PRIMARY CARE COMMISSIONING COMMITTEE

Primary Care Commissioning Committee Page 1 of 2 NHS West Cheshire Clinical Commissioning Group 17

th May 2018

PRIMARY CARE COMMISSIONING COMMITTEE

To be held in public on 17th May 2018 2:00pm – 3.30pm, Conference Room A, 1829 Building

AGENDA

Item No. Time Item

Action needed/ Paper

Presenter

2018-31 2:00 Welcome, Introduction and Apologies

- Chair

2018-32 2:03 Declarations of Interest

- All

2018-33 2:05 a. Minutes of last meeting 15th March 2018

DR

!PCCC minutes Part 1 March 2018 Final.pdf

Chair

b. Action List D

Action List Part 1 May 2018.pdf

2018-34 2:20 Primary Care Quality and Performance Report

D

3418 PCCC Quality and Performance Report May 18.pdf

Tanya Jefcoate-

Malam

2018-35 2:50 Primary Care Commissioning Report DR

3518 Primary Care Commissioning Report May 2018.pdf

Sarah Murray &

Tanya Jefcoate-

Malam

CONSENT ITEMS

2018-36 3:20 Minutes of Sub-Committees: Primary Care Operational Group - 29th March, 2018 IT Infrastructure Board

2. Primary Care Ops Minutes 29th March 2018.pdf

3618 IT Infractructure Board.pdf

Chair

2018-37 3:25 Any Other Business - Chair

Primary Care Commissioning Committee Page 2 of 2 NHS West Cheshire Clinical Commissioning Group 17

th May 2018

Item No. Time Item

Action needed/ Paper

Presenter

DATE OF FUTURE MEETINGS

Thursday 19th July 2018 2.00pm – 3.30pm Room B Thursday 20th September 2018 2.00pm – 3.30pm Room A Thursday 15th November 2018 2.00pm – 3.30pm Room A

I – Information D – Discussion DR – Decision Required

AGENDA ITEM: 2018-33a

Primary Care Commissioning Committee In Public

Meeting held on 15th March 2018 2:00pm, Conference Room D

Present:

Smith, Pam (PS) Lay Member, NHS West Cheshire Clinical Commissioning Group Ritchieson, Chris (CR) Chair, NHS West Cheshire Clinical Commissioning Group McAlavey, Andy (AMcA) Medical Director, NHS West Cheshire Clinical Commissioning

Group James, Gareth (GJ) Director of Finance, NHS West Cheshire Clinical Commissioning

Group Marsh, Laura (LM) Director of Commissioning, NHS West Cheshire Clinical

Commissioning Group Wedd, Paula (PW) Director of Quality and Safeguarding, NHS West Cheshire Clinical

Commissioning Group Murray, Sarah (SM) Head of Primary Care, NHS West Cheshire Clinical

Commissioning Group Pomfret, Steve (SP) GP Network Chair, Rural Perkins, Jeremy (JP) GP Network Chair, Ellesmere Port and Neston Jones, Annabel (AJ) GP Network Chair, City Powell, Simon (SPow) Local Medical Committee Representative Sutton, Carla (CS)

Senior Contract Manager, NHS England North (Cheshire & Merseyside)

In Attendance:

Jefcoate-Malam, Tanya (TJM)

Deputy Head of Primary Care, NHS West Cheshire Clinical Commissioning Group

France, Christine Governing Body and Committees Coordinator, NHS West Cheshire Clinical Commissioning Group

Agenda

No Agenda Item Action

2018-13 Welcome Introduction and Apologies Pam Smith welcomed everyone to the meeting and explained that she would be unable to chair the meeting today. CR explained that the terms of reference set out that if the chair or vice chair of the committee are unable to attend or chair the meeting one of the members, other than a GP, can be nominated to Chair, CR proposed GJ and the committee agreed. It was noted that this is a meeting held in public, although no members of the public were present. Apologies were received from Louise Barry and Alison Lee.

Notes of Primary Care Commissioning Committee 1 NHS West Cheshire Clinical Commissioning Group 17th May 2018


2018-14 Declarations of Interest No none standard declarations of interest were made.

2018-15 Minutes of last meeting 11th January 2018 The minutes of the meeting held on 11th January 2018 were agreed as an accurate record. Matters Arising There were no matters arising to be discussed. Actions 2017-45 Minor Ailments Scheme revised service specification - work up an enhanced offer and share with the Primary Care Operational group in the first instance in November. SM reported that the service specification has been signed off and it is hoped to be able to adopt some of the conditions used in the East Cheshire scheme. A further update will be provided at the March meeting. SM informed the committee that on review the conditions and medications within the East Cheshire Minor Ailments Scheme would be contrary to our medicines management self-care policy. However Rebecca Banks has suggested a number of areas the clinical commissioning group could increase the scope of the minor ailments scheme and she will be looking at this along with Di Taska. SM will provide a further update at the July committee meeting. 2018-14 Committee Workplan - SM will update the workplan and circulate to members for comment to allow for it to be formally reported to the next meeting for sign off. The Committee Workplan will be reviewed under item 2018-20.

SM

2018-16 GP Forward View SM informed the committee that the report is a highlight of projects and the funding that has come to our health economy as a result of the GP Forward View. She asked if there were any questions regarding the update. CR queried if there is a delay in the migration of the Cheshire Shared IT Network? SM responded that the migration has happened but the delay is with the North West Shared Infrastructure Services. The two initial test practice sites were successful, although some issues were identified as this was rolled-out, and so the migration was paused for review and considerable resource was added by Midlands and Lancashire Commissioning Support Unit to resolve these issues. This pause has meant we have a delay in the roll out of Qlik View, our risk stratification system. SPow reported a slowing down of the system in his practice following migration, SM will report these issues back to the commissioning support unit and attempt to find a resolution.

SM



AJ queried the timescale for the clinical pharmacists to be in post as part of the clinical practice pharmacists pilot. SM responded that she is attending a meeting with NHS England tomorrow, job descriptions for the pharmacists are complete and she is currently liaising with practices to ensure they are happy with them. It is likely to be three months before people are in post. LM queried whether there was any assurance around extended hours regarding funding for future years. SM assured her funding is guaranteed until 2021. CS queried whether this report gets shared with the practices as it does contain a lot of good news? SM responded that it will be presented at the April networks and the report will be subsequently shared with practices. AJ queried whether extended hours staffing is having an effect on staffing in other places? SM responded that staff see working in extended hours as a more attractive offer than working in GP Out of Hours. Extended hours were offering 15 minute appointments and out of hours 10 minute appointments although this has now been modified so that both offer 15 minute appointments. The urgent care team have been collating feedback to look at what has been causing recruitment and retention problems, there is piece of work to be done around this. The Primary Care Commissioning Committee noted the content of the report.

2018-17 Primary Care Quality and Performance Report TJM reminded the committee she had been set an action at the last meeting to contact those practices with a higher number of outstanding patient records to see if they had seen an improvement in the transfer of patient notes. The improvement reported by these practices has not been as significant as the Clinical Commissioning Group had hoped based on assurances by the provider and NHS England. TJM has sent the data to Primary Care Support England and NHS England, a response has been received from NHS England to say this needs investigating. It was agreed that TJM would repeat this audit in a months’ time to understand if the lack of improvement relates to a timing issue. Feedback will be received at the next Committee meeting. The Primary Care Operational Group received an update on work with practices regarding Care Quality Commission compliance and the group also discussed controlled drugs incidents. Barbara Perry reported these incidents to NHS England and the operational group are required to report them to this committee, information on them is contained within today’s report. As in previous months, although the support and escalation process focuses on a number of quantitative and qualitative areas, the body of the report has taken particular focus on secondary care activity areas.

TJM



The report contains an update on the progress of this work and the improvements that have been seen in patient pathways since the implementation of this process. The Committee agreed that they wished to receive additional assurance and reporting around the Primary Care Quality and Clinical Quality aspects of the Dashboard and asked for this to be discussed in detail at the next Primary Care Operational Group. TJM then opened up the discussion for queries and comments from the Committee members. CR commented that in regard to the thematic areas for escalation two standard deviations was used because it was deemed to highlight an area of statistical significance but it should not prevent us from discussing and focusing on those Practices that have not met this threshold in certain important areas. He queried whether there was any work we can do to improve screening and immunisation in practices. TJM will add this to the April agenda of the Primary Care Operational Group for discussion. SM said she had been with three practice managers today and they feel that other areas have improved with Primary Care Support England apart from the medical records issue. PW asked CS to raise the medical records issue with Tom Knight and ask him to ensure the provider gives real and credible next steps as the delay in receiving patient records is wholly unacceptable from a quality and safeguarding perspective. LM said we will need to agree primary care quality areas to focus on next year. TJM will provide information for the Primary Care Operational Group to review at their April meeting. The Primary Care Commissioning Committee noted the contents of the report, including: • the further steps taken to escalate Primary Care Services

England issues; • the continued work carried out to improve Primary Care quality

through learning from patient incident reporting, and • continued work carried out to monitor the performance of Primary

Care across West Cheshire.

TJM CS TJM

2018-18 Full Delegation of Primary Care Report SM stated that the paper circulated before the meeting sets out the process the clinical commissioning group has gone through in the process to become fully delegated. The next steps which need to be undertaken are listed at the end of the report. A Cheshire wide workshop is being arranged to look at, in more detail, what services/processes can be delivered on a wider footprint across Cheshire.



GJ queried the timescales and relationships for this work across Cheshire. SM responded that this will be looked at in the workshop that is being arranged, clinical leads will be invited to attend. SM said that assurance had been received from NHS England that they will continue to provide support to the clinical commissioning group for the next six months. Time has been set aside in April to look at completing tasks that need to be fulfilled at the beginning of the year with the NHSE Local Area Team. We will be recruiting additional capacity for both the primary care and finance teams. AMcA queried if there is an opportunity to look at why the administrative side of general practice is cumbersome and how these processed can be streamlined. SM responded that the focus in the first workshop will be to ensure we have capacity to deliver all we have to deliver in the first six months. It might be something that the releasing time for care workshops look at. LM commented the initial workshop is to look at process not quality. AJ said it is good that NHS England are supporting the clinical commissioning group for six months and asked if this would continue beyond the six months. LM responded that they will on an ad-hoc basis but we need to set up our processes and procedures within those six months. CR informed the committee that due to exceptional circumstances because of severe pressure in the health system, the membership council in February had been cancelled to ensure that there was sufficient capacity in general practice. As a result the vote with the member practices to agree the constitutional changes to allow delegation to take place was carried out virtually, he answered any questions which were received and will attend the networks in April for any outstanding questions from practices. SP said that the Local Medical Committee still have concerns regarding the process followed and will be writing to NHS England at a regional level with these. The concerns relate to the virtual vote which was taken without the chance to debate issues at the membership council. Delegation is not the issue but the constitution and the changes to it. CR said he believes that the clinical commissioning group abided by the clinical commissioning group’s scheme of reservation and delegation and followed the correct process with the membership council although the vote was taken virtually. The Primary Care Commissioning Committee noted the contents of the report.

2018-19 Primary Care Commissioning Report TJM informed the committee that the report contains two key areas, Personal Medical Services quarter three performance and the Primary Care Commissioning for Quality and Innovation Scheme, both of which are summarised within the today’s paper.



The key performance indicators for the practices on personal medical services contracts were previously discussed by the committee with regards to strengthening them as the funding decreases for the practices. The key performance indicators for 2018/19 were approved by the committee at the last meeting. Practices have continued to submit their evidence for the 2017/18 key performance indicators, which is detailed within the paper. As noted, the Primary Care Operational Group recommended approval for continued payment due to the achievement of these indicators by each Practice. In addition, there is information contained within the report on the consultation around the specification for the Commissioning for Quality and Innovation Scheme for 2018/19. Risks were flagged at the last committee meeting about not completing this specification within the expected time frame, however a final draft has now been achieved with extensive consultation and clinical engagement. Claire Baker and CR provided clinical input. The key changes to the scheme are noted within today’s paper. One of these is that the new £1.50 per head funding will be weighted to those practices with a slightly older population. PW said that she would like to ensure that as the Commissioning for Quality and Innovation Scheme develops, this continues to take more of a focus around quality, with performance separated out. CR responded that this year’s Commissioning for Quality and Innovation Scheme has been significantly slimmed down to focusing on a number of key clinical areas, but still retaining a focus on quality. The Primary Care Commissioning Committee: a) noted the work carried out to date by Personal Medical Services

Practices at quarter three; b) approved the payment of the premium to those Practices by NHS

England on the basis of work completed; c) noted the work carried out to date to develop and negotiate the

Primary Care CQUIN; d) approved the draft specification, noting that minor changes may

still be required before launch.

2018-20 Committee Workplan The workplan was brought to the January meeting for discussion and Sarah was tasked with adding more detail into specific areas which she has done. The committee approved the updated workplan.

2018-21 Terms of Reference The committee noted the updated terms of reference.



2018-22 Minutes of Sub Committees The committee accepted the minutes of the primary care operational group and IT Infrastructure Board.

2018-23 Any Other Business There were no other items of business discussed.

Date and Time of Next Meeting The next meeting will be on Thursday 17th May 2018 at 2:00pm in Conference Room A.


AGENDA ITEM: 2018-33b Agenda Item: 2017-16.b


Action List Part 1– May 2018

Agenda Item

Mtg. Date

Action Action By

Due Date

Status

2017-45 22.06.17

11.01.18

15.03.18

Minor Ailments Scheme revised service specification - work up an enhanced offer and share with the Primary Care Operational group in the first instance in November. SM reported that the service specification has been signed off and it is hoped to be able to adopt some of the conditions used in the East Cheshire scheme. A further update will be provided at the March meeting To do the above would be contrary to our medicines management self-care policy but one of the clinical leads has suggested it may be possible to increase the scope of the minor ailments scheme. A further update will be provided to the July committee meeting.

SM

An update will be provided to the July meeting

2018-14 11.01.18 Committee Workplan - SM will update the workplan and circulate to members for comment to allow for it to be formally reported to the next meeting for sign off.

SM 15.03.18 Complete

2018-06 11.01.18 Primary Care Quality Report c) Within 2018/19, working groups will be established to implement best

practice and reduce variation across West Cheshire regarding Care Quality Compliance requirements. TJM will provide an update on this work in quarter two.

TJM 20.09.18 An update will be provided to the September meeting

2018-17 15.03.18 Primary Care Quality and Performance Report a) Discuss the primary care quality and clinical quality aspects of the

dashboard at the Primary Care Operational Group. TJM 17.05.18 Complete

b) Discuss whether there is any work that can be done to improve screening and immunisation in practices at the Primary Care Operational Group.

TJM 17.05.18 Complete

c) Raise the medical records issue with Tom Knight and ask him to ensure the provider gives real and credible next steps.

CS 17.05.18 Complete

d) The Primary Care Operational Group to review areas for primary care quality to focus on.

TJM 17.05.18 Complete

Primary Care Commissioning Committee Action Log 1 NHS West Cheshire Clinical Commissioning Group 17th May 2018

AGENDA ITEM: 2018-33b Agenda Item: 2017-16.b

On Agenda/Complete On-going Overdue For future meeting

Primary Care Commissioning Committee Action Log 2 NHS West Cheshire Clinical Commissioning Group 17th May 2018

AGENDA ITEM: 2018-34

Primary Care Commissioning Committee

1. Date of Meeting: Thursday 17th May, 2018

2. Title of Report: Primary Care Quality and Performance Report

3. Key Messages:

• Following the investigation carried out by Primary Care

Services England into the outstanding medical records of patients at West Cheshire Practices, assurances had been given that the Service would now improve. Although anecdotally feedback has been that the situation is improving, in-Practice searches have not in all cases demonstrated this improvement. Practices have been asked to repeat their searches and submit evidence of the results back to the CCG. This has not yet been received from the majority of Practices, although the data that has been received demonstrates a mixed picture of improvement.

• Work continues to take place to monitor the quality and performance of Primary Care within West Cheshire. This includes tracking the secondary care activity of patients registered at West Cheshire Practices and support further investigation where required.

• Following a discussion at the March Primary Care Operational Group, the CCG has reinvigorated the GP Quality Group. The first meeting in May took a particular focus on screening and immunisation, as well as plans to support Practices in improving the quality of care delivered for patients who may be at risk of sepsis. Further actions to progress these areas have been agreed.

4. Recommendations The Primary Care Commissioning Committee is asked to

note the contents of this report, including: • The further steps taken to escalate Primary Care

Services England issues • The continued work carried out to monitor the

performance of Primary Care across West Cheshire • And the reinstatement of the GP Quality Group, along

with actions agreed to improve GP quality for screening, immunisation and sepsis prevention.

5. Report Prepared

By: Tanya Jefcoate-Malam Deputy Head of Primary Care

Primary Care Quality and Performance Report 1 West Cheshire Clinical Commissioning Group Primary Care Commissioning Committee 17th May 2018


NHS WEST CHESHIRE CLINICAL COMMISSIONING GROUP


PRIMARY CARE QUALITY & PERFORMANCE REPORT

PURPOSE 1. The purpose of this report is to provide the Primary Care Commissioning

Committee with an update of the key highlights and progress of the work of the Primary Care Operational Group in relation to Primary Care Quality and Performance Monitoring.

PRIMARY CARE SERVICES INVESTIGATION OF MISSING MEDICAL RECORDS 2. Following the Primary Care Commissioning Committee in January 2018, a

number of Practices that had experienced a proportionately higher level of outstanding patient notes within West Cheshire were contacted to understand whether the measures taken by the Service had resulted in improvements. The feedback received from the Practices that responded is contained within the table below: Practice Name

Original Nos Outstanding

Nos Outstanding

Feedback

Tarporley Adey

84 124 records 2.2% of list

This number has remained fairly static since the contract has been taken over by the new provider

Neston Medical

203 57 records 0.8% of list

A small number of these notes are outstanding from Sept 2016

Boughton 210 270 records 2.1% of list

17% of outstanding notes relate to 2016. From mid-Feb the Practice saw an increase in notes received

Tarporley Campbell

113 TBC Do not currently have numbers to share, however are aware that there are notes spanning several months that have not been received

3. This data was discussed within the March 2018 Primary Care Commissioning

Committee. Due to feedback from NHS England and Primary Care Services England, there was recognition that the improvement measures taken by the service may not yet have had time to take effect or make a positive impact. Therefore, the Primary Care Team was asked to re-contact Practices within April and May to give time for the improvements to happen.



4. Unfortunately, due to additional pressure on Primary Care, many Practices

have not yet had time to re-do the EMIS searches required to obtain this data and to send this to the CCG. They have therefore been chased. However, the data from Practices that have responded is contained within the table below:

Practice Name

Original Nos Outstanding

Nos Outstanding

Feedback

The Elms 64 33 Notes date back to 2016. Also having a number of issues relating to GP pensions and additions to Practice performers list

Westminster 369 322 Although contemporary transfers of notes are now happening quite quickly, there is still a back-log that has not been dealt with

Whitby Group

172 1 Although the transfer of notes are improving, there are still delays of several weeks

Old Hall 48 66 A small number of these still relate to 2016. The Practice continues to chase patient notes on a regular basis

The Villages 146 131 The Practice has a large number of these outstanding since 2017. These continue to be chased.

5. Although these figures appear to have improved generally, there are still

outstanding patient notes and Practices are experiencing a number of other issues that are taking time to improve. Therefore a log of these has been escalated to the provider and NHS England for a response.

PRIMARY CARE MONITORING REPORT 6. As reported previously, work continues to monitor the monthly Primary Care

dashboard and engage with those Practices that are one or two standard deviations from average in a range of indicators. The full details of this work is contained within Appendix 1, however, in summary: • Planned Care and Outpatient Activity • Two Practices previously identified continue to be a part of the Support

and Escalation Process for Planned Care. Due to these Practices continue to see a rise in their activity, work is taking place to re-connect with the Practices to discuss the data in more detail and carry out



further supportive investigations. With the launch of the new Risk Stratification Tool within the CCG in this locality, it is hoped that accessing relevant data around this will become easier.

• Two further Practices have been identified for the first time to receive additional support from the CCG. Contact will now be made with those Practices to start the process and agree what support and data will be useful.

• Unplanned Care and Emergency Activity • All three Practices identified within this thematic area have been within

the supportive process for some time. Two Practices informally within this process continue to work with the CCG to review their data. The Practice that is two standard deviations from average and therefore formally within the process is showing improvements within their data sets and is also engaging closely with the CCG. The Practice Management Team have asked to meet the CCG to demonstrate further work they have been carrying out to lead to improvements.

• Primary Care Quality • The two Practices at variance to average for their patient experience

data have demonstrated that the data recorded via the Primary Care Dashboard has not been accurate and therefore cannot be relied upon. Until this data is corrected, further action will not take place.

• However, one Practice has also been identified due to Clinical Quality reasons. This Practice has also been identified by NHS England Public Health and is discussed in more detail within the section below.

7. To date, the majority of Practices that have worked with the Clinical Commissioning Group as a part of this process (currently or historically) have implemented alternative patient pathways in order to ensure only those patients most appropriate for attending at a hospital clinic do so. The results of this work have been shared with all Practices via a “best practice” report at the Locality Network meetings. Within 2017/18, financial and activity impacts through this work have resulted in circa £297k of savings to the West Cheshire health economy (including in year repatriation savings). Unfortunately, due to an activity increase in some Practices, savings have reduced somewhat by year end compared to previous reports.

GP QUALITY GROUP 8. Following a discussion at the Primary Care Commissioning Committee in

March 2018, the Primary Care Operational Group agreed the best forum in order to enable sufficient scrutiny of Primary Care Quality and the progression of the GP Quality Agenda. It was decided to re-create the GP Quality Group and the first meeting of this reinvigorated forum took place in May 2018. The group discussed a number of GP quality issues and agreed actions to lead to improvement. These are summarised below.

9. The Primary Care Team, the Clinical Lead for Primary Care Nursing and the Screening & Immunisation Manager for Public Health and NHS England have



met to discuss which Practices have been highlighted to the team for poor performance in the clinical quality areas of screening and immunisation. Four Practices have been highlighted by Public Health, one of which had also been highlighted on the CCGs primary Care Dashboard. The team agreed to carry out a series of quality visits, with both “red” and “green” Practices, to understand what good looks like and to validate the data that has escalated the four Practices. Best practice sharing and quality improvement plans will then be agreed in order to lead to an improvement. An update will be given at the next GP Quality Group meeting.

10. In addition, as part of the NHS England Improvement and Assessment Framework, each CCG is required to engage with Primary Care to improve the knowledge and educations of health professionals around sepsis. The framework suggests the following as key actions that the CCG may wish to take: • Promoting the Health Education England resources available to support

professionals on this topic area including the National Early Warning System

• Each GP Practice having a sepsis lead • Utilisation of the GRASP-fever tool (identifying markers that may put

patients at risk of sepsis based on Practice coding)

11. These actions were discussed at the GP Quality Group. The Practice representatives within the room were aware of different national and evidence based tools that linked to EMIS that would provide similar performance to the GRASP-Fever tool. In order to determine which tool the CCG wished to engage with GP Practice around the usage of, the Primary Care Team were tasked with contacting NHS England to get their view on the various available tools. In addition, the Practice representatives present were tasked with researching the various tools available and reporting back to the next meeting on recommended next steps.

RECOMMENDATIONS The Primary Care Commissioning Committee is asked to note the contents of this report, including: • The further steps taken to escalate Primary Care Services England issues • The continued work carried out to monitor the performance of Primary Care

across West Cheshire • And the reinstatement of the GP Quality Group, along with actions agreed to

improve GP quality for screening, immunisation and sepsis prevention. Tanya Jefcoate-Malam Deputy Head of Primary Care May, 2018



Appendix 1 – Primary Care Monitoring Report MAY 2018

Thematic Area: Planned / Outpatient Activity Data

Practices at 1 Standard Deviation from CCG Average:

Great Sutton Francey Great Sutton Wearne

The Elms City Walls

No Practices identified as at two standard deviations from average.

Data: The two Great Sutton Practices continue to be one standard deviation above average for all three planned care indicators (first outpatients, GP referred first outpatients, outpatients discharged following first attendance and procedures of limited clinical value). Both Practices are also seeing a rise in their activity compared to the same period as last year. City Walls has been identified within this process for the first time, being at least one standard deviation above average in all planned care indicators other than procedures of limited clinical value. Their activity is also increasing compared to last year. In addition the Elms Practice has been identified for the first time, performing one standard deviation above average in the indicators of GP referred outpatients and all outpatients. The list below demonstrates the number of patients above CCG average per thousand that each Practice is referring via GPs into outpatient clinics.

• Great Sutton Francey +54.18 • Great Sutton Wearne +49.18 • City Walls +34.86 • The Elms +35.73

Progress / Feedback:

The Great Sutton Practices have received patient level data and discussed this at a Practice Meeting. The Practice has identified some key areas to focus on that may lead to a positive impact. The Locality Project Manager linking to these Practices is arranging to meet the Practice for an update and to agree an action plan / next steps. City Walls has been identified for the first month within the planned care theme. The Practice have been contacted and have fed-back that they are happy to get involved with the process but are struggling with time commitments at the moment. The Locality Project Manager linked to this Practice is looking to carry out a Holistic Practice Report, summarising all relevant data and identifying areas for further focus. In addition, conversations will be had with the relevant clinical lead, and the CCG



Team will attempt to use Qlik View as a pilot to support this Practice. The same process will now also be taken with the Elms Practice.

Thematic Area:

Emergency Activity Data


York Road Great Sutton Francey

Westminster Practice has been identified as at two standard deviations from

average within all three unplanned care indicators.

Data:

All three Practices identified have been within the Support and Escalation Process for some time. No new Practices have been identified within this month. York Road Practice are one standard deviation above average within the A&E attendances and readmissions indicators. Their A&E activity data is demonstrating a decline when compared to the previous year, although emergency readmissions are improving. Great Sutton Francey is demonstrating one standard deviation from average in the A&E, admissions and the readmissions data sets. Their data is also demonstrating a decline in performance compared to the same period as last year in all areas apart from emergency readmissions, which are improving. Westminster Practice are two standard deviations from average in all unplanned care indicators (emergency admissions, readmissions and A&E attendances), although their data within the emergency admission indicator is showing an improvement compared to the same period as last year, other than in the A&E indicator which is showing a decline.


York Road has received patient level data but at present has not had the capacity to progress this to any great effect. Therefore, the Locality Project Manager linked to this Practice is arranging a meeting with the Deputy Practice Manager to provide additional information support, and understand how this work links into the Cluster plans. Westminster Practice’s data has improved over recent months. The Practice are making good process – they are now two weeks into a counselling service via Healthbox. The Practice has also recently signed up to be a pilot practice for 12 months for the Elemental social prescribing system. Finally, the Practice has installed a patient information board in the waiting room. There is a variety of information on this but is also used to subtly dissuade patients from relying on A&E.



For example, the display screen includes current A&E waiting times. The Practice has asked CCG officers to attend at their premises to explain some of the other innovations that have implemented. A date for this meeting has yet to be agreed. The Great Sutton Practice feedback is contained within the section above.

Thematic Area:

Primary Care Quality


Great Sutton Francey Great Sutton McAlavey

Data:

Each Practice identified is one standard deviation from average within the patient survey and the Friends and Family test. Great Sutton Francey is however improving their GP Survey Results performance compared to the last period, as are Great Sutton McAlavey. The latter Practice are also improving in their Friends and Family Test Results.


On conversation with the Practice around these indicators, it has become clear that there has been some significant data and coding issues for the Friends and Family Test at the Practice. Therefore, this data will be scrutinised in more detail once this is correct for the 2018/19 financial year.

Thematic Area:

Primary Care Clinical Quality

Westminster

Progress / Feedback: The only Practice that has been identified from the Primary Care Dashboard is Westminster, who are displaying variance at two standard deviations from CCG average in the indicators of bowel and breast screening. The Practice is also one standard deviation from average in the cervical screening indicator. The Practice however dispute these figures and felt that their achievement is 68% for bowel screening, 75% for breast and 86% for cervical. Therefore, this will be discussed in more detail with the NHS England Public Health Representative at the PGP Quality Group Meeting.



In addition, Public Health have identified a number of further Practices who have not been identified within the Primary Care Dashboard for Screening and Immunisation. These are:

• Westminster • Willaston • And two Great Sutton Practices.

Further discussion will take place within the GP Quality Group meeting, and a meeting has been arranged outside of the Group to discuss how we are best to align the data between Public Health NHS England, Local Authority and the CCG.



Primary Care Commissioning Committee

1. Date of Meeting: 17th May, 2018

2. Title of Report: Primary Care Commissioning Report

3. Key Messages:

• Greater collaboration is being explored in relation to those functions and tasks undertaken to commission primary care, specifically general practice contracting, finance, Information Technology and Estates.

• In order to support the primary care commissioning agenda, the Clinical Commissioning Group has recruited a Primary Care Commissioning Manager who will take up post in June.

• Following the procurement of the Wellbeing Service Primary Care Cheshire Community Interest Company has been awarded the contract.

• As part of the development of the Integrated Care Partnership and in order to align more closely to the population levels described as best practice nationally, it is proposed to reduce the number of Care Communities from 9 to 7.

• The Personal Medical Services (“PMS”) Practices have continued to submit evidence to demonstrate the achievement of key performance indicators (“KPIs”). Based on the evidence submitted at quarter four, the Primary Care Operational Group has recommended that full premium payment is made to those Practices, although further evidence has been requested from one.

• The Primary Care CQUIN for 2018/19 was launched in April 2018. Sign-up so far, and engagement at all Network meetings in May has been positive. A number of Practices have raised concerns around the block funding to be received in the case of material changes to the Practices circumstances. An appeals process has been designed and recommended for approval by Primary Care Operational Group.

• NHS England have carried out an audit across the Cheshire and Merseyside area to understand whether there are Practices who are providing less than contracted hours or regular breaks in days.

Primary Care Commissioning Report 1 West Cheshire Clinical Commissioning Group Primary Care Commissioning Committee 17th May, 2018


4. Recommendations The Primary Care Commissioning Committee is asked to:

• Note the content of the report. • Approve the revised number of Care Communities. • Approve the payment, by NHS England, of the PMS premium

to the appropriate Practices. • Approve the appeals process in the CQUIN for material

changes.

5. Report Prepared By: Sarah Murray, Head of Primary Care Tanya Jefcoate-Malam, Deputy Head of Primary Care May, 2018



NHS WEST CHESHIRE CLINICAL COMMISSIONING GROUP


PRIMARY CARE COMMISSIONING REPORT

PURPOSE 1. The purpose of this report is to update the Primary Care Commissioning Committee

on developments in the commissioning of services from West Cheshire GP Practices, and to request approval to relevant schemes and specifications.

FULL DELEGATION OF PRIMARY CARE COMMISSIONING 2. Following the Clinical Commissioning Group taking on full delegation of primary

care commissioning, specifically general practice from 1 April 2018, a number of arrangements have been put in place to ensure there will be sufficient capacity and capability to support this function within the Clinical Commissioning Group.

3. Closer working between the governing bodies and executive teams of each of the

Cheshire Clinical Commissioning Groups had already begun with the creation of the both the Joint Committee and the Joint Executive Team. The Joint Executive Team requested that greater collaboration was explored in relation to those functions and tasks undertaken to commission primary care, specifically general practice contracting, finance, Information Technology and Estates.

4. A workshop was held with key stakeholders from each of the four Cheshire Clinical

Commissioning Groups, as well as NHS England and Midlands and Lancashire Commissioning Support Unit, on 1 May 2018. A report of the outcomes of the workshop and recommendations will be produced for the Joint Executive Team at their meeting on 21 May 2018, to then agree next steps.

5. In order to support the primary care commissioning agenda, the Clinical

Commissioning Group has recruited a Primary Care Commissioning Manager who will take up post in June.

WELLBEING SERVICE 6. The Wellbeing Coordinator Service was piloted across the Clinical Commissioning

Group footprint from July 2015. The service is for adults referred by their GP, practice staff or integrated care team, with a long term condition, who are also socially isolated, at greater risk of admission to hospital and/or frequent attenders at general practice.

7. The service has enabled appointments and capacity in general practice and community care to be released, to enable a greater focus on those with complex conditions.

8. Patients and health professionals report a very high level of satisfaction with the service.

9. A decision was taken to procure the service for a minimum of three years, and it

was agreed that the ‘Wellbeing Service’ should be extended to include the Self-



Management courses and Peer to Peer coaching. A combined specification was approved by the Primary Care Commissioning Committee (30th March 2017) and put out for tender in November 2017.

10. Five providers tendered bids. The tenders were scored by a panel made up of members of the Primary Care Team as well as Finance and Contracting Team from the Clinical Commissioning Group, the Commissioning Support Unit, the Public Health Department in Cheshire West and Chester Council, and patient representatives.

11. Primary Care Cheshire Community Interest Company emerged with the highest

score. 12. The total cost over the life of the three year contract will be £1.5 million, with an

option of an additional two years at further £1 million cost.

13. The Clinical Commissioning Group is meeting with Primary Care Cheshire bimonthly as part of the mobilisation process to ensure that the service is implemented smoothly and successfully on 1 July 2018.

CARE COMMUNITIES 14. The practices and community care teams within the West Cheshire health economy

have for a number of years, been arranged in clusters which wrap around geographical populations of between 30 and 50,00.

15. More recently, with the advent of the Integrated Care Partnership, the number and

function of what are now known as ‘Care Communities’ (this terminology will align us more closely with place based care models across Cheshire) have been revisited.

16. The care communities across West Cheshire will extend beyond Community Care

Teams and provide enhanced care through truly integrated working across the system. This will require significant culture shift and agreement across the system, with enhanced care communities focused on empowering people to drive their own wellness and optimal outcomes and keeping care and management in the community, as opposed to acute and bed-based settings wherever possible.

17. In order to do this, there needs to be a shift in resources and focus from high to low

acuity, from bed-based to home-based, and from professionally directed, to individually directed care. To deliver these changes successfully, the design of the system will need to be adapted so that care can be delivered in a fully integrated way, using efficient and effective processes.

18. In order to align more closely to the population levels described as best practice nationally, it is proposed to reduce the number of Care Communities from 9 to 7. This has been discussed with and supported by the GP Networks.



GP FORWARD VIEW Releasing Time for Care 19. Cohort 1 completed the programme in November 2017, with excellent outcomes

reported. The majority of practices focussed on clinical correspondence and workflow. The outcomes were that GPs saw between 40% and 80% fewer pieces of correspondence than prior to the work being done. (The lower reported figure was in a practice already implementing this system and to achieve a further 40% was a significant achievement). Anecdotal feedback has described the improved working lives of GPs, reducing the length of their working day. The Clinical Commissioning Group funded GP backfill of £18,000 in 2017/18.

20. Feedback and actions taken as a result of this programme have been extremely positive and the benefits associated with the whole cluster attending the workshops together, have been apparent.

21. A second cohort, made up of the 13 City practices commenced in April 2018 with a very positive workshop. All attendees were really engaged and there was a great deal of sharing of ideas and good practice.

22. A third Cohort, made up of 7 Ellesmere Port practices, commenced on 9 May.

The CCG will be funding £35,000 for GP backfill in 2018/19.

23. The Clinical Commissioning Group is in the process of obtaining agreement from NHS England to run the programme for a fourth Cohort. This will mean that all practices in the Clinical Commissioning Group will have had the opportunity to undertake the programme. This represents a significant achievement, given that our neighbouring Clinical Commissioning Groups in Cheshire are yet to commence the programme.

24. The NHS England Sustainable Improvement Team has approached the Clinical Commissioning Group to offer a further programme, The Sustainable Improvement Legacy Programme, for CCG staff, Practice Managers and GPs which would equip those attending with the skills and knowledge to undertake NHS IQ sessions within the health economy thereby leaving a legacy of competence in this area. This is planned to start in September 2018.

Clinical Practice Pharmacists 25. Following a number of delays with this project, recruitment for 2 WTE Band 7

Clinical Practice Pharmacists and 0.8 WTE Senior Clinical Practice Pharmacist is underway. Interviews are being held week commencing 7 and 14 May.

GP Resilience Programme 26. The process for accessing funding has been amended for 2018/19. The process

now includes an opportunity to provide a summary bid as an expression of interest. This allows an initial submission, without undertaking a significant amount of work. Once the bids are deemed to have met the criteria then a full application will be required to be submitted.

27. The following general principles will be applied to decide whether an application

should proceed to full application: Primary Care Commissioning Report 5 West Cheshire Clinical Commissioning Group Primary Care Commissioning Committee 17th May, 2018


The funding will not be used to:

• Fund additional posts • Fund locum cover for vacancies, unless it is the ‘top-up’ cost between the

cost of a salaried GP and a locum GP (please note, clinical backfill for development time / away days can be approved)

• Fund the delivery of new services (please note, scoping and set up costs can be approved)

• Fund any requests where there is a funding stream already in place, for example:

o Estates improvements o Practice Manager training o Clinical Pharmacists o Equipment / Technology (including software)

28. The deadline for the submissions of Expressions of Interest for the General Practice

Resilience Programme 2018/19 was 4 May. NHS England has collated a summary of all the Expressions of Interest received and each Clinical Commissioning Group as well as NHS England will be asked to assess the submissions.

29. The 2018/19 GP Resilience Programme allocation for Cheshire & Merseyside is

£355,000 and the expressions of interest received total over £2.3 million.

30. It is expected that the central funding will be allocated to NHS England North in July. Therefore the bid process is expected to align with this.

E-consult 31. Patient use of e-consult is building, following the implementation in the majority of

practices in November 2017. 32. Figures for April 2018 show that the highest number of appointments saved were

Garden Lane Medical Centre, which saved 75 appointments for the month (6.39 appointments saved per 1000 patients); Lache Health Centre, which saved 35 appointments (5.25 appointments saved per 1000 patients); and Boughton Health Centre, which saved 28 appointments (2.15 appointments saved per 1000 patients).

33. The ages of patients using the system ranged from 18 years to over 91. 55% of

users are aged between 31 and 60 years old; 29% are aged 30 years or below and 16% are aged over 61 years.

34. Patient feedback for April was positive, with 70% stating that they were either very

satisfied or fairly satisfied with the tool. 8% stated that they were neither satisfied nor dissatisfied and 21% stated that they were very or fairly dissatisfied.

INFORMATION TECHNOLOGY 35. Significant issues have been highlighted by the migration to NWSIS in a number of

practices. However, the issues are not directly as a result of this but an issue with the age of the IT infrastructure; hardware as well as networking and bandwidth.



36. The Commissioning Support Unit has been very responsive once escalated to senior managers (as a whole system issue rather than each issue being dealt with singly by the help desk) and is working hard to get a solution to these issues. These include:

• It is estimated that approx. 20% of PCs do not meet EMIS minimum

specification. The CSU will replace these PCs when rolling out NWSIS to different practices. This will also be done retrospectively for those practices already migrated. ‘Simple’ infrastructure issues will be picked up at the same time.

• The bandwidth will be increased from 10MB to 100MB and those practices

like Fountains & Princeway from 100MB to 1GB. The CSU are liaising with BT to progress. The CSU will work with the CCG and NHSE to bid for funding across the Cheshire CCGs to support this work. In the meantime the CSU will analyse network bandwidths where issues still exist and would look to fund an immediate upgrade until the bid is received.

• The CSU will undertake an infrastructure review over next 6 weeks including

a team to review existing issues at a number of nominated practices.

• For future NWSYS migration the CSU will bring in additional resource (preferably 4 individuals within the migration team). Weekend work will be considered if practices require.

ESTATES Ellesmere Port Hub 37. The development work is progressing with rental costs now being discussed with all

stakeholders. Rental rates are considered high for the location and will need District Valuer review. A project implementation document is being prepared for submission to NHS England for approval.

Blacon Development 38. Sanctuary has completed the required commercial work prior to taking the scheme

forward and this is expected to be reviewed at their Committee meeting in May.

39. As part of the information required to support the planning application, The Elms Medical Centre has undertaken a survey of their patients to identify how patients travel to the branch surgery.

40. The planning application is expected to be submitted in August 2018 and it is hoped that approval will be gained by Autumn. This will allow work on site to commence in early 2019, with the building ready sometime between December 19 and June 2020.

41. The lease for the Holy Trinity Church hall, which is the temporary home for The

Elms branch surgery, has been extended for a further 3 years from July 2018 to allow a smooth transition for the practice into the new building.



42. It is likely that once planning permission has been obtained, consultation with the community will begin to inform the use of the health and wellbeing space (aside from the Elms branch surgery).

Estates and Technology Transformation Fund 43. The Project Initiation Documents for Kelsal, Tarporley and Malpas have been

signed off by the Director of Finance at the CCG and will be reviewed by the NHSE Regional Board tomorrow prior to formal submission on 31 May 18.

PERSONAL MEDICAL SERVICES KEY PERFORMANCE INDICATORS 44. Five West Cheshire Practices remain on a PMS contract, with their premium

reducing over four years until April 2020. In order to receive their PMS Premium funding, these five Practices are asked to demonstrate that they are completing work over and above that of a GMS Practice to continue to receive their premium, albeit reducing, over a four year period. In 2017/18, the Key Performance Indicators (KPIs) for these Practices were delayed in circulation due to the Primary Care Commissioning Committee wishing to strengthen these and provide additional scrutiny. One Practice, Fountains Medical Practice, has not had KPIs implemented within 2017/18 whilst the provider continues to be in transition. A summary of the evidence received to date at quarter 4 is detailed within Appendix 1. Full details of these submissions are available upon request.

45. Following review by the Primary Care Operational Group, it has been agreed that all Practices have achieved their KPIs. However, the following issues should be noted:

46. Bunbury Practice has not received referrals for well man checks from other rural Practices to date. This issue was identified within quarter 3 and the Practice has continued to chase their neighbours and support administrative systems to receive referrals. Of the two Practices that agreed to refer patients into this service, one Practice has now withdrawn. The Primary Care Operational Group have asked the Practice to submit evidence to demonstrate what they have done to engage with their neighbouring Practices and whether clinical slots have been made available for other Practices to book into. The Practice has confirmed that they have engaged with other Cluster Practices in various ways including writing to the Practices to explain the benefits of the service, meeting with the Practice representatives to discuss, creating EMIS searches to identify relevant patients and offering to send out letters to relevant patients. Clinical slots have also been made available to other Practices via EMIS Cross Organisational appointments. However, these have not as yet been taken up.

47. Within the last report, Tarporley Adey identified a number of patients that had experienced issues of delayed discharge at end of life due to a lack of engagement with secondary care colleagues. Following the last committee, these issues were raised with the new clinical lead for end of life, Dr Dan Kelly and the Commissioning Manager for this programme who has highlighted these cases at the End of Life Steering Group. The Practice has additionally raised concerns for how similar pathways and issues can be raised with Mid Cheshire Hospitals Trust. This issue has been raised with the End of Life Clinical and Managerial Lead.

48. Finally, based on impact data reviewed, Western Avenue have decided not to renew the contract with the Commissioning Support Unit for a Clinical Practice



Pharmacist. Instead, this funding has been transferred to employ an additional Mental Health Worker within the Practice. The Practice have committed to submitting the data that was reviewed to make this decision, although the Primary Care Operational Group were concerned that the Practice had made a decision to alter their KPIs without reference to the CCG Team involved. This issue will be tackled at their next review meeting.

49. Due to the evidence received at the end of quarter four, the Primary Care Operational Group have recommended that full (but decreasing) premium continues to be made. However, this recommendation has not been made for the Bunbury Practice until further evidence has been received. This has now been received.

ADDITIONAL PRACTICE PAYMENTS 50. NHS England have notified the CCG that four Practices have received additional

funding, over and above their contract, for historically agreed services. Although these are not “Personal Medical Service” (PMS) contracts, they are legacy payments over and above the core contract and have been received by the Practice on an on-going annual basis.

51. In order to ensure that all Practices are receiving equitable funding, NHS England has written to the four Practices to ask for further information on what this funding has been used for.

52. It has been recommended by Primary Care Operational Group Part Two that a review now takes place, similar to the PMS review, to understand whether this funding is a duplication of payment for work already covered in the core contract or through the Quality and Outcomes Framework. This review will take place with a panel consisting of the following members: • CCG Primary Care Management Team representatives • CCG Primary Care Clinical Lead • NHS England representatives • And the Local Medical Committee.

53. Once this review has taken place, a recommendation for approval will be taken to

the Primary Care Commissioning Committee Part 2.

PRIMARY CARE CQUIN 2018/19 54. The Primary Care Commissioning for Quality and Engagement Scheme (CQUIN)

for 2018/19 was sent out to Practices as initially planned in April 2018. Practices have been asked to discuss each chapter within in Clusters and determine sign-up as soon as possible, by the end of quarter one at the latest. Approximately half of Practices have now made this decision and informed the CCG.

55. In order to support this decision making process, the Primary Care Team working with commissioning and delivery partners have carried out a workshop at all three Network meetings throughout May 2018. These workshops have raised a number of queries and challenges for Clusters and the CCG to look into further, however were generally well received.



56. A number of Practices have however submitted concerns that the block funding agreed with the Specification may not meet activity demands due to reasons outside of their control. For example: • Due to new housing developments in year, the population of the Practice

increases dramatically. Funding supplied to Practices through their contract currently updates more regularly (e.g. quarterly or monthly) therefore the CCG is out of step only updating funding annually

• Within the previous year (used to base the block funding levels) the Practice experienced a breakdown in their equipment e.g. ECG machine. This has caused their activity figures to look lower than expected for the following year

• Within the previous year, the Practice experienced a closed list. Therefore, nursing home beds have been registered elsewhere. When the list re-opens, the block funding set is likely to be artificially low.

57. The CCG is keen to ensure that Primary Care is adequately funded for the work it carries out. Therefore, the following proposes a process that could be used if the block funding agreed for the Practice is considered to be materially different to requirements: • Step 1 – Notify the CCG (via the Primary Care Team) within the quarter of

variance to block funding activity levels – this should be in writing, with data evidence to demonstrate the difference in activity levels within this financial year compared to the previous

• Step 2 – demonstrate that this variance is material. Material variance will need to be considered on a case by case basis taking in account:

1. Activity from the previous financial year and funding received (for example, an increase of over 10% may be considered material if funding for the previous year was not set at an artificially high level)

2. Overall CQUIN block budget 3. Wider CCG financial implications • Step 3 – data submitted is presented to the next Primary Care Operational

Group in order to agree a recommendation to the Primary Care Commissioning Committee. This will need to involve representation from the CCGs finance team

• Step 4 – the decision to be made at the Primary Care Commissioning Committee. The decision will then be communicated to the Practice and any changes in finance added to the following quarters CQUIN payment.

58. The Primary Care Operational Group felt that this process seemed a pragmatic way of dealing with concerns for Practices where funding levels are materially different to activity. It is therefore recommended that this process is approved and adopted for the Primary Care CQUIN going forward.

CORE HOURS REVIEW 59. NHS England have carried out a review across Cheshire and Merseyside to

understand whether there are Practices carrying out less than their contracted 45 hours per week, or are closing for periods throughout the day e.g. at lunchtime or afternoon closures that could be causing difficulties of access for patients.

60. Across West Cheshire, this situation has only been identified within two Practices. One Practice has agreed differences in their hours of operation within their contract



due to demographic reasons. It is thought that the other Practice has submitted incorrect data and is being contacted to query.

61. Therefore, NHS England have determined that they do not have concerns around this issue within the West Cheshire footprint.

RECOMMENDATIONS

The Primary Care Commissioning Committee is asked to: • Note the work carried out to date by Personal Medical Services Practices at quarter

four. • Approve the payment of the premium to those Practices by NHS England on the basis

of work completed, although note that one Practices has been contacted to request further evidence.

• Note the work carried out to date to engender sign-up and engagement for the Primary Care CQUIN.

• Approve the appeals process for material changes. • Note the work carried out by NHS England to review core hours across West

Cheshire. Tanya Jefcoate-Malam, Deputy Head of Primary Care May 2018



APPENDIX 1 – Summary of PMS Evidence per Practice Practice Name

PMS Q4 KPI Practice Response Additional Evidence

Date Received

Tarporley Adey

• Engagement / support to end of life agenda

• Development of an end of life template as an alternative to EPACCs

• Progressing lines of communication between Primary Care and the Countess of Chester to facilitate better discharge and preferred place of care

• The Practice has met with the new Clinical Lead for End of Life in March 2018 to receive an update on the programme, share best practice and offer support.

• In this meeting, it was reiterated that the Practice should not create a separate template but continue to use EPACCs. This is in place for 20 patients at the Practice.

• The Practice has additional reviewed changes to CWPs Care and Communication record to offer their feedback, as well as supporting the use of a “summary” EPACCs template, in time to be available through the Cheshire Shared Care Record. The Practice has also agreed to send one of their GPs to a future end of life meeting to support the better discharge planning of patients at the end of their life. They have agreed to understand and investigate their expected deaths that were not recorded on the ERISS system although have asked for additional support in setting up communication links with MCHFT.

Notes of meeting with clinical lead submitted

27/04/18

Bunbury • Offering 15 well man appointments to the Cluster Practices per month

• Offering CCG support for erectile dysfunction pathway development

• Supporting the development of care

• The Practice has contacted all three other Practices in their traditional “Cluster” to understand if well-man appointments can be offered. One Practice declined to be involved and a second Practice withdrew.

Breakdown of well man attendance and diagnoses

13/04/18



planning for Primary Care • Improving lines of communication

between Primary Care and the Countess of Chester

The Practice is still working with the remaining Cluster Practice to agree next steps and offer out appointments. In the meantime, they have completed 44 well-man appointments within the quarter.

• Within this time period, the CCG has not asked for support around the Erectile Dysfunction pathway, although the Practice has attempted to make appointments with CWP’s Urological Lead. This has been cancelled on two occasions.

• The Practice has been utilising the new care plan summary after supporting the development and piloting this template. The feedback from this template has been positive, with an increase in ease of use as well as the relevant information being available to support the patient’s clinical needs.

• The Practice has continued to make contact where possible and to use daily admissions / discharge reports from the Countess of Chester. Again, the Practice would benefit from a clearer communication pathway and one key contact. Work is ongoing within the Urgent Care Team to consider this. The Practice continues to work with their PPG to develop and promote self-care pathways for frail and vulnerable patients.

Garden Lane

• To increase utilisation of online access for patients

• To continue to act as a champion

• The Practice has continued to promote utilisation of online access to services for patients. In May 2017, the Practice had a

Patient feed-back around utilisation of E-Consult

29/03/18



or e-consult • To continue to lead the cluster

development of medical provision for university students

baseline of 25%. This has now increased to 33.46% achieving their year-end target (utilising front desk or EMIS online access).

• The Practice has continued to share best practice on the use of E-Consult and maintain their status as a high user of the system. Patient questionnaires demonstrate a high diversion from Practice with 37% of those completed being dealt with without needing to see the patient. In addition, the Practice Manager has supported individual Practices, as well at Network and Practice Manager Meetings with advice.

• The Practice previously submitted a Project Impact Statement to the Primary Care Operational Group which was not pursued as the opinion of the group was that the University should increase mental health service provision themselves. Therefore, the Practice has put itself forward for a pilot to increase IAPT support via the CCGs Mental Health Team. In addition, the Mental Health Team are in the process of making contact with the University to agree future service provision.

Western Avenue

• To act as a champion to the Starting Well programme

• To take a proactive approach to managing the health inequalities within the Blacon community

• To research and implement

• The Practice continues to work to support the Starting Well Workstream, and are currently looking at implementing pre-pregnancy health checks.

• The Practice continues to be a high performer for QOF and are considering

Data demonstrating service delivery

23/04/18



services that will support patients within an area of deprivation

• To continue to provide enhanced pharmacy and mental health support to patients within the Blacon community

further innovative ideas to improve screening. The Practice has also followed up 31 inappropriate A&E attendances in quarter.

• The Practice continues to work to research and deliver services to meet the demands of the Blacon community. Current innovations include working with a third sector organisation to set-up and deliver a “community shop” for those most at need. In addition, the Practice has met with Turning Point to understand the possibility of moving their services into the Blacon community using the Western Avenue premises.

• The Practice has decided not to continue to employ the clinical practice pharmacist as has not seen the impact from this role. Instead the funding is being used to fund additional mental health support. This latter service is developing and changing to ensure it continues to meet the need of patients and supports the reduction in DNA rates.

Fountains • None agreed within 2017/18 due to transition of Practice contract

• N/A N/A N/A


PRIMARY CARE OPERATIONAL GROUP ACTION NOTES 2pm – 3:30pm Thursday 29th March 2018

Conference Room B, 1829 Building, Chester Draft Minutes

Laura March (Chair) West Cheshire Clinical Commissioning Group

Director of Delivery

Carla Sutton NHS England Senior Contract Manager Louise Barry Healthwatch Cheshire CEO Tim Goldsbrough Hope Farm M. C. Practice Manager Julia Riley West Cheshire Clinical

Commissioning Group GP

Ken Salter West Cheshire Clinical Commissioning Group

Patient Representative

Andy McAlavey West Cheshire Clinical Commissioning Group

Medical Director

Sarah Murray West Cheshire Clinical Commissioning Group

Head of Primary Care

Hayley Pashley Garden Lane Medical Centre. Practice Manager Stacy Evans PHE Screening and

Immunisation Team Screening and Immunisation Manager

Tanya Jefcoate-Malam West Cheshire Clinical Commissioning Group

Deputy Head Primary Care

Donald Read Cheshire West & Chester Council

Public Health Consultant

Claire Baker Primary Care Lead, West Cheshire Clinical Commissioning Group

GP

Melanie Fell West Cheshire Clinical Commissioning Group

Note taker

Agenda no.

Agenda Item Action Owner

Welcome and Apologies Chair: Laura Marsh welcomed all to the meeting, introductions given by all. Apologies received: Sara Smith, Lynn Suckley, Barbara Perry

a. Previous notes of Primary Care Operational Group from 15 February

2018 – It was reported that item 1217 incident was detailed incorrectly – Primary Care reported incidents are actually 0.5% - MF was asked to amend the notes accordingly before saving as an accurate record of the meeting.

b. Action Tracker – The action tracker was reviewed with updates given

against each outstanding action. An updated action tracker will be circulated after the meeting. However, the following actions were noted:

Minutes of Primary Care Operational Group 29 March 2018 NHS West Cheshire Clinical Commissioning Group 1

Agenda no.


Action: TJM to chase Dan Jones to understand if the Inoculation Policy from CWP has now been updated – Post Meeting Note – the quality team have confirmed that this has now been updated.- Complete. Action: TJM to chase Sean Donnelly to ask for him to make contact with Hope Farm regarding Learning Disability Registers. Ongoing. Action: TJM to ask Emma Leigh, Head of Mental Health, to work with the University to consider future mental health provision. Ongoing.

c. Declarations of Interest – No new declarations of interest were noted at this point.

1217-03 Primary Care Delegation – Updated Terms of Reference

SM updated the group that following a Membership vote, the CCG will move to the delegated commissioning of Primary Care as of 1st April, 2018. It is therefore necessary to review the Primary Care Operational Group’s terms of reference to ensure these are in line with the Clinical Commissioning Group’s new responsibilities. TJM summarised the main changes as being:

• A number of new functions and responsibilities have been attributed to the group.

• A member of the CCG Finance Department, will be invited to future meetings.

• The group is not a decision making body.

The group agreed that there was a need to amend the new Terms of Reference in light of moving towards delegated commissioning, and also to consider which group Primary Care Quality reports to. The Terms of Reference were accepted and will be reviewed in 6 months.

Primary Care Programme Update:

Sarah also updated the group on the IT Issues that are being faced by a number of Practices and the steps being taken to address these. Action: SM to take both of these items to the Practice Managers Forum in April 2018.


Agenda no.


Nursing Associate Role:

Sarah gave the group an update on the role of Nursing Associates on behalf of Nursing Associates, she advised the group that there are currently 11 pilot sites across the Country, this role bridges a gap between registered nurses and health care assistance. Practice Managers Forum to understand whether there would be any practices interested on giving these placements. Action: SM to discuss at Practice Managers Forum in April 2018.

Extended and Core Hours Update: NHS England is going to work with CCGs to consider how ensure consistency across Cheshire and Merseyside. Rolling half days were discussed, although it was agreed that these subcontracting arrangements are covered within the updated guidance and the need to make good and effective use of Out of Hours. Locally, this will need to be considered including the potential to have different dates for RHDs in “in-house” events across Practices to ensure this does not have significant impact on the urgent care system. Carla stated that the next steps were to take this to Primary Care Leads across Cheshire and Merseyside and update at a later meeting. Action: Carla to update the group at a later meeting, once this has been discussed across Cheshire and Merseyside.

Primary Care Quality Update and Discussion (to include Primary Care Monitoring) Tanya updated the group on the progress of the Support and Escalation Process work, as well as the key items relating to Primary Care Quality that are already discussed within the group and reported to Primary Care Commissioning Committee. In addition, Tanya updated on the key areas of Primary Care quality focused on by other CCGs after her research. It was agreed that currently, although Primary Care quality is being covered, due to the short agenda of the Primary Care Operational Group, members are not able to give the scrutiny to these items as required. It was therefore suggested to re-open the Primary Care Quality Group monthly meeting with a view to comprehensive overview of quality improvement, performance and future planning and a need for a plan as to what the priorities are for 18/19. The group notes that this must include Sepsis and Infection Control. Concerns were raised about having extra meetings when members are already having trouble attending the meetings. Also, the CCG need more time to think about the membership. It was agreed that the administrative staff supporting the meeting would look to book in an additional 30 minutes to the Primary Care Operational Group to focus solely on Primary Care quality. Practice Managers need to stay as part of the Ops Group as we need to retain prescribing and NHSE priorities. Then, the CCG would need to consider a reduced membership of the Primary Care Operational Group. It was decided that Part 2 of the Group would be moved to another day and this time would be used for Primary Care quality instead. Action: TJM to confirm arrangements electronically once future meeting dates have been set.


Agenda no.


Screening and Immunisation Update:

Stacey Evans gave a summary on the key issues relating to screening and immunisation which are pertinent to West Cheshire. She talked about the difficulty in carrying out triple A Clinics at Great Sutton Medical Centre, due to the lack of available rooms for this. Patients are therefore being sent to Higher Bebbington on the Wirral. Stacey is therefore going to work with the Practice Managers and with the Local Authority in West Cheshire to understand the room requirements. The other elements discussed were Breast Screening and Cervical screening as well as and immunisations. She updated that the team are currently organising a dedicated project manager for Wirral and Chester together, that should hopefully lead to better co-ordination and improvement. Stacey updated the group that Flu season finishes on 31st March, with 0-19 service reaching 75.2% in the School age population and 2-3year olds 50-55% respectively, which was higher than last year. We are continuing with vaccination uptake with Cheshire West at 77.3% over 65 years, consistent with last year. The group discussed the issue with receiving consistent data around immunisation and screening across the CCG, the CHIS and the Local Authority and the need to share Practice level data in order to lead to improvement. As Stacey was not able to share this level of data, it was agreed that the CCG BI Team and Donald Read would meet to share and agree data to lead to quality improvement where necessary. Action: TJM link Donald to Sarah Goodchild and Stacey to ensure data is accurate and feed into Primary Care Quality.

Healthwatch A&E Report: Tanya summarised that this report had been brought to the Primary Care Operational Group due to some of the patients surveyed stating that they attended A&E due to not being able to access their GP. Although the numbers of patients involved were not statistically significant, this data has been triangulated with other data sets such as the GP survey and Friends and Family Test Results. The Operational Group may therefore wish to consider making softer intelligence investigations in order to understand if there is are any issues with patient experience within Ellesmere Port. The group discussed the data within the report. It was agreed that this item could be discussed further at the A&E Delivery Board, softer intelligence gathering should take place within relevant Practices and the report generally should be considered for wider circulation amongst Practices. Louise Barry was asked further questions on how the data within the report was gathered. She responded by stating that Health Watch visited A&E units in January 2018, with questions being asked using a survey style report. Action: Further follow-up to take place with Ellesmere Port Practices identified, with Health Watch taking this report to the local A&E board

AOBs: Donald Read requested and was granted a future update of Local Authority commissioning to come to Primary Care Operational Group.


Agenda no.


Trivalent Flu orders for West Cheshire are low – NHSE via SE to take action and contact all Practices. Administrative staff support the Primary Care Operational Group will consider changing the future dates of the April and May meeting – once new date has been identified, this will be circulated to all members of the group.

Date of Next Meeting: Thursday 10th May 2018 9am >11am 1829 Building, Room 1, First Floor.


Minutes from IT Infrastructure Board

Egerton Room, 1829 Building Chester

11:00 – 12:15, 15/02/18 Present:

Name: Organisation: Sarah Murray (SM) WCCCG Kevin Carberry (KC) WCCCG Ian Bradbury (IB) MLCSU Kerry Winsland (KW) MLCSU Howard Davies (HD) MLCSU Jon LeTissier (JL) MLCSU Dan Jones (DJ) WCCCG

Apologies

Name: Organisation: Stephen Lord MLCSU Andy Gaskell MLCSU Mike McLinden (MMc) MLCSU Gray Hewitt (GH) MLCSU

Actions in red.

Item: Notes: 1 Apologies

Apologies received as above – Board is quorate

2 Review of minutes and actions from previous meeting Minutes were approved as a true reflection of the January meeting. Agenda item 3: KC tabled the form that he has designed to obtain feedback from practices following their NWSIS migration. On further investigation into the fault logging post migration the practices are reporting issues to both the service desk and to GH which are resulting in issues not being logged into project issues log. GH has met with the technical team to address this, all calls to be logged via the service desk and tagged as an NWSIS issue to enable GH to extract reports.

3 Update on MPLS & NWSIS MLPS: Phase 1 of the migration of the 1829 Building has been re-scheduled for the evening of the 15th February (post meeting note – now completed). A number of practices have reported that they cannot access banking sites now they have migrated to MPLS. This has been escalated to SL by Chris Stenhouse for Senior Management support. NWSIS - 18 sites now completed including 5 branch sites. A number of issues where raised a recent practice managers meeting. Practice managers on NWSIS have been invited to a meeting on the afternoon of the 25th to discuss the issues with CSU staff. The CCG have requested that the NWSIS

project be paused until the issues outstanding with the practices already live on NWSIS have been resolved. Action: GH to pause NWSIS project

Infrastructure Projects – Phase 2 the pilot (10 sites) 4 Centralised Storage, Wi-Fi & VDI update

Centralised Storage Work has been completed on identifying the applications to be centralised at Garden Lane. Front Desk will be the first to be moved estimated to be early March. Helsby – technical support has been scheduled to assist the practice with their pre-migration housekeeping work on the server. Malpas – the CSU will look to progress their data migration once a date has been scheduled for Helsby. KW has met with Lexacom and they have provided discounted rates to migrate 20 practices over to Lexacom 3 cloud hosted whilst retaining the current revenue costs to the practices. Additional quotes have been received to migrate the remainder of the estate to Lexacom 3 hosted also. CoreCAL’s – the CCG has a 3 year Enterprise Licenses Agreement (ELA) that is scheduled to end in June 2019. A number of emails have been received this week by the CSU regarding the requirement to purchase the same number of Office licenses as CoreCALS’s. Further clarity on the requirement of CoreCAL’s against this ELA is required . The CCG will explore opportunities to place additional bids to support the purchase of additional licensing early next financial year. Staff Wifi HD reported that the issues with both the Staff Wifi and Patient Wifi are linked (although they are two separate projects). A number of WAPS’ have been dropping connectivity –a temporary fix has been put in place, by removing the link to the failover Wireless Controller server, which has re-enabled access to Patient Wifi. A bug has been identified in the Wireless Controller’s and a support call has been raised too CISCO Tech support team to resolve. Until the bug is resolved there will be a risk to patient Wi-Fi if the primary wireless controller fails, there is no redundancy available. HD has been liaising with CDW consultants re the Staff Wi-fi issue which has been identified as within the local network, CDW have linked this issue to the bug within the Wireless Controller. HD is unsure if this will resolve the issue and will investigate further and push back to CDW. (Post meeting note, both Wi-Fi issues have been resolved and certificates created and tested onto corporate devices). KC reported that he had spoken to Phil Bunn from LineWire regarding the non-payment of invoices and this is due to different names on the invoice to the finance system. KC is liaising between finance and Phil to resolve. VDI further work pending following a discussion (and subsequent meeting) with CDW to discuss timescales for delivery now that DM10 has been moved back to May. Actions: KC and KW to meet to discuss next steps on the Lexacom quotes. KW and MMc to discuss with CDW the licensing model for the CCG. KW and MMc to provide a single page update on current licensing agreements held by the CCG and known future requirements. HD to provide update to KC on progression of Wi-Fi incidents.

5 Risks and Issues Issues I34 added for the bug identified on the Wireless Controllers/network

Risks R28 has been added by KC identifying the cost of procurement of CoreCAL’s.

6 Dependencies Self-service tools Certero Asset Management and password management tool is to be deployed across the CCG footprint, timescales for deployment are to be confirmed. Remote access – the capacity for the existing swivel licensing will be increased to enable the roll out of the laptops to go ahead (pending proposal approval). Actions: MMc to confirm timescales for implementation of Certero.

Infrastructure Projects – Phase 3 7 Financial Position

KC reported that the financial summary has not changed since the last board meeting. The budget forecast against an income of £1,060,724 if a spend of £1,073,00 resulting in an over spend of £12,500 which is allocated from within the GPIT budget for 2016/17. The CCG will invoice NHSE for the additional £867,000 2017/18 capital monies during w/c 12th February. The pilots that will be competed post Docman 10 install will provide a realistic assessment of future costs of VDI.

From the £252,000 GP IT Capital monies and revenue underspend KC is reviewing the final allocation of monies against stock item purchases, the laptop CAL’s and CSU costs. KC stated there is no requirement for CSU to carry over this financial year.

Action:

KC to confirm items to be procured against GPIT monies.

Additional Infrastructure Projects

8

Docman Extended Services, Patient Wifi, IE 11 and Docman 10 progress reported via attachment.

Patient Wifi - update on issue provided under Staff wifi (Agenda item 4). Fountains Health and Princeway – waiting on a change request to be approved to allow configuration of WAP’s on existing networks. All other practices are now enabled for Patient Wi-Fi.

DM10 KW provided an update on the Medisec/DM10 integration issue post the meeting at Nantwich. The CCG have agreed to fund the development work required to enable the integration work to be completed by the end of April 2018. This deadline has been agreed between both parties and practice migrations will be scheduled from early May. Comms has been sent to all practices providing update to schedule and roll out plans.

Action:

HD to provide update to KC when work is to be scheduled for /completed.

For review

9 New Business Laptops – JL reported that as swivel has now been agreed as the remote access solution for the deployment of the 200 laptops but the issue of the CoreCAL’s and Office licensing remains outstanding and is delaying the issuing of the proposal. JL will provide KW with the latest version of the proposal to

be issued following on from KW and MMc call with CDW regarding licensing and the ELA. EMIS Remote Consult for the Extended Hours Service – KC tabled a paper which detailed a comparison on the EMIS Remote Consult (RC) and EMIS Clinical Services (CS) functionality. EMIS RC provides an update directly into the patients primary care record and is undergoing functionality testing with Docman Share in Wirral. The CCG seek re-assurance that the integration between EMIS and Docman works prior to making any decision to move to EMIS RC. There are no EMIS cost’s to move to EMIS RC from CS, but KC will need to compare revenue costs for the two systems. Action:

KW to arrange demonstration with Wirral on RC to enable the CCG to understand the interaction across 3rd party products. E.g ERS, integration with WROC’s. KW to provide progress update on EMIS RC and DocmanShare integration.

14 Communications

KC reported that both a programme comms and a Docman 10 communication have been shared with practices since the last meeting.

15 AOB Following on from the earlier Operational Group DJ reported that some functionality issues had been raised by practices on accessing the C drive which is used by local techs to store applications, users to store PST files. Performance was also raised where PC’s are on the 4GB required by EMIS but speed is still an issue. DJ also reported that the Lache and Dr Guinan were experiencing browser issues. Read/Write of CD is has been raised as an issue also by the group.

Action:

HD to investigate the issue of browser performance at the Lache and liaise with Chris Stenhouse.

Escalation of issues raised by DJ to be discussed during meeting with practice managers on the afternoon of the 15th Feb

Future Meetings

11:30 – 13:30 29th March 2018 - Egerton Room, 1829 Building Chester 11:30 – 13:30 26th April 2018 - Egerton Room, 1829 Building Chester 11:30 – 13:30 24th May 2018 - Egerton Room, 1829 Building Chester 11:30 – 13:30 28th June 2018 - Egerton Room, 1829 Building Chester 11:30 – 13:30 26th July 2018 - Egerton Room, 1829 Building Chester 11:30 – 13:30 30th August 2018 - Egerton Room, 1829 Building Chester 11:30 – 13:30 27th September 2018 - Egerton Room, 1829 Building Chester 11:30 – 13:30 25th October 2018 - Egerton Room, 1829 Building Chester 11:30 – 13:30 29th November 2018 - Egerton Room, 1829 Building Chester 12:00 – 14:00 20th December 2018 - Egerton Room, 1829 Building Chester

Minutes from IT Infrastructure Board

Egerton Room, 1829 Building Chester

11:00 – 12:15, 15/02/18 Present:

Name: Organisation: Sarah Murray (SM) WCCCG Kevin Carberry (KC) WCCCG Kerry Winsland (KW) MLCSU Jon Letissier (JL) MLCSU Dan Jones (DJ) WCCCG Gray Hewitt (GH) MLCSU Mike McLinden (MMc) MLCSU

Apologies

Name: Organisation: Stephen Lord MLCSU Andy Gaskell MLCSU Ian Bradbury (IB) MLCSU Howard Davies (HD) MLCSU

Actions in red.

Item: Notes: 1 Apologies

Apologies received as above – Board is quorate

2 Review of minutes and actions from previous meeting Minutes were approved as a true reflection of the February meeting. Actions carried forward: KW and MMc to provide a single page update on current licensing agreements held by the CCG and known future requirements. MMc to confirm timescales for implementation of Certero

3 Update on MPLS & NWSIS MLPS: Phase 2 of the project for the 1829 Building will entail a re IP of all devices in the 1829 Building, which will then allow full connectivity and traceability – date to be scheduled. Remaining pieces of work following on from phase 1 include the Princeway/Fountains phone system migration and City Walls phone system issues to Saughall. No dependency on the re-IP prior to the roll out of NWSIS for corporate staff, preference is to re-IP post NWSIS migration. NWSIS - KC updated the board on an ICP Risk Strat meeting recently attended where Qlikview has been identified as an element of their delivery programme. To deliver Qlikview for both the CCG and

practices requires NWSIS to be rolled out to all parties. Qlikview server is to be moved to the data centre, in Macclesfield, at the end of May. A review of the 15 practices data that have already being migrated to NWSIS will be undertaken with a view to them starting to use the application. GH & KC tabled a paper to provide an update on progress of NWSIS across GP practices. The document talks about the issues encountered by Tarporley practices and a pause in the roll and the CSU approach to improve the migration. Varied legacy issues will be inevitable at each practice due to networks/hardware and applications previously been supported by other system suppliers previously before being managed by the CSU. The complexity of the applications on each device and the different users accessing them add to the volume of issues. It was noted that there will be changes to the way that practices work – access to individual and shared drives and also to inhouse support levels. Many varied issues have been identified and BDS have revisited sites and asked to list the issues. Moving forward Callum Hart has been allocated as a dedicate CSU resource and will be on site at each practice during each migration. SM stated that she had received positive feedback on Callum & Chris Stenhouse on the support that they had provided the Tarporley practices following their migrations. The NWSIS schedule is due to restart with delivery at Fountains Medical Practice on the 10th April, followed by the other 3 practices within the same building. SM provided feedback following an escalation of issues via the LMC and Primary Care Commissioning meetings. SM emailed a template to all practice managers asking for their responses on a number of identified problem areas. These include both NWSIS and non NWSIS migrated practices. 23 practices had responded at the time of the board meeting. A number of issues were raised which include: review of NWSIS issues V operational IT issues, request from Whitby for PC replacement, incidents raised by practices through the S/D not being responded to within appropriate timescales. MMc suggested that the use of a SWOT type team by instigated which comprises of technical resource from field, networking and server all attending site together to provide in-depth analysis of configuration. Funding will be made available from the CCG to fund additional resource required. It was noted that due to the impact of the continuing Issues with NWSIS the CSU may struggle to book any further dates with practices for migrations. A communications is to be sent to all practices reminding them that documents should be stored on the H/S drives and not the C drive and that any personnel documents and synchronisation of phones should not be held/ completed on corporate devices. It was reported that Windows and AV updates are causing some delays on user machines as these are currently being pushed out to all practices and a number of machines are behind on updates. GH reported that two NWSIS migrations in East Cheshire CCG have been completed under the new processes outlined by the CSU have gone better than previous migrations. GH reported that each practice will be provided with a service account, that will be managed by each practice manager. This can be used by 3rd parties for support purposes. This was in response to an issue raised by practices following on from NWSIS being implemented. A discussion took place regarding new starters to practices and how locums need to be provided with a single login for working across multiple sites.

Action: GH, HD & MMc to review the process of the re-IP requirements and NWSIS migration for coporate staff. GH to challenge CDW regarding Monday being a non project delivery date and also to increase the number of PC’s migrated each working day (currently 8) GH to circulate the issues listed by BDS during site revisits SM to arrange for compiled responses from practices to be circulated post meeting KC to liaise with Steve @ Whitby re PC replacement that he has identified as being below spec. MMc & GH to review instigation of SWOT team KC to include in next communications regarding network drive and storing of corporate and personal documents and synchronisation of phones. KC to send out feedback form, post migration, to practices to monitor NWSIS migration activities. GH to take to the ICT Operation Group to see if issuing by issuing GP’s on the performers list would meet the requirements of the practices for allocation domain user ID and password for all their locum GP’s.

Infrastructure Projects – Phase 2 the pilot (10 sites) 4 Centralised Storage, Wi-Fi & VDI update

Centralised Storage KW has agreed with KC that any moves to centralised storage for practices will be post their Lexacom migration to reduce disruption to practices. Lexacom have been asked to schedule migrations before the end of May, with Helsby & Tarporley being requested as priorities. KW is also looking to dovetail some of the premigration tasks for centralised storage in with the NWSIS pre-migration requirements. Staff Wifi The wireless access points are now configured and available to practices, there is some work that needs to be completed in the background to improve the resilience of the solution but this is not impacting on the daily usage of Wifi. There is some planned work for the 5th April for this to take place and a comms will need to be sent to practices as wifi access will be impacted for approx. 3 hours. SM provided detail on a new tool that is to be demonstrated at a practice managers meeting for Apex. It is already in use in South Cheshire & Vale Royal practices but does not work with Front Desk. KW tabled a project timeline showing the implementation timescales to date for both Garden Lane and the CCG infrastructure.

5 Risks and Issues Issues I23 – a review and decision is required on the use of log me in I28 – the board agreed that the testing for Garden Lane would take place on the infrastructure as is at the moment but prior to moving any other practices to VDI the infrastructure would need to be upgraded to server 2012 etc. I31 – to be integrated into I28 I36 – number of practices are experiencing issues on the “old” network infrastructure. Risks R26 & R 27 closed R29 added regarding planned sick leave for nominated resource during the VDI planned testing phase. VDI project start -will need to be moved back for 2-3 weeks to align resource with CDW scheduling.

6 Dependencies Self-service tools Certero Asset Management and password management tool is to be deployed across the CCG footprint, timescales for deployment are to be confirmed.

Infrastructure Projects – Phase 3 7 Financial Position

KC provided the summary for the planned forecast for 2018/19 financial year. He will also provide the CCG finance team with a detailed spending plan based on this forecast.

VDI revenue plans for 2018/19 were originally based on full roll out for VDI across all users.

Planned spend of £38K for the implementation of laptops. KC stated that he required clarity on proposed funding regarding licensing from CDW and work with CSU team to estimate projected costs for the project. CSU asked CDW for costs several weeks ago though have not received the information.

Action:

KC to discuss with IB & JL re resource for Q4.

Additional Infrastructure Projects

8

Docman Extended Services, Patient Wifi, IE 11, Docman 10 & laptop progress reported via attachment.

For review

9 New Business EMIS Remote Consult for the Extended Hours Service – KC tabled a paper which detailed a comparison on the EMIS Remote Consult (RC) and EMIS Clinical Services (CS) functionality. The board approved the move to EMIS Remote Consult for the CCG’s Extended Services EMIS system. Action: New work request process to be followed.

14 Communications

KC to send comms on Wifi down time and use of network drives.

15 AOB None raised

Future Meetings

11:30 – 13:30 26th April 2018 - Egerton Room, 1829 Building Chester 11:30 – 13:30 24th May 2018 - Egerton Room, 1829 Building Chester 11:30 – 13:30 28th June 2018 - Egerton Room, 1829 Building Chester 11:30 – 13:30 26th July 2018 - Egerton Room, 1829 Building Chester 11:30 – 13:30 30th August 2018 - Egerton Room, 1829 Building Chester 11:30 – 13:30 27th September 2018 - Egerton Room, 1829 Building Chester 11:30 – 13:30 25th October 2018 - Egerton Room, 1829 Building Chester 11:30 – 13:30 29th November 2018 - Egerton Room, 1829 Building Chester 12:00 – 14:00 20th December 2018 - Egerton Room, 1829 Building Chester