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NHS Warrington CCG Primary Care Commissioning Committee 6th March 2019

WARRINGTON CLINICAL COMMISSIONING GROUP

JOINT PRIMARY CARE CO-COMMISSIONING COMMITTEE MEETING TO BE HELD ON WEDNESDAY 6th MARCH 2019

AT 1.00 p.m. – 3.30 p.m. IN THE BOARD ROOM, ARPLEY HOUSE

A G E N D A

A Welcome and Introductions

Verbal Chair

B Apologies: Ruth Dales, Healthwatch

C Statement of Quoracy – Chair A quorum necessary for the Committee to undertake its business is defined as at least 3 of the following members:

• Committee Chair (or nominated Vice Chair)

• NHS WCCG Senior Management Team Representative (or nominated Deputy who should also be a member of the NHS Warrington CCG management team)

• NHS WCCG Deputy Chief Finance Officer (or nominated Deputy who should work for the NHS WCCG finance team)

• General Practice representative (who should work for an NHS Warrington CCG practice)

• NHS England representative (non voting) Where the meeting is not quorate, owing to the absence of certain members, the meeting will be deferred until such time as a quorum can be convened. Where a quorum cannot be convened from the membership of the meeting, owing to the arrangements for managing conflicts of interest or potential conflicts of interests, the Chair of the meeting shall consult with the CCG Accountable Officer in the action to be taken.

D Declarations of Interest in Agenda Items

Verbal Chair

E Chair's Remarks

Verbal Ingrid Fife

013/19 East Cluster – successful bid as part of the Primary Care Network Funding

Presentation Dr R Raj

014/19 Investment and Evolution: A five-year framework for GP contract reform to implement The NHS Long Term Plan

Presentation Pam Broadhead

015/19 Minutes of the Meeting held on 9th January 2019 and update of actions (to approve)

Enclosure Ingrid Fife

016/19 Risk Schedule Report – Standing Item

• Risks created by Primary Care Commissioning Operational Group

(for approval and to note)

• Referrals made to other agencies for example CQC, MIAA

(any full details behind this verbal update will be provided in part 2 of the meeting)

Enclosure

Verbal

Pam Broadhead

Pam Broadhead

NHS Warrington CCG Primary Care Commissioning Committee 6th March 2019

017/19 Primary Care Commissioning 1. Primary Care Commissioning Report

(to approve and to note where required) 2. NHS Warrington CCG; Primary Care

Strategy

Enclosure

Presentation

Marie-Ann Hunter

Marie-Ann Hunter

018/19 Primary Care Contracting 1. Core Contract Report

(to approve and to note where required) 2. Procurement Policy

(for approval)

Enclosure

Enclosure

Aysha Devine

Aysha Devine

019/19 Financial Performance for the period ending 31st January 2019 (to note)

To follow Bryan Webb

020/19 PMS Redistribution Funding 1. Primary Care Clinical Lead Update Report

(for information) 2. Bank Holiday Opening Services

(for approval) 3. Blue Stream Academy Software

(for approval)

To note that committee members employed by GP practices in Warrington will be conflicted for items 2 and 3

Enclosure

Enclosure

Enclosure

Dr Sangeetha

Steevart Pam Broadhead

Marie-Ann Hunter

021/19 Public Engagement / Communications Plan

Enclosure Maria Austin/ Zoe Graham

022/19 Review of Risks

Verbal Ingrid Fife

023/19 Any Other Business

Verbal All

024/19 Date and Time of Next Meeting: The next meeting will take place on Wednesday 1st May 2019 in the Board Room, Arpley House, Birchwood at 1.00 p.m. – 3.00 p.m.

Investment and evolution:A five-year framework for GP contract reform to implement

The NHS Long Term Plan

Pam Broadhead, Chief Primary Care Officer

A five-year framework for GP contract reform to implement The NHS Long Term Plan

In July 2018 the Board agreed that NHS England should start significant discussions with the BMA General Practitioners Committee (GPC) in England on reform of the GP Contract, to take account of

i. the then forthcoming NHS Long Term-Plan and five-year funding settlement;

ii. the workforce challenge facing primary care;

iii. changes to indemnity;

iv. the review of QOF;

v. the development of Primary Care Networks; and

vi. the Partnership Review.

The Investment and evolution document translates the commitments in The NHS Long Term Plan1 into a five-year framework for the GP services contract.

A five year framework for the GP services contract

• Five-year GP Contract reform

• Implements The NHS Long Term Plan

• 2019/20 GMS Contract changes

• Joint proposals for contract reform

for next four subsequent years

• Direction for primary care

• Addresses PMC challenges

Summary of agreement

• Addresses workload issues

• Brings a permanent solution to indemnity

costs and coverage

• Improves the Quality and Outcomes

Framework

• Introduces a new Network Contract DES

• Helps join-up urgent care services

• Enables practices and patients to benefit from

digital technologies

• Delivers new services to achieve NHS Long

Term Plan commitments

• Gives five-year funding clarity and certainty for

practices

• Tests future contract changes prior to

introduction

Investment

• Increase by over £4.5 billion

• Core practice contract increases by £978 million per

annum.

• Includes £105m payable as a network participation

payment

• Up to £1.799 billion will flow nationally through the

Network Contract DES

The AgreementAddressing the workforce shortfall

Additional Roles Reimbursement Scheme

• Primary Care Networks will be guaranteed funding for additional staff in five specific roles (pharmacists, social prescribing link workers, physician associates, first contract physiotherapists, and community paramedics) by 2023/24.

• will be backed by £891million of new investment by 2023/24;

• will meet a recurrent 70% of the costs of additional clinical pharmacists, physician associates, first contact physiotherapists, and first contact community paramedics; and 100% of the costs of additional social prescribing link workers.

The AgreementA permanent solution to indemnity costs and coverage

• A centrally-funded Clinical Negligence Scheme for General Practice starting in April 2019.

• All of general practice covered, including out-of-hours and all staff groups.

• Membership is free.

• Funded through a one-off permanent adjustment to the global sum.

• Future costs of NHS practice under the scheme will be funded centrally, not met individually by practices.

The AgreementImproves the Quality & Outcomes Framework

In line with the findings of the comprehensive review of QOF in 2018

• 28 indicators, worth 175 points in total, are being retired from April 2019.

• The first two Quality Improvement Modules for 2019/20 are prescribing safety and end-of-life care. 101 points will be used for 15 more clinically appropriate indicators, mainly on diabetes, blood pressure control and cervical screening.

• The current system of exception reporting will be replaced by the more precise approach of the Personalised Care Adjustment.

• In 2019, the heart failure, asthma and chronic obstructive pulmonary disease domains will be reviewed.

The AgreementThe Network DES

“An automatic entitlement for practices to a new Primary Care Network (PCN) Contract as an extension of existing GP contracts.”

• Eligibility depends on meeting registration requirements.

• Like existing GMS, the Network Contract DES will be backed by financial entitlements.

• NHS E expects 100% geographical coverage of the Network Contract DES by July 2019, so that no patients or practices are disadvantaged.

• Each network must have a named accountable Clinical Director and a Network Agreement setting out the collaboration between its members.

The Network DES - Timeline

Jan-Apr 2019 PCNs prepare to meet the Network Contract DES registration requirements

By 29 Mar 2019 NHS England and GPC England jointly issue the Network Agreement and

2019/20 Network Contract DES By 15 May 2019 All Primary Care Networks submit registration information to the CCG

By 31 May 2019 CCGs confirm network coverage and approve variation to GMS, PMS and

APMS contracts Early Jun NHS England and GPC England jointly work with CCGs and LMCs to resolve

any issues 1 Jul 2019 Network Contract DES goes live across 100% of the country Jul 2019-Mar 200 National entitlements under the 2019/20 Network Contract start:

• year 1 of the additional workforce reimbursement scheme

• ongoing support funding for the Clinical Director

• ongoing £1.50/head from CCG allocations

Apr 2020 onwards National Network Services start under the 2020/21 Network Contract DES

The AgreementGoing “Digital First” & Improving Access

• The NHS Long Term Plan envisages Primary Care Networks joining up the delivery of urgent care in the community. Funding and responsibility for providing the current CCG-commissioned enhanced access services transfers to the Network Contract DES by April 2021 at the latest.

• From July 2019, the Extended Hours DES requirements are introduced across every network, until March 2021.

• As part of these access arrangements, £30 million of additional annual recurrent funding will be added to the global sum from 2019/20.

• Working with NHS Digital, GP activity and waiting times data will be published monthly from 2021, alongside hospital data.

• This includes IT infrastructure and digital first support, and new patient rights to digital-first primary care in 2021.

The AgreementDelivering new network services

• Investment in primary medical care is secured for phased and full delivery of all relevant NHS Long Term Plan commitments.

• The annual increase in funding for the Additional Roles Reimbursement Scheme is subject to agreeing seven national Network Service Specifications and their subsequent delivery. • 5 of the 7 start by April 2020: structured medication reviews, enhanced health

in care homes, anticipatory care (with community services), personalised care and supporting early cancer diagnosis. The other 2 start by 2021: cardio-vascular disease case-finding and locally agreed action to tackle inequalities.

• A national Network Investment and Impact Fund will start in 2020, rising to an expected £300 million in 2023/24 intended to help networks make faster progress against the dashboard and NHS Long Term Plan goals

The AgreementGuaranteeing Investment

Five-year funding clarity and certainty for practices

• Resources for primary medical and community services will

increase by over £4.5 billion by 2023/24, and rise as a share of the

overall NHS budget.

• This agreement confirms how much of this will flow through

intended national legal entitlements for general practice under the

practice and network contract.

• The extent to which these resources are spent will depend on the

extent to which general practice (Networks) draws down its

entitlements over this five-year period;

The AgreementTests future contract changes prior to introduction.

• A new testbed programme will be established to provide “real-world” assessment.

• GP practices in Primary Care Networks will each develop or test a specific draft contract change such as a service specification, QOF indicator or QI module.

• Testing is likely to include rapid cycle evaluation, with assessment of costs and benefits.

• Testing will be commissioned nationally, topic by topic, normally through open calls for practice or network participation.

• Network participation in research will also be encouraged from 2020/21, given the proven link to better quality care.

https://www.england.nhs.uk/wp-content/uploads/2019/01/gp-contract-2019.pdf

“The agreement sets out the next steps and the major programme of work that will be undertake over each of the next three years by NHS England working with GPC England and wider stakeholders.”

Ian Dodge: National Director, Strategy and Innovation, NHS E

https://www.england.nhs.uk/wp-content/uploads/2019/01/gp-contract-2019.pdf

Minutes of the

Primary Care Commissioning Committee 1 Held on 9th January 2019

PRIMARY CARE COMMISSIONING COMMITTEE WITH NHS ENGLAND HELD ON WEDNESDAY 9th JANUARY 2019 AT 10.00 A.M. – 12.00 NOON

ROOM 2, ARPLEY HOUSE, BIRCHWOOD, WARRINGTON

DRAFT MINUTES

ROLE Present Attendance

MEMBERS (OR THEIR REPRESENTATIVE)

Lay Chair Ingrid Fife, NHS Halton CCG In Attendance

NHS WCCG Chief Nurse Michelle Creed In Attendance

NHS WCCG Senior Management Representative

Carl Marsh (Chief Commissioner) In Attendance

NHS WCCG Chief Finance Officer or their appointed Deputy

Bryan Webb (Deputy Chief Finance Officer) In Attendance

GP representative (GP Primary Care Clinical Lead)

Dr Sangeetha Steevart In Attendance

GP representative (Primary Care Quality GP Lead)

Dr Justin McCarthy In Attendance

Member/ NHS England Representative Non Voting

Member

Cathy Leech, GPFV Transformation Programme Manager, NHS England - North (Cheshire & Merseyside)

In Attendance

ADDITIONAL NHS WARRINGTON CCG ATTENDEES

Marie Ann Hunter, Senior Commissioning Manager for Primary Care

Apologies

Aysha Devine, Contracts & Performance Manager (Primary Care)

In Attendance

Minutes Sam Lowe, Corporate Business Assistant

In Attendance

ADDITIONAL NHS ENGLAND ATTENDEES

INVITED ATTENDEES

Ruth Dales, Healthwatch In Attendance

LMC Representative Absent

Cllr Pat Wright, Warrington Borough

Council/Warrington Health and Wellbeing Board

Absent

A Welcome and Introductions Ingrid Fife welcomed everyone to the meeting and introductions were made.

Action:

B Apologies

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Apologies were received from Pam Broadhead (Chief Primary Care Officer, NHS Warrington CCG), Rose Gorman, Karon Coppell and Marie Ann Hunter.

C Statement of Quoracy The Committee was confirmed to be quorate.

D Declarations of Interest in Agenda Items

It was noted that Agenda Item 009/19 relates to ECG payments to practices and therefore this would present a conflict of interest for the GP representatives Dr Sangeetha Steevart and Dr Justin McCarthy. It was agreed that these members should remain in the meeting for some of the discussion around this item, before being asked to leave for the remainder of the discussion and decision.

E Chair’s Remarks

Ingrid Fife explained that she hopes the Committee can continue to build on what it has achieved during 2018 and that it is good to see that MIAA has given the Committee and its processes a clean bill of health in their recent governance review. Ingrid asked about the recently announced long term plans for the NHS and how these will impact primary care services in Warrington. She also asked what impact these will have on the plans that the CCG already has in process, for example around Multispecialty Community Providers (MCPs) and the Digital Agenda. Carl Marsh explained that it is still early, however a lot of the proposed changes reflect the CCG’s main efforts in Commissioning already. The CCG has been looking at MCPs as a model and the Commissioning Prospectus sets up the parameters for providers and the outcomes for joint commissioners, with particular focus around Special Educational Needs and Disability (SEND) and Frailty. Carl advised that there have been discussions at the CCG’s Management Team meetings about how to push these forward and an update will be provided in both the Clinical Chief Officer and Commissioning reports at the CCG’s Governing Body Meeting this afternoon. Ingrid asked the GP representatives about the primary care point of view of the plans. Dr McCarthy advised that in his opinion this is a good example of health being politicised. He explained that the health secretary is keen for GPs to use Skype and Web Based Apps as an alternative to face-to-face consultations however he advised that he would need to understand the evidence behind this in order to support this way forward as many of the elderly population would not wish to move to digital consultations. Dr McCarthy explained that his biggest concern is the safety of his patients and there are some symptoms and outcomes that GPs would find difficult to assess without the patient being in front of them, and that it is more difficult to convey a message to patients using technology and to be assured that they understand what you are saying. He explained that his fear is that there could be unforeseen difficulties with these proposals.

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Dr Sangeetha Steevart explained in her opinion the new proposals, whilst challenging, are the way forward as we need to accept that the current way of working is not viable, in terms of workload, demand and workforce issues and therefore in the future we need to open ourselves up to new ways of working and what we can bring in to make the job more viable. Dr McCarthy explained that he is not averse to technology, we just need to ensure that it is safe for the patients. Cathy Leech agreed that there is a place for technology in primary care, however this needs to be predicated by patient choice. She advised that for a lot of young people, they would prefer a consultation via an App or Skype however this may not be suitable for some of the older population, so we need to be in a position to offer both services and find a balance that suits our patients. Michelle Creed arrived at the meeting Ruth Dale agreed that this is about patient choice, but the clinicians also need to have a say about what is important to them and what isn’t, and they should also be able to express their preference. Dr Steevart stated that we need to find a balance between access, demand and workforce and look at how we manage this in a different way to match the population’s needs.

001/19 East Cluster – successful bid as part of the Primary Care Network Funding – Presentation

It was noted that this presentation has been deferred to the March Committee Meeting.

002/19 Minutes of the Meeting held on 28th November 2018 and update of actions

The minutes were approved as a true and accurate record of the meeting

Action 020/18 – Action ongoing. The first draft of the Internal Audit Framework report has been received and the management response has been submitted to MIAA. The gap analysis is on today’s agenda. Action 024/18 – Action complete. Action 030/18 – Action closed. Invitation was not sent due to timescales/venue size but in future Healthwatch will be invited. Action 031/19 – Action complete. Any future issues to be raised with Cathy Leech at NHS England. Action 032/19 – Action complete. Marion Dykes at NHS England to issue communications as soon as the new provider for translation services has a start date. Action 033/19 – Action complete. Bryan Webb advised that there is already an existing risk on the Assurance Framework (559) regarding

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Delegated Commissioning which captures the five risks highlighted within his finance report. Action 034/19 – Action complete. Item on January Committee Agenda.

003/19 Revised Terms of Reference

Aysha Devine presented this report on behalf of Pam Broadhead. It was noted that the CCG is now in receipt of a draft report from MIAA who have recommended that the following roles are added to the Committee’s Terms of Reference:

• Ensure that the Terms of Reference are amended to specifically state that Primary Care Finance is reported to the Primary Care Commissioning Committee and also to the Finance & Performance Committee.

• Ensure that the Terms of Reference are amended to reflect that the Committee and its members are responsible for risks that are attributable to Primary Care Commissioning and Contracting.

Bryan assured the Committee that, whilst not explicitly expressed within the Terms of Reference, that both of these roles are responsibilities that the Committee is already doing but confirmed his agreement with the paper that they should for governance purposes be written down. .

The Committee approved the revised Terms of Reference and agreed to submit the amended Terms of Reference to the NHS Warrington CCG Governing Body for ratification.

004/19 Risk Schedule Report

Aysha Devine presented this report on behalf of Pam Broadhead and explained that in relation to Risk Reference 568 (Actions 1, 2 and 3) Business Continuity Plans have been collated from Warrington GP practices. There are currently two missing which are being updated by the practices due to the requirement of minor improvements. Aysha advised that a desktop review of the Plans will take place however most plans appear robust and are on the correct templates. The results from this desktop review will be reported to the Primary Care Operational Group, before being escalated and/or reported to the Committee. It was noted that in terms of Action 4, this has been closed following confirmation from the Chief Finance Officer that the process for reporting suspected fraud is the same regardless of the reason for the suspicion. A more detailed update will be provided to the Committee in the Confidential Part B section of the meeting.

The Committee discussed the content of the paper and its associated appendix and considered the issues highlighted in the paper. The Committee agreed that the necessary actions are in

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place to manage the risk and agreed that no additional assurance or any additional reports are required in relation to the risk.

005/19 Primary Care Commissioning Report

Dr Sangeetha Steevart presented this report on behalf of Marie-Ann Hunter to inform the Committee on primary care related work in progress across Warrington. In terms of the Cluster Development Work, Dr Steevart advised that most clusters have now achieved the required level of maturity at this stage (Step 3). The clusters must now choose a pathway to commence collaborative work with other healthcare professionals and this work will be supported by the CCG primary care team. Dr Steevart explained that these areas should be in line with the CCGs commissioning intentions. Dr Steevart asked Cathy Leech for an update around two recent applications for funding made by the Clusters against the NHS England Primary Care Network Funding. Cathy advised that the clusters have revised and re-submitted their applications and the second application was received by NHSE this morning. Dr Steevart advised that the CCG has successfully appointed two clinical leads to support the delivery of the GP Forward View; Dr Quincy Chuka and Dr Rakhi Raj. She explained that the CCG has reviewed the priorities and remains committed to implementing on-line consultations by 1st April 2019. Work has already commenced on this and a project plan is in development. Dr Raj will commence engagement with practices in January 2019, with support from the CCGs primary care team and engagement team. Drs Raj and Chuka will be required to report and update the committee on their progress. In terms of the Local Enhanced Services (LES) Dr Steevart advised that the Quarter 3 submissions are required to be returned to the CCG by 31st January 2019. Ingrid Fife commented on the good progress of the practices to achieve Step 3 of the Maturity Model however asked if there is anything within the Model that needs to be changed, removed or added given that the model was set some two or three years ago. Dr Steevart advised that the team looked into this as part of the revised LES. The specifications require that by the end of June 2019 the clusters should have achieved at least two of the required pathways. If they are unable to achieve this, they will need to provide an explanation as to why. Dr Steevart explained that this work has helped improve relationships between practices over the past two to three years, as the practices are required to work closely together. Bryan Webb commended the clusters on their achievement of Step 3. Looking at the long term financial plan and scope to explore MCPs, he asked what level of maturity is required by the Clusters to achieve MCPs. Carl Marsh explained that Step 4 tees primary care up to achieve the MCP

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model and this plan would give the CCG a platform to focus on integrated care. Dr McCarthy explained that he recently attended an NHS England Primary Care Network Event where national experts were talking about the emergence of network and locality working. It was highlighted that the most important aspect to joint working is building good relationships. He stated that he feels that the Chief Officers at the CCG and the Cluster Managers should take responsibility during 2019 to present a shared vision and to bring our primary care colleagues along with that vision to enable them to work collectively and to promote and build relationships in primary care. Dr McCarthy added an appeal to NHS England to be more generous in their awarding of funds to practices as failure to secure funding creates a feeling of “why did we bother?”. Cathy Leech agreed and explained that NHS England is working on building bridges and increased partnership working during 2019. She explained that she admires the ambition of the clusters and wants to see what NHS England, working with the CCG, can do to really make a difference to the population of Warrington. Cathy commented that the two clusters who submitted the recent applications for funding appeared to have been very willing to engage and the most recent applications have provided NHS England with assurance that these pieces of work would make a difference. She explained that NHS England have been very open with the Clusters about the timescales for submission given that the funds need to be spent by 31st March and that the submissions will be viewed by the external panel on Monday 14th January, with the outcome being communicated to the applicants during week commencing 21st January. The practices were asked if they were happy to commence the work whilst waiting for the outcome of the panel, as they can be paid retrospectively but given the risk of not receiving funding this was not felt appropriate. Ingrid Fife asked if the Committee is clear on the action plan for the 5 year Forward View and how that action plan is being monitored. Dr Steevart advised that the Primary Care Strategy has been refreshed as the last Strategy was written before the 5 Year Forward View was published. The two new Clinical Leads for the Primary Care will only be working on this and there is an action plan in place to monitor each of the actions in the plan to achieve alignment. Michelle Creed asked if would be useful if the action plan was brought to the Committee on a regular basis for members to see the progress being made. She stated that it is sometimes not helpful when new guidance is left open to local interpretation and the CCG needs to be more honest about that this needs to look like in future. Dr McCarthy re-stated that he considers that there is a responsibility on the CCG Officers to set and share the vision and provide the leadership. Without this direction, it will be difficult to change anything. Ingrid asked members if it would be useful for progress against the 5 Year Forward View to be presented to the Committee at every meeting and asked if the Committee needs something more robust than an update that

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demonstrates measurement against the strategy. She asked if the Work Plan should be amended to reflect this. Cathy Leech agreed that this would be a good idea, and would correlate with movement through the Maturity Model, to show where there are blockers or gaps and enable any issues to be addressed immediately. Action: Aysha Devine and Carl Marsh to work with Marie Ann Hunter to ensure that the 5 Year Forward View progress against the Action Plan is reported to the Committee on a regular basis.

A Devine/ C Marsh

The Committee discussed and noted the Primary Care Commissioning Update Report.

006/19 Primary Care Core Contract Report

Aysha Devine presented this report to inform members on primary care related updates and work in progress across Warrington. She highlighted the following areas from her report: 100% of Warrington practices submitted their GP Electronic Annual Practice Declaration within the agreed timeframe and following this, the Contracts and Performance Team undertook an exercise to verify these submissions against documentation held by the CCG. Concern was raised that some practice maps on the Primary Care Webtool do not match those in the practice contracts and the team is working with practices to agree the amendments and issue contract variations. As a result some practices have had to submit boundary change applications. The Primary Care Operational Group (PCOG) reviewed an application from Chapelford Practice to reduce their boundary. It was noted that their boundary covered almost the entirety of Warrington. The approved change keeps the area of Burtonwood within the practice boundary and a boundary contract variation has been issued. Penketh Health Centre has also requested a boundary change which will follow the CCG approved decision making process, and once a decision has been made by the PCOG this will be reported back to the Committee. In relation to the translation services, Cathy Leech confirmed that a decision has been made to continue with the existing provider for a further three months until the new provider is in a position to commence their service. Aysha advised that there have been no list closure applications received from the practices. The Primary Care Dashboard is now almost complete and will be a useful tool to monitor areas of performance. The draft Dashboard has been viewed by the PCOG and will be shared, in an anonymised format, with the Committee once complete.

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The Committee noted the contents of the report and ratified the boundary change for Chapelford Medical Centre.

007/19 Financial Performance for period ending 30th November 2018

Bryan Webb presented this report and advised that the financial position for the primary care service budgets of the CCG portrays a year to date favourable variance of £0.165m at month 8. He advised that the cumulative forecast outturn position across all Primary Care commissioning lines is an adverse variance of £0.039m and within this reported position, the full year to date impact of No Cheaper Stock Obtainable (NCSO) prescribing costs have been absorbed and there is an overspend in prescribing budgets.

Bryan reported on the other financial pressures within the primary care budget lines, including locum costs, the national pay award and premises related costs.

Dr Steevart asked if the situation around the No Cheaper Stock Obtainable is due to Brexit, and if so, should this be escalated as a risk for next year. She stated that her practice is seeing increasing number of drugs being unavailable. Bryan advised that the situation is not due to Brexit however the CCG must manage any financial impact of Brexit collectively. Dr McCarthy advised that the situation around NCSO is the result of deliberate action taken by pharmaceutical companies who turn supply lines off or stop making certain drugs, and this causes massive disruption. He advised that the Practice Pharmacists are spending a great deal of their time explaining the situation to concerned patients. He advised that the cost of drugs has escalated and there are companies who will exploit that, particularly if they are the sole provider of a particular drug. Dr McCarthy asked if a piece of work could be undertaken by the CCG to provide greater awareness of the prescribing budget to practices, such as a PLT or Workshop, as many colleagues are unaware of the issues being experienced. Action: Marie Ann Hunter to take this forward with the Comms and Engagement Team. In terms of inconsistency in prescribing across practices, Cathy Leech advised that the workforce tool is useful to inform about prescribing costs and to see which practices are higher prescribers, and this data can also be broken down anonymously by patient. Bryan noted that this inconsistency has also been picked up in Contract meetings.

M A Hunter

In terms of the National Pay Award, Dr Steevart asked if the CCG would be reimbursed by NHS England. Bryan explained that in the planning, a level of 1% increase was assumed however when the National Pay Award of 2% was announced this created an additional 1% pressure. Bryan advised that this was covered by NHSI and NHSE for the running cost element and other providers, however primary care was not covered by this and correspondence from NHSE has outlined that the increase is to be managed locally by the CCG and funding will not be forthcoming to support this.

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The Committee noted the financial position stated at the end of November 2018 and noted the financial risks that have been identified. The Committee noted the financial outturn projection across primary care service lines.

008/19 Internal Audit Framework

Aysha Devine on behalf of Pam Broadhead presented this report to present the first draft of the MIAA governance review report and advised that the management response detailed within the report to the Committee has not yet been included in the MIAA report and therefore this report remains the draft report. Aysha reported that the overall assurance rating has been reported as “Substantial Assurance” which demonstrates that there is a good system of internal control designed to meet the system objectives and that these controls are generally being applied consistently. There are 5 recommendations within the report, some of which have already been completed and some of which cannot be completed until later in the year. Aysha explained that this draft report has come directly to the meeting to ensure that the time scales to implement the recommendations can be met. This report is not an internal audit but is a governance review. Dr Steevart was prompted by this agenda item to ask if there is any update around new Governing Body Members and the appointment of a Chair. Carl Marsh advised that an update will be provided to the Part B section of the Governing Body meeting this afternoon and as soon as there is something to report, this will be communicated. However he advised that there is a good direction of travel.

The Committee reviewed the draft report and reviewed the management response contained in paragraph 7 of the report. The Committee confirmed that it is assured by the Management responses to the draft report.

It was agreed at this point in the meeting to cover the final agenda items 010/19, 011/19 and 012/19 so that Dr Steevart and Dr McCarthy could leave the meeting following the initial discussions around agenda item 009/19.

010/19 Review of Risks

The following risks were noted as being highlighted during this meeting:

• The potential impact of Brexit on prescribing.

• Prescribing supply and demand

• GP Forward View – are we measuring progress well enough against the Primary Care Strategy and GP Forward View?

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Michelle Creed asked if it is a risk that in terms of the Maturity Model, in terms of getting to Step 4, Primary Care will be unable to implement the new guidance/model if they don’t know what it is. She asked if this is part of the Primary Care Strategy. Carl responded that the infrastructure is being developed through Warrington Together and a shared vision will be communicated. Dr Steevart explained that practices could see the changes as a threat rather than a move forward so they would need the CCG leaders to outline the vision and plan and to share this with primary care to demonstrate what is expected and to assure them that it is not a threat. Dr McCarthy agreed that there are new opportunities arising within the CCG, including new Clinical Leads, Governing Body Member and a new Chair and this is an opportunity for a new vision. Dr McCarthy advised on one criticism he hears when talking about transformation and delivery, and that is failure to integrate with Health Education England who are not being told what they need to know to equip new clinicians for the future. Cathy Leech advised that NHS England is working closely with Health Education England and hold regular joint meetings and workforce meetings where the primary focus of the agenda is about the portfolio model and how the workforce can rotate (which is a model being used in the Wirral) to create a model to be used by everyone. This will be fed through the training model to make new recruits aware of the opportunities that are open to them and looking at how this information can be filtered down. It is hoped that this will encourage people to consider general practice.

011/19 Draft Committee Workplan

Bryan asked if the Committee would appreciate some regular Deep Dives into specific areas, as carried out by other CCG Committees, if there is something in particular that the members would like more information about. Aysha to advise Marie Ann on the changes requested under Agenda Item 005/19.

009/19 (i) PMS Premium Redistribution Funding 2018/19

Dr Steevart presented this report to provide an update position to the Committee with respect to the commitments and/or proposed services provided against the PMS redistribution funding. Dr Steevart explained that the CCG continues to work with Bridgewater around the Acute Home Visiting Proposal however they have advised that they now consider that they can only get GPs to run the service and have come back with a business model to run the service using 2 GPs for the next 12 weeks, after which it is hoped there will be a clearer view of how we can move forward and next steps. Dr Steevart expressed disappoint that this scheme has not yet commenced and commented that Bridgewater have over promised but under delivered.

Minutes of the


Cathy Leech asked if when Clusters submit ideas around PMS funding, that these are different to the applications for funds submitted to NHS England and asked if there are any areas of double funding. Dr Steevart advised that the PMS requests are around access, commissioning and collaborative work and are not Primary Care Network related to ensure that there is no duplication of funding. All spend is audited. Bryan advised that the PMS grows over a four year period and this is year 3, so following the 4th year this will revert to GMS rate. He advised that there is £1.4m of resources available for next year. Dr McCarthy explained that this is a great opportunity to consider substantial investment for easing workforce pressures across all practices and we need the best plans in place for the best use of resources. He stated that this is a good opportunity to get the new Clinical Leads for primary care involved to look at what schemes would benefit the town and to look at the best utilisation of the resources we have available and combine this with the Primary Care Strategy. It was noted that the money is ringfenced and has to be spent in-year. Dr Steevart agreed that clinical leads should take lead roles in reviewing areas of spend and suggested that a regular meeting for all Clinical Leads to come together to discuss would help to move this forward. Action: It was noted that this should be the Commissioning & Service Development Committee, however Carl Marsh will take this back to the Management Team for decision. In terms of Bank Holiday opening, Dr Sangeetha advised that this paper is also requesting that the Committee extends the Bank Holiday opening dates to cover Good Friday and Easter Monday 2019. However, Dr Steevart also asked whether the committee felt that if practices are willing to do more if this could be opened a bit wider to include more sessions/days. The chair commented that this latter request could not really be discussed by the meeting as it was not included in the papers. Dr McCarthy advised that any additional opening would need to be spread equitably across the town and would need to be promoted to patients as they are not familiar with being able to access their GP over a Bank Holiday weekend. It was noted that this additional decision is not one that could be made by this Committee. The proposal will need to be presented to the PCOG for discussion and decision, with the decision being approved to allow enough time to communicate this with practices and patients. The committee did agree that the inclusion of the Easter Bank Holiday dates into the current specification was appropriate.

C Marsh

Minutes of the


The Committee noted the contents of the report and the commitment against the PMS premium redistribution funding.

The Committee approved including Good Friday 2019 and Easter Monday 2019 in the Bank Holiday service specification.

The Committee agreed that a proposal around offering more sessions over the Bank Holiday Weekend (to include Saturday and Sunday) should be sent to the Primary Care Operational Group for discussion and any decision should be based on whether there is funding available for any additional sessions. The Committee agreed to delegate authority to the CCG Management Team to ratify the decision to ensure that enough time is allowed to communicate any decision with the practices and patients before the Easter Bank Holiday.

009/19 ii Revised Business Case for the ECG Diagnostic Scheme

Dr Steevart presented this report on behalf of Marie-Ann Hunter and advised that a collaborative ECG scheme has already been approved by the Committee, however that as part of the programme of work the ECG Programme Board has been validating and reviewing expected activity levels in readiness for service implementation. During this review it was discovered that the Trust’s calculations in relation to activity was only based on ECGs delivered at the hospital and has not included ECGs performed within GP practices. Dr Steevart explained that this has raised concern in terms of ensuring sufficient staff are in place to meet the demand and the key performance indicators. Dr Steevart explained that a revised financial schedule is contained within the report at table 10 and this demonstrates the additional funding required for the project, to cover increased staffing costs, increased lease costs and increased consumables cost. Dr Steevart noted that the lease costs are only part year in 2018/19 due to the delay in start date. Bryan Webb gave an overview of the change in funding as outlined in the tables within the report and Carl Marsh stated that it is the figures in the bottom row of Option 2 that the Committee is being asked to approve. Dr Steevart explained that the Trust underestimated the total number of ECGs that would be performed and the impact of this is a requirement for additional Band 5 staff, at a cost of £9,092 per year. Dr Steevart advised that the operational components of the project are getting sorted and although it had been planned that there would be two pilot sites by the end of December, this has not yet been arranged which may lead to further delays. She also advised that the Trust has not yet ordered the equipment. Dr McCarthy advised that historically practices have invested in their own ECG machines, however they have delayed updating their machines

Minutes of the


pending this project and have not made any further investments in new equipment. He stressed that ECGs are an important aspect in managing patients and the CCG will see a return on this investment eventually due to the more effective management of patients presenting with chest pain within the practice setting without needed to send them to A&E for diagnosis. Dr Sangeetha Steevart and Dr Justin McCarthy left the meeting Ingrid Fife stated that in her opinion the Committee needs to approve this recommendation so that the project can progress and so that the CCG can demonstrate its willingness to promote collaborative working. Carl Marsh agreed, stating that this project will make a big difference to the practices. Michelle Creed highlighted paragraph 12 of the report which states that the increase in staffing required has been largely offset in 2018/19 by the reduction in consumables and lease costs and therefore the Committee would be prudent in their thinking that consumable costs in 2019/10 may increase. The report states that the net effect of the changes in lease costs should ensure that any further increase is not significant and the increases in demand should be commissioner led and therefore will be a managed change.

The Committee approved the revised funding schedule to ensure an integrated ECG pathway across primary care and secondary care and to mitigate risk against unplanned activity. The Committee noted that funding for this scheme will come from the PMS redistribution fund and noted that it is expected that there will be savings made against the main contract with the Trust. The Committee noted that this scheme is part of the foundation for future schemes between the Trust, Primary Care and Warrington Together to offer services closer to home.

012/19 Any Other Business

There was no other business to discuss

013/19 Date and Time of Next Meeting

Wednesday 6th March 2019 at 1.00 p.m. in the Board Room, Arpley House.

KEY:

Primary Care Co-Commissioning Committee with NHSE 9th January 2019

Complete

Not Started

In Progress

Delayed

PRIMARY CARE CO-COMMISSIONING COMMITTEE WITH NHS ENGLAND ACTION NOTES

9th JANUARY 2019

(Actions highlighted in red have been carried over from the previous meeting)

Present:

Lay Chair Ingrid Fife, NHS Halton CCG

NHS WCCG Chief Nurse Michelle Creed

NHS WCCG Senior Management Representative Carl Marsh (Chief Commissioner)

NHS WCCG Chief Finance Officer or their appointed Deputy Bryan Webb (Deputy Chief Finance Officer)

GP representative (GP Primary Care Clinical Lead) Dr Sangeetha Steevart

GP representative (Primary Care Quality GP Lead) Dr Justin McCarthy

Member/ NHS England Representative Non Voting Member Cathy Leech, GPFV Transformation Programme Manager, NHS England - North (Cheshire & Merseyside)

Additional WCCG Attendee Aysha Devine, Contracts & Performance Manager (Primary Care)

Invited Attendee Ruth Dales, Healthwatch

Minutes Sam Lowe, Corporate Business Assistant

Apologies:

Additional WCCG Attendee Marie Ann Hunter, Senior Commissioning Manager for Primary Care

Invited Attendee LMC Representative

Invited Attendee Cllr Pat Wright, Warrington Borough Council

KEY:

Primary Care Co-Commissioning Committee with NHSE 9th January 2019

Complete

Not Started

In Progress

Delayed

Action Ref

Agenda Item Action Lead Person Date Required

Status of

Action

Action Recorded

020 18 071/18 Internal Audit Framework 05.09.18

The Committee requested that the CCG develops a programme that will ensure compliance with the framework and that this programme is reported to the Committee in November.

M A Hunter A Devine

09.01.19 Action ongoing. The first draft of the Internal Audit framework has been submitted to MIAA. The gap analysis report was reported to the Committee on 9th January 2019.

001/19 005/19 Primary Care

Commissioning Report 9.1.19

Aysha Devine and Carl Marsh to work with Marie Ann Hunter to ensure that the 5 Year Forward View progress against the Action Plan is reported to the Committee on a regular basis.

A Devine/ C Marsh

As soon as

possible

The NHS Long Term Plan and the five-year framework for GP contract reform have both now been published. The committee on 6th March to agree how the committee will receive assurances on all of these documents.

002/19 007/19 Financial

Performance for period

ending 30th November

2019 9.1.19

Marie Ann Hunter to take this forward with the Communications and Engagement Team.

M A Hunter Discussion been held with the Comms and Engagement team to utilise some time on one of the PLT agendas for medicines management to present to the practices on NCSO and the sporadic availability of medicines. This will be factored into the workplan.

009/19 PMS Premium Redistribution

Funding 2018/19 9.1.19

It was noted that this should be the Commissioning & Service Development Committee, however Carl Marsh will take this back to the Management Team for decision

C Marsh As soon as

possible

Management team agreed that when all the clinical leads are in place that their workplans and areas of commissioning and spend would be reviewed with regular meetings.

AGENDA ITEM NO: 016/19

Risk Schedule Report NHS Warrington CCG Primary Care Commissioning Committee Meeting 6 March 2019

COMMITTEE MEETING:

Primary Care Commissioning Committee

DATE OF MEETING:

6th March 2019

REPORT AUTHOR AND JOB TITLE:

Pam Broadhead Chief Primary Care Officer

REPORT TITLE:

Risk Schedule

STRATEGIC OBJECTIVES:

Please tick which strategic objectives the paper relates to

Improve quality of services

✓

Sustained financial balance

Build an effective and motivated whole system workforce

Sound governance arrangements

✓

Ensure integration and joint working arrangements

OUTCOME REQUIRED (tick)

Approval

Assurance

✓

Discussion

✓

Information

✓

EXECUTIVE SUMMARY

a) There is one risk on the NHS Warrington CCG risk register that relates to Primary

Care. This risk is a high risk; b) Since the last meeting of the committee, there has been no slippage in the risk or

actions that were due for review; c) No new risks have been added to the NHS Warrington Risk Register since the last

meeting; d) No risks have been closed since the last meeting.

RECOMMENDATIONS

It is recommended that the Committee:

a) Agree that the necessary actions are in place to mitigate the risk; b) Agree any additional assurance that may be required in relation to the risk; c) Discuss whether any further assurance is required in relation to the risk d) Agree any requirement for more detailed reports in relation to the risk



Outline any engagement – staff, clinical, stakeholder and patient / public

Insert details of any staff, patient, public or stakeholder engagement activity. If this section is not relevant to the paper, state ‘not applicable’

Are there any conflicts of interest which may be associated with this paper?

Include details of any known conflicts of interest

Does this paper address any existing risks which are included on the Assurance Framework or Risk Register?

If yes, identify which risk it addresses and include a section on the mitigation provided within the main body of the report (strategic risks in Appendix)

Have the following areas been considered whilst producing this report?

Yes

N/A

Equality Impact Assessment (if yes, attach to paper)

Quality Impact Assessment (if yes, attach to paper)

Regulation, legal, governance and assurance implications (reference in the report if applicable)

Procurement process (reference in the report if applicable)

Document development

Has this document been presented to any other Committee or Forum? If yes, please list which meeting, date and outcome of presentation



Strategic Objectives and Risks 2018/19

A1 Failure to performance manage to ensure continuous improvement

A2 Failure to agree and measure outcomes

A3 Failure to ensure clear arrangements are in place for quality management of non-commissioned providers in the independent sector

B1 Failure to implement the financial strategy

B2 Failure to ensure sound business practices are at the heart of running the CCG

B3 Failure to secure best value

B4 Failure to adequately provide for external factors, which impact on financial sustainability

C1 Failure to continuously develop the organisational culture that meets the needs of the changing needs of the workforce

C2 Failure of delivery by outsourced critical business functions

C3 Failure to establish primary care capacity

D1 Failure to ensure that we are compliant with our statutory duties

D2 Failure to demonstrate patient and public engagement

E1 Failure to provide appropriate reporting, for joint working arrangements

E2 Failure to describe benefit of integration and joint working arrangements to local people



RISK SCHEDULE

Key changes to the risk register

1. Risk 568 on the NHS Warrington risk register is the potential closure of a GP practice. The risk and the scores have been reviewed since the last meeting and the committee is informed that the scores to remain the same.

2. Action number 6 has been updated and the review date changed from 31/01/19 to 29/03/19.

Risk assessments awaiting sign off

3. A new process has been implemented by the CCG to monitor risks that are awaiting sign off. This new process requires that these are added to Datix and remain in the “holding area” until the signed risk assessment has been received and reviewed by the Head of Assurance & Risk.

4. At present, there is one risk in the holding area which is a Mersey Internal Audit Agency (MIAA) report entitled Primary Care Medical Care Commissioning & Contracting Governance Review Assignment Report 2018/19. This report was discussed at the last meeting and has since been discussed at the Integrated Management Team meeting on 15/01/19 where Management Team discussed and agreed that the review was positive with positive assurance being received. The risk assessment will be drafted by the Head of Assurance & Risk for inclusion on the risk register when signed off.

5. There are no other risks on the risk register relating to Primary Care. Recommendation The Committee is asked to:- a) Discuss the content of the paper; b) Consider the key issues highlighted within the paper. Pam Broadhead Chief Primary Care Officer 27th February 2019



APPENDIX A - RISK REGISTER

Ref Description of Risk Current Controls Assurance in Controls

Current Impact Rating

Current Likelihood

Rating

Current Risk

Score

Management actions to mitigate the risk

Target Impact Rating

Target Likelihood

Rating

Target Risk

Score

Risk Owner

568 As a result of potential breach of contract, there may be an immediate closure of a GP practice which may result in reduced patient experience, possible complaints, business service interruption (permanent loss of facility), adverse publicity and financial loss

1. SOP in place for CQC report monitoring 2. Primary care contract dashboard in place 3. E-declaration by all GP practices on primary care webtool 4. Regular and adhoc contract meetings

1. Overview by Primary Care Operational Group, reporting to the Primary Care Commissioning Committee 2, 3 and 4. As detailed in current controls.

5 3 15 1. Collation of all GP practice Business continuity plans (29/03/19)

2. Desktop review of GP practice BCPs as per requirements (29/03/19).

3. Overview of collated results (28/02/19).

4. Develop SOP to include process for any referrals to counter fraud service, when applicable (Complete).

5. Implement SOP, where applicable (complete).

6. Review terms of reference for Primary Care Commissioning Committee to ensure referrals to counter fraud is included as a

5 1 5 Pam Broadhead



Ref Description of Risk Current Controls Assurance in Controls

Current Impact Rating

Current Likelihood

Rating

Current Risk

Score

Management actions to mitigate the risk

Target Impact Rating

Target Likelihood

Rating

Target Risk

Score

Risk Owner

standing agenda item (29/03/19).

7. Expressions of interest to be placed on a register as a caretaker practice (31/03/19).

8. Develop process for quality visits to GP practices (31/03/19).

Primary Care Commissioning Report – March 2019 NHS Warrington CCG Primary Care Commissioning Committee

MEETING:


DATE OF MEETING:

6th March 2019


Marie-Ann Hunter Senior Commissioning Manager for Primary Care

REPORT TITLE:

Primary Care Commissioning Report – Standing Item



Improve quality of services ✓



✓ Sound governance arrangements

✓



Approval

✓ Assurance

✓ Discussion

✓

Information

✓

EXECUTIVE SUMMARY

This report is to inform and promote discussion for the Primary Care Commissioning Committee on primary care commissioning in progress across Warrington. This report requests approval of the committee to amend the naming convention in Warrington to align to that of the NHS England naming convention to avoid confusion; the main change is to use the word Network rather than Cluster. The report includes updates on the following areas:-

• Local Enhanced Services 2018/19; the committee is asked to note the excellent progress in relation to Dementia reviews.

• Local Enhanced Services 2019/20 – timeline for implementation

• Cluster Development Work (maturity model)

• Primary Care Network Funding

• GP Five Year Forward View - Online consultations

RECOMMENDATIONS

The Primary Care Commissioning Committee is asked to: - ✓ Approve the naming convention change to Networks ✓ Approve the timeline for specifications for the 2019/20 Local Enhanced Service ✓ Note the contents of the report




None


None


None at this stage


Yes

N/A


✓


✓


✓


✓




Purpose of the Report

1. The purpose of this report is to inform the Primary Care Commissioning Committee members on current commissioning work streams for primary care medical services across Warrington.

2. The report will cover the following areas of work for the commissioning of Primary Care.

Local Enhanced Services (LES)

Primary Care Network Funding

Cluster (Network) Development Work (maturity model)

GP Five Year Forward View

Local Enhanced Services (LES) 2018/19

3. Practices have submitted Quarter three returns for the period October 2018 – January 2019.

4. 24 Practices submitted their Q3 returns but at the time of writing this report two practise were yet to submit a return, the deadline date for returns was 31st January 2019. This has been raised with the practices of a breach of their contractual requirements but a more supportive approach, as opposed to contractual, has been adopted to ensure that the returns are submitted.

5. The contracting and performance team is currently reconciling the information received and preparing the reconciliation letters to be sent to Practices. These letters confirm whether the practice is compliant with their evidence for successful completion of the actions and/or KPIs. Where practices have not met the required standard their service development manager and contract manager work with the practice to ensure achievement. This approach has worked very successfully to date and therefore the more contractual/formal line has not had to be taken.

6. Of note and to bring to the attention of the committee is the specification within the LES in relation to Dementia. Following previous years results for face to face reviews the specifications and related key performance indicators were amended to reflect the requirements of the Improvement and Assessment Framework for CCGs. The CCG has now received confirmation from NHS England with respect to the improvement in the rate of dementia face-to-face reviews for people with dementia in Warrington. The CCG has moved from the lowest to highest quartile, now being 20th out of 194 CCGs in England from 148th in previous year.

Local Enhanced Services 2019/2020

7. The Chief Commissioner [Carl Marsh] and the Senior Commissioning Manager for Primary Care met on Friday 8th February 2019, to discuss the direction of travel and the approach for agreeing and implementing new services under the local enhanced service from 1 July 2019. This date is required to ensure that the CCG is in line with the revised specifications, under the GP contract, from


NHS England which commence on this date to ensure that there is no duplication.

8. A timeline has been prepared to ensure implementation is kept on track and that the specifications along with the associated financial requirements are in place from 1 July 2019; this can be found in Appendix 1.

9. The Senior Commissioner for Primary Care will be presenting the journey of the LES to the Commissioning and Insight Group on 5th March 2019. The purpose of the presentation is to have discussions with commissioners across all areas to agree the most effective quality standards to commission for 2019/20.

10. The next steps will be to have a suite of suggestions and then engage with the GPs at the Commissioning PLT in April to have their thoughts and preferences on which LES’s will have the best impact to benefit patients.

11. For reference the presentation slides are attached as appendix 2. Primary Care Network Development Work Naming Convention

12. NHS England in collaboration with the BMA published their document “Investment and evolution: A five-year framework for GP contract reform to implement The NHS Long Term Plan” at the end of January.

13. This document sets out the requirements on how Primary Care, with the support from CCGs and NHS England will take and active role in delivering the NHS Long Term Plan. Within Warrington work has commenced to ensure timely delivery of the milestones and to ensure that practices are in a favourable position to enable smooth implementation of the requirements.

14. Of note within the document is the naming convention used by NHS England in particular with respect to the use of the word Network. The committee will be aware that in Warrington the collaboration of practices grouped together serving a geographical population has been called clusters but the NHS England terminology and of particular importance the new national DES refers to these groupings as Networks. Therefore, this report proposes that the current Warrington Clusters change their name to “Networks”. This recommendation will ensure that Warrington is in-line with the national direction of travel and will avoid confusion.

15. This has been discussed with our GP colleagues at a recent Commissioning PLT event and there appeared to be no objections.

16. The Committee is asked to agree to the name change for Warrington to align with the NHS England naming convention of Networks.


Primary Care Network Funding

17. As reported to the Committee in January 2019, NHS England extended their offer for applications from Warrington Networks for primary care network funding. Whilst the process for submission was the same as the previous requirements the funding streams are different in that the bids were for one-off funding and no additional population funding in either 2018/19 or 2019/20 with a requirement that all funding was committed by 31 March 2019.

18. Two Networks from Warrington submitted applications and were successful, the table below describes the outcomes and the total amount awards.

Networks Project Initial financial scoping

Financial Value awarded after conversations with NHSE prior to application

Expected Outcomes

Central West

Scoping the streamlining PM Back Office Functions (testing this on the Data Security and Protection [DSP] Toolkit

£38,675.00 £10,900.00 Expected outcomes, each Practice Manager will take ownership for the completion of a quarter of the toolkit with the intention of realising the benefits of precious PM time being released.

South Cluster

The South will be scoping ‘alternative models/ frameworks for best care for South Network Care Home patients.

£27,425.00 £9,100.00 To be defined after scoping with neighbouring CCGs who have already led on this piece of work.

GP Five Forward View Initiatives On-line Consultations

19. The on-line consultation project is progressing across Warrington; a market place event was held on 26th February 2019. The event was an opportunity for suppliers to show case their system to GP Practice staff. Attendance was excellent and the feedback is currently being analysed by the commissioning team to ensure that the views of practices in Warrington are utilised. The suppliers at the event were all offered equal opportunity for discussion with GPs, practice managers, practice nurses and CCG managers to understand the needs of Warrington and to explain how their system could benefit patients and practices. The suppliers all felt that the Warrington approach of including patients and practices at this stage was good.


20. NHS England awarded the CCG £5,000, towards engagement for the project. The funding has been fully committed.

21. The CCG is working with the National Procurement Team, to ensure successful completion of the project. A draft project plan/time line has been created to keep the project on track and is attached as appendix 3.

22. Prior to the supplier event the CCG team undertook a period of initial engagement with all GP Practices to establish their thoughts and needs on an appropriate solution for Warrington. The results can be seen below and will ensure that the needs of the practices and the patients of Warrington are at the forefront of the exercise.

23. A task and finish group is being formed with appropriate representation from

primary care, the group will lead on all aspects of on-line consultations for

Warrington.

24. Further information will be shared with the Committee as the project progresses.


GP home visiting service

25. Following a delay in implementation due to staffing issues of the provider (Bridgewater Community NHS Foundation Trust) the GP Acute Visiting Service is now operational.

26. A validated summary of the first three weeks practice data has been captured

below.

Week 1 Week 2 Week 3

Total requests 30 37 30

Number of actual visits 25 34 28

Number of requests refused (inappropriate) 2 3 2

Number of requests refused (no capacity) 3 0 0

Number of referrals to A&E 5 2 4

Number of practices referring in week 12 plus OOH 18 16 plus OOH

Practices yet to use service 14 5 4

27. Dr Sangeetha Steevart, Primary Care Clinical Lead and Marie-Ann Hunter, Senior Commissioning Manager for Primary Care, spent time in the service during February. The purpose of the visit was to gain an understanding of how the service operated to inform any future service specification and commissioning requirements.

28. Both Dr Steevart and Marie-Ann, agreed it was useful to see how the Single Point of Access service complemented and assisted the home visiting service. Time was spent out in the car accompanying the GP and Driver on the visits and time in the office speaking with the staff.

29. The service continues to be evaluated and a report will be presented to the Committee in April after the service has ended for the winter period. The practices in Warrington have given their support of this service but it is essential that as a commissioning organisation it is appropriately reviewed and evaluated and that an agreed service specification is in place that offers value for money and a return on investment.

30. The review will also need to look at the requirements within the five-year framework for GP contract reform document to ensure that any solution meets the conditions and constraints within this document.


Recommendations

The committee is asked to: -

i. Ratify the naming convention to Networks, to bring NHS Warrington CCG and

its’ practices in line with the national direction of travel.

ii. Approve the timeline for agreeing the service specifications for the 2019/20

Local Enhanced Service

iii. Note the contents of the report for the commissioning of primary care medical

services.

Activity Notes Lead Officer 4 11 18 25 4 11 18 25 1 8 15 22 29 6 13 20 27 3 10 17 24 1 8 15 22 29

Receive variation packs from NHS Rightcare Refreshed packs delay will use

current packs LT

Hold a session at COG to gain insight from commissioning leads to suppoort the BES and delivery of the CCGs operational plan.

MAH

Attend CIG to develop further insight on how PC can increase value for the population (spend, Quality and Outcomes) via the LES

MAH

Engage with practices via the PC Strategy engagement work MAH/LT

Develop the LES (with finance support) and seek appraval at IMT and PCC MAH / CM/BW

Write specifications MAH

Develop Pratice level Dashboard LB

Go‐Live with the LES PCSDG

IM&T

PC Operational Group

PC Commissioning Committee

F&P Committee ??

Key Meetings

Jul‐19Mar‐19Feb‐19 Apr‐19 May‐19 Jun‐19

NHS Warrington CCG Local Enhanced Servies 2019

Primary Care Local Enhanced Services

Local Enhanced Services for 2016/17

Local Enhanced Service 2016/18

Medicines Management

Ambulatory Care

• Reduce

inappropriate

antibiotic

prescribing

• Ensure cost

effective evidence

based prescribing

for the residents of

Warrington

• Reduce prescribing

costs for drugs

prescribed for minor

short term health

problems in

Warrington.

Primary Care Networks / maturity

model

DVT

NPT

MembershipEngagement

Prevention

Continued …..

Mental Health

Effective Referrals

• WRAG• Pathways

Workforce Development

• Military Veterans • Screening rates

for LD Patients • Dementia

Aristotle

Dedicated Care

• MEC Training• Public Health

champions

Local Enhanced Services for 2017/18

LES 2018/2019

Pathways

1:500 care plans /MDT

Maturity Model

• Demand and capacity planning

• Patient Advisers • MECC

Dedicated Care

• Medicines Management

• DVT• NPT• Sepsis

awareness

Workforce

• Dementia• Cancer x 2 areas• Diabetes 2

areas

LTC

LES 2019/2020

Primary Care Refresh Strategy 2019

Pre-Engagement on Priorities until 28th Feb 2019

Have we got it right ?????

Suggested Priorities • Access to Primary Care

• Delivering High Quality Care

• Delivering sustainable co-ordinated care closer to home and out of hospital

• Integrated Primary Care System (PCN’s)

• Developing the Workforce

Delivering High Quality

Care

Outcomes for Delivering High Quality Care

Delivering High Quality Care

Outcome 1: Improve early detection of illness

Outcome 2: Optimise long-term management of disease specific pathways

Outcome 3: Reduce hospital admissions

Outcome 4: Reduce premature mortality

We must do all we can to provide excellence across Warrington, we will ensure safe practices and

positive outcomes for patients. We will ensure good financial planning and practice through

minimising waste. This means reducing errors by getting it right first time through a highly skilled

workforce, using intelligence and insights to support planning and performance monitoring.

We will use nationally collated data from organisations such as NHS Right Care which will give the CCG effective knowledge by identifying priority areas to help us improve the way care is delivered for our patients. This intelligence will be used to look at variation and performance to encourage improvement in quality and make improvements in both spend and patient outcomes.

Framework for GP Contract Reform to Implement the NHS Long Term Plan

Introduction of seven specific national service specifications DES (no duplication)

I. Structured Medication Review and OptimisationII. Enhanced Health in Care Homes (to implement the vanguard model)

III. Anticipatory Care Requirements (for high need patients experiencing several long

term conditions joint with community services)

IV. Personalised Care (to implement the NHS Comprehensive model)

V. Supporting Early Cancer Diagnosis VI. CVD Prevention and Diagnosis, and VII.Tackling Neighbourhood Inequalities

Commissioner Insight

Things to consider ……..

• Not to be too onerous • No duplication (paying twice) • Not too many specifications • Be mindful we still have the strategy

outcomes to deliver

My initial thoughts ……..

• Have 5 specifications, 1 for each priority of the PC Strategy.

• Have a suite of specifications for engagement with GPs and let them help shape and choose – better by in and delivery

Over to you !!!!!!

No. Level % Status Task Owner Start Finish Notes Dependency Jan Feb Mar Apr1 Section Project Initiation1.1 Task 100% Complete Contact National Procurement Hub (NPH) VEB 18‐Dec 18‐Dec1.2 Task 100% Complete Meet with CCG Clinical Lead (Rakhi Raj [RR]) VEB 08‐Jan 08‐Jan1.3 Task 100% Complete Agree RR comms to be sent via CCG VEB 19‐Feb 19‐Feb Agreed monthly1.4 Task 50% Started Complete Initial Data Capture Form VEB 18‐Feb 22‐Feb2 Section Supplier Engagement2.1 Task 100% Complete Confirm date & time (internally) CCG 17‐Jan 25‐Jan 30‐Jan2.2 Task 100% Complete Contact venues & confirm date/ time CCG 14‐Jan 25‐Jan 30‐Jan 2.12.3 Task 100% Complete SDMs to discuss Online Consults and event at Jan Cluster meetings SDMs 15‐Jan 25‐Jan2.4 Task 100% Complete Confirm NPH attendance (Kelly McWilliams) VEB 17‐Jan 25‐Jan 08/02/2019 ‐ not attending 2.22.5 Task 100% Complete Create survey for Practice opinion VEB 21‐Jan 22‐Jan2.5.1 Subtask 100% Complete Confirm with RR email narrative VEB 22‐Jan 22‐Jan2.5.2 Subtask 100% Complete Send survey to Practices VEB 23‐Jan 23‐Jan 2.52.5.3 Subtask 100% Complete Practices to return completed survey Practices 23‐Jan 01‐Feb 81% response rate 2.5.22.5.4 Subtask 100% Complete Create email folder within generic account VEB 24‐Jan 24‐Jan2.5.5 Subtask 100% Complete Collate feedback VEB 23‐Jan 01‐Feb 2.5.22.5.6 Subtask 100% Complete Summarise survey feedback VEB 01‐Feb 06‐Feb 08‐Feb 2.5.52.6 Task 100% Complete Send 'save the date' to Practices, NPH, Comms&Engagement, PPG Rep, CCG Clinical Lead, CCG staff VEB 24‐Jan 24‐Jan 01‐Feb 2.22.7 Task 100% Complete Send supplier 'save the date' NPH 24‐Jan 24‐Jan 31‐Jan 2.22.8 Task 100% Complete Send official invite to Practices, NPH, Comms&Engagement, PPG Rep, CCG Clinical Lead, CCG staff VEB 07‐Feb 08‐Feb 12‐Feb 2.22.9 Task 100% Complete Send official invite to suppliers NPH 07‐Feb 08‐Feb 11‐Feb 2.22.10 Task 100% Complete Marketplace event update at Commissioning PLT VEB 14‐Feb 14‐Feb 2.22.11 Task 100% Complete Confirm process for £5k from NHSE (event payment) VEB Dec Jan2.11.1 Subtask 100% Complete Raise invoice request JH/ NHSE 31‐Jan 01‐Feb2.11.2 Subtask 100% Complete Receive £5,000 payment from NHSE CCG 31‐Jan 21‐Feb 2.11.12.12 Task 50% In Progress Discuss and agree allocation of NHSE payment CCG 18‐Feb 22‐Feb financial incentive, catering, ro 2.113 Section Supplier Product Review3.1 Task 100% Complete Supplier video link from NPH NPH 01‐Jan 01‐Jan3.1.1 Subtask 40% Started Review supplier videos/ material VEB 07‐Jan 01‐Feb In progress 3.13.1.2 Subtask 0% Future Task Summarise videos/ create matrix VEB TBC TBC 3.1.13.2 Task 0% Future Task Product review tasks TBC TBC TBC3.3 Task 0% Future Task Product review tasks TBC TBC TBC4 Section Supplier Event4.1 Task 50% In Progress Confirm room details VEB 18‐Feb 19‐Feb 2.24.1.1 Subtask 100% Complete Equipment provided VEB 18‐Feb 19‐Feb 2.24.1.2 Subtask 50% In Progress Cost VEB 18‐Feb 19‐Feb Awaiting email from Orford 2.24.1.3 Subtask 100% Complete WiFi VEB 18‐Feb 19‐Feb 2.24.1.4 Subtask 100% Complete Opening time VEB 18‐Feb 19‐Feb 2.24.1.5 Subtask 50% In Progress Liquid refreshments VEB 18‐Feb 19‐Feb ? Numbers 2.24.1.6 Subtask 60% In Progress Source catering VEB 13‐Feb 25‐Feb 2.24.2 Task 100% Complete Request confirmation of practice attendance VEB 12‐Feb 25‐Feb 2.84.2.1 Subtask 0% Future Task Practices to confirm attendance 4.24.3 Task 0% Future Task CCG scene setting blurb (key reqs, timescales, next steps) VEB 18‐Feb 25‐Feb4.3.1 Subtask 0% Future Task Create attendance sheet VEB 18‐Feb 22‐Feb4.3.2 Subtask 0% Future Task Create feedback form VEB 18‐Feb 25‐Feb4.3.3 Subtask 0% Future Task Print copies for event VEB 25‐Feb 25‐Feb 4.34.4 Task 100% Complete Source a "ballot box" VEB 20‐Feb 20‐Feb4.5 Task 0% Future Task Marketplace Event All 26‐Feb 26‐Feb4.6 Task 0% Future Task Post‐Event actions VEB 26‐Feb 01‐Mar4.6.1 Subtask 0% Future Task Collate event feedback VEB 26‐Feb 01‐Mar 4.64.6.2 Subtask 0% Future Task Digitise and summarise VEB 26‐Feb 01‐Mar 4.65 Section Task and Finish Group5.1 Task 90% Started Identify key members of T&F group VEB 12‐Feb 22‐Feb5.2 Task 100% Complete Contact RR re. T&F group VEB 15‐Feb 15‐Feb5.3 Task 0% Future Task T&F Comms VEB 14‐Feb 27‐Feb

GP ONLINE CONSULTATION PROJECT PLAN (v0.1) TIMELINE

5.3.1 Subtask 0% Future Task Comms to PMs VEB 14‐Feb 22‐Feb 5.15.3.2 Subtask 0% Future Task Comms to other T&F members VEB 14‐Feb 22‐Feb 5.15.3.3 Subtask 0% Future Task Responses back from T&F potentials T&F peopl 22‐Feb 27‐Feb 5.35.4 Task 0% Future Task Create T&F ToR VEB TBC TBC 5.1 & 5.35.5 Task 0% Future Task Arrange first meeting VEB TBC TBC 5.3 .35.6 Task 0% Future Task T&F related tasks VEB TBC TBC6 Section Specification & Procurement Questions6.1 Task 100% Complete Obtain example specifications & questions from NPH NPH 18‐Dec 18‐Dec 1.16.1.1 Subtask 50% Started Research other CCG example specifications VEB 18‐Feb 04‐Mar6.1.2 Subtask 30% Started Draft WCCG specification VEB 18‐Feb 04‐Mar 6.16.1.3 Subtask 0% Future Task Develop example procurement questions VEB 18‐Feb 04‐Mar 6.16.1.4 Subtask 0% Future Task Communicate Spec and questions for review and comment VEB 04‐Mar 11‐Mar 6.1.2 & 6.1.36.2 Task 75% In Progress Confirm sign off route (Spec & Q's) VEB 18‐Feb 20‐Feb Awaiting Pam Feedback6.3 Task 0% Future Task Identify Subject Matter Expert (SME) evaluators TBC TBC TBC7 Section Comms & Engagement7.1 Task 66% Started Regular comms to all Practices on behalf of RR VEB Jan Mar 1.37.2 Task 100% Complete Communicate survey results to practices & NPH VEB 18‐Feb 19‐Feb 20‐Feb 2.107.3 Task 0% Future Task Task TBC TBC TBC7.4 Task 0% Future Task Task TBC TBC TBC7.5 Task 0% Future Task Task TBC TBC TBC8 Section Procurement8.1 Task 0% Future Task Service specification sign off TBC TBC TBC 68.2 Task 0% Future Task Procurement question sign off TBC TBC TBC 68.3 Task 0% Future Task Invitation to Tender TBC TBC TBC 8.1 & 8.28.4 Task 0% Future Task SMEs to individually evaluate bids TBC TBC TBC 8.38.5 Task 0% Future Task Moderation session for evaluators to discuss & agree final score (each question, each supplier) TBC TBC TBC 8.48.6 Task 0% Future Task Confirm winning bidder TBC TBC TBC 8.58.7 Task 0% Future Task Contract Award Recommendation Report sign off TBC TBC TBC 8.68.8 Task 0% Future Task Raise PO TBC TBC TBC 8.78.9 Task 0% Future Task Contract negotiations TBC TBC TBC 8.78.10 Task 0% Future Task Contract sign off TBC TBC TBC 8.99 Section Mobilisation & Implementation9.1 Task 0% Future Task TBC TBC TBC TBC9.2 Task 0% Future Task TBC TBC TBC TBC9.3 Task 0% Future Task TBC TBC TBC TBC9.4 Task 0% Future Task TBC TBC TBC TBC

Primary Care Strategy Development

Marie-Ann Hunter

Senior Commissioner for Primary Care

Looking back over the past few years

Current StrategyWhat have we achieved?

• The Warrington Brand of Primary Care

• The Primary Care Home Model (Network Development)

• 7/10 Priorities for Primary Care

- Medicines Management and Prescribing- Warrington Offer – Primary Care Quality- Nursing and Residential homes - Complex Care - Promoting prevention and self-care- Mental Health- Public Engagement and Communications in

Primary Care

Remaining Priorities

• Workforce

• Access, Demand and Capacity

• Whole system, right care role of Primary Care in the effective utilisation of the whole system resource through system integration

Looking forward

Our new strategy will…..

• Be owned by Primary Care

• Describe the Primary Care priorities for the next 3 years

• Provide a basis for the workplans of the Networks

• Be in-line with National Strategy

Primary Care Strategy 2019-2022

Primary Care Strategy Development Group

• Chaired by Dr Steevart

• Representation from Primary Care Colleagues

• Developed Priorities and Outcomes

• Pre-engagement with all GP Practices, PPG and Governing Body until 28th Feb 2019

Suggested Priorities

Access to Primary Care Delivering High Quality

Care

Delivering sustainable co-ordinated care

closer to home and out of hospital

Integrated Primary Care System (PCN’s)

Developing the Workforce

Have we got it right ??

Developing the Strategy

Developing the Strategy

• Review feedback from Pre-engagement

• Finalise priority outcomes

• Hold a focus group with the PPG to help shape the engagement approach

• Engage / Engage / Engage / ownership from primary care

• Produce final version of the strategy for September Committees

• Develop delivery / action plans to support strategy

Commence Implementation


Primary Care Core Contract Report NHS Warrington CCG Primary Care Commissioning Committee Meeting 6 March 2019

COMMITTEE MEETING:


DATE OF MEETING:

Wednesday 6 March 2019


Aysha Devine, Contract & Performance Manager (Primary Care), NHS Warrington CCG

REPORT TITLE:

Primary Care Core Contract Report





✓



✓



Approval

Assurance

✓

Discussion

✓

Information

✓

EXECUTIVE SUMMARY

This report is to inform the Primary Care Commissioning Committee on primary care related updates and work in progress across Warrington. The report includes updates on the following areas:-

• Policies

• Translation Services

• Locum Claims

• Boundary Change Application for Penketh Health Centre

• List Closure Applications

• Dashboard Update

• Primary Care Estates



RECOMMENDATIONS

The Primary Care Commissioning Committee is asked to:- ✓ Note the contents of the report

✓ Ratify the following policies:

o PMS Contractors Right to a GMS Contract

o Process for Planned Practice Closure

o Process for Managing Contract Variations

o Process for Contract Breaches, Sanctions and Terminations

o Process for Managing the Death of a Contractor

✓ Ratify the boundary change for Penketh Health Centre

✓ Note the decisions made by the Primary Care Operational Group with respect to section 106 funding.


Insert details of any staff, patient, public or stakeholder engagement activity. If this section is not relevant to the paper, state ‘not applicable’


Include details of any known conflicts of interest


If yes, identify which risk it addresses and include a section on the mitigation provided within the main body of the report (strategic risks in Appendix)


Yes

N/A









PRIMARY CARE CORE CONTRACT REPORT Purpose of the Report 1. The purpose of this report is to inform the primary care commissioning

committee members on current work streams and updates for primary care medical services commissioned under delegated authority by NHS Warrington CCG.

Policies 2. The Primary Care Operational Group has approved a number of policies and

processes that have been put in place which are listed below:

• PMS Contractors right to a GMS Contract which enables NHS Warrington CCG as the delegated Commissioner to ensure that all parties to the contract understand the procedure that must be followed when a contractor requests to transfer from a PMS agreement to a GMS contract.

• Process for Planned Practice Closure helps those involved understand the procedure that must be followed when a primary medical services contract comes to an end and an urgent contract needs to be put in place.

• Managing Contract Variations details the process to determine any contract variation to ensure that any changes comply with legislation in order to maintain our contracts.

• Process for Contract Breaches, Sanctions and Terminations ensures that any decision to issue a Breach or Remedial Notice, apply sanctions or terminate a contract or agreement that could be challenged by the contractor under appeal, can demonstrate that it has followed, due process in investigating, communicating and implementing actions.

• Process for Managing the Death of a Contractor provides consistency when dealing with the death of a contractor, whether they are a single-handed contractor, in a partnership or a corporate organisation and includes consideration of GMS Contracts and PMS Agreements.

3. Due to the cancellation of the Primary Care Operational Group on 20 February 2019 due to non-quoracy the Process for Managing Disputes and Contract Review Process will now be approved at the next PCOG meeting. Given the more urgent requirement for the CCG to have a formal process with respect to procurement, “The Process for Managing a Procurement” is on the agenda (item number 018/19 ii) for this Primary Care Commissioning Committee.



Translation Services

4. NHS England has informed the CCG that the procurement for translation

services has failed. NHS England is now exploring other options and has given written assurance that the CCG will be informed of any changes.

5. Language Line will continue to take bookings until further notice.

6. On 27th February 2019 the CCG was sent gateway reference 07518: A Guidance for commissioners: Interpreting and Translation Services in Primary Care. This NHS England publication was issue following a serious case review in London regarding translation and interpreting services not meeting the needs of patients and practices not fully understanding their obligations.

7. The CCG has circulated the guidance for practices for their review and action.

8. The contract team working with NHS England and the practices will assess that the local arrangements, through Language Line, are compliant with the new

guidance.

Locum Claims

9. The processing forms for Locum Cover claims have been updated to ensure a

more streamlined process for all involved. Subsequently the Standard Operating Procedure have been amended and distributed to all practices.

Boundary Change Applications

10. Penketh Health Centre has had a boundary application approved by the

Primary Care Operational Group to reduce their boundary. The group received

the request after the CCG team whilst undertaking the boundary map review

exercise noticed an inconsistency between the electronic copy of the practice

contract and the manual version. The discrepancy was a small difference

with the contractual boundary and the actual boundary.

11. The proposed boundary removes the area of Westbrook and Sankey Bridges making them part of the practice outer boundary. PCOG reviewed the information and agreed the variation and the committee is informed that the contract variation has been issued.

List Closure Applications 12. There have been no list closure applications received. Dashboard Update

13. The purpose of the Primary Care Dashboard (Appendix A) is to see at a glance if there are any developing areas of concern in relation to PMS and GMS contracts for GP practices and to enable action to be taken pro-actively. A standard operating procedure has been developed which sets out the proposed



actions to ensure the dashboard is kept up to date with current and relevant information, and how this information is used.

14. The dashboard is a constantly evolving source of information and the Primary Care Contracting Team are working closely with the Quality Team to enable continued development of the document and any practices highlighted as a risk are supported, this ensures a robust and rounded contact management process.

15. The dashboard is not intended to be the only measure but it to enhance all other data sources.

Estates/Grants/GP IT Issues

16. The Primary Care Operational Group (PCOG) held on 23rd January received a

number of papers in relation primarily to planning applications in Warrington

that could affect the primary care estate and the delivery of primary care

services. Members of PCOG are collectively asked to review the impact on

primary care services and estate within the locality of each application to

determine whether section 106 funding should be applied for.

17. Under S106 of the Town and Country Planning Act 1990, as amended,

contributions can be sought from developers towards the costs of providing

community and social infrastructure, the need for which has arisen as a result

of a new development taking place. This funding is commonly known as

'Section 106'.

18. The Primary Care Operational Group agreed that a Section 106 is recommended for each residential phase, with a new healthcare facility to be provided within usable distance to the new development with the aspiration of combining existing health care services for the pre- application 2019/04233 at Peel Hall.

19. The Chief of Information, Technology & Estates advised the PCOG that

planning application 2018/33778 was for 79 dwellings on land bound by Delta Crescent, Westbrook Crescent and Westbrook Way and that the Local Authority approved this request in December 2018. He advised that a Section 106 contribution was required and proposed that this funding is used to enhance the existing facilities at Westbrook Medical Centre to allow reconfiguration to ensure registrations can be accommodated.

20. The Primary Care Operational Group agreed this contribution to Westbrook Medical Centre and the Chief of Information, Technology and Estates will commence discussions with the practice about proposals for use of the funding, to include innovative ways of working in line with the GP five year forward view and the NHS Long Term Plan.



Recommendations

21. The committee is asked to:-

i. Note the contents of the report

ii. Ratify the decision of the Primary Care Operational Group to approve the

following policies:

a. PMS Contractors Right to a GMS Contract

b. Process for Planned Practice Closure

c. Process for Managing Contract Variations

d. Process for Contract Breaches, Sanctions and Terminations

e. Process for Managing the Death of a Contractor

iii. Ratify the decision of the Primary Care Operational Group to approve the

boundary change for Penketh Health Centre

iv. Note the decisions made by the Primary Care Operational Group with

respect to section 106 funding.



Complaints SafetyOn Line

Services

E-

Declaration

Accountable

GP

Friends and

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Access

% change in

ONE year (Qtr

3) 2017 to

2018

Age 65+ Age 85+

No of

Patients

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Number of

Dementia

Assessments

Percentage

of Dementia

Assessments

against 65+

population

% Overall

Experience

% of patients

who would

recommend

the practice

to a friend

Ability to

book with

the GP of

choice

NHS

England

Complaints

Serious

Incidents

Safeguarding

Section 11

Patients

enabled to

Book/Cancel

Appointments

Electronically

E-

Declaration

Accountable

GP

Number of

FFT

Responses

Overall CQC

Rating Date of Visit

QOF Overall

Achieveme

nt score

(max. 559)

QOF Overall

Achieveme

nt score

(max. 559)

Increase/

Decrease

Is the practice an

outlier for

exception

reporting (twice

CCG average) -

Number of

Exceptions

Mutual AidSupport

Requested

Percentage

of DES Sign

Up

Extended

Access

offered

GP

Headcount

GP/Patient

Ratio

Nurse

Headcount

Nurse/Pat

ient Ratio

25/09/18 (AR)21/01/19

(AR)

10/10/18

(AR)

23/10/18

(AGD)

23/10/18

(AGD)

04/10/18

(AR)21/01/19 (AR)

04/10/18

(AR)

04/10/18

(AGD)(LB) 21/01/2019 04/10/18 (AGD) (AR/AGD) 04/10/18 (AGD)

08/10/18

(AGD)

04/10/18

(AGD)

04/10/18

(AGD)

04/10/18

(AGD)

04/10/18

(AGD)

04/10/18

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(AR)

21/01/19

(AR)

21/01/19

(AR)

21/01/19

(AR)

21/01/19

(AR)

25/09/2018Practice data

Jan 2019PCWT Feb 18

Practice data

Jan 2019

NHS Digital

Apr- Aug 2018

(Accumulated)

NHS Digital

Apr- Aug 2018

(Accumulated)

gp-

patient.co.uk

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hs.uk/publicat ion/frien

ds-and-family-test-

data-november-2018/

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2017/18

17/18

Risk dept Lisa

Woodall

'1-30 Nov 2018

Quality Team

21/1/1901/06/2018

CQRS - October

2018 NHS England

Aug 2018

01/10/2018 01/10/2018 2016/17 2017/18 2017/18

21/1/19

Business

Continuity

plans

2018/19 (Qtr 2

2018/2019)PCWT Jan 2019

PCWT Jan 2019

0.58 GP Ratio

https://www.nh

s.uk/Scorecard/

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PCWT Jan 2019

PCWT Jan

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'https://pract

iceindex.co.u

0.63% 301 43 3 14 5% 81.0% 100.0% 43.0% 2 1 Yes 15.29% Yes Yes 16 Good 04/02/2016 550.12 497.87 -52.25 No Not Received YES 94% No 1 0.39 0 0

-0.91% 1928 159 0 309 16% 80.0% 95.0% 44.0% 0 1 Yes 20.40% Yes Yes 72 Good 08/05/2018 543.72 532.43 -11.29 No YES No 0% No 10 0.89 3 0.27

-0.46% 1859 213 45 55 3% 87.0% 95.0% 54.0% 0 0 Yes 19.9% Yes Yes 60 Good 08/08/2016 528.53 507.82 -20.71 No Not Received No 100% No 7 0.78 2 0.22

0.49% 1304 139 64 100 8% 81.0% 83.4% 63.0% 1 0 Yes 27.42% Yes Yes 2 Good 03/09/2016 554.27 557.13 2.86 No YES No 0% No 4 0.48 2 0.24

0.48% 307 16 27 5 2% 85.0% no data 49.0% 2 0 Yes 16.66% Yes yes no data N/A ENTER DATE Not recorded 552.40 N/A No YES No 0% No 3 0.64 2 0.43

-1.36% 245 15 1 13 5% 94.0% 82.2% 82.0% 0 0 Yes 22.46% Yes Yes 1 Good 22/02/2018 551.00 544.00 -7.00 No YES No 0% Yes 1 0.32 2 0.65

0.06% 2760 413 110 352 13% 94.0% 86.0% 59.0% 1 3 Yes 22.51% Yes Yes 10 Good 16/07/2015 556.64 551.23 -5.41 No YES No 100% Yes 10 0.81 6 0.49


9.22% 1015 107 47 98 10% 78.0% 100.0% 35.0% 2 3 Yes 20.71% Yes Yes 4 Good 06/07/2017 559.00 559.00 0.00 No YES No 100% Yes 5 0.49 3 0.29


-0.01% 2339 240 12 50 2% 92.0% 94.0% 40.0% 1 2 Yes 3.78% Yes Yes 223 Good 11/11/2016 556.56 558.83 2.27 No YES No 100% Yes 7 0.49 6 0.42

-1.53% 1423 156 32 254 18% 89.0% 80.0% 36.0% 1 0 Yes 35.11% Yes Yes 18 Good 21/11/2016 559.00 559.00 0.00 No Not Received No 100% Yes 8 0.77 6 0.58




-0.45% 2081 170 35 132 6% 81.0% 80.3% 44.0% 0 1 Yes 68.05% Yes Yes 18 Good 14/03/2017 516.93 544.74 27.81 No YES No 100% No 10 0.96 3 0.29


3.42% 881 125 126 64 7% 90.0% 86.7% 52.0% 2 1 Yes 24.13% Yes Yes no data Good 19/09/2016 559.00 558.98 -0.02 No YES No 94% Yes 5 0.72 4 0.58



-0.31% 673 67 3 63 9% 63.0% 66.3% 45.0% 2 0 Yes 33.63% Yes Yes 0 Requires Improvement 10/08/2018 554.76 527.93 -26.83 No YES No 94% No 2 0.34 1 0.17


0.23% 1247 138 20 40 3% 92.0% 92.0% 77.0% 1 3 Yes 38.73% Yes Yes 46 Outstanding 29/03/2016 548.00 548.27 0.27 No YES No 100% Yes 4 0.58 3 0.43

-1.76% 3829 663 210 231 6% 83.0% 45.6% 20.0% 0 2 Yes 23.98% Yes Yes no data Good 29/08/2018 557.75 557.79 0.04 No YES No 0% Yes 12 0.74 7 0.43


3.09% 1618 139 64 51 3% 95.0% 84.3% 56.0% 4 0 Yes 22.37% Yes Yes no data Good 27/07/2016 553.97 548.30 -5.67 No YES No 0% Yes 5 0.47 3 0.28

Average

(0.75) 38715 4424 1506 2853 86.7% 82.5% 53.2% Average (31)

Growth 10%+ 86.5%+ 82.50% 54.4+ 0 0 Yes 50%+ Yes 30+ Good 95%+ 95%+ Increase Yes Yes 100% Yes

N/A 5%+ 80.0%+ 70.0%+ 50.0+ 1 1+ 25%+ N/A 1+ Requires Improvement 90%+ 90%+ N/A No 90%+ No

Reduction Below 5% Below 80.0% Below 70.0 Below 50.0 More than 1 5+ No Below 25% No 0 or No Data No Below 90% Below 90% Reduction Not Received Below 90% N/A

Workforce Data

Demographics

Patient Survey Results Quality & Outcomes Framework

Non-Core

Care Quality Commission

Core

Agenda Item: 018/19 ii

Process for Managing a Procurement NHS Warrington CCG Primary Care Commissioning Committee Meeting 6 March 2019

COMMITTEE MEETING:


DATE OF MEETING:

Wednesday 6 March 2019


Aysha Devine, Contract & Performance Manager (Primary Care), NHS Warrington CCG

REPORT TITLE:

Process for Managing Procurement





✓



✓



Approval

✓

Assurance

✓

Discussion

✓

Information

EXECUTIVE SUMMARY

NHS Warrington CCG, under its delegation agreement with NHS England, must ensure that

it complies with the law, regulations and published guidance and its own standing orders.

The objective of this document in relation to procurement decisions is to ensure that NHS

Warrington CCG acts with a view to:

• Securing the needs of the people who use the services

• Improve the quality of the services

• Improve efficiency of the services



RECOMMENDATIONS

The Primary Care Commissioning Committee is asked to:-

✓ Approve the Process for Procurement


‘not applicable’




Yes

N/A









PROCESS FOR MANAGING A PROCUREMENT

INTRODUCTION

1. This procurement policy informs how procurement decisions will be undertaken by

the CCG and where to seek guidance as to the selection procedure to be applied

for new, alternative or renewal of contracts for healthcare services.

2. This policy sets out existing legal framework for procurement by public bodies in

the UK and will be updated in line with any changes to UK and EU legislation.

3. A range of procurement options are available which include working with existing

providers, contract variations and service development, competitive tendering,

utilising existing framework contracts or bespoke light touch selection processes

in line with the EU Public Contracts Regulations 2015.

4. Procurement will form an important part of the commissioning cycle. A robust and

appropriate procurement function will need to inform any decision-making process

with regard to how gaps or developments in provision are met, taken into

consideration wider organisational priorities.

5. In all cases, procurement decisions must be taken within the parameters and

limitations of the existing legal framework.

PROCUREMENT GUIDING PRINCIPLE

6. The CCG will pursue and manage the delivery of choice, cooperation and

competition in the context of the following principles:

• Transparency: Procurement activities should be fair and open and where

appropriate include a sufficient level of advertising.

• Objectivity: Key decisions must be based on documented objective data and

criteria as part of the procurement process;

• Proportionality: The procurement process should be proportionate to the

value and complexity of the services to be procured;

• Equality and Non-discrimination: The Procurement Team and

commissioners must not discriminate among providers, and ensure that in the



delivery of services, providers do not discriminate among patients or patient

groups;

• Accountability: CCG managers should strive to align their authority and legal

powers with their accountability and legal duties. It should be clear, from

legislation and practice, who is accountable;

• Subsidiary: Decisions should be made by the lowest competent authority and

not escalated to Board level on a consistent basis. This may be achieved by

the establishment of Board Sub-Committees with appropriate delegated

responsibility and membership;

• Consistency: Formulation and implementation of policy must be internally

coherent and consistent;

• Interdependency: When assessing specific issues, commissioners and

providers should understand and minimise the potential unintended

consequences of any actions;

• Integrity: There should be no corruption or collusion with suppliers and others;

• Efficiency: Procurement processes should be carried out as cost

effectively as possiblel procurement activity will be undertaken in

accordance with Standards of business conduct including conflicts of

interest.

PUBLIC PROCUREMENT OBLIGATIONS

7. There are 2 key pieces of legislation which govern procurement in NHS

organisations. These are:

• The National Health Service (Procurement, Patient Choice and

Competition) (No 2) Regulations 2013

• The Public Contracts Regulations 2015

NATIONAL HEALTH SERVICE (PROCUREMENT, PATIENT CHOICE AND

COMPETITION) (NO 2) REGULATIONS 2013

8. The NHS (Procurement, Patient Choice and Competition) (No. 2)

Regulations 2013 (the 2013 Regulations) contain a number of requirements

that CCGs must comply with to ensure that they:



• adhere to good practice in relation to the procurement of health care

services funded by the NHS

• protect the rights of patients to make choices with respect to treatment or

other health care services funded by the NHS; and

• do not engage in anti-competitive behaviour unless this is in the

interests of NHS health care service users

9. The 2013 Regulations particularly govern the procurement of healthcare

services and operate alongside the Public Contracts Regulations 2015.

10. The 2013 Regulations require that, when procuring NHS healthcare services,

in all cases CCGs MUST act to:

• secure the needs of healthcare service users;

• improve the quality of services; and

• improve the efficiency with which services are provided

11. This includes situations where NHS Warrington CCG are seeking to secure

the delivery of healthcare services through integration including with other

healthcare and social services.

12. The Regulations do not impose a “one-size-fits-all” approach; rather they

attempt to allow the CCG flexibility within the framework of rules. It is

recognised that healthcare need will differ in accordance with local

conditions.

13. When procuring NHS healthcare services, in all cases NHS Warrington CCG

MUST:

• act in a transparent and proportionate way;

• treat providers equally and in a non-discriminatory way (showing no

favouritism, particularly on basis of ownership)

14. This requires the CCG to conduct all procurement activity openly and in a

manner which enables behaviour to be scrutinised. Procurement decisions

must be proportionate to the value, complexity and clinical risk associated with

the provision of the services in question; and commissioners must treat all



providers equally, not favouring one provider (or type of provider) over another –

differential treatment between providers will require objective justification.

15. The CCG is required to procure services from one or more providers that:

• are most capable of delivering the needs, quality and efficiency required

• provide the best value for money in doing so

16. When considering how best to procure healthcare services which improve

quality and efficiency, and which meet the health needs of the population, NHS

Warrington CCG must:

• consider how the services can be provided in an integrated way

(including with other healthcare services or social care services)

• how to enable service providers to compete to provide the services

• how to allow patients a choice of provider for the services

17. In order to be able to demonstrate compliance with the 2013 Regulations, NHS

Warrington CCG is required to maintain a record of the decision making process

in relation to the award of any contract for healthcare services, regardless of

whether the award of such contract was as a result of a competitive tendering

process.

18. While the 2013 Regulations do not impose a requirement on CCGs to

undertake competitive tendering in all circumstances, where a CCG awards a

healthcare contract without conducting a competitive process, it must again

ensure that it is able to evidence, via a robust audit trail, that the decision not to

tender followed a detailed review of the provision of local services and which

identified the most capable provider of the services; that there was only one

provider capable of providing the services; or that the benefits of tendering

would be outweighed by the cost.

19. There is also an obligation on the CCG not to award contracts in a manner

which can be considered anti-competitive, unless the CCG is able to evidence

that this is in the best interests of service users.

20. The 2013 Regulations place additional specific requirements on CCGs to

maintain records of all awarded contracts which demonstrate how the decision

to award that contract complied with the CCG’s obligations under the NHS Act

2006, and to maintain a record of all conflicts of interest arising as a result of a



decision to award a contract, and how the effect of those conflicts were

mitigated.

21. The 2013 Regulations make clear that they do not expressly require CCGs to

competitively tender for new contracts in all circumstances. The decision

whether or not to publish a contract opportunity is not an isolated decision and

will need to be taken in the context of commissioners’ decisions about what

services to procure and how to go about procuring them more generally.

22. Then deciding whether or not to publish a contract notice, the CCG will need to

ensure that this decision is consistent with the requirements of the 2013

Regulations and the Public Contracts Regulations 2015. NHS Improvement

guidance advises that a CCG will be justified in a decision not to competitively

tender a service where:

• there is only one provider that is capable of providing the services in

question

• where a commissioner carries out a detailed review of the provision of

particular services in its local area in order to understand how those services

can be improved and, as part of that review, identifies the most capable

provider or providers of those services;

• where the benefits of competitively tendering would be outweighed by the

costs of publishing a contract notice and/or running a competitive tender

process.

23. Regulation (EU) No 537/2014 of the European Parliament and of the Council of

16 April 2014 sets out specific requirements regarding statutory audit of public-

interest entities and repealing Commission Decision 2005/909/EC Text with EEA

relevance. This is described further in Appendix 2.

24. Under the Procurement, Patient Choice and Competition (No 2, 2013

Regulations), NHS Improvement has been granted certain enforcement powers

in relation to the healthcare procurement activities of CCGs, including:

• Investigatory power

• Declarations of ineffectiveness

• Directions



• Accepting Undertakings

25. NHS Improvement’s investigation powers are triggered by the receipt of a

complaint from third party alleging a failure to comply with the requirements of

the Procurement, Patient Choice and Competition (No 2, 2013 Regulations).

PUBLIC CONTRACTS REGULATIONS 2015

26. The Public Contracts Regulations 2015 (the 2015 Regulations) transpose

European Directives on the required process for conducting public procurement

into UK law. The 2015 Regulations require that certain procedures must be

followed by relevant public bodies when awarding contracts above specified

financial thresholds.

27. The EU treaty principles of non-discrimination, equal treatment, transparency,

and proportionality apply to all procurements. The CCG’s approach to fulfilling

these requirements is described below.

28. The 2015 Regulations came into force on the 26 February 2015 and replace the

2006 Regulations in relation to the procurement of public services.

29. The 2015 Regulations introduce a range of significant changes which will affect

the way in which public bodies are required to undertake their procurement

activities.

30. Providers raising a complaint against the 2015 Regulations will do so through

the courts.

THE LIGHT-TOUCH REGIME

31. The light-touch regime (LTR) is a specific set of rules for certain service

contracts that tend to be of lower interest to cross-border competition. Those

service contracts include certain social, health and education services, as

defined in the 2015 Regulations.

32. This simplified regime will have a higher threshold of €750,000 (£615,2781) and

the only obligations, apart from general EU principles, which apply to services

with a contract value above this threshold; are the rules in relation to

1 Correct as of January 2018 thresholds (https://www.ojeu.eu/thresholds.aspx) – threshold subject to review

https://www.ojeu.eu/thresholds.aspx



transparency and publicity i.e. that all relevant contracts in excess of this

threshold are advertised in the OJEU.

33. Below the LTR threshold, contracts do not normally need to be advertised in the

Official Journal of the European Union (OJEU), unless there are concrete

indications of cross-border interest.

34. In terms of procurement requirements for above-threshold services; the main

mandatory requirements are:

OJEU Advertising

35. The publication of a contract notice (CN) or prior information notice (PIN).

Except where the grounds for using the negotiated procedure without a call for

competition could be used, for example where there is only one provider

capable of supplying the services required.

Contract Award Notice

36. The publication of a contract award notice (CAN) following each individual

procurement, or if preferred, group such notices on a quarterly basis.

Compliance with Treaty principles of transparency and equal treatment.

37. Conduct the procurement in conformance with the information provided in the

OJEU advert (CN or PIN) regarding: any conditions for participation; time limits

for contacting/responding to the authority; and the award procedure to be

applied.

38. Time limits imposed by authorities on suppliers, responding to adverts and

tenders, must be reasonable and proportionate.

39. There are no stipulated minimum time periods in the LTR rules, so contracting

authorities should use their discretion and judgement on a case by case basis.

40. The CCG has the flexibility to use any process or procedure they choose to run

the procurement, as long as it respects the other obligations above. There is no

requirement to use the standard EU procurement procedures (open, restricted

and so on) that are available for other (non-LTR) contracts. The CCG can use

those procedures if helpful, or tailor those procedures according to needs, or

design a bespoke procedure.



PROCUREMENT APPROACH / DECISION TO TENDER

CCG Constitution and applicable financial thresholds

41. Where the CCG wishes to award a contract for services, it must consider which

of the relevant pieces of legislation is applicable, and whether any financial

thresholds should be applied. Attention should also be given to the CCG’s

Constitution. The table below summarises the potential routes to market in

accordance with the potential value of the contract and the requirements of the

2015 Regulations, for both healthcare and non-healthcare contracts. In certain

circumstances the procurement route specified below might not be appropriate.

Potential routes to market are also described in Appendix 1 as a reference guide,

as well as key points from elsewhere within this policy.

Total Contract

Value

Minimum Type of

Procurement Required

Applicable

Governance/legislation

Up to £5k whole life Non-healthcare contract Whole life

No formal requirement for external procurement process

CCG Constitution: which describes the authority for approval of single tender waivers

Procurement Policy: where describes the use of single tender waivers

Between £5k and £50k whole life Non-healthcare contract Whole life

Quotations should be sought from at least 3 firms/individuals (Single Tender Waiver should only be used in exceptional circumstances and must be reported to Audit Committee)

Between £50k and £118k2(EU threshold)

Non-healthcare contract Whole life

Competitive tender required (Single Tender Waiver should only be used in exceptional circumstances and must be reported to Audit Committee) The CCG can consider an open (advertised) or closed (framework or local approved supplier list) approach to market. Must include conflicts of interest declarations.

Above £118k (EU OJEU threshold)

Full open (advertised) or closed (framework) tender required. Advice

Public Contracts Regulations 2015

2 Correct as of January 2018 thresholds (https://www.ojeu.eu/thresholds.aspx) – threshold subject to review

https://www.ojeu.eu/thresholds.aspx



Total Contract

Value

Minimum Type of

Procurement Required

Applicable

Governance/legislation

Non-healthcare contract

and guidance from SCW Procurement Team if full tender cannot be undertaken

Below £615k Healthcare contract Whole life

Publication in Contracts Finder generally required. Route to market to be determined on a case by case basis in consultation with the SCW Procurement Team

NHS (P,PC &C) (No2) Regulations 2013, Section 14Z2 of the National Health Service Act 2006 on legal duty to involve patients and the public.

Above £615k (EU OJEU threshold) Healthcare Contract Whole life

Publication in OJEU and Contracts Finder generally required. Route to market to be determined on a case by case basis in consultation with the SCW Procurement Team Must publish an advert in OJEU for all services above £615k (“light touch”)

NHS (P,PC &C) (No2) Regulations 2013, Public Contracts Regulations 2015 (light touch regime), Section 14Z2 of the National Health Service Act 2006 on legal duty to involve patients and the public.

Decision whether to competitively tender

42. Decisions as to whether a contract opportunity should be put out to competitive

tender should be taken in light of the PCR2015 and Procurement, Patient Choice

and Competition (No 2, 2013 Regulations), and the requirement for transparency,

proportionality, fairness and equal treatment.

43. In relation to healthcare contracts, there is no “one size fits all” approach, and

regard will have to be given in each instance to how the CCG can best meet the

needs of the population, ensuring that the quality of services and the efficiency

with which they are provided is improved. This will need to be routinely

considered as part of the commissioning process and the rationale behind any

decision whether or not to competitively tender a contract should be fully

documented. Such decisions should be transparent and must be signed-off by

the relevant NHS Warrington CCG committee(s). In all instances, advice should

be sought from the Procurement Team in relation to decisions as to whether or

not to competitively tender a contract.

44. Particular regard should be given to the requirements of the Procurement, Patient

Choice and Competition (No 2, 2013 Regulations) that a CCG will be justified in

a decision not to competitively tender a service where;



• There is only one provider that is capable of providing the services in question;

• where a commissioner carries out a detailed review of the provision of

particular services in its local area in order to understand how those services

can be improved and, as part of that review, identifies the most capable

provider or providers of those services;

• WHere the benefits of competitively tendering would be outweighed by the

costs of publishing a contract notice and/or running a competitive tender

process

45. In instances of particular urgency where it is necessary to award a contract

without competitive tendering, and there is not time to follow the standard

governance and approval process, it will be necessary to seek approval from the

appropriate officer within the CCG in accordance with the relevant scheme of

delegation, in the form of a signed waiver document.

46. Under the light touch regime the CCG is required to publish an advert in OJEU

for all services over £615k2. The outcome of the responses to the advert will

indicate the market interest and will support the CCG in its decision as to how it

should secure the services and choose its route to market.

47. The CCG approval of the procurement strategy and readiness to proceed shall

be managed through the CCG PMO processes and shall include preparedness,

contract value and contract length plus any extensions.

ROUTE TO MARKET

48. A variety of procurement and tendering options are available by which the CCG

can secure the required service. The advice of the CCG Procurement Team

should be sought to ensure that the appropriate route is selected in each

circumstance, in compliance with all relevant legal and regulatory requirements.

• Contract Variation Process

• Single Tender Action award to a Single Capable Provider

• Any Qualified Provider

• Framework Agreement

• Competitive Tender



Contract Variation Process

49. It may be possible to use this option to secure incremental change to the service

provided. When procuring a service the CCG should consider potential

modifications it may wish to make during the term of the contract and state this in

the initial procurement and contract documents. Variations are permitted where

the change does not materially alter the nature of the contract as originally

procured, and always in line with regulation 72 of the PCR2015 Regulations.

50. The following circumstances are likely to be regarded non-permitted variations

and as such will require a new contract:

• the contract is materially different from the one initially concluded;

• other providers would have been interested in bidding for the contract if the

change had originally been part of the specification when the service was

originally procured;

• the contract would have been awarded to a different provider if the

change had originally been included in the original service specification;

• the change involves genuinely new services not originally within the scope of

the specification covered by the contract;

• there is a significant change in the value of the contract;

• the modification changes the economic balance of the contract in the favour

of the contractor considerably; or

• a new contractor replaces the one to which the CCG had initially awarded the

contract, save for where that replacement occurs due to a universal or partial

succession of the initial contractor including through a takeover, merger,

acquisition or insolvency and does not modify the overall nature of the

contract.

51. The Public Contracts Regulations 2015 stipulate criteria relating to the

modification of contracts mid-term and the CCG will comply with the requirements

set out in section 72 of these regulations.

52. The CCG may be subject to challenge if it uses a contract variation

inappropriately. Therefore it should always take appropriate procurement advice

before following this route.



Award of Contract without Competition

53. Where the CCG determines through analysis of the market and proportionate and

transparent engagement with potential providers that the service is capable of

being provided by one particular provider, or there is an urgent clinical need, it

may consider proceeding with an award of contract without competition. This is

where a contract is awarded to a single provider or a limited group of providers

or where the CCG determines the most capable provider delivers the best value

for money through a soft market engagement event, without competition.

54. It is important that, if the CCG decides to take this route, it clearly records the

rationale for the decision. Failure to plan adequately is unlikely to be accepted as

an urgent clinical need. Where a service is put in place for reasons of urgency or

safety, the CCG should consider this as an interim step and plan to undertake a

competitive process as soon as possible.

55. The CCG should ensure that it considers what steps it should take and what

evidence it should rely on to satisfy itself that there is only one capable provider.

The CCG should retain an audit trail of its decision making process.

Any Qualified Provider (AQP)

56. AQP is a key procurement option when wishing to extend patient choice. Under

AQP, any provider assessed as meeting rigorous quality requirements who can

deliver services to NHS prices and under the NHS Standard Contract is able to

deliver the service. Providers have no volume guarantees and patients will decide

which providers to be referred.

57. Assessment of the AQP option should include consideration of the characteristics

of the service, the local healthcare system, whether the service lends itself to

patient choice, an analysis of the current market, how much competition and

choice there is now and how much is required and any barriers to market entry.

58. Once an AQP procurement is advertised, providers are assessed using a

consistent qualification process and will qualify if they can:

• meet the quality requirements;

• meet the Terms and Conditions of the NHS Standard Contract;

• accept the NHS price for the service; and



• Provide assurance that they are capable of delivering the service

requirements that have been set.

59. Framework Agreement

60. The CCG may wish to consider whether it can use a framework agreement which

has been tendered in accordance with the EU procurement rules. A framework

agreement can save procurement costs and time. A framework agreement could

be established by the CCG and the CCG may use other framework agreements

established by other contracting authorities.

61. If the CCG were minded to use a framework agreement it should ensure that:

• it is entitled to use the framework agreement and it follows the correct

processes to appoint a provider;

• its requirements fall within the scope of the pre-established framework

agreement;

• The term of the contract has not expired.

Competitive Tender

62. This is the most common and wide-ranging route for procurement. Where there

is more than one potential provider for a service and an AQP approach is not

considered suitable, the CCG should consider running a competitive tender

process to award a contract. There are several types of competitive tender

processes available to the CCG:

Open process

63. If there are a small number of providers who are likely to express an interest, and

all are expected to be technically competent and financially robust, this process

should be considered.

Restricted process



64. A qualification requirement, sometimes in the form of a pre-qualification

questionnaire (PQQ) allows the CCG to assess the suitability of bidders either

during or prior to issuing tenders. This can make the process more manageable

and reduces costs both for the CCG and for the bidders.

Competitive dialogue procedure

65. This process should only be used in limited circumstances when the CCG’s

needs cannot be met without adaptation of readily available solutions. It includes

design or innovative solutions and where there is a need for negotiation due to

the complexity, evolving specification, legal or financial profile of the services

required. If such circumstances exist the CCG will consider using a process that

allows for a dialogue with bidders (post advertisement), rather than asking for

bids in response to a defined specification.

Competitive Procedure with negotiation

66. This allows the CCG to award a contract on the basis of an initial tender but also

enables the CCG to negotiate with bidders who submitted an initial tender, and

any subsequent tenders, until it decides to conclude those negotiations. The CCG

cannot negotiate following final offers.

Innovation Partnership

67. This is a procedure designed to allow contracting authorities to establish a long-

term partnership for the development and subsequent purchase of a new,

innovative product, service or works. The CCG should note that the scope on

relying on this procedure is limited and may only apply if the CCG is seeking

innovative ideas where solutions are not already available on the market.

68. For requirements under the Light Touch Regime the CCG has the flexibility to

use any process or procedure they choose to run the procurement, as long as it

respects the other obligations. There is no requirement to use the standard EU

procurement procedures (open, restricted and so on) that are available for other

(non-LTR) contracts. The CCG can use those procedures if helpful, or tailor those

procedures according to needs, or design a bespoke procedure.

Form of Contract



69. The CCG will ensure that the appropriate standard form national contract is used

for all contracts for NHS funded health and social care services that the CCG is

party to. Where non-healthcare contracts are awarded then the standard

appropriate version of the NHS Terms and Conditions for the Supply of Goods

and/or Services should be used, with the exception of procedures through an

existing framework contract.

Award of Contract

70. The CCG will approve the award of contracts in accordance with the CCGs

scheme of delegation as set out in the CCG Constitution (Appendix F).

71. The contract award recommendation will include the contract term plus any

extension period to be approved by the Governing Body. The extension of the

contract shall not require the Governing Body’s approval of the extension period

but will require the Directors Meeting to assess the satisfactory performance of

the contract prior to formally extending the agreement.

72. For all Fully Regulated procurement procedures under Public Contracts

Regulations 2015 the CCG will operate a 10 day standstill period for all tenders.

For standard EU procurements this is a mandatory requirement and

recommended best practice for contracts awarded under the light touch regime.

Where a framework contract is used as a route for Procurement the CCG will

follow best practice and guidance for the relevant framework.

Complaints and Dispute Procedure

73. The CCG's approach to contestability means that it may pursue a wide range of

competitive procurements to secure new and existing services.

74. The CCG has developed the processes that will be followed within the CCG that

enables any potential dispute relating to a procurement process or outcome from

any procurement to be resolved in an open and transparent manner.

75. The CCG will utilise a dispute resolution process (Appendix 3) to address and

resolve any complaint in relation to competition and procurement received from

either:

• Bidders/contractors,

• A member of the public.



76. This will at first require writing to the CCG Accountable Officer, as described in

the dispute resolution process.

ADDITIONAL CONSIDERATIONS

Data Privacy Impact Assessment

77. Where any new service is required it will be necessary for a data privacy impact

assessment (DPIA) to be completed. The project lead should liaise with the SCW

information governance lead and/or CCG Data Protection Officer to complete a

DPIA prior to selection of provider which should by updated once the provider is

identified.

Equality Impact Assessment

78. As with the DPIA above, a similar process should be completed for an equality

impact assessment. The project lead should liaise with the engagement and

diversity officer.

Quality Impact Assessment

79. As with both tools above, a similar process should be completed for a quality

impact assessment. The project lead should liaise with the CCG Quality Team

Sustainable procurement

80. The CCG is committed to the principles of sustainable development. Sustainable

procurement is defined as a process whereby organisations meet their needs for

goods, services, works and utilities in a way that achieves value for money on a

whole life basis in terms of generating benefits not only to the organisation, but

also to society and the economy, whilst minimising damage to the environment.

Public Services (Social Value) Act 2012

81. Social value is a way of thinking about how scarce resources are allocated and

used. It involves looking beyond the price of each individual contract and looking

at what the collective benefit to a community is when a public body chooses to



award a contract. The CCG should consider social value when evaluating

proposals from providers.

Code of Conduct (GP Conflict of Interest)

82. When commissioning services for which GP practices could be potential

providers, the Procurement Team will refer to the advice and guidance published

by NHS England. Conflicts could arise where the CCG commissions healthcare

services, including GP services, in which a member of the CCG has a financial

or other interest. It will need to be considered in respect of any commissioning

issue where GPs are current or potential providers.

Voluntary and community sector/Small and Medium Enterprises Support

83. The CCG will aim to support and encourage voluntary and community sector

and small and medium enterprise suppliers in bidding for contracts. The

Procurement Team will work with service commissioners to ensure that

competitive tender processes promote equality and do not discriminate on the

grounds of age, race, gender, culture, religion, sexual orientation or disability.

Integrated Support and Assurance Process (ISAP)

84. The CCG must consider this process for all novel and complex contracts and

work with NHS England and NHS Improvement to run a rigorous assurance

process alongside procurements which fall under the ISAP jurisdiction.

RECOMMENDATION

85. The Primary Care Commissioning Committee is asked to approve/the following: a. Process for Managing a Procurement

AGENDA ITEM NO:


Appendix 1 – Procurement route decision making process

AGENDA ITEM NO:


Appendix 2

Regulation (EU) No 537/2014 of the European Parliament and of the Council of 16 April 2014 on specific requirements regarding statutory audit of public-interest entities and repealing Commission Decision 2005/909/EC Text with EEA relevance

An evidence requirement of external auditors relates to whether the CCG Audit Committee has issued guidelines with regard to the services allowed by way of derogation under Regulation 537/2014, Article 5 (3), paragraph 3, provided certain requirements are complied with.

Regulation 537/2014, Article 5 (3), paragraph 3 reads as:

By way of derogation from the second subparagraph of paragraph 1, Member States

may allow the provision of the services referred to in points

(a) (i) (i.e. preparation of tax forms);

(a) (iv) to (a) (vii)

(iv) i.e. Identification of public subsidies and tax incentives unless

support from the statutory auditor or the audit firm

(v) i.e. Support regarding tax inspections by tax authorities unless

support from the statutory auditor or the audit firm in respect of such

inspections is required by law;

(vi) i.e. Calculation of direct and indirect tax and deferred tax;

(vii) i.e. Provision of tax advice;

And (f), (valuation services, including valuations performed in connection with

actuarial services or litigation support services);

Provided that the following requirements are complied with:

(c) (Aka paragraph 3) “the principles of independence laid down in Directive

2006/43/EC are complied with by the statutory auditor or the audit firm”.

This paragraph duly provides this guidance in stating that:

(a) None of the above listed services are provided to the CCG by its

external auditor, and hence it retains its independence as required

by (c) (Aka paragraph 3) above.

AGENDA ITEM NO: 020/19 (i)

PMS Premium Redistribution Funding – 2018/19 NHS Warrington CCG Primary Care Commissioning Committee Meeting 5th March 2019

COMMITTEE MEETING:


DATE OF MEETING:

6th March 2019


Dr Sangeetha Steevart, GP Clinical Lead for Primary Care,

REPORT TITLE:

PMS Premium Redistribution Funding – 2018/19





✓



✓


✓


Approval

✓ Assurance

Discussion

✓

Information

✓

EXECUTIVE SUMMARY

This paper 1. Provides an update position to the committee with respect to the commitments and/or

proposed services provided against the PMS redistribution funding the summary of which is detailed in the table below.

Funding Available 2018/19 Circa £900,000

Committed:

Extended Access & Homeless Services at The Medi-Centre, Warrington £ 50,000

Pilot Scheme – Acute Visiting Service £112,000

Bank Holiday Opening £130,000

Diagnostic Bundle: ECGs £250,000

Funding to meet aspirations within the PCN Funding Bids £215,000

Revised Model Acute Visiting Service TBC



RECOMMENDATIONS

The Primary Care Commissioning Committee is asked to:-

1. Note the contents of the report and the commitment against the PMS premium redistribution funding

2. Approve the installation of additional network points for ECG machines for those practices that demonstrate a business case for more than one network point.


Engagement held via GP Bulletin and Commissioning PLT with GP practices and GP principals in Warrington


Dr Sangeetha Steevart is a GP Principal in Warrington


No


Yes

N/A


✓


✓


✓


✓





INTRODUCTION

1. NHS Warrington CCG must ensure that the funding it receives through PMS

premium redistribution is spent fairly and transparently and is linked to quality

of care for patients or the particular needs of the local population.

2. This paper summarises, for the current year, the funding available and the

commitments to date.

3. There remains a requirement to ensure that the appropriate governance is in

place to ensure that the CCG discharges appropriate responsibility in

committing and spending this funding. This action remains outstanding but the

Finance & Performance Committee has required the Audit Committee Chair to

review this and make a recommendation.

2018/19 SUMMARY TABLE

4. The table below details the committed and proposed spend for 2018/19

Funding Available 2018/19 Circa £900,000

Committed/Approved:

Extended Access & Homeless Services at The Medi-Centre, Warrington £ 50,000

Pilot Scheme – Acute Visiting Service £112,000

Bank Holiday Opening £130,000

Diagnostic Bundle: ECGs £250,000

Revised Model for Acute Visiting Service TBC

Funding to meet aspirations within the PCN Funding Bids £215,000

5. The financial commitment against the extended access & homeless services

provided by The Eric Moore Partnership at the Medi-Centre in Warrington reflects

the NHS Warrington CCG obligation to correct an error in process which has come

to light with respect to services provided by the practice through its PMS funding.

These services provided by the practice were deemed by NHS England as “above

core contract” and therefore the CCG must provide for this commitment whilst it

continues the review process. It is therefore correct and prudent to commit the full

year effect of this service.



DIAGNOSTIC BUNDLE ECGS - £250,000

6. At its meeting on 4th July 2018 the committee agreed to support the

commitment of £250,000 for NHS Warrington CCG to work in partnership with

Warrington and Halton Hospitals NHS Foundation Trust for an interpretation

service for ECG’s and 24 hour tapes in practices and branch surgeries across

the Warrington footprint, procuring the necessary equipment via a lease

agreement.

7. This scheme continues to work to the mobilisation plan with network points

being installed in practices across Warrington in advance of service

commencement. The committee previously approved one network point per

practice however since then several practices have requested more than one

network point to support their ways of working. This is a reasonable request

and the committee is asked to approve the installation of more than one

network point for practices that provide a business case to support the request.

The additional funding to come from the slippage against this scheme.

8. Given the slippage in 2018/19 the funding commitment against this scheme

remains unchanged even with the approval of additional network points.

HOME VISITING (ACUTE) SERVICE PROPOSAL

9. The service, after a delay due to staffing is now in place. The changed staffing

model does mean that the scheme, if it is to continue will need to be re-evaluated

and a revised specification produced.

£1/HEAD TO CLUSTERS FOR THE DEVELOPMENT AND IMPLEMENTATION OF

PROPOSALS TO SUPPORT PRIMARY CARE NETWORKS

10. The committee agreed to award each practice/cluster the sum of £1 per head to

support the delivery of the proposals to support primary care and primary care

networks.

11. Contract variations have been enacted and that schemes are mobilised to

ensure that before the financial year end they have been completed.



RECOMMENDATIONS

12. The Primary Care Co-Commissioning Committee is asked to:-

i. Note the contents of the report and the commitment against the PMS premium redistribution funding

27th February 2019 Dr Sangeetha Steevart GP Clinical Lead for Primary Care NHS Warrington CCG


PMS Premium Redistribution Funding – Bank Holiday Opening NHS Warrington CCG Primary Care Commissioning Committee Meeting 5th March 2019

COMMITTEE MEETING:


DATE OF MEETING:

6th March 2019


Pam Broadhead Chief Primary Care Officer

REPORT TITLE:

PMS Premium Redistribution Funding – 2019/20 Bank Holiday Opening




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Approval

✓ Assurance

Discussion

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Information

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EXECUTIVE SUMMARY

• At its January 2019 meeting the committee requested a paper to consider the continuation into 2019/20 of bank holiday opening.

• Bank holiday opening as a service specification that commenced in 2018/19 as a pilot service to determine whether there is an evidence base to commission this service (from the GP practices in Warrington) as a routine offer to support the out of hours and extended access offer both locally and nationally.

• This paper summarises the review of the 2018/19 service and makes recommendations for 2019/20. The recommendations are such that practices who were unable to accept the offer can collaborate with other practices to ensure that the service offer is equitable.

The committee is asked to note that there is a potential for conflict of interest from committee members who are GPs in Warrington or members who are employed in a Warrington practice and the author would recommend their inclusion in any discussion but their exclusion from any decision making vote.



RECOMMENDATIONS

The Primary Care Commissioning Committee is asked to: -

1. Approve the development and offer of a revised service specification for bank holiday opening that incorporates more formal collaboration at Network level.

2. Approve into 2019/20 a maximum reimbursement per practice equivalent to £1,000 per practice on each agreed date

3. Delegate the approval of the specification to the Primary Care Operational Group with formal sign off via the Integrated Management Team.



Members of the committee who are employed by or who work in practices in Warrington


No


Yes

N/A


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INTRODUCTION

1. At its January 2019 meeting the committee requested a paper to consider the

continuation into 2019/20 of bank holiday opening.

2. Bank holiday opening as a service specification that commenced in 2018/19 as

a pilot service to determine whether there is an evidence base to commission

this service (from the GP practices in Warrington) as a routine offer to support

the out of hours and extended access offer both locally and nationally.

3. This paper summarises the review of the 2018/19 service and makes

recommendations for 2019/20. The recommendations are such that practices

who were unable to accept the offer can collaborate with other practices to

ensure that the service offer is equitable.

2018/19 SUMMARY DATA

4. Following the delivery of each bank holiday opening each practice was required

to complete a template detailing the outputs of the service. In addition, each

patient was asked to complete a satisfaction survey. The results of the data

extraction are shown in Appendix 1.

5. On average, across Warrington when the service is in operation

an additional 142 GP appointment slots are available

30 nursing homes are contacted to discuss any primary medical care

support required for their residents (each nursing home rung will have

3 or more residents from the practice)

6. The patient feedback was unanimously in support of the scheme with

comments such as

“Good to see a GP who knows you”

“Good service”

“During the winter period it is good to see the practice is open”



“Very grateful the practice was open otherwise I would have gone to

A&E”

“More convenient for older people”

“Good to see your own doctor when you are ill”

7. The average cost per appointment, factoring in the number of practices open

and factoring in the contacting of the nursing homes is £42.86.

SUGGESTED IMPROVEMENTS FOR THE SCHEME

8. On average only 9 practices accepted the offer to open on a bank holiday which

means that 17 practices have not. It is important that all patients in Warrington

and their practices benefit from the outcome of the service and that there is

equity of provision. This service not only supports primary care but also

supports the urgent care system within Warrington.

9. The suggestion for improvement is that the current service specification is

amended to formally enable resource sharing by practices to allow either a GP

or a GP locum to work out of practices that have accepted the offer. Patients

of those practices would then buddy up with another practice will need to travel

to the alternative practice location but would be seen by their own GP, or a GP

working for that practice with full access to their records. The suggestion would

be that the buddy arrangement is within the geographical Network. The

unintended benefit would be that a shared reception resource would be in place

for those practices offering the service in this way.

10. The new workforce solution for relief and locum GPs would be the preferred

option to source any locum requirements and it is proposed that this in factored

into the specification.

11. During 2019/20 further evaluation should continue with exploration by the

primary care commissioning team on how a future bank holiday opening offer

should be commissioned in line with the framework for primary care to

implement the Long Term Plan and the CCGs review of extended access.



RECOMMENDATION

12. The Primary Care Commissioning Committee is asked to: -

i. Approve the development and offer of a revised service specification for

bank holiday opening that incorporates more formal collaboration at

Network level.

ii. Approve into 2019/20 a maximum reimbursement per practice

equivalent to £1,000 per practice on each agreed date

iii. Delegate the approval of the specification to the Primary Care

Operational Group with formal sign off via the Integrated Management

Team.

PAM BROADHEAD CHIEF PRIMARY CARE OFFICER 27TH FEBRUARY 2019



Appendix 1 – Data Summary

Practice Hours Offered

Birchwood 9-1 16 11 2

Chapelford 9-1 16 12 2

Cockhedge 8-12 0 0 Yes

Culcheth Medical Centre 9-1 16 10 1

Dallam Lane 8am - 12pm 16 12 3

Padgate 8.30-12.30 16 8 3

Helsby Street 8-12 16 8 0

Stockton Heath 8.30-12.30 16 9 0

Stretton 10-2 16 12 3

Westbrook 9-1 16

10 (7 patients were

seen as there were

3 DNAs

0

28th May 2018 Number of

slots

Number of pre-

bookable slots

Number of same-

day


Birchwood 9 am- 1 pm 16 12 0

Causeway 8.00-12.00 16 12 0

Chapelford 9am - 1pm 15 15 1

Cockhedge 08-12 midday 19 19 5

Culcheth Medical Centre 9-1pm 16 slots 8 8

Dallam Lane 10.30am - 2.30pm 16 slots 12 slots 1

Padgate 8.30-12.30 16 8

Helsby Street 8.00am -12.00pm 16 8 0

Stockton Heath 8.30am to 12.30pm

12 face to

face and 4

telephone

consultatio

ns

9 face to face (4

available on-line from

23 August, 5 via

telephone from 24

August) and 4

telephone

consultations. The

Practice has learnt

from previous bank

holidays to prebook

majority rather than

being left with empty

consultations

0 - all appointments booked

prior to Monday- some

appointments were booked

on-line over the weekend.

1 appointment slot was left

unfilled and 1 patient did not

attend. Saw one temporary

patient. No calls received

from 111.

Stretton 10am - 4pm 24 18 6

Number of

slots

Number of pre-

bookable slots

Number of same-day

appointments used

27th August 2018




Cockhedge 8-12pm 24 24 9

Dallam Lane 10.30am - 2.30pm 16 12 1

Eric Moore 9.00-1.00 16 9 0

Greenbank 8-12pm 16 12 2

Helsby Street 8-12pm 32 24 2

Penketh 9.30-1.30 16 8 6



26th December 2018 Number of

slots

Number of pre-

bookable slots

Number of same-

day


Cockhedge 8-12pm 24 24 10

Dallam Lane 1pm - 5pm 16 12 1

Eric Moore 9.00-1.00 16 9 1

Greenbank 11.00-3.00 16 12 0

Helsby Street 8-12pm 16 12 1

Penketh 10.00 to 14.00 16 8 0



1st January 2019 Number of

slots

Number of pre-

bookable slots

Number of same-day

appointments used

Agenda Item: 020/19 iib

SCHEDULE 2 – THE SERVICES

A. Service Specifications

Service Specification number.

1

Service Local Enhanced Service (to support implementation of the Warrington Brand) Bank Holiday Opening

Commissioner Lead Marie-Ann Hunter, Senior Commissioning Manager for Primary Care

Provider Lead GP Practices Warrington

Period 18th May 2018 – 31st March 2019

Date of Review 1st April 2019

1. Population Needs

1.1 National/local context and evidence base Patients benefit from direct and easy access to clinicians who have access to their clinical records, can assess their condition and advise them about the best course of action needed to assist with their health or medical problem whether this is during routine opening or whether this is at weekends or on bank holidays.

This service is a pilot service during the financial year 2018/19 and will run on at least one of the following bank holiday dates to determine whether there is an evidence base to run this service as a routine offer in Warrington to support the out of hours and extended access offer both local and national:

• Monday 28th May 2018

• Monday 29th August 2018

• Wednesday 26th December 2018

• Tuesday 1st January 2019

2. Outcomes

2.1 NHS Outcomes Framework Domains & Indicators

Domain 1 Preventing people from dying prematurely

Domain 2 Enhancing quality of life for people with long-term

conditions

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Domain 3 Helping people to recover from episodes of ill-health or

following injury

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Domain 4 Ensuring people have a positive experience of care ✓

Domain 5 Treating and caring for people in safe environment and

protecting them from avoidable harm

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2.2 Local defined outcomes

• This service provision will seek to increase the type of sustainable access over bank holidays


3. Scope

Aims and objectives of service The aim of this service provision is to:

i. provide the registered population of the practice with a primary care access offer at their registered practice

ii. increase patient satisfaction in regards to access to services iii. reduce demand on other NHS urgent care services iv. increase the availability of primary care medical care v. offer convenience and choice to patients vi. improve the continuity of care

Service description/care pathway

i. Practices will operate for an agreed minimum four hour period on at least one of the

following dates: ▪ Monday 28th May 2018 ▪ Monday 29th August 2018 ▪ Wednesday 26th December 2018 ▪ Tuesday 1st January 2019

ii. Practices should offer predominantly (75%) pre bookable routine appointments iii. Minimum staffing levels will include a General Practitioner and appropriate

administrative support iv. The practice will offer at least 16 General Practitioner appointments providing routine,

pre bookable/same day services and telephone advice & guidance. v. The General Practitioner will have full access to the patient record and electronic

prescribing vi. There should be equitable booking/access to these appointments for all patients

registered with the practice vii. Practices must make available a telephone number for patients contacting NHS 111 to

be directed to the practice during the first two hours of opening to utilise the unbooked slots. This will enable patients to access primary care services during the period of opening. This information must be provided at least 3 working days before the date of opening to NHS Warrington CCG

viii. The Practice will contact by telephone any care homes where the practice have 4 or more registered patients to actively offer advice and guidance.

Population covered

This service provision is available to all eligible registered patients with the practice

4. Applicable Service Standards

4.1 Applicable national standards (eg NICE) The Provider will ensure appropriate CQC registration, in line with Registration under the Health and Social Care Act 2008 4.2 Applicable standards set out in Guidance and/or issued by a competent body (eg Royal Colleges) The Provider has a duty to ensure that all staff involved in the provision of the service remain appropriately trained, aware and operate within local protocols. The Provider will carry out clinical audit of the care of patients against this criteria, including untoward incidents.


4.3 Applicable local standards

Local Policy Context

• Health and Wellbeing Strategy (2015-2018)

• Primary Care Strategy

• Together We Strategy (2016)

• CCG Commissioning Intentions

• CCG Operational Plan

4.4 Risk Management

The Provider will operate in accordance with all Acts of Parliament, statutory regulations or other such laws, recommendations, validated or approved guidance or practices as may affect the provision for services specified under the Agreement

Any litigation resulting from an accident or negligence on behalf of the service provider is the responsibility of the service provider who will meet the costs and any claims for compensation, at no cost to the commissioner

The Provider must ensure that their professional indemnity insurance provider has confirmed that this activity will be included in their policy

4.5 Complaints The Provider should inform NHS Warrington CCG of any complaints or adverse incidents that occur during the period of this service within 3 working days. 4.6 Breach of Contract Breach of the conditions of this contract may result in a reduction or withdrawal of payment and cancellation of this contract Those matters which would be regarded as breach of contract are as follows:

• Failure to comply with any of the terms of the agreement without reasonable cause

• Inability to provide any of the agreed monitoring information without reasonable cause Should any of the above be demonstrated through the normal monitoring procedures, NHS Warrington CCG will consider

• Whether payments under the scheme should be suspended

• Whether any payments should be recovered, or

• Whether payment should cease altogether and the scheme is terminated This would be done in full consultation with the Provider

5. Applicable quality requirements and CQUIN goals

5.1 Applicable Quality Requirements (See Schedule 4A-C)

5.2 Applicable CQUIN goals (See Schedule 4D)


5.3 Local Quality Requirements

The following local quality requirements will be in place for all four bank holidays that this service is available during 2018/19. Practices will be required to demonstrate assurance to the CCG across all areas to qualify for payment.

At least 3 working days prior to each service offer

• Inform the CCG on [email protected] as to the opening times of the practice

• Inform the CCG on [email protected] as to the contact number for patients during the opening times of the practice

• Promote the service to patients registered with the practice for example on posters and on the website

During the service offer

• Distribute to, and collect from, all patients a satisfaction questionnaire

Within 3 working days after the service offer

• Inform the CCG of the total number of slots offered

• Inform the CCG of the number of pre-bookable slots used

• Inform the CCG of the number of same day appointments used

• Inform the CCG of the number of care homes contacted

• Inform the CCG of the number of patient contacts other than GP appointments

Within 10 working days after the service offer

• Send written feedback to the CCG of the summary outcomes of the patients satisfaction questionnaire including any lessons learnt to support future commissioning processes

6. Location of Provider Premises

The Provider’s Premises are located at: Primary Care GP Practices Warrington Cheshire

7. Performance and Payment

7.1 Payment Claims for payment will need to be submitted within 30 days of the service offer

Frequency Criteria Payment

Per each bank holiday opening period

Minimum opening time of 4 hours and receipt of all information detailed at 5.3

£1,000

mailto:[email protected]

mailto:[email protected]


The Provider will send the contract monitoring form electronically (see 5.3) to the CCG, and the associated invoice to SBS (at the same time) after each opening period. The CCG reserves the right to undertake a Post Payment Verification quality audit 7.2 Patient Experience Patient experience will be audited using feedback patient satisfaction questionnaires distributed by the Provider. All patients should be invited to put their patient identifier on the questionnaire, if they so wish. The questionnaire should be given to the patient following their appointment The Provider will need to demonstrate, where relevant, lessons have been learnt or changes made, as a result of reviewing patient feedback. The Provider will also notify the CCG of any recommendations to support the commissioning process.

020/18 iii Blue Stream Academy Funding Request from PMS Redistribution Funds NHS Warrington CCG Primary Care Commissioning Committee March 2019

MEETING:


DATE OF MEETING:

6th March 2019


Marie-Ann Hunter Senior Commissioning Manager for Primary Care

REPORT TITLE:

Blue Stream Academy Funding Request from PMS Redistribution Funds.




Sustained financial balance ✓





Approval

✓ Assurance

Discussion

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Information

EXECUTIVE SUMMARY

The Blue Stream Academy is a service provider who has designed a suite of interactive training modules which are easy to use, in line with CQC Outcomes, cost effective and provide proof of competency for GP Practices. The software enables practices to have access to information, training and template policies which in turn assist with maintaining CQC standards and meeting the requirements of their contracts. Practices in Warrington have collaborated in their use of this software and secured an agreement with the provider to meet their needs but to date have used funding provided by the CCG for the creation and maintenance of the electoral colleges/federations. This paper seeks permission to use PMS premium redistribution funding to pay for this service to ensure that the electoral college/federation funding is utilised to support practices in their commissioning roles. RECOMMENDATIONS


Approve the funding of £23,820.36 (total for two-year period) for Blue Stream Software to support all GP Practices across Warrington.

AGENDA ITEM NO: 020/19 (iii)



None


None


None at this stage


Yes

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Purpose of the Report

1. The purpose of this report is to request funding from the PMS redistribution funds for Blue Stream Academy software to be available for all GP Practices across Warrington. Given the potential conflict of interest of the Primary Care GP clinical lead this paper is brought to the committee by the Senior Commissioning Manager for Primary Care.

Background

2. Following concerns raised by the chairs of the federations in Warrington Dr Andrew Davies and Marie-Ann Hunter attended a meeting with the chairs to discuss running costs. The Chairs requested the meeting to discuss the current funding and associated expenditure for the four federations in Warrington which they considered insufficient to meet their running costs.

3. The committee is informed that in Warrington there are effectively four electoral colleges historically called federations who are practices who have similar profiles who come together to discuss and agree healthcare commissioning. The NHS Warrington CCG constitution requires there to be 4 elected GP members and these four members are elected from each of the federations hence the reference to electoral colleges.

4. The meeting considered how the funding is currently spent and it was noted that

a large proportion of the federation budget is currently used to fund the Blue Stream Academy software. The meeting discussed how this software is pivotal to practices as it enables access to mandatory training and assists with compliance for the CQC and NHS England contracts and without this software Practices may struggle to achieve compliance.

5. The meeting agreed that the CCG would take an action to explore an alternative funding stream for the software so that the allocation for electoral college/federations could be utilised to support, as intended, the meetings. It was agreed by the Federation Chairs that if the funding could be sourced elsewhere then the financial allocation for the operation of the federations would be sufficient.

6. 24 Practices currently use Blue Stream at a reduced rate of £0.05 + VAT per patient and practices are in their first year of a two-year contract which expires on 30/09/2020.

7. The Committee is asked to approve the funding of £23,820.36 to reimburse Practices for this cost. The reimbursement route would be through the NHS Standard contract in place with practices and would have a corresponding specification requiring that the funding is used for the software.

Recommendations


i. Approve the funding, from the PMS Redistribution provision of £23,820.36 total

price for two years until 2020.


Primary Care communications strategy Warrington CCG Primary Care Co-Commissioning Committee Meeting 6th March 2019

COMMITTEE MEETING:

Primary Care Co Commissioning Committee

DATE OF MEETING:

6th March 2019


Maria Austin, Chief of Public Affairs and Engagement

REPORT TITLE:

Primary Care Communications Action Plan







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Approval

Assurance

Discussion

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Information

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EXECUTIVE SUMMARY

This update details the work planned for the CCG’s communications team to support effective communications and engagement across Primary Care.

RECOMMENDATIONS

The committee is asked to:

• Note the updated action plan and activity that has taken place




Primary Care


N/A




Yes

N/A


x


x


x


x



N/A

Primary Care Communications activity action plan

Communications activity Themes Purpose of activity/messages

Lead

Start date Link to

national/local priorities

Internal/external Comments/status

GP Five year Forward View • Care redesign

To inform all key stakeholders on developments to the redesign of general practice as they emerge.

ZG/ PT TBC

✓ External To be developed when

Improvement Manager in post.

• Care

navigation/effective signposting

All administrative posts across primary care receiving care navigation and effective sign posting training.

ZG/PT

From Jan 2018 ✓

External/internal Phase 1 signposting - completed Phase 2 – To be developed

• Investment

Informing Primary Care colleagues about the proposed investment into Primary Care by the CCG/NHS England.

ZG/PT

Ongoing ✓

External/internal Ongoing – updates as necessary via existing channels

• Estates

To inform members of the public in how the CCG, together with NHS England, will develop the Primary Care estate.

ZG/NA/NHS E

On going ✓

External Current focus in place - Chapelford, GSH

• Workforce

Focus is utilising workforce differently to develop news ways of working across Primary Care

ZG/PT

On going ✓

Link with: Warrington Together Cluster development GOP Five Year Forward View

• Supporting patients to self-care (how to keep well throughout the year)

To help to relieve the pressure on GPs and A&E departments; ensure the best use of medicines; help to drive better value and improve patient outcomes. This work is already underway in Warrington as part of the Mid Mersey seasonal communications plan across the area. This plan covers how to stay well through the seasons.

ZG/PT

On going

✓

External Ongoing: Winter campaigns Cluster initiatives Links to Public Health

• Online consultation Approach in Warrington currently being scoped.

ZG/PT TBC

✓ Internal/external To be developed when

Improvement Manager in post.

• Releasing time for

practices

To ensure that practices are engaged with RTFC programme, focussing on the ten high impact changes

ZG/PT

TBC ✓

Internal Workshops are on-going. Final one Dec 2018 Further comms required following meeting

Communications activity Themes Purpose of activity/messages

Lead

Start date Link to

national/local priorities

Internal/external

Delegation • Support the CCG To inform Primary Care about how MAH/Maria TBC Internal/external Completed. CCG received

going fully delegated and taking full commissioner responsibility for Primary Care

NHS England will transfer full commissioner responsibility to the CCG for Primary Care. To inform members of the public, for their reference, about delegation. Assure Primary Care that the CCG is prepared to receive and effectively deliver delegated responsibility. A full communication strategy will be developed to support the implementation of delegation.

Austin ✓ full delegation onn1st Sept 2018. Managed through contract meetings.

Local Enhanced Service (LES)

• Support the Primary Care Commissioning team in communicating with Primary Care about the LES

To develop effective channels to communicate LES requirements.

ZG/PT

March 31st 2019

✓ Internal Completed. Managed through individual contract meetings and clinical leads updates

Procurement

• Support the Primary Care Commissioning team with communications around Primary Care procurements

To inform Primary Care of the CCG’s approach to any procurements to ensure an open and transparent process.

ZG/PT

On going ✓ Internal On going in line with commissioning intentions. GP5YFV procurement process

Paper Switch Off

• Ensure that Primary Care are adequately informed and prepared for the full implementation of paperless referrals

To ensure that Primary Care is aware of the timeframes of change and support them through implementation.

ZG/MA

Implementation completed Feb 2018. Monitoring throughout the year

✓ Internal Completed

Cluster development

• Ensure that Primary Care clusters are fully engaged in all Primary Care developments

To ensure that clusters are at the heart of all Primary Care planning and developments through Warrington Together

ZG/PT

On going ✓ Internal/external

Cluster maturity model

• Engaging with clusters to implement a phased approach to working together across a central footprint

To ensure that clusters are at the heart of all Primary Care planning and developments

ZG/PT

On going ✓ Internal

Self-care • Self-care

(consultation, phase two)

To inform patients/public about the change proposal and the outcome of the consultation that will see more self-care medicines added to the list of medicines that will not be routinely prescribed, rather patients will be required to buy these over the counter.

ZG/PT

Completed Feb 2018

✓ External/internal Completed

Key: ZG - Zoe Graham MAH - Marie Ann Hunter PT - Primary Care Team NA - Nick Armstrong

MA - Melanie Alsop Last updated: 20th November 2018

warrington clinical commissioning group joint … · presentation dr r raj 014/19 investment and...

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