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Primary Care inNorth Somerset

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Number of GP practices by contract :• General Medical Services (GMS) 6 • Personal Medical Services (PMS) 16 • Alternative Medical Services (APMS) 2

• Total number of practices 24

• Registered population 215,266 • WTE GPs/Pts per WTE 111/1929

Overview

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• GP Patient Survey: March – Sept 2014 (published Feb 2015)

• ED1 – Satisfaction with the consultation at the GP surgery 443.3 (range 399.4 – 458.8)• Bristol 437.7; S.Glos 435.4; Somerset 452.2

• ED2 – Overall satisfaction with the care received at the surgery expressed as a percentage 83.9% (range 71.4% – 92.4%)• Bristol 85.6%; S.Glos 84.1%; Somerset 88.6%

• ED3 – Satisfaction with primary care expressed as a percentage 73.7% ( range 56.1% - 86.1%)• Bristol 72.8%; S.Glos 70.7%; Somerset 79.8%

Patient Experience in North Somerset

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• Implementation of the 2015/16 contract • Continued implementation of the Single operating

framework for managing primary medical care contracts

• Developing quality indicators for General practice• Working with CQC• GP practice sustainability through transformation• Working on development through patient satisfaction

surveys and Friends and Family Test

Priorities for managing GP contracts in North Somerset:

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Directed Enhanced Services/number of practices providing the service:• Avoiding Unplanned admissions/21• Extended Hours/19• Facilitating timely diagnosis of Dementia/24• Minor Surgery/17• Learning Disability Health Checks/22• Contraceptive Devices IUCD/LA commissioned• Violent Patient Scheme/commissioned across BNSSG

cluster from a single provider

15/16 contract

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• Global sum funding and uplift• Named accountable GP for all patients (by 30 June 2015

for patients on the registered list prior to April 2015 and within 21 days for all new registrations and advertised on the practice website and leaflet by 31 March 2016)

• From 1 April 2015 all practices must publish on their website the mean earnings for all GPs for the previous year (2014/15)

• Seniority payments will be phased out from this financial year until 2020

15/16 contract requirements

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• Military personnel will be able to register with a GP practice in certain circumstances with permission from the Defence Military Services

• Reimbursement for GP practices for parental leave – maternity/paternity/adoption leave

• The alcohol risk reduction enhanced service and patient participation enhanced service ceased on 31 March 2015 and the funding forms part of the global sum

• Patient on line access to their medical record – all practices must offer this from 1 April 2015. This includes the opportunity to book on line appointments.

• http://www.nhsemployers.org/your-workforce/primary-care-contacts/general-medical-services/gms-contract-changes/gms-contract-changes-2015-16

15/16 contractual requirements cont

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• All primary care budgets split to match CCG indicative allocation, whether delegated or not

• Draft finances attached based on payments direct to practice and those that are not, are split on weighted list size

• Allocation needs to be split to CCG based on initial allocation and additional items apportioned

• QIPP is included in Other GP services line• Headroom allocated to CCG• Contingency is ring fenced for central reserve• Finance working group needs to be set up to understand budget

and spend apportionment

Overview - Draft Finance Report

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South West Primary Care Governance

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Responsibility remains with NHS England

At all levels of co-commissioning, NHS England will retain a role in supporting delivery of commissioning and contracting functions. Also the following responsibilities will remain with NHS England and will not be included in joint or delegated committees:

• Continuing to set nationally standing rules to ensure consistency and delivery goals outlined in the Mandate set by government.

• The terms of GMS contracts and any nationally determined elements of PMS and APMS contracts will continue to be set out in the respective regulations/ directions.

• Functions relating to individual GP performance management (medical performers’ lists for GPs, appraisal and revalidation).

• Administration of payments to GPs.• Patient list management will remain with NHS England.• Capital expenditure functions• Complaints management• Decisions relating to the Prime Minister’s Challenge Fund (PMCF)

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Functions decided in the JCC (1) - determination of key decisions or requests

Function JCC decision needed

Decision possible under existing approved policy

Potential Need for urgent decisions

List closure

Practice merger/moves

Boundary changes

Securing services /APMS

PMS (reviews etc)

Discretionary payments

Remedial breach notices

Contract termination

Contractual changes (contentious)

Contractual changes (transactional)

Monitoring of contractual performance

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Functions decided in the JCC (2) –financial processes

Function JCC decision needed Decision possible under existing approved policy

Potential need for urgent decision

Ensuring budget sustainability

Management accounting

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Functions decided in the JCC (3) –strategy and policy

Function JCC decision needed

Decision possible under existing agreed policy

Potential need for urgent decision

Securing quality improvement

Developing and agreeing outcome framework – 16/17?

Development of DESs/utilisation of QOF points

Premises plans including discretionary funding

Commissioning of enhanced optometry and pharmacy services to align with CCG objectives

Collaboration with stakeholders to assess health needs and decide strategic priorities

Design of local contracts such as APMS, PMS and NHSE enhanced services

Commissioning new providers and managing procurements

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Governance and Membership

Committee constitution and Terms of Reference • While much of the decision-making processes will be determined by

the JCC and aligned with existing governance processes , the constitution of the Committees have been approved by NHSE as a condition of co-commissioning.

• In the interests of transparency and the mitigation of conflicts of interest, the North Somerset CCG has a lay chair and vice chair. In addition a representative from Health Watch and The People of Communities Board are non-voting attendees. This will help to support alignment in decision making across the local health and social care system.

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Voting in the Joint Committee

• The JCC will be quorate when 5 pay and executive members are present – including one NHSE and one CCG member.

• The Committee should aim wherever possible to make decisions by consensus. However, where this is not achieved, a voting method will need to be used.

• The voting process will determined by a simple majority of members present. Absent members will not be allowed to vote – unless agreed with the Chair beforehand.

• Each voting member of the JCC will have one vote except in the following circumstance:NHSE functions – votes of NHSE members will be weighted to have parity with CCG members

• In cases where the vote has not determined an outright decision, the Chair will have a second, deciding vote except in respect of:NHSE statutory functions – 1 NHSE member to have deciding voteCCG statutory functions – 1 CCG member to have deciding vote

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Voting Process in a Joint Committee

Except for NHSE/CCG statutory functions when NHSE/CCG holds casting vote

Weighting may apply