Primary Care Committee Agenda · Carol Varlaam (CV) Lay Member, Patient and Public Involvement Katie Bugler (KB) Director of Primary Care Transformation Stephen Hickey (SH) Lay member,

W A N D S W O R T H C C G P A G E 1 O F 1

Board Intelligence Hub template

Primary Care Committee Agenda

Meeting of the Primary Care Committee

Thursday 23rd January 2020

15:00 – 17:00

Nightingale House

AGENDA – PART 1

P A R T A | M E E T I N G O P E N S T A R T D U R A T I O N

A01 Apologies, Declarations, Quorum Pg.2 CV 15:00

5 mins

A02 Chair’s Opening Remarks CV 15:00

A03 Minutes: Approval and Status of Actions Pg.6 CV 15:00

A04 Decisions ratified outside of the meeting since

the last meeting on 3rd September 2019 CV 15:00

P A R T B | D E C I S I O N S A N D D I S C U S S I O N S

B01 NHS Digital Update Pg.16 KB 15:05 30 mins

B02 PCN Development Update incl. additional roles

reimbursement update Pg.37 HP 15:35 10 mins

B03 Integrated Primary Care Commissioning Paper

incl finance Pg.53

KS, EG

and

NMD

15:45 15 mins

B04 PMS Specification Review Pg.69 TS 16:00 10 mins

B05 Governance of Primary Care across SWL Pg.80 KB/AMc 16:10 15 mins

B06 Any Other Business CV 16:25 5 mins

P A R T C | P A R T 1 M E E T I N G C L O S E

C01 Chair’s Closing Remarks CV 16:30 5 mins

C02 Close of Part 1 16:30

C03

Date of next meeting

Tuesday 3rd March 2020 at 09:30 am

Nightingale House

W A N D S W O R T H C C G P A G E 1 O F [ X ] W A N D S W O R T H C C G P A G E 1 O F [ X ]

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Register of Interests (updated November 2019)

All GPs have declared an interest in Primary Care Networks

Name

Current position (s) held in the CCG i.e.

Governing Body member; Committee

member; Member practice; CCG

employee or other

Do you

have any

interests to

declare?

(Y or N)

Declared Interest

(Name of the organisation and nature of business)

Fin

anci

al In

tere

st

No

n-F

inan

cial

pro

fess

ion

al

Inte

rest

No

n-F

inan

cial

Pe

rso

nal

Inte

rest

Ind

ire

ct

Inte

rest

Nature of Interest

From To

Action taken to mitigate

risk

James Blythe Managing Director

Governing Body Member

Member of Executive Management

Team

Member of Primary Care

Commissioning Committee

Member of Finance Committee in

Common

Member of Integrated Governance

Quality Committee

Y

1. Spouse is no longer an employee of St George's University Hospitals NHS

Foundation Trust and has a specialist training number with HEE South London

2. Spouse is an employee of Kingston Hospital from Oct 2019.

1

2

1. May 2017

2. Oct 2019

1. Oct 2019 I am not present at specific

discussions relating to the

relevant service.

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Name




employee or other

Do you

have any

interests to

declare?

(Y or N)

Declared Interest


Fin

anci

al In

tere

st

No

n-F

inan

cial

pro

fess

ion

al

Inte

rest

No

n-F

inan

cial

Pe

rso

nal

Inte

rest

Ind

ire

ct

Inte

rest

Nature of Interest

From To


risk

Neil McDowell Director of Finance for Merton and

Wandsworth CCGs

Member of Governing Body, Merton

and Wandsworth CCGs

Member of Finance Committee, Merton

and Wandsworth CCGs

Member of Audit & Governance

Committee, Merton and Wandsworth

CCGs

Member of Primary Care Commissioning

Committee, Merton and Wandsworth

CCGs


Committee

Member of Integrated Governance and

Quality Committee

Y

1. Spouse is Chief Finance Officer for Surrey Heartlands CCGs. 1 Adherence to COI policy

Julie Hesketh Director of Quality and Corporate

Governance, LDU

Member of Governing Body Merton and

Wandsworth


Committee


Quality Committee

Member of Audit and Governance

Committee Merton and Wandsowrth

Y

1. Personal involvement in Richmond Education Network (not for profit organisation).

This is done outside of CCG hours.

1 Adherence to COI policy

Katharine (Katie) Bugler Director of Primary Care Transformation

Member of MCCG Governing Body

Member of WCCG Board

Member of LDU Clinical Oversight Group


Team

Member of Merton Primary Care

Committee

Member of Wandsworth Primary Care

Committee

N

No interests declared Adherence to COI policy

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Name




employee or other

Do you

have any

interests to

declare?

(Y or N)

Declared Interest


Fin

anci

al In

tere

st

No

n-F

inan

cial

pro

fess

ion

al

Inte

rest

No

n-F

inan

cial

Pe

rso

nal

Inte

rest

Ind

ire

ct

Inte

rest

Nature of Interest

From To


risk

John Atherton Director of Performance Improvement

Member of Governing Body


Quality Committee


Committee

Interim Director of Commissioning (from

November 2019)

N


Stephen Hickey Wandsworth CCG - Governing Body

(Vice Chair);

Lay Member, Governance Wandsworth -

Health and Wellbeing Board;

LDU and SWL Finance Committee in

Common;

Audit Committee (Chair); Remuneration

Committee (Chair);

Workforce Committee;

Primary Care Committee;

Integrated Quality & Governance

Committee

Y

1. Trustee for Merton Community Transport Charity.

2. Occasional consultancy with Eastside Primetimers (voluntary sector consultancy

organisation).

3. Chair Designate, Healthwatch Wandsworth (to take effect April 2020)

2

3

1 1. 01/12/2017

2. 2012

3. April 2020

Transparency if relevant

issues arise and declare if

EP bid for work related to

the CCG.

Dr Mike Lane Governing Body voting member

CCG Deputy Clinical Chair

Joint Wandle Locality Lead

Member of Integrated Governance

Quality Committee member

Wandsworth Primary Care Committee

member

Y

1. Non-partner GP, Grafton Medical Partners (Grafton Primary Care Network)

2. Practice is a member of Battersea Healthcare CIC but Dr Lane holds no director post

and has no specific responsibilities within that organisation other than those of other

member GP.

3. London Maternity Lead, Royal College of General Practitioners.

4. Volunteer Doctor - Crisis Homeless charity.

5. Volunteer Doctor - St Johns Ambulance Charity.

6. Member - National Maternity Transformation Board Stakeholder

1

3

6

4

5

1. 2019

2. 2014

3. 2006

4. 2006

5. 2016

6. 2016

1-6 Adherence to COI

policy

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Name




employee or other

Do you

have any

interests to

declare?

(Y or N)

Declared Interest


Fin

anci

al In

tere

st

No

n-F

inan

cial

pro

fess

ion

al

Inte

rest

No

n-F

inan

cial

Pe

rso

nal

Inte

rest

Ind

ire

ct

Inte

rest

Nature of Interest

From To


risk

Dr Kieron Earney Joint West Wandsworth Locality Lead

Y

1. GP Partner, Putneymead Group Medical Practice.

2. Putneymead is a member of Battersea Healthcare CIC although I hold no role within

that organisation.

3. Putneymead Group Medical Practice is a member of the West Wandsworth Primary

Care Network.

1

2

1. July 2016 1. and 2 adherence to COI

policy

Chris Savory Lay Member, Finance

LDU Finance Committee

Wandsworth Audit Committee

Wandsworth Primary Care Committee

Y

1. Chair of Lyme Regis branch of the Liberal Democrats. 1 1. Oct 2019 Adherence to COI policy

Dr Waqaar Shah Wandsworth CCG Governing Body

member.

Joint Wandle Locality Lead.

Wandsworth Health and Wellbeing

Board member.

Finance Committee in Common.

Y

1. GP partner at Chatfield Health Care (practice is a member of Battersea Healthcare

CIC and of Wandsworth Primary Care Network).

2. Chairman of the Neonatal Infection Guideline Committee, National Institute for

Health and Care Excellence.

3. Royal College of General Practitioners National Representative in Eye Health.

4. Eye Health Forum member, Department of Health.

5. Board member, Clinical Council for Eye Health Commissioning.

6. Honorary Treasurer, Section of Primary Care and General Practice, Royal Society of

Medicine.

7. Expert Adviser, Centre for Guidelines, National Institute for Health and Care

Excellence.

1

2

3

4

5

6

7

1. 2017

2. 2018

3. 2017

4. 2017

5. 2017

6. 2017

7. 2018

1-7 To declare this interest

at the start of any meeting

where a conflict may be

relevant; to discuss with

the chair at the outset

whether participation is

possible or appropriate; to

step out of meetings or

decision making if the

conflict cannot be

managed

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Name




employee or other

Do you

have any

interests to

declare?

(Y or N)

Declared Interest


Fin

anci

al In

tere

st

No

n-F

inan

cial

pro

fess

ion

al

Inte

rest

No

n-F

inan

cial

Pe

rso

nal

Inte

rest

Ind

ire

ct

Inte

rest

Nature of Interest

From To


risk

Carol Varlaam Wandsworth CCG Board Lay Member,

Patient and Public Involvement

Integrated Governance & Quality

Committee

Audit Committee

Remuneration Committee

PPI reference Group (Chair)

Primary Care Committee (Chair)

N


Shaun Stoneham Director of System Resilience and

Transformation

Nothing to declare

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Minutes of the meeting of the Primary Care Commissioning Committee (Part 1) held on

Tuesday 3rd September 2019 at Nightingale House

Chair: Carol Varlaam Present: Voting Members Carol Varlaam (CV) Lay Member, Patient and Public Involvement Katie Bugler (KB) Director of Primary Care Transformation Stephen Hickey (SH) Lay member, Audit Dr Natasha Curran (NaC) Secondary Care Doctor Neil McDowell (NM) Director of Finance Non-Voting Members Dr Mike Lane (ML) Locality lead for Wandle Dr Ismat Nasiruddin (IN) LMC representative Dr Nicola Jones (NJ) CCG Chair In attendance: Emma Gillgrass (EG) Associate Director of Primary Care

Transformation Kate Symons (KS) Associate Director of Primary Care

Transformation Kasia Gaj (KG) Deputy Head of Primary Care, NHS England -

South West London Primary Care Team Hannah Pearson (HP) Primary Care Transformation Manager Muna Ahmed (MA) Interim Governance Officer Apologies: James Blythe (JB) Managing Director Julie Hesketh (JH) Director of Quality and Governance Nick Cuff (NiC) Associate Lay Member Dr Waqaar Shah (WS) Locality lead for Wandle James Gillespie (JG) Wandsworth Healthwatch Dr Kieron Earney (KE) West Wandsworth LCG Lead John Atherton (JA) Director of Performance Chris Savory (CS) Lay member Josh Potter (JP) Director of Commissioning Dr Nicola Williams (NW) Clinical Director Battersea Councillor Melanie Hampton (MH) London Borough of Wandsworth Public in attendance: Ritu Vadhera Takeda Hannah Redman Takeda

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A01

Apologies, Declarations, Quorum

Apologies were received as above. No additional conflicts of interest were declared. The meeting was declared quorate.

A02

Clinical Chair’s Opening Remarks

None.

A03

Minutes of Previous Meeting on 28 May 2019 and action log

Minutes The minutes of the 28th May meeting were approved, as an accurate record of the meeting, subject to the removal of the percentage sign after “348” on page 3. Action log None.

A04

Decisions ratified outside of the meeting

The following items were ratified outside the meeting by James Blythe:

1. Minutes from Sept and December 2018 2. Updated guidance on Managing Serious Incidents in General Practice 3. Special Allocation Scheme service for SWL (excluding Croydon) 4. NHS Transformation Funding 5. Applications for Primary Care Networks in Wandsworth

The Primary Care Committee NOTED the decisions ratified outside of the meeting.

B01

Terms of Reference

The Primary Care Committee noted the changes made, following the previous meeting and APPROVED the Terms of Reference.

B02

Integrated Primary Care Commissioning

KS reported that the Primary Care Operations Group (PCOG) have been developing Primary Care Networks which will be discussed in detail, later in the meeting. PCOG also looked at locality initiatives. There was a focus on the re-procurement of the Citizens Advice and Welfare Service and interpreting services. Members forums will feed into the procurement process. The Junction procurement – the Primary Care Committee agreed to re-procure on an APMS contract. The procurement process is underway and the deadline for bidders is 16th September. This Committee will make the decision to award the contract in a private meeting in November. Joint Primary Care Quality Review Group (PCQRG)

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Lavender Hill Group Practice CQC report – the practice was rated overall as “requires improvement”. The CCG has met with the practice to discuss the outcomes of the report and the contractual breaches and to ensure action plans are in place to address the issues raised. The practice has also been offered support through the Practice Support Team (PST), in addressing the areas identified as requiring improvement. NJ highlighted the blank prescriptions issue. Guidance has been given to the practice and will be shared with other practices at the PCQRG. It was felt it needs to be fed back to the CQC. National GP Patient Survey 2019 An annual survey. A small sample of patients responded. In Wandsworth, 16,880 surveys were sent out, with a response rate of 24%. This is a lower response rate than England (33%) and South West London (29%). EG highlighted:

- For the overarching question, “Overall, how would you describe your experience of your GP practice”, 87% of Wandsworth patients rated their surgery as Fairly or Very Good, ranging for individual practices from 71% to 96%. This is above the national (England) rating of 83% and South West London (Croydon, Kingston, Merton, Richmond, Sutton, Wandsworth CCGs) average of 85%.

- Wandsworth is generally rated in line with or above the South West London (SWL), London and England averages.

Areas identified for improvement at a borough level, either because they have the lowest average scores or the biggest variation between practices include:

- Overall experience of making an appointment. - How easy is it to get through to someone on the phone. - How easy is it to use your GP practice’s website, to look for information

or access services. Survey results compared to last year – there have been slight decreases in the following questions:

- Overall how would you describe your experience of making an appointment? (% Good) – decrease by 1%.

- Generally, how easy is it to get through to someone at your GP surgery on the phone? (% Easy) – decrease by 2%.

- How easy is it to use your practice’s website to look for information or access services? (% easy) – decrease by 5%.

Borough level results and the individual results have been discussed at PCQRG and shared with practices to identify where they can make improvements. SH queried whether we have data to say how long patients are waiting for appointments in Wandsworth. KB explained that we do not have this data and use patient feedback. However, a national tool to do this is being developed to measure this.

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IN asked whether there was any scope to look at the impact of NHS 111 and 8-8 blocking appointments. EG stated that we do look at 8-8 appointment utilisation. KB added that emergency department re-directions to practices is good. NHS 111 re-directions could be improved. ML commented that every practice handles access differently. Many use digital solutions or a telephone triage. KB stated that practices make their appointments available to cater for the needs of their patient cohort – i.e. digital/online, phones. There is no direct question asking how long someone had to wait for an appointment. It is difficult to know what improvements need to be made. Infection Control - each year a list of GP practices are prioritised for infection control audit visits by the Infection Prevention and Control team. In 2019-20, approximately 4 practices in Wandsworth will be audited. The PCQRG reviewed the current inspection ratings for practices and identified those whose last inspection was more than three years ago, and one practice that had a more recent inspection but was rated amber and so due for a follow up. Mental Capacity Act - information was shared relating to a new template and guidance for completing Mental Capacity Act assessments. This has also been shared with practices. Learning from Incidents - recent learning has followed two incidents relating to the monitoring of patients on anti-psychotic medication, ordering and collecting prescriptions. Work is ongoing to share the learning and guidance with practices and to support them in implementing appropriate systems. The Committee noted the contracting decisions. CV noted that recruitment is not included in the update and felt it would be useful to have this information. It was explained that the CCG reviews the workforce for practices but is not responsible for recruitment in practices. NJ added that international GP recruitment has been slow. Action B02.1: KB to bring update on workforce within practices in Wandsworth. The Primary Care Committee NOTED the Primary Care Commissioning Update Report.

B03 Practices half day closure review

KG provided an introduction and stated that in April 2018, NHS England guidance was sent to Commissioners outlining the expectations for the review of GP practice access arrangements, for assurance they meet the reasonable needs of their patients during core hours. Last year’s focus was on the practices who had declared regular periods of half day closing on the annual electronic GP Practice self-declaration (eDec). A number of practices had also declared that they were also closed regularly more than 7.5 hours per week during core hours or are open 45 hours or less. The core hours are 52.5 hours. The guidance requests that a review of the access arrangements for this cohort of practices is also undertaken. There are 6 practices in Wandsworth who have declared regular periods of closure during core hours in 2018/19. Three of these practices have declared

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regular closing of 7.5 hours or more per week, and the SWL Primary Care Team have followed up with the practices concerned. The Committee discussed and reviewed the 6 practices. The first practice corrected the opening hours. However, they still remain closed between 1.30pm-3.30pm four days of the week. They advised that the practice and clinical staff are available during this time. The second practice closes between 1pm-2pm five days per week. On following up with the practice they have confirmed that:

- There are reception staff on duty. - Patients can still gain physical access to the practice and by phone. - A GP is available for urgent appointments. - Their Patient and Public Group (PPG) and the CCG have been

informed of these arrangements. The third practice has declared they close Monday, Tuesday, Thursday and Friday 1.30pm-2.30pm. During this time cover is provided by Care UK and they have the contact details for the GP on call who provides triage and deals with any urgent appointments. There are no reception staff and there is poster in the entrance. An automated telephone message provides patients with the contact number for Care UK. The practice advised that this arrangement has been in place for many years and that the arrangements have been discussed/agreed with CCG. A fourth practice closes between 1pm-2pm Monday to Friday. On following up with the practice they confirmed that they have emergency mobile access number only, which is used by patients to access the on-call clinician. They have advised that they have consulted their PPG and that the CCG are aware of this arrangement. A fifth practice confirmed they close intermittently each month on a Monday for a practice meeting, on a Tuesday for staff training, on a Wednesday for a reception staff meeting, and on a Thursday for a practice staff and clinical meeting. A sixth practice declared half day closing in 2017/18 which was queried by the commissioning team and has since confirmed the practice no longer closes half day. However, their website still needs updating, so requires further follow up by the SWL Primary Care Team. The practice has also declared that they close between 1pm-4pm Monday to Friday, and cover is provided by Care UK who provide a telephone answering service, and a receptionist is available for face to face contact. This is currently being reviewed by the CCG. Next steps The CCG will need to provide assurance to NHSE that the arrangements in place meet the needs of patients. KS highlighted that the practices are contracted to provide the core hours of 52.5 hours and that the Primary Care Network DES regarding access specifies that all practices should offer the core contract in the PCN, as it will have an impact on a network. It was noted that some practices close for various reasons, included staff training, lunchtime, some smaller practices do not have the staff to cover lunch breaks. It was felt that there should be consistency with what practices are

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doing. There was a discussion about whether protected learning time was the best way forward in SWL. The Committee queried whether PCNs could be utilised to provide cover. KG clarified that each practice is required to provide the core contracted hours. There was a discussion about the limitations of sub-contracting to fulfil contracting requirements, such as having staff at a reception desk. The Committee AGREED to delegate the task of taking this forward to the Primary Care Operations Group, to devise a plan for the next 6-12 months. The Committee would like an update on the progress at a future meeting. It was noted that in that time, with the introduction of PCNs, there may be a different approach.

B04

Finance Report

NM highlighted from the month 4 finance report:

- The financial position is at break even. - PCN DES budget currently has an underspend. - CCG adjustment line i.e. the difference between the allocation and the

CCG plan is a shortfall of £1.1m. Will be managed by accruals, any underspend and the overall CCG position.

- The £1.50 per head allocation is committed for this financial year. NJ queried why MSK is included within Primary Care. NM explained that this is the MCAS service which is part of the MCP. NJ raised concern that money may be taken from the Primary Care budget, if there was an overspend in MSK elsewhere. NM noted the concern and stated that it will be clearer in future reports where there are pressures for Primary Care.

The Primary Care Committee NOTED the Primary Care Finance Report.

B05 Primary Care Networks (PCN) Development and Primary Care at Scale (PCAS) Update

HP provided the key highlights from the paper. Primary Care Transformation Funding 2019-20 HP informed all that this is the second year of transformation funding from NHS England. The CCG will receive £2.2m which will fund the 8-8 extended access and Primary Care at Scale (PCAS). The key requirements of the PCAS funding are to build upon the work undertaken last year on transformation, to support the development of general practices. Battersea Healthcare (BHCIC) will continue to deliver the PCAS. EG highlighted some of BHCIC’s achievements to date, including the delivery of workforce projects such as development of a local locum bank, induction model, introduction of joint and new roles and the development of a model for enhanced support to care homes. In 2019-20, BHCIC has been consulting with their practices and the newly formed networks to identify what support they think they will require and develop a coordinated approach and offer. Five workstreams have been identified, which are – 1) PCN support and development; 2) PCN specific and

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borough wide projects; 3) Business intelligence; 4) Workforce and 5) Policies and procedures. Extended access will continue to be delivered in the three hubs. The Primary Care team will be working with BHCIC to develop specific areas of work and measures via KPIs. New Roles - during 2019/20 a key area for development is the introduction of the new roles in primary care networks, in particular: Clinical Directors, Social Prescribing Link Workers and Clinical Pharmacists. Primary Care Network Development Based on learning to date (including from Merton, where there is a well-developed social prescribing service which has delivered positive outcomes for patients and practices), the CCG offered to hold a contract for service delivery across PCNs and to ‘top up’ the NHS England funding to enable delivery of elements which cannot be covered within the salary funding. This includes areas such as training, supervision and role development of the Link Worker. Seven of the nine Wandsworth PCNs signed up to this model and a procurement process is underway to identify a suitable provider. The other two PCNs have chosen to proceed independently, working directly with a provider with whom they have worked previously. Additional clinical pharmacy input in primary care brings significant opportunities to improve patient care, particularly supporting the proactive management of patients with complex needs. PCNs are currently focussing on introducing clinical pharmacists, associated ways of working and key areas of focus. The CCG’s Medicines Management Team is providing support and guidance and work is underway in terms of determining the most appropriate linkages between different pharmacy roles. PCN Maturity Matrix and diagnostic tool The PCN maturity matrix outlines components that will underpin the successful development of networks. It sets out a progression model that evolves from the initial steps and actions that enable networks to begin to establish through to growing the scope and scale of the role of networks in delivering greater integrated care and population health for their neighbourhoods. The PCN maturity matrix is made up of the following 5 components: 1. Leadership, planning and partnerships; 2. Use of data and population health management; 3. Integrating care; 4. Managing resources; 5. Working with people and communities. It is designed to support network leaders, working in collaboration with systems, places and other local leaders within neighbourhoods, to work together to understand the development journey both for individual networks, and how groups of networks can collaborate together across a place in the planning and delivery of care. The accompanying diagnostic tool will help PCNs and other local organisations involved in the development of PCNs to self-assess the current maturity of a network and to help understand the development trajectory of the network.

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Next steps Work is underway to map current priorities and plans to the PCN maturity matrix and to use the matrix to identify any additional opportunities and gaps. This will be used to develop a roadmap to describe the anticipated development journey of the Wandsworth PCNs. With the support of the Federation and the CCG, Wandsworth PCNs are currently in the process of identifying where they are within the PCN Maturity matrix, where they want to be and what support they may require to achieve this. This information will feed into a South West London plan. CV queried whether there are enough clinical pharmacists in SWL and nationally. HP explained that the roles will vary in different practices and therefore require different skills. NJ added that there is a network of pharmacists working across Wandsworth and SWL. It was clarified that partners have started discussing what the integrated teams will look like. Discussions are taking place at the Transformation Group. The new PCN Clinical Directors are meeting on a monthly basis and have been reviewing how their time will be allocated. Clinical Directors have been asked to identify priority areas for training and development. There is a variation in training needs. The Committee NOTED the Primary Care Networks Development and the use of the Primary Care at Scale Funding.

B06

Any Other Business

1. It was clarified that there will be a part 2 WPCCC meeting after the Board on 6th November, for voting members only.

2. NC informed all that she will be stepping down from the Wandsworth Board at the end of the September. CV thanked NC for her contribution to the meetings and stated that she will be missed. The Committee wished NC all the best for the future.

There were no questions from the public.

Close of Part 1

Date of next meeting: The next meeting will be held on Thursday 23rd January 2020, 15:00-17:00, Nightingale House.

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ACTION LOG

Date Minute Ref Action Description Responsible Officer Target Completion Date Update Status CCG Committee Type

03.09.19 B02.1 Part 1 Integrated

Primary Care Commissioning: CV noted that recruitment is

not included in the update and felt it would be useful to

have this information. KB to bring an update on workforce

within practices in Wandsworth.

Katie Bugler (nee

Denton)

23.01.20 Open Wandsworth Primary Care Action

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Wandsworth Clinical Commissioning Group Primary Care Commissioning Committee

Date Thursday, 23 January 2020

Document Title Digital First Accelerator Programme Update

Lead Director (Name and Role)

Katharine Bugler, Director for Transforming Primary Care

Clinical Sponsor (Name and Role)

Author(s) (Name and Role)

Francis Masinde, Programme Manager Digital First

Agenda Item No. B01 Attachment No. B01i

Purpose (Tick as Required) Approve Discuss Note

Executive Summary

Background: The Digital First Accelerator Programme is an NHS England funded programme which aims to enhance and streamline digital service delivery across primary and urgent care.

Purpose: This report provides the Wandsworth Primary Care Committee with an update on the Digital First Accelerator Programme in Merton and Wandsworth CCGs, which have been identified as pilot sites for this programme in South West London.

Reason for Committee Review: The Committee are asked to note the progress on the programme to date.

Key Issues: The slide pack summarises the following issues:

• The strategic objectives of the Digital First programme and the case for change

• The programme development process

• The key local priorities and deliverables for Merton and Wandsworth

• A focus on how we will use PCNs to champion the successful roll out of digitalinitiatives.

Conflicts of Interest: As per the usual GP COI

Mitigations: As per the usual GP COI

Recommendation:

XX

YES

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The Committee are asked to note the ongoing work.

Corporate Objectives This document will impact on the following CCG Objectives:

Improving Outcomes and Reducing Inequalities: Ensuring access to high quality and sustainable care.

Risks This document links to the following CCG risks:

None

Mitigations Actions taken to reduce any risks identified:

N/A

Financial/Resource/ QIPP Implications

NHS England have allocated funding of £636k to South West London for delivery of the Digital First Accelerator Programme over the coming year (2020/21)

Has an Equality Impact Assessment (EIA) been completed?

EIAs have been completed for individual work-streams within the Digital Accelerator programme.

Are there any known implications for equalities? If so, what are the mitigations?

None.

Patient and Public Engagement and Communication

• Patient workshop held as part of project scoping.

• A focus group has been created that will test elements of the programme as they roll out.

Previous Committees/ Groups Enter any Committees/ Groups at which this document has been previously considered:

Committee/Group Name: Date Discussed:

Outcome:

N/A Click here to enter a date.

Click here to enter a date.


Supporting Documents Slide pack to be presented at the Committee

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NHS England and NHS Improvement

South West London Digital First Accelerator Programme

(Merton and Wandsworth CCGs – Digital First Pilot Site for SWL)

Presenting to Wandsworth Primary Care Commissioning Committee

23rd January 2020

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Principles of Digital First

1. Strategic priorities

Allows for nationwide system maturing.

It is an opportunity to build the digital ecosystem’s

aligned with national deliverables and strengthens

the system to work together.

1 Strategic priorities 2 Local priorities 3 Accelerator 4 Pathway design 5 Maturing 6 Outputs

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Benefits of Digital First







Streamlined and integrated

patient flows across primary and

urgent care services

• Streamlining and integrating patient flows across primary and urgent care services;

• Making better use of clinical time by enabling access to the right skillset the first time;

• Optimising demand and capacity across the system.

Improved access and patient

experience

• Quick, convenient and secure alternative ways to access Primary Care;

• Enhanced ability to make an appointment, order repeat prescriptions and view medical records;

• Availability of timely, trusted and locally sensitive advice online

Encouraging innovation• Enriched and developed supplier market to support future NHS ambitions;

• Development of a single digital front door for all NHS services.

Embedded change management

• Wider and more standardised adoption of digital technologies through embedding business change

techniques;

• Reduced duplication, project management effort and spend by CCGs on implementing disjointed,

fragmented digital solutions

1

2

3

4

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Local Priorities – Wandsworth Landscape

2. Local priorities

Local analysis that identify local population

needs addressing variation and alignment with

clinically driven requirements. A number of

local priorities will be applicable to other

London STPs.


• 40 GP practices• 9 Primary Care

Networks • 1 GP Federation - all

practices are members• Extended access

services delivered via a combination of individual practices and 3 practice based access hubs

• 4 Out of Hours bases• 2 Urgent Treatment

Centres• 1 major acute trust with

increasing pressures on A&E

Digital First Accelerator Pilot21 of 90

The Programme Design Process

3. Accelerator

Are defined areas with susceptibility for technology

enabled change. Identifies

challenges with current pathways, iteratively

develops solutions, supports national targets

and PCN development.

3. Accelerator






4. Digital products embedded in redesign

pathways

The development of products are produced collaboratively between

clinicians, the wider workforce and patients bringing the market alive

to respond to system challenges. Process involves workflows and

pathways, supporting emerging healthcare technologies and ultimately

delivering digital maturity.


We gathered our delegates and stakeholders together across 3 pathway mapping

sessions

1. Cost-Benefit : What are the predicted short, medium and long term cost savings for this project/resolving this issue2. Patient Experience: Perceived impact on experience relative to other focus areas3. Staff Experience: Impact on staff dissatisfaction/wellbeing (stress leave, burnout measures) relative to other focus areas4. Clinical Risk: Clinical Risk (impact x likelihood) of not addressing issue identified5. Non-Clinical Risk: Operational and Organisational Risk Scores (impact x likelihood) of not addressing issue identified6. Alignment with National and SWL Strategy: Does this align with clinical strategy or NHS long term plan, GPFV, Must dos7. Cross-Over with Existing Programmes: Being addressed through other SWL programmes, or at a London level?8. Feasibility: Can this project/issue be addressed within the programme timeframe and cost constraints, 9. Viability: Will the solution/project have sustained success and required patient/staff utilisation 10. Usability: Will the focus area deliver a solution that can be used by target audience/ will there be a large training burden

We identified a number of key criteria to help us

prioritise our work programme

We formed a network of partnerships to achieve our

local priorities together.

Workshop 16th June 19

Clinical Focus

18 Delegates

Workshop 215th July 19

Patient Focus

11 Delegates


Prioritisation

12 Delegates


Clinical Focus

18 Delegates


Patient Focus

11 Delegates


Prioritisation

12 Delegates


Clinical Focus

18 Delegates

Workshop 215 th July 19

Patient Focus

11 Delegates

Workshop 330 th July 19

Prioritisation

12 Delegates

22 of 90

Accelerator Shortlisting

PRIORTY FOCUS AREA PROBLEM STATEMENT POTENTIAL PROJECTS

1Demand & capacity optimisationfor both in hours service and out of hours services

Inappropriate or avoidable clinical face-to-face appointments leading to significant risks and negatively impacting on cost, staff and patient experience.

1. Pilot use of A&E waiting time app

2. Identify and target patients who use NHS services frequently and inappropriately

3. Utilise digital GP Online Consultation hub models

4. Pooling access to extended access hubs in general with access via the NHS App

2Effective triage tools/ effective risk stratification and processes

1. Real-world evaluation of the Doctorlink's symptom checker

2. Identify and incorporate red flags from systems in different care settings

3. Standardising practice's online appointment offering (DOS)

4. Pilot and evaluate e-triage within UCC or A&E setting via check-in tablets

3 Video consultation1. Pilot and evaluate Doctorlink's (or multi-vendor's) video consultation solutions

2. Evaluate impact of video consultation within care homes

3. Support the adoption of video consultation within extended access hubs

4Improve Telephony functionality/ variability

1. Identify and pilot and evaluate an advanced telephony solution within W&M LDU

2. Identify best solutions and standardise telephony systems across W&M LDR.

5 Photo sharing ability

Clinicians not being able access relevant clinical information at the appropriate time and patients having to repeat their story multiple times.

1. Identify and implement a secure messaging system that allows patients to share pictures

6 Two-way messaging1. Identify and implement more appropriate text messages to direct patients to services

2. Pilot and evaluate two-way clinician patient messaging system

7 Access to shared records 1. Linking patient record systems together

8Having patient record delegated access / proxy access for carers

Family and carers not being able access a person's relevant clinical information at the appropriate time for the purposes of direct care.

1. Work with supplier and carers to incorporate proxy access within solution/s.

9Incorporate Wearable Technology in unscheduled care pathways

Clinicians not being able access data from wearable technologies (especially in the context of vulnerable patients)

1. Identify most clinically impactful wearable technology and associated data to share with clinicians

2. Pilot and evaluate the linkage of a wearable technology's data into patient record.

3. Accelerator






3. Accelerator







pathways







23 of 90

Accelerator plans to April and Beyond

3. Accelerator






3. Accelerator







pathways







PCN Development

Immediate priority

Heathier cities initiatives / Social

prescribing / personalisation

Medium Priority

LHCRE / Access to records

collaboration and joining to App

Medium Priority

Telephony Access to services / IVR and redirection

High priority

Low Priority

Demand and capacity (Real time) management

of access

High priority

Evaluation of impact on front line services to

date

Medium Priority

Digital Outpatients / Scheduled care initiatives

High priority

Proactive care LTP

requirements /

personalisation local services

Medium Priority

Mental Health

access via the NHS app

Medium Priority

Directory of services integration with the NHS

app /local cleansing

High priority

Horizon scanning and prioritising opportunities

Beyond April 2020

24 of 90

Innovating through Merton & Wandsworth PCNs with Digital First: Improving signposting through Doctorlink integration with the Directory

of Services (DOS)

25 of 90

SWL – Digital First Programme Scope – The Directory of Services







What is the Directory of Services?

• The Directory of Services (DoS) is a central directory that is integrated with NHS Pathways and is automatically accessed if the patient does not require an ambulance or by any attending clinician in the urgent and emergency care services.

• MIDOS – is a third party application that feeds off the main DOS system, allowing clinical staff to search the DOS and sign post patients to other available services which could appropriately treat the patient, such as those offered by pharmacies and other community services.

26 of 90

SWL – Digital First Programme Scope – Initial Pilot PCNs







Wand CCGWest Wandsworth

PCN

No. of Practices: 4List Size: 39,365

Selected Pilot PCNs (Total 6)

Selection Criteria

Wand CCGWandsworth PCN


Wand CCGNightingale PCN


Merton CCGEast Merton PCN


Merton CCGSouth West Merton PCN

No. of Practices: 2List Size: 39, 030

Merton CCGMorden PCN


• Rates of non-elective ambulatory activity per head of population (Essential) – 20%• Clinical Sponsor and Leadership (Essential) – 10%• Percentage of patients with detailed care record access (Essential) – 15%• Percentage of online booking activity – Direct booking (GP Hubs and in-hours) (Essential) – 17.5%• Patient engagement and experience survey results – 17.5%• Patient Champions – 10%• Population Insights - 10% 27 of 90

Doctorlink integrates with GP systems

3. Accelerator






3. Accelerator







pathways







28 of 90

Doctorlink pathway: Patient signposted to GP appointment in-hours

3. Accelerator






3. Accelerator







pathways







29 of 90

Doctorlink Pathway: Patient Signposted to GP out of hours (AS-IS)

3. Accelerator






3. Accelerator







pathways







GP practice not open in timeframe

appointment needed

Patient advised to call 111 or attend Urgent

Care Centre

30 of 90

Doctorlink Pathway: Patient Signposted to GP out of hours (TO-BE)

3. Accelerator






3. Accelerator







pathways







GP practice not open in timeframe

appointment needed

Doctorlink maps to MiDOS to identify the

closest OOH/IUC centre that could see the

patient

Patient told location and

opening hours of nearby IUCs

31 of 90

Doctorlink pathway: Signposting to alternative services via MiDOS

3. Accelerator






3. Accelerator







pathways







Doctorlink signposts to more appropriate

service

Pharmacy

Optician

Dentist

Self-care

Sexual health clinic

IUC/UEC

Doctorlink provides the patient details

of the most appropriate service

to meet their clinical need, with their

opening hours and location details

Current priority: DOS integration

Future possibility?: direct booking via

connected appointments

Doctorlink directly booking an

appointment into the recommended service at a time suitable for the

patient

32 of 90

SWL – Digital First Programme – Benefits of Signposting







Benefits of Signposting

• Better experience for patients• Increased patient safety• Appropriate use of NHS resources • Reduction in GP workload when patients directed to self-care/pharmacy• Reduced failure demand across the system by reduction in inappropriate appointments and reduction in patients having

multiple contacts with different providers• Reduced workload for GP administrative staff and for 111 through digital signposting• Improved staff satisfaction

33 of 90

Maturing our footprint – starting with PCN’s

5. Maturing Landscape

Continued evolvement and a consistent

platform with the objective to iteratively

improve services. Requires agile responses

and learning from past experiences to deliver

required services.

6. Outputs

New technology and ways of working for clinicians offering

better access for patients and wider workforce. Delivers

co-designed solutions developing outcomes

for transformational and cultural change.


Access

Timely advice,

information and

services

Reduced waiting

times

Convenience

Support people who

prefer to access care

remotely

Patient experience

High levels of

satisfaction

Feel more at ease

Continuity of care

Avoid the waiting

room

Save time/cost in

travelling

Quality ofcare

Pick up red flags

early using triage

Comprehensive

symptom enquiry

Empower

self-care

Prioritise care based

on needs

Efficiency

Signpost patients to

the right place or

professional

Optimise appropriate

use of skill-mix

Clinician has access

to the history before

the consultation

Less time spent

documenting and

better data capture

Supportingstaff

Greater control over

workload

Opportunities for

flexible and remote

ways of working

increasing staff

retention and practice

capacity

Give people the time

they need

Staff satisfaction

Save time in travelling

What improvements did we want to see? (Clinicians and Patients)

We asked our PCN colleagues and

Digital colleagues what changes and

improvements would be important

34 of 90

Maturing our footprint in PCNs – Empowering Patients & Communities

5. Maturing Landscape

Continued evolvement and a consistent

platform with the objective to iteratively

improve services. Requires agile responses

and learning from past experiences to deliver

required services.

6. Outputs

New technology and ways of working for clinicians offering

better access for patients and wider workforce. Delivers

co-designed solutions developing outcomes

for transformational and cultural change.


✓ PPG QI Initiative

✓ Engage with digitally uninterested and non-digital patients at PCN

✓ Mapping the patient journey

✓ Digital Insight work

✓ Identify Champions

35 of 90

NHS England and NHS Improvement

Thank you

36 of 90

Wandsworth Clinical Commissioning Group

Primary Care Commissioning Committee Part 1


Document Title Primary Care Network Development Update


Katie Bugler, Director for Transforming Primary Care



Hannah Pearson, Primary Care Transformation Manager

Emma Gillgrass, Associate Director for Transforming Primary Care

Agenda Item No. B02 Attachment No. B02


Executive Summary

This report provides an update on the development of Primary Care Networks (PCNs).

This follows a report that came to the Primary Care Commissioning Committee (PCCC)

in September 2019.

Key Issues:

The GP contract framework sets out seven national service specifications that will be

added to the Network Contract DES. Draft outline service specifications for the first five

services were released on 23rd December 2019.

Wandsworth PCNs are developing plans for the use of additional funding for Primary

Care Network development. (Information about this funding was provided in the

September PCCC paper and further details are included in this report).

Conflicts of Interest: GP members and their practices are members of Primary Care

Networks and the GP Federation.

Mitigations: N/A – no specific decision making is associated with this paper.

Recommendation:

Wandsworth Primary Care Committee is asked to note the developments described in

the paper.

Corporate Objectives This document will impact on

the following CCG Objectives:

• Improving Outcomes and Reducing Inequalities:

Ensuring access to high quality and sustainable care.

• Leading with ambition for our communities, driving

transformation through innovation: Delivering better

care and a better patient experience.

✓

XX

✓

37 of 90

• Working Together: Continually improve delivery by

listening to and collaborating with our patients,

members, partners, communities and other

stakeholders.

• Meeting our performance and financial objectives:

Make the best use of our resources to benefit our

patients and communities.

Risks This document links to the

following CCG risks:

No specific risks in relation to the content of this report

have been identified.

Mitigations Actions taken to reduce any

risks identified:

N/A

Financial/Resource/

QIPP Implications

There are various funding flows associated with PCNs and

the Network Contract DES provides funding entitlements.

There is new dedicated PCN development funding. The

allocation for South West London is £1.134m for 19/20.

Wandsworth has received £277,000 which is an equitable

share based on list size as approved at the South West

London Finance Committee on 29th October 2019.

Has an Equality Impact

Assessment (EIA) been

completed?

Not applicable for this report.

EIAs would need to be completed in relation to new

initiatives once the detailed implications have been

considered.

Are there any known

implications for

equalities? If so, what

are the mitigations?

It is anticipated that developments will improve equity of

outcomes and that there will be no negative implications

for equalities.

Patient and Public

Engagement and

Communication

High level information about Primary Care Networks and

the direction of travel has been shared with the

Wandsworth Patient and Public Involvement Reference

Group (PPIRG). However, significant patient engagement

has not yet been undertaken and consideration is being

paid to how engagement with local people and

communities could best be undertaken at a PCN level.

Previous

Committees/

Committee/Group Name: Date

Discussed:

Outcome:

38 of 90

Groups Enter any

Committees/

Groups at which

this document has

been previously

considered:

N/A Click here to

enter a date.

Click here to

enter a date.

Click here to

enter a date.

Supporting Documents

39 of 90

1) Introduction

Following the publication of the NHS Long Term Plan and the five year GP Contract Reforms

a new Primary Care Network Contract went live on 1st July 2019. In Wandsworth practices

have formed into nine Primary Care Networks, which were approved by the Primary Care

Commissioning Committee (PCCC) in May 2019.

In September 2019 the PCCC reviewed 2019/20 plans for the use of Primary Care at Scale

funding and received an update on PCN development, including the additional funding to

support the evolution of networks in line with the PCN Maturity Matrix.

2) Primary Care Network Development

2.1 National Supporting Documents

The September update for the Primary Care Commissioning Committee provided

information about the following national documents:

• PCN Development Support Prospectus – which describes good development support

and sets out an agreed consistent view for regional and local teams to use and build

upon to ensure any support put in place meets local needs.

• PCN Maturity Matrix – which outlines components that will underpin the successful

development of networks and sets out a progression model that evolves from the

initial steps and actions that enable networks to begin to establish through to growing

the scope and scale of the role of networks in delivering greater integrated care and

population health for their neighbourhoods.

• PCN Maturity Matrix diagnostic tool – which should help primary care networks and

other local organisations involved in the development of PCNs to self-assess the

current maturity of a network and to understand the development trajectory of the

network.

2.2 PCN Development Funding

Nationally, new dedicated PCN support funding is being provided to help networks mature

and be in a position to operate and deliver care differently. Development support has been

released and the allocation for South West London is £1.134m for 2019/20. Funding is

expected to be recurrent for five years dependant on need and effective use.

Report to Wandsworth Primary Care Commissioning Committee

Update on Primary Care Network Development

23rd January 2020

W A N D S W O R T H C C G

40 of 90

Approximately 10% of the funding should be used for Clinical Director development, and the

rest for PCN Development Support. The funding is intended to help PCNs make early

progress against their objectives, for example supporting closer collaboration between

PCNs and their community partners. It should also support preparatory activity for the

forthcoming national service specifications.

In South West London it has been agreed that the development funding should be split

between CCGs according to list size, an approach consistent with previous allocations to

primary care. This approach has been approved through the Transforming Primary Care

Group, and was ratified at the SWL Finance Committee on 29th October 2019. This means

that the funding available for Wandsworth in 2019/20 is £277,000.

2.3 Funding Allocation

In light of the maturity matrix, Clinical Directors and PCNs have identified their priorities

regarding development. How the borough’s allocation is split between PCNs is for local

determination, and there will be further discussions regarding some elements of

development plans to establish which are best delivered at PCN level and where there may

be areas more effectively delivered at either borough or SWL level.

The following principles have been supported in terms of splitting the funding:

• Funding for Clinical Director (CD) development allocated per Clinical Director (rather

than per PCN – as a number of PCNs have joint CDs).

• Majority of the PCN funding allocated per PCN in line with their list size (in keeping

with the manner that funding is being allocated to each CCG).

• An amount of funding allocated to borough wide initiatives which address priority

areas for all PCNs.

Clinical Director Development

Clinical Directors (CDs) have considered their training needs. To support this a template

was produced which involved reflecting upon the level of need for training and support in

relation to the skills and areas of understanding included within the national PCN

Development Support prospectus.

There are varied development needs and priorities amongst the CDs but some common

themes include:

• Using data and information to drive change and support clinical decision making

• Managing finances and budgets

• Understanding the needs of local communities and utilising the voice of local citizens

• Change management and leadership development

• Developing the workforce, including understanding newer primary care roles and how

they can best be deployed

41 of 90

Collaborative discussions have taken place and feedback has included:

• Training and development need to be tailored to the individual and it will be important

for there not to be a 'one size fits all' solution. Different approaches for delivery are

being considered, for example:

- Attending a structured course

- Attending one day courses on specific subjects such as finance, HR etc.

- Having a mentor/ coach (which could be valuable and support a personalised

approach)

• Approaches need to take into consideration the busy schedules of CDs.

• Innovative/ creative methods may be beneficial and virtual learning should be

considered.

• Training/ development needs beyond CDs (to support other professionals in PCNs)

are also very important and consideration should be paid to upskilling the ‘next

generation’ of CDs.

• There is the potential for PCNs at the same level of development to work together on

common goals (possibly using the National Association of Primary Care (NAPC)),

and CD training could also be linked to the PCN action plan sessions that are

currently being arranged with the NAPC (see commentary below under ‘PCN

Development’).

Battersea Healthcare has developed a Clinical Director Development Options Paper which

provides a ‘menu’ of options which CDs can consider. Where there are opportunities to

coordinate initiatives, these will be taken forward.

PCN Development

A number of areas have been identified already by PCNs that the development funding

could support. These include:

• Organisational development specific to individual PCNs

• Business intelligence / analytics

• Interoperability and data sharing

• Patient / community / other partner engagement

• Governance and system integration

It has been identified that the provision of backfill for practice staff will be needed so that

practices within a PCN can have dedicated time to develop and deliver their action plans to

progress through the maturity matrix.

Outcomes expected to be delivered from the development funding (dependant on specific

activities undertaken) include:

• PCNs have an agreed vision and direction of travel and have established

development plans for the short, medium and longer term that produce tangible

benefits to practices and their patients

42 of 90

• Effective decision-making processes and communication approaches are in place for

PCNs

• PCN governance is strengthened and linkages are established with wider ‘system

governance’. Joint work is undertaken with other providers, to identify and implement

PCN related developments, including how to achieve greater alignment with PCNs

and how to improve collaborative working to provide enhanced care and support for

complex patients

• Appropriate data sharing arrangements are in place to enable read/write access to

records within networks that have been reviewed via the Londonwide LMC assurance

process.

• PCNs undertake workforce planning and are in a position to support new roles

effectively and in a position to embed within practice and PCN teams.

• Staff from across PCNs work more closely as a single team and have established

shared processes and ways of working where appropriate.

• PCNs have mechanisms to engage with patients, communities and other partners

• Inclusion of all levels of practice staff so everyone feels part of a PCN.

• Business intelligence and population health analytics are deployed in a strategic and

systematic way. There is dedicated input and support to provide relevant information/

dashboards that is meaningful for PCNs.

• Expertise is sourced externally where services have already been established that

meet priorities identified by Wandsworth PCNs.

In relation to overall PCN development, it was agreed at the September Clinical Directors

Forum that arranging facilitated sessions with each PCN would be the best way to develop

action plans and progress through the maturity matrix. This will be supported by the

National Association of Primary Care (NAPC). As an introduction to this work and to

support other areas, the NAPC has run an initial session with all the CDs and it is

anticipated that most of the initial individual PCN facilitated sessions will take place in

January 2020.

3) Draft Outline Service Specifications

3.1 Context

The GP contract framework sets out seven national service specifications that will be added

to the Network Contract DES. Draft outline specifications for the first five services were

released on 23rd December 2019. These services are as follows:

• Structured Medications Review and Medicines Optimisation

• Enhanced Health in Care Homes

• Anticipatory Care

• Personalised Care

• Supporting Early Cancer Diagnosis

43 of 90

The document including the specifications is available at the website address below, along

with a link to a survey which can be used to provide feedback (until 15th January 2020).

https://www.engage.england.nhs.uk/survey/primary-care-networks-service-specifications/

The purpose of the document is to provide PCNs, community services providers, wider

system partners and the public with further detail of – and seek views on – the draft outline

requirements for the services, as well as plans for phasing and supporting implementation.

3.2 Summary

Included below are some overall key messages from the documentation (regarding all of the

specifications).

Developing the outline service specifications:

• NHS England and NHS Improvement (NHSE/I) has undertaken a wide-ranging

process of evidence-gathering and engagement in order to inform the outline service

specifications.

• The service requirements set out in the specifications focus on interventions and

cohorts where there is significant scope to improve outcomes and people’s health and

wellbeing.

• The outline service specifications illustrate proposed metrics which – through a new

Network Dashboard – will enable PCNs to understand their own position and support

peer learning and quality improvement.

• The final version of the specifications will be published in early 2020 as part of the

wider GP contract package for 2020/21. The final versions will include further detail for

each requirement, followed by guidance, to support PCNs and other providers to deliver

the requirements as effectively as possible.

Funding and Additional Roles:

• Funding is not allocated directly for delivery of the service specifications. The largest

portion of network funding provides reimbursement for additional workforce roles that

PCNs can engage to support the delivery of the specifications and alleviate wider

workforce pressures. There will be significant additional capacity within primary care in

2020/21 to deliver the specifications.

• CCGs will be asked to support PCNs and their community providers to institute shared

workforce models that can help maximise the collaboration between local partners to

deliver the specifications and build the wider PCN.

• Under NHSE/I’s proposals, community services providers will take a significant role in

co-delivery in two of the service specifications - Enhanced Health in Care Homes and

Anticipatory Care, enabling the development of integrated multidisciplinary teams.

Phasing of service requirements:

44 of 90

https://www.engage.england.nhs.uk/survey/primary-care-networks-service-specifications/

• NHSE/I is proposing to phase in the requirements over time in order to ensure that

they are deliverable as PCN workforce capacity grows, and as the wider system

infrastructure develops to support them. This means:

o implementing the requirements of Structured Medication Reviews and Optimisation

and Enhanced Health in Care Homes in full from 2020/21, as agreed in the GP contract

framework; and

o phasing in the requirements of the Anticipatory Care, Personalised Care and Early

Cancer Diagnosis specifications over the period from 2020/21 to 2023/24.

• There are also significant overlaps between the requirements of the specifications and

with other elements of the wider GP contract package.

Support from the wider system:

• The establishment of PCNs will improve the links between providers of primary and

community services, so that general practice feels much more connected and supported

by the wider NHS system. CCGs will be required to play a major role in helping to co-

ordinate and support delivery of the specifications, in particular those that involve close

collaboration with other partners such as the care homes specification. CCGs will also

support PCNs to develop standard operating processes for their partnership, and ensure

a clear and agreed contribution to service delivery is made by other system partners

within Integrated Care Systems (ICSs) – documented in a local agreement. It is

recommended that the Local Medical Committee should be involved in the development

of any local agreement.

• Where the outline specifications contain requirements for community services

providers, the intention is to incorporate these into the NHS Standard Contact from

2020/21 to ensure they are taken forward in a consistent way.

• Where PCNs are struggling to recruit, CCGs and systems should take action to support

them.

Relationship with existing locally commissioned services:

• These proposals are in draft: Clinical Commissioning Groups (CCGs) should not,

therefore, take final decisions about existing locally commissioned services until the final

Network Contract DES for 2020/21 is published.

• CCGs should work with PCNs, community services providers, Local Medical

Committees (LMCs), and other stakeholders to support the transition – and, where

required, enhancement – of existing local service arrangements to meet the new

requirements.

• Funding previously invested by CCGs in local service provision which is delivered

through national specifications in 2020/21 should be reinvested within primary medical

care and community services in order to deliver the £4.5bn additional funding guarantee

for these services.

3.3 Overview of Specifications

45 of 90

Structured Medications Review and Medicines Optimisation

Structured Medication Reviews (SMRs) are a NICE approved clinical intervention that help

people who have complex or problematic polypharmacy. SMRs are designed to be a

comprehensive and clinical review of a patient’s medicines and detailed aspects of their

health and are delivered by facilitating shared decision making conversations with patients

aimed at ensuring that their medication is working well for them.

The specification involves providing SMRs to people who have been identified by the PCN

as most likely to benefit from the intervention. A number of patient groups are provided and

potential tools to support with identification are suggested.

Enhanced Health in Care Homes

The Long-Term Plan and GP Contract Framework made a commitment to implementing the

clinical elements of Enhanced Health in Care Homes (EHCH) Framework nationally during

2020/21. Implementation of the EHCH service is a national priority for primary and

community care-based service integration, and the expectation is for all ICSs/STPs and

CCGs to prioritise supporting full and successful delivery.

The EHCH service will focus on national roll out of the first four clinical elements of the

EHCH framework: enhanced primary care support; multidisciplinary team support;

reablement and rehabilitation; and high-quality end-of-life care and dementia care. The

service requirements are shared across both PCNs and other providers (particularly

community services) who will work together to deliver the model.

Anticipatory Care

Anticipatory care helps people to live well and independently for longer through proactive

care for those at high risk of unwarranted health outcomes. Typically, this involves structured

proactive care and support from a multidisciplinary team (MDT). It focuses on groups of

patients with similar characteristics (for example people living with multimorbidity and/or

frailty) identified using validated tools (such as the electronic frailty index) supplemented by

professional judgement, refined on the basis of their needs and risks (such as falls or social

isolation) to create a dynamic list of patients who will be offered proactive care interventions

to improve or sustain their health.

The specification outlines that it is expected that, by 2023/24, all PCNs and community

service providers – working together – will offer an Anticipatory Care model which includes

the following components:

• Identification of specified key segments of the PCN’s registered practice populations who

have complex needs and are at high risk of unwarranted health outcomes.

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• Maintenance of a comprehensive and dynamic list of identified individuals who would

benefit from anticipatory care, based on the outcome of population segmentation.

• The delivery of a comprehensive set of support for those individuals identified as eligible

through the anticipatory care list, through an MDT based across PCNs and community

service providers.

Proposed service requirements for 2020/21 are included for PCNs and community services

providers which will support the delivery of the model.

Personalised Care

Chapter one of the NHS Long Term Plan (LTP) makes personalised care business as usual

across the health and care system as one of the five major, practical changes to the NHS

service model. Personalised care means people have choice and control over the way their

care is planned and delivered, based on ‘what matters’ to them and their individual diverse

strengths, needs and preferences.

Universal Personalised Care: Implementing the Comprehensive Model is the delivery plan

for personalised care, published by NHS England in January 2019 following the LTP. The

Comprehensive Model for Personalised Care brings together six evidence-based and inter-

linked components, each of which is defined by a standard, replicable delivery model. The

six key components are:

1. Shared decision making

2. Personalised care and support planning

3. Enabling choice, including legal rights to choose

4. Social prescribing and community-based support

5. Supported self-management

6. Personal health budgets (PHBs) and integrated personal budgets.

The specification includes increasing levels of activity across the six component areas over

the period 2020/21 to 2023/24.

Supporting Early Cancer Diagnosis

The NHS Long Term Plan (LTP) sets an ambition that, by 2028, the proportion of cancers

diagnosed at stages 1 and 2 will rise from around half now to three-quarters (75%) of cancer

patients. The specification aims to support the improvement of local early diagnosis rates.

The requirements in the specification relate to the following three domains:

• Improve referral processes across GP practices, including by introduction of locally agreed

standardised systems and processes for identifying people with suspected cancer, referral

management and safety netting.

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• Lead and coordinate the contributions of practices and the PCN to efforts to increase the

uptake of existing National Cancer Screening programmes among their local populations.

• Improve outcomes through reflective learning and collaboration with local partnerships.

The requirements will be phased over time, as capacity both within PCNs and the wider

pathway for cancer diagnosis and treatment increases. The specification summarises the

expected phasing of objectives from 2020/21 to 2023/24 and it is noted that specific

requirements will be determined in future years.

3.4 Next Steps

At the time of writing initial feedback about the specifications is being collated and will be

submitted by Wandsworth and Merton CCGs as part of the engagement process. Local work

and collaborative discussions have commenced and a programme of work will be developed

to explore the implications for PCNs and other partners, the overlap and alignment between

the specifications and existing services and initiatives and the joint work that will be required

to support implementation.

An initial facilitated session is being held between PCNs and CLCH on 16th January to discuss PCN/ community services alignment. The session will encompass benefits of alignment, process improvements and next steps.

4) Summary and Next Steps

Collaborative work is taking place involving PCNs and their Clinical Directors, Battersea

Healthcare, the CCG and other partners to support PCN development, including meeting

the priorities as detailed in the Network Contract as well as progressing local programmes.

During the remainder of 2019/20, there will be a focus on maximising the impact of the

available PCN development funding, which will include creating an action plan for each PCN,

and on planning for the introduction of the new network specifications from April 2020.

The intention is to adopt a collaborative and supportive approach to ensure the successful

delivery of new models of care and greater integration between health and care services for

the benefit of Wandsworth patients.

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Additional Roles Reimbursement 2019/20

1. Purpose

This briefing provides information regarding the 2019/20 additional roles reimbursement funding to

aid financial forecasting and to support Primary Care Networks (PCNs) to make informed decisions

about the use of their allocation.

2. Funding for Additional Roles

2.1 2019/20

In 2019/20, as part of the Network Contract Directed Enhanced Service (DES), from July 2019 all

PCNs are entitled to receive funding for one Social Prescribing Link Worker (SPLW) (100%

reimbursement) and one Clinical Pharmacist (CP) (70% reimbursement).

The associated funding is shown in the tables below. For each Wandsworth PCN the maximum

allocation (for both roles) is £53,942.25 and for Wandsworth CCG as a whole (comprising 9 PCNs) the

maximum allocation is £485,480.25.

PER PCN

Maximum reimbursable amount per annum

Maximum reimbursable amount per month

Maximum 19/20 allocation (9 months - Jul-19 to Mar-20)

Social Prescribing Link Worker (SPLW) £34,113.00 £2,842.75 £25,584.75

Clinical Pharmacist (CP) £37,810.00 £3,150.83 £28,357.50

TOTALS £71,923.00 £5,993.58 £53,942.25

WANDSWORTH (9 PCNs)

Maximum reimbursable amount per annum

Maximum reimbursable amount per month

Maximum 19/20 allocation (9 months - Jul-19 to Mar-20)

Social Prescribing Link Worker (SPLW) £307,017.00 £25,584.75 £230,262.75

Clinical Pharmacist (CP) £340,290.00 £28,357.50 £255,217.50

TOTALS £647,307.00 £53,942.25 £485,480.25

As stated in Additional Roles Reimbursement Guidance1, if PCNs do not spend their entitlement at

the start of the year as a result of a lag in recruiting the additional roles, they can look to bring

forward the recruitment of a further SPLW or CP into 2019/20 in order to use the full entitlement.

1 Available here: https://www.england.nhs.uk/wp-content/uploads/2019/12/network-contract-des-additional-roles-reimbursement-scheme-guidance-december2019.pdf

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2.2 2020/21

From April 2020, each PCN will be allocated a single combined maximum additional roles reimbursement sum which will be based on the PCN’s weighted population share (in relation to England’s total weighted population). PCNs will be able to recruit from the following roles as they require to support delivery of the Network Contract DES requirements: clinical pharmacists, social prescribing link workers, physician associates and physiotherapists. (From April 2021, paramedics can also be appointed). The total amount that can be claimed in any given year for all roles – except social prescribing link

workers - will be 70% of actual full-time equivalent salary plus employer on-costs (NI and pension) in

respect of individual additional staff, up to the maximum amounts for the relevant role.

3. 2019/20 Forecast

Across all PCNs, the projected spend for SPLWs and CPs has been calculated, and in light of this, also

the projected unallocated funding. The principles and findings of this are summarised below.

Maximum 19/20 funding:

• For each PCN, the maximum 19/20 new roles funding is £53,942.25. This is the payment that would be associated with nine months employment of 1 SPLW and 1 CP

(from Jul-19 to Mar-20).

• Across all nine Wandsworth PCNs, the maximum 19/20 new roles funding is £485,480.25 (‘Value A’).

Social Prescribing Link Workers:

• Seven Wandsworth PCNs signed up to a social prescribing model where the CCG holds the contract. For these PCNs:

o SPLW start date: 1st November 19 o Projected number of months a SPLW will be in post: 5 months o 19/20 projected spend per PCN: £14,213.75

• Two PCNs chose to proceed independently, working directly with a provider with whom they have worked previously. For these PCNs:

o SPLW start date estimate: 1st September 19 o Projected number of months a SPLW will be in post estimate: 7 months o 19/20 projected spend per PCN estimate: £19,899.25

• Across all Wandsworth PCNs, the 19/20 projected spend for currently employed SPLWs is £139,294.75 (‘Value B’).

Clinical Pharmacists:

• Six Wandsworth PCNs have a CP in post. One of these PCNs has 2 CPs. o Start dates varied from 1st June 19* to 2nd December 19. (*1 PCN appointed a CP before

1st July 19 which was when the additional new roles funding commenced). o Projected number of months a CP will be in post in 19/20 ranges from 4 to 9. o 19/20 projected spend per PCN ranges from £12,501.69 to £28,357.50.

• Three PCNs do not have a CP in post currently. It is possible that they could have their first CP in place for 2 months of 19/20.

o Potential CP start date: 1st February 2020 o Potential number of months a CP will be in post: 2 months

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o Potential 19/20 spend per PCN: £6,301.67 • Across all Wandsworth PCNs, the 19/20 projected spend for PCN CPs is £145,151.78 (‘Value C’).

o For 6 PCNs this includes the projected spend of currently employed CPs and for 3 PCNs the spend is included if CPs come into post from Feb 20.

o This reflects 1 CP per PCN; the second CP employed by 1 PCN is not included.

Projected unallocated spend:

• Across Wandsworth the total projected unallocated funding is £201,033.72 (Value A - (Value B + Value C).

• The projected unallocated funding for individual PCNs ranges from £11,371.00 to £33,426.83. • These values are underpinned by several estimates/ assumptions (as noted above).

4. Considerations

4.1 Individual PCN decision making regarding bringing forward recruitment

As a joint approach with the South West London team who are managing the payments for the

additional roles and other funding flows which form part of the Network DES, further details

regarding the roles reimbursement funding can be shared with Wandsworth PCNs. Whilst all

relevant guidance regarding roles reimbursement and the Network DES has been shared, PCNs may

benefit from considering the local calculations outlined above as PCNs may not have explored this

individually.

PCNs may want to use their current projected unallocated funding to bring forward the recruitment

of a further SPLW or CP. One PCN already has a second PCN CP in place and another has a second CP

starting imminently so the funding could be used for these roles.

However, it is relevant to note that at present it is felt that there is a level of uncertainty regarding

the new network specifications which may affect PCN decision making regarding recruiting more

staff at this point. In addition, as noted above, for 2020/21 practices will receive a single sum for four

new roles and PCNs will need to consider the implications of introducing additional CP/ SPLW

capacity in relation to what complement of staff they would be able to employ with their 2020/21

allocation.

4.2 Reallocation of funds across PCNs

There is the following statement in the Additional Roles Reimbursement Guidance published in

December (see link on pg 1): ‘NHS England strongly encourages CCGs to put in place local schemes to

share that unused financial entitlement across the other PCNs in the area to enable them to carry

out further recruitment’

At present there are no plans in place to reallocate funding across Wandsworth PCNs. There was an

early discussion about potential risks of this sort of approach at a PCN Clinical Directors meeting and

it was felt that this could create a competitive rather than collaborative ethos which would not be

desirable. However, formal decisions have not been made regarding whether this would be pursued,

and this is an area that could be considered by the Wandsworth Primary Care Commissioning

Committee.

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For 2019/20 the viability of this would need to be considered and bearing in mind the timescales

establishing a process for this is unlikely to be feasible. In addition, all PCNs have a reasonable

‘projected unallocated sum’ which should generally be able to ‘cover’ any additional recruitment

which they wish to undertake for the remainder of 2019/20.

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Document Title Integrated Primary Care Commissioning Update Paper


Katherine Bugler, Director for Transforming Primary Care



Kate Symons & Emma Gillgrass



Executive Summary Background: This report provides the Wandsworth Primary Care Committee with an update on how delegated Primary Care commissioning is being managed in Wandsworth; providing an update on some of the key programmes of work. Purpose: This paper provides the Committee with an update on the following:

• Winter COPD Scheme

• Practice Variation Visits

• An update from the Joint Primary Care Quality Review Group

• A summary of the primary care contracting decisions Reason for Committee Review: 1. The Committee are asked to note the updates for both the Winter COPD Scheme and

Practice Variation Visit update.

2. The Committee are asked to note the update from the Primary Care Quality Review

Group with specific focus on Learning Disabilities Health Checks, and QOF Results.

3. The Committee are asked to note the decisions taken over the last quarter.

Key Issues: 1. See above points

Conflicts of Interest:

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YES

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As per the usual GP COI

Mitigations: As per the usual GP COI

Recommendation: The Committee are asked to note the ongoing work that has been jointly implemented

across Primary Care under delegated commissioning arrangements.




None


N/A


None


N/A


N/A.


N/A.



Outcome:




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General Purpose – Integrated Primary Care

Commissioning Paper Author: Kate Symons & Emma Gillgrass Sponsor: Katharine Bugler Date: January 2020

The Report 1. Winter COPD Local Incentive Scheme

The Winter COPD scheme aims to support winter resilience in 2019/20 by looking at the management of Chronic Obstructive Pulmonary Disease in Primary Care. The aim of the scheme is to improve the quality of care for patients on the Primary Care COPD QOF register, as well as to reduce A&E attendances and admissions for this population by running alongside and supporting QOF COPD reviews. A further aim of this scheme is to try to identify undiagnosed cases of COPD within the general population. The project was first run in Merton in 2017/18. Looking at secondary care data during the period the scheme was rolled out and comparing with the same period during the previous 12 months there was a reduction of 35 emergency admissions, equating to a saving of £87,500. The rationale for this scheme is that if practices were incentivised to proactively manage their COPD cohort beyond current national quality standards requirements, it is expected that there would be an improvement in quality of care provided to patients and less A&E attendances and emergency admissions. As part of the LIS practices are asked to attend a training session on COPD to include Spirometry and use of hand-held spirometers, appropriate prescribing of inhalers and inhaler technique training, use of rescue packs and latest guidance from NICE and use of EMIS search. They then have to contact patients on their COPD register to offer a rescue pack and ensure that patients have been offered smoking cessation advice where relevant and referred to Pulmonary Rehabilitation if eligible. For the case-finding arm of the project they are asked to perform an EMIS search to highlight possible cases of undiagnosed COPD and then review these patients. This project was presented through the Primary Care Ops Group and was then approved by the LMC. The offer to participate was distributed to practices in January 2020 and will run till 31st March 2020.

2. Practice Variation Visits

In 2019/20 the Primary Care Team are continuing with the Practice Variation Visit

Programme across all practices in Wandsworth. Following the successful practice variation

visits carried out by Merton CCG in 2016/17, it was recognised that it would be beneficial to

carry out similar visits with Wandsworth practices.

The Wandsworth visits started in 2017/18 and form part of the Referral Management

Programme. Due to the challenges facing the local health system and ever-increasing

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pressures on secondary care; the CCG has continued these clinically led visits to practices

with one visit per practice each year. The purpose of these visits is to identify best practice,

as well as explore areas where we know there is variation in activity, which practices may

need support to address. The feedback from these visits has been very positive and

practices have found it useful to see a breakdown of their referral rates, which enables them

to investigate specific areas further.

The 2019/20 visits are underway; 40% of Wandsworth practices have been visited and the

rest of the visits are due to take place between Jan-Mar 2020.

3. Joint Primary Care Quality Review Group (PCQRG) Update

Learning Disabilities Health Checks The NHS Long Term Plan commits to improving uptake of the existing annual health check in primary care for people aged over 14 years with a learning disability (LD), so that at least 75% of those eligible have an LD health check each year. The care of patients with learning disabilities is incentivised in primary care via QOF and the learning disability health check DES. Both of these areas of work are contractually optional but across Wandsworth all practices deliver QOF and all submit data for the LD Health Check DES. The learning disability health check DES requires practices to agree a register of patients aged 14 and over who have a learning disability and are eligible to receive a health check. Practices are then required to provide the health check on an annual basis. The intended focus is on people with moderate and severe needs. Data for 2018/19 suggests that Wandsworth Practices did not achieve the 75% target (a 55% completion rate was reported). Some local issues which may be affecting this target were identified, including the following:

• Coding issues which mean the LD registers are not complete

• Incorrect use of templates leading to data not being captured accurately

• Misinterpretation of the DES claim process (i.e. the need to submit register numbers on a quarterly, not annual, basis).

• The use of some historic read codes

• Training needs to improve confidence in coding and offering LD health checks. Following the identification of these issues, a summary document has been developed, to provide practices with additional information around the LD Health check coding and reporting process. This has been developed in collaboration with local Clinical Leads and the LMC and will be circulated to GP Practices in January 2020. The aim is to support practices in the process and show improvement against local achievement targets. The data submitted by Practices will continue to be monitored on a quarterly basis, and further support offered where appropriate. Quality and Outcomes Framework (QOF) Results 2018-19

The Quality and Outcomes Framework (QOF) is a voluntary annual reward and incentive programme for all GP surgeries in England. The objective is to improve the quality of care

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patients are given by rewarding practices, based on a number of indicators across a range of key areas. The QOF contains three main components (domains):

• Clinical: 65 indicators across 19 clinical areas, maximum 435 points available

• Public Health: Seven indicators across four clinical areas, maximum 97 points available

• Public Health Additional Services: Five indicators across two service areas, maximum 27 points available

The maximum number of points a practice could achieve in 2018-19 was 559, with each point having a value of £179.26 In 2018-19 Wandsworth practices had an average overall achievement of 96.06%, compared to a national average of 96.16%. The table below breaks down the overall achievements to Primary Care Network (PCN) level.

Area Achievement (%) Clinical

Exception Rate (%)

Overall Clinical

domains Public health

domains

Wandsworth CCG 96.06% 96.02% 96.17% 7.98%

South West London 97.26% 97.34% 96.99% 8.39%

England 96.16% 96.01% 96.85% 10.05%

Wandsworth Primary Care Networks

Balham, Tooting & Furzedown 95.44% 95.08% 96.71% 6.65%

Battersea 97.37% 97.70% 96.24% 7.69%

Brocklebank 98.17% 97.96% 98.92% 10.82%

Grafton 95.09% 94.94% 95.65% 6.84%

Nightingale 95.99% 96.42% 94.47% 8.35%

Wandle 94.24% 94.10% 94.74% 7.93%

Wandsworth 96.12% 96.19% 95.85% 9.71%

Wandsworth PRIME 96.44% 96.79% 95.22% 7.62%

West Wandsworth 96.28% 95.96% 97.40% 10.12%

The clinical domains where less than half the practices achieved 100% were Diabetes, Mental Health and Secondary Prevention of CHD. This is in line with previous years. Diabetes and Mental Health are also the clinical domains with the highest number of indicators, Diabetes has 11 indicators, and Mental Health has 7 indicators (Secondary Prevention of CHD has 4). A number of practices were identified that has a significant change either positive or negative in their total achievement, clinical achievement or clinical exception rates compared to 2017-18 data. The data for these practices will be looked at in further detail to identify of there is any support that could be offered to the practices going forward.

4. What general Primary Care Contracting decisions have been made in the last quarter?

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The following details the primary care contracting decision made from for Q3 of 2019/2020;

under business as usual arrangements.

C O N C L U S I O N

The Committee are asked to note the ongoing work that has been jointly implemented

across Primary Care under delegated commissioning arrangements.

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Document Title Month 5 Finance report


Neil McDowell, Local Director of Finance


N/A


Robert Hudson, Local Deputy Director of Finance

Agenda Item No. B03 Attachment No. B03iii


Executive Summary This report covers the spend up to month 5 on Primary Care Co-commissioning, core allocation funded primary care and prescribing. Overall the Primary care budget is forecast to be £725k overspent.

The overspend is due to –

• Delegated commissioning £383k due to overall contracts and commitments beinggreater than allocation. This has been in part mitigated by non-recurrentmeasures but £383k remains outstanding.

• Prescribing £410k over due to both higher costs and usage.

• Partial mitigation due to underspend on OOH contract.

Reason for Committee Review: To note

Key Issues: 1.Significant overspend on PCC and prescribing.2.Use of non-recurrent mitigations means problem in 20/21 will be greater

Conflicts of Interest: N/A

Mitigations: N/A

XX

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Recommendation: The Committee is asked to: Note


Statutory financial duties


N/A


N/A


N/A


N/A


N/A


N/A



Outcome:




Supporting Documents Primary care finance report

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Primary Care Finance Report

PCC - December 2019

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1. Month 9 Background & Overview

2. Month 9 Primary Care Overall Position

3. Primary Care Narrative

4. Recommendations

Contents

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• Background

• Primary Care Delegated Commissioning was introduced on 1st April 2016.

• This paper reflects information available to the CCG to support the financial position for

the nine months ended 31st December 2019

• For prescribing there is a two months time lag on receipt of data therefore forecast is

based on seven months of data

• This report covers services that are paid out of the programme and primary care

allocations. The latter covers the costs of running general practice whilst the former

covers services that the CCG has always commissioned such as local enhanced

services and prescribing.

• Overview

• Overspent by £725k due to delegated commissioning £383k and prescribing of

£410k with the balance being covered by a net underspend on Core funded primary

care excluding prescribing.

1. Month 9 Background & OverviewDecember 2019

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2. Primary Care Position

Full Year Budget Budget to Date Actual to Date Variance to Date Forecast ActualForecast

Variance

£000s £000s £000s £000s £000s £000s

Essential and Additional Services 37,711 28,220 28,233 (13) 37,723 (12)

Enhanced Services 450 386 374 12 442 8

Quality and Outcomes Framework (QOF) 3,084 2,390 2,390 0 3,084 0

Premises Payment 7,007 5,162 5,182 (20) 7,052 (45)

Seniority 277 208 196 12 265 12

Other Administered Funds (Maternity etc) 1,011 758 712 46 1,011 0

Personally Administered Drugs 175 131 145 (14) 175 0

Other Medical Services (15) (11) (7) (4) (15) 0Primary Care Networks

1,938 1,344 1,081 263 1,594 344

CCG Adjustments (1,105) (829) 0 (829) (177) (928)

Prior Year Accruals 0 0 (198) 198 (238) 238

Total Primary Care Delegated Budgets 50,533 37,759 38,108 (349) 50,916 (383)

Local Enhanced Services 2,200 1,650 1,640 11 2,200 0

Out Of Hours 2,622 1,967 1,793 174 2,390 232

Prescribing 36,241 27,180 27,488 (308) 36,651 (410)

Other Primary Care Budgets 7,427 5,571 5,625 (55) 7,587 (160)

Total Primary Care - BAU 99,023 74,127 74,654 (527) 99,745 (721)

Practice Transformation Support/PCN Development (£1.50 per head) 610 458 458 0 610 0

Winter COPD Scheme (QIPP Investment) 92 69 69 0 92 0

Clinical Decision Support Tool (2019-20) (QIPP Investment) 93 70 78 (8) 104 (11)

GPFV - GP Access Initiatives (WCCG) 1,601 1,201 1,195 5 1,594 7

GPFV - Primary Care at Scale - WCCG 600 450 450 0 600 0

0 0

Primary Care Investments 2,996 2,247 2,249 (3) 2,999 (3)

Total Primary Care 102,019 76,374 76,903 (530) 102,744 (725)

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2. Primary Care delegated budgets

£000's £000's £000's £000's £000's £000's

PMS

Essential and Additional Services 32,670 24,473 24,473 0 32,670 0

Enhanced Services 407 347 342 (5) 402 (5)

Quality and Outcomes Framework (QOF) 2,669 2,078 2,079 1 2,669 0

Premises Payment 5,949 4,383 4,405 22 5,995 46

Seniority 237 177 168 (9) 224 (13)

Other Administered Funds (Maternity etc) 881 661 664 3 881 0

Personnally Administered Drugs 157 118 129 11 157 0

Total PMS 42,970 32,237 32,261 24 42,998 28

GMS

Global Sum & MPIG 3,933 2,920 2,921 1 3,933 0

Enhanced Services 37 32 30 (2) 37 0

Quality and Outcomes Framework (QOF) 354 266 266 0 354 0

Premises Payment 681 501 501 0 681 0

Seniority 41 30 28 (2) 41 0

Other Administered Funds (Maternity etc) 103 77 43 (34) 103 0


Total GMS 5,162 3,838 3,800 (38) 5,162 0

APMS

Essential and Additional Services 1,108 827 838 11 1,120 13

Enhanced Services 7 7 3 (4) 3 (4)

Quality and Outcomes Framework (QOF) 61 46 46 0 61 0

Premises Payment 377 278 276 (2) 377 0

Seniority 0 0 0 0 0 0

Other Administered Funds (Maternity etc) 26 20 5 (15) 26 0


Total APMS 1,583 1,180 1,172 (8) 1,592 9

Other Medical Services

Indemnity Insurance 0 0 0 0 0 0

Premises valuation and other associated costs 0 0 0 0 0 0

Primary Care Networks 1,938 1,344 1,081 (263) 1,594 (344)

CCG Adjustments (1,105) (829) 0 829 (177) 928

Prior Year Accruals 0 0 (198) (198) (238) (238)

Other (15) (11) (7) 4 (15) 0

Total Other Medical Services 818 504 876 372 1,164 346

Total Primary Care Medical Services 50,533 37,759 38,108 349 50,916 383

Forecast Variance

DescriptionAnnual Budget YTD Budget

YTD Actual

Expenditure

YTD

Variance

Forecast

Outturn

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3. Primary Care Narrative

Delegated budgets

• £349k overspend year to date, forecast £383k by year end. However this is supported by £759k of

non-recurrent measures including old year accruals and slippage on PCN. Without non recurrent

measures the budget would be £1.1m over.

• Within the contracts themselves the budget is broadly in line.

Prescribing

• Prescribing continues to overspend, forecasted to be £0.4m over by year end. This is caused by

increases in Libre, DOAC and Cat M with flu expected to impact in the winter months.

Core funded Primary Care

• Broadly in line with an underspend on the Out of Hours Contract covering a shortfall of income on the

Junction.

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4. Recommendations

The Primary Care Committee are asked to note the outturn financial

position.

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Wandsworth Clinical Commissioning Group Primary Care Committee Meeting


Document Title Wandsworth PMS Specification Update


Katie Bugler, Director for Transforming Primary Care


N/A


Tanya Stacey – Senior Primary Care Commissioning Manager



Purpose The purpose of this paper is to provide the Wandsworth Primary Care Committee (PCC) with an update on the progress of the PMS premium services which were implemented following a review and development process in 2017. Where required, data submissions are received from Practices on a quarterly or annual basis and are monitored by the CCG. This paper presents the findings to date of this data analysis and recommendations for actions resulting from this.

Reason for Committee Review:

The monitoring of Practice data submissions has allowed us to identify some encouraging

improvements which will result in improved patient care. The Primary Care Committee

are asked to note the information in this paper and the planned next steps.

Key Issues: The key area for the Committee to note is:

• Analysis section – outcomes from data analysis in relation to the following specifications: o PS1: Improvement in the Provision of a Comprehensive Annual Diabetes Review

(8 care processes) in Primary Care o PS2: Increasing the uptake of Influenza Vaccination in Primary Care for over 65s o PS3: To Support Improvement in Uptake of Childhood Immunisations o PS4: Supporting uptake of Bowel Cancer Screening in Primary Care

Conflicts of Interest: N/A

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YES

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Mitigations: N/A

Recommendation: N/A


This document impacts on the following Corporate Objectives:

• Commission high quality services which improve outcomes and reduce inequalities

• Make the best use of resources, continually improve performance and deliver statutory responsibilities

• Develop the CCG as a continuously improving and effective commissioning organisation


N/A


N/A


N/A


N/A


N/A


N/A

Previous Committees/


Outcome:

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Groups Enter any Committees/ Groups at which this document has been previously considered:

N/A Click here to enter a date.


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Wandsworth PMS Specification Update Author: Tanya Stacey Sponsor: Katharine Bugler Date: January 2020

Executive Summary

Context The purpose of this paper is to provide the Wandsworth Primary Care Committee (PCC)

with an update on the progress of the PMS premium services which were implemented

following a review and development process in 2017. Where required, data submissions are

received from Practices on a quarterly or annual basis and are monitored by the CCG. This

paper presents the findings to date of this data analysis and recommendations for actions

resulting from this.

Question(s) this paper addresses

This paper addresses the following key question:

• What themes have been identified from the PMS Premium Service data that

has been submitted to date?

Data related to the following premium services has been reported in this paper;

• PS1: Improvement in the Provision of a Comprehensive Annual Diabetes Review (8

care processes) in Primary Care

• PS2: Increasing the uptake of Influenza Vaccination in Primary Care for over 65s

• PS3: To Support Improvement in Uptake of Childhood Immunisations

• PS4: Supporting uptake of Bowel Cancer Screening in Primary Care

Conclusion

The monitoring of Practice data submissions has allowed us to identify some encouraging

improvements which will result in improved patient care. The Primary Care Committee are

asked to note the information in this paper and the planned next steps.

W A N D S W O R T H C C G P A G E 1 O F 7

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The Report

F U R T H E R C O N T E X T

Background to the PMS Review Process

The importance of continuing to develop a strong and stable General Practice infrastructure

across Wandsworth cannot be understated. Primary Care is crucial to managing the out of

hospital challenges facing the local health and social care sector .

The most recent PMS Review in 2017 was an opportunity for the CCG to contractualise the

delivery of a number of key strategic initiatives within General Practice. A PMS Working

Group was established and regular meetings with the Local Medical Council (LMC) took

place in order to refine and develop the local PMS premium offer.

Following discussions with the Executive Management Team (EMT) a number of

overarching priorities were agreed which the PMS offer would support the CCG in delivering

against. These included:

• Delivering quality across Primary Care,

• Creating sustainability in Primary Care,

• Supporting Primary Care Transformation.

The PMS Premium relates to the locally designed service areas that were developed as part

of the review process in conjunction with local clinicians and clinical leads, clinical reference

groups, Public Health and the LMC. They are as follows;






• PS5: Increasing Use of Referral Management Software to Support Appropriate &

High Quality Referrals from Primary Care

• PS6: Make a Difference (MAD) Alerts

• PS7: Registered Patients Residing in Deprived Areas

• PS8: Supporting the management of Children in Primary Care (under 5s)

In total there are 39 Practices in Wandsworth; 28 of which are PMS Practices, 9 GMS and

2 APMS Practices.

Following the implementation of the above specifications, a PMS Review group was set up

which meets quarterly to monitor and discuss the data that has been submitted by Practices

as part of their PMS reporting requirements. The validity and appropriateness of the PMS

Premium specifications is also continually reviewed at these meetings.

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The purpose of this paper is to update the committee on any observations made to date

regarding performance against the aims of the PMS Premium specifications. Due to the

nature and frequency of data submitted, this paper will focus on the following areas;






A N A L Y S I S

What themes have been identified from the PMS Premium specification data

submitted to date?

1. PS1: Improvement in the Provision of a Comprehensive Annual Diabetes Review

(8 care processes) in Primary Care

The Wandsworth PMS service specification relating to diabetes has been in place since 1st

April 2018 in all PMS and GMS Practices in the borough). The specification supports GP

practices to provide a comprehensive and proactive annual review of their diabetic patients.

This aims to reduce morbidity and encourage self-management and lifestyle changes with

the benefit of reducing the need for unplanned care in primary and secondary care.

NICE guidelines set out eight clinical care processes that should be completed, which are

as follows;

• Weight

• Blood Pressure

• Smoking Status

• HbA1c

• Urinary Albumin

• Serum Creatinine

• Cholesterol

• Foot Surveillance

As part of the specification, Practices have been required to participate annually in the

National Diabetes Audit (NDA), using their previous audit results as a baseline. The NDA

monitors the percentage of patients who have received the eight care processes.

Achievement targets were set for each Practice, taking into account their baseline

performance in the NDA 2015/16, the Wandsworth CCG average and the London and

England averages for this indicator. Practices have been asked to submit their achievement

against these targets on an annual basis. Figure 1 outlines the progress of each Practice as

of 31st March 2019, and demonstrates the following;

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• 25 out of 37 Practices (68%) have already met or exceeded their 2020/21 target

• 32 out of 36 Practices (89%) demonstrated an improvement in 2018/19 when

compared to the previous year (one Practice did not submit data)

• 31 out of 34 Practices (91%) demonstrated an improvement in 2018/19 when

compared to the 2015/16 baseline data (data not available for 3 Practices)

2. PS2: Increasing the uptake of Influenza Vaccination in Primary Care for over 65s

Influenza occurs every winter in the UK and is a key factor in the NHS in Winter Pressures.

It impacts on those who become ill, the NHS Service that provide direct care, and on the

wider health and social care system that support the at risk groups. In the two years prior

to the PMS premium specification being introduced, there was a decline in the percentage

uptake of influenza vaccine in those over 65 years old.

The specification aims to support practices to implement systems to help support

improvements in the uptake of the flu vaccination.

Practices have been set achievement targets based around a stepped improvement model

which aims to see all practices achieving the national target requirements (70%) by 2020/21.

As uptake data is submitted on an annual basis, the most recent data available is from Q4

2018/19 which tells us the following;

• 15 Practices have demonstrated an increase in uptake rates when compared to their

baseline uptake (recorded February 2017).

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WCCG PS1: Diabetes Annual ReviewDiabetic patients in whom all 8 care processes measurements have been undertaken annually

2018/19

Q1 YE Baseline (National NDA Data) 2020/21 Target 2020/21 TargetPMS GMS

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• 14 Practices exceeded their 2018/19 target.

Those practices who did not meet their 2018/19 targets were asked to submit an action plan

to identify a method for increasing uptake during 2019/20. The CCG also reviews this

information and offers support to Practices where appropriate. As data is submitted on an

annual basis, the impact of this work will be assessed after the end of Q4 2019/20.

3. PS3: To Support Improvement in Uptake of Childhood Immunisations

Primary Care offer a schedule of immunisations to children from birth to 5 years of age. This

programme ensures that Children are protected from serious disease and complications of

those diseases. There are many reasons for non-attendance for immunisations and this

affects uptake rates. It is also important to identify patients who are not attending as it may

present a safeguarding concern.

The premium service supports practices in establishing and subsequently reviewing their

systems for calling children who do not attend their routine immunisations. Practices are

required to submit the following:

• Practices to complete and submit an initial baseline assessment template by 31st

March 2018

• Report the number of children aged 1 whose notes record the 5-in-1 vaccine has been

administered.

• Report the number of children over 2 and less than 3 who have received the

recommended immunisation courses

• Report the number of children over 5 and less than 6 who have received the

recommended reinforcing doses

• Practices to submit a progress report at 6 months

• Practices to submit an annual action plan which will include lesson learned and

information regarding the number of non-attendees and the reasons given i.e.

recurrent non responder, declined, accessing vaccination privately or abroad

When comparing the data received in Q1 2017/18 to that received in Q1 2018/19, we can

observe the following points;

• There was an improvement in immunisations rates for 2 year olds in 13 Practices

• There was an improvement in immunisations rates for 5 year olds in 8 Practices

Looking at immunisation data on a London and national level, it is evident that meeting the

national target of 90% coverage is a widespread challenge. Using the data and action plans

submitted through the PMS premium requirements, it will be important for learning to be

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shared and for Practices to be offered support to implement new processes to improve

uptake in the remaining practices.

4. PS4: Supporting uptake of Bowel Cancer Screening in Primary Care

Bowel Cancer is the third most common cancer in Wandsworth in both sexes and the

incidence has been rising. Bowel Cancer screening uptake has been historically poor in

Wandsworth at around 40% compared to the National Quality Standard of 60%.

As part of the PMS Premium which commenced from 1st April 2019, Practices have been

asked to identify and contact patients who have not responded to the bowel screening invite

and encourage participation by practice endorsement, advice and help. Practices are also

asked to identify all non-responders within the last 12 months using searches, they will then

be expected to contact these patients via a letter or telephone call to promote and endorse

the screening service. Evidence shows that such GP endorsement of bowel screening can

increase uptake by 10%.

When comparing the Q1 2018 submission to the Q2 2019 submission (latest data available),

the following points emerge;

i. Uptake of Bowel Cancer Screening

• As shown in the graph overleaf, 25 of the 37 reporting Practices demonstrated an

increase in uptake, compared to only 10 Practices who saw a decrease (2 Practices

saw no change)

• The Practices who reported a decrease in uptake saw quite a significant decrease,

with ranges from -3% to -55%, whereas where increases were reported, these were

less significant at +3% to +28%.

• However, overall there has been a 6% reduction in the uptake of bowel cancer

screening across all reporting Practices

Based on the above observations, it is recommended that the CCG works with the 10

Practices who reported decreases in uptake to better understand any reasoning behind this.

Based on Practice feedback, it would also be beneficial to ensure the searches being used

are accurate. Additionally, it will be important to ask Practices who reported an increase in

uptake how this was achieved with the view to share learning across the borough.

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ii. Number of people who have not responded to bowel screening invitation

• Overall, 865 more people did not respond to their bowel screening invite.

iii. Number of people who have been contacted via information letter, leaflet or telephone

• Overall, 1610 more people have been contacted by their Practice after not responding

to their bowel screening invitation. This demonstrates that Practices are being more

proactive and have put systems in place to contact non-responders.

iv. Number of people who have actively declined bowel cancer screening

• Overall, 313 more people actively declined bowel cancer screening. The majority of

these (275) were at one Practice so it is recommended that the CCG works with this

Practice to look into any reasons relating to this significant change.

C O N C L U S I O N

Following the implementation of the PMS premium services, as detailed in this paper, the

consistent monitoring of Practice data submissions has allowed us to identify some

encouraging improvements which will result in improved patient care. The Primary Care

Committee are asked to note the information in this paper and the planned next steps.

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Uptake of Bowel Cancer ScreeningQ1 2018/19 vs Q2 2019/20

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PMS GMS

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For Reference Edit as appropriate:

1. The following were considered when preparing this report:

The long-term implications [Yes]

The risks [Yes]

Impact on our reputation [Yes]

Impact on our patients [Yes]

Impact on our providers [Yes]

Impact on our finances [Yes]

Equality impact assessment [Not applicable]

Patient and public involvement [Not applicable]

2. This paper relates to the following corporate objectives:

• Commission high quality services which improve outcomes and reduce

inequalities [Yes]

• Make the best use of resources, continually improve performance and deliver

statutory responsibilities [Yes]

• Continually improve delivery by listening to and collaborating with our patients,

members, stakeholders and communities [Not applicable]

• Transform models of care to improve access, ensuring that the right model of care

is delivered in the right setting [Not applicable]

• Develop the CCG as a continuously improving and effective commissioning

organisation [Yes]

3. Executive Summaries should not exceed 1 page. [My paper does comply]

4. Papers should not ordinarily exceed 10 pages including appendices.

[My paper does comply]

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Document Title Governance for Primary Care Across SWL


Andrew McMylor SWL Director Primary Care



Andrew McMylor SWL Director Primary Care



Executive Summary Background: The paper, along with the attached FAQ slide set, articulate the process for primary care

governance from April 1st 2020. This governance principally concerns matters pertaining

to core general practice contracts, and follows an established process across the UK.

Within SWL we have ensured these processes can be transacted as locally as possible,

in order to strengthen and empower primary care within each Borough. This enables each

Borough to maintain control over primary care budgets and strategy; but safe in the

knowledge there is an agreed process for ensuring the contracting of primary care is

conducted as efficiently as possible.

Reason for Committee Review: 1. The Committee are asked to note the proposals for the new governance arrangements

in particular the role of the new SWL Primary Care Committee from April 2020.

Key Issues: 1. The Role of the SWL PCCC from 1st April 2. The Worked Examples 3. The reporting arrangements

Conflicts of Interest: As per the usual GP COI

Mitigations:

XX

YES

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As per the usual GP COI

Recommendation: The Committee are asked to note the proposals for the new governance arrangements

for Primary Care across SWL in particular the role of the new SWL Primary Care

Committee




None


N/A


None


N/A


N/A.


N/A.



Outcome:




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General Purpose – Integrated Primary Care Commissioning Paper Author: Andrew McMylor Date: January 2020

The Report 1. The Function of Primary Care Commissioning Committees

Primary Care Commissioning Committees (PCCCs) deliver the statutory functions of

CCGs as set out by NHS England as part of the delegation agreement for primary

care.

Functions PCCCs deliver include ratifying new incentive schemes, agreeing significant

changes to practices or overseeing primary care contracts.

We currently have six PCCCs in SWL (i.e. one for each CCG). All operate with very

similar terms of reference and membership given the statutory functions are the same

for each.

Each PCCC is supported locally by Primary Care teams with the support of the SWL

contracting team.

Typically they meet every two to three months in public and along with ensuring the

statutory functions are delivered, also provide a steer on the local primary care

strategy and budget.

2. The role of the SWL PCCC from April 1st 2020

In keeping with the commitment to maintain and enhance primary care locally, we

propose to transact as much business as possible at Borough level. The terms of

reference for the PCCC are attached as an appendix to this paper, and have been

developed following detailed discussions with the Surrey & Sussex Local Medical

Committee.

Whilst we are required to have a single PCCC for SWL to mirror one CCG, the PCCC

only needs to ensure the statutory functions are delivered. These are articulated in the

attached terms of reference and include the following;

• GMS, PMS and APMS contracts; taking contractual action such as issuing

breach/remedial notices, and removing a contract;

• Ratification of newly designed Local Incentive Schemes (LISs) on the

recommendation of the relevant Borough Committee of the CCG.

• Ratification of newly designed local incentive schemes as an alternative to the

Quality Outcomes Framework (QOF) on the recommendation of the relevant

Borough Committee of the CCG.

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

recommendation of the relevant Borough Committee of the CCG.

• Approving practice mergers on the recommendation of the relevant Borough

Level Committee of the CCG; and

• Making decisions on ‘discretionary’ payments where Standard Operating

Procedures do not exist on the recommendation of the relevant Borough

Committee of the CCG.

It is important to note that the PCCC membership will contain a representative of the

Wandsworth Committee.

The terms of reference for the PCCC are very similar to the existing Wandsworth

PCCC given the statutory functions will be the same. We envisage the PCCC meeting

every two months in public initially.

This approach will ensure that primary care continues to be strengthened and

empowered within Wandsworth with only matters needing formal PCCC ratification

being escalated.

3. The role of the Wandsworth Primary Care Management Group

Wandsworth will have its own formal Primary Care Management Group (PCMG) where

the vast majority of business can be agreed, delivered and monitored. Typically this

will be chaired by a Wandsworth senior manager with membership including local GP

colleagues.

The PCMG will report into the Wandsworth Committee who in turn will ensure the

PCCC receive the appropriate papers.

Only decisions formally needing PCCC approval will be sent to the PCCC.

The Wandsworth Committee may ask for advice or guidance from SWL colleagues

before making a local decision. Such an advisory group would help us share our

learning and make sure we are making the right decisions for local people, including

managing any conflicts of interest if these could not be resolved locally.

4. Reporting Arrangements

In order to ensure the smooth running of the PCCC, the Wandsworth Committee and

the PCMG need to establish clear reporting lines.

Wandsworth Primary Care Management Group:

Reports to. The Wandsworth Committee; establishing appropriate relationships with

other committees for example quality and finance where required. It should be noted

the vast majority of primary care contracting is considered ‘business as usual’ and

would not need discussion at the PCMG.

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Membership. Monthly meeting chaired by a Wandsworth senior manager with

membership including local GPs, the LMC and the SWL contracting team. Its function

is to have an understanding of all matters concerning local primary care, with a specific

approvals and recommendations remit.

Responsible for. Across London and the UK, Standard Operating Protocols have

been agreed covering a number of transactional elements. For example, a request to

vary a contract (e.g. one Partner retiring) or a small boundary change amendment

request. These areas can be discussed and agreed at the PCMG without further

escalation providing any conflicts of interest are managed accordingly.

However, there will be a number of functions that cannot be resolved by the PCMG.

For example, a contract termination. On these matters the PCMG will develop a paper

for the Wandsworth Committee and/or key officers to scrutinise before a paper along

with recommendation is sent to the PCCC to make a formal decision.

The Wandsworth Committee may not require papers for some functions however it is

suggested members receive the papers before being sent to the PCCC, and as such

the Wandsworth Committee will act as a gate-keeper for the PCCC. This will ensure

that all local leaders are fully sighted on Wandsworth primary care matters.

Worked example – new APMS contract

Where it has been identified a new APMS contract is required in Wandsworth area (for

example, a closure of a large practice requiring new capacity) the following process

would be used;

The Primary Care Management Group would develop the procurement documents,

and with the input of local GPs, recommend any relevant targets for any new provider

to attain.

The Wandsworth Committee would take a wider-system view in ensuring that the

service provider will play a strong role in the Wandsworth health and care system, and

also that the PCMG has developed a strong service model for the provider to deliver

against. The Wandsworth Committee would then recommend approval to the PCCC.

The Primary Care Commissioning Committee would formally authorise the

establishment of a new APMS provider and assure itself that the process followed in

Wandsworth was compliant with good-practise procurement and will deliver value for

money.

Members of the Primary Care Management Group would then oversee the

implementation of the contract, and offer support to the new provider.

Worked example - Practices merging

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Members of the Primary Care Management Group would meet with the practices to

understand the proposal and to work with them to ensure due process is followed, for

example, to consult with patients and to ensure the proposal would maintain or

enhance existing service delivery.

The Primary Care Management Group (managing conflicts of interest accordingly)

would scrutinise the subsequent business case proposal from the practices and

assure itself that any service changes are clearly articulated, for example, a change

of location(s) or opening hours of bases. In addition to ensure that any risks are

highlighted and mitigated.

The Primary Care Management Group would also work with the practice to ensure key

changes, for example, new IT configuration have a deliverable action plan.

The Wandsworth Committee will seek assurances from the PCMG that the proposal

supports the wider primary care strategy of the borough, for example, in the

development of Primary Care Networks.

The Wandsworth Committee, or key officer(s) will make a formal recommendation to

the Primary Care Commissioning Committee that due process has been followed and

the proposal maintains or enhances existing service delivery.

The Primary Care Commissioning Committee would formally authorise the merger

assuring itself that all the appropriate documentation has been completed satisfactorily

via the PCMG and Wandsworth Committee. Where members of the PCCC require

further information, this will be provided in advance so that a decision can be made at

the next available opportunity. As applications to merge must be submitted four months

in advance, scheduling onto a PCCC agenda will be achieved without causing a delay

to the process.

Members of the Primary Care Management Group would then oversee the contract,

as per other primary care contracts.

5. Summary

The paper, along with the attached terms of reference for the Wandsworth PCMG,

SWL PCCC and FAQ slide set, articulate the process for primary care governance

from April 1st 2020. This governance principally concerns matters pertaining to core

general practice contracts, and follows an established process across the UK.

Within SWL we have ensured these processes can be transacted as locally as

possible, in order to strengthen and empower primary care within each Borough. This

enables each Borough to maintain control over primary care budgets and strategy; but

safe in the knowledge there is an agreed process for ensuring the contracting of

primary care is conducted as efficiently as possible.

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Within Wandsworth, work has begun to ensure the PCMG will begin to operate

effectively ahead of April 1st so that there is sufficient time to embed ways of working

in the context of one SWL PCCC.

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We believe in an inclusive and innovative approach to care. 1

Primary Care Governance Summary – conflicts will need to be managed at all levels

PCMG Local Committee SWL PCCC

Chaired by Locally agreed senior person A local GP/ other if conflicted A lay member of the CCG governing body

Meeting frequency / notes Monthly Reports to the Local Committee

Monthly Every two months Reports to the CCG governing body

Key members Will include a number of local GPs including the LMC

Members of the local primary care team

Retains clinical majority – if conflicted will manage these locally on advice from the PCCC

Will include a representative of each local committee

LMC to be present as a non-voting member mirroring current arrangements

Primary care remit Oversee the day-to-day business of primary care; including making decisions where a clear procedure exists (see below)

Making recommendations to the Local Committee (and/or key officers) where a SWL PCCC decision is needed

Maintaining primary care at the heart of local system plans

Receiving papers from the PCMG and making formal recommendations to the SWL PCCC

Comply with the statutory duties the CCG has with regards to primary care

Outline of key primary care responsibilities

Agreeing a number of actions where clear procedures exist, for example;List closureList suspensionBoundary changesDiscretionary paymentsContractual changes (transactional)Locum reimbursementsGP performer payments, e.g. sick pay

Develop and oversee the implementation of the primary care strategy

Ensure the wider health and care system is inclusive of primary care and that primary care views are taken account

To receive papers and recommendations from the Local Committee (having first been developed by the PCMG) in respect of;Taking contractual action such as issuing breach noticesApproving new local incentive schemesApproving practice mergersEstablishing new GP practices

Comparison to now Each PCMG meets in a similar manner to what is being proposed however not all have an approvals role. By ensuring clear decision-making at PCMG we will reduce duplication and reduce the time it takes to make decisions, without the need for PCCC approval

Whilst there is no Local Committee, the existing CCG governing bodies perform a similar role in setting the overall primary care strategy

The six existing PCCCs often undertake the roles that PCMGs can deliver, and thereby we are confident that moving to one PCCC will not mean six times the work

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Primary Care Commissioning - FAQ

Who will the voting members be on the SWL PCCC, and how different is it to now?

In keeping with NHS England requirements, the PCCC will be chaired by a lay member along with key CCG officers. Local GPs will be non-voting members so they can provide advice and guidance to the voting members. The voting members are very similar to the existing PCCCs. This is because the requirements from NHS England on this are very clear.

Why can’t local GPs be a voting member of the PCCC?

Again, the requirements from NHS England are clear on this, and since PCCCs started over three years ago, none have had local GPs as voting members. The PCCC exists to ensure that any possible conflicts of interest, for example in the development of a new service with funding going to local GPs, are managed appropriately.

The PCCC has a vital governance role in ensuring that matters around individual contracts or new services have been developedfairly and there is no risk of a legal challenge. In fulfilling this role the PCCC acts as an important safety net to protect the integrity of the CCG and its Member practices.

What will be the relationship between the SWL PCCC and the Local Committee and PCMG?

The local PCMG and Local Committee will be responsible for developing any proposals that require the approval of the PCCC. Typically this is where the proposal recommends payment to GP practices or a decision has a large impact on one individual contract. The PCCC will receive all its information, along with a recommendation from the Local Committee on what to approve andwhy. The PCCC then acts as the final check to ensure the proposal represents good value for money and has been developed fairly.

Will the SWL PCCC reject local recommendations?

This is not the intention of the SWL PCCC. In the unlikely event the SWL PCCC had reason to question how a service or a proposal was developed, before approving it, the PCCC would wish to work with the Local Committee and PCMG to answer any questions.

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Primary Care Commissioning - FAQ

Will the SWL PCCC be responsible for the primary care strategy across each Borough?

No, this sits firmly with the Local Committee and our commitment to enhance primary care support locally.

Won’t the SWL PCCC just do all the work of the six existing PCCCs?

Many changes affecting GP practices do not need the approval of the PCCC. For example, discretionary payments, GP rent reviewprocess, boundary changes, infection control and contract changes (for example, addition of a new Partner) can all be approved locally. Where items that significantly affect a contract require approval, for example a PMS Review, contract termination or merger along with the award of a new contract, only these matters need the approval of the PCCC. As stated, before they reach the SWL PCCC each will have been discussed locally with a recommendation made to the SWL PCCC.

Won’t have a meeting every two months slow our progress locally if we want to deliver a service?

Firstly, we would expect that the SWL PCCC will ‘forward plan’ so would know in advance of any new proposals requiring its approval, so that it could be timetabled accordingly. However if something required an urgent approval, then there are a number of options available. For example, the Chair could take a ‘Chair’s action’ in consultation with other voting-members to approve with the decision communicated at the next meeting in public. Of course, we could decide to meet more frequently and as such we will keep this under review.

Will the SWL PCCC manage primary care budgets?

No, this is delegated to the Local Committee to manage accordingly. This includes both core contracts as well as locally designed incentive schemes.

How will we ensure sufficient local debate and input into primary care?

By having more local GP input at the PCMG including the LMC we are confident this will ensure a healthy and robust debate. Equally, by having a clinical majority on the Local Committee, and by having the budgets delegated locally, there are a number of ways in which to input into primary care.

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