Item Number: 11 Name of Presenter: Constance Pillar Meeting of the Primary Care Commissioning Committee 20 December 2016 NHS England Primary Care Update Purpose of Report For Information Reason for Report Summary from NHS England North of standard items (including contracts, planning and finance) that fall under the Primary Care Commissioning agenda. Strategic Priority Links Primary Care/ Integrated Care Urgent Care Effective Organisation Mental Health/Vulnerable People Planned Care/ Cancer Prescribing Financial Sustainability Local Authority Area CCG Footprint City of York Council Impacts/ Key Risks Financial Legal Primary Care Equalities East Riding of Yorkshire Council North Yorkshire County Council Covalent Risk Reference and Covalent Description Recommendations The Committee is asked to receive this report and note the recommended actions. Responsible Chief Officer and Title Rachel Potts, Chief Operating Officer NHS Vale of York CCG Report Author and Title Clare Streeter Primary Care Business Manager NHS England North 1
Vale of York Update Prepared by Clare Streeter Primary Care Business Manager NHS ENGLAND North (Yorkshire and The Humber) 9 December 2016 2
1. CONTRACT ISSUES a) PMS Reviews Practice Code CCG Practice Name Signed Not signed Notes B82097 VOY Scott Road Medical Centre X The Practice has requested a further discussion with the CCG to clarify the position regarding PMS Premium and options to defer recovery and start from April 2016 rather than April 2015. b) Contract Changes The following table confirms any contract changes that are currently under discussion: Practices Further Information Clifton Medical Practice and The Merged into York Medical Group on 1 Petergate Surgery July 2016 Beech Grove Medical Practice Merged into Front Street Surgery on 1 October 2016 Sherburn Group Practice Application to close branch surgeries at Church Fenton and Ulleskelf effective from 5 December. 2. GENERAL PRACTICE FORWARD VIEW UPDATE This was published in April 2016. The NHS England Board gave an update on five key actions which illustrate progress against the commitments made in this document. a. GP indemnity proposals In recognition of concerns around the rising costs of indemnity, NHS England and the Department of Health established a GP Indemnity Review group to consider proposals to address the rising costs of indemnity in general practice, working with the profession and medical defence organisations. The review concluded the best way to relieve the immediate pressure was through a new and tailored scheme which would provide financial support to general practice whilst developing actions to resolve the long-term drivers of increased costs. This new Indemnity Support Scheme is funded through the SFE for practices for at least the next two years and comes on top of 33m that was 3
invested into GP contracts as part of the 2016/17 contract negotiations. It will be payable in arrears (April 2017 for the 2016/17 financial year) and will seek to cover the inflationary rises of indemnity costs for practices, using an agreed and transparent methodology, based on best available data. Funding will be based on a registered practice population. Whilst this scheme will mitigate the effects of rising indemnity costs in practices, the DH will commence work leading to Tort reform aimed at reducing the overall rising costs of claims and litigation affecting the NHS NHS England is committed to further work to address costs of indemnity impacting on Out of Hours (OOH) services. A number of CCGs have already recognised rising indemnity costs for OOH and NHS 111 and so work will need to be done to inform the CCGs commissioning intentions for 17/18. In 16/17 the Winter Indemnity Scheme will be run for a further year, details of which will be published in the autumn. b. General Practice Resilience Programme (GPRP) The guidance around the implementation of this describes how the new GPRP will operate to deliver the commitment set out in the General Practice Forward view to support struggling practices over the next four years. This programme is aligned to the Vulnerable Practice Scheme (VPS) and aims to build on work already underway as part of this scheme. It allows a wider range of support to be delivered that will help practices to become more sustainable and resilient, better placed to tackle the challenges they face now and into the future and securing continuing high quality care for patients. The menu of support offered will need to include: a) rapid intervention and management support for practices at risk of closure b) coordinated support to help practices struggling with workforce issues, such as access to experienced clinical capacity or to develop skill mix c) change management and improvement support to individual practices or groups of practices Earlier work undertaken as part of the VPS can be used to select practices for support under this new programme this year e.g. allowing the funding to be used to support even more practices including those less vulnerable. Funding can be used to deliver/secure this support in more flexible ways such as: Additional local team capacity Backfill for peers support Section 96 funding Backfill for GPs who are assisting others The deadlines are tight to ensure that practices are clear the cavalry is coming. This means: 4
By mid-october any practices in urgent need not receiving support via vulnerable practice scheme will need to have begun to receive support (this could include Section 96 funding ahead of our delivery arrangements being in place). By end of October - 10m needs to have been spent or fully committed to individual practices. By end of December - 16m need to have be spent or committed to individual practices. Further resources will follow as identified in the guidance or following discussions with practices. c. General Practice National Development Programme This new development programme aims to support practices to manage their workload differently, freeing up time for GPs and improving care for patients. The programme will provide tailored support for groups of practices to implement the 10 High Impact Actions to release time for care. Practices, or CCGs, can submit an expression of interest form any time until summer 2018. They will be allocated an expert development advisor, who will help them plan their own Time for Care programme. Over the course of a typical 9-12 month programme, most practices could expect to release about 10% of GP time. Also available are free places on the General Practice Improvement Leaders programme, to build capabilities for improvement and change leadership in practices and federations. NHS England is also providing a new 45m fund over the next five years to support training for reception and clerical staff and, from 2017/18, a new 45m three-year fund to support purchase of online consultation systems. Further details of webinars etc. are available from dedicated web page https://www.england.nhs.uk/ourwork/gpfv/ d. Retained doctor scheme - extra resources for GPs and practices Although the Retained Doctor Scheme has been in place for many years the 2016 scheme delivers a number of improvements. From July 2016, NHS England is increasing the money received by practices employing a retained GP and the annual payment which GPs on the scheme receive towards professional expenses. The additional support is available to doctors already on the scheme and those doctors joining the scheme and in post before 31 March 2017. e. Improving how hospitals work with general practice new requirements on hospitals in the NHS Standard Contract 2016/17 5
Matthew Swindells, NHS England National Director for Operations and Information and Bob Alexander, NHS Improvement Deputy Chief Executive, have today written out to CCGs and NHS Trusts to highlight the importance of ensuring that the six new requirements for hospitals - which were introduced in the 2016/17 NHS Standard Contract to clarify the expectations across the hospital and general practice interface and to reduce avoidable extra workload for GPs - are fully implemented in a robust and timely way. Further updates will be provided as they become available. 3. ESTATES AND TECHNOLOGY TRANSFORMATION FUND (ETTF) UPDATE The CCG submitted 20 Estates and Technology Transformation Fund (ETTF) bids, 15 of which passed the initial assessment stage. The schemes that are still under consideration at this point have then been put into 3 different cohorts to reflect when they can be delivered by: Cohort 1 to be delivered by 31 st March 2017 although these are recognised as least transformational as they can be fully delivered and funded this year they have been prioritised to proceed. Cohort 2 to be delivered by 31 st March 2019 these schemes will be asked to proceed on an individual basis as and when funding allows. Cohort 2 plus to be delivered by 31 st March 2019 CCGs have requested part funding in 2016/17 to develop the relevant scheme Cohort 3 unlikely to be delivered within the project timeframe, any other possible funding routes for these schemes will be shared with CCGs at a later date. Of the 15 bids that passed the initial assessment stage, 2 schemes are progressing as cohort 1, 6 schemes as cohort 2, 1 scheme as cohort 2+ and 6 schemes as cohort 3. CCGs were asked to reconfirm their support for each scheme or whether it should be withdrawn from the programme. 4. REVISED STATUTORY GUIDANCE FOR CCGS ON MANAGING CONFLICTS OF INTEREST In June 2016, NHS England published the revised statutory guidance on managing conflicts of interest for CCGs. The guidance has been developed in collaboration with CCGs and national partners. Conflicts of interest are inevitable in commissioning and it is how we manage them that matters. The guidance includes a number of strengthened safeguards to mitigate the risk of real and perceived conflicts of interest arising in CCGs. The key changes in the revised guidance, agreed following public consultation, are: The strong recommendation for CCGs to have a minimum of three lay members on the Governing Body The introduction of a conflicts of interest guardian in CCGs 6
The requirement for CCGs to include a robust process for managing any breaches within their conflict of interest policy and for anonymised details of the breach to be published on the CCG s website Strengthened provisions around decision-making Strengthened provisions around the management of gifts and hospitality A requirement for CCGs to include an annual audit of conflicts of interest management within their internal audit plans A requirement for all CCG employees, governing body and committee members and practice staff with involvement in CCG business, to complete mandatory online conflicts of interest training The revised guidance forms part of a system-wide governance project to improve conflicts of interest management across the NHS and increase public confidence in decision-making processes. A link to the full document is shown below. https://www.england.nhs.uk/commissioning/pc-co-comms/coi/ The Primary Care Co-commissioning Committee is asked to note the new guidance regarding managing conflicts of interest. 5. GP APPRAISAL AND REVALIDATION Please find attached separate report at Appendix One NHS England North (Yorkshire and the Humber) Annual Assurance Report on Revalidation and the Responsible Officer Regulations 2015/16. 6. VULNERABLE GP PRACTICE FUND Within Vale of York, there were 6 practices who submitted bids for the above scheme via the LMC. After discussion with the CCG, one of these was approved and the successful practice has been informed and is currently updating their plans before submitting invoices against their plans for the committed monies. The Committee is asked to note this update. 7. VIOLENT PATIENT SCHEME YORKSHIRE AND THE HUMBER NHS England Primary Care teams across West, South and North Yorkshire and the Humber have been collaborating with CCG s and Yorkshire and Humber LMC Alliance to formulate a work stream that seeks to align the Violent Patient Scheme across the Yorkshire and the Humber region. The purpose of this work is to ensure that the criteria and quality of the patient referrals on to the scheme are appropriate and that the three localities are working consistently when referring and allocating. In addition, this will ensure that the referrals made by contractors are appropriate and in the best interests of the patient as well as the staff. A report was presented to the Direct Commissioning Senior Management Team at NHS England in August that outlined the planned work and offered 7
recommendations, which were approved. The recommendations set out a proposal to not only align the three policies, using a more robust referral process but to also reiterate the importance on the purpose of this scheme to avoid misuse. The revised policy will clarify the criteria that practices need to follow when considering a referral to the scheme and the management of patients who fall outside of this as there is clear evidence that a robust system needs to be in place to ensure that the patients are effectively managed and reviewed and that practice clinicians and staff, as well as the wider community, are kept safe. The committee is therefore asked to agree the recommendation that NHS England remain the transactional managers of this scheme to ensure consistency, assurance, oversight and scrutiny. However, the commissioning and procurement responsibility will remain with Fully Delegated CCGs. A fully delegated CCG can however express to take over all responsibility from NHS England, should it wish to do so If the Patient Risk and Disputes Resolution Panel (PRDRP) the method by which all referrals will be considered before a decision about inclusion is reached should decide not to allocate the referred patient to the scheme, the practice would be informed of such in writing by NHS England, with the relevant CCG informed so that they can decide upon any further support required for the practice and patient. This recommendation is taken from local relationships and knowledge perspective to include Safeguarding and is regardless of the level of delegation. This work is still ongoing and in consultation therefore it is envisaged that the new policy with accompanying leaflets and template forms will be available to practices in the early part of 2017. 8. FRIENDS AND FAMILY TEST Recent clarification was sought on the current guidance in relation to failure to carry out FFT in GP practices. For information, the Heads of Primary Care at NHS England agreed that no breach notice should be issued unless it is part of a holistic view, relating to other issues being investigated with a practice. NHS England had worked with Health Watch to provide tools to assist practices, which are available on the NHS England website. The approach that should be adopted is one of supporting and encouraging practices the letter template circulated in November 2015 is available at Appendix Two for onward distribution if required. 8