Consultation
For Level 2 CCGs NHS E remain ultimately accountable
The Committee shall ensure that all parties comply with statutory requirements to consult and engage with stakeholders. This is includes reporting to Local OSC, Healthwatch and HWB
For undertaking local engagement Engagement related to strategic planning Engagement linked to changes in urgent care or LES
Engagement and consultation associated with changes to GP services, including: -closures, - premises development, - mergers
Supporting engagement and consultation associated with changes to GP services
Tasks: Consultation with LMC Presentations to OSC. HWB and Healthwatch
Tasks: Notification letters to patients Consultation letters to patients and stakeholders, with wording agreed with CCGs
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Annex 2: Section 13Z - CCG statutory duties
Arrangements made under section 13Z do not affect NHS England liability for exercising any
of its functions, and in turn, CCG must comply with its statutory duties, including:
a) Management of conflicts of interest (section 14O);
b) Duty to promote the NHS Constitution (section 14P);
c) Duty to exercise its functions effectively, efficiently and economically (section 14Q);
d) Duty as to improvement in quality of services (section 14R);
e) Duty in relation to quality of primary medical services (section 14S);
f) Duties as to reducing inequalities (section 14T);
g) Duty to promote the involvement of each patient (section 14U);
h) Duty as to patient choice (section 14V);
i) Duty as to promoting integration (section 14Z1);
j) Public involvement and consultation (section 14Z2).
Still subject to any directions and decisions made by NHSE or by the Secretary of State.
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Annex 3: Performer Contract Decision Making Process
Figure 11 – Interface between the Performer Management and Contract Issue processes
Interface between the Performer Management and Contract Issue processes
Concerns about performer performance may come to NHS England’s attention through a number of
channels, including:
- Complaints from patients;
- Whistle-blowers;
- CCGs;
- CQC;
- GMC or other professional regulator;
- MPs; or
- The Police.
Concern raised
PAG
PLDP
Appropriate body investigates and
takes action (may be joint investigation)
Closed
Contract issue process (CCG or
CCG/NHS E)
Contractual issue
Individual performer issue
Concerns may come through a number of channels:- Complaints- Whistle blowers- CCGS- CQC- GMC- MPs- Police
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Responsibility for Performer List Management
NHS England retains the responsibility for Performers being admitted to the National Performers List.
The National Health Service (Performers Lists) (England) Regulations 2013 entrusts the responsibility
for managing the performers lists to NHS England. Issues raised are triaged by the performance
advisory groups (PAGs) within regional teams. Where the issue raised may have an impact on the
performance of a contract, PAG will escalate information relating to the contractual impact, to the
appropriate CCG (Level 3 delegation) and NHS England body (Level 2 delegation).
For issues with a contractual impact, the PAG may carry out a joint investigation with the CCG, with
the PAG considering performer issues, and the CCG considering contractual issues. If action is
considered to be necessary under the performers’ lists regulations, the case is referred to a PLDP.
Commissioner Involvement
Where there are no contractual issues arising, commissioners may choose to receive a quarterly
report, for information only, on performer performance issues which provides an overview of the
numbers of issues by CCG, and key themes of issues arising. This may be submitted to part one of
committee meetings.
Commissioner involvement is expected in instances where poor individual performance will have a
contractual impact. Incidents which affect the medical services contract will be discussed at a joint
committee or sub-committee, depending on the timeline for providing a response, with a decision
provided for the contractual action taken to be taken.
Only information relevant to the contractual impact of issues should be shared. Discussion of
sensitive issues should be carried out in a private pre-meeting, or submitted to a private part two
committee to maintain confidentiality and to allow for the relevant information to be made
available, discussed and any actions agreed. The decisions made on contractual actions should be
reported in part one of committee meetings.
Performer List Decisions
NHS England has established performers lists decision panels (PLDPs) within regional teams in order
to support its responsibility in managing performance of primary care performers. The role of the
PLDP is to make decisions under the performers lists regulations. As a retained role of NHS England,
there is no basis for CCG involvement in this process.
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Annex 4 - Safeguarding – responsibilities at different levels of CCG co-commissioning delegation
Task Level 2 Level 3
IMR sign off Joint sign off process CCG sign off
Named GPs* – role transfer Financial transfer
Recruitment
Training
MOU in place
Costs met from delegated budget
HR process with NHS England, joint appointment panel
Responsibility for training sits with NHS England
MOU in place
Costs met from delegated budget
Recruitment process and appointment panel under CCG control
Responsibility for training sits with CCG
LSCB attendance Based on risk based approach NHS England and CCG attendance
Based on risk based approach CCG attendance
Domestic homicide Attendance at panel and support to GP to complete IMR negotiated with CCG
CCG attends panel and supports GP to complete IMR if required
Performance issues NHS England leads on any performance issues
NHS England leads on any performance issues
CQC safeguarding issues in practices
NHS England and/or CCG, by negotiation,
CCG follow up individual issues raised
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The table below provides a high level analysis of responsibilities related to safeguarding at different levels of co-commissioning:
dependent on each regional arrangements
Further detail related to the functions expected of fully delegated (level 3 CCGs) is shown below. The Nursing directorate would retain oversight of these
responsibilities, and it is important to note that the tasks might vary dependant on area etc.:
Summary of responsibilities Overview of tasks (not exhaustive)
Provide advice for GPs undertaking investigations relating to primary care safeguarding issues
Manage named GP roles Contribute to the system wide
oversight of safeguarding
Quality monitoring andimprovement of primary care
Approval final IMRs or investigationsincluding DH panels
Ensure any actions resulting frominvestigations
Recruit, line manage and providetraining for role
Represent health system atsafeguarding boards
Undertake safeguarding assurance ofpractices. Follow up on practice issuesidentified at CQC inspections, reviewtrends and themes
follow up individual issues raised by CQC with practices Themes/trends shared with CCG
by CQC with practices Themes/trends shared with CCG
Primary care safeguarding quality assurance
Jointly NHS England and CCG responsibility
CCG responsibility
Quality improvement CCG responsibility, working with NHS England
CCG responsibility, working with NHS England
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Annex 5 – Pan London Responsibilities of NHS England STP Based Teams Category Responsibilities Lead STP Responsibilities Other STP responsibilities Forum Lead Notes
T&F Contract Management policies/
Standard Operating Framework
Task and Finish proposals to ensure consistency. One engagement with local
committees
Comment and agree PCMB TBD for each task
T&F Homeless specification Input to Public Health initiative from a primary care commissioning perspective
Comment and agree PCMB NWL & NEL Time limited
Contract Management
Infection Control SLA Oversight of SLA with NEL CSU. Delivering infection control framework which gives assurance that primary care and dental
practitioners are meeting required standards. Activities include: - quarterly SLA performance review meetings with NHSE dental lead
- negotiation of annual budget - ensuring network meetings are operational where CCGs have local arrangements in place to undertake aspect of GP/dental infection prevention
and control support or monitoring visits - annual review of specification to agree priority visits, informed by liaison with STP leads - dissemination of arrangements,
including reinforcement of process flow for urgent and planned visits - negotiation of revisions to audit tool for general practice, as and when necessary with London LMC reps
- Feedback on service priorities - implementation of STP day to day process, based on agreed process flows for planned
and urgent visits - Feedback on any issues of concern in terms of SLA activities undertaken by NELCSU to lead - provision of STP footprint information/data, as requested by lead
- attendance at ad hoc meetings that may be called
PCMB SEL To be reviewed annually
Retained Business Rates and Rent
Review - Backlog
Challenge session on business rates and
rent; QIPP measure for practices
Feedback PCMB SWL Time limited
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Category Responsibilities Lead STP Responsibilities Other STP responsibilities Forum Lead Notes
Contract Management
National contracts - Clinical Waste
Set up of new clinical waste contract Feedback PCMB SWL Time limited
Contract Management
National contracts - PCSE PCSE - stakeholder management Feedback PCMB SWL Time limited
Retained Quality and performance management
Liaise with analytical services on BI development
Provide primary care input into quality
and clinical governance meetings
Feedback on BI developments required.
Provide insight into quality / clinical governance issues for escalation
Provide insight into local quality initiatives
SMT Retained team
Retained GP IT Co-ordination of London response on non-ETTF capital proposals on GP IT.
Liaison with National.
Co-ordination of development of STP level GP IT capital proposals
PCMB
FIPA
Retained team
Retained Risk management Co-ordinate response and updates of London Region risk register for Primary Care Medical Services
Identification of new / changed risks
Update on risk management actions / crystallisation of risks
SMT Retained team
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Category Responsibilities Lead STP Responsibilities Other STP responsibilities Forum Lead Notes
Retained APMS Responsibilities include:
- complete and update the suite of
toolkits, templates and guidance produced for the programme in order that they can be shared with commissioners for future use (London retained responsibility).
- maintain and update the baseline number of, and information about, contracts identified as to be procured, negotiated, extended or continued (London information is dependent upon
STPs maintaining up to date baselines). - identify a list of contracts for primary medical services expiring before the end of each financial year for which
commissioners will need to determine commissioning options - ensure the London APMS contract, including Schedules, is brought up to date and reporting arrangements finalised
(London retained responsibility). - manage the arrangements for updating and putting in place required contract variations of all London APMS live contracts (London initial responsibility).
- - procurement of STP APMS contracts in tranches, based on same consistent timelines (London retained function)
-Designate STP programme lead - Input of STP strategic commissioning intentions into the development of
procurement programme. - designate procurement lead responsibilities either on a contract by contract, or STP basis - undertake required commissioning activities, strictly in line with agreed
project/programme timetable including (but not limited to): - strategic review of expiring APMS contracts - preparation of report to PCCCs and feedback on outcome to Programme lead (CCG
responsibility) - patient engagement events(CCG responsibility) - preparation of MOIs, including liaison with
current APMS provider and input to ITT, in collaboration with relevant CCG(CCG responsibility) - prepare report on outcome of patient engagement (CCG responsibility)
- respond to clarification questions(CCG responsibility) -support site visits to practice premises(CCG responsibility) - evaluation and moderation of ITT responses,
based on agreed London (or STP) arrangements (CCG responsibility) - nominated officer to attend interview panels(CCG responsibility) - mobilisation of new APMS contracts(CCG
responsibility) -attendance at local project or STP programme meetings (CCG responsibility) NOTE – this is not an exhaustive list of activities but is indicative of type of activities
STP Programme leads are responsible for co-ordinating, regardless of whether APMS contracts are procured on a London or STP footprint basis. In addition, all activities must be undertaken with strict adherence to
procurement programme timescales approved.
PCMB
FIPA
Retained procurement team Role of Band 8b London
Asst Head to maintain best practice tools STPs responsible for Programme management, linking in
to consistent London procurement programme
See revised lead responsibilities to be
discussed at extraordinary PCMB meeting on 15th September 17
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Category Responsibilities Lead STP Responsibilities Other STP responsibilities Forum Lead Notes
Retained Premises (incl ETTF and LIG)
SRO for General Practice Premises Programmes, including:
- Member of London Estates Delivery Unit - Policy lead and adviser on GP premises, including disseminating information and learning to NHSE and STP/CCG responsible commissioners
- Leads on formal consultation and meetings with London LMCs on interface issues every 6 weeks, including CHP and NHSPS London leads - London region’s ETTF and London IG
lead, responsible for performance of programmes and monthly formal reporting to LCC and bi monthly to GP DOG - Responsible for ETTF & London IG
programmes, including regular programme meetings involving technology PMO in the former Reports every other month to national ETTF programme board and GPFV DOG
on London’s performance; takes part in weekly regional teleconferences
Responsible for: - advising and making recommendations CCGs
on application of Premises Directions and London premises policies, which form part of their GP contract/commissioning delegated responsibilities - managing and making decisions on STP
footprint general practice premises issues, including liaison with practices - ensuring up to date on new or revised premises policies, and their implementation - providing information/data, on premises
matters within STP footprint to London lead, as appropriate - dealing with and making decisions/advising CCGs on rent review and lease matters, obtaining advice, as necessary from DV or
London/STP responsible team
GP DOG for oversight of GPFV
infrastructure programme
London Estates Primary Care
Capital Panel for oversight of and advice about all schemes that include general
practice
LCC/FIPA for capital and business case sign
off
PCCCs for decisions on GP contract changes
London Estates Delivery Unit for strategic system wide schemes
Retained team
Initial 12 month post to support SRO with SEL pc commissioning and contracting work and premises lead
responsibilities agreed, subject to review as London Estates Board arrangements crystallise.
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Category Responsibilities Lead STP Responsibilities Other STP responsibilities Forum Lead Notes
and supports national ETTF team on
policy matters that affect London - Leads design and oversees implementation of STP and CCG communication plans in the context of new or revised policy and operational
requirements, supported by relevant colleagues. - Responsible for establishment & management of commissioner led London Estates Primary Care Capital Panel to
replace London’s Pipeline, supported by ETTF band 6 and ETTF PMOs & London IG Programme lead. - Responsible for bi annual review of London’s ETTF Pipeline
- Development & oversight of implementation of London’s policy of financial assistance for GPs with running costs & services charges, in collaboration
with Finance lead & providing national support to roll out
Retained Media, MP correspondence, FOIs (pan London)
Co-ordinate and manage responses to queries
Provide information and locally agree responses
By correspondence
Retained team
Project PMS Lead customer of CSU PMO Progress reporting
Sharing leading practice
LMC engagement
PMS stakeholder reference group
NWL
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Category Responsibilities Lead STP Responsibilities Other STP responsibilities Forum Lead Notes
T&F For example: - Violent patient scheme - Minor surgery portal
- Caretaking framework - Occupational health service procurement
Lead on development of pan-London approach
Input into T&F group. Local implementation.
PCMB TBD per T&F NEL have been leading on a task and finish group for moving to new primary
care occupational health arrangements in line with national guidance. Following procurement, as from 1st December 2017
there are now three providers, contracted to provide a limited range of OH services, funded by commissioners. This will
entail a small amount of contract management going forward covering both dental and general
practices. This contract management will be a retained function.
Working Group Enhanced Services Lead on development of process to implement national ES
Provide input into development
Ensure pan-London approach followed
Working Group
Recommendations to PCMB
NWL
Working Group CQRS Systems lead to escalate issues and to
ensure Primary Care staff trained on CQRS
Liaise with lead on any CQRS issues Virtual network NWL
Assigned STP team responsibility
EPRR Not applicable To act as liaison point for in-hours incident management
Not applicable Individual STPs
Assigned STP team responsibility
Quality and performance management
Not applicable Production of reports for Committees Not applicable Individual STPs
Assigned STP team responsibility
National Primary Care Leads
Attend HoPC and PC-DOG Input into meetings
Note output of meetings
SMT HoPC
Assigned STP team responsibility
CAS alerts Not applicable Cascade CAS alerts highlighted by Nursing Directorate
Not applicable Individual STPs
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Category Responsibilities Lead STP Responsibilities Other STP responsibilities Forum Lead Notes
STP responsibility Resilience Planning - e.g. Winter / Bank Holiday opening
Not applicable Ensure Primary Care included in resilience planning Provide information to NHSE L assurance process
Not applicable A&E Boards
STP responsibility Complaints Not applicable To include in quality reporting
Feedback on local complaints management
Feedback on complaints process
Not applicable STP Complaints Leads
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Forum Description Frequency Invitees
PCMB Part 1 Issues with operation of MOU Bi-monthly Deputy Regional Director Regional Director of POD Director of Primary Care Commissioning STP Leads
Part 2 GP & DOP commissioning matters of pan-London interest (incl agree T&F groups) Non-delegated financial issues
As above, plus: Heads of Primary Care DOPs Regional Lead NHSE Finance Senior Reps NHSE Medical Directorate Reps
NHSE Nursing Directorate Reps DCOs
Part 3 Assurance Deputy Regional Director Director of Primary Care Commissioning DCOs
SMT Operational and staffing issues Emerging National or pan-London guidance Suggest Task and Finish Groups
Fortnightly Director HoPC Assistant HOPC DOPs Regional Lead
DOPs Assistant Regional Lead DOPs Heads
All staff meeting National and pan-London developments Staff development sessions Team news
Quarterly All NHSE Primary Care Commissioning Staff
All staff call National and pan-London developments Team news
Monthly All NHSE Primary Care Commissioning Staff
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Annex 6 – Pan London Fora
Forum Description Frequency Invitees
All staff forum / email
group
Ongoing queries
Vacancy notifications
Continuous All NHSE Primary Care Commissioning Staff
ES working group Develop and implement national ES schemes on a consistent pan-
London basis
Bi-monthly ES Group Lead (HoPC - NWL)
Once for London 8B STP nominated reps
T&F Groups Set up as required to develop and implement agreed pan-London
projects (identified at SMT and ratified at PCMB)
As required Group lead
Once for London 8B STP nominated reps
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Annex 7 – Template - Access for FutureNHS
The template below should be shared via STP leads with relevant stakeholders, and populated with the required information, following
which it should be sent back to Adrian Mccloskey [email protected] who will enable access.
Access to FutureNHS can take place from the beginning of January, subject to when STP leads return their completed templates :
Name Role CCG or STP? Organisation Name Email Address
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Primary Care Commissioning Committee Part I - 28 March 2018 Committee Rooms, 4th Floor Unex Tower
Title GP access: expectations in respect of core and extended hours
Agenda item 2.1
Author Jenny Mazarelo, Associate Director Primary Care, Newham CCG
Presented by Jenny Mazarelo, Associate Director Primary Care, Newham CCG
Contact for further information
Jenny Mazarelo, Associate Director Primary Care, Newham CCG E: [email protected]; T: 020-3688-2156
This paper is for Decision
Action required The Committee is asked to note the contents of this report and approve the revised approach to NHS England’s letter and survey attached at Appendix B.
Executive summary
Both national and Londonwide guidance has been drafted to help commissioners to work with their providers of general practice, in respect of the services that they offer to patients during ‘core hours’, as well as the conditions that should govern the commissioning of extended hours.
Most recently, NHS England has published Londonwide policy guidance of its expectations for GP access. This policy is intended to create a standard approach to:
Identifying GP Practices who are closed for a regular period during core hours;
• Establish sub-contracting arrangements and confirm the relevantnotice/approval has been provided to the commissioner; In the absence of formal approval, provide an opportunity for practices to seek formal approval in accordance with contractual requirements from the Primary Care Commissioning Committee;
• Where GP Practices continue to close without approval, provideevidence to the Primary Care Commissioning Committee to determine whether the GP Practice is satisfying the reasonable needs of patients.
This policy guidance proposes that both current core hours and sub-contracting arrangements are reviewed to assess adequacy.
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Supporting papers • Appendix A: NHS England letter and survey to practices• Appendix B: Proposed letter and survey to practices
Next Steps/ Onward Reporting • Primary Care Commissioning Committee for review of practice
arrangements – April 2018• Newham LMC
Where has the paper been already presented?
No previous presentation to any previous meetings/forums
How does this fit with NHS Newham CCG strategy?
Value: • Patient/public voice throughout our decision making• Transparency with our decision-making and leadership• Accountability and responsibility• Caring culture and behaviour• Working with our partners to improve health outcomes
Aim: • Improving health outcomes through developing models of integrated care
and focusing on prevention• Reducing inequalities and improving accessibility• Reducing quality variation• Ensuring equity of health and wellbeing outcomes.
Risk There is a risk that:
- failure to review GP Patient Access will reduce health inequalities and equity of health and wellbeing outcomes; - failure to deliver core and extended hours access will adversely impact on the delivery of seven day primary care access and unscheduled care - Commissioners are not seeing value for money delivered in respect of primary care services commissioned
Equality impact This document relates to all Newham residents in the nine protected characteristics that are covered by the Equality Act 2010 and our Equality Duties.
Stakeholder engagement • Newham LMC – 27 February 2018
• Unscheduled Primary Care Workshop – 16 February 2018
Financial Implications
GP access is currently commissioned in three ways - through core GP contracts, via an Extended Hours Access Enhanced Service and 8-8 Seven Day Primary Care Access Service. It is possible that that these arrangements may not be delivering value for money, if inadequate core hour and extended hour arrangements are being delivered.
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1. Introduction and background
1.1
1.2
1.3
1.4
1.5
1.6
1.7
The General Medical Services (GMS) and Personal Medical Services (PMS) regulations require general practice contractors to provide essential and additional services at such times within core hours “as are appropriate to meet the reasonable needs of patients” and require the contractor to have in place arrangements for its patients to access those services throughout core hours in case of emergency.
Core hours for GMS practices are 8am to 6.30pm Monday to Friday, excluding weekends and bank holidays. PMS and APMS terms are applied in the same manner following national negotiations and the definition ‘core hours’ is in the contract and in the underpinning regulations.
The Public Accounts Committee report into GP access held in March 2017 set out a number of recommendations available at the following link: https://publications.parliament.uk/pa/cm201617/cmselect/cmpubacc/892/892.pdf One was to ensure that no practice that was closed weekly for half a day should be in receipt of additional funds to provide ‘extended hours’, i.e. outside ‘core hours’ and secondly that patients should know what they can ‘reasonably’ expect of their GP practice during core hours.
The Committee will be aware that as a result of the subsequent change of regulations on 1 October 2017, the number of Newham GP practices who closed for half a day reduced from 24 to 5 practices.
Both national and Londonwide guidance has been drafted to help commissioners to work with their providers of general practice, in respect of the services that they offer to patients during ‘core hours’, as well as the conditions that should govern the commissioning of extended hours.
Most recently, NHS England has published Londonwide policy guidance of its expectations for GP access. This policy is intended to create a standard approach to: • Identifying GP Practices who are closed for a regular period during core hours;• Establish sub-contracting arrangements and confirm the relevant notice/approval has
been provided to the commissioner;In the absence of formal approval, provide an opportunity for practices to seek formalapproval in accordance with contractual requirements from the Primary CareCommissioning Committee;
• Where GP Practices continue to close without approval, provide evidence to thePrimary Care Commissioning Committee to determine whether the GP Practice issatisfying the reasonable needs of patients.
This policy guidance proposes that both current core hours and sub-contracting arrangements are reviewed to assess adequacy, so that patients are able: • To attend a pre-bookable appointment (face to face)• To book / cancel appointments• To collect / order a prescription• To access urgent appointments / advice as clinically necessary• To request a home visit (where clinically necessary)• To ring for telephone advice
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1.8
1.9
1.10
1.11
1.12
1.13
• To be referred to other services where clinically urgent, including for examplesuspected cancer
• To access urgent diagnostics and take action in relation to urgent results.
This policy guidance had been presented for immediate implementation to ensure revised arrangements are in place early in 2018 and provides the CCG with the opportunity to review and re-assess both delivery of core hours access and existing sub-contracting arrangements. However following the publication of this policy guidance and sharing it with Londonwide LMCs, the national General Practitioner’s Committee (GPC) has advised that it does not agree with the guidance published for Commissioners, that as guidance it is non-binding on Commissioners and has published its own guidance about meeting the reasonable needs of patients. This states that the GMS Regulations allow individual practices to decide which services to provide when, to meet the needs of their patients, i.e. practices are not required to be open at all times or deliver all services at all times during core hours. Practices should be able to show that they have engaged with their Patient Participation Group (PPG) to check the arrangements are meeting their reasonable needs and take measures to address any areas of concern (recognising the requirements within the regulations regarding PPGs).
In terms of sub-contracting, the GPC asserts that there are no requirements that subcontracting arrangements must provide specific services for patients beyond meeting the obligations of the GMS contractor. The practice must satisfy itself that the subcontracting arrangements in place are appropriate and can indeed meet the Contractor’s obligations. If not, the practice must not agree those arrangements. Practices must notify the commissioner who can only object on the grounds that it would put patient safety at serious risk or put the commissioner at risk of material financial loss. To enforce such an objection under the terms of the Regulations, the Commissioner needs to be able to demonstrate that either of these criteria apply. The commissioner cannot object based upon failure to meet the criteria in the recently published NHS England policy guidance.
The NHS England guidance asks Commissioners to review the hours of service delivery and subcontracting arrangements for all practices. If the commissioner believes a practice’s hours of service provision are not meeting the reasonable needs of its patients, they will likely approach the practice to discuss this in the first instance. A practice can be asked to provide reasonable information to the commissioner, upon request, showing that the times of delivering services are appropriate to meet the reasonable needs of patients, and that at other times within core hours, there are arrangements in place so that patients can access services in an emergency. Practices should also show engagement with your patients (usually via the PPG) around hours and service delivery.
The GPC has advised that if the commissioner serves a breach notice as it believes hours of service provision are not meeting the reasonable needs of a practice’s patients, the onus under the regulations is on the commissioner to evidence that claim as part of the breach notice.
The GPC has advised practices to inform the Commissioner that this new policy guidance is not a contractual requirement and that if approached regarding the reasonable needs of their patients and produces NHS England guidance as evidence, that the commissioner is advised that this guidance is not a contractual requirement.
In addition, NHS England has commissioned a survey of all GP practices whereby practice has been contacted to enquire about the availability of their third available appointment.
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The survey has been conducted twice in the last six months, however the outcome has not yet been shared with CCGs.
2. Local Context
2.1
2.2
2.3
2.4
2.5
Currently 96% of Newham’s 51 GP practices are signed up to deliver extended hours access. 55% of these GP practices, sub-contract the delivery of their extended hours access to Newham GP Co-Operative. Newham GP Co-Op currently delivers the service, sub-contracted to them, from ten GP Practice sites across Newham This arrangement is delivered from ten separate These arrangements are in addition to the 8-8 Primary Care Access Service commissioned by the CCG and delivered.
Conversely six thousand patients per month currently present to unscheduled care services, i.e. A&E, Urgent Care Centre or GP Out of Hours service during core and out of hours with a primary care presentation/complaint. This activity equates to four appointments per practice per month. Although there are a variety of reasons why patients seek unscheduled care, the perceived or actual challenge patients encounter when seeking advice/care from their own practice does undoubtedly have an impact.
Representatives of Newham’s Health Overview and Scrutiny Committee have provided a range of examples of patients experiencing excessively long waits for practice telephones to be answered and availability of appointments. There is an opportunity in 2018/19 to support practices to ensure that the capacity they provide addresses the patient demand they see.
NHS England has proposed that the letter attached at Appendix A be sent to practices who close for half a day during core hours, so that an assessment of these arrangements can be made and considered by the Committee at its meeting on 25 April 2018.
Although only five practices would be eligible to receive this letter, practice declarations have identified a number of practices whose arrangements do not meet core hours delivery, e.g. no arrangements are available for patients wishing to seek advice before 8.30am/9am, after 6pm and over a lunchtime period. In addition, as outlined above twenty-seven practices sub-contract their extended hours access arrangements to Newham GP Co-Op – an arrangement that was established in 2010, but the adequacy of which has not been assessed.
3 Recommendation
3.1 It is proposed that the letter at Appendix A be amended to reflect an assessment of core and extended hours arrangements for all Newham’s GP practices.
A revised letter and survey is attached at Appendix B for consideration and approval
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Appendix A
Dear ….,
GP access: expectations in respect of extended and core hours
The Public Accounts Committee published a report into GP access on 27 April 2017 which set out a number of recommendations. One recommendation was to ensure that no practice should be in receipt of additional funds to provide extended hours if the practice was closedweekly for half a day. Another stated that patients should know what they can reasonably expect of their GP practice during core hours.
The General Medical Services (GMS) and Personal Medical Services (PMS) Regulations require general practice contractors to provide essential and additional services at such times within core hours, “as are appropriate to meet the reasonable needs of patients,” and require the contractor to have in place arrangements for its patients to access those services throughout core hours in case of emergency. Core hours for GMS practices are defined as 8:00 – 18:30, Monday – Friday, excluding weekends and bank holidays. Opening hours for PMS and APMS practices are set out in their contract but largely mirror GMS opening hours or longer.
Following correspondence with practices last year in respect of the Extended Hours Access Scheme (DES), the practice eDec submissions for 2017-18 were reviewed and the information on opening hours validated with practices via phone discussions in January and February. Consequently, it was confirmed that your practice closes for a half day during core hours.
I am writing to request confirmation of what sub-contracting arrangements are in place and seek assurance that they align to patient expectations. Attached is a template for completion to set out your sub-contracting arrangements. Your submission and all supporting evidence will be reviewed to assess the sub-contracting arrangement.
The template should be completed and returned by e-mail by 11 April 2018 with supporting evidence to [email protected]. Please contact your local primary care team in the event of any queries.
Yours sincerely,
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Sub-Contracting Arrangements for Practice Closure during Core Hours
Practice Name Practice Code CCG
Subcontractor providing services:
Name and Address
Address of Premises used for Service Provision
Services Provided under the Sub-Contracting arrangements
Duration of Sub-Contract
Please provide a response to the following questions and include any evidence or commentary as required.
Y/N Evidence / Comments
As part of the subcontracting arrangements, are Patients able to:
attend a pre-bookable appointment (face to face)?
book / cancel appointments?
collect / order a prescription?
access urgent appointments / advice as clinically necessary?
request a Home visit (where clinically necessary)?
receive telephone advice?
access the alternative service locally by public transport?
77
be referred to other services where clinically urgent?
access urgent diagnostics and take action in relation to urgent results?
Communication with patients:
Have patients (through the PPG) been consulted in respect of closing during core hours? Do patients understand the arrangements?
Do patients have any concerns with service provision during core hours when the alternative service is operating? If yes, please provide details.
How are patients informed of opening hours?
When the alternative service is operating, what are the arrangements when a patient needs to speak to either a receptionist or clinician?
Can the sub-contractor have access to the patient’s clinical record (not just the summary care record)? Please provide details.
Is the alternative service local or easily accessible by public transport?
Please return to … by not later than 11 April 2018
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Appendix B
Dear ….,
GP access: expectations in respect of extended and core hours
The Public Accounts Committee published a report on GP Access on 27 April which set out a number of recommendations. One recommendation was to ensure that no practice should be in receipt of additional funds to provide extended hours if the practice was closed weekly for half a day. Another stated that patients should know what they can reasonably expect of their GP during core hours.
The General Medical Services (GMS) and Personal Medical Services (PMS) Regulations require general practice contractors to provide essential and additional services at such times within core hours, “as are appropriate to meet the reasonable needs of patients,” and require the contractor to have in place arrangements for its patients to access those services throughout core hours in case of emergency. Core hours for GMS practices are defined as 8:00 – 18:30, Monday – Friday, excluding weekends and bank holidays. Opening hours for PMS and APMS practices are set out in their contract but largely mirror GMS opening hours or longer.
Following correspondence with practices last year in respect of the Extended Hours Access Scheme (DES), the practice eDec submissions for 2017-18 were reviewed and the information on opening hours validated with practices via phone discussions in January and February.
I am writing to request confirmation of what core and extended hours access arrangements your practice has in place and seek assurance that they align to patient expectations. Attached is a template for completion to set out your sub-contracting arrangements. Your submission and all supporting evidence will be reviewed to assess arrangements for consideration by the Primary Care Commissioning Committee on 25 April 2018.
The template should be completed and returned by e-mail by 11 April 2018 with supporting evidence to [email protected]. Please contact your local primary care team in the event of any queries.
Yours sincerely,
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Practice Core Hours and Extended Hours Arrangements
Practice Name Practice Code CCG
Availability of Core Hours and Extended Hours Arrangements At Your Practice
What are your practice’s core hours arrangements each day?
Please provide details of:
- Door opening and closing times each day
- Telephone availability times each day
- Afternoon/Half day closures - When patients can attend
the practice to book/cancel an appointment, order and/or collect a prescription, request a home visit, ring for telephone advice, take action in relation to urgent results
- How patients are made aware of these arrangements
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
For occasions when your practice is not available between 8am and 6.30pm Monday to Friday, what arrangements have you made for patients to seek support? If a patient was to contact your practice today for a face to face appointment with any GP, what date and time would the third available appointment be? The CCG is considering commissioning some demand and capacity management support to practices in 2018/19. Would this support be of interest to your practice?
Y / N
Is your practice signed up to the Extended Hours Access Enhanced Service?
Y / N
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Please confirm whether this is delivered by the practice or sub-contracted to Newham GP Co-Op?
Sub-Contracted Core or Extended Hours Access Arrangements
Subcontractor providing services:
Name and Address
Address of Premises used for Service Provision
Services Provided under the Sub-Contracting arrangements
Duration of Sub-Contract
Please provide a response to the following questions and include any evidence or commentary as required.
Y/N Evidence / Comments
As part of the subcontracting arrangements, are Patients able to:
attend a pre-bookable appointment (face to face)?
book / cancel appointments?
collect / order a prescription?
access urgent appointments / advice as clinically necessary?
request a Home visit (where clinically necessary)?
receive telephone advice?
access the alternative service locally by public transport?
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be referred to other services where clinically urgent?
access urgent diagnostics and take action in relation to urgent results?
Communication with patients:
Have patients (through the PPG) been consulted in respect of closing during core hours? Do patients understand the arrangements?
Do patients have any concerns with service provision during core hours when the alternative service is operating? If yes, please provide details.
How are patients informed of opening hours?
When the alternative service is operating, what are the arrangements when a patient needs to speak to either a receptionist or clinician?
Can the sub-contractor have access to the patient’s clinical record (not just the summary care record)? Please provide details.
Is the alternative service local or easily accessible by public transport?
Please return to … by not later than 11 April 2018
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Primary Care Commissioning Committee Part I - 28 March 2018 Committee rooms, 4th Floor Unex Tower
Title Estates – Development Schemes
Agenda item 2.2
Author Jason Kelder, Programme Director – Estates, Newham CCG
Presented by Jason Kelder, Programme Director – Estates, Newham CCG
Contact for further information
Jason Kelder [email protected]
This paper is for ☐ Decision ☒ Monitor ☐ Discussion ☐ For Information
Action required Monitor the content of the report and note the following points: • Number of Development Schemes over next 3 years• Funding pathways for development schemes• 2017/18 Development schemes completed.
Executive summary The report asks the committee to - Note the content of Appendix A - The inter-relation of funding sources required to deliver development
schemes - Acknowledgement of resource requirement in delivering the development
plan.
Supporting papers • Appendix A: Estates Development and Extension Build Programme• Appendix B: Development and Extension Build Mapping
Next Steps/ Onward Reporting
Commissioning Committee for support
Where has the paper been already presented?
No previous presentation to any previous meetings/forums
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How does this fit with NHS Newham CCG strategy?
Value: • Collective clinical leadership• An inclusive organisation• Effective and collaborative communication• Patient/public voice throughout our decision making• Transparency with our decision-making and leadership• Enhancing local experience and talents• Accountability and responsibility• Caring culture and behaviour• Working with our partners to improve health outcomes
Aim: • Improving health outcomes through developing models of integrated care and
focusing on prevention• Reducing inequalities and improving accessibility• Reducing quality variation• Ensuring equity of health and wellbeing outcomes.
Risk • BAF Reference: BAF.07• Risk Register Reference: Failure to effectively deliver a primary care strategy
that is adequately resourced to service Newham residents and secure asustainable and viable GP Federation.
Equality impact The development of health care facilities planned across the borough is to assist in providing equitable premises across Newham as well as meeting the forecast population growth over the next 10 years. All patients and staff will benefit from modern fit for purpose health facilities that will promote integrated working across providers.
Stakeholder engagement
• Each Development will have managed a number stakeholder engagementevents during the course of the development programme.
• Stakeholder engagement event details are included in individual schemebusiness cases.
Financial Implications
With the approval of any development business case, the CCG are required to confirm that any increase in annual rent and rates would be reimbursed to the practice on agreement with the District Valuer who sets the cost per m2 based on current market rent valuations. The impact on recurrent revenue budgets are addressed in individual approved business cases.
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1. Introduction and background
1.1
1.1.1
1.1.2
NCCG – Supported Development Schemes
Delivered Schemes – 2017/18 NCCG have supported 3 estates development schemes in this financial year through a mix of NHS Funding and Third Party Development (3PD) funding, below schemes are based on gross project cost.
Westbury Road (£2.3m) This is a 3PD development scheme to provide a modern fit for purpose health premise. The current site is not fit for purpose and does not meet DDA compliance. The CQC gave the practice 5 years to commission a new facility. On completion of the scheme there may be an opportunity to relocate neighboring practice into this site subject to all partners’ agreement.
Woodgrange Medical Practice (£912k) This is an Improvement Grant development scheme to maximize clinical space within the existing health centre. An extension was built at the back of the health facility and changes to “dead space” to incorporate additional clinical space to meet the list size growth of the practice.
Essex Lodge (£3.2m) This is an Improvement Grant development scheme which involved building a large extension to the rear of the existing site and to also refurbish and increase the size of the reception area in the front of the building which is listed. The scheme was approved by the CCG with the agreement of a practice merger or co-location into Essex Lodge to ensure newly created clinical space is fully utilised.
Planned Schemes – 2018/19 NCCG have provided their support in developing 2 schemes in 2018/19 which are subject to approval of a formal Full Business Case by the PCCC and London Capital Committee. Below schemes are based on gross project cost.
Pontoon Dock Health Centre (£6m) This is a new build scheme based at the entrance to the Royal Wharf Residential Development to meet the population increase of the ward of circa 25k new residents. This will be a relocation of an existing practice based at Britannia Village as the current facilities will not be sufficient to meet the increase list size. An outline business case has been presented to the PCCC in November 2017. NCCG will be submitting the FBC to the LCCC by end of May 2018 for formal approval to progress with the fitout of the shell and core space.
Froud Development (£3.1m) This scheme is being proposed as a 3PD scheme with the NHS providing funding for fees to develop the business case. The CCG has made a formal offer for annual rent which includes a ground rent and a return on development costs. If agreed by the landlord the CCG will finalise the business case and submit to the PCCC and LCC for approval to progress with the development plans. The Manor Park Care Group has formed into a single practice through a merger of four smaller practices. Clinical activity is being provided to patients from 3 sites (down from 5) which are all inadequate. On completion of the development of Froud, all activity will be provided from 1 modern fit for purpose health centre to the benefit of patients and staff.
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2.
2.1 2.1.1
Development Funding Breakdown The table below provides a high level view on funding pathways across a number of years with the detail included in Appendix A - Estates Development and Extension Build Programme
Project Funding Summary Total 2017/18 2018/19 2019/20 2020/++ NHS Funding £11,065,749 £3,088,149 £2,727,600 £0 £5,250,000 S106 Funding £10,200,000 £0 £2,600,000 £0 £7,600,000 3PD Funding £14,381,308 £3,728,223 £3,521,400 £2,683,685 £4,448,000
£35,647,057 £6,816,372 £8,849,000 £2,683,685 £17,298,000
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Newham CCG - Estates Developments and Extension Builds
Practice Scheme Details CCG Project Lead Gross Project Cost GP/3PD Funding/S106 NHSE Funding Project Approval Status
Westbury Road Practice New Build to replace exisiting site as per CQC recommendations Jason Kelder £2,339,904 £2,089,604 £250,300
Fully approved and in process of build. Expected occupation date Q1
2019/20
Woodgrange Medical Practice
Construction of extension to create additional consulting rooms, admin areas and toilets complies with Para 8(a). Refurbishment of garage is not eligible for funding. Andrew Bulloch £911,693 £341,746 £569,947
Extention build is complete and fully operational from February 2018.
Essex Lodge
Works to build an extension to provide additional clinical space complies with Para 8(a) however the proposal to purchase the land required to facilitate this is not eligible for funding as per Para 9(b) Jason Kelder £3,215,509 £1,296,873 £1,918,636
Formal approval has been given by NHSE. Practice needs to contract with supplier by the 9th of December. No funding approved for land purchase, build and design fees only and based on 66% as per Premises Direction
St Bartholemew's Surgery
Ceiling fans in reception and waiting areas comply with Para 8(c). Fixed seating for the elderly or infirm complies with Para 8(f). Hearing loop and automatic entrance doors comply with Para 8(b). Installation of compliant sinks and taps in clinical rooms complies with Para 8(j). Bev Norton £12,740 £0 £12,740
NHSE in process of due diligence - waiting for formal approval to progress with scheme
Claremont Clinic
Installation of Equality Act compliant reception desk complies with Para 8(b). Fixed waiting room seating complies with Para 8(g). Installation of infection control compliant sink units and splashbacks in clinical areas comply with Para 8(j). Bev Norton £22,906 £0 £22,906
Formal approval has been provided, practice is required to contract with supplier by the 9th December. Funding based on 66% as per Premises Directions
Froud Development
Fees only to get to Business Case.The Manor park Care Group has formed into a single practice through a merger of four small practices. One surgery has closed but three other inadequate premises remain in operation, whilst the new development is undertaken. The practices need to secure alternative premises as a matter of urgency to enable the clinicians to work together and deliver the services required for their populations. The case for change is: Bev Norton £3,080,360 £2,851,400 £228,960
A annual rental offer has been made to the landlord, DV has engaged with the CCG on negotiation on rent per m2. We are waiting for the landlord response, if this offer is not acceptable the CCG will have to withdraw from the scheme.
Pontoon Dock Health Centre
New Build health centre at the Royal Wharf Development to meet the population increase of circa 25k. The will be a relocation of an exisiting practice at Britannia Village Jason Kelder £5,997,600 £3,270,000 £2,727,600
S106 funding to purchase shell and core £2.6m, NHS Funding £2.7m for fit out costs. Landlord funding shortfall of £670k. Landlord cost to be recovered through rental.
Custom House Surgery
As part of the redevelopment of Custom House locality the London Borough of Newham (LBN) are proposing to demolish the existing Custom House surgery. This will require the practice/LBN to negotiate an alternative site. In addition to a ‘like for like’ replacement NCCG will be working with LBN and the developers to increase the footprint to provide accommodation for the planned increased population and potential colocation of Dr Lwin’s practice. Andrew Bulloch £5,550,000 £3,600,000 £1,950,000
The development will not be completed in ETTF timeframe ie completion by 2021. This is a risk to funding if the NHS cannot access capital post 2021. S106 to fund the shell and core (£3.6m) NHS funds to pay for fitout (£1.9m)
Hallsville Qrt (Canning Town)
New Build to accommodate regeneration plans around Canning Town. Scheme is supported on the relocation of primary care facilities at St Lukes Health Centre. This is a reprovision and not commissioning of new practices Jason Kelder £7,300,000 £4,000,000 £3,300,000
The development will not be completed in ETTF timeframe ie completion by 2021. This is a risk to funding if the NHS cannot access capital post 2021. S106 to fund the shell and core (£4m) NHS funds to pay for fitout (£3.3m)
Boleyn Medical Practice
This proposal is to refurbish and reconfigure the existing surgery at 162 Boleyn Road and redevelop the adjoining premises at 185 Neville Road, so as to provide an enlarged facility, 750-950 NIA M2, to meet current NHS standards and co-locate practices creating a facility that can potentially serve a list size to 20,000 population with additional GP provided services. Andrew Bulloch £2,475,000 £2,475,000 £0
Scheme has not progressed to next stage of ETTF funding. Remains on pipeline in case other projects fall away
Brampton Park (Rainbow Centre)
New Build on the Brampton School premises, lack of primary care facilities in this area, relocation of existing practice, not commissioning of new GP, must have childrens services as part of the offer Jason Kelder £1,973,000 £1,973,000 £0
Scheme has not progressed to next stage of ETTF funding. Remains on pipeline in case other projects fall away
Star Lane Medical Centre
Redesign part of the existing building to improve the use of clinical space,Provide improved patient waiting accommodation,Upgrade the current lift and install a second lift for improved DDABuild a two storey extension with additional multipurpose clinical consulting room on the first floor Bev Norton £2,068,345 £1,983,685 £84,660
NHSE funded £85k for fees to complete business case for submission to next level of build approval. Scheme is not able to progress due to funding concerns with the Practice having to contribute 34% of build cost
St Bartholomew's Surgery
This opportunity would provide 2 additional consulting rooms and 2 fully equipped nurse treatment rooms as well as an extended waiting room, training room and staff areas. Bev Norton £700,000 £700,000 £0
CCG advised St Barts Practice to resubmit this scheme under the IG 2017/18 application as we are concerned scheme would not be funded under the ETTF 2016/17 submission. CCG needs to check why costs has increased by £100k vs the ETTF submission
£35,647,057 £24,581,308 £11,065,749
Gross Project Funding Summary Total 2017/18 2018/19 2019/20 2020/++NHS Funding £11,065,749 £3,088,149 £2,727,600 £0 £5,250,000S106 Funding £10,200,000 0 £2,600,000 £0 £7,600,0003PD Funding £14,381,308 £3,728,223 £3,521,400 £2,683,685 £4,448,000
£35,647,057 £6,816,372 £8,849,000 £2,683,685 £17,298,000
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88
Primary Care Commissioning Committee Part I - 2.30-3.30pm Wednesday 28 March 2018 Committee rooms, 4th Floor, Unex Tower, 5 Station Street, London E15 1DA
Title Accelerating Primary Care Improvement Capability in Newham
Agenda item 2.3
Author Steve Gilvin, Special Projects Director, North East London CCGs
Presented by Ashwin Shah, Newham CCG, co-opted Board member
Contact for further information
Jenny Mazarelo, Associate Director Primary Care, NHS Newham CCG [email protected], 020 3688 2156
This paper is for Decision
Action required The Committee is asked to:
Approve: • The proposed vision, ambition and Academy activities 2017-2019• The mandate to scope and develop the proposed future Academy• The recommended governance structure.
Executive summary
A Quality Improvement Academy was launched in April 2017 as a result of the Newham Partnership Programme 2013. The programme addresses the challenge to deliver increasing demand for high-quality services with limited and diminishing resources. The report asks the Committee to approve:
• The proposed vision, ambition and Academy activities 2017-2019• The mandate to scope and develop the proposed future Academy• The recommended governance structure.
Supporting papers Appendix A – Full proposal Accelerating Primary Care Improvement capability in Newham
How does this fit with NHS Newham CCG strategy?
Values Commitment to continuous learning and development Enhancing local experience and talents Aims Reducing inequalities and improving accessibility
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Where has the paper been already presented?
Health and Well-being board – 1 November 2017– Approved Newham Partnership Steering Group – 9 November 2017 – Approved Newham CCG Primary Care Committee – 29 November 2017
Risk The proposal addresses the challenge to deliver increasing demand for high-quality services with limited and diminishing resources. Failing to adopt the proposal will:
• Impact the future sustainability of improvement activities and initiativesalready being invested in Primary care over the last years
• Impact the sustainability of existing training and education across Newhamdue to diminishing resources.
Equality impact This report conserves the duty of Newham CCG in respect of equality and this has been considered when developing the proposal for consideration and any mitigating actions.
Stakeholder engagement
This proposal has been developed with input from Primary care, LBN, CCG, public health and TST staff and is based on conversations with providers including The Newham Health Collaborative (the GP Federation), Newham Together Community Education Providers Network (CEPN) and UCLPartners.
Financial Implications
The Improvement Academy proposal for 2017/18 - 2018/19 will be delivered within the existing financial envelop of £502,000.
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1. Introduction and background
1.1 A Quality Improvement Academy was launched in April 2017 as a result of the Newham Partnership Programme 2013. The programme addresses the challenge to deliver increasing demand for high-quality services with limited and diminishing resources.
In 2017/18 the key focus of Quality Improvement Programme has been: • 5 Newham Improvement projects resulting in a range of practical interventions related to Low
weight birth babies feeding, Diabetes and pre-diabetes, Cardiovascular patients, Dynamic population and churn, GP Development and Emotional resilience in young people
• 4 Quality Improvement Collaboratives for approx. 300 primary care staff• 6 Improvement learning primary care network events• Embedding an evidence based approach and evaluation to improvement work supported by
Academic Researchers (University East London, UCL, Queen Mary’s University of London)• RCGP accredited Primary care leadership Programme for 17 selected emerging leaders.
1.2 Proposal Improvement Academy 2018/19 - vision, ambition and activities and governance 1.2.1. Our vision is to grow and develop a workforce who prioritise high quality patient care and wellbeing, understand the science of improvement, feel empowered to lead change in their own workplace and know where and how to seek further support.
1.2.2. By April 2019, Newham CCG ambition is that all primary care training and education in Newham will be aligned, and hosted within the umbrella of an Improvement Academy to provide and support an evidence based quality improvement approach to all initiatives.
1.2.3. Activities during 2018 include: • The Academy to transition from delivering some workforce training and courses, to a
structure that brings together and facilitates all existing training and development options.
• Bringing together evidenced based improvement, training and education provided byproviders to ensure better use of resources supporting long-term sustainability, accelerationand spread of learning in Newham.
1.2.4. Delivering the ambition will require a different governance structure: • A single Strategic Advisory Group will comprise of representatives from the Newham Health
Collaborative, Newham CCG, Newham Council, East London Health & Care Partnership, the Local Workforce Action Group and Public Health.
• Providers of services would report into this group and the group would be responsible for thestrategic direction of all Academy programmes, oversee progress and ensure that trainingand other staff development initiatives were aligned.
1.2.5. To deliver the Improvement Academy 2018/19, we need to initiate a process to: 1. Agree our shared vision for developing our workforce2. Determine the scope and extent of primary care staff development activities across Newham3. Design an effective governance structure4. Quantify the resources and support mechanisms we need to deliver our vision
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Document Accelerating Primary Care Improvement Capability in Newham Proposed activities, next steps and roadmap for Newham Improvement Academy to April 2019
Version Final October 2017 Reviewed 24th Jan 2018 – Strategic Advisory group
Author(s) Newham CCG in partnership with UCLPartners
Presenter(s) Steve Gilvin (Newham CCG) Ashwin Shah (Newham CCG)
Meeting Health and Well-being board – 1 Nov Partnership Steering Group – 9 Nov
CCG Primary Care Committee – 29 Nov CCG Board – 13 Dec CCG Primary Care Committee – 28 Mar
Purpose of paper Proposal to address the long-term sustainability of workforce training and education in Newham.
Background An Improvement Academy was launched in April 2017 as a result of the Newham Partnership Programme 2013. It addresses the challenge to deliver increasing demand for high-quality services with limited and diminishing resources. Between April and September 2017, the Academy’s focus has been Quality Improvement and Leadership training and QI Learning network events facilitation.
Recommendations The Newham Oversight Group seeks the approval for:
1) The proposed vision, ambition and Academy activities 2017-20192) The mandate to scope and develop the proposed future Academy3) The recommended governance structure and the outline plan for theAcademy development in 2018
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Accelerating Primary Care Improvement Capability in Newham Proposed activities, next steps and roadmap for Newham Improvement Academy to April 2019
1.Introduction and background
1.1. Introduction In Newham there are 53 GP surgeries to serve a growing population of over 365,000 patients. The borough is facing a huge challenge to deliver increasing demand for high-quality services with limited and diminishing resources. Many health care staff in the area are nearing retirement age, meaning that the borough will need to attract staff.
To face this challenge, we are committed to equip our primary care staff with the skills they need to work in new ways, maximising capacity and freeing up time for care.
To achieve this, we now need to initiate a process to: 1. Agree our shared vision for developing our workforce;2. Determine the scope and extent of primary care staff
development activities across Newham;3. Design an effective governance structure;4. Quantify the resources and support mechanisms we need to
deliver our vision.
Our aspiration is for the Newham Improvement Academy to support patient care, needs and well-being, to be at the heart of tackling our workforce challenges and to attract new staff to
Newham. The Academy’s founding principle is to support population well-being, addressing: health literacy, community engagement, and prevention. It will bring together all existing and future primary care improvement and workforce development activities in one place. The activities bring together all development and improvement opportunities.
Our vision is to grow and develop a workforce who prioritise high quality patient care and wellbeing, understand the science of improvement, feel empowered to lead change in their own workplace and know where and how to seek further support.
In the long-term the Academy will: • Improve the ability and capacity to achieve rapid, safe and
sustainable improvements to any aspect of care • Improve awareness of primary care quality improvement
science and achievements • Increase the sustainability of improvement initiatives• Attract more and retain staff
The road-map to April 2019 in section 4, sets out a process for further engagement on this vision and the establishment of the Academy.
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1.2. Background The Academy was established in April 2017 as a result of the Newham-UCLPartners partnership programme1. The programme accelerates our understanding of how to improve the health of people in Newham. It puts ideas into practice to make a real, long-term difference.
Examples of the successes to date include:
• A diabetes self-management programme which hasimproved the health of young people
• An integrated electronic referral form that has improvedinformation sharing for patients with cardiovascular disease,creating better patient and staff experiences
• Over 300 staff have been trained to release more time tocare for patients, increasing staff satisfaction using qualityimprovement methodology
The Academy April 2017/18 will consist of the following elements (see figure 1 and appendix 1):
• Four Quality Improvement collaboratives• The Emerging Leadership Programme• Co-developed local improvement learning network to share
improvement and quarterly UCLPartners primary caredevelopment events
1 The Programme partnered with NHSE, Xytal, Dartmouth, Staff College, Care City, QMUL, UEL, Barts Health to deliver improvement training and evidence based intervention
• Access to online platforms including the Institute for HealthImprovement's e-learning modules, Life QI, and the CEPNNewham Together website
• Business management support to embed the learning fromthe Improvement Themes carried out through 15/16 and16/17 into ‘business as usual’ and commissioning intentions
• The development of improvement implementation projectsas result of the QI collaboratives
• Embedding an evidence based approach and evaluation toall work programmes supported by a Researcher inResidence
The outcomes of the Academy are aligned with Newham’s prioritised Care Quality Commissioning outcomes framework themes, East London STP themes and Patient Satisfaction outcomes measures. 2
Figure 1. Academy Summary of Activities 2017/18
2 CQC themes: Safe, effective, caring responsive and well led. STP level themes are Patient experience, Staff satisfaction, Efficiency (time to care)
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The total investment from Newham CCG for the Academy over 2017/19, is £502k. The breakdown of these funds is detailed in Figure 2.
Figure 2. Academy’s £502k offer launched in April 2017
To ensure the continued success of the Academy there are several objectives which must be achieved. This will be addressed as follows:
In the short-term (6 months) • Ensure clarity across Newham regarding the purpose and
role of the Academy; • Agree a shared commitment and mandate to achieve our
aims, to which all parties, will sign-up and support; • Develop a governance structure that enables stakeholders to
contribute meaningfully to the Academy, and holds organisations to account where necessary;
• Create the right capacity in our ‘business as usual’ structuresto implement change and assure long-term sustainability.
In the longer-term (12 months) • Develop an open system that encourages and enables
existing improvement skills and capability to join and work with the Academy, to help achieve our vision;
• Align with the wider East London wide vision to primary caredevelopment.
Always • Ensure that the staff’s voice is at the core of the Academy
and that all relevant stakeholders are appropriately involvedin responding to it;
• Commit to and support learning across the wider system;• Structure our governance and actions around, and in
conjunction with, our staff to ensure positive impact;• Support the development of a patient focused culture;• Support primary care to develop and implement local
initiatives;• Promote service innovation and learning from best practice
nationally and internationally.
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2. Developing improvement capability 2018/19
By April 2019, our ambition is that all primary care training and education in Newham will be aligned, and hosted within the umbrella of the Academy to provide and support an evidence based quality improvement approach to all initiatives.
This may include improvement training and education provided by:
• Community Education Providers Network (CEPN)• The National Resilience programme providers• UCLPartners Programme• General Practice Vocational Training Scheme
During 2018 the Academy will transition from delivering some workforce training and courses, to a structure that brings together and facilitates all existing training and development options.
Bringing together training and education provided by the organisations listed above and others will ensure better use of resources supporting long-term sustainability, acceleration and spread of learning in Newham.
The future offer includes the following activities:
• Quality Improvement training• Leadership programme• Primary care and care workforce education, training,
awareness of technology and digital solutions
• Patient and public prevention education• International workforce induction programme• Network learning events, providing a platform to promote
improvement• Access to online platforms• Improvement implementation projects• Evidence and academic research
Figure 3. Proposed future Academy offer
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3. Ensuring progress and accountability
3.1. Capacity required We need to move towards an Academy that spreads learning faster, increasing the impact for our local population. This will require different resources and governance structures.
In future, capacity must be drawn from within our local staffing:
• The Newham Health Collaborative (the GP Federation)• The Newham Together Community Education Providers
Network (CEPN)• The GP practice support team• Existing Quality Improvement Leads across Newham• Resilience support team• Public Health
3.2. Governance and accountability Our governance must:
• Support leadership across Newham, including within ourlocal GP Federation as they become the focal point fordelivering high quality integrated services to local people;
• Provide a set of enabling functions that support workforcedevelopment delivery across the Newham care system;
• Provide a platform to track progress and outcomes
A single Strategic Advisory Group will replace the existing reporting lines into the various boards for providers. The advisory group, would comprise of representatives from the Newham Health Collaborative, Newham CCG, Newham Council, East London Health & Care Partnership, the Local Workforce Action Group and Public Health.
Providers of services would report into this group and the group would be responsible for the strategic direction of all Academy programmes, oversee progress and ensure that training and other staff development initiatives were aligned.
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4. Plan to implement the Academy
4.1. Road map January 2018 to April 2019 Our aim is to deliver a fully developed Academy by April 2019, therefore requiring us to have affirmed our vision and have collectively agreed the proposed Academy infrastructure and governance structure required to deliver it (see figure 4 below). This will involve engagement across Newham Primary Care staff.
To progress the work a small design and development group should complete the mapping of existing training/courses, scoping of resources and develop a business plan.
Figure 4. Suggested blueprint future Academy 2019
4.2. High level timeline (between now and March 2019)3
3 The plan shows the key steps required between now and March 2019
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Milestone 2018 2019
Key steps Dec Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Sign-off Academy MoU 2017/19 by Commissioner Establish a small local Academy design and development group Initial scoping funding, requirements, resources and training/courses Approval Prototype Business model and Academy specification Approval Delivery plan 2018/19 Transition to new Academy structure Sign-off specification and Service Level Agreement 2019 onwards Complete transition and fully functioning Academy
APPENDIX 1. Improvement Academy Delivery plan 2017-2018
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100
Primary Care Commissioning Committee Part I - 28 March 2018 FO21/FO24, 4th Floor, Unex Tower
Title Newham Primary Care Risk Register
Agenda item 4.1
Author Jenny Mazarelo, Associate Director Primary Care
Presented by Jenny Mazarelo – Associate Director Primary Care
Contact for further information
Joseph Lee, Senior Commissioning Manager, [email protected] Jason Clarke, Risk and Information Governance Manager, [email protected]
This paper is for Information
Action required The committee is asked to: Note for Information
Executive summary
Newham CCG is a fully delegated commissioner of primary care services and as such, part of the governance and oversight falls within the bounds of the Primary Care Commissioning Committee. The Primary Care Team have produced a risk register to identify key risks and mitigating actions associated with the CCG’s delegated functions of commissioning primary medical services.
Supporting papers None
How does this fit with NHS Newham CCG strategy?
Values • Effective and collaborative communication• Transparency with our decision-making and leadership• Accountability and responsibility
Aims • Improving health outcomes through developing models of integrated care
and focusing on prevention• Reducing inequalities and improving accessibility• Reducing quality variation• Ensuring equity of health and wellbeing outcomes.
Where has the paper been already presented?
Regular updates to PCCC
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Risk Failure to monitor and manage the risks identified within primary care may lead to the Committee’s inability to deliver on its constitutional requirements and may lead to the CCG being unable to effectively deliver the primary care strategy to serve Newham residents through a sustainable and viable GP Federation.
Equality impact The paper has conserved the duty of Newham CCG in respect of equality and this has been considered when developing the risks for consideration and any mitigating actions. An Equality Impact Assessment has been conducted for Primary Care and the delivery of primary care services are for all residents.
Stakeholder engagement
There has been no engagement regarding the current risks within primary care, however other CCG colleagues, such as finance, provide information which contributes to the assessment if the current risks.
Financial Implications
There are no financial implications associated with this report other than those identified within the specific risks and actions.
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1. Introduction and background
1.1 1.1
1.2
1.3
1.4
Primary Care Risk Register Risk management is the recognition and effective management of all threats and opportunities that may have an impact on the CCG’s reputation, its ability to deliver its statutory responsibilities and the achievement of its objectives and values. Newham CCG became a Level 3, fully delegated, commissioner on 1 April 2015 and took on the responsibility of commissioning GP services for the residents of Newham.
In supporting the PCCC in discharging these functions a primary care risk register has been developed to clearly identify high risk areas along with mitigating actions.
At a discussion meeting on 25 October, the PCCC completed a deep-dive of the current risk on the Board Assurance Framework. The BAF risk was reviewed and updated to reflect a number of additional controls and assurances in place such as the progress made with extended access, primary care home, the AFO and GP IT. The updated BAF risk was included as Appendix A in November’s report.
A full risk report has been developed to supplement this paper to give greater detail in regards to the controls and internal assurance processes in place to help deliver against the mitigating actions of each risk as Appendix A of this report. This has been updated to reflect the risks on NHS England’s risk register in respect of fully delegated commissioning.
2. Primary Care Risks for 2017/18
2.1
2.2
2.3
2.4
The risk register was updated in January 2018 (items 15 and 16) to reflect two risks from NHS England’s Primary Care risk register in respect of Primary Care Support England services delivered by Capita. These risks were added to NHS England’s risk register on 17 February 2017 with an anticipated resolution date of nine to twelve months.
The risk rating for items 1 and 4 have been reduced to the target risk since the last report. NHS England and Londonwide LMCs (LLMCs) have approved the equalisation process for PMS and GMS practices. The PMS Offer pack is currently with LLMCs for final approval and will be circulated to practices with immediate effect once this process has concluded.
The rating for all other risks remain unchanged since the last meeting.
At its last meeting, he Committee requested to see the detail on risks 15 and 16 as a result of a recent announcement regarding Capita’s financial difficulties in order to ensure mitigations are in place, if necessary, for Newham residents. This is attached at Appendix B.
3. 3.1
Recommendations The Committee is asked to note the content of this report.
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Appendix A – Proposed Risk and Risk Rating
No Risk Original Risk
Current Risk
Target Risk
1. Financial impact of month 12 14/15 4 2 2 2. Failure to deliver on 17/18 QIPP target 12 12 6 3. Failure to develop the federation and at scale
providers (ACS) 15 12 6
4. Failure to agree equalisation process for PMS and GMS GP contracts 12 4 4
5. Failure to review GP Patient Access (GP Core Hours) in respect of part day closures 9 6 3
6. Failure to ensure the development and utilisation of IT to increase access 9 6 4
7. Failure to ensure the delivery of 8-8 services 12 6 4 8. Failure to develop the primary care workforce to
improve practice capacity, attraction and retention through training and development
16 15 8
9. Ensuring the delivery of QI programmes and initiatives which will help deliver against the 10 High Impact Areas outlines in the GPFV
9 6 3
10. Ensure the delivery of resilience programme (16/17 and 17/18 funds) 8 6 3
11. Failure to increase the quality of primary care service provision and ensure safe services are delivered to patients
12 12 4
12. Failure to deliver against Referral Pathway Service targets 15 12 8
13. Failure to secure adequate estates to deliver the primary care strategy 16 16 6
14. Failure to ensure sufficient support provided to practices identified within Practice Quality Improvement Group
12 8 8
15. NHS England related Primary Care Support Service functions have not successfully transitioned to the new provider, resulting in impact on business continuity of services, quality of service to primary care users and cost pressures.
16 16 2
16. Performers' List application process not managed appropriately by Capita 16 16 2
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Appendix B
Date
Raised
Facilitat
or
Risk
Category
Risk
DescriptionTREND
Mitigatin
g
Actions
Action
Owner
Completi
on Date
for
Actions
Action
updates
Last
Reviewe
d Date
Next
Review
Date
Closed
Date
Risk
Register
Title
Risk
Register
Owner
RR Lead
15Primary
Care
Director
Of
Primary
Care
(London)
Jeremy
Wallman,
Head of
Primary
Care
Commissi
oning;
Dentistry,
Optometry
and
Pharmacy
17/02/17
Director
Of
Primary
Care
(London)
Primary Care
Support
Services
(PCSS)
There is a risk
that the NHS
England
related
Primary Care
Support
Services
functions do
not
successfully
transition to a
new provider
as core
business
functions and
cost
reduction/futur
e site closure
transition
periods
resulting in
impact on
business
continuity of
services,
quality of
service to
primary care
R 4 4 16 9 - 12 Mths R 4 4 16 9 - 12 Mths ↔
Commissio
ners are
increasing
scrutiny
and
validation
of this
action on a
case by
case basis
Liz Wise Completed Although
actions
have been
underatken
, the
situation is
being
constantly
monitored
due to
inconsisten
t PCSE
perfroman
ce. In
some cases
performan
ce has
improved
but not to
the level
where
NHSE is
assured
that the
the risk has
been
mitigated
sufficiently.
The SOPs
introduced
within the
R 4 4 16 31/03/17 01/11/17 31/01/18
16Primary
Care
Director
Of
Primary
Care
(London)
Jeremy
Wallman,
Head of
Primary
Care
Commissi
oning;
Dentistry,
Optometry
and
Pharmacy
17/02/17
Graham
Boullier,
Medical
Directorat
e/Jeremy
Wallman,
Head of
Primary
Care
Commissi
oning;
Dentistry,
Optometry
and
Pharmacy
Performers'
List
Application
Process Not
Managed
Appropriately
by Capita
CAUSE:
Capita has
taken over
the
management
of London's
PCS services
with the new
service
centralised
and relocated
in Leeds. The
London
Medical
Directorate
(MD) rely
significantly
on PCS
services to
deliver "
business as
usual ". As of
September
2016 the
management
R 4 4 16 9 - 12 Mths R 4 4 16 9 - 12 Mths ↔
1. All new
PL
application
s will be
scrutinised
by the
London PL
teams to
ensure that
the
application
is accurate
and meets
the
requireme
nts of the
PL
regulations
.
Incomplete
application
s will be
returned
to Capita
who will
be asked to
ensure that
the PL
application
is
completed
1 - 4
Graham
Boullier,
Medical
Directorate
5.Jeremy
Wallman,
Head of
Primary
Care
Commissio
ning;
Dentistry,
Optometry
and
Pharmacy
All Actions
Completed
by
31/03/17
Although
actions
have been
underatken
, the
situation is
being
constantly
monitored
due to
inconsisten
t PCSE
perfroman
ce. In
some cases
performan
ce has
improved
but not to
the level
where
NHSE is
assured
that the
the risk has
been
mitigated
sufficiently.
R 4 4 16 31/03/17 01/11/17 31/01/18
CURRENT RAG PREVIOUS RAG
POST MITIGATION TARGET
[Set by Risk Owner]
Date risk
was first
identified
(DD/MM/Y
Y)
Name &
job title of
the sole
person
responsible
for the
Categories
from the
Risk
Categorisat
ion Model
A statement
describing:
1. Risk event -
impacting aims
and objectives
2. Because -
RAG
Status
Likeli-
hood
(1-5)
Impact (1-
5)
Update on
mitigating
action(s)
progress
Score Proximity RAG
Status
Likeli-
hood
(1-5)
Impact
(1-5)Score Proximity
The
direction
indicates
any
change in
the current
The key
actions to
put in place
the
required
mitigations,
Name &
job title of
the person
responsible
to the
Action
Each
action
should
have a
completion
date set or
Date when
it is
planned to
next review
the risk
(DD/MM/Y
Date risk
was closed
or
transferred
from
register
RAG
Status
Likeli-
hoodImpact Score
Target
Date
(DD/MM/Y
Y)
Date when
the risk
was last
reviewed
and/or
updated
105
Primary Care Commissioning Committee Part I – Wednesday 28 March 2018 Committee rooms, 4th Floor Unex Tower
Title: Primary Care Medical Finance Report – Month 11 Report
Agenda item 4.2
Author: Lei Wei, Interim Chief Finance Officer Newham CCG
Presented by: Lei Wei, Interim Chief Finance Officer Newham CCG
Contact for further information:
Lei Wei, Interim Chief Finance Officer Newham CCG 020 3688 2334 / [email protected]
This Paper is for: Monitor
Action required: The Primary Care Commissioning Committee are asked to: • Note the summary Primary Care Finance Report
Executive summary:
The CCG identified the 2017/18 allocation at £51.588million.
It has received allocations at a practice level and these are in the ledger.
At Month 11 the CCG delegated budget reports a small over spend of £95k; it is projected to break even over the financial year.
A Primary Care Risk and Innovation Reserve of £1.0m was established by the CCG for 2017/18. All additional primary care funding in 2017/18 including Federation capacity building must be contained within this cash envelope. The reserve will be reported monthly as part of the reporting cycle.
The CCG is the host for some budgets and staff managed on an STP basis. Newham will accommodate staff managing delegated budgets at a regional level as part of the devolution of primary care functions to STP. However, the cost of staffing is retained within NHSE budgets.
Supporting papers: Appendix 1 – Primary Care Delegated Budgets – Month 9 Position Appendix 2 – Primary Care Reserves Analysis – Month 9 Position
How does this fit with Newham CCG Strategy:
Accountability and Responsibility - Requirement to meet target surplus.
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Where has the paper been already presented?
N/a
Risk: The Primary Care delegated budget financial plan as identified in the CCG Finance and Activity Plan is an essential component in identifying and managing financial risk and ensuring the CCG delivers its financial requirements.
Equality Impact: Effective delivery of the financial plan will support the CCG in achieving its duty to reduce inequality of health provision and outcomes for the residents of Newham.
Stakeholder engagement:
This report has been subject to no specific prior consultation but reflects any comments from NHSE assurance processes and any comments, queries or suggestions raised by CCG members in relation to earlier reports.
Integrated Care Impact
Effective financial planning, monitoring and control delivering value for money enables effective targeting of resources to support delivery and continuous improvement of high quality services for patients.
Financial Implications
The report provides a high level view of the CCG’s Primary Care Medical financial budget for 2017/18.
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Appendix 1
Primary Care Delegated Budgets – Month 11 Position – February 2018
Expenditure
Currently delegated co-commissioning continues to report a breakeven position against the £51.588 million allocation. The Annual Budget and cumulative position are summarised in Table 1 below.
Table 1
Practice Type Annual Budget YTD Budget YTD Actual YTD Variance Over/(Under)
APMS 6,224,158 5,704,957 5,717,245 12,288 GMS 10,577,054 9,665,565 9,618,657 (46,908) PMS 34,950,929 31,912,252 31,983,409 71,157
51,752,141 47,282,774 47,319,311 36,537
Expected Growth 505,049 (13,903) 7,614 21,517 Net Savings Requirement (669,190) 148,104 184,804 36,700
(164,141) 134,201 192,418 58,217
51,588,000 47,416,975 47,511,729 94,754
The unallocated balance is available to be applied to primary care budgets. Revised list size growth estimates the costs of list growth to in excess of £400k for the current year. In addition it is expected that there will be an increase in the cost of leases within Primary Care following the finalisation of the national lease negotiations.
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Appendix 1
It should be noted that the Primary Care Risk and Innovation Reserve of £1.0 million, details of which are provided in Appendix 2 are not held to offset any overspend on delegated budgets but for specific purposes. The potential overspend will therefore have to be managed over the period or offset by QIPP or other savings either in delegated budgets or elsewhere in the CCG savings framework.
The Interim CFO will work continue to work with Primary Care teams to identify the scope for controlling primary care core contract spend or options for identify QIPP and update the Primary Care Committee in future reports.
Risk and Reserves At this point the CCG is holding a Risk and Innovation reserve of £1.0 million for primary care which is currently committed. Details of the identified risk and proposed innovation commitments are attached as Appendix 2.
Conclusion This report updates PCCC members on the financial position based on Month 11 data. The report also lists the Risk and Innovation reserves provided to support Primary Care by the CCG in Appendix 2. Currently spend is reported as break-even against the allocation but while early in the financial year there is clearly risk of overspend and the CFO will update the Committee in future reports on mitigating actions.
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Appendix 2
Primary Care Reserves Analysis
The CCG has established a Primary Care Risk and Innovation Reserve from which all Primary Care risks and innovation that cannot be met within the delegated budget must be met. Known pressures within the delegated budgets will normally be funded from QIPP and other savings and the CFO will work with the primary care team and NHSE to identify achievable measures within the delegated budget. Support from this CCG funded reserve will only be provided as a last resort and on the basis of Committee approval.
As of Month 11, the £1.0 million reserve has been fully committed. However this will be kept under review and any opportunity to release reserves back into contingency will be followed through to increase resilience.
Newham Primary Care ReserveIndicative Q1 Q2 Q3 Q4 Total
AppliedTotal
Balance£ £ £ £ £ £ £
Primary Care Risk Reserve ApplicationCurrent additional spend (Managed practices) 121,000 0 0 0 121,000 121,000 0Violent Patients 50,000 0 0 0 50,000 50,000 0Risk reserve balance 79,000 0 0 0 0 0 -79,000Primary Care Reserve 250,000 0 0 0 171,000 171,000 -79,000Primary Care InnovationNHSE GP development programme 0 0 0 0 0 0 0GP organisation Capacity Building 350,000 79,000 116,667 116,667 116,667 429,000 79,000Addnl Capacity support 150,000 30,000 40,000 40,000 40,000 150,000 0EPCS/LIS strech risk 150,000 0 0 0 150,000 150,000 0Support AFO initiatives 100,000 30,000 30,000 20,000 20,000 100,000 0Sub-Total - Non-delegated 750,000 139,000 186,667 176,667 326,667 829,000 79,000
0Total 1,000,000 139,000 186,667 176,667 497,667 1,000,000 0
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Appendix 2
Standing Notes: Where reserves for specific items are deemed to be no longer required, initially they will be transferred to the risk reserve balance within the overall Primary Care Reserve. The CCG financial position requires all unapplied reserves to be held pending development of measures currently in place to guarantee financial balance. However, until the end of Quarter 3 any unallocated reserves will remain held in the Primary Care Reserve schedule and may be used as a first call on any unavoidable costs that may yet emerge in Primary Care. A decision on any transfer out of Primary Care will be made in the new calendar year as part of a report to the Board following consultation with the Primary Care Committee.
The reserve will be updated on a monthly basis with a formal quarterly review that will be shared with the Chair of the PCCC and the CCG Executive Committee.
111
Primary Care Commissioning Committee 28 March 2018 Unex Tower, Committee Rooms
Title Appendix 3 – Primary Care QIPP Performance update 2017-18
Agenda item 4.2
Author Saem Ahmed, Newham CCG, Head of Performance and Planning
Presented by Jenny Mazarelo, Newham CCG, Associate Director of Primary Care
Contact for further information
Saem Ahmed, Newham CCG, Head of Performance and Planning, [email protected], 0203 688 2304
This paper is for ☐ Decision ☐ Monitor ☐ Discussion ☒ For Information
Action required Note for Information: No action is required the board/committee/group are asked, “to note the report which will be included within the meeting papers but will not be discussed as part of the agenda.
Executive summary
To note
Supporting papers None.
Next Steps/ Onward Reporting
Executive Committee April 2018.
Where has the paper been already presented?
No previous presentation to any previous meetings.
How does this fit with NHS Newham CCG strategy?
Value: • Accountability and responsibility
Aim: • Reducing inequalities and improving accessibility.
Risk BAF.02 – Failure to effectively meet the CCG’s financial targets and savings plans in 2017/18.
112
Equality impact This document relates to all Newham residents in the 9 protected characteristics that are covered by the Equality Act 2010 and our Equality Duties.
Stakeholder engagement
No consultation has taken place nor is it required for this report. However specific schemes will require consultation and therefore this would be done as part of the QIPP scheme development.
Financial Implications
The report outlines an update against the performance of Primary Care related QIPP schemes in 17/18. Work continues alongside commissioners to determine the impact of QIPP delivery on the schemes presented in this paper.
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1. Introduction and background
1.1 1.1.1
Primary Care QIPP 2017-18 There table below shows performance against the three Primary Care QIPPs for 2017-18.
QIPP Scheme Performance Update as at: Language Shop Re-design RED 05 March 2018
Review of Cluster Meetings GREEN 05 March 2018
Outpatient Referral Pathway Scheme (ReFas)
TBC 05 March 2018
2.
2.1 Language Shop Re-design While the language shop has seen an increase in uptake of telephone interpretations, the levels of face to face interpretations has not reduced, therefore this has impacted on the target QIPP not being achieved. Clinical decision tree and reception protocols have been circulated to GP practices to support practice transition from face-to-face to telephone interpretation. Approximately £40K of costs have been attributed to the Barts Health Audiology service. The CCG has indicated in its commissioning intentions letter for 2018/19 that it will not continue to meet the cost of this from the new financial year.
Review of Cluster Meetings This scheme has over performed against its target and is likely to see further savings in addition to the original target set.
Cluster meeting attendance has been closely monitored and validated over the year to date, reflecting the QIPP over-performance delivered. It is anticipated that this will increase further in Q4. There is the potential for further QIPP to be delivered if practices are not paid for cluster meeting attendance where they are represented by their Cluster Lead at that meetings which could currently be construed as a double payment.
Outpatient Referral Pathway Scheme The performance against this scheme is to be confirmed for a number of reasons, while we have seen increase in activity based on CEG data, there remains an issue in relation to data quality. At this stage it has been challenging to correlate the usage of Outpatient Referral Pathway Scheme with the financial savings as a result of the scheme, and this is being addressed through the 18/19 QIPP process.
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