AGENDA NHS Leeds CCG Primary Care Commissioning ……Jun 03, 2020 · Direct 01/09/2013 Ongoing Declare any potential conflict of interest at Governing Body/Board, sub committees

AGENDA

NHS Leeds CCG Primary Care Commissioning Committee

MS Teams Meeting

Date: Wednesday 3 June 2020 Time: 15:00 – 17:00

Venue: MS Teams Meeting

Item Description Lead Paper Time PCCC 20/01

Welcome and Apologies Purpose: To record apologies for absence and confirm the meeting is quorate.

Chair N

15:00

PCCC 20/02

Declarations of Interest Purpose: To record any Declarations of Interest relating to items on the agenda: a) Financial Interest

Where an individual may get direct financial benefit from the consequences of a decision they are involved in making;

b) Non-financial professional interest Where an individual may obtain a non-financial professional benefit from the consequences of a decision they are involved in making;

c) Non-financial personal interest Where an individual may benefit personally in ways that are not directly linked to their professional career and do not give rise to a direct financial benefit, because of the decisions they are involved in making; and

d) Indirect Interests Where an individual has a close association with another individual who has a financial interest, a non-financial professional interest or a non-financial personal interest who would stand to benefit from a decision they are involved in making.

Chair

Y

PCCC 20/03

Questions from Members of the Public Purpose: To receive questions from members of the public

Chair N 15:05

PCCC 20/04

Minutes of the Primary Care Commissioning Committee meeting held on 5 February 2020 Purpose: To approve the minutes

Chair Y 15:15

Item Description Lead Paper Time

PCCC 20/05

Matters Arising Purpose: To consider any outstanding matter arising from the minutes that is not covered elsewhere on the agenda

Chair N

PCCC 20/06

Action Log Purpose: To note the items on the outstanding action log

Chair Y

PCCC 20/07

Chief Executive’s Update Purpose: To receive the Chief Executive’s update for information

Tim Ryley N 15:20

PCCC 20/08

COVID 19 – Working Arrangements and Decisions Undertaken Purpose: To receive an update on the impact of COVID-19 on Primary Care

Kirsty Turner Y 15:25

PCCC 20/09

Primary Care Networks: Direct Enhanced Service Update and Principles Purpose: To receive an update for discussion

Gaynor Connor/ Kirsty Turner

Y 15:35

PCCC 20/10

Primary Care Quality Improvement Scheme – Principles: End of Year 2019/20 Process Purpose: To reflect on achievements and summary for payments


PCCC 20/11

Summary from the Primary Care Operational Group meeting in May 2020 Purpose: To receive a verbal update from the Chair

Kirsty Turner N 15:55

PCCC 20/12

Summary from the Quality and Performance Committee meeting held on 12 May 2020 Purpose: To receive a verbal update from the Chair

Dr Phil Ayres N 16:00

PCCC 20/13

Primary Care Integrated Quality & Performance Report (IQPR) Purpose: To receive the IQPR and consider any issues escalated by the Quality & Performance Committee

Kirsty Turner

Y 16:05

PCCC 20/14

Primary Care Risk Report Purpose: To receive an updated risk report


Item Description Lead Paper Time

PCCC 20/15

Primary Care Finance and Estates Update Purpose: To receive an update

Visseh Pejhan-Sykes

Y 16:20

PCCC 20/16

Proposal to Commence Patient Engagement – Alwoodley Medical Practice Purpose: To receive a verbal update on the patient engagement

Kirsty Turner N 16:30

PCCC 20/17

Forward Work Programme 2020/21 Purpose: To receive, accept and input to the programme

Chair

Y 16:40

PCCC 20/18

Any Other Business

Chair N 16:45

PCCC 20/19

Items for Consideration/ Escalation Purpose: To agree items to bring to the attention of the Governing Body, the Audit Committee and the Quality & Performance Committee

Chair N

Exclusion of the public - it is recommended that the following resolution be passed: "That representatives of the press and other members of the public be excluded from the remainder of the meeting, having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest" PCCC 20/20

Confidential Minutes of the Primary Care Commissioning Committee meeting held on 5 February 2020 Purpose: To approve the minutes

Chair Y 16:50

PCCC 20/21

APMS Contract Extension – Future Long Term Options Purpose: To review and approve the APMS contract extension


PCCC 20/22

Ratification of Urgent Actions – 17 March 2020 Purpose: To ratify the urgent actions

Kirsty Turner/Deborah McCartney

Y 17:05

Dates and venues of future meetings:

• 5 August 2020 – venue (tbc)

Title Name Job Title

(where applicable)

Role Practice B

Code

(Practice

Only)

Declared Interest- (Name of the

organisation and nature of

business)

Type of Interest Is the

interest

direct or

indirect?

Interest From Interest Until Action Taken to Mitigate Risk

Angela Collins Lay Member for Patient

and Public Participation

Governing Body Member N/A Nil Declaration

Anna Ladd Senior Primary Care

Manager NHS England

Other Committee Member N/A Husband works as the Head of

Contracts for Yorkshire

Ambulance Service

Indirect

Interests

Indirect 01/01/2015 Ongoing Declare any conflict or perceived

conflict within context of any

relevant meeting or project work

Carl Smith Head of Commissioning

Finance

Band 8d and above or

Employee Decision Maker

N/A Partner is Chief Finance Officer

at NHS Barnsley CCG.

Non-Financial

Personal

Interests

Indirect 01/12/2015 Ongoing Declare conflict or perceived conflict

within context of any relevant

meeting

Deborah McCartney Head of Primary Care

Commissioning and GP

Forward View



N/A Nil Declaration

Gaynor Connor Associate Director of

Primary Care embedded

into the Leeds GP

Confederation as

Director of

Transformation



N/A Role embedded within Leeds

GP Confederation

Non-Financial

Professional

Interests

Direct 01/10/2018 Ongoing Declare any potential or perceived

conflict of interest at relevant

meetings/workshops.

Joanne Harding Executive Director of

Quality and

Safety/Governing Body

Nurse

Governing Body Member N/A Joint Chair of the NHSCC

National Nurses Forum

Non-Financial

Professional

Interests

Direct 01/07/2019 Ongoing Declare any conflict of interest at

relevant meetings/workshops.

Dr Julianne Lyons GP Member

Representative

Governing Body Member B86110 GP Partner at Leeds Student

Medical Practice

Financial

Interests

Direct 01/01/2016 Ongoing Declare any potential conflict of

interest at Governing Body/Board,

sub committees and relevant

meetings


Representative

Governing Body Member B86110 Leeds Local Medical Committee

Member

Financial

Interests




meetings


Representative

Governing Body Member B86110 Spouse is a Director of Leeds

Haematology Ltd

Indirect

Interests

Indirect 01/05/2013 Ongoing Declare any potential conflict of



meetings


Representative

Governing Body Member B86110 Spouse is a trustee of UK

Myeloma Forum

Indirect

Interests




meetings

NHS Leeds CCG Primary Care Commissioning Committee - May 2020


Representative

Governing Body Member B86110 Spouse is an employee of the

University of Leeds

Indirect

Interests




meetings


Representative

Governing Body Member B86110 GP lead for Leeds Primary Care

Workforce and Training Hub

Financial

Interests




meetings


Representative

Governing Body Member B86110 Spouse has an honorary

contract with Leeds Teaching

Hospitals NHS Trust

Indirect

Interests




meetings


Representative

Governing Body Member B86110 Shareholder of Leeds West

Primary Care Limited

Financial

Interests




meetings


Representative

Governing Body Member B86110 I am a member of LSMP and

The Light PCN

Financial

Interests



meetings/workshops


Representative

Governing Body Member B86110 Daughter employed by Leeds

Student Medical Practice.

Project Co-ordinator for Leeds

Primary Care Workforce Hub.

Indirect

Interests

Indirect 01/07/2019 Ongoing Declare any potential or perceived


meetings/workshops.

Helen Lewis Interim Director of Acute

and Specialised

Commissioning.

Governing Body Member N/A Trustee, Leeds Jewish Welfare

Board

Non-Financial

Personal

Interests

Direct 01/12/2017 Up to 9 year

term

Declare any potential or perceived


meetings/workshops

Karen Lambe Corporate Governance

Office

Employee Non-Decision

Maker

N/A Spouse is employed by NHS

England as a Senior Knowledge

Manager

Financial

Interests



meetings/workshops

Katherine Sheerin Director of System

Integration (Interim)

Governing Body Member N/A Director, Ambition Health Ltd

(Health consultancy service)

Financial

Interests

Direct 30/09/2017 Ongoing Ambition Health Ltd not to bid for or

undertake work in the West

Yorkshire and Harrogate area.

Explicit permission from CCG CEO for

any work to be undertaken.



Governing Body Member N/A Part of the role of Director of

System Integration is to work

for the NHS Providers in Leeds

to support integration of

services. The role is part

funded by these providers as

follows - Leeds Community

Healthcare NHS Trust; Leeds

Teaching Hospitals NHS Trust;

Leeds and York Partnerhsip

NHS Foundation Trust; Leeds

GP Confederation.

Non-Financial

Professional

Interests

Direct 01/04/2019 31/12/2019 Declare any interest/potential

interest at relevant

meetings/workshops. If relevant

decisions to be taken, meeting Chair

to check with Conflicts of Interest

Guardian/ Head of Corporate

Governance whether further actions

are required. KS not to be involved

in any procurement

decisions/processes. Attendance at

Governing Body and other

committees will be in a non-voting

capacity.



Governing Body Member N/A Member of the Institute of

Health Management Executive

Board

Non-Financial

Professional

Interests

Direct 13/09/2019 31/12/2019 Declare any potential conflict of

interest at relevant meetings with

the CCG

Kirsty Turner Associate Director of

Primary Care



N/A Husband is the Deputy Chief

Finance Officer

Financial

Interests


interest at relevant meetings

Laura Parsons Head of Corporate

Governance and Risk



N/A Close friend Resourcing Co-

ordinator for LTHT

Indirect

Interests

Indirect 03/09/2018 20/01/2020 Declare as appropriate at meetings.

Phil Ayres Secondary Care

Consultant and Chair of

the Quality and

Pewrformance

Committee

Governing Body Member N/A Personal friendship with the

Chief Executive of Leeds

Community Healthcare

Indirect

Interests

Indirect 27/11/2019 Ongoing The action required to manage any

conflicts of interest will be agreed

with the Chair of the relevant

meeting. In relation to the Quality

and Performance Committee which I

chair, the Deputy chair will be asked

to agree any required actions.

No confidential/sensitive

information to be shared or

discussed with the LCH Chief

Executive.

Phil Ayres Governing Body Member Governing Body Member N/A I have personal friendships with

GP of the Rawdon Surgery

Indirect

Interests

Indirect 01/01/2017 Ongoing Maintain awareness of potential

influence over decisions I may take

as independent practitioner. Abide

by GMC code of conduct. Declare

this interest at relevant meetings.

Cllr Rebecca Charlwood Chair HW Board Other Committee Member N/A Nil Declaration

Sabrina Armstrong Director of

Organisational

Effectiveness

Governing Body Member N/A Personal friendship with a non-

executive director of Leeds

Community Healthcare NHS

Trust.

Non-Financial

Personal

Interests



meetings/workshops.


Organisational

Effectiveness

Governing Body Member N/A Close friend works as Director

of System Capability and

Operations at NHS England.

Indirect

Interests



meetings/workshops.


Organisational

Effectiveness

Governing Body Member N/A Pool member with NHS Interim

Management and Support

(NHS IMAS).

Non-Financial

Professional

Interests



meetings/workshops.

Sam Senior Lay Member for Primary

Care Co-Commissioning

Governing Body Member N/A Lay Member for Primary Care

Bassetlaw CCG

Financial

Interests



meetings/ workshops



Governing Body Member N/A Lay Representative National

School of Healthcare Science

Financial

Interests



meetings/ workshops



Governing Body Member N/A Lay Advisor Health Education

England (West Midlands)

Financial

Interests



meetings/ workshops



Governing Body Member N/A Patient and Public Panel

Member - National Institute

Health Research

Financial

Interests



meetings/ workshops



Governing Body Member N/A Chairperson - Brampton United

Junior Football Club (S63 6BB)

Non-Financial

Personal

Interests



meetings/ workshops



Governing Body Member N/A Independent Lay Member to

Rotherham Federation Connect

Healthcare

Non-Financial

Professional

Interests



meetings/ workshops



Governing Body Member N/A Volunteer for CortonWood

Miners Welfare Scheme

(registered charity)

Non-Financial

Personal

Interests



meetings/ workshops

Dr Simon Stockill Medical Director Governing Body Member N/A Partner at Sleights and

Sandsend Medical Practice,

Whitby (Hambleton,

Richmondshire & Whitby CCG)

Financial

Interests

Direct 01/04/2016 Ongoing Declare any conflict or perceived



Dr Simon Stockill Medical Director Governing Body Member N/A GP Appraiser, NHS England

(Yorkshire & Humber)

Financial

Interests




Dr Simon Stockill Medical Director Governing Body Member N/A Clinical Lead for Quality

Improvement, Royal College of

GPs

Financial

Interests




Dr Simon Stockill Medical Director Governing Body Member N/A Clinical Director, Whitby Coast

& Moors Primary Care Network

Financial

Interests




Tim Ryley Chief Executive Officer Governing Body Member N/A Nil Declaration

1

Minutes NHS Leeds CCG – Primary Care Commissioning Committee – Held in Public Wednesday 5 February 2020 1.30pm – 5.00pm Hinsley Hall, 62 Headingley Lane, Leeds LS6 2BX

Members Initials Role Present Apologies Sam Senior (Chair) SSe Lay Member – PCCC Angela Collins AC Lay Member – Patient & Public

Involvement

Dr Phil Ayres PA Secondary Care Specialist Doctor

Tim Ryley TR Chief Executive Jo Harding JH Executive Director of Quality & Nursing Helen Lewis HL Interim Director of Acute and Specialised

Commissioning

Sue Brear SB Lay Member – Audit & Conflicts of Interest

Visseh Pejhan-Sykes VPS Executive Director of Finance

Dr Simon Stockill SSt Medical Director

Additional Attendees Councillor Rebecca Charlwood

RC Health & Wellbeing Board Representative

Dr Ian Cameron IC Director of Public Health Medicine

Dr Sarah Forbes SF Associate Medical Director

Dr Julianne Lyons JL Member Representative Katherine Sheerin KS Director of System Integration Dr Oliver Corrado OC Healthwatch Leeds Representative Sabrina Armstrong SA Director of Organisational Effectiveness Kirsty Turner KT Associate Director of Primary Care

Gaynor Connor GC Director of Transformation, Leeds GP Confederation

Deborah McCartney DM Head of Primary Care Commissioning and GP Forward View

Sam Cavanagh SC Primary Care Manager, NHS England Laura Parsons LP Head of Corporate Governance & Risk Sam Ramsey (Minutes) SR Corporate Governance Manager

2

Members Initials Role Present Apologies Karen Lambe (Minutes) KL Corporate Governance Officer

Members of the Public Observing the Meeting – 3

No. Action PCCC 19/96

Welcome and Apologies The Chair welcomed everyone to the meeting. Apologies had been received from SSt, RC, IC and JL. SF would be deputising for SSt as a non-voting member.

PCCC 19/97

Declarations of Interest The Chair noted members’ Conflicts of Interests (CoI) and asked members to declare any updates or changes to the COIs which were relevant to the meeting. SF and GC declared a financial interest in relation to items 19/104, 19/105, 19/106, 19/107 and 19/108, in their capacity as a partner at a member practice and Director of Transformation, Leeds GP Confederation respectively. Due to acting in a non-voting capacity, both would move to the public gallery for these items. With regards to agenda item 19/104, HL declared that she was a patient at Alwoodley Medical Centre. As the committee would only be considering the commencement of engagement, it was agreed that she could remain at the table. There were no other declarations of interest.

PCCC 19/98

Questions from Members of the Public A query was raised by a member of the public regarding Adel Surgery. KT explained that the committee would be considering whether to approve Alwoodley Medical Centre’s proposal to commence public consultation regarding Adel Surgery. If approved, the consultation would commence at the end of February 2020. KT emphasised that the request for consultation had been made by Alwoodley Medical Centre and that the practice would be responsible for running the exercise. The proposals would be discussed later in the meeting at agenda item 19/104. There were no further questions from members of the public.

PCCC 19/99

Minutes of the Primary Care Commissioning meeting held on 4 December 2019

3

No. Action The minutes of the meeting held on 4 December 2019 were approved as a correct record. The Primary Care Commissioning Committee:

a) approved the minutes of the PCCC meeting held on 4 December 2019.

PCCC 19/100

Matters Arising There were no matters arising.

PCCC 19/101

Action Log The Primary Care Commissioning Committee (PCCC) reviewed the action log and noted that actions relating to items 19/65, 19/71 1 and 19/78 had been deferred until the next PCCC meeting on 1 April 2020. With regards to 19/88, KT stressed that, following the Primary Care Estates Group meeting on 4 February 2020, there continued to be risk in supporting practices with historic finances. She cautioned that the committee should be mindful of increasing costs for practices’ buildings when it was discussed at the next PCCC meeting. The Primary Care Commissioning Committee:

a) received the action log.

PCCC 19/102

Chief Executive’s Update TR updated members on the delayed NHS Operational Planning and Contracting Guidance for 2020/21. Written responses from West Yorkshire would be submitted in the following few weeks and these would reflect the CCG’s expectations regarding Primary Care Networks (PCNs). It was acknowledged that there would be a tight turnaround for responses. With regards to the CCG’s ‘Shaping Our Futures’ project to improve health outcomes and reduce health inequalities, TR explained that the CCG was reviewing its role in the city in consultation with its staff and partners. An update from a forthcoming Governing Body workshop would be brought to the next PCCC meeting to consider issues relating to Primary Care and to be included in the future workplan. ACTION: Update from Governing Body workshop to be brought to PCCC meeting on 1 April 2020 to consider issues relating to Primary Care. Members were informed that, following a recent recruitment process, the NHS Leadership Academy had been unsuccessful in appointing a lead to address

TR

4

No. Action NHS workforce issues. TR emphasised the importance of the role which would be re-advertised in the near future. The Primary Care Commissioning Committee: a) received the Chief Executive’s update.

PCCC 19/103

Primary Care Networks Update GC provided an update on the development of the PCNs in Leeds. Assurance was given that all PCNs had submitted their spending plans prior to the release of funding. Members were informed that PCNs were planning regular forums for Clinical Directors (CDs) to review priorities and share knowledge. Providers’ Chief Executive Officers had also been invited to meet with CDs for strategic discussions. With regards to consultation on the PCN Directed Enhanced Services (DES) draft specifications, members were informed that there had been significant local and national concern, particularly due to lack of capacity and short timescales. A response had been submitted by Leeds GP Confederation and Leeds Local Medical Council (LMC) on behalf of the city’s general practices. The final DES draft specifications were likely to be delayed until March 2020. It was noted that the delay was problematic for PCNs in terms of their decision making and what would be expected of the additional roles. GC observed that some practices remained uncertain as to whether they would participate in the DES specifications. KS cautioned that the need to ensure PCNs signed up to all the specifications going forward could represent a risk to the CCG. In terms of the additional roles reimbursement scheme, 15 social prescribing link workers and 15 clinical pharmacists had been recruited. Assurance was given that work was ongoing to recruit physiotherapists and rotational paramedics for 2020/21. GC explained that Yorkshire Ambulance Service (YAS) had expressed concern that recruitment of additional rotational paramedics by PCNs could have a potentially destabilising effect on its service. To date, of three paramedics recruited to PCNs, one had formerly been employed by YAS. The committee was informed that one practice had given formal notification of its intention to leave Chapeltown PCN to join Burmantofts, Harehills and Richmond Hill PCN. TR thanked GC, the Leeds GP Confederation and the Primary Care team for their work in developing PCNs. He observed that the proposed sharing of resources and the collaboration with providers’ Chief Executive Officers demonstrated real maturity on the part of the PCN leadership. JH informed members that NHS England (NHSE) was actively supporting PCNs with the development of nurse CDs. In addition, the Leeds GP

5

No. Action Confederation was proposing to launch a programme for aspiring female PCN leaders. The Primary Care Commissioning Committee:

a) noted the progress in supporting the development of PCNs; b) considered any actions necessary to support the continued

development of PCNs; and c) approved the change in configuration of the two identified PCNs.

PCCC 19/104

Proposal to Commence Patient Engagement - Alwoodley Medical Centre SF and GC left the table. KT informed the committee that the CCG had received an application on behalf of Alwoodley Medical Centre to carry out a patient engagement on the proposed closure of its branch surgery in Adel. KT explained that Adel Surgery served a patient list of approximately 2500, following a merger with Moorcroft Surgery in 2016. It was noted that Adel Surgery’s list size had not increased despite new housing developments in the area. Conversely, Alwoodley Medical Centre reported that, due to the high demand for appointments at its Moortown site, the Adel Surgery was being utilised to absorb excess appointments. In its application, Alwoodley Medical Centre cited concerns that the premises in Adel were not fit for purpose, offering limited availability to clinicians. The lease on the premises was due to expire in March 2021. The committee noted that potential consolidation of both sites would better utilise clinician time and improve practice resilience and sustainability. KT reminded members that the committee was required to decide whether it supported Alwoodley Medical Centre in carrying out a patient engagement. The intention of the consultation would be to assess the impact of changes and to inform the CCG’s future commissioning intentions. Following consideration, the Primary Care Operation Group (PCOG) on 22 January 2020 had supported the carrying out of patient engagement. The committee discussed a number of issues affecting the surgery. It was noted that no GPs worked solely at the Adel Surgery; rather, GPs worked across both sites. Assurance was given that, following consultation with other local practices, there was sufficient capacity to absorb all of Adel Surgery’s patients. Further assurance was given that, in the event of the closure of Adel Surgery, there would be additional appointment capacity at Alwoodley Medical Centre. With regards to the proposed engagement, SA stressed that this would be carried out by Alwoodley Medical Centre. The role of the CCG Engagement team would be to provide the tools to facilitate the engagement. The practice Patient Participation Group (PPG) would act as the assurance mechanism, ensuring the engagement was a robust one.

6

No. Action KT reflected on public interest in the engagement. She reiterated that a public engagement exercise would be of real value in informing the CCG of the population’s needs when commissioning future services. It was noted that the local Member of Parliament (MP) was aware of the situation and local councillors had been briefed on developments. AC queried the process on completion of the public engagement. Assurance was given that the practice would have to consider the impact of closure on the population of Adel, which may result in reconsidering proposals. The outcome of the engagement would be reported publically in a ‘You said, We did’ format. KT stressed that the role of the CCG was to consider if it supported Alwoodley Medical Centre’s decision or if it wished to consider alternative options. Following an invitation by the Chair, a member of public raised the issue of access to Alwoodley Medical Centre for elderly patients and patients with disabilities. KT stressed the need for all patients to engage in the consultation in order to express their needs and priorities. In response to a further question, she emphasised that the results of the public engagement would be considered alongside information concerning population growth and demographics. If approved, the engagement would commence in February/ March 2020, with both practices contacting all registered patients. A petition objecting to the proposed closure of Adel Surgery was presented to the PCCC by Nick Rutherford from the office of MP Alex Sobel, Leeds North West. The petition was accepted by the Chief Executive. Action: Petition to be discussed at PCCC meeting, following patient engagement. The Primary Care Commissioning Committee:

a) approved the proposal for Alwoodley Medical Centre to commence a period of engagement regarding the future of the branch surgery at Adel; and

b) noted the recent political attention around the proposal.

KT

PCCC 19/105

Allerton Medical Centre and Westfield Medical Centre – Proposed Merger The committee was presented with the recommendation to approve a proposed merger of Allerton Medical Centre and Westfield Medical Centre. Both practices were based in the Chapeltown PCN, 0.7 miles apart, and had worked with neighbouring practices for a number of years. It was noted that the two practices were in the process of completing a full business merger; a contractual merger would further support the integration of the process and help ensure the sustainability of both practices.

7

No. Action Allerton Medical Centre served a population of 5947 patients, while Westfield Medical Centre served 4262 patients. KT commended the excellent patient engagement carried out by the practices. Having reviewed the proposal, PCOG acknowledged that the merger would be a positive step in increasing the resilience of both practices and recommended its approval by the PCCC. The Primary Care Commissioning Committee:

a) approved the recommendation to merge Allerton Medical Centre and Westfield Medical Centre.

PCCC 19/106

Primary Care Enhanced Specifications Proposals 2020/21 DM presented the Primary Care Enhanced Specifications proposals for 2020/21 that comprised the Quality Improvement Scheme (QIS) and the Enhanced Care Home Scheme. With regards to Year 3 of the QIS, a number of changes were recommended following consultation with Clinical Leads for Long Term Conditions, Older People and End of Life. DM highlighted the proposed addition of End of Life improvements to Year 3 of the QIS. This had formerly been included in Year 1, but subsequently removed from Year 2 on its inclusion in the Quality Improvement (QI) domain in the Quality Outcomes Framework (QOF). Members were presented with details of the Enhanced Care Home Scheme which had previously been released for one year while transitioning to a single Leeds-wide scheme. Due to delays in the DES specifications, it was recommended that the local enhanced service be recommissioned to current providers for a further year. The current scheme was run by 49 practices. DM explained that the additional transitional year would allow sufficient time to work through workforce and workload issues. It was proposed that the CCG would work with CDs to review pathways for vulnerable populations. While funding for the scheme was recurrent, there would be an option for recurrent funding for enhancement. Members discussed whether Learning Disability (LD) health checks would be included in the QIS or QOF. DM explained that this had not been finalised in the QOF. Assurance was given that the CCG would align payment with the achievement of the target, whether it was part of the QIS or the QOF. PA questioned the underperformance of LD health checks. Assurance was given that this would remain on the Practice Quality Improvement Dashboard, with information being subsequently shared with PCNs. Action: LD health checks to be reviewed at Quality & Performance Committee meeting on 11 March 2020.

KT

8

No. Action OC emphasised the need for a proactive approach to frailty and for the contract to address the quality of the approach. Assurance was given that CDs would be working with providers to develop a clinical model for care homes, which would draw on national guidance prior to commissioning. With regards to care home funding, TR stressed that this would be recurrent, with some possible non recurrent funding. Assurance was given that this would continue once DES specifications had been agreed nationally. The Primary Care Commissioning Committee:

a) noted and discussed the content of the QIS; b) approved the recommendation to accept the proposed changes to the

QIS for Year 3; c) noted and discussed the content of the Enhanced Care Home

Scheme report; and d) approved the recommendation to continue the local scheme for a

further 12 months whilst a clinical model is developed across the City.

PCCC 19/107

APMS Contract Extension of York Street Health Practice The committee was updated on the Alternative Provider Medical Services (APMS) contract held by Bevan Healthcare for the York Street Health Practice. The contract, awarded following procurement in 2016/17, was for three years plus two years. It was noted that the practice supported Leeds City Council street worker services and provided bespoke primary care with outreach to a number of vulnerable populations. Both the provider and the CCG Primary Care team were supportive of extending the contract to the end of the three plus two years’ term. KT observed that the rolling over of the contract would provide an opportunity to review the service specification in the light of the CCG’s ambition to move towards a population health needs approach. Assurance was given that there would be no funding change for the additional two years. The Primary Care Commissioning Committee:

a) approved the proposed contract position and enabled the primary care team to carry out the next steps.

PCCC 19/108

Review of Domiciliary Phlebotomy The committee was informed that a domiciliary phlebotomy service had been previously commissioned by NHS Leeds South and East CCG and had continued to roll over for the last few years. A service review had been undertaken to understand the current arrangements against the service

9

No. Action specification to identify if it was still required. The service review had been presented to the PCOG with a recommendation to decommission the service as it was not demonstrating best practice or value for money. Members acknowledged that this service was the last historic legacy issue of inequality. A query was raised in relation to whether there had been an explanation from the providers on why the service had not been delivered and whether there had been any missed opportunities for patients. The committee was assured that the service proposal was in relation to initial assessments and that it had been suggested there was underutilisation of the additional tests that the provider had chosen to deliver which were over and above the specification. In relation to patients with dementia, the committee discussed the potential duplication of the service as this was also offered by the practice. As the service was included within the core general practice contract and healthy living initiative, members were assured that the service would continue to be delivered and this would be communicated to patients. The importance of seeing vulnerable patients at home was recognised. The committee discussed whether there was any learning and it was acknowledged that this had been due to a capacity issue an there were robust mechanisms elsewhere with no risk from a primary care point of view. The Primary Care Commissioning Committee:

a) received the briefing paper; and b) approved the decision to decommission the service (subject to

Local Medical Committee consideration).

PCCC 19/109

Health Inequalities Audit 2019 – Access to General Practice SF and GC rejoined the table The committee was presented with an update to the action plan of the Health Inequalities Audit which had been converted into a working plan. The CCG had worked with colleagues in Public Health and a plan on a page had been produced to outline responsibilities for actions. In relation to the improvement to access to routine appointments, the committee was informed that an access steering group had been established in collaboration with the GP Confederation. Members were provided with feedback on the end of year reporting on specific population groups and identified that reporting of ethnicity had increased by 7%, and first language had increased by 8%. The better recording of information would enable practices to best meet the needs of their population. Members were informed that there had been focused attention on Learning

10

No. Action Disabilities which had seen an improvement. An overview of key priorities for the next quarter was provided which would include focusing on addressing barriers to registration to practices and sharing best practice. Members were informed that health inequalities would be a focus area for a forthcoming Clinical Directors forum. The Chief Executive highlighted the importance of considering inequalities as a whole organisation and not only from a primary care perspective. Members commented that the plan on a page was helpful and could also be shared with providers. The Primary Care Commissioning Committee:

a) received the briefing paper and action plan.

PCCC 19/110

Chair’s Summaries from the Primary Care Operational Group in December 2019 and January 2020 KT presented the summary from the PCOG meetings in December 2019 and January 2020. The committee’s attention was drawn to work with Carers services to consider how they could provide more support to practices. The Primary Care Commissioning Committee:

a) received the summary for information.

PCCC 19/111

Chair’s Summary from the Quality & Performance Committee meeting held on 15 January 2020 The committee noted the Chair’s Summary from the Quality & Performance Committee. An update was provided in relation to the coronavirus and it was confirmed that there had been no increased demand as yet. The Primary Care Commissioning Committee: a) received the summary for information.

PCCC 19/112

Primary Care Integrated Quality & Performance Report (IQPR) The Committee was presented with the updated Primary Care Integrated Quality & Performance Report (IQPR). KT highlighted the figures in relation to flu vaccinations and highlighted that,

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No. Action by the end of January 2020, there had been a significant improvement in some areas for patients over 65 (75%), patients at risk (41%) and pregnant women (47%). It was acknowledged that this represented improved progress to what had been reported. The committee noted that there had been issues with supply. A query was raised in relation to the supply issue of the flu vaccinations and whether this had a correlation with increased incidences. Members were informed that this had not been recognised, and were assured that the campaign was running longer than it normally would to reach those that had not yet had their vaccination. With regards to the vaccination figures, a query was raised in relation to the distribution, median and mean of the uptake. KT informed members that this data had previously been mapped against localities and that some practices were taking a proactive approach to vaccinations and immunisations. It was important to encourage practices to do so. Action: The committee was assured that detailed data would be presented and considered at the PCOG. The committee noted that 99% of practices were rated Good or Outstanding and that this was a continuous improvement cycle with Care Quality Commission (CQC) inspections. The Primary Care Commissioning Committee:

a) received the Integrated Quality and Performance Report.

KT

PCCC 19/113

Primary Care Risk Report The Primary Care risk report was presented to the committee and members’ attention was drawn to a new risk in relation to procurement. The risk was scored at 8 and therefore was for information only. Risk 651: General Practice Workforce was reported to the committee as the current score was high amber (12). An update was provided on this risk which highlighted the establishment of the One Workforce Board which sat across the health and care system and recognised the scale of workforce. A key update in relation to primary care workforce was that there had been a change in the training hubs which had expanded to the workforce and development hub and the Confederation was supporting this. There were pockets of risk within the workforce highlighted in terms of ageing workforce and attracting new GPs. However members were assured that the system was well sighted on these and these were nationally recognised issues in relation to workforce challenges. A query was raised in relation to the scoring of the risk, and members were informed that due to many mitigating actions and awareness of what the risks

12

No. Action were, the high amber was an appropriate score. It was highlighted that the impact of the risk would be in pockets across the city rather than the city as a whole. The Primary Care Commissioning Committee: a) reviewed the high scoring (12+) risk; and b) considered that the controls and actions were effective and assurances were sufficiently robust.

PCCC 19/114

Primary Care Finance and Estates Update OC left the meeting. VPS presented the Primary Care Finance and Estates update. The CCG was forecasting an underspend of £500k in relation to payments to the PCNs, largely due to time delays in recruiting staff. Nationally, CCGs were asked to put in place local schemes to share the unused funding across the PCNs. A query was raised in relation to the proposal which included phlebotomy and the committee was assured that this was primarily based on social prescribing and would cut down on duplication. In relation to the prescribing budget, members noted it had been difficult in terms of forecasting due to Brexit implications, however the CCG planned to hit the forecast position. The committee was informed that there had been an Estates meeting on 4 February. An update would be brought to the next committee meeting on 1 April 2020. A query was raised in relation to the forecasting for prescribing budgets and whether this had changed in this year. VPS informed members that additional time had been set when setting the budget to be more directed. Further horizon scanning would be done when setting future prescribing budgets. The Primary Care Commissioning Committee: a) noted the Primary Care financial position for December 2019; and b) noted the proposed scheme to spend the full Role Reimbursement budget.

PCCC 19/115

Forward Work Programme 2019/20 The Committee received the Forward Work Programme. The Primary Care Commissioning Committee:

a) received the Forward Work Programme for 2019/20.

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No. Action PCCC 19/116

Questions from Members of the Public There were no members of the public present.

PCCC 19/117

Any Other Business Sam Cavanagh, NHSE, provided an update on the proposed closure of the dispensary at Harewood Surgery. Following on from the previous update, the practice engagement had concluded and the feedback had been collated and shared with NHS England, who then shared with the Primary Care Operational Group. NHSE had taken a paper to their regional Primary Care Commissioning Committee in January and agreed to support the proposal to close the dispensary. Members were informed that the practice had communicated with all patients informing them that the dispensary service would be closing at the end of March 2020. NHSE had updated the Health and Wellbeing Board and would work with local community pharmacists in the area. The committee was assured there were no concerns regarding capacity.

PCCC 19/118

Items for Consideration/Escalation The Committee agreed that the action in relation to Learning Disabilities health checks being reviewed at the Quality & Performance Committee would be escalated to the Governing Body for their information. The action in relation to the data that would be presented and considered by the Primary Care Operational Group would also be escalated.

The Primary Care Commissioning Committee resolved that representatives of the press and other members of the public be excluded from the remainder of the meeting, having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest.

Approved and signed by: Sam Senior, Lay Member – Primary Care Co-Commissioning / Deputy Chair Date:

MINUTES ACTION LOG – PRIMARY CARE COMMISSIONING COMMITTEE

UPDATED 27 May 2020

ITEM NO:

ACTION NO:

ACTION: ACTION BY:

COMPLETED/UPDATE

PRIMARY CARE COMMISSIONING COMMITTEE MEETING OUTSTANDING ACTION LIST

2 October 2019 PCCC 19/65

1. Primary Care Risk Report Results of digital consultation to be brought to PCCC meeting in December 2019.

VPS/ KT In progress. Update to be provided on the figures in relation to digital work in practices.

PCCC 19/71

1. APMS Contract Extension – Future Long Term Options Bring paper to December PCCC meeting to clarify risks and benefits of options.

KT/DM In progress. Agenda item PCCC 20/20, 3 June 2020.

PCCC 19/71

2. APMS Contract Extension – Future Long Term Options Develop framework for decision making guidance - bring draft to December PCCC meeting.

KS In progress. Deferred due to COVID-19

4 December 2019 PCCC 19/88

1. Primary Care Finance Update Further details to be provided regarding the process and actions to provide assurance that debt would not reoccur between CHP and GP practices in LIFT buildings.

CS/KT In progress. The working behind this assurance will be discussed and finalised at the Primary Care Estates Group on 4 February. Update to be provided at PCCC on 3 June 2020 - agenda item 20/14.

PCCC 19/89

1. The Whitfield Practice and Drs Khan & Muneer – proposed merger Staff numbers to be confirmed at PCCC meeting on 5 February 2020.

KT Completed. Staff levels have been confirmed with the practice and the CCG is assured that there are no actual reductions in staff numbers.

5 February 2020

MINUTES ACTION LOG – PRIMARY CARE COMMISSIONING COMMITTEE

UPDATED 27 May 2020

ITEM NO:

ACTION NO:

ACTION: ACTION BY:

COMPLETED/UPDATE

PCCC 19/102

1. Chief Executive’s Update Update from the Governing Body workshop to be brought to PCCC meeting on 1 April 2020 to consider issues relating to Primary Care.

TR In progress. Deferred to PCCC meeting on 5 August 2020.

PCCC 19/104

1. Proposal to Commence Patient Engagement – Alwoodley Medical Practice Petition presented at PCCC meeting on 5 February 2020, to be discussed at PCCC meeting on 3 June 2020, following end of patient engagement.

KT In progress. Agenda item PCCC 20/15, 3 June 2020.

PCCC 19/106

1. Primary Care Enhanced Specifications Proposals 2020/21 LD health checks to be reviewed at Quality & Performance Committee meeting on 11 March 2020.

KT Complete. Referenced in QIS agenda item 20/10, 3 June 2020.

PCCC 19/112

1. Primary Care Integrated Quality & Performance Report Detailed data regarding vaccinations to be presented and considered at the PCOG.

KT In progress. Deferred to PCCC meeting on 5 August 2020.

PCCC 19/120

1. Confidential item: Urgent Action An interim proposal on support to be provided to practitioners to be presented to PCCC on 3 June 2020.

KT In progress. Deferred to PCCC meeting on 5 August 2020. KT to provide interim verbal update on support provided to practitioners during COVID-19.

PCCC 19/120

2. Confidential item: Urgent Action A long term proposal and approach on support to practitioners to be brought to the PCCC by February 2021.

KT In progress. Added to forward work plan 2020/21.

PCCC AOB

1. Any Other Business – Confidential session Invite Cllr Charlwood to send a deputy to PCCC meetings if unable to attend.

KL Completed.

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Leeds Health & Wellbeing Strategy Outcomes – that this report relates to: 1. People will live longer and have healthier lives 2. People will live full, active and independent lives 3. People’s quality of life will be improved by access to quality services 4. People will be actively involved in their health and their care 5. People will live in healthy, safe and sustainable communities

NHS Leeds CCG Strategic Commitments We will focus resources to: 1. Deliver better outcomes for people’s health and wellbeing 2. Reduce health inequalities across our city We will work with our partners and the people of Leeds to: 3. Support a greater focus on the wider determinants of health 4. Increase their confidence to manage their own health and wellbeing 5. Achieve better integrated care for the population of Leeds 6. Create the conditions for health and care needs to be addressed around local neighbourhoods

Assurance Framework – which risks on the GBAF does this report relate to: 1. Inadequate patient and public engagement results in ineffective decisions and challenge 2. Failure to assure the delivery of high quality services, leading to commissioned services not reflecting best practice and improving care

3. Failure to achieve financial stability and sustainability 4. Lack of provider and clinical support for change will impact on the development and implementation of the CCG strategy

5. Resources are not targeted effectively to areas of most need, leading to failure to improve health in the poorest areas

6. Insufficient workforce capacity, capability and adaptability to deliver the ambitions 7. Failure to enable partners to work together to deliver the CCG commitments 8. Failure of system to be adaptable and resilient in the event of a significant event

Agenda Item: PCCC 20/08 FOI Exempt: N

NHS Leeds CCG Primary Care Commissioning Committee Meeting

Date of meeting: 3 June 2020

Title: COVID 19 – Working Arrangements and Decisions Undertaken

Lead Governing Body Member: Katherine Sheerin, Interim Director of System Integration Category of Paper

Tick as appropriate

() Report Author: Kirsty Turner, Associate Director for Primary Care. Gaynor Connor, Director of Transformation, Leeds GP Confederation

Decision

Reviewed by EMT/Date: Discussion Reviewed by Committee/Date: n/a Information

Checked by Finance (Y/N/N/A - Date): Y Approved by Lead Governing Body member (Y/N): Y

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EXECUTIVE SUMMARY: General Practice in Leeds has had to rapidly adopt a different operating model in order to respond to the Covid 19 pandemic. This paper intends to summarise the decisions and processes implemented. NEXT STEPS: Support will continue to be given to practices as we move to the next phase of Covid. The team will be reviewing what initiatives implemented as part of the Covid response remain as part of the ‘returning stronger’ programme of work. RECOMMENDATION: The Primary Care Commissioning Committee is asked to:

a) Note the General Practice response.

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COVID 19 – GENERAL PRACTICE IN LEEDS 1. SUMMARY 1.1 General Practice in Leeds has had to rapidly adopt a different operating model in order to

respond to the Covid 19 pandemic. This paper intends to summarise the processes implemented and acknowledge some of the operational decisions that have taken place to facilitate safe working for staff and patients.

2. BACKGROUND 2.1 NHS England (NHSE) has led the central communication of messages to general practice

to ensure a consistent approach to managing the epidemic across England. This has taken place through a regular production of letters, briefings, standard operating procedures and weekly webinars.

2.2 A key letter was issued on 19 March 2020 which very much shifted the way general

practice operated through the specific guidance below:

1. Move to a total triage system (whether by phone or online) 2. Agree locally with your CCG which practice premises and teams should be used to manage essential face-to-face services 3. Undertake all care that can be done remotely via appropriate channels 4. Prepare for the significant increase in home visiting as a result of social distancing, home isolation and the need to discharge all patients who do not need to be in hospital 5. Prioritise support for particular groups of patients at high risk 6. Help staff to stay safe and at work, building cross-practice resilience across primary care networks, and confirming business continuity plans.

2.3 There was also a clear message regarding funding which confirmed that GP practices in

2020/21 continue to be paid at rates that assume they would have continued to perform at the same levels from the beginning of the outbreak as they had done previously, including for the purposes of the Quality Outcomes Framework (QOF), Directed Enhanced Service Specification (DES) and Local Enhanced Service Specification (LES) payments.

2.4 On the 29th April, the government announced the move to the second phase of the

outbreak response. For primary care this meant: • Ensuring patients have clear information on how to access primary care services and

are confident about making appointments (virtual or if appropriate, face-to-face) for current concerns.

• Completing work on implementing digital and video consultations, so that all patients and practices can benefit.

• Given the reduction of face-to-face visits, stratify and proactively contact their high-risk patients with ongoing care needs, to ensure appropriate ongoing care and support plans are delivered through multidisciplinary teams.

• In particular, proactively contact all those in the ‘shielding’ cohort of patients who are clinically extremely vulnerable to Covid-19, ensure they know how to access care, are

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receiving their medications, and provide safe home visiting wherever clinically necessary.

• To further support care homes, the NHS will bring forward a package of support to care homes drawing on key components of the Enhanced Care in Care Homes service and delivered as a collaboration between community and general practice teams. This should include a weekly virtual ‘care home round’ of residents needing clinical support.

• Make two-week wait cancer, urgent and routine referrals to secondary care as normal, using ‘advice and guidance’ options where appropriate.

• Deliver as much routine and preventative work as can be provided safely including vaccinations immunisations, and screening.

2.5 On 1st May, primary care was instructed to build on existing work, to further support care homes with community services. Practices and community providers were asked to ensure: • timely access to clinical advice for care home staff and residents. • proactive support for people living in care homes, including through personalised care

and support planning as appropriate. • care home residents with suspected or confirmed COVID-19 are supported through

remote monitoring – and face-to-face assessment where clinically appropriate – by a multidisciplinary team (MDT) where practically possible (including those for whom monitoring is needed following discharge from either an acute or step-down bed).

• sensitive and collaborative decisions around hospital admissions for care home residents if they are likely to benefit.

3. LEEDS POSITION 3.1 Through the Covid 19 governance arrangements, a Primary Care focused group was

established to oversee the primary care response. The group, made up of CCG and Leeds GP Confederation colleagues along with a Clinical Director representative have met daily and continues to do so. Some key features of the Leeds response overseen by the group are:

• Establishing daily situation reports (sitrep) from every practice; monitoring the staffing levels at practice but also the overall Operational Pressures Escalation Levels (OPEL) score to help determine where additional support may be required and whether the situation is currently manageable.

• 100% availability of online and video consultations (starting from a low 30% baseline). Continues to be some variation with regard to ability to offer and actual implementation

o We have 100% of practices that are able to offer a video consultation o 82/94 (87%) of practices now live with online consultations o 12 (13%) practices remaining but all with mobilization plans

• Co-ordinated central communications through a daily briefing, providing a Leeds response to nationally released guidance and opportunity for general practice to raise concerns.

• Oversight of the primary care response to care home support which has included rolling out the local care home scheme to those practices not currently providing the scheme.

• A weekly webinar outlining key clinical and operational issues.

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• Direct support to practice ensuring supplies of Personal Protective Equipment (PPE) (represented as part of a City wide specific group for PPE).

3.2 Leeds General Practices should be commended for their positive response to managing the situation, with rapidly changing guidance. Practices and PCNs with the positive support from the GP Confederation have been able to mobilise services from the implementation of video consultations to the identification of hot / cold sites or zoning within buildings to keep safe patients and staff.

3.3 Local ‘best practice’ guidance has also been issued to support long term condition support along with how to run an effective Multidisciplinary Team (MDT) to support the response to care homes

3.4 Support was provided to practices to close branch sites as a way of providing resilience. The impact on patients was reduced due to the rapid move to a triage service first ensuring that all patients should have been avoiding physical presence at practice sites.

3.5 In respect of the bank holiday arrangements, whilst nationally practices were directed to

open at both the Easter and May (VE) Bank holidays. Leeds CCG took the decision to allow practices to close for the May (VE) bank holiday and utilise the extended access / out of hours services given the manageable activity at the time. It is also the intention that the 25 May 2020 will also be managed as a ‘normal’ bank holiday i.e. practices will close.

4. NEXT STEPS 4.1 Support will continue to be given to practices as we move to the next phase of Covid 5. FINANCIAL IMPLICATIONS AND RISK 5.1 Leeds CCG confirmed with practices the availability of a Covid support fund to support

practices with costs that have been incurred to date. This was established as an initial payment to acknowledge costs with a claim for practices to submit further costs.

5.2 To date, a total of £826,542 has been paid to date in respect of general practice costs.

This can be broken down as follows:

£99,600 Initial support payments £85,415 COVID19 Tranche 1 Costs Reimbursements to Practices £60,271 COVID19 Tranche 2 Costs Reimbursements to Practices

£384,638 COVID19 Costs Reimbursements to Practices – Easter opening £196,618 PPE

5.3 A decision was taken to roll out the local care home scheme to ensure that the majority of

beds were covered. The costs for this have been estimated as £300,000 (off-set by some of the costs coming from the PCN DES).

6. COMMUNICATIONS AND INVOLVEMENT

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6.1 It was identified early on in the situation that clear and concise communication was essential to support the local response. We have had positive feedback from members on the briefings and webinar and will be seeking further feedback as to how these can adapt as we move into the next phase.

7. RECOMMENDATION

The Primary Care Commissioning Committee is asked to:

a) Note the General Practice response.

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Title: Primary Care Network DES Update and Principles


Tick as appropriate

() Report Author: Lisa Kundi, Primary Care Commissioning Manager Decision

Reviewed by EMT/Date: Discussion Reviewed by Committee/Date: 7 May 2020 Information Checked by Finance (Y/N/N/A - Date): Y Approved by Lead Governing Body member (Y/N): Y

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EXECUTIVE SUMMARY: The purpose of this paper is to update the Primary Care Commissioning Committee (PCCC) on the recently published Primary Care Network Directed Enhanced Service (DES) Specification and its conditions that require further consideration in relation to the additional roles reimbursement scheme (ARRS). NEXT STEPS: The Primary Care Commissioning team will work with the development team to support implementation of the enhanced service to ensure implementation that best meets local need whilst operating within the framework of the specification. RECOMMENDATION: The Primary Care Commissioning Committee is asked to:

a) Receive the update on new additions to the DES; b) Consider and discuss the implementation of the scheme within Leeds; and c) Agree the approach with regard to FCP reimbursement.

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1. SUMMARY 1.1 The Primary Care Network (PCN) DES Specification was published on 31 March 2020, marking the

second year of this DES. 1.2 The purpose of this paper is to update the Primary Care Commissioning Committee on the additions

to this specification in respect of the additional roles reimbursement scheme (ARRS) element and its conditions that require further consideration.

1.3 The focus of the first year of the DES was on establishment of PCNs and the recruitment of the first

two roles under the additional roles reimbursement scheme element to bring on board social prescribing link workers and pharmacists to work as part of a multidisciplinary network team. PCNs also took on responsibility for delivering extended access services from 1 June 2019 which were previously delivered as a stand-alone DES by each general practice.

1.4 There are a number of new elements or rules that the new DES includes which bring further

opportunities to PCNs to invest in more staff but which will also have implications for implementation. 1.5 The scheme was amended shortly before publication to take account of the impact of Covid-19 on

the ability of PCNs to deliver the full requirements of the DES. This has not necessarily affected the ARRS other than including a delay in the submission of the workforce plan and the impact of Covid-19 in delaying the recruitment process.

2. Core Elements of the Scheme 2.1 The scheme can be categorised into 5 main elements:

a) PCN organisational requirements including leadership b) Network service specifications c) Additional roles reimbursement scheme (ARRS) d) Extended hours delivery e) Impact and Investment Fund (IIF) Framework.

2.2 The CCG has commenced the sign up process for the 2020/21 Primary Care Network DES. As part

of the contract arrangements, practices have until the 31 May 2020 to notify the CCG of any changes.

2.3 As of 22 May 2020, all PCNs have confirmed their participation.

2.4 Other changes to the service specification as a result of Covid-19 include: a) The implementation of the structured medications review specification has been amended to

start on 1 October 2020. b) The implementation of the Early Cancer Diagnosis specification has been amended to start on 1

October 2020 however, PCNs are encouraged to commence work on this earlier if capacity allows.

c) The introduction of the Investment and Impact Fund has been postponed for 6 months; in recognition of this, PCNs will receive 0.27p per patient funding for these 6 months with a review on next steps for the remaining 6 months of the year. Payment for this revised PCN Support fund will commence in May 2020 backdated to include April 2020, and thereafter will be paid monthly until September 2020.

d) NHS England outlined in the preparedness letter dated 19 March 2020 that the care home scheme would be implemented as outlined in the “Update to the GP Contract agreement 2020/21- 2023/4” published on 6 February 2020. The timeframe for implementation is:

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By 31 July 2020

PCNs will: agree which care homes it has responsibility for with the CCG and have a simple plan about how the service will operate with local partners ( including community service providers) People entering the care home should be supported to re-register within the aligned PCN

By 31 July 2020

PCNs will ensure a lead GP or GPs with responsibility for this service is agreed for each aligned care home Confirmation of all care homes within the PCN

By 30 September 2020

PCNs will work with community service providers (whose contract will describe joint responsibility in this respect) and other relevant partners to establish and coordinate a MDT to deliver this service

From 30 September

PCNs will deliver a weekly “home round” for people living in the care home who are registered with Practices in the PCN. Digital technology may support the weekly home round and facilitate the medical input

3. Additional Roles Reimbursement Scheme 3.1 Each PCN has an allocation available based on list size to employ staff working across the PCN to

deliver the service specifications which for this year include; enhanced care health in care homes, structured medication reviews and early cancer diagnosis. Dependent on the population and need within each PCN, the requirements for each of the roles supporting delivery of the specifications will differ. Up to £7.131 is available in 20/21 per weighted patient using January 2020 list size; funding available will increase each year over the 5 year term of the agreement.

3.2 The Additional Roles Reimbursement Scheme has the following key considerations for

implementation of which some are new for 20/21.

• All roles are now 100% reimbursable with a maximum amount per role. • PCNs can now recruit to 10 roles; previously this was 6 and will increase further to 12 to include

paramedics and mental health practitioners in 21/22. • Roles employed must be above the agreed baseline; baseline will include only the 6 original roles

as defined by the data collection in March 2019. • Whilst a baseline will not be established for the new roles brought on board in 20/21, additionality

principles still apply. • Baseline must be maintained and if a post is vacant for more than 3 months then a PCN will not

be eligible for additional role reimbursement. • With the agreement of the commissioner, a PCN will be able to substitute between clinical

pharmacists, first contact physiotherapists and physician associates within the PCN baseline. • First contact physiotherapists and pharmacy technicians will be capped at one per 50,000 (can be

waived in agreement with CCG and ICS) • PCN Pharmacy technicians can now be transferred over from the Medicines Optimisation in Care

Homes (MOCH) Scheme to the ARRS (deadline 31 March 2021) • If pharmacists and technicians are not transferred over from the scheme by this date the

commissioner must align their work to the network enhanced health in care homes specification. • PCNs should submit recruitment plans for 2020/21 by 31 August 2020 and indicative intentions

through to 2023/24 by 31 October 2020 (amended timescale due to Covid-19), commissioners to publish ‘unclaimed funding’ by 30 September 2020 to enable PCNs to submit bids to employ further staff within the agreed roles.

• The maximum entitlement for all roles is based on a WTE post and entitlements will be calculated on a pro rata basis.

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• For the social prescribing role only within the maximum reimbursable amount, if employment is external to the PCN up to £2400 may be claimed for management fees.

• PCNs should be mindful that dependent on the employment option taken, VAT may be applicable.

• The specification outlines minimum role requirements that should be included in each roles job description.

4.0 Further Considerations 4.1 PCNs across Leeds are keen to explore a model whereby first contact physiotherapists are

employed externally to the PCN. This is of course allowable within the framework of the scheme but there are affordability issues to consider as the full reimbursable amount is only available for full-time equivalent (FTE) posts. If an external provider is the employer and supplies the PCN with a service as opposed to an individual there may be associated VAT costs that could be passed onto the PCN. The specification only makes reference to a management fee being available within the maximum reimbursable amount for social prescribing roles.

The specification includes minimum role requirements for each of the roles and PCNs have the ability to further enhance the job descriptions to meet the needs of their population. We need to give due consideration to the impact this could have on equitable access for patients and the impact on services across Leeds with this being particularly relevant for the first contact physiotherapist role. Our ambition is to ensure that the additional capacity is genuinely additional within primary care and not a duplication of the service already available within the Leeds Musculoskeletal (MSK) service provided by Leeds Community Healthcare NHS Trust (LCH).

There is a range of costs available from providers and we will need to agree, how we can consistently support first contact practitioner (FCP) services at PCN level. Based on applying the guidance the current proposals would result in the following reimbursement. We would obviously need to take into account annual leave etc. which would adjust the cost but we need to identify a specific rationale/principle to make any adjustment. Primary Care Operational Group (PCOG) met on 7th May 2020 and recommended further work taking place with providers to ensure that they meet the criteria outlined within the DES. We will seek assurance that the hours provided are for patient facing contacts only which may enable us to put forward a proposal to NHS England that whilst the proposals aren’t for whole-time equivalent (WTE) roles, taking into account the annual leave and administrative time the proposals are equivalent to an employed WTE physiotherapist. PCOG also recommended that we establish a panel to confirm that providers meet the criteria to support PCNs in appointing suitable providers.

4.2 As a city with a large student population we have a PCN that could be described as atypical; Leeds

Student Medical Practice (LSMP) and the Light. Much of the work of PCNs will be focused on delivering the service specifications (further specifications to be introduced in future years) supported by additional staff employed under the ARRS scheme. We are seeking clarification from NHS England around whether we might be able to amend some of the service specifications to better reflect the needs of these populations or if there are any implications for the PCN around

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eligibility to access the full amount available under the ARRS scheme. Discussions to date have not yet identified any further national guidance or similar PCN profiles in the region.

Allocations for the ARRS are already weighted and so in theory should take into account

differences in population. We will also be able to have detailed discussions with the PCN as part of the workforce planning process to ensure that the workforce reflects the requirements of the service specifications.

4.3 Prior to amendments made due to Covid-19, the intention was that PCNs would submit a workforce

plan to the commissioner in June 2020; this has since been amended to 31 August 2020. We may wish to consider in conjunction with Leeds PCNs if there is capacity and value in bringing forward this timescale. This would allow support to be identified if required to enable recruitment earlier in the year. It would also enable commissioners to make available earlier than 30 September 2020, any unclaimed funding that can then be made available earlier in the year to PCNs wishing to go further with their recruitment in year.

4.4 The new specification has introduced a cap on two of the roles, pharmacy technicians and first

contact practitioners. This cap can be waived in conjunction with the PCN, commissioner and Integrated Care System (ICS). It would be prudent to explore now before plans are submitted at the end of August if as a system we would support this cap being applied or are confident in the availability of the workforce so that PCNs can reflect this in their plans. We are aware that there is a limited supply of pharmacy technicians and would therefore support the cap for this role, further analysis needs to take place around the supply of physiotherapists.

4.4 There is a small team in Leeds working under the Medicines Optimisation in Care Home Scheme

(MOCH) and the ARRS schemes allows this team to be funded as long as they transfer over before March 2021 which is when the current scheme is currently commissioned to. We must consider the future of this team and whether this specialised team remaining focused on care homes only or whether they should be transferred over in a more generic capacity to individual PCNs. This scheme includes pharmacy technicians where there is a limited supply both under the MOCH scheme and nationally, it would therefore be prudent to consider the future of the team alongside the workforce plans of PCNs once submitted but also recognising the specific focus on support to care homes at this current time.

4.5 PCNs are also requesting flexibility with regard to the employment of respiratory focused

physiotherapists. The CCG would be supportive of this principle providing the following key elements could still be confirmed:

Where a PCN employs or engages a First Contact Physiotherapist under the Additional Roles Reimbursement Scheme, the PCN must ensure that the First Contact Physiotherapist:

• has completed an undergraduate degree in physiotherapy; • is registered with the Health and Care Professional Council; • holds the relevant public liability insurance; • has a Masters Level qualification or the equivalent specialist knowledge, skills and experience; • can demonstrate working at Level 7 capability in MSK related areas of practice or equivalent (such

as advanced assessment diagnosis and treatment); • can demonstrate ability to operate at an advanced level of practice, • work independently, without day to day supervision, to assess, diagnose, triage, and manage

patients, taking responsibility for prioritising and managing a caseload of the PCN’s Registered Patients

• receive patients who self-refer (where systems permit) or from a clinical professional within the PCN, and where required refer to other health professionals within the PCN;

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• work as part of a multi-disciplinary team in a patient facing role, using their expert knowledge of movement and function issues, to create stronger links for wider services through clinical leadership, teaching and evaluation;

• develop integrated and tailored care programmes in partnership with patients, providing a range of first line treatment options including self-management, referral to rehabilitation focused services and social prescribing;

• make use of their full scope of practice, developing skills relating to independent prescribing, injection therapy and investigation to make professional judgements and decisions in unpredictable situations, including when provided with incomplete or contradictory information. They will take responsibility for making and justifying these decisions;

• manage complex interactions, including working with patients with psychosocial and mental health needs, referring onwards as required and including social prescribing when appropriate;

• communicate effectively with patients, and their carers where applicable, complex and sensitive information regarding diagnoses, pathology, prognosis and treatment choices supporting personalised care;

• implement all aspects of effective clinical governance for own practice, including undertaking regular audit and evaluation, supervision and training;

• develop integrated and tailored care programmes in partnership with patients through: • request and progress investigations (such as x-rays and blood tests) and referrals to facilitate the

diagnosis and choice of treatment regime including, considering the limitations of these investigations, interpret and act on results and feedback to aid patients’ diagnoses and management plans; and

• be accountable for decisions and actions via Health and Care Professions Council (HCPC) registration, supported by a professional culture of peer networking/review and engagement in evidence-based practice.

5.0 FINANCIAL IMPLICATIONS AND RISK 5.1 There is a risk that PCNs will not claim their full entitlements under the ARRS scheme which is now

compounded even further due to Covid-19. 6. WORKFORCE

6.1 This scheme clearly has huge opportunities to enhance the general practice workforce with

entitlements rising substantially over the term. By considering some of the areas in this paper we will be better placed to support and guide PCNs to maximise the value of the scheme.

6.2 Although not quantifiable at this time, whilst funding is available it is not clear if there is a suitably

qualified workforce available to recruit for all 19 PCNs. As a commissioner we would want to give due consideration to any inequity that a lack of available workforce could bring.

7. RECOMMENDATION The Primary Care Commissioning Committee is asked to:

a) Receive the update on new additions to the DES; b) Consider and discuss the implementation of the scheme within Leeds; and c) Agree the approach with regard to FCP reimbursement.

1










Title: Primary Care Quality Improvement Scheme – Principles: End of Year 2019/20 Process


Tick as appropriate

() Report Author: Lisa Kundi, Primary Care Commissioning Manager & Deborah McCartney, Head of Primary Care Commissioning

Decision

Reviewed by EMT/Date: Discussion Reviewed by Committee/Date: 7 May 2020 Information Checked by Finance (Y/N/N/A - Date): Y Approved by Lead Governing Body member (Y/N): Y

2

EXECUTIVE SUMMARY: The purpose of this paper is to propose a principle based approach to support the revised end of year position 2019/20 regarding the Quality Improvement Scheme (QIS) achievement payment. This revised approach is presented due to the COVID19 pandemic which resulted in General Practice adapting their delivery model of care to reduce the risk of contagion to its population and workforce and the suspension of the QIS on 20 March 2020 in line with the national suspension of the Quality and Outcomes Framework (QOF). NEXT STEPS:

• Work with Business Intelligence (BI) and finance colleagues to enable the achievement payment to practices

• Develop communications to share with practices and the development team regarding the achievement payment.

RECOMMENDATION: The Primary Care Commissioning Committee is asked to:

a) Note the positive improvements made by general practice in delivering the Learning

Disabilities (LD) and Severe Mental Illness (SMI) health checks; b) Approve the principle of adopting the QOF approach to determining QIS achievement in light

of Covid 19; and c) Approve an interim payment to be made based on the Quality and Outcomes Framework

principle.

3

1. Summary This paper sets out a revised approach to agreeing the end of year achievement payment for the Quality Improvement Scheme (QIS). The reason for the revised principle approach is due to the emergence of the COVID 19 Pandemic which resulted in the urgent need for Primary Care providers to adopt their model of service delivery to protect the population, workforce and ultimately the NHS.

This unprecedented situation also saw NHS Leeds CCG suspend the QIS in March 2020 in response to the situation. It was acknowledged that in taking this action Practices would not be adversely affected by this decision.

2. Background

2.1 All practices in Leeds signed up to participate in the Quality Improvement Scheme for 2019/20 with 3 practices agreeing a bespoke scheme to better reflect their atypical populations. Practices have received 85% of the funding for the scheme with the remaining 15% (£1.50 per head of population) payable on delivery of the agreed outcomes. This paper only applies to those practices that are implementing the CCG QIS.

2.2 The framework outlines a number of improvement goals with a further option to receive the full achievement payment of 15% if, as a Primary Care Network (PCN) the targets for Serious Mental Illness (SMI) and Learning Disability (LD) were achieved.

2.3 On 17 March 2020, the CCG confirmed that the scheme was suspended and provided the following message:

Finance update including suspension of local schemes We are expecting national direction from NHS England with regard to any changes to your GMS/PMS/APMS, QOF and DES contracted services. However until this is received, the CCG wants to provide practices with financial stability to be able to direct your efforts to supporting patients during the COVID-19 situation. With that in mind, the CCG is suspending local schemes such as QIS to support the reduction in any non-essential work. Payments will continue post April 2020 despite the scheme not being operated fully.

3. Current Situation

3.1 A timeline and process to support the year end process was agreed; however due to the Covid 19 situation that emerged in March 2020 this has not been possible to follow. In part this is due to:

a) Practices being informed that the scheme was suspended to enable to focus on implementing a range of systems and processes to support the delivery of care and management of patients.

b) The BI team has been mobilised to support the current position, and their workload and capacity has shifted accordingly and therefore they are unable to process end of year data.

4. Proposal

4.1 The QIS strategic group met on 9 April 2020, and reviewed how a proportion of the final payment

due to practices could be made based on the criteria and the data available.

4.2 In line with the national approach described in the letter dated 19 March 2020 - in supporting practices to prepare and respond to Covid 19 whilst protecting practices income, our approach takes into account the impact this may have had on achievement in the final month of March 2020.

4

https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/preparedness-letter-primary-care-19-march-2020.pdf

4.3 Due to the pressures of Covid 19 on practices, around 3 weeks were lost at the end of the year to

complete the final work required for the scheme.

4.4 In a non-covid situation, we would make an initial decision on payments based on the SMI and LD criteria with decisions on the remaining PCNs being put on hold until we would have access to the full dataset and practices have the capacity to participate a year end the process.

4.5 The group applied several principles in reviewing the data and attempting to determine a revised

process for the year end.

5. Data

5.1 We now have data for the period ending 31 March 2020 in relation to LD and SMI health checks which can be adjusted to reflect an indicative year end position by dividing the February achievement by 11 and multiplying by 12 gives us an assumed achievement as outlined below.

Actual Checks

Actual Register

%Actual Achievement

Goal Amended achievement

18/19 achievement

SMI - 6 Checks 4,082 6,893 59.2% 60% 62.82% 39.8% SMI - 9 Checks 2,320 6,893 33.7% 30% 35.76% - LD Healthchecks 2,056 2,927 70.2% 75% 74.49% 65.0%

6. Options

6.1 Option 1 - Based on Achievement In line with the original intentions of the scheme the CCG can make a payment of the full 15% where the targets for both SMI and LD health checks have been achieved (reflecting the impact of practices not having the full year to complete the scheme). The group also recommended that as practices collectively as a city achieved the goal for SMI health checks that all practices be considered as achieving this metric. Where practices have not been able to meet the LD and SMI targets, the process of reviewing the further achievement criteria is applied when the data becomes available.

6.2 Option 2 - Based on historic

QOF is currently being reviewed with a guarantee that achievement payments will be made on whichever is the highest between the 2019/20 and 2018/19 QOF years. This principle could be applied for QIS to support a principle of financial stability. There will be some winners and losers (compared to the actual achievement) if this approach is adopted. As payments were based on an individual practice achievement, we cannot provide a comparison to the PCN achievement in this paper.

We will need to provide a consistent approach to practices and cannot have a different approach for different PCNs.



5

6.3 Preferred Option

Primary Care Operational Group (PCOG) discussed the options and agreed that the QOF principle should be adopted whereby practices are paid on whichever is the highest when comparing 2019/20 achievement with 2018/19.

In adopting this option, an interim achievement payment based on either achievement of the SMI/LD indicators for which we have the data available. Where this achievement is less than last year we will make an interim payment based on last year’s achievement until the full data is available.

This principle is supported by the Leeds Local Medical Committee.

7. Finance and risks There are no financial risks – both options will be funded through the primary care budget and QIS achievement payment allocation that has been held by the CCG. Practices were aware of the 15% achievement payment as this was outlined in the financial schedule of the scheme. There is a risk in relation to the perception of what income guarantee has been given to practices and also what further risk and achievement should be given for 2020/21.

8. Next Steps

Subject to the outcome of the discussion at Primary Care Operational Group, the team and QIS strategy group will: • Work with BI and finance colleagues to identify the achievement payment to practices • Develop communications to share with practices and the development team regarding the

achievement payment.

9. Recommendation

The Primary Care Commissioning Committee is asked to:

a) Note the positive improvements made by general practice in delivering the LD and SMI health checks;

b) Approve the principle of adopting the QOF approach to determining QIS achievement in light of Covid 19; and

c) Approve an interim payment to be made based on the QOF principle.

1










Title: Primary Care Integrated Quality & Performance Report


Tick as appropriate

() Report Author: Kirsty Turner, Associate Director for Primary Care / Jane Isherwood, Senior Information Analyst

Decision

Reviewed by EMT/Date: Discussion Reviewed by Committee/Date: n/a Information Checked by Finance (Y/N/N/A - Date): Y Approved by Lead Governing Body member (Y/N): Y

2

EXECUTIVE SUMMARY: The audit data to support the Quarter 4 Integrated Quality & Performance Report (IQPR) has been delayed due to the Covid situation. The intention will be to circulate the Practice level data once this is complete to maintain an overview of quality and support quality improvements. From the data that is available, the following should be noted:

• Flu vaccinations – the final 2019-20 data from February showed- 2019-20 to 2018-19 o Over 65s –slightly higher than last year – 76.0% compared to 74.8% o At Risk – lower than last year – 44.1% compared to 47.9% o Pregnant women - lower than last year – 48.5% compared to 49.0% o Children –lower last year but did show over a 10 percentage point increase from

January to February– final position 41.2% compared to 46.3%

• Severe Mental Illness (SMI) 9 Checks – the percentage of patients receiving all 9 checks (in primary care only) has risen sharply from 13.1% in Q3 to 33.7% in Q4. 25 practices achieved the 60% target.

• SMI 6 Checks – this proportion has risen in Q4 to 59.2%. Leeds and York Partnership NHS Foundation Trust (LYPFT) are also undertaking SMI checks, this increases the overall CCG performance to 65.2%, but the data isn’t available at practice level and is therefore not reflected in the PQI.

• Learning Disabilities (LD) Checks – 70.2% of patients have had a health check in the last 12 months, this increased from 50.1% at the end of Q3. 53 practices achieved the 75% target.

• Datix reporting continues to decrease compared to previous years – April 19 to March 20 – 3,132 incidents compared to 3,503 for the same period last year, with a significant drop off in March 20. Medication related incidents were down as well, 1,141 compared to 1,661 in 2018-19. There was a 58% rise in Significant Event Analysis (SEAs) though in March, with a total of 1,059 completed in year. This only equates to 33.8% of all incidents with a completed SEA though.

In terms of our approach to quality monitoring, the quality surveillance group meeting was cancelled in April 2020 due to the capacity of the team and all routine quality visits to practices were cancelled. We are now however re-establishing business as usual procedures albeit recognising and reflecting how general practice is operating. The Committee should acknowledge that many routine services have been suspended either to focus clinical resources in managing patients with Covid or to support patient/staff safety. NHS England guidance was circulated in March 2020 which specified the following services should be suspended (unless where clinically appropriate/high risk):

• New patient reviews • Over 75 health checks • Annual patient reviews (unless could be undertaken remotely) • Routine medication reviews

3

• Clinical reviews of frailty • Friends and family test • Engagement with and review of feedback from patient participation groups • Dispensing list cleansing.

Similarly guidance was shared by the Royal College of General Practitioners (RCGP) which provided a tool for workload prioritisation based on the resources and prevalence of disease in the area https://www.rcgp.org.uk/-/media/Files/Policy/A-Z-policy/2020/covid19/RCGP-guidance/202003233RCGPGuidanceprioritisationroutineworkduringCovidFINAL.ashx?la=en

Quality Monitoring The Care Quality Commission (CQC) have suspended all visits to practices and therefore our current CQC position remains that we have 99% of practices rated good and outstanding with 1 practice still rated inadequate as we await a further full inspection. NEXT STEPS: The team will be reviewing the approach to quality assurance during Covid as part of the next Quality Surveillance Group, specifically identifying the key indicators that we need to focus on such as access, vaccinations and immunisations (including flu) and patient experience. We are working with the programme “Covid-19 Impact on provision of healthcare services for non-Covid conditions” to ensure there is a co-ordinated approach across the system; this in turn will determine future prioritisation which will need to be taken into account when considering our future approach to quality assurance Discussions with CQC are also underway as to how collectively we can continue to monitor quality during the pandemic. RECOMMENDATION: The Primary Care Commissioning Committee is asked to:

a) Note the approach to quality monitoring during Covid.

https://www.rcgp.org.uk/-/media/Files/Policy/A-Z-policy/2020/covid19/RCGP-guidance/202003233RCGPGuidanceprioritisationroutineworkduringCovidFINAL.ashx?la=en

https://www.rcgp.org.uk/-/media/Files/Policy/A-Z-policy/2020/covid19/RCGP-guidance/202003233RCGPGuidanceprioritisationroutineworkduringCovidFINAL.ashx?la=en

1










Title: Primary Care Risk Report

Lead Governing Body Member: Katherine Sheerin, Director of System Integration Category of Paper

Tick as appropriate

() Report Author: Anne Ellis Playfair, Risk Manager Decision

Reviewed by EMT/Date: N/A Discussion Reviewed by Committee/Date: N/A Information Checked by Finance (Y/N/N/A - Date): N/A Approved by Lead Governing Body member (Y/N): Y

2

EXECUTIVE SUMMARY: Risk Register The risks are included on the CCG operational risk register and reviewed within individual directorates on a regular basis. In line with the Risk Management Strategy, Executive Management Team (EMT) and relevant CCG Committees receive and review the risks rated as high amber (12) and above. The CCG Governing Body receives the corporate risk register (all red risks scored at 15 and above) for review at each meeting, supported by the CCG committee chair updates. Primary Care Active and Accepted Risks Current Previous (Feb 20) Risks Aligned to PCCC 10 11 Red Risks 15+ 0 0 Amber 12+ 2 1 Amber <12 5 6 Accepted Risks 4 4 New Risks 0 1 Closed Risks 1 0

The risk register now contains 61 risks in total, (previously 60), 10 of which are aligned to the CCG Primary Care Commissioning Committee. 4 of these 10 risks are categorised as ‘Accepted’ risks. This means that the current level of risk is deemed acceptable. Accepted risks are risks that are at, or below, the target risk score (approved by the responsible Director) or are green on the risk matrix below. These risks are reviewed by management at least on an annual basis or when the CCG becomes aware of a change to the risk. High amber (12) or red risks are unlikely to be accepted and will continue to be reported to the relevant Committee and Governing Body. Impact score Likelihood 1 2 3 4 5 Insignificant Minor Moderate Major Catastrophic 5 Almost Certain 5 10 15 20 25

4 Likely 4 8 12 16 20 3 Possible 3 6 9 12 15 2 Unlikely 2 4 6 8 10 1 Rare 1 2 3 4 5

There are six Active risks aligned to the Committee, this is a reduction from seven to six. One risk has been closed; this relates to R717: Primary Care Procurement Challenge, this risk has been closed as there is no specific risk to Primary Care procurement and there is a general risk relating to procurement challenge on the CCG risk register (R722). Two risks are reported to the Committee as the current scores are high amber (12) or above, this is an increase from one high amber risk. This relates to the following two risks:

3

• R651: General Practice Workforce • R660: Delivery of High Quality Primary Care Services – the risk score has increased

from 9 to 12 due to the need to suspend some services during the initial response.

A summary of the above risks is provided below but further detail, including controls and assurances, can be seen in Appendix 1.

Ris

k ID

Ris

k Ti

tle

Current Position Risk Rating

Cur

rent

Previous

Targ

et S

core

Targ

et D

ate

Cha

nges

to

Targ

et D

ate

Febr

uary

20

Dec

embe

r 19

651

Gen

eral

Pra

ctic

e W

orkf

orce

The risk score has been reviewed and remains at 12, reflecting a likelihood of 4 and a consequence of 3 as the risk is in pockets as opposed to a global risk across the city.

The additional workforce under the Additional Role Reimbursement Scheme will be critical to the Covid-19 response. NHSE recognise that PCNs may need more time to consider their workforce needs during this time. NHSE have therefore delayed the deadlines for the workforce planning templates from 30 June to 31 August 2020, and the associated requirements on CCGs to redistribute unused additional roles funding to other PCNs until the end of September 2020. The overall target date is 31 March 2021.

12 12 12 6

31/0

3/21

0

660

Del

iver

y of

Hig

h Q

ualit

y Pr

imar

y C

are

Serv

ices

Risk score increased from 9 to 12, due to Covid-19. Revised target date 30/6/20.

The current Covid-19 situation is likely to have an impact on quality measures due to the need to suspend some routine work (such as the QIS) to focus on managing acute presentations and those most at risk. Additionally, CQC have suspended routine visits to practices.

12 9 9 4

30/0

6/20

1

4

Covid-19 Risks Risks and issues specifically relating to Covid-19 are being logged by the Primary Care Task Group, and are escalated as required through the command structure via Risk, Action, Issue and Decision Logs (RAID Logs). The Risk Manager is supporting this activity to avoid duplication, ensure consistent recording and to identify any interdependencies between task groups. Where appropriate, risks will be added to Datix and managed through the CCG Risk Management arrangements. This will include risks with a system or longer term impact, for example those that impact the quality of services and the creation of backlogs in the delivery of services. Risks which are not directly related to Covid-19 will continue to be recorded and managed via the Datix system in the usual way. All Active and Accepted risks on Datix have been reviewed and flagged where they are impacted by the outbreak. The areas of risk impacted by Covid-19 is wide, specifically for Primary Care the following areas are being managed:

• The Principal risks on the Governing Body Assurance Framework (GBAF) have been reviewed for the Governing Body meeting in May to identify how these risks are impacted by Covid-19; this includes the impact on Risk 6: Insufficient workforce capacity, capability and adaptability to deliver the ambitions (Primary Care). The immediate impact of Covid-19 on the capacity of the primary care workforce has been a radical change in the way services are delivered, with up to 90% of patient contacts now being undertaken ‘remotely’, and activity levels being significantly below normal. The changes to the way services are delivered should release capacity going forward, and provide more flexible services for people. However, the backlog of patients who need care will need to be dealt with. There will also be an impact on the development of PCNs, and in particular the recruitment to additional roles. However, this is counter-balanced by the rapid development of some PCNs where practices have worked together in responding to the pandemic.

• Active risks on Datix that are impacted by Covid-19, risk score is in brackets: o Delivery of High Quality Primary Care Services (12) – score increased to 12 from

9 due to the need to suspend some services during the initial response. o Digital transformation in general practice (9) - Online consultations provides

practices with an alternative solution to consult with patients during the current Covid-19 situation. This has therefore expedited the roll out of the new platform. Some practices have engaged their own solution through the Covid-19 situation particularly with regard to video consultations which we will need to procure for a long term solution.

• Primary Care risks being identified through the RAID process include, but are not limited to:

o Impact of patients not seeking medical help during the crisis leading to delayed diagnosis e.g. cancer symptoms not being referred at an early stage;

o Patients with long term conditions do not attend GP appointments due to perception that they do not want to burden the NHS or fear of exposure to the virus, with the possibility that outcomes significantly decrease.

5

NEXT STEPS:

• All risks will be reviewed as per the bi monthly cycle in accordance with the CCG risk management strategy.

• The corporate risk register will be presented to the Leeds CCG Governing Body

meeting. RECOMMENDATION: The Primary Care Commissioning Committee is asked to:

a) Review the high scoring (12+) risks; b) Consider whether the controls and actions are effective and whether assurances

are sufficiently robust; and c) Agree any further actions required to manage the risk to the target set.

Appendix A

Risk IDD

ate

ris

k ad

de

d

Ris

k Ti

tle

Risk Description

Dat

e la

st

revi

ew

ed

Lead

Dir

ect

or

Ris

k O

wn

er

Co

mm

itte

e

Re

spo

nsi

ble

Init

ial

C 1-5

Init

ial

L

1-5

Init

ial S

core

1-2

5

Positive Controls & Existing Assurance in Place

Cu

rre

nt

C 1-5

Cu

rre

nt

L 1-5

Cu

rre

nt

Sco

re

1-2

5

Gaps in Control and Assurance Actions required

Targ

et

C

1-5

Targ

et

L 1-5

Targ

et

Sco

re

1-2

5

Targ

et

dat

e

Ch

ange

s to

tar

get

dat

e

Re

aso

n f

or

chan

ge t

o t

arge

t

dat

e

651

01

/09

/20

17

Gen

eral

Pra

ctic

e W

ork

forc

e

There is a risk that the quality of and

access to general practice services in

Leeds is compromised due to local

and national workforce shortages

resulting in the inability to attract,

develop and retain people to work in

general practice roles.

15

/05

/20

20

Kat

her

ine

Shee

rin

, Dir

ecto

r o

f Sy

stem

Inte

grat

ion

Co

nn

or,

Gay

no

r

Pri

mar

y C

are

Co

mm

issi

on

ing

Co

mm

itte

e

4 5 20

There is a joined up approach to workforce across the whole health and care

system with Sara Munro as the executive lead and a Leeds Workforce Board

established which will oversee the identified 7 strategic priorities.

A specific primary care workforce group is also established with links to West

Yorkshire to oversee the workforce plan for Leeds.

All practices are required as part of the contract to submit workforce data as part

of the national workforce reporting system. The reporting system has now been

improved with figures now nationally available. The additional role

reimbursement scheme has been revised for 2020/21 which includes a number

of additional roles including first contact physiotherapists, pharmacists, pharmacy

technicians, occupational therapists , physician associates, dieticians, podiatrists,

care co-ordinators and health and well being co-ordinators.

The Leeds GP Confederation has provided each PCN with a breakdown of the

workforce for each area and highlighted where risks may be which will enable a

more focussed approach. At the January 2020 members meeting, a specific focus

was on workforce to introduce new roles and to allow PCNs time to discuss

workforce opportunities.

A number of projects and schemes are already underway such as the nurse

preceptorship, Generation X

Review of ToR and membership of primary care workforce group now

completed. New chair will be director of workforce for GP Confed who will also

be workforce lead at WY workforce board. During the COVID 19 response a daily

SITREP has been implemented which has provided detailed information on

absence levels to support assurance of the workforce availability and identified

areas for support.

3 4 12

NHSE have revised the timescale for

when PCNs need to submit their

workforce plan although discussion with

the GP Confederation may take place

before the nationally mandated deadline

of 31 August 2020 and therefore may not

fully utilise the allocated budget.

There are pockets of risk across the City

in either specific PCNs or individual

practices.

As GPs are independent contractors, the

CCG has limited control over their

workforce practices

Workforce plan for each PCN has

now been completed and a deep

dive will take place with 3 PCNs.

2 3 6

31

/03

/20

21

0 N/A

660

10

/11

/20

17

Del

iver

y o

f H

igh

Qu

alit

y P

rim

ary

Car

e Se

rvic

es

There is a risk of limited access to

high quality services; due to services

that are rated as requires

improvement or inadequate by CQC.

Resulting in, increased waiting times,

and poor patient experience.

15

/05

/20

20

Kat

her

ine

Shee

rin

, Dir

ecto

r o

f Sy

stem

Inte

grat

ion

Kir

sty

Turn

er

Pri

mar

y C

are

Co

mm

issi

on

ing

Co

mm

itte

e

3 4 12

Quality session delivered to member practices to raise awareness of support

available and promote 'self-referral' for support

Use of various of sources of intelligence for improvement to help identify themes

and trends and areas for quality improvement i.e. primary care indicators, PQI,

patient experience

Quality surveillance processes to monitor themes and trends

Clinical lead for Quality identified

Proactive schedule of quality visits planned

QRP processes in place where quality issues are identified .

Quality Support Group to monitor progress against action plan

Multi team approach to review approach (Medicines Optimisation, Quality,

Primary Care, Clinician)

Regular meeting planned with LMC to share approach to quality surveillance

Report to PCCC and Quality and Performance Committee

Systematic sharing of information through PQI now established across the City.

Current position of CQC ratings compared to national position

3 4 12

Practices may not pro-actively engage

with the CCG in raising any concerns

around quality

The current COVID 19 situation is likely to

have an impact on quality measures due

to the need to suspend some routine

work (such as the QIS) to focus on

managing acute presentations and those

most at risk.

CQC visits may highlight areas of

concerns which have previously been

unidentified.

Many partnership changes have recently

taken place/due to take place which may

have an impact on quality due to change

and engagement of staff.

Failure to appoint a provider through

procurement may have a detrimental

impact on the service due to uncertainty.

CQC have suspended routine inspections

to support practices in managing the

COVID situation

Support Offer

Quality Visits 2 2 4

30

/06

/20

20

1

Imp

act

of

Co

vid

19

C = Consequence (Impact)

L = Likelihood

Current ScoreInitial Score Target Score

1








NHS Leeds CCG Primary Care Co-Commissioning Committee


Title: Primary Care Finance and Estates Update

Lead Governing Body Member: Visseh Pejhan-Sykes, Chief Finance Officer Category of Paper

Tick as appropriate

() Report Author: Carl Smith, Head of Commissioning Finance / Kirsty Turner, Associate Director for Primary Care

Decision

Reviewed by EMT/Date: N/A Discussion Reviewed by Committee/Date: N/A Information Checked by Finance (Y/N/N/A - Date): N/A Approved by Lead Governing Body member (Y/N): Y

2

EXECUTIVE SUMMARY: The purpose of this paper is to update the Primary Care Commissioning Committee on the Primary Care and Prescribing outturn position for 2019/20, and the payments being made in 2020/21. The paper will also update the committee around the Primary Care Estates position. NEXT STEPS: The CCG Finance and Primary Care teams along with NHS England will work closely together to understand and mitigate any known risks in the system throughout the year. RECOMMENDATION: The Primary Care Commissioning Committee is asked to:

a) Note the Primary Care financial position for 2019/20; b) Note the Financial support passed to practice due to COVID-19; and c) Note the Estates update around practices within Local Improvement Finance Trust

(LIFT) buildings.

3

1. SUMMARY

The paper describes the final outturn position for Primary Care, Prescribing and Proactive care for 2019/20. The paper also describes the funding passed to Practices to support them through the COVID-19 pandemic.

2. FINANCE UPDATE

2.1 NHS Leeds CCG 2019/20 Co-Commissioning Budget Of the £140 Million budget held for Primary Care £118.2 Million is allocated to the Co-Commissioning budget held with NHS England. The remaining £21.8M are locally commissioned budgets (by the CCG) including Proactive Care.

The Co-Commissioning final outturn position was in line with the budget for 2020/21. Although there looks to be an under spend on Personal Medical Services (PMS) contracts, the spend on this area has not reduced. The issue is that budgets were set before the new Primary Care Networks (PCN) contract was fully implemented so areas of spend have been directed to other subjective codes. The Quality Outcomes Framework (QOF) position is showing an overtrade of £339K; this is due to anticipating a higher QOF achievement payment. Due to COVID-19 practices will receive the higher value of the 2018/19 QOF achievement or the 2019/20 value. The role reimbursement scheme was fully spent in line with national guidance, a proportion of this spend was committed as part of the proposal put forward towards additional Social Prescribing Clinical Support. These posts also cover aspects of Health Care Assistants work, it was agreed that this blended resource will be more beneficial to PCNs as it will cover areas such as phlebotomy, foot screening and frailty assessment.

NHS Leeds CCG 2019-202019-20 Budget

Forecast Outturn

Forecast Variance

£'000 £'000 £'000GMS 28,267 29,049 782PMS 51,644 50,244 -1,400APMS 7,550 7,592 42Premises cost reimbursements 15,087 15,071 -16Other premises costs 751 828 77Enhanced Services 2,786 2,922 136QOF 9,768 10,107 339Other GP Services(inc PCO) 2,380 2,433 53Total Primary Care Co-Commissioning 118,234 118,245 11

4

2.2 NHS Leeds CCG 2019/20 Locally Commissioned Primary Care Budget

Within the locally commissioned primary care budgets there is slippage across a number of areas, this is predominantly against the Estates reserve due delays with the Estates and Technology Transformation Fund (ETTF). To mitigate the risk a number of Non Recurrent schemes have been offered to PCNs and practices. These include a winter funding scheme to reduce waiting times in general practice and practice resilience schemes, this has led to a slight overspend across the local schemes. As nationally with QOF, the CCG is committed to ensuring that practices aren’t penalised with reduced funding for local schemes, due to the focus on COVID-19 issues towards the end of the financial year. Covid-19 Costs The CCG has supported practices through the lockdown by supplying PPE and laptops as well as covering cost across the following areas in line with national guidance.

• Decontamination-Infection Control/Cleaning (over and above usual levels) • Increased admin support • Staffing – to support any absences up to normal levels • Remote Management of patients

The CCG also reimbursed practices for bank holiday opening over Easter. All the costs relating to Covid-19 will be reclaimed through the national reimbursement scheme


Forecast Outturn

Forecast Variance

£'000 £'000 £'000Quality Incentive Scheme 8,685 8,696 11Care Homes/Nursing Homes 778 778 0Core £1.50 PCN Funding 1,327 1,327 0Estates Reserves 500 7 (493)Amber Drugs 907 907 0GPFV Improved GP Access 5,325 5,325 0Other Primary Care Budgets 1,163 1,735 572Total Core Primary Care Services 18,686 18,776 90

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2.3 NHS Leeds CCG 2019/20 Proactive Care Budget

The final outturn shows a slight overspend of £31K against the Proactive Care budget of £3.2M. This is due to agreeing projects that started towards the end of the financial year such as street medicine outreach. 2.4 NHS Leeds CCG 2019/20 Prescribing Budget

The 2019/20 outturn position is based on eleven month of data, although this looks like a significant underspend £2.1m of the underspend relates to 2018/19 and was set aside as a risk reserve to mitigate any increased costs due to Brexit. These risks didn’t fully arise so the under spend was released. The overall Prescribing position showed a small overtrade against budget of £111K, after adjustments due to adding in the budget reserve and accruing the Prescribing Incentive Scheme this left the overall under trade against prescribing of £688K.


Forecast Outturn

Forecast Variance

£'000 £'000 £'000Social Prescribing 1,600 1,589 (11)Vulnerable Populations 161 170 9Welfare Advice 93 93 0Alcohol Services 289 289 0Home Independence & Warm Service 150 115 (35)Supporting Wellbeing Independence for Frailty 120 60 (60)Neighbourhood Networks 300 300 0Other Projects 464 593 129Total Proactive Care Services 3,177 3,208 31


Forecast Outturn

Forecast Variance

£'000 £'000 £'000Prescribing 122,316 119,551 -2,765Ex centrally funded drugs 3,414 3,794 380Oxygen contract 1,243 1,336 93Out Of Hours 130 67 -63Total Prescribing Services 127,103 124,748 -2,355

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3. Estates Update

The Primary Care Estates Group met on the 4th February 2020. Community Health Partnerships (CHP) Local Investment Finance Trust (LIFT) practices. Following conclusion of our local process and analysis, a draft of proposed funds for support to offer all GP Practices, who currently occupy LIFT buildings has been compiled. This was presented and the funds for support totals £325k. The method to arrive at the funds has been based predominantly on charges relating to Cleaning and Security, which were the main areas of disputes of higher than anticipated increases. Charges were looked at from 2014/15 to 2018/19, as the charges indicated high increases from 2014/15 onwards. As details of charges from all financial years were not available for all GP Practices, the proposed support has been based on providing a notional 20% of Cleaning and Security charged in 2018/19, and backdated for 4 years (from 2014/15 onwards). The total amount is therefore the proposed offer of funds for support. The Group supported and agreed with the method which produced the support funds. The Group discussed the process around offering the practices funds for support and acceptance of the funds would contribute to, or any outstanding historical debt will be paid and fully settled. Additionally, assurance similar issues would not reoccur in future as part of acceptance of the funds would be detailed. It was recognised that as charges are from CHP, the CCG and Practices have limited control over the increase of charges for the future, and as such full assurance may not be provided that similar issues would not reoccur in the future. The Group recognised and agreed further financial support could be requested in future, and that it would be in-line with the Primary Care Policy and Guidance Manual, which will need to include a further assessment using the NHS England published financial model. Any funds would then be discussed and considered in-line within the overall CCG affordability. Furthermore, due to the recognition of limited control over further increases of charges from CHP for the future, it was agreed that a benchmarking analysis would be conducted to compare Cleaning & Security charges with other similar buildings both within and outside of Leeds, and a comparison with other CCGs with CHP buildings would also be looked at. If the exercise produces a high variation, the CCG would engage and challenge with CHP as appropriate. Further updates and details will be brought to the meeting as progression continues.

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

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a) Note the Primary Care financial position for 2019/20; b) Note the Financial support passed to practice due to COVID-19; and c) Note the Estates update around practices within Local Improvement Finance Trust

(LIFT) buildings.

Primary Care Commissioning Committee– Work Programme 2020/21

June Aug Oct Dec Feb Mar Notes

STANDING ITEMS

Welcome & apologies X X X X X X

Declarations of interest X X X X X X

Questions from Members of the Public

X X X X X X

Minutes of previous meeting

X X X X X X

Matters arising X X X X X X

Action log X X X X X X

Forward Work Programme

X X X X X X

Chief Executive’s Report X X X X X X

GOVERNANCE ITEMS

Terms of Reference X

Assessment of Committee Effectiveness

X

PCCC Annual Report X

COMMISSIONING AND STRATEGY

New GP Contract Overview

X X X X X X

GP Confederation Update/ PCN update

X X X X X X

PPGs/Primary Care Engagement

Local Primary Care Schemes

Includes delivery and prescribing schemes

Quality Improvement Scheme

X X X X X X

Approve newly designed enhanced services (LDS/DES)

As required

Chair’s Summary from Primary Care Operational Group

X X X X X

Health Inequalities Audit – Update

Recommended Bidder Report

Digital First Consultation Including estates and workforce

NHSE National Policies As required

QUALITY, PERFORMANCE AND RISK AND SUMMARY REPORTS

Integrated Quality and Performance Report

X X X X X X

Summary from Quality and Performance Committee

X X X X X X

Corporate Risk Report

X X X X X X

FINANCE

Finance update

X X X X X X

Approve ‘discretionary’ payments

As required

OTHER

Approve contractual action e.g. branch/remedial notices, contract variation GMS, PMS and APMS contracts

As required

Approve new GP practices and practice mergers

As required

Documents

AGENDA NHS Leeds CCG Primary Care Commissioning ……Jun 03, 2020 · Direct 01/09/2013 Ongoing Declare any potential conflict of interest at Governing Body/Board, sub committees