Primary Care Commissioning Committee Meeting Agenda

Primary Care Commissioning Committee Meeting Agenda Thursday 2nd June 2016, 3.30pm – 5.00pm

Conference Room 1, 1st Floor, the Gateway, Gatehouse Road, Aylesbury, Bucks, HP19 8FF

No Agenda Item Desired Outcome(s) Contributor Papers/Times 1 Welcome & Introductions:

Apologies: Graham Smith CHAIR

3.30pm – 3.40pm

2 Declarations of Interest Graham Smith CHAIR

2.1 Questions from members of the public Graham Smith CHAIR

3 Minutes of the April 2016 meeting and action log

PAPER Graham Smith CHAIR

Clinical Commissioning

4 Additional Portakabin at Berryfields Surgery in Aylesbury

Decision Nicky Wadely, NHSE Lou Patten, AVCCG

3.40pm – 3.55pm

5 Verney Close Practice in Buckingham PAPERS: consider options and agree a way forward.

Lou Patten, AVCCG

3.40pm – 4.10pm

6 Mandeville Update Verbal Nicky Wadely, NHSE 4.10pm – 4.20pm

7 Request to delegate approval of the QoF & DES+ data to a subcommittee of the PCCC

Decision Lou Patten, Chief Officer AVCCG 4.20pm – 4.35pm

AOB 8 AOB Graham Smith CHAIR 4.35pm – 5.00pm

FOR INFORMATION ONLY

Finance Report Paper for information only

Quality Report Paper for information only

Primary Care Commissioning Committee (PCCC) Thursday 28th April 2016, 8.45am – 10.00am

AVCCG Boardroom, the Gateway, Gatehouse Road, Aylesbury, Bucks

Present: Graham Smith, Lay Member for AVCCG (GS) CHAIR Louise Patten, Chief Officer AVCCG (LP) Nicky Wadely NHS England (NW) Jessica Newman, NHS England (JN) Gary Passaway, AVCCG Primary Care Manager (GPy) Robert Majilton, AVCCG Chief Finance Officer (RM) – arrived at 9am Robert Parkes, AVCCG Lay member and Co-Chair (RP) Dr Karen West, AVCCG Clinical Lead (KW) Colin Thompson, Director of Operations & Performance, AVCCG (CTh) Vicki Parker- AVCCG (Minute taker) (VP) Members of the public in attendance: Debbie Ratu and Dr Martina Hens from Verney Close Surgery

Item No.

Agenda Item Lead

1 Welcome & Apologies Members of the Primary Care Joint Committee were welcomed to the meeting and introductions given. Apologies were noted from Dr Graham Jackson, Colin Seaton and Colin Hobbs

2 Declarations of Interest. Debbie Ratu and Dr Martina Hens declared an interest in the Verney Close discussions. Dr Karen West advised she is a GP Partner in an Aylesbury Vale practice.

Page 1 of 7

3 Minutes and Actions of Joint Committee Meeting 24th March 2016

Minutes of 24th March 2016 agreed as a correct record. Action log updated accordingly. LP asked for action 9 to be chased up. NW agreed to chase this with NHSE colleagues.

4 Verney Close Questions raised by Members of the public: Verney Close did a huge amount of work with a large financial outlay to secure the signage of forms that NHSE required and it was asked how they go forward with NHSE and the CCG as it has become apparent what was asked for was not enough, and why was legal advice not sought earlier to secure GMS contract. NW explained the collection of legal advice was an ongoing process and understands the pressure the practice was put under. NW explained the contract does not cover any costs associated with partnership disputes and there is a process to resolve these issues, which are outside the core contract. LP explained at the beginning of the award of the GMS interim contract we should have gone out to tender at that point. However at the time the Partners needed to sort through if this was a disillusion and there were overshadowing issues of a challenge form the exiting Partner. Every possible option was looked at to avoid looking to go out to tender, and this has taken a large amount of time. MH asked the committee to recognise the trauma Verney Close has been through and asked what it takes to recognise the work they have done. MH asked the committee to look at how well they are looking after their patients and to consider this in any decision made. NW explained the background of the paper presented and explained the partnership dispute occurred in March 2015 and by February 2016 confirmation was received that the dispute has been resolved. An interim contract was put in place until legal procurement advice was received. NW explained there are 4 options to consider: a) Do nothing (and award a continuation of the GMS contract to the re-formed practice partnership) b) Run an open tender c) Run a “closed” tender – i.e. inviting certain potential providers d) Run some form of initial market testing NW explained advice received indicated there is still an issue with the interim contract in place and there is a risk of challenge from any potential provider on these procurement arrangements. Gpy explained there is significant growth planned in Buckingham of approx. 30,000 new residents over the coming years and it is important to note the expected increase in demand within Buckingham and the surrounding areas. NW added patient satisfaction from Verney Close is higher than NHSE averages which is a reflection of the service provided by the practice.

Page 2 of 7

LP asked to understand the risks and what would happen with a contract challenge. NW explained this would be a legal process and would halt any procurement underway and risk a challenge to any contract already put in place, potentially ending in a judicial review. If a judicial review was found against the CCG and NHSE, it would mean another procurement process will have to begin. It was noted a challenge could come anytime in the procurement process or in the early stages of an award of contract. NW explained an interim GMS contract can only be offered for a limited time. When a procurement process begins, a GMS contract is not offered, an AMPS contract will be issued. KW asked if the current provider continues, can they continue with their existing GMS contract? It was clarified NHSE can no longer award a long term GMS contract and there is only a short term interim GMS contract or an APMS contract on offer. RP asked what the process is when a Partner retires and what is distinguishing this situation from a normal change in a Partnership? NW explained at the point when this dispute occurred, because it was understood that an agreement could be reached, something had to be put in as an interim solution to maintain the level of service. LP explained the Partnership was eventually dissolved and reformed without the exiting Partner, and eventually it was agreed the exiting Partner would “retire” and this was no longer a partnership dispute, but at the beginning of the process it was assumed this was a dispute. RP asked if there has been any interested from the market place. NW explained this has not been circulated in the public domain. LP feels, with the developments in North Bucks and S106 monies available, there is a risk of a procurement challenge as this has a very high profile in the public domain KW asked what is best for the patients. LP explained Verney Close is a popular practice with patient satisfaction exceeding above NHSE national averages. LP feels a challenge would disrupt patients and unsure if the current workforce would cope with the pressure of a possible procurement, and feels we should look at a procurement route that is as short as possible. CTh explained the practice has first class GP’s and we risk losing good staff and lost relationships with neighbouring practices and we need to protect the staff to make sure they come through this with the least disruption. RM asked what would happen to the practice population if the current partners decided to “hand in the keys. NW explained the process would be to get an immediate provider in or disperse the list to other practices in the locality, under their existing GMS contracts. KW feels, from a patient and locality point of view, the service should continue with the current providers but understands this conflicts with the legal advice and there is a substantial risk if we do go down a procurement route, the existing practice provider may decide not to bid and destabilises what currently exists. GS explained if we did have a challenge, the fall out for patients could be worse than if we put it put it out to tender now. It was asked what a short procurement would look like which does not involve high cost? NW explained the PQQ (pre-qualification questionnaire) and Invitation to tender goes in one package i.e. the advert goes out with a timescale and completed within a 12 week process. However it was noted this process will be beyond the timescale of the existing interim contract currently in place at Verney Close.

Page 3 of 7

LP asked who determines the scoring of the bids. NW advised the CCG would agree and set the evaluation criteria, to be clear on the specification and design the evaluation questions based on competency and capability, financial element and ability to deliver the service stated in the specification. LP asked, in theory, you could look at a track record of knowing the local population and having established premises. NW explained NHSE recommend running an open tender but within a reduced timescale, with a clear specification to evaluate bids against. The contract length and type will be detailed in the bid specification. Members of the PCCC agreed with this recommended option, on the basis we will make the process as short as possible, with details of the timescales (once discussed with the procurement team) announced as soon as possible. It was noted a discussion and decision will be needed at the next meeting on the period of time the interim contract is extended for to see through this process.

5 Mandeville Gpy explained the Mandeville practice is now operated by the Practice Group and formally thanked the Partners and Practice Manager at Mandeville for all their hard work and dedication. The weekly conference calls will continue and the monthly contract review meetings are booked up to April 2017. Gpy explained that although it is early days there have been some positive changes from the feedback received and that staff have increased capacity and patients are happy. Areas like improvement with the telephone lines have been noted. Gpy explained we have begun the work to procure a new provider. Key dates and deliverables have been discussed to lead up to a July advert. A workshop has been booked for 26/5/16 with key stakeholders invited. BCC Public Health will present a health needs assessment and a view of other services and models available.

6 PCTF Panel Review Gpy advised this has now been renamed to “Estates and Technology Transformation plan” Gpy explained an objective panel reviewed the 4 bids including one bid from the Bucks Federation group. There was a prior agreement the endorsement for the Bucks Federation Group bid will be submitted by Chiltern CCG. NW explained the CCG has until the 28th of June (the portal will open on June 2nd) to sign off and upload their final bids into a national portal. It was agreed the level of detail of these bids will be bought to the next meeting, however it was noted the practices with successful submissions (in order) are Berryfields Norden House Trinity- Thame Trinity- Long Crendon

Page 4 of 7

7 AOB:

None Meeting Closed 10.08am

Date of the next meetings: Primary Care Operational Meeting: 24th May 2016, 2.00pm – 4.00pm Primary Care Commissioning Committee 2nd June 2016, 3.30pm – 5.00pm

Open Action Log – Primary Care meeting Meeting Date: 24th March 2016 Date Agenda

Item No. Action Owner Open/

Closed 14/12/15 9 LP advised the CCG has had to fund an administrator in the

multi-agency safeguarding hub. GH requested further details to assess if NHSE are able to cover this funding. Updated 24.03.16: No update available. Action Point remains open. Updated 28.04.16:NW will chase this up with GH

Gary Heneage Nicky Wadely

OPEN: 14122015 Updated 24.03.16 Updated 28.04.16

CLOSED Action Log Date Agenda Item No. Action Owner Open/

Closed 09042015 4 Invite LMC, Health-Watch Bucks and the Health

and Wellbeing Board to all future meetings Louise Smith OPEN 090415

CLOSED 150615 09042015 5 LS/GH to discuss the membership of the

Operational Group

Louise Smith Ginny Hope

OPEN 090415 CLOSED 150615

Page 5 of 7

09042015 5 LS to amend the TOR to reflect meeting can be

held virtually Louise Smith OPEN 090415

CLOSED 150615 09042015 7 The committee need to develop a progression

and exit strategy

Louise Smith OPEN 090415 CLOSED 150615

09042015 7 GH to sign off the comms message to our members

Ginny Hope OPEN 090415 CLOSED 150615

09042015 7 GH to feedback the discussions to Jess Newman

Ginny Hope OPEN 090415 CLOSED 150615

09042015 7 LS to produce a 12 month work plan Louise Smith OPEN 090415 CLOSED 150615

09042015 7 LS to produce a FAQ sheet

Louise Smith OPEN 090415 CLOSED 150615

15062015 4 LS to add this amendment to the TOR to state GS will appoint a replacement Chair (namely Health-watch Bucks representative) if he is unable to attend future meetings.

Louise Smith OPEN 15/06/2015 CLOSED 24/09/2015

15062015 7 LS and CH to hold further discussions on the payment mechanisms needed to implement the C&SP changes MET and had op meetings

Louise Smith Colin Hobbs

OPEN 15/06/2015 CLOSED 24/09/2015

15062015 8 It was agreed a delegated group will be established consisting of 2 NHSE reps, GS as chair and LP to sign off AUS DES + once the areas of concern are clarified by NHSE

OPEN 15/06/2015 CLOSED 24/09/2015

15062015 15 NW to speak to JF to establish practice nurse revalidations NW has flagged to JF who has reported back to LP.

Nicky Wadley OPEN 15/06/2015 CLOSED 24/09/2015

24/09/15 4 LS to amend the Care & Support Planning Business Case by adding the presentation shown in the meeting as an appendix and provide clarity needed on the business plan for 2016/17 including a value for money assessment and a process for the evaluation framework.

Louise Smith OPEN: 24092015 CLOSED: 14.12.15

Page 6 of 7

24/09/15 11 LS to invite the AHSN onto the Healthy Town

Partnership group Updated 14.12.15: LS has made contact but no reply to date. Action remains open Updated 24.03.16: Unfortunately we were not successful with the bid.

Louise Smith OPEN: 24092015 Updated 14.12.2015 CLOSED: 24.03.16

14/12/15

7 PR asked NHSE if practices have to sign the results of CQRS and if they want to dispute the extraction figures contradicted within first part of the specification, should they sign or hold of signing? NW agreed to raise this question nationally as national guidance is needed to resolve this issue.

Nicky Wadely OPEN: 14122015 CLOSED: 24.03.16

14/12/15

8 LP raised a concern with the lack of safeguarding information in the report. We need this information in the next report. The paper does not reflect the amount of training and support AVCCG gives to practices on safeguarding issues. NW to raise this with the NHSE Quality Team. Updated 24.03.16:Report has been amended accordingly

Nicky Wadely OPEN: 14122015 CLOSED: 24.03.16

14/12/15 10 It was agreed a meeting with AVCCG, NHSE and the new provider at Mandeville Surgery will be set in the new year. Updated 24.03.16: CLOSED

Gary Passaway OPEN: 14122015 CLOSED: 24.03.16

Page 7 of 7

Total Solutions

Portakabin Total Solutions Confirmed Quotation Prelims Health and Safety Management and Supervision. 15 linear metres Heras fencing to the perimeter of the work area (includes setting-up and dismantling and 1 weeks hire). 1nr chemical toilet (for 1 weeks hire). Please Note:- Any extra costs that may occur due to unforeseen unsuitable ground conditions, Building Control inspections, or project variations will be the subject of a further charge to the customer. Any variations will have to be quoted and agreed by the client before any works can be restarted and a rescheduling of the delivery program may need to be considered. No information has been provided regarding buried services and no responsibility can be taken for any services in the ground should they become apparent at a later date. Confirmed Cost = £805. Water and Foul Water Connections Excavated water and foul connection from the Portakabin Ltd Building to client’s water and sewage connections. 15m of cold water supply pipe supplied and installed, including all necessary isolation valves. 15m of 110mm foul water pipe work supplied and installed. 8m of trench work, excavated and back filled, along the agreed route to existing Solus building. Supply and installation of macerator pump, and all pipework/macerator

insulated, boxed in and painted to match existing Solus building. Weekend working has been allowed for. The specification does not included for any flow rate assessments, meters or chlorinating. The client is recommended to ensure their water pressure is sufficient to supply the extra capacity. The supply is assumed to be mains fed, and not by tank, or any other method. Any external water pipe work will be lagged as standard but this will not guarantee the pipes freezing in cold weather. Trace heating installed with the pipe work will help to protect from freezing. Presently, this has not been included, but we can quote this an additional extra if the client so wishes. Confirmed Cost = £2,426. Specific Exclusions Fees to local authorities or service providers.

Variations to the proposed works (e.g. Building Control / Clients requirements) will be billed as extra cost to the client. All works quoted have been priced to be undertaken at the same time, any part works may incur extra mobilization costs. Quotation is valid for 3 months. No Stone blinding provided for under and around the perimeter of the Portakabin Ltd building. No provision for closing of the gap between the top of the foundations and the sub ground level i.e. timber skirt, unless quoted as a separate item. Employment of specialist consultant's not included in quotation (e.g. Structural Engineer). No provision for Pathway's, ramps, steps etc unless quoted as a separate item. Prices do not include Landscaping works as the result of machine movement and Portakabin Ltd delivery (e.g. grass seeding). No allowance for Principal Designer or Principal Contractor duties if required for CDM2015 Regulations. No Bolting down of the Portakabin Ltd building or staircases to its foundations. No provision of any Trakway access, barrier removal, tree cutting or any other works that may be required to facilitate the delivery of the building Prices do not include disconnection of services, foundation removal or any reinstatement costs when the building hire contract is terminated. These works can be quoted for at a later date.

Portakabin Total Solutions Old Parkbury Lane Park Street St Albans AL2 2DZ Quality – this time – next time- every time Telephone 01923 853 710 Fax 01278 588670 Email [email protected] Web site www.portakabin.co.uk Registered office Huntington House Jockey Lane Huntington York YO32 9XW. Registration no. 685303 England

Total Solutions

Portakabin Total Solutions Confirmed Quotation Prelims Health and Safety Management and Supervision. 15 linear metres Heras fencing to the perimeter of the work area (includes setting-up and dismantling and 1 weeks hire). 1nr chemical toilet (for 1 weeks hire). Please Note:- Any extra costs that may occur due to unforeseen unsuitable ground conditions, Building Control inspections, or project variations will be the subject of a further charge to the customer. Any variations will have to be quoted and agreed by the client before any works can be restarted and a rescheduling of the delivery program may need to be considered. No information has been provided regarding buried services and no responsibility can be taken for any services in the ground should they become apparent at a later date. Confirmed Cost = £805. Water and Foul Water Connections Excavated water and foul connection from the Portakabin Ltd Building to client’s water and sewage connections. 15m of cold water supply pipe supplied and installed, including all necessary isolation valves. 15m of 110mm foul water pipe work supplied and installed. 8m of trench work, excavated and back filled, along the agreed route to existing Solus building. Supply and installation of macerator pump, and all pipework/macerator

insulated, boxed in and painted to match existing Solus building. Weekend working has been allowed for. The specification does not included for any flow rate assessments, meters or chlorinating. The client is recommended to ensure their water pressure is sufficient to supply the extra capacity. The supply is assumed to be mains fed, and not by tank, or any other method. Any external water pipe work will be lagged as standard but this will not guarantee the pipes freezing in cold weather. Trace heating installed with the pipe work will help to protect from freezing. Presently, this has not been included, but we can quote this an additional extra if the client so wishes. Confirmed Cost = £2,426. Specific Exclusions Fees to local authorities or service providers.

Variations to the proposed works (e.g. Building Control / Clients requirements) will be billed as extra cost to the client. All works quoted have been priced to be undertaken at the same time, any part works may incur extra mobilization costs. Quotation is valid for 3 months. No Stone blinding provided for under and around the perimeter of the Portakabin Ltd building. No provision for closing of the gap between the top of the foundations and the sub ground level i.e. timber skirt, unless quoted as a separate item. Employment of specialist consultant's not included in quotation (e.g. Structural Engineer). No provision for Pathway's, ramps, steps etc unless quoted as a separate item. Prices do not include Landscaping works as the result of machine movement and Portakabin Ltd delivery (e.g. grass seeding). No allowance for Principal Designer or Principal Contractor duties if required for CDM2015 Regulations. No Bolting down of the Portakabin Ltd building or staircases to its foundations. No provision of any Trakway access, barrier removal, tree cutting or any other works that may be required to facilitate the delivery of the building Prices do not include disconnection of services, foundation removal or any reinstatement costs when the building hire contract is terminated. These works can be quoted for at a later date.

Portakabin Total Solutions Old Parkbury Lane Park Street St Albans AL2 2DZ Quality – this time – next time- every time Telephone 01923 853 710 Fax 01278 588670 Email [email protected] Web site www.portakabin.co.uk Registered office Huntington House Jockey Lane Huntington York YO32 9XW. Registration no. 685303 England

RWP

F

RWP

S

O

4808 INSIDE

4904 OUTSIDE

26

88

OU

TS

IDE

25

92

IN

SID

E

25

61

10

3

61

25

10

3

DB

1

Scale 1:50Scale is for design purposes ONLY

Solus SL051

Title:-

Revision:-

Date:- Scale:-

Drawing Number:-

Drawn By:-

Client:- Drawing Provided By :-

Quality this time - next time – every time

C

Practice Managers

Office

Berry Fields

Medical Centre

1.3.16 NTS Kay Bennett

Example HND0572540

Portakabin Limited

Oxford Hire and Visitor

Centre

http://www.portakabin.com

DO NOT SCALE OFF THIS DRAWING

Unit Number:-

SL051

DB1

V/BShutter

WGOBS

OFS

RWP

- Cat 2 Lighting

- Cat 1 Lighting

- Consumer Unit

- Double Socket

- Single Socket

- Heater With Spur

- Wall Light Switch

- Window Blinds

- Window Shutter

- Coat Hooks

- Background Vent

- Std Partition - Wire Mesh Guards- Obscure Window

or - Opening Window

- Fixed Window

- Sliding Window

- Rain Water Pipe

KEY

- 30min Fire Partition

B

Carpet Tiles and Total Climate Control

Throughout

Small path

to exiting

path

alongside

main

building

Extra Accommodation - Summer 2016

This is an example of what your building could look like:

Portakabin are you local national company, providing you the confidence andreassurance of dealing with a nationally recognised brand.

BK Health Ltd

Your quotation -BK Health Ltd

Bob GaleBK Health LtdColonel Grantham AvenueAYLESBURYHP19 9AP

Oxford Hire CentrePortakabin Limited

Pear Tree Hill RoundaboutOxford

OX2 8JD

Date: 09 March 2016Quote Number: 220129342

Extra Accommodation - Summer 2016

Dear Bob

Further to our recent meeting, I am pleased to enclose your quotation for the above project.

Your Objectives - To work with a trusted supplier.- To be sure of the handover of the project to an agreed programme.- To find a solution to meet your budget.

OurRecommendation

We recommend a SL051 Portakabin Solus building. Drawing numberHND0572540 shows the proposed floor plan for your comments.

Benefits - With 99% of our customers confirming they would use Portakabin again,you will have the confidence that we can achieve your expectations.

- Extensive range of building styles and sizes means absolute flexibility toalways offer an effective solution on time.

- Our buildings are competitively priced with no compromise on quality.

We trust our proposal meets your requirements, and will be in contact shortly to discuss further. In themeantime, if you have any queries please do not hesitate to contact me on 01865 848008.

Yours sincerely

Kay BennettArea Hire Manager

Accreditations

This page shows a selection of accreditations or supply chainmembership for Portakabin Limited and the Shepherd Group ofcompanies.

Financial summary -BK Health Ltd

Excellent valuefor money asstated by 91% ofour customers.

Hire of 1 x SL051 Portakabin Solus Building

The minimum hireperiod

Project elements WEEKLY HIRE RATE ONE OFF COSTS

104 weeks

Building(s) hire £ 40.00

Heat/cool air-conditioning £ 28.00

1 x Set of Steps £ 15.00

Data and Telephone Points £ 15.00

Damage Waiver £ 4.00

Delivery of building(s) to site £ 285.00

Overall weekly hire rate £ 102.00

Total installation charges £ 285.00

Projected contract value for 104 weeks £ 10,893.00

Optional items - in addition to the above(Please refer to the following pages for a full breakdown)

The minimum hireperiod

Project elements WEEKLY HIRE RATE ONE OFF COSTS

104 weeks

Agent for Planning & BuildingControl

£ 2,500.00

Foundations and ElectricalConnection

£ 8,117.00

Estimated Council Planning Fees £ 220.00

Building Control ApprovedInspector Fees

£ 520.00

Hire charges will be invoiced monthly in advance. As standard, payment will be collectedby Direct Debit and a deposit may be required. Installation charges will be invoiced inadvance with payment terms as detailed in our hire contract.

Building collection & removal from site will be priced at time of termination unlessotherwise quoted above.

Note: prices exclude VAT.

Building specification -BK Health Ltd

Portakabin Solus Building

SL051 Portakabin Solus hire

building

External Length 5.10 m

External Width 2.90 m

Ceiling Height 2.3 m

Floor Area 12.46 m2 A smart, modern & professional working environment

to complement your organisation's image.

What's included within your overall hire rate:

External DoorsFully insulated, steel faced doors in aluminium frame as standard for added security withmortice cylinder lock.

1 x 926mm wide inward opening external door with lock

WindowsLarge square cornered aluminium frame, with trickle vents for natural ventilation. Doubleglazed tinted glass.

3 x 860 x 996 mm double glazed tinted window

3 x Venetian blind

3 x Steel wire mesh window guard

ElectricalAll items are installed and tested in accordance with the latest edition of the IET WiringRegulations BS7671.

1 x Wall mounted 2kw electric convector heater

1 x External sensor controlled bulkhead light fitting

2 x Light fitting with louvre

5 x 13amp double socket

1 x 1 way light switch

Building specification -BK Health Ltd

Data and Telephone Points

This quotation is to supply and install data cabling solutions designed and configured foryour Portakabin building. All our structured cabling will be tested and will comply with BSEN 50173

Your Data / Voice system will include the following equipment:

2 x Double CAT5e outlets1 x 6u Wall mounted data cabinet1 x 24 port patch panel1 x Cable Management bar1 x 6 way Power Distribution Unit (PDU)1 x Connection to a fused spur power outletInternal cable containment (trunking) as required

Switches and Routers have not been included within our quotation.

Alternate sized data cabinets can be priced for on request, as can, fibre optic, wireless andtelephony connections to your main data network.

Heat/cool air-conditioning

Provide a comfort heating and cooling solution in the form of underceiling and/or wallmounted air conditioning system. All heat/cool systems designed to acheive a targettemperature of 22deg C +/-2deg C.Included are the following, fitting of all systems plus associated pipework and electricalsupplies, full maintenance package throughout length of hire period, decommission andremoval of all systems at end of hire contract.

Flooring & Ancillary FittingsVinyl flooring as standard unless otherwise stated.

12 m2 Heavy duty carpet tiles

1 x Set of Steps

High quality, Modular Step System which complies with all relevant building regulations.Landings and tread plates are fabricated in galvanised steel with high visibility, anti slipnosings. The balustrade has wooden hand railing to all open faces. Maximum ground tothreshold height of 450 mm. Higher thresholds can be quoted on request.

1 x Single door set of steps

Additional Items - included within your overall weekly hire rate

Damage Waiver

Damage Waiver cover has been chosen at a cost of 10% of your weekly hire rate(Minimum charge of £100 per building applies).

Damage Waiver Terms & Conditions are attached to this quotation.

Project installation specification -BK Health Ltd

Our projectmanagementservice extendsfrom the momentyou place yourorder, through tocompletion ofyour building andbeyond.

Our approach

- Fully insured delivery & installation- Trained professional workforce to

relevant construction industrystandards

- Dedicated Project Manager- Site specific method statements, risk

assessments & site inspectionssupplied as standard.

- Guaranteed handover date- Personal on site handover meeting

available 99.9% of all projects delivered on time

and on budget.

Everything that's included within your one off costs - so you know exactly what you're getting:

Delivery

Estimated costBuilding will be off-loaded and positioned on your site by a fully trainedoperative using a lorry mounted crane.

£ 285.00

Collection

To be quoted at time of termination

Electrical Testing

All integral building electrics are tested prior to installation by NICEICregistered electricians qualified to the latest edition of the IET WiringRegulations BS7671.

Free of Charge

Optional Items - additional one off costs:

Keeping all services under one banner reduces procurement time and because we ensureyou have one main point of contact throughout your project, everything is coordinatedfor you.

Agent for Planning & Building Control

PLANNING PERMISSION AND BUILDING CONTROL APPLICATIONConfirmed Cost - £2,500.00

These are statutory requirements obtained from the local council toerect a building.

Portakabin Total Solutions can act as Agent to submit the Planningand Building Control Applications for the proposed Portakabin Building(s).

Our Agent duties include:-

£ 2,500.00


" Pre- submittal application research." Undertake necessary site visit." Calculate Council and Approved Inspector Fees and adviseclient." Completion of all statutory Council Forms." Production of all required drawings." Create a Design and Access Statement." Submit Applications." Keeping client informed at each key stage using a progressreport." Handling Building Control technical queries." Building Control inspections.

Exclusions :-" Our Agent's costs do not include Council Application Fee,Approved Inspector Fee or Council Discharge of Conditions Fees." Our prices do not include VAT." Specialist consultancy e.g. Tree Survey, Flood Risk Assessment,Structural Engineer.

The Council's lead time to process the applications is approximately 8weeks.

The Council (not Portakabin Limited) grant or refuse a Planning orBuilding Control Application. Any client who proceeds with theirbuilding installation before a Council decision is made does so at theirown risk of a refusal. Our Agent's fees must be paid to Portakabin Ltdregardless of the Council's application decision. In the event that theapplication is cancelled by the client, any proportional agent's costswill be chargeable.

Foundations and Electrical Connection

Portakabin Total Solutions Confirmed Quotation

Prelims and FoundationsHealth and Safety Management and Supervision.Setting out the foundations relative to existing site features.15 linear metres Heras fencing to the perimeter of the work area(includessetting-up and dismantling and 1 weeks hire).1nr chemical toilet (for 1 weeks hire).4nr 600mm³ excavations and removal of all spoil from site.Mass pour of concrete into excavations and allow to cure.4nr Mortared concrete slab piers built to a common level and withinthe tolerances required of the building (average pier height 100mm).Checking of all levels and grid lines prior to the arrival of thePortakabin Ltdbuildings.

£ 8,117.00


Weekend working has been allowed for.

Please Note:- In the absence of more detailed information we havebased our price on an assumed ground bearing pressure of 100Kn/Mtr²at 1Mtr depth, and on the generic Portakabin Ltd foundation design.Any extra costs that may occur due to unforeseen unsuitable groundconditions, Building Control inspections, or project variations will bethe subject of a further charge to the customer. Any variations willhave to be quoted and agreed by the client before any works can berestarted and a rescheduling of the delivery program may need to beconsidered.No information has been provided regarding buried services and noresponsibility can be taken for any services in the ground should theybecome apparent at a later date.

Confirmed Cost = £3,052.

Electrical ConnectionExcavated electrical connection from client's supply to the PortakabinLtd Building.35m of electrical cable, appropriately sized to suit the electrical loadrequirements of the Portakabin Ltd Building, supplied and installed30m of excavation and back filling of trench work along the agreedroute.The provision of an Electrician to fully test the supply cable, issue atestcertificate and to connect it to both the building and to the clientsown switchgear.

Client is advised to check if their existing supply has spare capacity asthere is no inclusion in our quotation for upgrading client's supply,larger Electrical Enclosures, extra Switchgear, or any Meters that maybe required.


PathwayConcrete slab pathway created 1200mm x 3000mm.


Specific ExclusionsFees to local authorities or service providers.Variations to the proposed works (e.g. Building Control / Clientsrequirements)will be billed as extra cost to the client. All works quoted have beenpriced tobe undertaken at the same time, any part works may incur extra


mobilization costs. Quotation is valid for 3 months.No Stone blinding provided for under and around the perimeter of thePortakabin Ltd building.No provision for closing of the gap between the top of the foundationsand thesub ground level i.e. timber skirt, unless quoted as a separate item.Employment of specialist consultant's not included in quotation (e.g.StructuralEngineer).No provision for Pathway's, ramps, steps etc unless quoted as aseparateitem.Prices do not include Landscaping works as the result of machinemovementand Portakabin Ltd delivery (e.g. grass seeding).No allowance for Principal Designer or Principal Contractor duties ifrequiredfor CDM2015 Regulations.No Bolting down of the Portakabin Ltd building or staircases to itsfoundations.No provision of any Trakway access, barrier removal, tree cutting orany otherworks that may be required to facilitate the delivery of the buildingPrices do not include disconnection of services, foundation removal oranyreinstatement costs when the building hire contract is terminated.These works can be quoted for at a later date.

Estimated Council Planning Fees

COUNCIL PLANNING APPLICATION FEES Estimated Cost £220.00

Required by the local Council to process a Planning Application." Portakabin Limited can pay these Planning Application Feesdirect to the Council and will invoice the client when the application issubmitted." The cost of these Council fees for the Portakabin Building onthis quotation is £220.00 (This includes a 13% handling charge)." The client has the option of paying the Planning Application Feesdirect to the Council, a cheque being the usual method" The Application Fees may change if the Building size increasesand does not include any extra charges the Council may levy at a laterdate .e.g Validation of a Condition Fee)

This fee must be must paid regardless of the Council's decision.

£ 220.00

Building Control Approved Inspector Fees

BUILDING CONTROL APPROVED INSPECTOR APPLICATION FEES Estimated Cost £520.00

£ 520.00


Required by the Building Control Approved Inspector to process aBuilding Control Application." Portakabin Limited will pay these Building Control Fees direct tothe Approved Inspector and will invoice the client when the applicationis submitted." The cost of these Building Control Fees for the PortakabinBuilding on this quotation is £520.00" The Application Fees may change if the Building size andcomplexity increases.

This fee must be must paid regardless of the Approved Inspector'sdecision.

Getting your project started

These are the stages we will guide you through to ensure your project is successfullymanaged from start to finish, making the process hassle free.

Confirm OrderRaise written order referencing our quotation number and complete our CustomerDetails Confirmation form.

Design FreezeAt order confirmation specification is finalised and design signed off. The programmecan then be confirmed and building(s) reserved. Your designated Project Manager willbe assigned and will take care of your project from here.

Sign ContractA Hire Contract will be provided for signing along with an insurance value for you toarrange the necessary cover.

Ongoing Project SupportWe will assist with further advice and information regarding planning permission,building control applications and any site specific requirements.

Project MeetingsFor more complex projects, we recommend a pre-start meeting on site and regularprogress meetings between relevant parties.

Project CompletionA personal handover of your building can be provided, where the necessary systemstraining as well as handy hints on how to get the best from your building(s) will bediscussed.

Customer CarePortakabin Limited's service continues throughout your hire, with automatic inclusioninto our Customer Care Programme.

Need to know anything else? Please just give us a call and ask.

Peace of Mind

Guaranteed On Time and On Budget. In the unlikely event that we fail, we will give you one week's free hire for every day we are late*Local Hire Centre - One point of contact from start to finishPlease see www.portakabin.co.uk/hire-charter.html for further details

*Terms and Conditions apply. A copy is available on request.

Your quotation explained

We believe in a policy of no hidden costs. Please take time to read the information that follows, sothat you can make an informed decision about your project. This section details what is usuallyexcluded from our pricing (unless otherwise stated in your quotation) and provides other importantinformation for your consideration.

Planning Permission & Building Regulations

Planning Permission and Building Control approvals may be required. We would be very pleased toquote to act as your agent, make the necessary applications on your behalf and provide specialistconsultancy if required. The cost of carrying out this work does not include for any Local Authorityfees which will be payable directly by you. Whilst every endeavour will be taken to ensure asuccessful outcome, this cannot be guaranteed. All costs and fees are non-refundable.

For complete quality assurance all our buildings are certified by the BBA (British Board ofAgrement) as meeting the relevant Building Regulations applicable at time of manufacture. Ourproposal is based on our experience of providing a pragmatic cost effective solution to meet theneeds of your specific project. It is your responsibility to advise on any industry specificrequirements to which the building should also be designed to and comply with. We will bepleased to discuss this further with you.

You will also be responsible for any additional costs, including design and construction workrequired to obtain any approvals. All extra work will be treated as a variation to the contract andmay also affect overall programme timescales.

On-Site Works

General - We have quoted based on our normal weekday working.

Delivery & Installation - We have assumed unimpeded safe and adequate access to the site for allvehicles. This includes clear on-site access routes i.e. trees trimmed; obstructions removed etc.and adequate ground protection. Allowance has not been made for re-instatement of surfacesfollowing delivery. Should you require us to assist with any site preparation, traffic/pedestrianmanagement, and road closures or parking suspensions, we would be pleased to quote for this.

We cannot be held responsible for any additional or abortive costs incurred due to adverseweather or failed deliveries outside our control.

Groundwork, Service & System Connections - Level foundations and mains service connectionsmay be required. We can provide an additional cost for this work. Please note that our buildingsare designed to operate on a TN-S mains electrical power supply and a mains pressure watersupply: both of suitable size and capacity. If this is not the case please advise us prior to order. Itis assumed that mains services will be available at commencement of installation.

In the absence of more detailed information, the following assumptions have been made:

i) Ground bearing pressure to be at least 100kN/m2 at 1 metre depth.ii) There is no requirement for stone-blinding, landscaping or fencing.iii) Skirting is not required to close the gap between the top of the foundation and ground level.iv) No pathways, ramps, steps & covered walkways. are included unless otherwisestated.v) Flow rate assessments, pumps, chlorination, electric & water meters are not


required.vi) Storm water connections & associated soakaways are not required.vii) No re-instatement & service disconnection is included on termination of the hire contract.viii) The building does not need to be bolted down to the foundations.ix) Although external water pipes should be lagged as standard, this may notguarantee that they will not freeze in cold weather. Trace heating can be installed as anoption which could help provide additional protection.

We would be happy to provide prices for these items, or for any other work you might like us toundertake.

The Construction (Design and Management) Regulations 2015 are the main set of regulations formanaging the health, safety and welfare of all construction projects, from concept to completion.

The Hirer (referred to as the "Client" in accordance with CDM 2015 regulations) of a Portakabinbuilding has overall responsibility for the successful management of the project and must ensurethat the project is set up, so that it is carried out from start to finish in a way that manages therisks to the health and safety of those whom may be affected.

The Client has a legal duty to select the project team and formally appoint the other duty holders.If there will be more than one contractor working on the project, then the Client must appoint aPrincipal Designer and Principal Contractor in writing. If the Client does not appoint these roles,then the Client must take on these roles and associated legal duties.

We would be pleased to provide quotations for these services.

Other Important Information

Validity - This quotation is valid for 30 days from the date of issue.

Notice of Termination - The hire shall continue for the minimum period stipulated in the HireContract and thereafter until determined by the appropriate written notice.

The hire may be terminated after completion of the minimum hire period subject to the appropriatewritten notice being given, as stipulated in your hire contract.

Aftersales Service - Your local Portakabin Hire Centre offers a full customer support programme toassist you with any rectification or modifications to your building throughout the hire period.Please do not undertake any work on your building without specific authorisation from us.

Additional Considerations - Portakabin are able to offer a range of additional services to provideyou with a 'One Stop Shop' so unless otherwise quoted, you may wish to consider the following:-- Emergency lighting, smoke detection, fire & intruder alarms- Toilet & washroom facilities.- Data & telecommunications provision- Furniture- Climate Control (Heating & Cooling)- Modular ramps & steps- Linking to client existing services e.g. data, fire alarm

Advice and information on the above is available on request. No matter how diverse yourrequirements.....we can help!


THE PORTAKABIN HIRE DIVISION

CUSTOMER CHARTER'ON TIME, ON BUDGET'

'When you absolutely positively must have your buildingon time and on budget - Trust Portakabin to deliver'

'OUR PROMISE TO YOU''We promise that we will deliver your building on time and on budget.

If we fail to meet your contract start date, we will give you a week's freehire for every day we are late.' 1

1. On Time- We promise to visit you within 24 hours of your initial contact- We have more than 50 Hire Centres comprising the largest network in the UK and our people

are unlikely to be further than one hour's drive away from you- We deliver 80% of our buildings within 14 days and some within 24 hours!- 99.6% of Portakabin buildings were delivered on time over the last four years (we believe no

other hire company in the UK, possibly even in the world, can offer this level of service)

2. On Budget- We promise you no hidden costs (everything that you will pay for is costed in our quotation)- We are independently accredited by Zurich Insurance, who have verified that we offer excellent

value for money- 91% of our customers believe we offer excellent value for money

3. Service- We will meet you to gain a thorough understanding of your needs and create a tailored proposal

for your ideal building- We offer you a 24 hour/7 day a week service- The quality of our technical advice is rated better than 9 out of 10 by our customers in customer

satisfaction surveys- 99% of our customers say they will use us again

4. Building Quality- We promise you a working environment of the highest quality. We constantly score more than 9

out of 10 for building quality, in customer satisfaction surveys- Our customers are so pleased with our building quality that more than 80% of them would

recommend us to a colleague or friend- We have been independently voted as one of the top 500 UK business Superbrands representing

quality, reliability and distinction

5. Safety- Our accident incident rate is 33% less than the average for the construction industry (which also

takes safety on site very seriously)

1 Terms and Conditions apply. A copy is available on request.

Damage Waiver Protection

Protect yourself against damage repair costs - for your peace of mindDamage waiver protection from Portakabin gives you the peace of mind that you won't have to pay forrepairing any damage caused to your building, either accidentally or as a result of vandalism

No more unexpected repair chargesThat means you won't be faced with any additional charges for repairing or replacing damaged fixtures orequipment at the end of your hire contract. So there'll be no unexpected bills to pay when you send yourbuilding back to us. The policy covers your building and any additional equipment or systems supplied byPortakabin.*

Fixed cost for your entire hire contract - with no hidden chargesYou can add damage waiver cover to hire contracts of any length. The cost is simply added to your weeklyhire rate. What's more, the cost is fixed for the entire duration of your hire contract, so you won't have toworry about facing increasing charges - enabling you to budget with certainty

No excess to payUnlike most comparable damage waiver schemes, you won't have any excess to pay when you make a claim.

Damage waiver protection - terms and conditionsThe charge for damage waiver protection is fixed at 10% of your weekly hire rate, including all fixtures,fittings and additional equipment supplied by Portakabin. This is subject to a minimum charge of £100 for eachbuilding covered. If you choose damage waiver protection as part of your contract, the charge willautomatically be added to your monthly invoice of hire charges. You can opt to add damage waiver protectionright up to your contract start date.

Exclusions:o Wilful and deliberate damageo Fire and theft, including damage caused in the course of theft or attempted thefto Glazingo Items supplied by Portakabin that are paid via a one-off charge, such as foundations and other external workso External kitchen units and generatorso Any items specifically excluded under your hire contractDamage waiver protection does not replace insurance cover for your building. Please remember that you willneed to obtain a suitable insurance policy in accordance with our standard conditions of hire.

What happens if I don't take out damage waiver protection?If damage waiver protection is not included in your hire agreement, then the cost of repairing or replacingdamaged items will be invoiced at the end of your contract, as detailed in our standard terms and conditions ofhire. Damage waiver protection is optional. Your hire rate will not be affected if you decide to exclude thiscover

Please note: These terms and conditions are supplementary to our standard terms and conditions of hire. Ifdamage waiver cover is provided, these terms will take precedence over any standard terms that conflict withthe above

For more informationTo find out more about damage waiver protection, please call 0845 355 0350.Alternatively, visit www.portakabin.co.uk/damagewaiver

Damage Waiver Protection

Agenda item: Primary Care Joint Committee

2nd June 2016

Verney Close Surgery – Agreement of further action

Purpose of Paper Further to discussion at the Primary Care Joint Committee on 28th April 16 this paper proposes a final course of action for the Verney Close GMS contract given the latest intelligence from the practice, market place and NHS England. It is proposed that the CCG moves to disperse the circa 8,700 patient list by 1st July 2016 in order to provide the least disruption and maintain continuity of care for patients. Executive Summary This paper sets out the possible options to provide continuity of primary care services in Buckingham following the Primary Care Committee decision on 28th April to advertise the provision of services for the patients registered at the Verney Close Surgery.

Since the 28th April meeting, the Verney Close Practice partners have decided not to extend their interim GMS contract on a short-term basis past the 30th June 2016. There is subsequently a risk of major disruption to patient continuity of care because the procurement process for a longer term contract will take at least six months to complete. In a briefing note from NHS England dated May 16 the following options for urgent action were given for consideration:

• A mini procurement from an interim provider on the “Short term primary care provision of general medical services framework” to take over the running of the practice from current GPs from 1st July whilst the procurement takes place;

• Negotiate with a local practice to become an interim provider to take over the running of the practice from 1st July whilst the procurement takes place, maintaining the staffing and use of surgery premises;

• To undertake a managed dispersal of patient list, which would in effect close the practice as a separate entity and the partners may have some liabilities in terms of staffing and/or premises

The feasibility of these actions and impact on patient care has been reviewed and it is proposed that managed list dispersal would be the most appropriate course of action. The primary care committee is asked to support this decision. Actions Required The Primary Care Commissioning Committee is asked to: 1) agree to the list dispersal proposed for the circa 8,600 patient list; 2) delegate the management of this process, including the agreement of costs incurred, to the Operational Group together with the Accountable Officer, CFO and Lay Chair.

Objectives supported by this Paper (Please Tick) Support realisation of the primary care strategy √ Support delivery of in-year performance and the financial plan Supports quality agenda

2

Future primary care provision in Buckingham: Verney Close Practice Introduction This paper sets out the possible options to provide continuity of primary care services in Buckingham following the Primary Care Committee decision on 28th April to advertise the provision of services for the patients registered at the Verney Close Surgery. The Committee on 28th April agreed that the procurement should be as minimal a time as possible (estimated six month timescale at very least) and understood that in order to achieve this, the current Contract must be extended for a further 6-9 months to enable this procurement to happen. However, since the 28th April meeting the Verney Close Practice partners have confirmed that they will not be extending their interim GMS contract on a short-term basis past the 30th June 2016. The Partners have been in discussions with the other Buckingham GP Practice regarding a merger of the two practice lists under the latter’s existing GMS contract. These discussions are ongoing. As the current short term cover will not continue, there is a risk of major disruption to patient continuity of care, because the procurement process for a longer term contract will take at least six months to complete. In a briefing note from NHS England dated May 16 the following options for urgent action were given for consideration:

1. A mini procurement from an interim provider on the “Short term primary care provision of general medical services framework” to take over the running of the practice from current GPs from 1st July whilst the procurement takes place;

2. Negotiate with a local practice to become an interim provider to take over the running of the practice from 1st July whilst the procurement takes place, maintaining the staffing and use of surgery premises;

3. To undertake a managed dispersal of patient list, which would in effect close the practice as a separate entity and the partners may have some liabilities in terms of staffing and/or premises.

The benefits and risks of each option are set out below: 1. Mini procurement from an interim provider on the “Short term primary care provision of general medical services framework” Benefits

• Allows open competition to take place for the longer term contract; • This method follows due procurement process with minimal risk of challenge.

Risks

• Disruption to patients and potentially a loss of confidence in their local GP provision as they may move through two further providers before a long term solution is reached;

• Short term provision of an interim Provider will be required to maintain patient care whilst the procurement takes place. Given the very short timescale to get this organised and the CCG’s previous experience of procuring a short term provider last year, this is unlikely to be possible and even if a provider is found it is likely to be prohibitively expensive;

• Potential further extension of an interim solution if we are not successful in the longer term procurement. Latest intelligence from the NHS England procurement team is that APMS

contracts with a fixed term of between 5 -10 years duration for list sizes under 10,000 do not have much interest through the tender process and many have not appointed a provider at the end of the process;

• High opportunity costs for CCG and NHSE management in undertaking a short-term solution and a further reprocurement.

2. Local practice to become the interim provider: Benefits

• In light of discussions with the local providers this would be a possible interim solution given current capacity and timescales and would enable the 30th June deadline to be met.

Risks

• Potential Disruption to patients – as in option 1 above • This would be a short-term solution and further reprocurement will be required – with the risks

set out as in option 1 above; • The cost of a short term APMS solution by a local GP Practice may be prohibitive – as above.

3. Managed List Dispersal Benefits

• Minimal disruption to patients and staff – provided the main receiving practice is willing to TUPE staff and lease the current building from which services are delivered.

• This would provide a final solution; further procurement would not be required • The 30th June deadline could be met.

Risks

• This method does not offer the opportunity for open competition to take place • This method effectively closes the practice as a separate entity and the partners may have

some liabilities in terms of staffing and/or premises. Preferred Option The CCG takes its responsibility for the continuation of patient care very seriously and has engaged with local Practices and the Locality Group (Member Practices and members of the public) to fully consider all options. Part of this work has included listening to the current GP Partners and to the other Buckingham Practice to understand the willingness and capacity to enable a managed dispersal of the Verney Close list. Based on the above options appraisal and the response from the Swan Practice (see attached letter), the Primary Care Joint Committee is asked to support option three, managed list dispersal as this offers the most potential for the maintenance of service delivery and continuity for patients.

The Primary Care Joint Committee must ensure that systems and processes are in place to support the seamless integration of lists including support with information management and technology, rates and central communications. It is likely that this option will incur some costs to the CCG and NHSE, however these are expected to be minimal in comparison to the costs of procurement and of a future APMS contract. The Primary Care Committee is asked to agree to delegate the management of this process, including the agreement of costs incurred to the Operational Group together with the Accountable Officer, CFO and Lay Chair. Louise Smith Louise Patten May 2016 Appendix 1 Practices with overlapping boundaries to Verney Close Surgery The Swan Practice (K82007) The Norden Practice (K82043) To the North Brackley practices (3) Stony Stratford practices Towcester practices Milton Keynes practices To the South Bicester practices (4) Aylesbury practices

Appendix 2 – Verney Close Practice boundary and patient distribution

Appendix 3: Letter from Swan Practice Appendix 4: Letter from Verney Close

31st May 2016 Mrs Lou Patten Chief Officer AVCCG Dear Lou Thank you for your letter dated 27th May regarding the provision of GMS Services to the patients currently registered at Verney Close. As you will be aware, all the practices in the North Locality work well together, and we are keen to continue to do so. We would definitely be interested in absorbing the Verney Close patients, although as you point out the deadlines are tight. We would need support and resources to facilitate this as we would not wish to be financially penalized for doing so. When we merged North End with Masonic the preparatory work took approximately one year, and now we have one month, but we are confident that with the right support and resources we can achieve a seamless transfer of care. We would be unable to provide the care from our current premises, which are already challenged by our current list size, however we have provisional agreement from Verney Close that we could continue to rent their building. We also have agreed that we would offer Partnership to Dr Hens and Dr Banks and transfer the other Salaried Doctors where appropriate. We are interviewing for a new GP ourselves in June so this is an opportunity to ensure we have adequate medical staffing. We would look to continue employing the other current staff at Verney, both medical and non-medical. With regards IT we both currently use EMIS Web and we do not see this as a problem although there would of course be a cost associated with this. From a patient perspective, we could continue to run the Verney premises very much as it is now from 1st July 2016, and allow relationships to grow organically as we work together as a larger team. Over the following months we can then look at some innovative ways of changing how we provide care for the population of Buckingham along the lines of both the 5YFV and GP Forward View. I attach a document, which is work in progress, on our current thoughts of the support and resources that we would need to facilitate this transfer. We would be grateful for a swift response to our proposals. Yours sincerely

Dr Jonathan Pryse Executive Partner

Agenda item:

Primary Care Joint Committee

Financial Report for month 1

Purpose of Paper To update the committee on the financial position for month 1 of 2016/17 for the Primary Care Services joint commissioning budget of Aylesbury Vale CCG. Executive Summary The position at month 1 is a variance of £0k against plan. Actions Required

To note the financial position for month 1.

Objectives supported by this Paper (Please Tick) Support realisation of the primary care strategy Support delivery of in-year performance and the financial plan Supports quality agenda Support development of the CCG to take on the primary care commissioning role

Joint Commissioning Primary Medical Services Committee

Page 2 of 5

Report to the Joint Primary Care Co-Commissioning Committee Operational Group – Aylesbury Vale CCG

Prepared by: Alan Overton, NHS England South (South Central), Finance Analyst

Classification: OFFICIAL

The National Health Service Commissioning Board was established on 1 October 2012 as an executive non-departmental public body. Since 1 April 2013, the National Health Service Commissioning Board has used the name NHS England for operational purposes.

Page 3 of 5

1. Introduction

1.1. This paper sets out the financial position for month 1 of 2016/17 for the primary care services joint commissioning budget of Aylesbury Vale CCG.

Aylesbury Vale CCG Month 1 Year to Date Full YearGP Services 16/17 Plan Actual Variance Plan Actual Variance Plan FOT Variance Prior yr £k £k £k £k £k £k £k £k £k £k GP Contract payment 1,346 1,346 0 1,346 1,346 0 16,147 16,147 0 15,252 QOF payments 194 194 0 194 194 0 2,328 2,328 0 2,320 GP Seniority and Locums 46 46 0 46 46 0 550 550 (0) 782 GP Drug payments 146 146 0 146 146 0 1,758 1,758 (0) 1,673 GP Premises 229 229 0 229 229 0 2,752 2,752 (0) 2,840 GP Enhanced Services 106 106 0 106 106 0 1,275 1,275 (0) 1,465 GP Other Items 3 3 0 3 3 0 33 33 0 135 CCG Prescribing 0 0 0 0 0 0 0 0 0 0 Collaborative Fees 5 5 0 5 5 0 60 60 0 78 GP Premises other 19 19 0 19 19 0 229 229 (0) 15 GP General Reserves 0 0 0 0 0 0 762 762 0 0

Total 2,094 2,094 0 2,094 2,094 0 25,894 25,894 0 24,560

Page 4 of 5

2.0 Month Position The position for month 1 is a variance of £0k.

• All items have been accrued to plan.

2.1 Year to Date Position Overall the YTD position is a variance of £0k.

• All items have been accrued to plan. 2.2 Forecast Outturn The actual FOT is on plan.

3.0 Assumptions on reporting The figures have been prepared in accordance with the following national guidance:

• Prior year balances/costs will remain with NHS England. • Accruals will be as per accounting standards and will be to the expected year

end outturn position.

4.0 Contracting and procurement activity Mandeville Surgery, Aylesbury - New provider commenced 1st April Verney Close, Buckingham – Current provider is operating under a temporary contract and procurement advice will determine future options.

1

Improving Patient Safety in Primary Care Medical Services A Themed Report by the Nursing Directorate, Quality and

Safety Team for Aylesbury Vale CCG

NHS England South (South Central) May/June 2016

Objectives- to provide an overview…..

• What the Quality and Safety Team have been doing and how we have been working with the CCG’s to help drive improvements in quality and patient safety

2

What have we been doing?

• Reflecting on patient safety culture within General Practice

• PPG focus groups on patient safety • Working with HETV to deliver human factors and quality

improvement training for admin and support staff

• Provided eight significant event audit (SEA) masterclasses across South Central

• Pilot practices with the NRLS GP e-form

Working with CCG Colleagues to:

4

• increase national and local incident reporting • respond to CQC inspections and support practices

with an inadequate rating

• share the learning from CQC and SEA’s across South Central

• implement the vulnerable practice support programme

5

Patient safety culture

Patient Safety Culture • Five practices in Thames Valley participated in

MAPSAF workshops 2014-2015: • Main areas of improvement identified were

how SEA meetings were held and who was involved, reviewing for trends and themes, communicating and sharing learning. (These areas are mirrored in the CQC inspections)

• Admin and support staff didn’t always understand their role in patient safety

• NHS England South Central have simplified the framework tool for use within practices

6

What is a JUST Culture?

• If you make an error, you are cared for and supported

• If you behave in a risky manner by not adhering to policies, you are asked why first before being judged

• If you recklessly and intentionally put your patients or yourself at risk, you are accountable for your actions

• Find out more www.signuptosafety.nhs.uk

7

8

PPG Focus Group

Patient Focus Groups- what does a ‘safe’ practice look and feel like……

Rebecca Tyrrell Primary Care Patient Safety Project 9

Assume clinicians

‘know’ and competent

Want more info but don’t know where

to find it

Don’t want to

complain

Don’t want something bad to happen to

someone else Frontline staff help ‘feel’ safe

Trust No emotional

harm

Want to know a GP has learnt lessons

Want care tailored best for

me

No-one slipping through the net

Want feedback

Want to see

it is clean

Continuity is

important

Want to be listened to

• Training for admin and support staff • Improving standards of SEA to enable learning, and

sharing • Encouraging responses to patient feedback and FFT • Encouraging patient involvement in investigations and

awareness of Duty of Candour • Encourage practices to keep patients up to date with

their improvements by posting on their website • Attention to infection control audits, risk assessments,

cleaning schedules

You said, we did....

10 www.england.nhs.uk

11

Identifying and delivering training

• As a result of the work in General Practice a training need has been identified for admin and support staff to understand and enhance their role in patient safety

• NHS England South Central is working with the

Academic Health Science Network’s Oxford Patient Safety Academy and HETV to deliver free training in September 2016

• Human factors is a broad discipline which studies the

relationship between human behaviour, system design and safety

Human Factors Training Sept 2016


• 8 Significant event analysis masterclasses held across South Central 2015/16

• 150 staff including admin, practice managers and clinical staff attended 1 day training

• 40 accreditation qualifications available • Feedback has been very positive • ‘Sharing SEA’ masterclass due November 2016

Significant Event Masterclass


14

A promise to learn- Donald Berwick

Safe in the NHS? A promise to learn………

16

Avoidable harm Encourage in primary care? incident reporting

Barriers for reporting • Nearly 20% feared blame • 61% said that they lacked time to

report • 6% suggesting it was a waste of time • 28% felt the process was too

complicated.

Incident Reporting Survey Autumn 2015 (total respondents 83)


• Reporters want ‘feedback’ to engage with reporting externally

• Very few practices had reported nationally • Still fears about what happens with the information • Need clarity on what types of incidents to report • Don’t want to duplicate reporting • System needs to be quick and simple

Incident Reporting Survey Autumn 2015


New GP eform – a reporting tool specifically designed for general practice https://report.nrls.nhs.uk/GP_eForm

https://report.nrls.nhs.uk/GP_eForm

Reported Patient Safety Incidents South Central

20

0

5

10

15

20

25

30

Thames Valley Non - SIRIs

BGSW Non - SIRIs

SIRIs South Central

Total Non - SIRIs

Patient Safety Incidents AVCCG April 15- April 16

21

0

1

2

3

4

5

6

7

8

AC CA BH DOC IM IN INF MAT MD MED PA PAC PU SH TP O

n= 18

Key- for incident table

22

KEY Access, admission, transfer, discharge (including missing patient) AC Clinical assessment (including diagnosis, scans tests, assessments) CA Disruptive, aggressive behaviour (includes patient to patient) BH Documentation (including electronic & paper records, identification and charts) DOC Implementation of care and ongoing monitoring / review IM Infection control incident IN Infrastructure (including staffing, facilities, environment) INF Maternal fetal neonatal incidents CNST triggers MAT Medical device / equipment MD Medication MED Patient abuse (by staff / third party) PA Patient accident PAC Pressure ulcer PU Self-harming behaviour SH Treatment, procedure TP

Other O

Sharing the learning from reported NRLS incidents

23

• NHS England feedback and review the SEA with

a view to help support the practice reduce the risk of the incident happening again

• Trends and themes are triangulated with complaints, safeguarding and patient feed back.

• Themed action learning bulletins • National safety alerts • Identify learning needs and further work required

at local, regional and national level

Challenges and next steps

24

• Improving safety cultures • Challenges facing primary care workforce • Encouraging local and national reporting • Incident management systems • Feedback to practices- resource to do so • Ensuring that learning has taken place and

sustainable actions in place to help reduce the risk of it happening again

• Effectively sharing lessons learnt- reaching those that need it most

• Trends/themes and alerts, identifying further work

25

Responding to CQC inspections

• Vision and values, developed and shared with staff and patients- how are they demonstrated?

• Identifying, managing and monitoring risks • medicines management, safeguarding, infection

control, cold chain, prescription security • Leading through Learning from incidents,

complaints, patient feedback, QOF and audit • Following up on actions and reviewing changes • Practice management, policies, HR, recruitment,

staff appraisals and training

CQC- Safe and Well Led- Key Themes


• Supporting robust action plans to lead to sustainable improvements

• several practices now rerated as ‘good’ • Action learning bulletins and top 10 tips • PLT learning sessions to prepare for CQC- using CCG,

NHS England and practices’ experiences to share learning to other practices.

• Encourage ‘buddying’ and exemplars • RCGP support- match funding

CQC- our response


28

Vulnerable practice support programme

• Practices identified for support • Sustainable and quality pathways

Vulnerable Practice Support


Documents

Primary Care Commissioning Committee Meeting Agenda