Rural Locality GP Network Meeting, 2-5pm, Tuesday 12 July ... · Rural Locality GP Network Meeting, 2-5pm, ... financial recovery and it was noted at the end of quarter 1 the CCG

Rural Locality GP Network Meeting, 2-5pm, Tuesday 12 July 2016, Cheshire View, Chester

Chair – Steve Pomfret (Chair)

APPROVED MINUTES

GP Name Practice Name Practice Manager Name Helen Black Bunbury Medical Practice Debbie Bailey & Alan Courtenay Jonathan Gregson Helsby & Elton Practices Brian Yorke Kylie Daniels Kelsall Medical Centre Neil Symonds Mark Edney Malpas Surgery Lynn Suckley Andrew Campbell Tarporley (Campbell) Sue Dewhirst Alistair Adey Tarporley (Adey) Sam Jeffery Steve Pomfret (Chair) The Knoll / Frodsham Paul Smith Melissa Siddorn The Village Surgeries -

In attendance Sarah Murray Programme Lead – Primary Care (WCCCG) Lee Hawksworth Director of Operations (WCCCG) Colin McGuffie Primary Care Team (WCCCG) Tanya Jefcoate-Malam Primary Care Manager (WCCCG)

Diane Taska Primary Care Team (WCCCG)(Minutes) Helen Cunningham Integrated Care Team Manager (Princeway) Sue Pratt Integrated Care Team Manager

Agenda No

Action

1. Welcome & Introductions The Chair welcomed colleagues to the meeting and in particular Alan Courtenay, Practice Manager at Bunbury Surgery and Dr Mark Edney representing Dr Louise Davies. Apologies were noted from: Melissa Siddorn , Emma Lea.

2. Previous Minutes The minutes of the previous meeting (June 2016) were approved as an accurate record of the meeting with no matters arising. Declarations of Interests Nil

Minutes of Rural GP Network by 1 NHS West Cheshire Clinical Commissioning Group Date: 12 July 2016

3. Financial Recovery The Director of Operations updated the Rural Network around the ongoing financial recovery and it was noted at the end of quarter 1 the CCG will report to NHS England that it will deliver on all financial programmes. The CCG is focusing on 3 main work streams: elective care, urgent care and meds management and an update will be brought to the Network each month going forward on an alternating basis. The CCG financial plan is embedded for information and will again be brought to Network on a monthly basis to give colleagues an over sight of the work streams and the financial recovery programme.

Price Waterhouse Cooper’s final report on West Cheshire CCG is expected to be published imminently with the CCG remaining under scrutiny and managed for a year.

4. Elective Care Update The Head of Elective Care updated the Network on the current work stream and it was noted the portal has been uploaded on to the CCG’s website and contains mutually agreed pathways which will be updated on a regular basis to keep them ‘current’. Referral templates will be uploaded too, linking in to EMIS and reflecting the pathways. Colleagues were asked if they would be happy to complete a Survey Monkey to advise the current work on elective care but they preferred for the CCG to evaluate the data of how many people are using the portal and ultimately how many referrals it is impacting upon and it what way. Along with the portal there will be a ‘virtual basket’ which allows GP colleagues to process referrals appropriately in to the acute system with the support of consultant colleagues at the Countess. The Network noted the CCG are working closely with the Countess on e-consultations and in particular with Acute Physician, Hospital at Home, TIA and Cardiology amongst the first specialties. The Network asked the Head of Elective Care to signpost by email all the relevant links to dashboards, Aristotle, Portal etc. Action: AL to signpost by email all practices to the various links including dashboard and Aristotle. Elective Care data was shared with the Network and it was noted the data has been broken down to show how West Cheshire CCG compare to peer CCGs, similar in size and demographics. Practices asked to be advised by the CCG of their high referral outliers. Action: AL to work with practices on a process to identify individual areas of high referral outliers.

AL AL


In summary practices would like to keep the portal simple and linked in to Emis, receiving only relevant data (re: outliers).

5. Consultant Connect The Network noted Consultant Connect was launched on 04 July with Paediatrics’ as the first specialty, feedback data is expected towards the end of 2016.

6. CCG Update Lower GI Referrals Update: Colleagues noted the Lower GI referral pathway is being re-designed. Patients will be contacted by the Lower GI team for triaging. GPs are asked to make patients aware. Flu Planning Meeting: The Network were advised about a flu planning meeting and asked for a GP/Practice Manager representative from the Locality to attend the meeting on Tuesday 19 July 2016 2.00-4.00pm. Paul Smith, Practice Manager from The Knoll volunteered to represent the Rural Network. PMS: The Network noted NHS England and WCCCG Finance & Performance Committee support the proposal for the PMS premium of £78k to be invested in the Wellbeing Service for the last quarter of 2016/17 only. This will help to retain the staff and resources and will allow for a robust evaluation of the service. Physio Service: Sarah Murray, Head of Primary Care, thanked practices for completing the recent Physiotherapy Service Survey Monkey. Amanda Lonsdale, Head of Elective Care, will take this project forward to sustain it in to the MSK service long term.

Action: DT to include the Physio First Utilisation data with the minutes for information.

DT

7. CQUIN Frailty Feedback The Network noted that grey flag triggers and search criteria has been identified and searches are now available to all practices to identify a particular cohort of frail, elderly patients. Feedback from the Network on using the Edmonton tool is as follows:

• Tarporley (Adey) have triggered 27 patients (402 patients on the register) with 10 patients not relevant (minor UTIs).

• A third of patients are potentially not applicable for referral.

Practices asked if they should be recording patients who aren’t ‘appropriate’ for the frailty score but who have been through the identification process - what should these patients be coded to?

Post meeting Note: At the subsequent Cluster meeting a code for patients who have been through the frailty identification process but not actually triggered the need for further care was agreed.


• The Edmonton frailty Assessment tool needs tailoring to practice

needs (for example: ‘draw a clock’ needs to go towards the end of the assessment and the question ‘have you had a fall’ needs to be included).

Action: Alan Courtenay, Bunbury Practice, to share Bunbury’s frailty templates with the Rural Network. Practices noted the need to engage Integrated Care Team Coordinators to ensure the appropriate care package is progressed. Care Plan The Network agreed to use the existing EMIS care plan template. CWP will have a temporary template uploaded and will use the same codes as primary care. EMIS templates were tabled and the Network was asked for feedback through to Lynn Suckley. Action: ALL to feed back thoughts around the EMIS templates (frailty tool) to Lynn Suckley for amends.

AC ALL

8. Health Checks Sarah Marshall, Public Health England (PHE) commissioner, updated the Network on the results from the recent public consultation around Health Checks. It was noted PHE are proposing a slightly different model from 01 September 2016 and the attached slide reflects the variation of uptake within GP practices over the last couple of years:

Health Checks presentation GPs 201

It was noted the public support having their health checks delivered in practice and in a choice of work places and/or leisure venues. The GP contract will be reviewed and as from September the proposal is to offer a flat rate of £26.00 per health check. A community provider will also be commissioned to address the needs of rural areas in particular. PHE asked for volunteers from within the Network to work with them creating the new model to ensure the service meets the needs of both the public and the GP expectations. Action: Practices to email Sarah Marshall (PHE) with nominees to help develop the proposed Health Check model.

Attached for information: NHS Health Check

Version 8a.jpg (Also Appendix 1. attached)

Action: Sarah Marshall to contact Nicola Daniels from Primary Care

ALL Sarah


Next Meeting: Tuesday 13 September 2016: 2.00 – 5.00pm @ Cheshire View, Christleton E’Port & City Network Minutes – June 2016

EP&N APPROVED June 2016.docx

City APPROVED June 2016.docx

Cheshire (PCC) to explore possibilities of PCC contracting with PHE on behalf of all practices around Health Checks.

Marshall

9. Future Agenda Items No future agenda items were raised.

10. Any Other Business Urology – Prostate Cancer Pathway: Colleagues noted the Urology Prostate Cancer pathway is being re-designed. GPs noted there will be an expectation upon them when making prostate cancer referrals (2 week pathway) for patients under 70 years of age to request an MRI scan in with the initial referral (attached pathway slide for information):

Indications for GPs for requesting MRI.pptx

The Network raised concerns including:

• Locums and GPs alike may not remember to include this information • Patients will need to be advised and prepared for an MRI •

The Network noted the imminent changes to the Urology-Prostate pathway. Integrated Care Team (Bunbury/Tarporley) Co-location? The Network noted the Integrated Care Team is currently not co-located, District nurses are in Tarporley Medical Centre with other members of the team based at Bunbury Surgery. Plans/funding for a new build premises are currently pending approval from NHS England/WCCCG. The Network raised the ongoing issue of McMillan nurses working out of St Lukes Hospice. It was noted the CCG are currently liaising with CWP to establish who will commission the service from September onwards. A further update will be brought to the September Network. Action: Lee Hawksworth to update the September Network around the McMillan nurses working out of St Luke’s Hospice and the commissioning of this service. No further business was raised.

LH


Outstanding Actions NB: Actions will be taken off the table upon completion

Key:

Red Overdue Green Completed

Amber On-going Blue For future / On agenda

Date Initiated Action By Whom

Due Date

12 July 2016 AL to signpost by email all practices to the various links including dashboard and Aristotle.

AL September 2016

12 July 2016 AL to work with practices on a process to identify individual areas of high referral outliers.

AL September 2016

12 July 2016 DT to include the Physio First Utilisation data with the minutes for information.

DT September2016 - COMPLETE

12 July 2016 Practices to email Sarah Marshall (PHE) with nominees to help develop the proposed Health Check model.

ALL September 2016

12 July 2016 Sarah Marshall to contact Nicola Daniels from Primary Care Cheshire (PCC) to explore possibilities of PCC contracting with PHE on behalf of all practices around Health Checks.

Sarah Marshall

September 2016 - COMPLETE

12 July 2016 Lee Hawksworth to update the September Network around the McMillan nurses working out of St Luke’s Hospice and the commissioning of this service.

LH September 2016




Rural Locality GP Network Meeting, 2-5pm, Tuesday 13 September 2016, Cheshire View, Chester

Chair – Steve Pomfret (Chair)

APPROVED MINUTES

GP Name Practice Name Practice Manager Name John Berry Bunbury Medical Practice Alan Courtenay Jonathan Gregson Helsby & Elton Practices Brian Yorke Kylie Daniels Kelsall Medical Centre Apologies Mark Edney Malpas Surgery Lynn Suckley Apologies Tarporley (Campbell) Sue Dewhirst Alistair Adey Tarporley (Adey) Sam Jeffery Steve Pomfret (Chair) The Knoll / Frodsham Paul Smith Melissa Siddorn The Village Surgeries Trevor Ferrigno & Kate Evans

In attendance Lee Hawksworth Director of Operations (WCCCG) Tanya Jefcoate-Malam Deputy Head of Primary Care & Being Well (WCCCG) Colin McGuffie Primary Care Team (WCCCG) Diane Taska Primary Care Team (WCCCG)(Minutes) Barbara Perry Meds Management, Midlands & Lancs CSU – Item 5. Kath Titchen Urgent Care Team (WCCCG) – Item 8. Helen Cunningham Integrated Care Team Manager (Princeway) Sue Pratt Integrated Care Team Manager Emma lee Integrated Care Team Manager

Agenda No

Action

1. Welcome & Introductions The Chair welcomed colleagues to the meeting. Apologies were noted from: Helen Black, Andrew Campbell, Louise Davies and Neil Symonds.

Minutes of Rural GP Network 1 NHS West Cheshire Clinical Commissioning Group Date: 13 September 2016

2. Previous Minutes The minutes of the previous meeting (July 2016) were approved as an accurate record of the meeting with no matters arising. Actions: The Director of Ops (WCCCG) updated the Network around the MacMillan Nurses contract. It has been agreed that the current arrangement will continue until 31st March 2017. Bunbury and Tarporley GPs have been informed of this. The matter has been raised as a risk at PDG so senior managers in the CCG are aware of the situation. CWP, who are commissioned to provide specialist palliative care across West Cheshire are also aware of the issue and have provided the CCG with an SBAR outlining the implications for their service and possible options for the service in 2017. The CCG will also be reviewing/mapping EOL provision locally during September. The information from the review and the SBAR will be presented to the CCG to discuss/agree a solution (October) for when the current service arrangement ceases in 2017. Action: LH & LH to take this forward and feedback to the Rural Committee April 2017. The Network noted the process to recruit a new West Cheshire CCG Chair is progressing with one candidate through to the last stage, Chris Ritchieson. The final decision will be announced at Memberships Council, 28 September 2016. The Network was in agreement with this process. Declarations of Interests Nil

LH&LH

3. Financial Recovery The Network received an updated on the CCG’s financial recovery position. It was noted the Sustainability and Transformation Plan (STP) is progressing to enable health organisations to work at scale together and form. Cheshire and Merseyside have 4 work streams and 3 localities including:

• Cheshire and Wirral • North Mersey • Mid Mersey

and will review the following:

• Demand management and out of hospital work • Hospital reconfiguration • Back office/middle office functions • Governance

A presentation around the Sustainability Transformation Plan was provided and is now attached for information:


The Network is keen to work with and participate in the new models of care and a joint clinical strategy. The forth coming Membership Council will include further consultation with GPs. The Multi-Specialty Community Provider (MSCP) work will continue to be developed on a cluster basis for GP practices to work at scale and the West Cheshire CCG Vanguard work will continue to fit in with the STP work. It was noted Quarter 3 of the financial year should see the CCG recouping the majority of savings from the plan.

4. CCG Update Colin McGuffie, Locality Project Manager WCCCG, provided the following presentation to the Network:

Presentation GPFV September 16 (3).ppt

The Following points were highlighted: The GP Forward View focuses on 5 priority areas including:

• GP Indemnity • GP resilience • National development programme • Workforce retention and recruitment • Improving how acute trusts work with primary care

It was noted NHS England are looking at a new GP Indemnity support scheme to provide additional support to practices linked to workload, initially for a 2 year period providing a one off payment each year to cover the rise in indemnity costs. Funding of circa £45m will be available to Accountable Care Organisations (SCOs) from April 2017 via the GP Forward View.

5. Prescribing/Meds Management Update Barbara Perry, Senior Medicines Optimisation Lead, West Cheshire, Midlands and Lancs CSU provided the following presentation to the Network:

Rural Network presentation Sept 201

It was noted the outcome from the recent Medicines Management Public Consultation will be discussed further at the next Governing Body meeting and then shared wider with stakeholders. Repeat Prescribing The Rural Network noted the CCG and CSU are working together on a a new model of centralized repeat prescribing which will identify and


reduce waste within the system. The Network queried why Malpas practice is receiving scripts for Lymphedema garments from the acute trusts (CoCH, APH & C’Bridge). Action: LH to investigate the acute trusts requesting Lymphedema garments on script from Malpas surgery and feedback to the October meeting.

LH

6. Dressing Clinics The Network noted West Cheshire CCG have submitted a bid to NHS England (to the fund previously known as the Prime Minister’s Challenge Fund) allowing them to offer additional dressing clinics outside of core hours. The hub and spoke model will continue but the CCG will also run dressing clinics in all 3 localities (E’Port, City and Rural), in extended hours. Action: Laura Jones to provide an update to the October Network on the Phlebotomy review.

LJ

7. Referral Management Update Network members noted the CCG are going out to public consultation around the policy of Procedures of Limited Clinical Priority (previously ‘Value’) to decide which medical treatments will be reviewed. Engagement and consultation with the public will start across West Cheshire at the end of September. The outcome will be brought to a future Network meeting for information. The Network felt strongly that the total list of procedures in question should be sent for public consultation to ensure equity across the treatments. Elective Care The Network noted the update on the Consultant Connect service currently operating in the Pediatric service since its launch 01 July 2016. The following statistics were noted:

• Calls – 54 from 21 practices • Call connection rate – 43 (80%) of the 54 calls connected • Average time taken by Consultants to answer calls = 18 seconds • Average talk time – 5 minutes, 42 seconds

Outcomes:

• Referrals avoided = 8 • Referrals made = 9 • Diagnostics requested = 1 • Admissions made = 4 • Outcome not reported = 18

Consultant Connect will shortly be undertaking a GP and Consultant survey and wills hare feedback with the CCG. Network members were reminded to complete the Consultant Connect call in its entirety as the questions asked at the end of the call (automated) will feed in to a future evaluation of the service. The next stage of the


Consultant Connect will be implemented in A&E. Practices will be engaged with over the comings months around this roll out.

8. Urgent Care Update An update around the current CCG Urgent Care work was received and it was noted that the Systems Resilience Group (SRG) now includes representation from primary care including Sarah Murray and Steve Pomfret, Catherine Wall and Rebekah Banks. Primary Care feedback in to SRG including practice staffing levels and any issues that impact upon the wider system will be shared with other health agencies to support the flow and discharge of patients. SRG’s 5 key priorities are:

• Information Systems – Cheshire Care Record • GP Out of Hours relocation and GP streaming in A&E (primary care

triaging) • EMI – EMI pathways including CWP Mental Health support and

wider agencies such as the fire service linking in to a single pathway for urgent care

• 7 day working • Intermediate bed review (step up/step down beds). New step up

beds coming on line in the Princeway cluster who are piloting 2 beds for lower acuity patients, remaining under the management of their own GP. An evaluation of this service will be provided and fed back to Network with the Intermediate Care pathway reviewed shortly.

The Urgent Care team are also working on a process for Continuing Health Care fast tracked discharged from CoCH providing a plan of care for the first 48 hours after discharge. Network members were asked to DATIX any discharge incidents to enable the CCG to address them and follow them up. A kitbag of data to support all of the above will go live in September 2016. It was further noted that collaboration with CoCH and CWP is ongoing to provide a whole system approach which will help to predict what’s happening within the local health economy on a daily basis and it is hoped provide flexibility in the system over the longer term. The CCG’s Primary Care Dashboard will feed in ot this process. The discharge to assess philosophy has been rolled out from CoCH to E’Port Hospital to decrease the length of stay of patients. A therapy, high intensity ward has been set up in CoCH and will provide intensive physio and integrate patients back in to the community. The Integrated Care Teams Managers highlighted issues around discharge since the MDT conference calls have ceased. These issues have been DATIXED and will be flagged at the Systems Resilience Group.

9. CQUIN Frailty Update The Rural Network was provided with an update around the Primary Care CQUIN work. It was noted feedback from practices around the frailty assessment, rolled out earlier in the summer, has influenced the CCG to


Next Meeting: Tuesday 11 October 2016: 2.00 – 5.00pm @ Cheshire View, Christleton

broaden the assessment tool (4 per 1000 KPIs). Patients who are put through the Edmonton Frailty Score Assessment but do not trigger can be counted as part of the KPI. The preferred way to complete an assessment is through the Edmonton Frailty tool but if a clinician feels a patient is too frail to complete the assessment then a clinician can code the patient as triggering without the need to complete the Edmonton Frailty Assessment. It was reiterated that the purpose of the exercise is to find patients who aren’t already in the system and not already under GP/CWP scrutiny to provide them with an improved quality of care. The Network was reminded outcome codes require completing as part of KPIs too.

10. Future Agenda Items

• Extended Hours update – requested.

11. Any Other Business An update from the Winter Planning meeting held in July was received and provided clarity around the following points:

• Pharmacies will provide flu vaccinations again this year. • Pharmoutcomes have been commissioned to provide the data

feedback to GP practices. • If a nursing home or care home is CQC registered pharmacies can

potentially go out to those homes and provide vaccinations to their patients.

• LMC and LPC have met to discuss the arrangement between the two providers (pharmacies and GPs) and will feedback to practices around a local agreement.

• Pharmacies will advise practices of any vaccinations given within 48 hours.

• Pharmacies holding antivirals have been appointed again this year. • Antivirals – a conclusion has not yet been agreed around antivirals

to be communicated to practices asap. • Housebound vaccinations – CWP will provide vaccinations if patients

are on their caseload list along with their Carers. No further business was raised.


Outstanding Actions

NB: Actions will be taken off the table upon completion Key:

Red Overdue Green Completed

Amber On-going Blue For future / On agenda

Date Initiated Action By Whom

Due Date

12 July 2016 AL to signpost by email all practices to the various links including dashboard and Aristotle.

AL October 2016

13 September 2016

Lee Hawksworth to update the Network with details of the agreed service commissioned to provide MacMillan nurses working out of St Luke’s Hospice.

LH April 2017

13 September 2016

Lee Hawksworth to investigate the acute trusts requesting Lymphedema garments on script from Malpas surgery and feedback to the October meeting.

LH October 2016

13 September 2016

Laura Jones to provide an update to the October Network on the Phlebotomy review.

LJ October 2016



Documents

Rural Locality GP Network Meeting, 2-5pm, Tuesday 12 July ... · Rural Locality GP Network Meeting, 2-5pm, ... financial recovery and it was noted at the end of quarter 1 the CCG