Clinical Commissioning Group (Ccg)
CLINICAL COMMISSIONING GROUP (CCG)
Minutes of the Primary Care Co-Commissioning Committee (PCCC)
held on Tuesday 15th November 2016 at 12.30 p.m.
in Meeting Room 2, Blackburn Central Library,
Town Hall Street, Blackburn. BB2 1AG
PRESENT:
Mr Graham Burgess Chair Blackburn with Darwen CCG – Lay Member
Dr Nigel HorsfieldLay Member - Clinical Advisor (Retired)
Mr Roger ParrChief Finance Officer
Dr Malcolm Ridgway Clinical Director of Primary Care & Quality
Mr Paul HinniganLay Member - Governance
Dr Geraint Jones Lay Member – Secondary Care Doctor (Retired)
Mr Peter SellarsPrimary Care Transformation Manager
IN ATTENDANCE:
Dr Stephen GunnPrimary Care Development Lead
Mrs Sarah DansonNHS England
Mrs Sheena Wood NHS England Clinical Leadership Manager
Mr Joe SlaterLay Person Representative
Mrs Catherine LawlessPrimary Care Support Officer (minutes)
Min No:9.01 / Chair’s Welcome
The Chair welcomed everyone to the meeting and gave a short brief with regards to thecontent of the agenda and housekeeping.
9.02 / Apologies for Absence and Confirmation of Quoracy
Mr Gifford Kerr Public Health Consultant
Mr Stephen Gough NHS England
The meeting was confirmed as quorate.
9.03 / Declarations of Interest
The Chair asked members if they would like to declare any Conflicts of Interest (CoI) relating to items on the agenda. The Chair reminded those present that if, during the course of discussion a CoI became apparent, it should be declared at that point.
9.04 / Questions from Members of the Public
No questions had been received from members of the public.
9.05 / Minutes of the Meeting held on 20th September 2016
The minutes of the previous meeting were reviewed and accepted as an accurate record, with an exception that actions 9.07, 9.08 and 9.09 to be added to action matrix.
ACTION: Mrs Lawless to coordination the additions.
RESOLVED: That, following the above amendments being made in line with discussions, the Minutes of the Meeting held on 20th September2016were approved as an accurate record.
9.06 / Matters Arising/Action Matrix
Items to be discussed as agenda items.
The action matrix was reviewed and completed actions were accepted as such by the Committee.
Item 7.14 – Legal Costs –Mr Roger Parr has advised that there was no budget allocated for primary care legal costs by NHS England and that the CCG going forward would have to fund any legal costs throughits running cost allowance. Mr Parr further commented that NHS England is to refresh the Memorandum of Understanding around this area. PCCC members raised concern that the CCG was not aware of this when it assumed delegated responsibility for the Co Commissioning of Primary Care Services and that the issue around legal costs should be discussed further and placed on the CCG’s Corporate Risk Register.
ACTIONS:
- Mr Parr to assess the issue around legal costs to ascertain whether it should be placed on the CCG’s Risk Register.
- Mrs Sarah Danson to raise the concern expressed by the PCCC to NHS England
- Mr Parr to raise at the Lancashire Chief Finance Officers’ meeting, and also if necessary for Amanda Doyle to raise at National Commissioners meeting.
9.07 / Revision of the Terms of Reference
Mr Parr advised that Mrs Claire Moir, Governance, Assurance and Delivery Manager, has been in discussionswith NHS England with regards tothe CCG’s Constitution. NHS England has flagged an issue around thecurrent definitions/roles of the CCG’s lay membership. NHS England has advised that the CCG should reviewlay membership as a whole and in particular in relation to lay members’ attendance at the CCG’s corporate meetings as indicated in the Terms of Reference.Mr Parr advised that until the CCG’s issues around definitions/roles are resolved between lay member roles and clinical/nurse rolesthe current Terms of Reference for the PCCC will be used in shadow form until further discussions are held.
ACTION: Deferred until further discussions. Current Terms of Reference to be used in shadow form.
RESOLVED: That the PCCC received the Terms of Reference and noted the recommendations from NHS England
9.08 / Primary Care Update Report: -
Mr Peter Sellars asked the Committee to note the contents of the Primary Care Update Report and drew the Committee’s attention to key points of information:
QOEST – The CCG have now received the Federations Project plans around Quality, Access and Sustainability. There is to be a meeting with CCG colleagues looking at the plans to give additional feedback with a plan for early January implementation.
Primary Care Group - Estates & Technology Transformational Fund (ETTF) Mr Sellars advised that the three Blackburn with Darwen project initiation documents against the ETTF which were announced by Mr Simon Stevens, Chief Executive, NHS England, have all progressed to the project initiation document stage. Further information from NHS England is to be advised around the next stages. Mr Sellars further advised that the funding arrangements have changed substantially from the initial 66% grant, and asked the PCCC to note that the fundinghas now been reduced to 20-40% grant. It was noted that the West locality practices are aware of the reduction in grant monies, to which there are ongoing discussionsto ascertain whether they wish to continue. Mr Parr advised that the paper around the West bid would be brought back for the Committee’s attention when the West Locality practices seek more financial advice and receive more clarity. It was further noted that the CCG’s financial commitment could now change and that the CCG may be liable as the rent rebate will go, to which the CCG will be potentially liable for a greater figure. Mr Parr further advised that once clarity from the West locality practices has been given a business case wouldbe brought to the Committees attention around the CCG’s financial commitment.
APMS: The procurement programmehas now been switched back on and is currently in theInvitation To Tender Stage. The timeframe for mobilising the new combined Bentham Road/Waterside contract is April 1st 2017.
PMS: Mr Sellars advised that 11 of the contract variations have all been signed off.
Mr Sellars advised that the remaining practice is shortly to sign off the contract variation and informed the PCCC that the delay was around the change ofnames on the document.
Good News – Prescribing – Dr Malcolm Ridgway advised that the Medicines Management Team has recently been nominated for seven awards and won four at an event in London. The communications team are to do some public relations around this.
9.09 / APMS Practice Temporary Arrangements – Item deferred to Part 2
9.10 / Blackburn with Darwen CCG Draft Estates Strategy
Dr Stephen Gunn provided committee members with version 3 of the Blackburn with Darwen Estates Strategy and requested that the Committee note that their previous comments have been taken into consideration when reviewing the Strategy. Dr Gunnasked the PCCC to note the additional information on pages 8-13 around ifthe Estates and Technology Fundis withdrawn what actions will be taken to mitigate the risks.
Questions and answers followed.
Mr Paul Hinnigan asked who monitors the progress on the action plan and the next steps to which it was agreed that it would be the PCCC.
RESOLVED: That the PCCC ratified the Blackburn with Darwen Estates Strategy.
9.11 / General Practice (GP) visits and the Care Quality Commission (CQC)
Appendix 1 – CQC Provider handbook
Appendix 2 – CQC Guidance – Special Measures
Appendix 3 – Family Practice Report
Dr Ridgway provided the PCCC with an update regarding the processes followed by the CCG to address any contractual issues that may arise at practice level. It was noted that the primary care quality team carry out yearly quality visits which monitor clinical outcomes and patient experience and also includes practice development and looks at areas to share good practice.
Following the visits,practicesare given a detailedreport, which includes any recommendations and actions.This information may also help inform next year’s QOEST plans and may also pick up any contractual issues.
Each practice produces an action plan which is monitored by the CCG on a yearly basis.
Dr Ridgway further advised that with regards to the Family Practice the CCG had informed the CQC that following the CCG’s quality visit,it had picked up on a number of areas were the practice were the main outliers in certain areas and requested that the CQC visited the practice first.
Dr Ridgway further outlined the processes the CQC uses when carrying out practice visitsand that from thisit produces a report which is given to the practice concerned. The reportincludes arating; outstanding, good, requires improvement and inadequate.
Any Practice that is given an inadequate rating does receive a further visit from the CQC and if it is still not up to standard could have its registration removed.
Dr Ridgway further advised that the CCG’s role is to support the practice throughout the visit and asked the PCCC to notethat the Family Practice have already put steps in place to address some of the CQC inspection findings and to improve its practice rating.
RESOLVED: That the PCCC agreed to receive further reports.
9.12 / Zero Tolerance Scheme
Mrs Sheena Wood provided the PCCC with background information with regards to the Zero Tolerance Scheme, which was to accommodate patients who have exhibited challenging and sometimes violent behaviour when visiting their GP practice.
Mrs Wood asked the PCCC to note the contents of the paper which is to approve and sign off the decision to procure the service from a provider via an APMS contract agreementin accordance with the Zero Tolerance requirement, and also to note the progress to date and to consider the proposed service delivery model based on a single point of access hub model, and that it will operate across identified sites within the five local development plan areas.
Members raised concern around the numbers of current patients identified across Blackburn with Darwen who have registered on the zero tolerance patient scheme. Dr Ridgway provided a rationale as to why patients could be registered at Blackburn with Darwen practices. The PCCC noted that NHS England is managing the zero tolerance scheme on the CCG’s behalf andis part of the GP contract. It was noted thatthere will be no cost pressures to the CCG and that the scheme will be fully funded for the next five years.
RESOLVED: That the PCCC noted the contents of the report and agreed to continue to support the decision to procure the zero tolerance scheme.
9.13 / Vulnerable and General Practice Resilience Programme Update:
Mrs Danson provided the PCCC with a verbal update in relation to the vulnerable and general practice resilience programmes and advised that the PCCC that all practices apart from oneacross Lancashire have taken up the offer of support.A panel has met to look at the bids from practices and that all practices have been notified of the outcome of their bids.
The Primary Care Transformation Team will be contacting each CCG with the outcome of their bids for each area and are also currently picking up any queries raised from practices. In terms of the vulnerable practice scheme any practice that have requested a diagnostic have had their bids approved and have been notified to make instruction to their chosen provider to which the payment will go direct to the practice.
Memorandums of Understanding have been sent to the practices which have been identified as vulnerable to which practices will have to sign and once signed the diagnostic payment will be released. Dr Ridgway further commented that the schemes are important schemes designed to support practices that are struggling for all different reasons and our designed to get sustainability in the system and to help stop general practice failing.
RESOLVED: That the PCCC noted the update of the Vulnerable and General Practice Resilience Programme
9.14 / eDEC Submissions:
Mrs Danson asked the PCCC to note the contents of the report which provides an update from theeDEC annual practice submissions in relation to their negative responses to questions relating to contract requirements and also to the CQC registration requirements.
It was noted that 13 of the practices have been contacted with regards to their submissions to which 11 practices have responded with the necessary information. Mrs Danson asked that that the PCCC agree to NHS England’s recommendation in issuing a contractual notice to the remaining 2 practices who have not responded. Mrs Danson further commented as part of the Memorandum Of Understand with NHS England they would draft the remedial notices on behalf of the CCG.
Questions and answers followed.
RESOLVED: That the PCCC agreed to NHS England serving the remedial notices.
9.15 / Financial Summary
9.16 / Any Other Business
9.17 / Date and Time of Next Meeting
The next meeting of the PCCC will be held on Tuesday 15th November 12.30 – 2.00 p.m.in Meeting Rooms 2 Blackburn Central Library, Town Hall Street, Blackburn BB2 1AG.
The Chair thanked everyone for their attendance and input and the meeting closed.
EXCLUSION OF THE PRESS AND PUBLIC – ‘That representatives of the press and other members of the public be excluded from the remainder of the meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest’ (Section1(2)Public Bodies(Admission to Meetings)Act 1960).
Signed ………………………………………………….. Chair ……………………………………….……..Date
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