Meeting Primary Care Commissioning Date Tuesday 3...

Meeting Title

Primary Care Commissioning Committee – meeting in public Date Tuesday 3 September 2019

Meeting No. 50. Time 9:30am – 10:25am

Chair Ms Fiona Barber Deputy Chair of the CCG and Independent Lay Member

Venue / Location

Guthlaxton Committee Room, Leicestershire County Council, County Hall, Glenfield, Leicester, LE3 8TB.

ITEM AGENDA ITEM ACTION PRESENTER PAPER TIMING

PC/19/70 Welcome and Introductions Fiona Barber Verbal 9:30am

PC/19/71 To receive questions from the Public in relation to items on the agenda

To receive Fiona Barber Verbal 9:30am

PC/19/72 Apologies for Absences: • Tim Sacks • Donna Enoux


PC/19/73 Notification of Any Other Business To receive Fiona Barber Verbal 9:35am

PC/19/74 Declarations of Interest on Agenda items


PC/19/75

To Approve minutes of the previous meeting of the ELR CCG Primary Care Commissioning Committee held on 6 August 2019

To approve Fiona Barber A 9:40am

PC/19/76 To Receive Actions and Matters Arising following the meeting held on 6 August 2019

To receive Fiona Barber B 9:40am

PRIMARY CARE FINANCE REPORT

PC/19/77 Primary Care Finance Report 2019/20 (Month 4, July 2019)

To receive Colin Groom C 9:45am

OPERATIONAL ISSUES

PC/19/78 Local Primary Care Contracting Policies – Update September 2019

To approve Seema Gaj D 9:50am

ITEM AGENDA ITEM ACTION PRESENTER PAPER TIMING

PC/19/79 Digital-First Primary Care Policy Consultation – LLR Response

To receive Jamie Barrett E 10:00am

PC/19/80

Leicester, Leicestershire and Rutland (LLR) GP Information Management and Technology (IM&T): Work Programme Update

To receive Tim Sacks F 10:10am

ANY OTHER BUSINESS

PC/19/81 To receive Fiona Barber Verbal 10:20am

DATE OF NEXT MEETING

PC/19/82

Tuesday 1 October 2019 at 9:30am – 12:30pm, Framland Committee Room, ELR CCG, Leicestershire County Council, County Hall, Glenfield, Leicester, LE3 8TB.

Fiona Barber Verbal 10:25am

Blank Page

Paper A ELR CCG Primary Care Commissioning Committee

3 September 2019

Minutes of the Primary Care Commissioning Committee held on Tuesday 6 August 2019 at 9:30am in the Gartree Committee Room, ELR CCG, County Hall, Glenfield,

Leicester, LE3 8TB

Present: Mrs Fiona Barber Deputy Chair of the CCG and Independent Lay Member (Chair) Mr Clive Wood Independent Lay Member Dr Nick Glover GP Locality Lead, South Blaby and Lutterworth Dr Vivek Varakantam GP Locality Lead, Oadby and Wigston Mr Jamie Barrett Head of Primary Care (on behalf of the Chief Operating Officer) Mr Richard George Senior Primary Care and Non-Acute Commissioning Accountant (on

behalf of the Chief Finance Officer) Mrs Tracy Burton Chief Nursing and Quality Officer Dr Katherine Packham Public Health Consultant In attendance: Mrs Daljit Bains Head of Corporate Governance and Legal Affairs Mr Jamie Barrett Head of Primary Care Mrs Seema Gaj Senior Primary Care Contract Manager Dr Fahreen Dhanji Leicester, Leicestershire and Rutland Local Medical Committee

(LLR LMC) Representative Mrs Amardip Lealh Corporate Governance Manager (Minutes)

ITEM LEAD RESPONSIBLE

PC/19/58 Welcome and Introductions Mrs Barber welcomed all members to her first Primary Care Commissioning Committee (PCCC) meeting, in particular Dr Dhanji. Mrs Barber thanked Mr Wood for an overview of the progress by the Committee to date and welcomed input from Mr Wood going forward. Mrs Barber looked forward to working with members of the Committee and developing primary care. This was followed by a short background into Mrs Barber’s career and a series of introductions by all members present.

PC/19/59 To receive questions from the Public in relation to items on the agenda There were no members of the public at the meeting and no questions had been received.

PC/19/60 Apologies for absence: • Mr Tim Sacks, Chief Operating Officer • Ms Donna Enoux, Chief Finance Officer

PC/19/61 Notification of Any Other Business

Page 1 of 8


3 September 2019


Mrs Barber had not received notification of any other business.

PC/19/62 Declarations of Interest GP members present declared an interest in items relating to commissioning of primary care where a potential conflict may arise, which did not include any specific declarations on this occasion. It was RESOLVED to:

• NOTE the conflicts of interest declared.

PC/19/63 To Approve minutes of the previous meeting of the ELR CCG Primary Care Commissioning Committee held on 9 July 2019 (Paper A) The minutes of the meeting held in July 2019 were accepted as an accurate record of the meeting. It was RESOLVED to:

• APPROVE the minutes of the meeting.

PC/19/64 To Receive Matters Arising following the meeting held on 9 July 2019 (Paper B) Mrs Barber noted there were no outstanding matters arising following the meeting held in July 2019, which was positive. It was RESOLVED to:

• RECEIVE the matters arising.

PC/19/65 Primary Care Finance Report 2019-20 (Month 3, June 2019) (Paper C) In the absence of Ms Enoux, Mr George presented this report, which was taken as ‘read,’ and summarised as follows:

• The annual budget for Primary Care Services totals £101.6m;

• At Month 3, a year to date overspend of £76k and the forecast outturn overspend of £350k is being forecast due to the following cost pressures: - Co-Commissioning - Other Primary Care

• Appendices 1 and 2 provided further analysis of all service

Page 2 of 8


3 September 2019


areas. In addition, to the above, Mr George informed the Committee that the Category M prices increased on 1 August 2019, however, it was too early at this stage to translate the overall cost and impact of this for the CCG. However, QIPP plans are in the process of being reviewed in order to mitigate the impact and/or risk. Mr Wood reminded the Committee of the conversation held at the previous meeting in relation to its responsibility for financial delegation and informed Mrs Barber that at the beginning of each financial year, the PCCC has full financial responsibility for the primary care co-commissioning budget. However, as and when this budget has been overspent, this right is revoked and all responsibility for financial delegation of this Committee is to be recommended to the Governing Body for approval. Mr George confirmed this was the current situation as this budget has been overspent. Dr Varakantam recalled a conversation at a previous meeting in relation to indemnity and funds from NHS England, which has been removed and would be helpful to include within future reports. Mr George confirmed that the indemnity funds did not impact Practices, however, would include within future reports, as requested. Mrs Barber queried whether Locum costs for the CCG had reduced; Mr George confirmed this had increased due to the level of cover required for GPs in terms of sickness, maternity and paternity leave across the CCG. In response to Mrs Barber’s query as to what action is being taken in light of the increased Locum costs, Mr George confirmed the CCG is limited in terms of activity, however, this is reviewed in conjunction with the Locality Leads and at the Locality meetings too. Mrs Burton added that the level of workforce has been an issue for GP Practices in terms of recruitment and retention, however, the CCG is involved within the International GP Recruitment Scheme that is led by West Leicestershire CCG and further work undertaken within the Nursing and Quality Directorate too. Mrs Barber thanked Mr George and members of the Committee for the update. It was RESOLVED to:

• RECEIVE the update.

Page 3 of 8


3 September 2019


PC/19/66 Leicester, Leicestershire and Rutland (LLR) GP Information Management and Technology (IM&T) Work Programme: Update (Paper D) In the absence of Mr Sacks, Mr Barrett presented the monthly report, which provided an update on the IM&T Work Programme across LLR that supports the delivery of the Local Digital Roadmap and implementation of the GP Five Year Forward View (5YFV). Mr Barrett confirmed that the IM&T Tracker has been excluded the report as this sits within IM&T and continues to be reviewed and updated within that function; however, the 7 key initiatives of the IM&T Work Programme have been listed within section 2 of the report. Appendix A of the report included the IM&T Newsletter for July 2019 that has been disseminated across GP Practices within LLR. Mr Barrett drew the Committee’s attention to Online Consultations, which will be piloted in 11 GP Practices across LLR following an engagement event in mid-August 2019. As previously mentioned, Practices are expected to ensure 25% of their appointments are available for online bookings and further work was required in order to quantify this, which has also been raised at the Practice Manager’s Forum too. It is anticipated that as GPs will have an understanding of the number of appointments available, as well as a breakdown of the amount of pre and post bookable appointments too; it would be helpful to obtain feedback from GPs in relation to their systems and how this could be calculated. In response to Mrs Barber’s query as to whether Mr Barrett forms part of the IM&T function, Mr Barrett confirmed the Locality Lead Manager and STP GP Programme Lead within the CCG attends the IM&T forums on behalf of LLR and Mr Sacks is the Senior Responsible Officer for this function. In response to Mrs Barber’s query as to how Practices views are captured and taken forward, Mr Barrett confirmed Locality meetings are held on a monthly basis, which have governance structures in place; and the Practice Manager’s Forum allows for a range of technical issues to be raised – a member of whom is an IM&T Representative and can influence the agenda. Dr Glover noted the request made by Mr Barrett and suggested the CCG look at what they want to achieve by the 25% online bookings as this will determine a sensible way forward. For example, if the outcome of the activity is to calculate the percentage of appointments booked on a daily basis, this may prove to be counterproductive as on the day access could be limited to a Monday and Friday only for some Practices. In addition, it may not be possible to use the online facility to book urgent appointments

Page 4 of 8


3 September 2019


for acute access due to the time these appointments are released. Therefore, it was suggested the CCG carefully review the requirements of the 25% online bookings; how this will be measured; and consider a denominator and numerator to preserve the acute access element. Mr Barrett thanked Dr Glover for his comments, which were helpful and confirmed the guidance for online consultations refers to planned appointments. In addition to the above, Dr Dhanji confirmed some appointments will also be booked via NHS 111 and some patients prefer to book appointments to see their own GP. Work is underway within her Practice, the Latham House Medical Practice, to release appointments with the Practice Nurse too. Dr Varakantam agreed with comments made and suggested the calculation of the 25% of online bookings is not too prescriptive; that Practices are given enough time to ensure their systems and processes are reviewed and updated accordingly; and a flexible approach is applied as one size will not fit all. The overall outcome of this should be to increase patient access. Dr Glover referred to the ‘Windows 10 Upgrade – Reminder’ within the IM&T Newsletter and queried whether the CCG was confident that Practice Managers were aware of the impact of the clinical software on their systems during this process. Dr Glover referred to a recent development session at Board level on Cyber Security where the Cyber Security Manager at Leicestershire Health Informatics Service (LHIS) confirmed that any software or hardware that has not received prior approval from LHIS will not be reinstalled. Mr Barrett confirmed LHIS are in the process of liaising with each and every Practice in order to review any third party software and technical impacts. Dr Glover also informed the Committee that the Care Quality Commission (CQC) has published recent advice / a myth buster in relation to the CQC inspection process, which includes more than 70 additional questions / prompts in addition to the current CQC process. Given the level of uncertainty identified in relation to the collation of evidence, it was suggested urgent clarification is sought in relation to this. In response to Mrs Barber’s query as to whether this has been communicated to Practices, it was noted further clarification is required in the first instance. It was agreed for Mr Barrett and Mrs Burton to liaise with Dr Glover in order to review the CQC issues highlighted and obtain guidance / clarification from the CQC Inspector when they next meet. Mr Barrett agreed to discuss this at the next Risk Sharing meeting. It was RESOLVED to:

Page 5 of 8


3 September 2019


• RECEIVE the report and note the progress to date.

PC/19/67 Digital-First Primary Care Policy Consultation (Paper E) Mr Barrett presented this report, which provided the Digital-First Primary Care Policy as published by NHS England and NHS Improvement in June 2019. It was reported that following a thorough review of the document, it describes proposals to reform the patient registration, funding and contracting rules to ensure patients have both choice and access to integrated care especially those within remote or deprived areas, who do not live near a GP surgery, and/or with long term conditions. Therefore, it was imperative to bring this to the Committee’s attention. The document is based on the following four areas, for which feedback is required to be submitted online or in writing by Friday 23 August 2019:

1. Out of Areas Registration 2. CCG Allocations 3. New Patient Registration Premium 4. Harnessing Digital-First Primary Care to cut Health

Inequalities Mr Barrett informed the Committee that a Practice within Hammersmith and Fulham (London) are registering patients at a branch surgery within Birmingham, which is permitted under the longstanding General Medical Services (GMS) regulations. This may be due to patients living in London and working in Birmingham who are unable to see their GP locally. Although it was noted that that ELR CCG was not a like for like comparison with Birmingham, it was agreed that this document could be implemented across LLR due to local universities that fall within Leicester City CCG. Therefore, Mr Barrett welcomed views from members of the Committee on the questions within each of the sections of the document, which will be coordinated across the LLR CCGs and a collective response submitted. However, as the questions appear to be slightly misleading, it was suggested any comments / feedback are provided as an alternative. A summary of the consultation questions was provided in Annex A of the document. In response to Mrs Barber’s query as to whether each CCG and GP Practice could respond to the consultation individually, Mr Barrett confirmed this was possible as it was a public consultation, however, it would not be productive for each LLR CCG to submit an individual response as these could be very similar in terms of content; and Practices may view the document differently as the

Page 6 of 8


3 September 2019


proposals are mainly from a commissioning perspective. Therefore, it was agreed for one response to submitted on behalf of the CCGs within LLR, which includes input from GP colleagues. Mrs Barber welcomed the approach and requested the feedback to be reviewed by the Committee prior to submission. As some members of the Committee had not fully reviewed the detail of the document, it was agreed for all members of the Committee to review the document and provide feedback and/or comments directly to Mr Barrett who will liaise with the neighboring LLR CCGs in order for a joint response to be compiled and submitted. Dr Glover suspected Practices may not necessarily provide a response to this consultation as highlighted by Mr Barrett, however, it would be useful to identify any specific issues, safeguards in place and the destabilising of registrations and access. Mrs Barber noted thousands of patients have registered for digital services within primary care in the past and subsequently de-registered and queried whether the CCG had sought any intelligence that identifies what digital services look like; as well as any feedback, learning or issues that could be taken into consideration. Mr Barrett confirmed there was no local feedback at this stage and suggested patients may have de-registered due to the time and distance taken to travel to Birmingham, however, the branch surgery is also selective of the patients they register (i.e. those with less complex care needs). Dr Varakantam requested clarification in relation to whether patients are registering with the branch surgery purely for an online digital primary care service. Mr Barrett confirmed Practices can sub-contract primary care services under their GMS contract across a wider geographical area. Mrs Barber thanked Mr Barrett for the update and requested members of the Committee to provide any comments / feedback in relation to the public consultation on Digital-First to Mr Barrett by 13 August 2019 and suggested this is also raised at Locality Meetings and considered by the LMC too. It was RESOLVED to:

• RECEIVE the report.

PC/19/68 Any other business There was no other business to discuss.

Page 7 of 8


3 September 2019


PC/19/69 Date of next meeting The date of the next Primary Care Commissioning Committee meeting will be held on Tuesday 3 September 2019 at 9:30am – 12:30pm, Guthlaxton Committee Room, County Hall, Glenfield, Leicester, LE3 8TB.

Page 8 of 8

Blank Page

Paper B ELR CCG Primary Care Commissioning Committee Meeting

3 September 2019

NHS EAST LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUP PRIMARY CARE COMMISSIONING COMMITTE MEETING

ACTION NOTES

Minute No.

Meeting Item Responsible Officer

Action Required To be completed

by

Progress as at 3 September 2019

Status

PC/19/66 August 2019

LLR GP Information Management and Technology (IM&T) Work Programme

Jamie Barrett Tracy Burton

To liaise with Dr Glover and obtain guidance / clarification from the CQC Inspector in relation to the recent guidance from the CQC and the additional questions / prompts.

August 2019

Verbal update to be provided at the meeting. Action ongoing.

AMBER

PC/19/67 August 2019

Digital-First Primary Care Policy

All To provide feedback and/or comments on the questions within the document.

13 August 2019

Feedback received from Public Health and Dr Glover. Action complete.

GREEN

Jamie Barrett To liaise with colleagues in neighboring LLR CCG’s to ensure a joint response is submitted.

23 August 2019

Feedback received from the LLR CCG’s PCCC; LLR GP IT Steering Group; and the LLR Primary Care Board; update on the agenda. Action complete.

GREEN

No progress made On-Track Completed

Key

Page 1 of 1

Blank Page

Paper C ELR CCG Primary Care Commissioning Committee Meeting

3 September 2019

EAST LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUP PRIMARY CARE COMMISSIONING COMMITTEE MEETING

Front Sheet

REPORT TITLE: Primary Care Finance Report 2019/20 (Month 4 July)

MEETING DATE: 3 September 2019

REPORT BY: Richard George, Senior Primary Care and Non-Acute Commissioning Accountant

SPONSORED BY: Donna Enoux, Chief Finance Officer

PRESENTER: Colin Groom, Deputy Chief Finance Officer

PURPOSE OF THE REPORT: The purpose of this report is to provide a 2019/20 forecast outturn position for Primary Care services.

RECOMMENDATIONS: The East Leicestershire and Rutland CCG PCCC is requested to:

• RECEIVE the 2019/20 year to date and forecast outturn position for Primary Care services.

REPORT SUPPORTS THE FOLLOWING STRATEGIC AIM(S) 2017 – 2018: (tick all that apply) Transform services and enhance quality of life for people with long-term conditions

Improve integration of local services between health and social care; and between acute and primary/community care.

Improve the quality of care – clinical effectiveness, safety and patient experience

Listening to our patients and public – acting on what patients and the public tell us.

Reduce inequalities in access to healthcare Living within our means using public money effectively

Implementing key enablers to support the strategic aims (e.g. constitutional and governance arrangements, communications and patient engagement).

EQUALITY ANALYSIS An Equality Analysis and due regard to the positive general duties of the Equality Act 2010 has not been undertaken in the development of this report as it is judged that it is not required at this point.

RISK ANALYSIS AND LINK TO BOARD ASSURANCE FRAMEWORK:

• Report covers finances for (but not the operational delivery of) Primary Care Budgets that support the delivery of Primary Care Strategy (BAF 6);

• Report supports the appropriate management of Primary Care Budgets and the achievement of financial targets (BAF 10).

Page 1 of 5


3 September 2019

EAST LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUP

PRIMARY CARE COMMISSIONING COMMITTEE MEETING

Primary Care Finance Report 2019/20 (Month 4, July 2019)

03 September 2019

1. Month 03 Year to Date and Forecast Outturn Position

The 2019/20 annual budget for Primary Care services totals 102.2m. At Month 4, a year to date overspend of £318k and forecast outturn overspend of £735k is being forecast. In comparison to the position reported in month 2, there is a £385k worsening in the position which is largely attributable to cost pressures within GP Prescribing following the recent announcement of Category M drug price increases. Movements in variance across service areas are summarised in the table below: Area Month 03

Forecast Outturn Variance

£’000

Month 04 Forecast Outturn Variance

£’000

Movement in

Position

£’000

Explanation of key movements

Prescribing 0 404 404 Increase in Category M drug prices, partially offset by additional income from rebates and other underspending areas of prescribing

Community Based Services

0 -11 -11 Outcome of PPV audits which have highlighted a net over-claim by practices

Co-Commissioning 362 368 6 GP Support Framework

0 0 0

Other Primary Care -12 -26 -14 Reduced income from LLR Urgent Care Centre recharges offset by further underspending against the licences budget

Total 350 735 385 Appendices 1 and 2 provide further analysis of all service areas.

2. Delegated Co-commissioning Despite removing £1m of cost out of this budget in 2019/20 for Oadby Urgent Care Centre, a forecast outturn overspend of £368k is anticipated.

Page 2 of 5


3 September 2019

This is largely due to pressures relating to the reimbursement of locum staff employed by practices to cover sickness, paternity and maternity leave and while costs are expected to be less than that incurred in 2018/19, the forecast includes an estimate of £283k for the year. Premises budgets are forecast to overspend by £93k as inflationary pressures exceed the 0.09% uplift allowed in the CCG’s delegated co-commissioning allocation. There has been no employment of additional roles in July under the new Primary Care Network DES and is forecast to result in an underspend of £112k.

3. GP Prescribing Prescribing budgets are forecast to overspend by £404k which is due to price increases of Category M drugs that took effect on 01 August. The financial impact of the price increase is estimated to be £644k but is offset by additional rebate income and underspending against the High Cost drugs, Central Prescribing and Home Oxygen budgets. The CCG’s financial plan includes a QIPP target of £2.6m and while there is an element of risk in the plan, it is currently forecast to be delivered in full.

4. Community Based Services A small underspend of £11k is forecast against this budget which is due to an element of over claimed activity identified in the PPV audit process.

5. Primary Care Corporate A small underspend of £15k is being forecast due to slippage in recruitment for the LLR Medicines Optimisation in Care Homes project.

6. Urgent Care Centres

This budget is forecast to overspend by £23k as a result of reduced income recharges for Leicester City patients attending ELR Urgent Care Centres.

7. All other areas of primary care are forecast to be in line with the planned budget.

8. Recommendation: The ELR CCG Primary Care Commissioning Committee is requested to:

• RECEIVE the 2019/20 year to date and forecast outturn position for Primary Care

services.

Page 3 of 5


3 September 2019

Appendix 1

M04 Primary Care Commissioning Report YTD Budget

YTD Actuals

YTD Variance

Annual Budget

Annual Forecast

Annual Variance

Over/ (Under)

Area (£'000s) (£'000s) (£'000s) (£'000s) (£'000s) (£'000s)

CCG Prescribing

OptimiseRX 35 34 -1 104 101 -3

Central Prescribing 438 434 -4 1,346 1,311 -35

High Cost Drugs 316 312 -3 970 943 -27

Home Oxygen 152 142 -10 456 426 -30

GP Prescribing 15,147 15,295 148 45,151 45,649 499

Prescribing Incentive Scheme 112 112 0 335 335 0

Total Practice Prescribing 16,199 16,329 129 48,362 48,766 404

Enhanced Services

Community Based Services 699 688 -11 2,097 2,087 -11

Total Enhanced Services 699 688 -11 2,097 2,087 -11

Co Commissioning 14,194 14,413 219 43,405 43,773 368

Total GP Support Framework 503 503 0 1,510 1,510 0

Other

PCN Netw ork Support 167 167 0 501 501 0

GPFV - GP Extended Access (inc Oadby UCC) 590 590 0 1,805 1,805

GPFV - GP Receptionist Training 62 62 0 191 191 0

GPFV - GP Online Consultation 102 102 0 311 311 0

GPFV - International GP Recruitment 0 0 0 0 0 0

GPFV - Doctors Retention 76 76 0 232 232 0

GPFV - Practice Resilience 48 48 0 146 146 0

GPFV - Primary Care Netw orks 261 261 0 799 799 0

GPFV - Training Hubs 20 20 0 183 183 0

GPFV - Fellow ships - Core Offer 18 18 0 165 165 0

GPFV - Fellow ships - Aspiring Leaders 23 23 0 210 210 0

Licences 23 12 -11 69 36 -33

Primary Care Corporate 143 129 -14 430 415 -15

Section 106 0 0 0 0 0 0

GP IT 387 387 -1 1,162 1,161 -1

Urgent Care Centres (exc Oadby UCC) 320 328 8 960 983 23

Primary Care Other -119 -119 0 -356 -356 0

Total Other 2,123 2,105 -18 6,808 6,783 -26

Total Primary Care 33,719 34,037 318 102,183 102,918 735

YTD Position Forecast Outturn Position

Page 4 of 5


3 September 2019

Appendix 2

Budget ActualVariance (Under)/

OverBudget Forecast

Variance (Under)/

Over£000's £000's £000's £000's £000's £000's

GMS Global Sum 9,223 9,218 -5 27,795 27,799 4MPIG Correction Factor 183 182 -1 548 546 -2

PMS Reinvestment 0 0 0 0 0 0FDR Payment 0 0 0 0 0 0Ear Irrigation 28 30 2 84 91 8Wound Clinics 112 112 0 335 335 0Acute Access 266 266 0 799 799 0SLA Pharmacists 197 197 0 592 592 0Subtotal PMS & FDR Reinvestment 603 606 3 1,810 1,818 8

Total General Practice - GMS 10,009 10,006 -3 30,153 30,163 10

Occupational Health 13 13 0 39 39 0Locum Adoption/Paternity/Maternity 52 52 0 156 156 0Locum Sickness 32 65 33 97 127 30Locum Suspended Doctors 19 19 0 58 58 0Seniority 71 71 0 212 212 -0Sterile Products 7 7 0 22 22 0GP Training 32 32 0 95 95 -0PCO Doctors Ret Scheme 25 25 -0 80 80 0CQC Registration 71 72 1 212 216 3Narborough HC Dispersal Costs 0 0 0 0 0 0Total Other GP Services 322 356 34 971 1,004 33

QOF Achievement 378 378 0 1,134 1,134 0QOF Aspiration 1,015 1,015 0 3,044 3,044 -0Total QOF 1,392 1,392 0 4,177 4,177 -0

DES Extended Hours Access 91 190 100 519 520 2DES Learning Disability 38 38 -0 114 114 -0DES Violent Patients 16 16 0 47 47 0DES Minor Surgery 166 166 -0 498 498 0DES PCN- Participation 189 189 0 566 566 -0DES PCN - Clinical Director 19 19 0 168 168 0DES - PCN Additional Roles 56 0 -56 503 392 -112LES Translation Fees 6 6 0 18 18 0Leicester Asylum Service 6 6 0 19 19 0Total Enhanced Services 585 629 44 2,450 2,340 -110

Dispensing Quality Scheme 31 31 0 93 93 0Prof Fees Dispensing 517 517 0 1,551 1,551 0Prof Fees Prescribing 77 77 -0 230 230 0Prescribing Charge Income -101 -101 0 -303 -303 0Total Dispensing/Prescribing Drs 524 524 0 1,571 1,571 0

Premises Actual Rent 616 616 0 1,849 1,849 0Premises Health Centre Rent 11 11 -0 33 33 0Premises Notional Rent 515 516 1 1,545 1,548 3Premises Clinical Waste 101 114 13 303 341 38Premises Health Centre Rates 2 2 -0 7 7 -0Premises Rates 202 227 24 607 680 73NHSE / GL Hearn Rates Rebates 0 0 0 0 0 0Premises Water Rates 22 14 -8 65 45 -20Other premises 5 5 0 15 15 0Total Premises Cost Reimbursement 1,475 1,505 30 4,424 4,517 93

In Year Cost Pressure -114 0 114 -341 0 341

GRAND TOTAL - Co-Commissioning 14,194 14,413 219 43,405 43,773 368

MemoOriginal allocation received including allowance for indemnity scheme 44,691In year deduction in respect of the indemnity scheme handled centrally -1,286Current allocation 43,405

Month 04 Primary Care Co-Commissioning

Year-to-Date Position Forecast Outturn Position

Page 5 of 5

Blank Page

Paper D ELR CCG Primary Care Commissioning Committee Meeting

3 September 2019


Front Sheet

REPORT TITLE: Local Primary Care Contracting Policies – Update September 2019


REPORT BY: Hayley Moore, Primary Care Support Contract Manager

SPONSORED BY: Jamie Barrett, Head of Primary Care

PRESENTER: Seema Gaj, Senior Primary Care Contract Manager

PURPOSE OF THE REPORT In September 2018, the Primary Care Commissioning Committee were presented with a report on all NHS England Policies and Local guidelines for the PCCC to approve and incorporate within the CCG’s governance suite. Across Leicester, Leicestershire and Rutland local guidance policies were implemented and due for review in September 2019. Acknowledging no amendments have been made, the Primary Care Commissioning Committee is asked to approve the next review date as September 2020 for the following;

• Agreed Financial Assistance for Practices Experiencing the Impact of Dispersed List

• Applications for Proposed Practice Mergers Guidance for Practices • Boundary Change Principles

RECOMMENDATIONS: East Leicestershire and Rutland CCG Primary Care Commissioning Committee are asked to:

• APPROVE the next review date as September 2020 for the following local LLR

guidance policies:

o Agreed Financial Assistance for Practices Experiencing the Impact of Dispersed List and.

o Applications for Proposed Practice Mergers Guidance for Practices o Boundary Change Principles

However policies will need to be re-visited should an LLR wide CCG reorganisation occur.

Paper D ELR CCG Confidential Primary Care Commissioning Committee Meeting

3 September 2019

REPORT SUPPORTS THE FOLLOWING STRATEGIC AIM(S) 2019 - 2020: (tick all that apply) Transform services and enhance quality of life for people with long-term conditions




Reduce inequalities in access to healthcare

Living within our means using public money effectively


EQUALITY ANALYSIS An Equality Analysis and due regard to the positive general duties of the Equality Act 2010 has not been undertaken in the development of this report as it is not deemed appropriate for this report.

RISK ANALYSIS AND LINK TO BOARD ASSURANCE FRAMEWORK: The report highlights the following risks:

• BAF 3 - Quality Primary Care - The quality of care provided by primary care

providers does not match commissioner’s expectation with respect to quality and safety.

• BAF 6 (a) Primary Care Commissioning – ability to perform delegated duties whilst maintaining member relations and Clinical Engagement

Page 2 of 4


3 September 2019


Local Primary Care Contracting Policies – Update September 2019

3 September 2019

Background

1. In September 2018 a paper was presented to the Primary Care Commissioning

Committee which provided a summary of the NHS England National Policies which included contract management and operational procedures in relation to the management of Primary Care Contracts.

2. In line with ELR CCGs delegated responsibility, all National and Local polices

were incorporated as part of ELR CCGs governance process. . To ensure the CCG is adhering to the most up to date policy, the Primary Care Commissioning Committee are asked to note the status of the following local Leicester, Leicestershire and Rutland (LLR) CCG guidance polices which are due for review in September 2019 and presented as follows;

Table 1: Local LLR Primary Care Contracting Policies for Review POLICY TITLE AUTHOR REVIEW DATE REVIEW STATUS

Agreed Financial Assistance for Practices Experiencing the Impact of Dispersed List

Adapted from NHSE - CCG

Sep - 19 No suggested change to the policy

Applications for Proposed Practice Mergers Guidance for Practices



Boundary Change Principles



3. As there has been no amendments made to the LLR local guidance policies, the

Primary Care Commissioning Committee are asked to approve the next review date as September 2020.

4. However policies will need to be re-visited should an LLR wide CCG reorganisation occur.

Recommendations

5. The Primary Care Commissioning Committee are requested to:

• APPROVE the next review date as September 2020 for the following local

LLR guidance policies: Page 3 of 4


3 September 2019

o Agreed Financial Assistance for Practices Experiencing the Impact of Dispersed List and.

o Applications for Proposed Practice Mergers Guidance for Practices o Boundary Change Principles

This could be subject to change with the current CCG reorganisation proposed.

Page 4 of 4

Blank Page

Paper E ELR CCG Primary Care Commissioning Committee Meeting

3 September 2019


Front Sheet

REPORT TITLE: Digital-First Primary Care Policy Consultation – Leicester,

Leicestershire and Rutland (LLR) Response


REPORT BY: Jamie Barrett, Head of Primary Care

SPONSORED BY: Tim Sacks, Chief Operating Officer

PRESENTER: Jamie Barrett, Head of Primary Care

EXECUTIVE SUMMARY: The purpose of this report is to highlight the LLR response to the Digital First Primary Care Policy Consultation document on the proposed options of:

• Out of Area Registration • CCG Allocations • New Patient Registration Premium • Harnessing Digital-First Primary Care to cut Health Inequalities

This is moderated response sent following feedback received from the following as detailed in appendix 1:

• East Leicestershire and Rutland Clinical Commissioning Group (ELR CCG) PCCC

• West Leicestershire CCG PCCC • Leicester City CCG PCCC • LLR GP IT Steering Group • LLR Primary Care Board.

RECOMMENDATIONS: The East Leicestershire and Rutland CCG Primary Care Commissioning Committee is requested to:

• RECEIVE for information.

Page 1 of 2

Paper E ELR CCG Primary Care Commissioning Committee Meeting

3 September 2019

REPORT SUPPORTS THE FOLLOWING STRATEGIC AIM(S) 2019 – 2020: Transform services and enhance quality of life for people with long-term conditions






EQUALITY ANALYSIS An Equality Analysis and due regard to the positive general duties of the Equality Act 2010 has not been undertaken in the development of this report as it is judged that it is not proportionate on the basis that this is a consultation document.

RISK ANALYSIS AND LINK TO BOARD ASSURANCE FRAMEWORK: The content of the report identifies action(s) to be taken / are being taken to mitigate the following corporate risk(s) as identified in the Board Assurance Framework:

BAF 10

Page 2 of 2

Response ID ANON-7RJU-4F5D-U

Submitted to Digital-first Primary Care: Policy consultation on patient registration, funding and contracting rules

Submitted on 2019-08-23 09:42:10

About you

In what capacity are you responding to this survey?

In what capacity are you responding to this survey?:

Clinical Commissioning Group

Other::

Leicester, Leicestershire and Rutland CCGs

Are you responding on behalf of an organisation?

Yes

If you have selected "Yes", which organisation are you responding on behalf of? :

East Leicestershire and Rutland CCG

West Leicestershire CCG

Leicester City CCG

Have you read the document: Digital-First Primary Care: Policy consultation on patient registration, funding and contracting rules?

Yes

Out-of-area registration consultation questions

1a Do you agree with the principle that when the number of patients registering out-of-area reaches a certain size, it should trigger those

patients to be automatically transferred to a new separate local practice list, that can be better connected with local Primary Care Networks

and health and care services?

Yes

Please provide more details::

The agreement to this principle is predicated on high levels of out-of-area registrations being in place and becoming the norm. The LLR system does not believe

that NHS Primary Care services should be commissioned and contracted in a way that encourages and/or supports the normalisation of out-of-area registration.

Given the focus on geographical contiguity and population alignment underpinning PCN development, to enable this major change in patient use of Primary Care

services, the drivers behind PCN development and the maturity of Population Health Management are at risk of being lost.

1b Are there any factors which you think should be taken into account if this option were to be implemented?

Are there any factors which you think should be taken into account if this option were to be implemented?:

The proposal allows for patients to register across large geographical areas, implying a patient could register with a high performing practice with a CCG which

commissions a wide range of services, unintentionally resulting in the creation of inequitable service access and post code lottery.

PCNS are in the early stages of development and will require intensive NHSE&I and CCG help and support to develop their maturity to hold and manage

contracts.

In relation to sub-contracting arrangements, there is an opportunity, through this process, to ensure providers who wish to sub-contract undertake appropriate and

robust due diligence and CCGs are given the authority, if not in the best interest of the patients or the wider health and social care system to be able to refuse any

sub-contracting arrangements.

All plans and contracting arrangements must align to PCN and STP plans.

When discussion catchment areas, NHSE&I must take into consideration large rural areas and not disadvantage patients who reside in these areas.

To support improved practice recording, NHSE&I should consider the development and deployment of a national recoding process and associated coding (as

discussed latter in the consultation document).

Clarity is required as to the use of and storage of paper medical records. Traditionally general practice will hold the patient record, what will happen to this record

under a digitised system?

Paragraph 33 states compel providers, this need to be much stronger, e.g. providers will

CCG funding implications and cost pressures need to be fully understood and mitigated against.

1c Please provide any views you may have about the proposed threshold of 1,000-2,000 patients for the triggering of this localisation:

Please provide any views you may have about the proposed threshold of 1,000-2,000 patients for the triggering of this localisation::

The trigger levels propose are over 20% of the average list size. This could therefore result in over 20% of Primary Care funds across the country being in active

flow between CCGs. With this level of uncertainly for CCGs and practices, planning for step change improvements in integrated local health and social care

provision, would suffer a major step change in difficulty and complexity. This would also impact on overall resilience of local practices if the level/threshold was set

this high.

2 Do you agree that, although the service obligations are not identical, given the small scale of any possible change and the burden of its

implementation, payments for out-of-area patients should remain the same as those for in-area patients?

Yes

Please provide more detail::

Our concern remains that in agreement of any part of this consultation, that the scale of potential change is not small. The obligations are very different and in

noting how an early implementer of Digital-First have directed patients to an overstretched urgent care system when patients cannot travel for face to face

support, if this system of delivering Primary Care was to continue, a very different tariff would need to be introduced.

CCG allocations consultation questions

3a Do you agree with the principle that resources should follow the patient in a timely way where there are significant movements in

registered patients between CCGs as a result of digital-first models?

Yes


The consultation discusses the use of payment in arrears and to prevent unintended cost pressures to CCGs, consideration may wish to be given to an initial front

loading approach, supported by a 6 month balancing exercise. The process should be as easy to calculate and check as possible as if it is too complex it would

be difficult to verify that the correct values have been used. A quarterly adjustment would be sufficient in line with the publication of the quarterly list sizes.

As a concept, yes funding should follow the patient and facilitate choice and access to the best local services. However, in the context of a sudden surge of

out-of-area flow driven by a change in Primary Care delivery models, this should not be supported as the impact on local service delivery is unknown and

unmanaged.

3b For these purposes, how do you think “significant” movements in registered patients should be defined?

For these purposes, how do you think “significant” movements in registered patients should be defined?:

Any change above a historic (previous year) average (mean) natural practice increase/decrease in patients. (approximately 4.7% change in list size).

3c What threshold, if any, do you think should be applied to the flow of out-of-area patients to a CCG before this adjustment is applied?

What threshold, if any, do you think should be applied to the flow of out-of-area patients to a CCG before this adjustment is applied? :

Any change above a historic (previous year) average (mean) natural practice increase/decrease in patients. (approximately 4.7% change in list size). For an

average practice of 9000 patients this is 423 patients.

3d Do you think it is necessary to cap or restrict the maximum deduction from any one CCG on an in-year basis?

Yes


It is vital to manage the change in financial flows between CCGs and systems. The inability to manage the variation and therefore the predictability of finances,

further restricts both planning and innovation in terms of service improvements for patients.

4 Do you agree that a capitation-based approach is the best way to determine the size of the adjustment required per patient or do you

have other proposals?

Do you agree that a capitation-based approach is the best way to determine the size of the adjustment required per patient or do you have other

proposals?:

Yes, an adjustment based on the capitation funding level of the CCG will ensure that the CCG is receiving funding at the correct levels for that CCG to cover all

commissioning expenditure. There may however be a discrepancy between the CCG losing funding and the CCG receiving funds as they may be differences in

funding levels – depending on their distances from the funding target. How will these differences be funded?

If this was to go ahead, then capitation is a sensible way to approach this. However, we would also recommend this is restricted, has a time lapse to enable

CCGs to be able to plan and respond to change and also introduces a reduced tariff to compensate for the reduced service experienced by these patients and the

results overall increase in patient acuity experienced by the original host practices.

New Patient Registration Premium consultation questions

5a Do you agree that we should only pay the new patient registration premium if a patient remains registered with a practice for a defined

period?

No


The premium is in place to support a practice to spend time with patients to understand their longer term and more complex needs and to put the relevant

proactive support in place. This is not offered by a digital practice. Therefore this should not apply to these services and question.

5b What do you consider to be the right period of time for a patient to be registered with a practice for the practice to be paid the new

patient registration premium?

Other (please specify below)

Other::

This again should not be offered to a digital provider

Harnessing digital-first primary care to cut health inequalities consultation questions

6 Do you agree that we should not create a right to allow new contract holders to set up anywhere in England?

Yes


NHS E&I should not create the right for new providers to set up anywhere they wish. The entry of new providers into a CCG / STP locality should be at the

discretion of the local CCG, supported by a national framework. There is a potential risk in providing more services to well-provided-for areas/less deprived areas

otherwise.

7a Do you agree we should seek to use the potential of digital-first providers to tackle the inverse care law, by targeting new entry to the

most under-doctored areas?

No


There is no evidence to support that digital-first services will reduce health inequalities, and could actually inadvertently increase health inequalities to do with the

assumption that everyone can access the internet either from a technology point of view of IT or other literacy point of view. It is our opinion that to assume digital

healthcare is the solution to the Inverse Care Law is unsubstantiated and must be approached with caution. It is also documented in the Ipsos MORI review of

Babylon GP at hand considers that a digital-first approach can create capacity-led demand from the patient group who are already accessing healthcare regularly

and effectively giving further cause for concern about this approach.

7b What methodology could we apply to identify these areas, specifically those that are under-doctored?

What methodology could we apply to identify these areas, specifically those that are under-doctored?:

Use of PHE, ONS and national documentation, e.g. English Indices of Deprivation Data

Ideally a composite measure would be used to take into account a range of metrics e.g. patients per doctor, health inequalities metrics etc. I don’t know if there is

an evidence base for this but would encourage the people developing the methodology to do a review of the evidence/guidance as it may be that something has

already been developed.

7c Do you think that opportunities should be made available to a wider range of local areas in future following any successful evaluation?

Yes


Evaluation would need to consider whether health inequalities are being made worse as a consequence of the services. Does the population accessing the

services reflect the population served? Are there any deprived/vulnerable groups that are ‘missing’ from the accessing services data i.e. are there groups that we

would hope are using these new services but aren’t? And then considering what could be done about that.

The group felt the crux of LLRs response from GPIT steering group should focus on existing and planned Primary Care digital capabilities vs the example core

digital capabilities that are expected of a Digital First Primary Care Practice.

Example Digital Capabilities expected of DFPC provider vs the LLR current position:

• The ability for patients to book appointments online;

o Current LLR position: Online consultations are in progress and this is planned to be 75% coverage across LLR General Practice. Some practices already use

alternatives such as Ask My GP and other practices are using alternative to solution therefore a range of Digital Capabilities are already offered here in LLR.

• An evidence-based symptom checker;

o Current LLR position: The LLR Online Consultations solution has capability to provide a level of algorithm based self-help, however the package has the

flexibility to offer a symptom checker if required.

• Video consultations;

o Current LLR position: Skype for Business is compatible with consumer Skype and therefore could be adapted to use with patients.

• Asynchronous (online) consultations e.g. via text, email;

o Current LLR position: In addition there is the available capability in LLR to undertake consultations via task/ secure email.

• Management of repeat prescriptions online;

o Current LLR position: Already offer the management of repeat prescriptions.

• Full and integrated access to a GP medical record and personal health record.

- Current LLR position: The NHS application offers access to medical health records. In addition Patients can currently access medical information via GP online

or clinical systems online solutions therefore a range of access channels exist. In LLR full integration across Primary and most community services (will be all by

2020) exists through the significant prevalence of a single clinical platform. This provided full access to enable working at practice but also place level so that

PCN’s will be able to operate as a single delivery team early in their development.

There was also a discussion around the fact that in addition, LLR has a good level of take up and consent in line with National and local obligations which further

supports the view that LLR is in a good place to delivery Digital First Primary Care for its population and improve the offer to patients.

Overall the group reflected and concluded that LLR GP practices and PCN’s are in a good place to be offering a digital first provision without the need for external

new entrants to LLR and therefore there isn’t an apparent requirement for providers in the form of a Babylon model in LLR and that we and the National

Programme should be encouraging local practices to become Digital First Providers to shape the local offer.

7d Do you agree with the proposal to require new contract holders to establish physical premises in deprived areas of a CCG?

Yes


Yes, with the provision of fully integrated health and social care services. Funding support for the premises requires clarification and should NOT be funded by the

local commissioning organisation due to the adoption of this policy.

A one size fits all solution to responding to low levels of healthcare access and local deprivation is not supported and requires a proactive solution from local

partners including Primary Care, the CCG and Public Health colleagues.

7e If we require new contract holders to establish physical premises in deprived areas of a CCG, what methodology could we apply to

identify such areas?

If we require new contract holders to establish physical premises in deprived areas of a CCG, what methodology could we apply to identify such

areas? :

Yes, supported by and ensuring clear alignment to PCN and STP plans.

Lower Super Output Areas and consider using the Index of Multiple Deprivation. Also consideration should be given to access (transport options). Does a service

require a car to get to otherwise you’d need two different buses for example.

7f Do you agree with the proposal to require new contract holders to demonstrate that they will bring additional GP capacity to the local

area?

Yes


Yes and also to demonstrate where the clinical teams, including nursing are coming from and that it does not result in the destabilisation of another area. As

above, concern is about where this new GP capacity is going to come from.

7g Do you agree that we should require new contract holders to seek to ensure that their registered list reflects the community they are

serving?

Yes


Yes, definitely. I would like to see consideration given to GPs who are going to end up with a higher proportion of people with multi-morbidity/complex needs and

how to support them.

Local (PCN-based) integration is not yet possible across geographical boundaries. If additional out-of-area patients are added to the list, these patients should be

those who are screened regularly to ensure that they are low-level users of Primary Care with the ability to travel when necessary.

7h Do you agree with the proposed approach to avoiding local bureaucracy by awarding contracts on the basis of satisfying agreed

national criteria?

Yes


The national criteria suggested are not robust enough. “physical care when necessary” is open to too much interpretation and would need to define clearly how

access to face to face appointments is to be delivered in terms of both urgent and planned Primary Care. If not, proactive care for complex needs is at risk in

terms of quality as is the ability for the Urgent Care system to cope with the additional workload.

8 Alongside these potential changes, do you agree that PCNs could become the default means to maintain primary care provision, thus

removing the need for most local APMS procurements?

Yes


Yes, once in line with EU Procurement rules and regulations.

PCNs should be the only means to maintain Primary Care provision. The PCN should be supported to assess and understand the local access needs of the

population and how digital methods can best be incorporated into service provision to meet patients’ requirements.

Blank Page

Paper F ELR CCG Primary Care Commissioning Committee

3 September 2019


Front Sheet

REPORT TITLE: Leicester, Leicestershire and Rutland (LLR) GP Information Management and Technology (IM&T) Work Programme update


REPORT BY: Kirsty Tite, IM&T Work Stream Manager for LLR

SPONSORED BY: Tim Sacks, Chief Operating Officer

PRESENTER: Tim Sacks, Chief Operating Officer

EXECUTIVE SUMMARY: This paper provides an update on the IM&T Work Programme across LLR which supports the delivery of the Local Digital Roadmap and implementation of GP 5YFV requirements. • IM&T August Newsletter (appendix a) • IM&T Tracker (appendix b)

RECOMMENDATIONS: The East Leicestershire and Rutland CCG Primary Care Commissioning Committee is requested to:

• RECEIVE the report.

REPORT SUPPORTS THE FOLLOWING STRATEGIC AIM(S) 2019 – 2020: Transform services and enhance quality of life for people with long-term conditions






1


3 September 2019


Leicester, Leicestershire and Rutland (LLR) GP Information Management and

Technology (IM&T) Work Programme update

Introduction

1. The aim of the GP IM&T work programme is to deliver the IM&T initiatives which support the GP Five Year Forward View (GP5FV) and the Leicester, Leicestershire and Rutland Local Digital Road Map, overseen by the GP IM&T Steering Group. The Steering Group are also the forum to discuss any emerging initiative or development that will impact on GP IT.

IM&T Work Programme

2. Within the programme there are 7 key initiatives which are being delivered in response to national NHS E GP IT framework mandates, GP5FV or those locally defined strategic objectives of the LDR (Record sharing, Supporting pathways, Digital self-care and BI& research).

a. Online Consultations b. GP Clinical System Migration c. Electronic Record Sharing d. Flagging and notifications e. Clinical System Optimisation f. Patient WIFI g. Self-care and mobile apps

3. Progress updates and current position are given for each project on the IM&T

tracker and key points for information covered in the items for escalation to PCCC section of this paper.

Items for escalation from the LLR GP IM&T Steering Group 8th August 2019

Key Update for Information

4. eConsultations. Local configuration of a minimum standard is underway

which incorporates minor ailment self-help information and urgent and emergency care LLR messages.

5. An engagement event for the 13 early adopter practices held on 15 August 2019 and roll out to these practices will follow the event. A further event for the remaining practices will be held in early autumn.

6. System Migration. The position remains the same previously reported as are

still awaiting the outcome of the revised capital funding bids for 19/20 funding. Practices who have expressed interest will be kept informed and we will progress with migrations as and when we are able based on funding.

2


3 September 2019

7. Electronic Record Sharing. All Leicester, Leicestershire and Rutland Council staff involved in the LLR Proof of Concept for Summary Care Record into Adult Social Care are enabled to view SCR. Following a review of the initial feedback the pilot will be extended to other staff that will benefit from SCR access.

RECOMMENDATIONS

The East Leicestershire and Rutland CCG Primary Care Commissioning Committee are requested to:

• RECEIVE the report for information.

3

Paper F - Appendix AELR CCG Primary Care Commissioning Committee

3 September 2019

Page 1 of 4

IM&T Jul-19No. Project Areas Lead Project Summary Current Position July Key Actions and Outputs for next

monthKey Actions and outputs for next quarter

Risks and key issues including mitigation plans Items for Escalation to LLR GP IM&T Group

Action required from LLR GP IM&T Group

Previous month rag status

Current month rag status

Online Consultations

As part of the General Practice Forward View, NHS England has allocated £45 million to support the implementation of online consultation systems, with the aim of improving access, improving patient experience, whilst reducing workload and freeing up GP time. This is a one-off transformation fund being provided and overseen as part of the General Practice Forward View, and does not constitute a commitment to ongoing funding after the three year period. Ongoing allocation of funding after year 1 will depend on evidence of uptake by practices and focused actions to realise the benefits of this approach for patients. Participation is optional for practices, but it is hoped that the majority of practices will benefit from the fund over the three year period and it is expected that all CCGs submit coordinated plans for this funding.The fund is to be used towards the costs of providing patients with the facility to conduct a clinical consultation with their GP practice online. The CCGs will purchase licences on behalf of their practices for a hosted service on a per-patient basis. The funding may be used towards the cost of services or software for online systems and to support the introduction of the new way of working, for example through backfill of staff time, engagement with patients or provision of project management support.•Where systems are already in place, this funding may be used to increase take-up by patients or used in other ways to derive benefits from online consultations. In the event that the CCGs anticipate an underspend of this fund, NHSE recommend that practices are offered support for implementing new ways of working that make best use of their online consultation system.

2017/18 FundingWEST CCG £95,715.69 CITY CCG £97,434.64 ELR CCG £81,703.53 Total for LLR £274,853.86

2018/19 FundingWEST CCG £130,000CITY CCG £135,000 ELR CCG £110,000 Total for LLR £375,000

Project spend to date Project Manager costs £24,375.00

Remaining funds for the project £625,478.86

Kirsty Tite1 amberamber• Locally agreed the minor illness customisation of the system for LLR. Online Consultation supplier is making requested amendments to the system

• Urgent Care are currently reviewing the flagging and wording which are standard within the system to ensure consistency with current local LLR policy

• 12 Early adopter practices (4 per CCG have been invited to attend a launch event in mid August

• Skype for business will be implemented to early adopters to allow for training and meetings to be held between the practice and the supplier

• Confirm roll out plan for LLR

• Confirm local requirements for the flagging within the system and supplier to amend

• Meet with Mids and Lancs colleague to discuss requirements for EIA

• Confirm if a DPIA is required for Skype for business for training and MDT use

• Confirm roll out plan for LLR

• Hold early adopter launch event

• Plan and hold webinars for early adoptor sites

• Begin engagement with PPG and HealthWatch

• Continue engagement with practice for rollout

• Continue engagement with PPG and HealthWatch

•Practices implement non approved IT solutions. No evidence of non-approved solutions in use across LLR. Risks of using non-approved systems to be outlined

• Lack of engagement by practices. Good engagement so far, key benefits to be identified from early adopter practices

• Change in the way the funding for Online Consultations is allocated for 19/20. Carry out financial modelling to identify committed spend

• Delays to contract sign off by CCG's


3 September 2019

Page 2 of 4

No. Project Areas Lead Project Summary Current Position July Key Actions and Outputs for next month

Key Actions and outputs for next quarter





SCR into Adult Social Care -

• Rutland Council and Leicestershire County Council have completed refresher training and the PoC teams all have access to SCR.

Record Flagging -

• LHIS are currently looking at flagging for records for patients who are difficult to intubate and those who are steroid dependent. Tirath Singh is the lead for this.

• Outstanding ISAs to continue be chased by all CCGs for Search and Reports

• Investigate the possibility of increasing Leicester City PoC to include the Emergency Out of Hours team that covers LLR

• NHS D to provide further training and support to privacy officers if required

• PoC teams to collect benefits data post go live

• Provide a report to NHS D SCR Expert Committee to obtain authority to proceed with full roll out

• Leicestershire County Council continue to review the options available for a longer term solution for the VDI issue

• Provider low usage of SCR, until a large proportion of the patient population has consented to SCR v2.1.

• Obtaining up to date figures for the number of SCR consents captured, still not possible for some practices due to not signing the revised Search and Reports ISA

• NHS Digital would like us to go through their advisory committee with a proof of concept for SCR and Social Care. Approval to proceed following the PoC could present delays in the roll out to remaining LA teams

None amber amberNone3 Electronic Record Sharing & Flagging and Notifications

Kirsty Tite In 2016/17 the three Leicester, Leicestershire and Rutland (LLR) CCGs successfully bid for funding from the Estates and Technology Transformation Fund (ETTF) to enable the implementation and delivery of interoperable record sharing across LLR with Health and Social Care Colleagues. It was agreed that Summary Care Records v2.1 will be the record sharing tool of choice.

The project will be split into 3 phases:• Phase 1 relates to the Primary Care roll out of Summary Care Records v2.1 plus the locally developed Integrated Care Planning (ICP) clinical template, which enables the feed from GP systems to SCR for care plan patients • Phase 2 will look at streamlining and improvement of the Special Patient Note process, and the challenge of encouraging Provider organisations to use SCR more readily• Phase 3 will facilitate the introduction of SCR across Adult Social Care in LLR.

Running in parallel is the task of promoting and gaining patients explicit consent to sharing their enhanced Summary Care Record (SCR v2.1), which will enable health care professionals access SCR v2.1 and deliver the most appropriate care to patients.

2 System Migrations

Kirsty Tite This project will support our aspiration to move to one single platform (one clinical system) across LLR and contribute towards key deliverables within the STP, LDR, Integrated Locality Teams, further progress sharing of electronic records and interoperability.The CCGs were successful and received £470K from Estates and Technology Transformation Funding to financially support practices in ELR and WL CCG during 2017/18 who are interested in migrating clinical systems from EMIS Web to SystmOne. ELR and WL CCG have both bid for funds to migrate 4 practices each during 19/20.

• All 18/19 migrations are now complete and 88.6% of LLR patients are registered at a SystmOne GP practice.

Current EMIS WEB position remains the same:

ELR CCG - 3 Practices have had demonstrations but not committed to migrations 8 Practices in total with no migration booked (Including the 3 who have had demos)

WL CCG - 1 practice requested a demo3 practices requested migration8 Practices in total with no migration booked (Including the 3 who have requested migrations)

LC CCG -1 Practice in total with no migration booked

• Dependent on securing funds from the revised bid submission

• The ability to progress with these migrations are based the outcome of the 19/20 capital funding, we await NHS E on this.

• EMIS are promoting interoperability which promises to bridge an important gap for EMIS practices with TPP, however this is not a fully functioning or interoperability solution. EMIS have been demonstrating this with practices so they can see what it will/won’t offer. Still in pilot at one site and no date for roll out

• Unable to book migrations for practices who have confirmed that they would like to migrate as we are awaiting the outcome of the revised submission

• GP Connect has been approved for roll out

Unable to book migrations for practices who have confirmed that they would like to migrate due to awaiting the outcome of the revised bid submission

For information red red


3 September 2019

Page 3 of 4

No. Project Areas Lead Project Summary Current Position July Key Actions and Outputs for next month

Key Actions and outputs for next quarter





4

NoneNoneNone5 Self care and Mobile Apps

East Leicestershire and Rutland CCG (acting as STP lead for all 3 Leicester Leicestershire and Rutland CCGs) has submitted a bid for Technology Enabled Patient Self-Management Scheme under the Estates and Technology Transformation Funding to financially support implementation across General Practice in Leicester, Leicestershire and Rutland.This project align to the 3 CCGs vision as outlined in the Local Digital Roadmap (LDR) for IM&T and Sustainability and Transformation Partnership which is to enable a consistent approach across Leicester, Leicestershire and Rutland (LLR) of using remote device technology, to empower our patients with long term conditions to self-manage, improving their experiences and outcomes. The solution will look at a range of devices to capture the relevant clinical information which will be shared electronically with the GP directly into their clinical system. Self-Care devices and Mobile Apps project is one of the priorities in LLR Sustainability and Transformation Partnership (STP) over the next two financial years. This project is about investment in self-care devices for patients to monitor their vital statistics to help aid decision support for the patient and clinical staff. Integrated mobile apps will help with well-being, self-care, transactional services, and access to the patient records, and management of medication, communication to and from healthcare organisations, patient information, and health service navigation.

• Work stream not commenced

System Optimisation

Kirsty Tite This Project will allow practices to work more efficiently, reduce workload, the ability to work atscale across practices, localities, Integrated Team and Federations. It will be delivered through additionaltraining and support to all practices across LLR. This will be via a number of routes such as at individualpractices, groups of practices/locality training sessions, or LHIS workshops.Benefits include:• Reduction in practice workload and pressures• Enable practices to work at scale• Support whole systems efficiency

The content of the training that is offered from LHIS through LMS was reviewed and the 3 CCG IM&T Leads agreed that the content was still current and should remain the same. One half day practice based training on system optimisation will be offered to all LLR practices.

•LHIS continue to provide a half day site based training per practice as well as the class based training that is available through the LMS website

• Carry out a review of the numbers of staff booking onto the LMS training and practices who have booked the practice based training following the newsletter reminder. Review any trends or patterns and feedback.

greenNone None green

IM&T Apr-19No. Project Areas Lead Project Summary Current Position April Key Actions and Outputs for next month Key Actions and outputs for

next quarterRisks and key issues including mitigation plans Items for Escalation to

LLR GP IM&T GroupAction required from LLR GP IM&T Group


Current month rag

green6 Patient Wifi Phil Hodson

As part of the GP Five Year Forward View, the CCGs now have commissioning responsibil ity for the provision of WiFi services that meet the needs of general practice.

Three types of WiFi have to be provided; which are Corporate use, Guest Wi-Fi, Patient WiFi and medical devices. The first two WiFi services are already in existence after a Capital Investment in 2013 between the CCGs and LPT. This was further enhanced in 2014 by adding the larger care homes to the network.

There is now requirement to provide only the Patient WiFi and medical devices access which is a commitment in the General Practice Forward View and is backed up as a “core and mandated” requirement in the GP Operating Model 2016-18.

NHS England has committed to providing revenue funding to CCGs to support delivery in years 1 and 2.

WiFi to be made available to patients in all GP surgeries by 31/12/2017.

The project must be delivered as part of a National Directive and with the guidance issued must meet the following project outcomes:-

• All sites where GPs provide a service from must offer patients free Wi-Fi access.• Bandwidth to offer a good end user experience scaled to l ikely concurrent connections.• Patient Wi-Fi must be up and running by 31st December 2017.• It must use 802.11 and WPA2 compliant.• Publish a SSID of “NHS Wi-Fi” at all sites with a strong signal in patient waiting areas.• Offer a landing page which can be tailored for local messages by the Practice, CCG and as a service by LHIS staff.• Collect authentication user information via the landing page.• Offer assistance to patients on common trouble shooting problems.• Do not allow patient WiFi traffic to degrade GP WiFi traffic and N3 access.

• Centre Surgery in Hinckley are now live due as part of the secondary care roll out

• All practices in LLR are now live with patient WiFi

• None project complete • Project complete None None None green

1

IM&T Update Leicester, Leicestershire and Rutland

August 19 Volume 1, Issue 8

PCN Email Distribution Groups 2

PCN IT Solutions 3

PCN IT Solutions—Next Steps 4

Cancer Care Review template 4

SNOMED 5

SKYPE for Business 5

Online Consultation Update 5

Reminder – New clinical PRISM letter template - EMIS practices

5

Online appointments 6

SCR Additional Information (SCR 2.1) Reminder

6

A Partnership of Clinical Commissioning Groups:

East Leicestershire and Rutland CCG Leicester City CCG

West Leicestershire CCG

LLR PCN IT Discussion Afternoon

Inside this issue:

Leicester City and South Coroner - Turning off fax machine

We have been informed by the Leicester City and South coroner’s office that from 1st August, they will be turning off their fax machine. All correspondence to the Leicester City and South coroner’s office including GP summaries will need to be emailed to [email protected].

Practices will need to ensure they send their request summaries and reports for the Leicester City & South coroner’s from the practice nhs.net

account. Email requests from the Coroner will also go to the practice generic nhs.net account.

If you need reminding of your practices nhs.net account details, please contact the LHIS service desk 0116 2953500.

If you are not situated in the area of Leicester City and South coroner, no further action is required.

With the use of fax machines across the county becoming an increasingly unpopular communication route, Spire have been granted an “nhs.net” email address. This email address will enable surgeries to send referrals for both self-funding and insured patients in a quick and easy, safe and secure manner.

Similarly to the process the referrals that are sent via Spire Connect or fax, on receipt of the referrals the team will endeavour to contact the patient that day to organise an appointment at a time that suits them.

The address for our new inbox is; [email protected]. If you have any questions in regards to the inbox or referring into Spire, please feel free to contact them on 0116 265 3695 or our Outpatient Bookings Team on 0116 272 9005.

*Please note that for imaging referrals we do require a GP signature and all NHS referrals must be sent through the NHS e-referral service.

Spire NHS.net email address

Please report all ICE technical issues to the LHIS helpdesk. Following this process enables LHIS to record and monitor the issues, raise through the appropriate channels at UHL and ensure that issues are resolved.

Please call LHIS service desk on 0116 295 3500

Reporting UHL technical issues

mailto:[email protected]


2

As part of the ongoing work for PCNs in LLR, LHIS are in the process of setting up the following email distribution lists for each of the PCNs, in the format below.

PCN Name PCN (All)

PCN Name PCN (GPs)

PCN Name PCN (Practice Managers)

PCN Name PCN (Nurses)

PCN Name PCN (Pharmacists)

PCN Name PCN (Admin)

PCN Name PCN (HCAs)

LHIS will be adding all the current email practice groups that are part of the relevant PCN group into these new ones.

Email clarification will be sent when the groups are ready for use.

Ongoing changes to PCN level distribution list will be maintained by nominated administrators within each PCN, who will be responsible for adding/removing staff at PCN level.

In addition to the PCN distribution lists there will also be CCG level PCN groups (as below) which corresponding CCGs will use to send communications in the future.

Leic City CCG PCN (All)

Leic City CCG PCN (All Clinical Directors)

Leic City CCG PCN (All Practice Managers)

Leic City CCG PCN (All GPs)

Leic City CCG PCN (All Nurses)

Leic City CCG PCN (All Admin)

Leic City CCG PCN (All Pharmacists)

Leic City CCG PCN (All HCAs)

Leic City CCG PCN (All Social Prescribers)

Thank you to those of you that have sent through your nominated administrators, for PCN email groups, however we still have a few outstanding, (Belgrave PCN, Leicester City South PCN, Market Harborough & Husband Bosworth PCN, Soar Valley PCN). These PCNs are requested to forward the names of the nomi-nated administrators asap to [email protected].

It is advisable that at least 3 staff from difference practices within your PCN should be nominated to ad-minister (to be owner of) these email groups, in order to have sufficient cover in managing these groups. (The administrators, will not automatically receive e-mails sent to the groups or sub-groups).

Can we also please remind practices that they need to ensure email distribution lists at the practice level reflect current practice details, as there are many distribution list at practice level that refer to GPs that either are no longer working at that practice or have retired. Practices also need to ensure all staff with the C code email of their practice are still employed and working at the practice. Any changes should be reported to LHIS to ensure the list is current and up-to-date.

If you require any further information please email [email protected]

PCN Email Distribution Groups



3

LHIS have been exploring an IT solution for PCNs. The proposed solution is a SystmOne GP Hub, which will work for where all practice are on SystmOne and those that have a mixture of SystmOne and EMIS Web practices. Below are some screen shots of what they can and can’t currently do:

Shared Admin PCN Hub Model: All SystmOne PCN

Shared Admin PCN Hub Model: Mixed SystmOne and EMIS PCN

Those with all on SystmOne had much better interoperability and record sharing than those with mixed clinical systems.

LHIS have presented the model at last PCN event on 25th July 2019, which was well received. Currently two PCNs are piloting the solution and will assist in developing the model further.

S1/S1 PCN environments are covered under the current LLR EDSM ISA, whilst S1/EMISWeb mixed are not. Until the mixed ISA is signed off, we are not in a position to do pilot testing work in mixed environments, although some explority work has been done on system functionality. The LLR ISA is currently being re-viewed to incorporate EMISWeb practices.

PCN IT Solutions

–

–

–

Cannot do :

Pathology requesting problematic -

should be done from GMS practice

Referrals should be made from the

GMS practice – no ERS

PCN Hub cannot run reports on PCN

patient EMIS cohort

PCN Hub cannot stop, amend or Issue

repeats for EMIS GP Practices

EPS – DUE FOR RELEASE END OF

AUGUST 2019

4

Cancer Care Review template LHIS have been working closely with Macmillan to create a new Cancer Care Review Template that is available to all practices in LLR. The new resource has been designed to help bridge the gap between the care provided to patients diagnosed with Cancer in secondary care and primary care. The Cancer Personalised Care Plan is designed to be patient led and we believe this has been achieved with a new template.

Alongside a new template, we have designed reports to help practices identify patients eligible for a Cancer Care Review.

Thomas Smart and James Goode are currently booking their first practice visits to demonstrate this new resource to practices. While in practice they will also be discussing Enhanced Summary Care Records and demonstrating a new tool to make the documentation of patient consent easier for clinical and non-clinical members of staff and also to identify patients that could be registered as a Carer.

If you have any further questions or would like to book your practice visit, please contact either:

[email protected] or [email protected].

Electronic Repeat Dispensing The 2019/20 GMS Contract builds on the previous EPS requirements and the links below contain infor-mation on benefits, patient promotion and identifying patients. 2019/2020 requirement: Offer and promote electronic ordering of repeats and using electronic repeat dispensing for all patients for whom it is clinically appropriate by April 2020 EPS Benefits and updates on Phase 4 developments https://www.nhsbsa.nhs.uk/pharmacies-gp-practices-and-appliance-contractors/prescribing-and-dispensing/electronic ERD Benefits and identifying patients for inclusion https://www.nhsbsa.nhs.uk/pharmacies-gp-practices-and-appliance-contractors/prescribing-and-dispensing/electronic/electronic NHS Digital guide to maximising repeat dispensing including a toolkit for prescribers and dispensers to make the most of electronic repeat dispensing https://digital.nhs.uk/services/electronic-prescription-service/electronic-repeat-dispensing-for-prescribers/maximising-electronic-repeat-dispensing

PCN IT Solutions— next steps Aegis PCN will be presenting the findings back at the next events, which is on:

Thursday 29th August at 9.30am to 12.00pm. The meeting will be held at Gwendolen House,

Gwendolen Road, Leicester, LE5 4QF in the Cloud Room.

Please note there is limited parking at Gwendolen house, however there is a park and display car park next door on the grounds of the General Hospital

If you wish to attend please send an email to confirm your attendance to: [email protected]



https://www.nhsbsa.nhs.uk/pharmacies-gp-practices-and-appliance-contractors/prescribing-and-dispensing/electronic

https://www.nhsbsa.nhs.uk/pharmacies-gp-practices-and-appliance-contractors/prescribing-and-dispensing/electronic

https://www.nhsbsa.nhs.uk/pharmacies-gp-practices-and-appliance-contractors/prescribing-and-dispensing/electronic/electronic

https://www.nhsbsa.nhs.uk/pharmacies-gp-practices-and-appliance-contractors/prescribing-and-dispensing/electronic/electronic

https://digital.nhs.uk/services/electronic-prescription-service/electronic-repeat-dispensing-for-prescribers/maximising-electronic-repeat-dispensing

https://digital.nhs.uk/services/electronic-prescription-service/electronic-repeat-dispensing-for-prescribers/maximising-electronic-repeat-dispensing


5

We have 13 Online Consultation early adopter practices within LLR and are holding an engagement event for these practices on 15th August 2019. Our aim is to roll out to the remaining practices shortly and will be holding an engagement event in the autumn.

If you have not yet registered your practice interest or would like more information please email [email protected]

Details of the Engage Consult the procured solution can be found at:

https://www.youtube.com/watch?v=cofJaGuYOF0&t=348s

SNOMED

EMIS

Pilot work continues to go well, with full deploy-ment now due to complete in early Septem-ber. Users are encouraged to review the EMIS guide available on the system prior to their local migration.

TPP

SNOMED CT became the default terminology in SystmOne on 25 June, with no issues reported from the change.

SKYPE for Business

We are pleased to inform you that the CCG’s have secured the funding to purchase a number of Skype for business licences for GP practices. Skype will be required for the training and ongoing support of Engage Consult and we will look to implement this alongside the Online Consultation System.

SKYPE will also be available to any practices who are not utilising the CCG procured Online Solutions sys-tem.

A survey will shortly be sent to practices to enable us to ascertain the numbers of webcams currently within LLR GP practices.

Online Consultation Update

Can you please ensure that you have the most up to date PRISM clinical letter template on EMIS (this was updated last month) and that you have re-moved any earlier versions.

The most recent version can be downloaded from PRISMweb here (or search for EMIS template on PRISM):

https://prism.leicestershire.nhs.uk/ViewDocument.aspx?doc=213 (this is V4 of the PRISM clinical template letter).

If you require any additional support please call the PRISM team on 0116 295 3500 Option 7 then 1.

Reminder – New clinical PRISM letter template - EMIS practices

https://prism.leicestershire.nhs.uk/ViewDocument.aspx?doc=213

https://prism.leicestershire.nhs.uk/ViewDocument.aspx?doc=213

6

Online appointments

If you have any feedback or questions relat-ing to anything you have read in this newsletter or any other IM&T issue please contact Kirsty Tite, IM&T Workstream Manager

[email protected]

Feedback or Questions?

Since 1st July 2019 practices have been required to make 25% of appointments bookable online. In order for these appointments to be utilised it’s essential that patients have access to online services. Currently 33/57 city practices, 18 West practices and 23 East practices have more than 20% of their patients regis-tered to use online services. It’s therefore important that the other practices put plans in place to in-crease patient uptake of online services to ensure they can become compliant with the new contract re-quirement.

Practices are advised to support patients struggling to log in to their accounts, including providing infor-mation on how to reset passwords. Advice on how to encourage more patients to actively sign up to use online services can be found at https://www.rcgp.org.uk/patientonline and https://www.england.nhs.uk/gp-online-services/

We would like to thank you for all of your work on consenting patients for SCR additional information. Please can we remind practices to continue to capture patient consents, as we approach flu season this could be an ideal opportunity. Currently 18.5% of all LLR patients have an SCR 2.1, this is 4 times above any other STP.

Positive feedback has been received from the SCR into Adult Social Care project. With reports that access to the additional information reducing the need to contact the GP practice and reducing the delay in care.

Last month information on searches to identify moderate and severe frail and EoL patients as well as a patient information video was circulated with the newsletter.

Links to patient promotional material :

Printable poster for GP Surgeries:

https://digital.nhs.uk/binaries/content/assets/legacy/pdf/g/a/scr_poster_gp.pdf

Posters for GP waiting room screens

https://digital.nhs.uk/binaries/content/assets/legacy/powerpoint/m/7/scr_a_e_slide.pptx

Patient information leaflet

https://digital.nhs.uk/binaries/content/assets/website-assets/services/summary-care-record/scr_trifold_leaflet-170918.pdf

SCR Additional Information (SCR 2.1) Reminder

https://www.rcgp.org.uk/patientonline

https://www.england.nhs.uk/gp-online-services/

https://www.england.nhs.uk/gp-online-services/

Meeting Primary Care Commissioning Date Tuesday 3...

Documents

Transcript of Meeting Primary Care Commissioning Date Tuesday 3...