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A Public meeting of NHS North Tyneside Primary Care Committee is to be held on Thursday 30 March 2017 at 14:30 to 16:00 in Priory Meeting Room, Hedley Court, NE29 7ST

Agenda

Item No Item Lead

1 Welcome and Apologies for Absence Chair Verbal

2 Confirmation of Quoracy Chair Verbal

3 Declarations of Interest Chair Enclosure

4 Minutes of meeting held on 14 December 2016 Chair Enclosure

5 Actions from previous meeting 14 December 2016 Chair

Enclosure

6 Woodlands Park Medical Centre Branch Closure CK Verbal

7 Operational Update LYM/JM Enclosure

8 Level 3 Delegated Commissioning LYM/JM Verbal

9 Strategy Update LYM/JM Enclosure

10 Quality Update LYM/JM Enclosure

11 Primary Care Self Assessment – (Tabled) JM Enclosure to follow

12 Any Other Business All Verbal

13

Date of Next Meetings: Thursday 29 June 2017, 14:30 – 16:00 Thursday 28 September 2017, 14:30 – 16:00 Thursday 21 December 2017, 14:30 – 16:00

14 Closure of meeting

Meeting of the Primary Care Committee - Public

Register of Declarations of Interests: October 2016 v6-0 issued 23.3.2017 KEY: Declaration made within last 6 months at date of issue of the register. More than 6 months.

Surname Forename Job title Current position Declared Interest (name of organisation and nature of business) Type of Interest

Is the interest direct or indirect? Nature of interest From To Ongoing Action taken to mitigate risk

Date Declaration made (mm/dd/yyyy)

Primary Care Committee

Coyle Mary Deputy Lay Chair Governing Body Member Newcastle University, Trustee Member of Pension Trustee LimitedNon-financial professional interest Indirect There may be a connection between the University and the CCG Still ongoing Not required 17/10/2016 Member

Coyle Mary Deputy Lay Chair Governing Body Member Forum Member. Northumbrian Water ForumNon-financial professional interest Indirect Northumbrian Water and CCG may have some connection Still ongoing Not necessary 17/10/2016 Member

Coyle Mary Deputy Lay Chair Governing Body Member Non-Executive Director, Gentoo GroupNon-financial professional interest Indirect There may be connection between Gentoo and CCG Still ongoing Not required 17/10/2016 Member

Coyle Mary Deputy Lay Chair Governing Body Member Board Chair, Shared Interest Society and Shared Interest FoundationNon-financial professional interest Indirect There may be connection between Shared Interest and CCG Still ongoing Not required 17/10/2016 Member

Evans Ruth Clinical Director Clinical Director Village Green Surgery Financial Direct Ongoing I will comply with the Standards of Business Conduct policy. 10/11/2016 Member

Evans Ruth Clinical Director Clinical Director Action FoundationNon Financial Personal Interest Direct Ongoing I will comply with the Standards of Business Conduct policy. 10/11/2016 Member

Evans Ruth Clinical Director Clinical Director TyneHealth Ltd (North Tyneside GP Federation) Financial Direct Ongoing I will comply with the Standards of Business Conduct policy. 10/11/2016 Member

Hayward Eleanor Lay Member Governing Body Member Susan Duncan - Daughter, HR Manager North Tyneside Council Non Financial Indirect Susan Duncan - Daughter, HR Manager North Tyneside Council 4 Years Ongoing Compliance with Business Standards Policy 26/10/2016 Member

Keen Christine Director of Commissioning (NHS England Cumbria and North East Area Team) NHS England Employee None 23/01/2017 Member

Matthews Dr. John Clinical Chair Clinical Chair Partner of Park Road Medical Practice Financial Direct Partner of GMS Service Ongoing I will not participate in decision making 08/11/2016 Member

Matthews Dr. John Clinical Chair Clinical Chair Practice is a member of Tynehealth Financial Direct Ongoing I will not participate in decision making 08/11/2016 Member

Matthews Dr. John Clinical Chair Clinical ChairPractice is a partner in a service development together with Northumbria FT and Portugal Place HC Financial Direct Ongoing I will not participate in decision making 08/11/2016 Member

Matthews Dr. John Clinical Chair Clinical ChairBoard member/Trustee for Wallsend Memorial Hall & Peoples Centre of Community Service

Non Financial Personal Interest Direct Ongoing I will not participate in decision making 08/11/2016 Member

Matthews Dr. John Clinical Chair Clinical Chair Spouse is a palliative care consultant at Newcastle Hospital FT Indirect Interest Indirect Ongoing I will not participate in decision making 08/11/2016 MemberYoung- Murphy Lesley Carol Executive Director of Nursing & Transformation CCG Employee Fellow at Northumbria University

Non-financial professional interest direct

I am an unpaid hon fellow at Northumbria University which has just been extended for another 3 years 01/04/2013 Still ongoing Non required 10/10/2016 Member

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Primary Care Committee (Public) Minutes of the Primary Care Committee Meeting held on Thursday, 15 December 2016, 2.30pm – 4pm, at Hedley Court Present: Mary Coyle CCG Deputy Lay Chair, NTCCG (Chair) Lesley Young-Murphy Executive Director of Nursing & Transformation, NTCCG James Martin Commissioning & Performance Manager, NTCCG John Matthews Clinical Chair Cllr Margaret Hall Health and Wellbeing Board Denise Jones Primary Care Commissioning Manager In Attendance: Shelagh Cockburn Programme Management Officer (notes) Apologies: Christine Keen Director of Commissioning, NHS England Iain Kitt Health-Watch NTPCC/16/040 Agenda Item 1 – Welcome & Apologies for absence

Mary Coyle welcomed all to the Primary Care Committee and apologies

were noted as above. Introductions were made for the purpose of the committee.

NTPCC/16/041 Agenda Item 2 – Confirmation of Quoracy

The meeting was confirmed to be quorate.

NTPCC/16/042 Agenda Item 3 – Declarations of Interest

The Register of interest was checked for up-to-date accuracy.

NTPCC/16/043 Agenda Item 4 – Minutes of the previous meeting

The minutes from the meeting held on 29 September16, were agreed to be a true record.

NTPCC/16/029 Agenda Item 5 – Actions from the previous meeting

NTPCC/16/020.1 – Complete JMt advised that he had received no suggestions as to how balance could be reached regarding items to be discussed by the committee in private and in public. MC requested that JMt could prompt committee members for their suggestions.

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Action: JMt to prompt committee members for their suggestions regarding balance in agenda items for private and public meetings and update committee at the next meeting. NTPCC/16/020.2 – Complete.

NTPCC/16/030 Agenda Item 6 – Earsdon Park Contract Extension

DJ introduced the report and explained that the paper was to request the extension of the Alternative Provider Medical Services (APMS) contract for Earsdon Park, for one month to the end of September 2017. The extension of the contract would enable the CCG to review that contract and the APMS contract for Battle Hill at the same time, which could provide an increase in the options for the procurement of Primary Medical Services across the area. The committee agreed to extend the APMS contract for Earsdon Park.

NTPCC/16/031 Agenda Item 7 – Operational Update JMt explained that the purpose of the report was to inform the committee

of the decisions made since the last meeting of the committee in public. Decisions had been made on three items, they were;

• Extension of the Battle Hill APMS contract by six months until 30 September 2017.

• Extension of the violent patients’ service, in Cruddas Park, service level agreement (SLA) by three years.

• Refusal of the request to close the Whitley Bay Health Centre, patient list for three months, due to the practice having the lowest patient clinician ration amongst the six other local practices and due to concerns raised by neighbouring practices on the impact on their own lists.

The committee noted the decisions made.

NTPCC/16/032 Agenda Item 8 – Level 3 Delegated Commissioning

JMt explained that the report set out the benefits and risks of the CCG moving to Level 3, delegated Primary Care Commissioning, for which the CCG had completed and submitted the application to NHSE on 6 December 2016. The CCG should receive a response to the application in January 2017. The committee discussed the benefits of the CCG having the ability to commission the full patient pathway, but acknowledged that there were significant risks around the capacity of the CCG to manage the workload. DJ advised that NHS England (NHSE) would continue to provide support. LYM advised that the CCG had plans to recruit staff to reinforce the capacity of the CCG team.

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Action

The committee discussed recruitment of another GP to the committee and the committee structure required to manage the potential conflict of interest by the CCG Clinical Directors. MC requested that JMt keep the committee informed regarding the progress of the CCGs application. JMt to update the committee on the outcome of the application to NHSE regarding Level 3, Delegated Primary Care Commissioning.

NTPCC/16/033 Agenda Item 9 – Strategy Update

JMt presented the report and informed the committee of progress made in implementing the North Tyneside Tripartite Primary Care Strategy. He explained that the strategy focussed on the four main strands of; access, the enhanced primary care team, speciality support and prevention and self-management, which fits with the GP Five Year Forward View. JMt explained that a three stage process was being utilised that of; explore, focus and development of the process. The ‘explore exercise had identified 75 projects, of which 11 had been identified as something which could be taken forward across all four localities. 12 projects had been identified across three localities and 15 across 2, possible funding sources had also been identified. Business cases were now in development to be presented to the CCG for decision. The committee noted the progress made.

NTPCC/16/034 Agenda Item 10 – Additional Winter Opening

JMt presented the report and advised that in response to a mandate from NHSE, the CCG had commissioned both enhanced opening hours in Primary Care over the holiday period and a proactive marketing campaign. The marketing campaign will inform patients on how to access the most appropriate part of the system for urgent care. The enhanced opening hours in primary care will be provided through two hubs based in GP practices which will be open over both holiday weekends. Appointments for the two hubs will be accessible via NHS 111 and will be available for North Tyneside residents registered with a North Tyneside GP and their guests. The GPs providing the service do not usually provide Out of Hours services and all work in NTCCG member practices. A record of consultation will be logged on SystemOne Out of Hours which will enable patients regular GP access details of the issue. The committee discussed the importance of ensuring messages were clear to the public. The committee noted the contents of the report.

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NTPCC/16/035 Agenda Item 11 – Quality Update

LYM presented the paper and advised that the first CCG Primary Care Quality Group had taken place. The group has been established to review quality issues in member practices and is a sub-committee of the CCG’s Quality and Safety Committee. Minutes from the group would be received by both this committee and the Quality and Safety Committee. The group identified that input from a further GP member would be beneficial; this is being taken forward as an action from the meeting. The paper highlighted the difficulty the group had in understanding the data which had been provided and informed of the actions been taken to rectify the situation. DJ advised that NHSE would help in any way they could to ensure the information provided had sufficient detail to enable a full understanding of the issues. The committee noted the contents of the report.

NTPCC/16/036 Agenda Item 12 – Any Other Business

MC highlighted that the committee was public facing and because of this requested that when papers are being written care is taken to ensure that acronyms are spelt out in the first instance and that the level of jargon is kept to a minimum.

NTPCC/16/037 Agenda Item 13 – Date of next meetings

2.30 pm – 4.00 pm, 30 March 2017. NTCCG, Hedley Court

Meeting Date Minute Action

No. Action Resp. Officer Target Date Status

15.12.16 NTPCC/16/032 1 JMt to update the committee on the outcome of the application to NHSE regarding Level 3, Delegated Primary Care Commissioning.

James Martin Mar-17 Outstanding

North Tyneside Primary Care CommitteeAction Log

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Report to: Primary Care Committee Date: 30 March 2017 Agenda item: 07 Title of report: Operational Update Sponsor: Lesley Young-Murphy, Director of Nursing and Transformation Author: James Martin, Commissioning and Performance Manager Purpose of the report and action required: The committee are requested to note the below recent decisions that have been made outside of the Primary Care Committee held in Public.

Operational Update In the time since the previous Primary Care Committee held in public there has been a need to make a decision on the below 3 items. This paper gives a brief overview of the decisions that have been made and the rationale. The Bridge Medical breach closure On 03 March 2016, Shiremoor Medical Group, now known as Bridge Medical was inspected by the CQC and a report was published on 21 April 2016. The surgery was placed into special measures as a result of being rated Inadequate across all 5 domains with a number of concerns raised. NHS England and the CCG met with the new partners of the practice to discuss the outcome of the CQC inspection and a remedial breach notice was issued to the practice on 01 August 2016 with specific actions to be taken to remedy the breach.

The practice put in place significant improvements and completed the planned actions. The CQC revisited Bridge Medical on 11 October 2016 and published the report 08 December 2016; the service is now rated as ‘Good’. As the practice had satisfactorily completed all of the actions on the remedial breach notice, and had a positive re-inspection the recommendation to close the breach notice was agreed by the committee. The practice were also commended on the work undertaken and the improvements made. Primary Care committee – Terms of Reference amendments The Terms of Reference for the Primary Care Committee have been updated to reflect the CCG’s successful application to NHSE for delegated primary medical services commissioning (level 3).

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The main changes relate to the change in decision making process from a joint decision between NHs England and North Tyneside CCG to one made by the CCG. Additionally there will be increased membership to recognise the additional responsibility for the CCG and need for finance and increase senior management input into decision making. The committee are asked to not the above decisions. Governance and Compliance 1. Links to corporate objectives

2016/17 corporate objectives Item links to objectives √

1. Commission high quality care for patients, that is safe, value for money and in line with the NHS Constitution

√

2. Deliver the Financial Recovery Plan, leading to the achievement of the CCG’s statutory financial duties and future sustainability

3. Work collaboratively with partners and stakeholders to develop health and social care fit for the future in North Tyneside

√

4. Continue to develop North Tyneside CCG as a patient focused, clinically led commissioning organisation with a continuous learning culture

√

2. Consultation and engagement

Primary Care Committee appraised of latest position through this paper. 3. Resource implications

No additional resource implications 4. Risks

N/A 5. Equality assessment

N/A 6. Environment and sustainability assessment

N/A

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Report to: Primary Care Committee Date: 30 March 2017 Agenda item: 09 Title of report: Strategy Update Author: James Martin, Commissioning and Performance Manager Purpose of the report and action required: The committee are requested to note the progress being made in implementing the Tripartite Primary Care Strategy

Strategy update The Tripartite Primary Care Strategy has been developed in North Tyneside to ensure sustainability of primary care in the future and align Out of Hospital Care to the needs of the population, delivering care closer to home. It’s based around 4 “Pillars”

• Access – how to get patients to the right care at the right time. • Enhanced primary care team – what skill mix would support GP practices to

manage their demand e.g. pharmacists, physios, mental health workers. • Specialist support – What additional services could be offered in primary care

with the right training and clinical support • Prevention & Self-Management – how can GPs support patients to better their

own condition and prevent further deterioration in patients with long term conditions

A 3 stage explore / focus / develop process was undertaken with locality groups of GP practices to identify, prioritise, and develop possible projects to deliver the strategy. Projects could be delivered by groups of like-minded practices, GP localities or CCG-wide as appropriate. The projects currently being initiated are DVT pathway A GP-led pathway in primary care for the diagnosis, treatment and ongoing monitoring of those suspected of having DVT, avoiding the need to travel to the ambulatory care centre in Cramlington. A GP practice in each locality is identified to be the specialist practice in that locality. Patients are referred to that practice when there is a suspected DVT for investigation, diagnosis and treatment. The benefits include improved patient experience, reduced travel, improved patient safety, reduced workload and reduced cost.

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Menorrhagia pathway This proposal sees the transfer in to primary care of treatment for Menorrhagia, currently carried out in secondary care. A number of practices do not currently have the skills within their practice to provide this service and therefore refer patients into secondary care for treatment. This pathway will allow inter-practice referrals to practices that currently provide this treatment for their own patients. This will reduce patient travel, the clinician treating the patient will have access to the full patient notes, will improve sustainability, and reduce cost. Care Navigators This scheme covers the forthcoming introduction of the Care Navigators service in North Tyneside. An initial cohort of 25 receptionists will receive training & accreditation to be able to direct patients to the most appropriate source of help or advice, often avoiding the need for a GP consultation. This may include services in the community as well as within the practice. This adds value for the patient and reduces demand for GP appointments. A training company has been identified and the initial cohort of staff is beginning training. Online GP consultations This proposes the introduction of online consultations within North Tyneside, making use of funds allocated via the GP Forward View. This will allow practices to offer initial GP consultations online, either via a standard questionnaire online or via bespoke questions that relate to the specific patient’s condition. A GP will review this before deciding the best action – a face to face appointment, telephone consultation, prescription, reassurance. All patients will be contacted to let them know the outcome within a specified period of time. For GPs, being able to see a detailed history, as well as receiving answers to often-asked questions, before seeing/treating the patient means saving minutes every time, freeing up capacity for those most in need. Eight practices have agreed to pilot the software, and this will be taken forward from April. Extended GP access The first ‘pillar’ in the strategy relates to increasing access to GP practices. Additionally there is a mandate for CCGs to provide a set increase in the number of hours that patients can access services in evenings and on weekends. This project will develop the model to deliver that requirement and explore how in hour access can be improved through joint working. An initial blueprinting event has been held with representatives from a large number of practices to work through the priorities and model for delivery. This will then be turned into a business case for sign off with an aim for procurement and implementation of the service to start in October 2017. A fortnightly steering group continues to meet to provide oversight to the implementation of the strategy and provide a forum to resolve issues as they develop. The committee is asked to note the progress being made.

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Governance and Compliance 1. Links to corporate objectives

2016/17 corporate objectives Item links to objectives √

1. Commission high quality care for patients, that is safe, value for money and in line with the NHS Constitution

√

2. Deliver the Financial Recovery Plan, leading to the achievement of the CCG’s statutory financial duties and future sustainability

3. Work collaboratively with partners and stakeholders to develop health and social care fit for the future in North Tyneside

√

4. Continue to develop North Tyneside CCG as a patient focused, clinically led commissioning organisation with a continuous learning culture

√

2. Consultation and engagement

Primary Care Committee appraised of latest position through this paper. 3. Resource implications

No additional resource implications 4. Risks

N/A 5. Equality assessment

N/A 6. Environment and sustainability assessment

N/A

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Report to: Primary Care Committee Date: 30 March 2017 Agenda item: 10

Title of report: Quality update – Primary Care Quality Group synopsis Sponsor: Lesley Young-Murphy, Executive Nursing and Transformation Author: James Martin, Performance and Commissioning Manager and Shelagh Cockburn, Programme Management Officer Purpose of the report and action required: This report outlines the business which was discussed at the Primary Care Quality meeting on 14 February 2017. The committee is requested to note the contents for information. Executive summary: The Primary Care Quality Group (PCQG) sub-group of the Quality and Safety Committee met on the 14 February 2017. The formal minutes will be presented to the Quality and Safety Committee once approved in the next meeting (April). Below is a synopsis of the key points from the discussion. The Medical Director advised the group that an expression of interest had been received regarding the position of locality Director. This would be followed up and the group informed if/when an appointment was made. Review of the data provided by NHS England identified some outstanding issues despite the data being reformatted by the Business Intelligence Unit, North of England Commissioning Support (NECS). The group agreed that the data remained difficult to interpret. It was noted that although seven practices have been identified as having outlier status (risk rating > 10), the highest risk rating scored was 12. The committee discussed weighting of the data to enable a standard approach to identify the wider quality issues and practices which required input, prior to the development of a plan. The group agreed that the action would be taken to provide practices with ensuring compliance with the submission of the Friends and Family (F&FT) data. The Transformation Team would continue their work around improving access. Practices identified as being outliers were to be provided with a copy of their own data along with an offer of assistance to understand how the ranking had been arrived at.

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Governance and Compliance 1. Links to corporate objectives

2016/17 corporate objectives Item links to objectives √

1. Commission high quality care for patients, that is safe, value for money and in line with the NHS Constitution

2. Deliver the Financial Recovery Plan, leading to the achievement of the CCG’s statutory financial duties and future sustainability

3. Work collaboratively with partners and stakeholders to develop health and social care fit for the future in North Tyneside

√

4. Continue to develop North Tyneside CCG as a patient focused, clinically led commissioning organisation with a continuous learning culture

√

2. Consultation and engagement

N/A 3. Resource implications

N/A 4. Risks

N/A 5. Equality assessment

Applicable to all equally 6. Environment and sustainability assessment

N/A