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NHS DORSET CLINICAL COMMISSIONING GROUP

PRIMARY CARE COMMISSIONING COMMITTEE

PRIMARY AND COMMUNITY CARE COMMISSIONING UPDATE

Date of the meeting 03/04/2019

Author R Payne, Head of Primary and Community Care

Purpose of Report This report provides an update on areas of work being undertaken to support delivery of our Primary and Community Care Commissioning Strategy and areas of CCG responsibility as part of full delegation. It includes details of our local response to the GP Contract reforms and refreshing our Primary and Community Care Commissioning Strategy and GP Forward View delivery programme in line with the NHS Long Term Plan.

Recommendation The Committee is asked to note the report.

Stakeholder Engagement NHS England / Local Medical Committee / Public Health / Clinical Leads / Primary Care Operational Group / Primary Care Reference Group / Member Practices.

Previous GB / Committee/s, Dates

February 2019 Primary Care Commissioning Committee.

Monitoring and Assurance Summary

This report links to the following Strategic Objectives

Prevention at Scale

Integrated Community and Primary Care Services

One Acute Network

Digitally Enabled Dorset

Leading and Working Differently

Yes [e.g. ]

Any action required?

Yes

Detail in report

No

All three Domains of Quality (Safety, Quality, Patient Experience)

Board Assurance Framework Risk Register

Budgetary Impact

Legal/Regulatory

People/Staff

Financial/Value for Money/Sustainability

Information Management &Technology

Equality Impact Assessment

Freedom of Information

I confirm that I have considered the implications of this report on each of the matters above, as indicated

Initials: RP

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1. Introduction

1.1 This report provides an update on a number of areas of Primary Care planning to support sustainability and transformation in line with our Integrated Care System plans, Primary and Community Care Commissioning Strategy and GP Forward View ambitions.

1.2 The report includes details of GP Contract reform and plans to refresh our Primary and Community Care Commissioning Strategy in line with the NHS Long Term Plan (LTP).

2. Commissioning and Contracting

National Contract Changes Update Core Contract 2.1 The core Practice Contract has been agreed for the next five years and is

expected to increase by 1.4% in 2019 / 20 rising to 2.7% in 2023 / 24. This includes funding for uplifts to pay for GPs and Practice staff as well as a Network Practice participation payment which forms part of the core contract value.

A new Network Contract DES for Primary Care Networks

2.2 In line with the GP Contract reform guidance issued by NHS England (NHSE), the current transformation funding has now been replaced and uplifted in line with the new Network Contract DES.

2.3 The funding will go to Primary Care Networks (PCNs) based on £2.01 per patient registered with its constituent Practices in 2019 / 20 and is anticipated to increase to £2.19 in 2021 / 22. This includes the funding for a Clinical Director role in each Network.

2.4 The PCN Contract goes live from 1 July 2019. The PCN Contract will be a very large Directed Enhanced Service (DES). As a DES, it is an extension of the core GP Contract, not literally a separate contract. It is established in accordance with Directions given to NHSE. This will be offered to all Practices and it is expected that CCGs will ensure there is full population coverage.

2.5 Eligibility applies to all existing and future holders of in-hours (essential) Primary Medical Services contracts. This includes GMS, Personal Medical Services (PMS) and Alternative Provider Medical Services (APMS).

Registering for the PCN Contract Directed Enhanced Service (DES)

2.6 The CCG is currently developing formal processes for the management of the DES (once this has been released) guidance to Practices will cover the core requirements for the following areas:

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The names and the ODS codes of the member Practices;

The Network list size i.e. the sum of its member Practices’ registered lists as of 1 January 2019;

A map clearly marking the agreed Network area;

The initial Network Agreement signed by all member Practices;

The single Practice or provider that will receive funding on behalf of the PCN and;

The named accountable Clinical Director.

2.7 In the first quarter of 2019-20, the CCG will work with Networks to facilitate and ensure that the requirements for the PCN DES and the Clinical Commissioning Local Improvement Plan (C-CLIP) aligned to this are in place. A project plan has been set up with timescales to support delivery.

Network Level Commissioning

2.8 In line with the GP Contract Reform guidance we will commission the Extended Hours Directed Enhanced Services at the Network level from 2019-20. In addition and in line with our commissioning intentions, we will commission the Frailty model and additional improving access to General Practice services through all Dorset Networks.

Our local plan for delivery We will support Networks to deliver local improved access to General Practice services and integrated urgent care ensuring a single access offer for physical and digital services.

Our local plan for delivery We will work with PCNs to deliver our Integrated Community and Primary Care Services Strategy and the new national service specifications through integrated care teams and investment in new roles.

Investing in Primary Care

2.9 Financial investment will be made per network in line with the GP Contract Reform guidance and includes local investment through the C-CLIP.

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Practice Funding

Core contract increases over 5 years with 1.4% in 2019-20 rising

to 2.7% in 2023 / 24;

New Network Participation payment as part of core contract

increase;

Membership and Network engagement* £3,000;

Workforce planning and Network development* £7,700;

Quality improvement* £1 per weighted population.

*As part of a C-CLIP.

Network Funding

£2.01 per registered patient in 2019-20 rising to £2.19 in 2021 – 2022;

Additional role reimbursement up to £53,942 per Network in 2019 – 20;

£1.50 per registered patient in cash;

Extended hours DES and Improving Access funding;

Frailty contract funding.

Our local plan for delivery We will publish our commissioning plans for Primary Care ensuring investment into General Practices and the formation of PCNs to serve the registered population of Dorset – see Appendix 1.

Current Financial Position

2.10 Up to Month 11 the Primary Care finances are forecast to be in line with agreed budgets. There are pressures within the delegated budget and these are due to higher levels of sickness and GP retainers compared to previous years, however, these are being offset with one off rebates on rent and rates. Up to quarter 3 the local enhanced services are forecast to reach expected levels of activity by year end.

3. Models of Care

3.1 We are working towards embedding the NHS LTP and GP Contract Reform guidance into the current work programmes to create new service models for the 21st century.

3.2 The NHS Operational Planning guidance expects all systems to work with the NHS RightCare programme to implement national priority initiatives for cardiovascular and respiratory conditions in 2019 / 20.

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3.3 Transformative action required in 2019 / 20 includes work across the STPs / ICSs to develop proposals to transform outpatient services by introducing digitally-enabled operating models to substantially reduce the number of patient visits in line with the goal of reducing the number of outpatient visits by a third over the next five years.

3.4 The NHS LTP expects care for patients will increasingly be:

More joined up and co-ordinated - especially between Primary and Community health services;

More pro-active - with a greater focus on prevention and Population Health Management (PHM);

More differentiated in its support - with a focus on support tailored to meet individual need and personalised care and support;

Supported by digital enabled care.

3.5 The GP Contract Reform guidance expects all Integrated Care Systems to plan care around populations of 30-50,000 in PCNs, targeting local need and expecting to achieve a ‘triple integration’ between primary and specialist; physical and mental, health and social care.

3.6 PCNs will be expected to deliver new Network services based on seven new national service specifications:

Structured medications review and optimisation;

Enhanced health in care homes;

Anticipatory care for high need patients;

Personalised care;

Supporting early cancer diagnosis;

CVD prevention and diagnosis;

Tackling neighbourhood inequalities.

3.7 Our Primary and Community Care Commissioning Strategy and plan with be refreshed to reflect these new areas of focus, with the plan to bring a refreshed strategy to the Primary Care Commissioning Committee in June for approval.

3.8 In terms of our current Care Model programme, over the next few months we are focusing on four key areas:

Enhanced Care in Care Homes;

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Personalisation - including End of Life (EOL) care and social prescribing;

Personal Health Budgets;

Population Health Management.

Enhanced Health in Care Homes (EHCH)

3.9 A stocktake is being undertaken which will review existing governance and update the programme plan in collaboration with the Quality team. Two NHSE bids have been submitted with successful outcomes, totalling £48,000, this is intended to strengthen links between PCNs and Care Homes alongside support for easier, secure, sharing of information between care homes and NHS staff. A key priority going forward will be supporting networks in the delivery of the EHCH framework in anticipation of the national service specification which will form part of the Network services described in the GP Contract reform guidance.

Personalisation

3.10 Personalised care matters as it enables the commissioning of more appropriate, better co-ordinated and more cost-effective services, which genuinely meet individuals’ needs, therefore Personalisation should be a priority within all areas of the ICS.

3.11 A full stocktake is being undertaken, utilising a benchmarking tool being developed with the NHS South West region which will involve re-working governance and updating the programme plan and structure whilst maintaining the current Task and Finish groups already underway.

3.12 The outcome of the stocktake will inform the 19 / 20 action plan and next steps for Memorandum of Understanding between NHSE and Dorset CCG as part of an agreed plan for Dorset to be a national Demonstrator site. The plan will provide clarity on our Dorset vision for Personalisation as an underpinning philosophy across the system and demonstrate how we capture the personalised care and support planning that is being delivered across the system, the tools used and the outcomes achieved. This approach will be embedded across all commissioned services by including a Personalisation focus in all contract review meetings and revisions of specifications.

3.13 We will personalise and improve EOL care by building on the mobilisation of our pilot to wider networks. Through working with patients, families, health and care organisations and the voluntary sector we aim to introduce proactive personalised care planning for everybody identified as being in their last year of life, resulting in the development of comprehensive EOL care support across the system.

3.14 The plan will continue to have a focus on training and development:

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NHSE Personalised Care and Support Planning training - development of a system-wide workforce to support personalised care. Following positive feedback from our initial sessions, we will develop a rolling programme of training, using a train the trainer model;

Continued roll-out of training on social prescribing and sign posting to patient centred care for non-clinical staff in Primary and Community care via PCNs.

Social Prescribing

3.15 Mobilisation and delivery of the new Social Prescribing contract is underway across Dorset, with go live in April 2019. We anticipate that there is scope to expand this model further in line with the new GP Contract requirement for link workers and social prescribing across networks. This will continue to support the development of the role of the community and voluntary sector as an integral part of PCNs.

3.16 Scoping is underway to ensure we effectively map and utilise existing community to support wellbeing initiatives and new models within PCNs. We anticipate this will identify community based solutions for supporting those not engaged with statutory services.

Personal Health Budgets (PHBs)

3.17 To-date only adults in receipt of NHS Continuing Healthcare (CHC) and children and young people in receipt of Continuing Care, have the legal right to have a personal health budget. Following the ministerial announcement in February, this legal right has been extended to include personal wheelchair budgets and for those eligible for Section 117 mental health aftercare. This, together with the legal right to personal health budgets by default for those in receipt of CHC, which comes into effect on 1 April, will require a significant focus to be placed, at pace, on extending the use of PHBs and integrated budgets.

Population Health Management (PHM)

3.18 Working closely with Public Health and our Business Intelligence team at ‘place’ level, we will support Networks on how to use resources, design services and improve population health and focus on Prevention at Scale in PCNs. There will be greater emphasis on self-management, starting with diabetes prevention and management, asthma and respiratory conditions, maternity and parenting support and online therapies for common mental health problems. The team will work closely with the digitally enabled self-care programme to ensure a seamless approach is taken across Networks.

3.19 Data packs are in development for Practices to support Networks to develop a project plan to deliver PHM and Capacity and Demand planning within all Networks linked to the CCLIP and PCN DES. Our new Business Change Manager posts will work with Networks to develop capabilities of looking at and analysing patient flow and understanding demand at Practice and local level.

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3.20 We continue to work with PCNs to support the mobilisation of their Integrated Community and Primary Care Services (ICPCS) investment plans. Workforce planning for PCNs will include both the ICPCS Investment Plan and GP Contract reform investment in new roles as part of a PCN level workforce plan.

3.21 The PHM Development Programme is a 20-week programme funded by NHSE to enable ICS areas to make early, more rapid progress in the use of PHM techniques, and thereby enabling both providers and commissioners to redesign care to best meet the needs of their local populations.

3.22 The PHM Development programme in Dorset builds on existing work across three of the localities, in order to develop data-led approaches to redesigning these offers for specific population cohorts. These localities and areas of focus are:

Weymouth and Portland – COPD and Primary Care Operating Model;

North Dorset – Frailty and;

East Bournemouth – Diabetes.

3.23 This programme is intended to build on existing work in each locality, with the aim of spreading learning across the whole system. The development and strengthening of PCNs will be an important outcome for the work, through embedding this data-driven approach within the Network level operating model. By the end of the programme, there will be at least one case study of the progress made in Dorset that will be accessible to wider audiences and for use across the NHS.

Our local plan for delivery We will encourage and support our PCNs to work as part of any agreed national test-bed programmes.

4. Network Development Update

Developing Primary Care Networks across Dorset

4.1 In line with the NHS LTP and GP Contract reform framework, we continue to support General Practice to form PCNs to achieve 100% population coverage. We will do this by supporting a Directed Enhanced Service contract and a development programme which includes an updated Menu of Support; agreeing a local Network definition (see Appendix 2) and developing a toolkit which can respond to the assessed development needs of each Network.

4.2 The plan will ensure that each PCN completes a validated baseline position and progress to level 3 maturity. The three steps to this can be described as:

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Dorset PCN Development

Primary Care Network Maturity

Level Key indicators

Step 1

The relationship and trust of key partners is established, understanding needs, resources and arrangements for team working.

Step 2

Network builds on plans to deliver care incorporating population health management and risk stratification; models put in place to manage routine, complex and urgent care.

Step 3

Fully developed Network with business and service delivery model in place delivered by an integrated team. Network has a defined role within the ICS.

4.3 We are currently supporting all PCNs to validate their baseline position based

on feedback from Clinical Chairs and key stakeholders.

Current Network Profile and anticipated Trajectory

4.4 There are currently 15 PCNs across Dorset providing around 98% population coverage:

4.5 Our planned trajectory through to the summer of 2019 sees a gradual increase in maturity of all of our Networks to achieve all Networks at Step 2 and at least three Networks at Step 3.

Network Population

East Bournemouth Collaborative 50,758

South Coast Medical Group 30,801

Christchurch 48,872

Central Bournemouth 60,993

North Bournemouth 65,597

Shore Medical 58,355

Poole Central 63,751

Castleman 124,264

Mid Dorset 45,069

North Dorset Shaftesbury 38,314

North Dorset Sherborne 22,824

North Dorset Blandford 24862

Weymouth and Portland 75830

Purbeck 34261

West Dorset 41,473

(Westbourne MC) 17812

803,836

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Next Steps

4.6 We expect all PCNs to:

Complete a validated baseline of their Network maturity and identify development needs (Q1 2019);

Identify and agree Network development priorities (Q1 2019);

Engage in a programme of support and development during 2019-20, with an accelerated programme already commenced with two PCNs (Weymouth and Portland and South Coast Medical).

4.7 An action plan is currently being finalised to agree how the CCG, working with the National Association of Primary Care (NAPC), can best support Network development over the coming months. This covers the following key activities: confirming the Networks, Clinical Director role appointment, developing a set of FAQs working with the national team and local feedback, a baseline assessment for each Network, developing communications to support PCNs and some specifics around holding sharing and learning events and progressing an integrated nursing project.

4.8 The table below confirms the timetable for the 2019-20 PCN DES. The Primary and Community Care team will be working with Member Practices to support the sign up to PCNs within the indicated timeframe.

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Our local plan for delivery We will ensure that all Dorset Practices are supported to join a PCN benefitting from additional investment in Workforce, Practice participation, Network services and a Local Improvement Plan; achieving 100% Network coverage across our registered population.

5. Infrastructure and Workforce Planning

Work Plan

5.1 With the publication of the NHS LTP and the Five Year Framework for GP Contract Reform in January 2019, workplans and priorities have now been reviewed.

‘’A new service model for the 21st century’’ (Chapter 1 NHS LTP) and ‘’Delivering New Network Services’’ (Chapter 6 GP Contract Reform):

5.2 The built estate, the workforce and digital technology are the key enablers underpinning the new service model. The Primary and Community Care team aims to work closely with stakeholders to support the delivery of the new service model through:

The development of robust strategic plans (estate, workforce and digital);

The development and constant refreshing of prioritised action plans ensuring that Dorset has the right buildings / the right workforce / the right technology in the right place at the right time;

The identification of a range of innovative funding solutions, including consideration of any future guidance on Rent Reimbursement which may assist when deciding how best to fund space used for Network or Integrated Service Delivery.

‘’NHS Staff will get the backing they need’’ (Chapter 4 NHS LTP) and ’’Addressing the Workforce Shortfall’’ (Chapter 1 GP Contract Reform):

5.3 The CCG is working closely with Dorset’s Primary Care Networks / Localities to develop sustainable workforce models centred on the expanded multi-disciplinary team.

5.4 This work is currently focused on a number of activities including:

Supporting the development of Network / Locality Workforce Plans and Profiles to support delivery of the ICPCS model of care and additional roles to support new Network services as part of GP contract reform;

Piloting the use of a new Workforce Information Tool;

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Supporting a number of Dorset Primary Care Workforce Centre initiatives aimed at improving recruitment and retention of staff (including GP Retainers, Career Flex, GP Passport, Locum Chambers, Doorway to Dorset);

Exploring opportunities for involvement in innovative workforce developments (including International GP Recruitment, Mental Health Practitioners, Physician Associates and Clinical Pharmacists in Primary Care).

5.5 It will be important to review the current workforce baseline for each Network to inform workforce planning. A number of areas have already recruited Clinical Pharmacy roles in both Primary Care and enhanced care in Care Homes. The social prescribing link role forms part of the recent procurement of Social Prescribing providing an early opportunity for Networks to secure these roles working in partnership with the Voluntary sector.

Our local plan for delivery We will work with each Dorset PCN to develop workforce plans to support implementation of the NHS LTP.

Our local plan for delivery We will work with NHSE and the LMC to support local implementation of the new indemnity scheme in order to ensure all staff delivering primary medical services benefit.

‘’Digitally-enabled care will go mainstream across the NHS’’ (Chapter 5 NHS LTP) and ‘’Going digital-first and improving access’’ (Chapter 5 GP Contract Reform):

5.6 Working closely with the CCG’s Digital experts the aim is to support efficiency improvements in Primary and Community Health Services through the introduction of a wide range of digital technology. These innovations will support staff to work more efficiently, reduce the administrative burden and release time for care; encourage the public to take greater responsibility for their health; and provide the public with easier access to health and social care information and services.

5.7 Programmes currently being introduced include:

GP Online Consultations Programme - currently being rolled out across Dorset;

The Pharmacy Pilot – a technology enabler supporting direct referral from General Practice into pharmacies.

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Our local plan for delivery We will support all PCNs to introduce digital consultations and a range of on-line services for patients whilst developing better demand and capacity planning and personalised care plans.

‘’Taxpayers’ investment will be used to maximum effect’’ (Chapter 6 NHS LTP):

5.8 The work with Primary and Community Care stakeholders seeks to ensure that there is a focus on:

Improving the quality of the existing built estate;

Making better use of the existing built estate;

Reducing the amount of non-clinical space;

Improving energy efficiency through use of LED lighting and smart energy management;

Enhancing digital capabilities;

Releasing surplus property.

5.9 This work includes seeking out innovative funding solutions ensuring that available Capital and Revenue are used to best effect.

‘’The NHS LTP supports wider social goals’’ (Appendix NHS LTP):

5.10 The principles of this work are in accordance with ‘Putting Health into Place’ guidelines. When developing estate projects (new builds, refurbishments and minor improvements) the team will require its consultants and contractors to:

Plan and design a healthy built environment;

Focus on design that support prevention and wellbeing;

Plan for sustainable development, reducing the use of natural resources wherever possible;

Adhere to best practice efficiency standards and adoption of new innovations;

Utilise local suppliers wherever possible.

Further Guidance

5.11 The CCG is awaiting the publication of two additional guidance documents expected this year from NHSE:

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The Primary Care Premises Review – publication expected in early 2019;

The refreshed Premises Costs Directions (current version is dated 2013) – publication expected in early 2019.

5.12 In Chapter 9 of the GP Contract Reform (‘’Schedule of future contract changes and development work’’) it indicates that implementation of the Primary Care Premises Review will commence in 2019 / 20.

5.13 A further review of our workplans and priorities will be required post publication of this new guidance.

Workforce Planning Update

5.14 Our Dorset Passport - 204 GPs have signed up to the new platform across Dorset. 72 GP practices are now live on the system and 408 locum sessions have been posted since going live. We are seeing an increase in bookings made with an average of 60% of sessions posted being filled via the platform. General Practice Nursing will go live in March 2019 and the new Integrated Urgent Care service goes live from April 2019. A pilot with volunteers working in Bournemouth and Poole hospitals will go live in April 2019 with scope to widen to Dorset County Hospital and Dorset HealthCare.

5.15 GP Retention – we have successfully bid for and received £192k of NHSE GP retention funds. Initiatives supported by this funding include the Our Dorset Passport, GP Coaching Faculty, Career Flex and GP Fellowships. A campaign to find and engage GPs who have left practice in the last two years or are thinking of leaving practice has also been funded. A GP Coaching Faculty has been established and six GPs recruited to become qualified coaches (ILM Level 5 Coaching training commenced end of January 2019). GP Coaches will support GP Fellows as part of local retention plans in addition to offering support to all GPs. Coaching support focuses on career progression, personal effectiveness and pastoral support.

General Practitioner with Extended Role (GPwER)

5.16 Dermatology - funding has been acquired to support six GPs to complete the new RCGP accreditation. We are working closely with providers to identify best option to support the increase in supervision / mentoring capacity for future GPwERs whilst increasing the number of appropriately trained / experienced clinicians supporting the running of services.

5.17 In addition to work to develop GPwER Dermatology roles across the county, development of an accredited pathway for GPwER Frailty and Consultant Practitioner Nurse and Allied Health Professional (AHP) pathway are being progressed. This work will provide a system-wide template to roll out across multiple conditions / pathways and support the development of enhanced generalists in primary / community care.

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5.18 Training Needs Analysis (TNA) – this has been conducted across Primary Care during the period October to December with 41% of Practices responding. The TNA focused on current and future needs linked to developing new services and transforming existing services. All medical and non-medical roles were in scope and work is underway to pilot access to the education and training required working collaboratively with system partners. This work is aligned to the ICPCS portfolio and programme delivery.

5.19 Shared Learning Events – 24 education sessions have been delivered within localities in the last 12 months, covering Diabetes, Paediatrics (two rounds), Cancer, MSK and Pain, Cardiology and Respiratory. These education sessions are delivered collaboratively using expertise from secondary care specialists and Primary Care leads. Feedback received to-date shows that 100% of attendees across all sessions have been satisfied or more than satisfied with the education provided. On average, across all sessions, we have seen a 50% increase in competence around the key learning/skills. In addition, attendees have fed back that building connections and networks with colleagues across the system has been another significant benefit.

5.20 Our Dorset Next Generation GP Programme – a programme designed to engage and inspire GPs in the first seven years post qualification aligned to GP leadership roles and opportunities. The Dorset programme builds on the model of the national Next Generation GP programme and provides leadership development and core skills for a GP leadership role. The programme is being partnered with GP fellowships and all attendees will be supported by a GP Coach. A first cohort of 16 has now been fully recruited to with the first session due to be delivered in March 2019.

5.21 GP Fellowships - 16 GP Fellowship roles are being developed across Dorset. The fellowships will be aligned to local needs with a mix of Digital and Clinical fellows focused on projects that will transform and integrate care and support locality / PCN priorities, e.g. implementing eConsult, development of an integrated frailty service.

5.22 Physician Associate – a new programme commenced in January 2019, with 20 students recruited. Providers for clinical attachments across Primary and secondary care and mental health have been sourced. Interest in the programme has significantly increased with Bournemouth University (BU) receiving 10 expressions of interest per week on average. Consideration is to be given to running a second cohort in September 2019.

5.23 Dorset Workforce Information Group – a Primary Care specific task and finish group has been established. A Pilot of a Primary Care workforce tool is in progress.

5.24 Registered Nurse Degree Apprenticeship (RNDA) scheme - RNDA recruitment for 50 apprentices is now underway.

5.25 ICPCS Workforce mobilisation – a gap analysis is being completed to inform Network level profiles of ICPCS roles, this will help planning for further recruitment as well as the additional role reimbursement scheme as part of the GP contract reforms.

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5.26 Pharmacy – there is an expected increase by 2024 to 96 pharmacists in community and Primary Care. The Workforce Delivery team is working with the CCG Medicines Management team to support local engagement events following on from a planned regional event to be held in March.

Estates Update

Reimbursement of On- Cost Payments

5.27 Dorset CCG makes quarterly payments to a number of GP Practices for reimbursement of “on-cost charges”.

5.28 These are costs that GP Practices incur due to external providers using rooms in their Practice, to provide a service to their registered patient population (e.g. physiotherapy service or chiropody service). These oncosts are an allowance made to include heating, lighting, water and administration support for services hosted.

5.29 Currently there is no requirement for GP Practices to confirm ongoing usage of rooms. The total on-cost payment is in the region of £370,000 per annum and individual payments have not been reviewed for over five years. The CCG intends to review these payments (during Q1 2019/20), seeking evidence from Practices of continued utilisation of rooms by external providers. Where ongoing utilisation of rooms can be evidenced, on-cost payments will continue. The CCG will introduce an annual review of these payments.

Technology Update

GP Online Consultations

5.30 The eConsult platform is now offered to all Practices as a digital gateway, and under the new GP Contract is mandatory for all Practices from March 2020.

5.31 The CCG has agreed two year licenses for 100% of Dorset practices this year, with the option of a third year depending on development and success of the initiative.

5.32 Roll out of the platform is proceeding well and the February highlight report confirms that:

18 Practices Live;

15 Practices ‘signed up’ and a go-live date agreed;

2864 Unique visitors leading to;

825 eConsults submitted;

216 Self-Help visits;

91 Pharmacy Self Help visits;

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495 Estimated GP appointments saved.

5.33 eConsult are currently working with NHSE to pilot the NHS App, with a single NHS Login and using eConsult as the entry to Primary Care advice and appointments. Intensive support is being provided to local Practices to create at least two Dorset exemplars.

5.34 Discussions are underway between eConsult and Dorset Health Care as lead provider for the Integrated Urgent Care Service about the potential for eConsult to provide the digital gateway into Urgent Care.

5.35 As part of the digital gateway signposting to local services (e.g. Steps to Wellbeing) is soon to be added to condition specific advice pages.

6. Recommendation

6.1 The Committee is asked to note progress with our Primary Care Commissioning Strategy and GP Forward View Programme delivery together with details of how the GP Contract reforms will be implemented and our strategy refreshed to support delivery of the NHS Long Term Plan.

Author’s name and Title: Rob Payne, Head of Primary and Community Care

Date: 19 March 2019 Telephone Number: 01202 541400

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APPENDICES

Appendix 1

Primary Care Commissioning and Contracting Intentions – March 2019 update

Appendix 2

Primary Care Networks – A Working Definition