Meeting of NHS Bristol CCG Primary Care Joint Commissioning Committee Meeting

Meeting of NHS Bristol CCG Primary Care Joint Commissioning Committee Meeting Minutes of the meeting held on Tuesday 15 March 2016 at 2-3.30pm CCG Conference Room Minutes Present: Tara Mistry Lay Member for PPI, Bristol CCG (Chair) Dr Martin Jones Bristol CCG Chair, Bristol CCG Uli Freudenstein Bristol CCG Governing Body Member & North & West Locality Executive Group Member, Bristol CCG Patsy Hudson Lay Member for Governance, Bristol CCG Alison Moon Director of Transformation & Quality, Bristol CCG Jill Shepherd Bristol CCG Chief Officer, Bristol CCG Jo White CCG & Primary Care Development Director, Bristol CCG Barbara Coleman Service Manager, Public Health Nicola Bowden Jones Service Manger Domestic Violence Services, Healthwatch Sarah Carr Corporate Secretary, Bristol CCG Carol Slater Head of Localities, Bristol CCG Marina Muirhead Interim Head of Primary Care, NHS England Tariq White Associate Director for Clinical Strategy, NHS England 1. Apologies for Absence Apologies were received from Linda Prosser, John Readman and Netta Meadows. 2. Declarations of Interest There were no declarations of interest. 3. Public Questions There were no questions from the public. 4. Minutes of the previous meeting & Action Log The minutes were agreed as an accurate record. Action Minutes Page 1 of 10

The Committee reviewed the action log: Item 22/07/15 2: Declarations of interest forms had been received from NHS England. Action Closed. Item 22/07/15 7: It was confirmed that a protocol for public questions had been published on the Bristol CCG website. Action Closed. Item 19/11/15 6 (1): It was confirmed that information relating to practice development was now included in NHS England s report to the Joint Commissioning Committee. Action Closed. Item 19/11/15 6 (2): It was confirmed that the draft plan for the Quality Report would be discussed under the Quality section in today s meeting. Action Closed Item 19/11/15 6 (3): Marina Muirhead confirmed that there was a Primary Care Finance Group and finance colleagues had shared information with this group in regarding the enhanced services budget. Action Closed Item 19/11/15 6 (4): Marina Muirhead confirmed that the specific risk log register went to the Commissioning Oversight Group meeting in February as it was a Primary Care wide risk log. Action Closed. Item 19/11/15 6 (5): Marina Muirhead confirmed that this action had been clarified post meeting. Action Closed. Item 19/11/15 6 (6): It was confirmed that the Strategic Estates Plan would be discussed at today s meeting. Action Closed. It was agreed to add NHS England s logo to joint papers such as the action log. Marina Muirhead agreed to provide NHS England logo. Action: Marina Muirhead 5. Report to Bristol Co-Commissioning Group Section 1 Primary Medical Care Contracts Update Marina Muirhead explained that Bristol CCG had 52 contracts. It was noted that a number of practices had CQC reports published since the last meeting and these were all rated Good. There had been no contract terminations and there were three APMS procurements currently progressing which included Broadmead, Homeless Health and the Violent Patient Scheme. A decision would be made on the Broadmead and Homeless Health on the 11 April 2016 and a decision on the Violent Patient Scheme would be made at the end of April 2016, with a new provider in place by the 4 July 2016. It was explained that as these were competitive procurements NHS England were unable to comment any further. Jo White asked if it would be possible to review the process for practices to refer patients to the Violent Patient Scheme. Action Minutes Page 2 of 10

Marina Muirhead confirmed that there was a review panel for the Violent Patient Scheme that met quarterly. The panel had been asked to review all application forms, all patients that were currently on the scheme, all paperwork supporting the scheme and the referral process. This review would form part of the contract negotiation stage and the schemes development. At the December Commissioning Oversight Group meeting the merger of Avonmouth, Bradgate and Ridingleaze practices was approved with effect from 1 April. Since this meeting a further application had been received for the Hotwells practice to join the merger.. There was an intention to maintain a local surgery and the current staffing arrangements at the surgery as it would not be appropriate to move the patients, merge and lose a property.. Marina Muirhead explained that Avonmouth, Bradgate and Ridingleaze received funding under this current year s Primary Care Transformation Fund to undertake a feasibility study around their current estate. Following this, NHS England subsequently approved the addition of exploring feasibility around the Doctor establishment to find a solution for the whole merger. It was confirmed that NHS England were happy to approve this merger, but under the joint commissioning arrangements it was important that Bristol CCG also approved this.. It was confirmed that NHS England and Bristol CCG were happy to approve the merger. Marina Muirhead explained that in relation to closed list applications there were two approved closures which included Bedminister Family Practice and Malago Surgery. There were no new applications to close lists and no new Practice Boundary Changes. Section 2 General Practice Quality Report Marina Muirhead explained that NHS England, the 4 CCGs and regulatory agencies such as the CQC would meet quarterly from May 2016, to form a quality hub which would be chaired by Dr Liz Thomas, Medical Director NHS England. This hub would review quality, patient experience and patient safety across the primary care system. It was explained that invitations would be sent via Jo White for Bristol CCG to decide on representatives. Marina Muirhead stated that it was important that CCG colleagues had a good oversight of the quality and governance in place to prepare for possible full delegation of the primary care contracting function. Jill Shepherd asked how this group would work with the Performance Decision management Group, led by NHSE. Marina Muirhead confirmed that there was a reporting structure and agreed to share the Terms of Reference of the Quality Hub with the Committee. Action: Marina Muirhead Action Minutes Page 3 of 10

Jo White asked that the dates for the quality hub meeting were shared as soon as possible. Marina Muirhead confirmed that the first meeting would take place in May and dates would be circulated once confirmed. It was explained that the terms of reference for the group set out joint responsibilities and individual organisational responsibilities Jill Shepherd asked if there were transition arrangements, should practices become unsustainable. Marina agreed to raise this at the National Heads of Primary Care Meeting on 16 March 2016. Action: Marina Muirhead In relation to the Quality Hub, Alison Moon suggested that it would be good to learn from what was done elsewhere in the South. It was noted that Bristol CCG had responsibility for quality in Primary Care but found it difficult to access quality data for Primary Care GP services from NHS England Alison Moon observed that there was an NHS England GP Dashboard and commented that Bristol CCG needed to understand this more broadly. It was confirmed that the dashboard included the annual significant event audits which GP practices completed Marina Muirhead explained that feedback had been received regarding elements that didn t work in relation to the Quality Hub. It was suggested that for the north of the patch the first report would contain what was requested and NHS England would try to access this data. It was also commented that at the first meeting of the Quality Hub there would be a discussion around the expectations for the group. Alison Moon asked what was Bristol CCG s day to day relationship with NHS England in terms of access to data. It was agreed to clarify this outside of the meeting. Action: Jo White/Marina Muirhead Marina Muirhead agreed to explore if there would be any governance or IT issues around Bristol CCG accessing the GP dashboard. Action: Marina Muirhead Section 3 General Practice Finance Report Marina Muirhead explained that the Primary Care budget for this financial year was just over 724 million, and that NHS England currently predicted an underspend of 14 million. The majority of this underspend arose from non-primary medial service budgets. It was noted that as a result of the PMS reviews the NHS England budget around contracting groups would reduce in 2016/17 as funds would be transferred to CCG s for reinvestment. It was explained that the Primary Care budget was approximately 106 million, with a forecast outturn position of around 103 million. Action Minutes Page 4 of 10

Underspend areas included other GP services and some pressure points were around secondary care dental, but this was consistent with other CCG s nationally. NHS England s QIPP was set at 8.5million and mitigated by the use of headroom to ensure delivery of the required surplus. There were concerns that if there was insufficient headroom to offset the 2016/17 QIPP target that there would be an impact on services. Alison Moon asked why GP IT was red. Marina Muirhead confirmed that GP IT was a budget that was delegated to the CCG but where practices decide to merge or close there was a cost associated which was not part of the contract with the CSU, and NHS England were expected to cover this. Jill Shepherd asked that if Bristol CCG progressed to delegated cocommissioning would the rules regarding headroom offsetting QIPP continue to apply. Marina Muirhead agreed that this could be a problem and commented that it was important to think about transformation of services and the longer term models of care for the future. Jill Shepherd asked Marina Muirhead to bring a summary of current QIPP schemes relating to primary care to the next meeting for information and discussion. Action Marina Muirhead and next meeting agenda Section 4 Prime Ministers Challenge Fund Wave 2 It was noted that the title should be changed to Prime Ministers Access Fund. Marina Muirhead explained that there had been pieces of work taking place around the Physio pilot and the Mental Health pilot. It was explained that IT assets had been acquired through the Prime Minister s Challenge Fund funding. The Primary Care Foundation was carrying out an evaluation of the schemes which would help inform a decision regarding the appropriate asset owner for the long term. Once the evaluation has taken place the decision would be taken to the Strategic Informatics Group. Alison Moon reported that the CCG Governing Body had received the Primary Care Report in November. It was explained that a number of GP s had queried the accuracy of some of the data. Alison Moon asked how accurate and up to date the data was and who was encouraging the practices to sign up. Marina Muirhead confirmed that the data was accurate and up to date. She explained that the development facilitator at One Care was leading the work around data sharing and encouraged sign up. Marina Muirhead explained that NHS England would not be the future Action Minutes Page 5 of 10

commissioner of some of the listed initiatives. Jill Shepherd commented that Bristol CCG had not been asked by One Care whether they were prepared to continue funding these initiatives. The CCG was clear that it would not be in a position to fund initiatives which did not release savings. Marina Muirhead agreed to arrange a meeting across NHS England, One Care and all three CCGs to discuss these issues. Action: Marina Muirhead Section 5 Primary Care Infrastructure Fund Marina Muirhead explained that the title should now be Primary Care Transformation Fund (PCTF). It was explained that there was a 1billion national transformation fund launched in March 2015 ( 250million per year) designed to increase capacity and a number of other issues within the Primary Care estates. It was explained that there were a number of schemes within Bristol that were progressing and were projected to complete in 2015/16. Eight of these schemes were in category 1 and 2 and were supported as a priority. Eleven were in category 3 which were being aligned with strategic estates plans. NHS England gave permission for feasibility studies to be carried out at Ridingleaze and Lennard/Grange surgeries. Marina Muirhead explained the process for the 2016/17 Transformation Fund; there would be 250 million available across the country and guidance would be part of the package. CCGs would need to submit recommendations by 29 April 2016. CCG s would receive a response from NHS England in June 2016. Tariq White asked if the PCTF submissions that were looked at regionally would be triangulated with the Sustainability and Transformation plans to ensure consistency. Marina Muirhead confirmed this was the case. Jo White provided an update in relation to the Strategic Estates plan. It was explained that Bristol CCG had worked closely with NHS England on the plan. Bristol CCG and the other CCG s were working with Capita to complete the first draft. It was noted that due to challenges regarding information about the state of buildings from NHS Property Services and CHP, the baseline data to inform decisions was not available. Bristol CCG had met with Capita to look at what the key strategic challenges were and expected a response in the next 2 weeks. Marina Muirhead noted that estates was a bigger issue in the Bristol area than elsewhere in the region, adding that she sat on the South Action Minutes Page 6 of 10

Panel as the South West Premises lead and had information specific to Bristol. It was also noted that the full 250 million had not been spent nationally for 2015/16, so there was likely to be slippage into future years. Jo White asked what was likely to happen in terms of premises directions as this was a barrier to practices working together. Marina Muirhead responded that there would be changes in relation to premises directions for 2016/17 and that a national review was being undertaken. Section 6 Primary Care Development Fund Marina Muirhead explained that a Primary Care Development Fund had been established across the 7 CCGs in the South WestJo White would work with counterparts at the other 2 CCGs to discuss the deployment of the funded project managers for this fund. Marina highlighted page 17 of the report where the 4 work streams were described. Section 7 APMS Procurements GP Practices & Violent Patients Scheme Marina Muirhead explained that this item had been covered earlier in the meeting. Section 8 Friends & family Test Marina Muirhead explained that the data for the Friends and Family test would be feed into the Quality Report in future. Section 9 GP Patient Survey Marina Muirhead highlighted page 22 of the report where the GP Patient Survey questions and range of scores were listed. It was noted that there had been a decrease in scores for some practices. This would need to be considered in discussions about practice sustainability as it possibly reflected workforce issues. Jill Shepherd asked if this was an unusual range of scores. Marina Muirhead confirmed that these were a normal range of scores. It had been agreed not to name the practices which scored low in the survey results. Jo White explained that Bristol CCG and NHS England were working with practices in parallel to provide information, recognising that there were different factors which caused issues within practices. Marina Muirhead confirmed that she was on a group for the South around developing a balanced scorecard for primary care which included various measures. Nicola Bowden Jones asked whether when patients were answering the question if they recommend the service to family/friends if they Action Minutes Page 7 of 10

needed similar care or treatment, they were aware of alternatives to treatment.. Martin Jones responded that the question was asking the patient if they recommend the practice or an alternative practice. Section 10 GP Workforce Survey Marina Muirhead explained that a GP Workforce Survey had been undertaken by Exeter University. It was noted that recruitment across Bristol was difficult but better than some other places in the country. Marina Muirhead explained that the NHS England package for GP s aimed at keeping people within the GP profession was important for Bristol. 6. GP practice workload Making time in General Practice Jo White explained that Bristol CCG had summarised the report and took the key recommendations to the member s event in November 2015 to gain feedback from local GP s and Practice Managers. The feedback was collated and analysed by the CCG, to agree what recommendations for action could be taken at a local level between provider and commissioner There were four key themes identified from the feedback; Payment & EMIS Reporting, working together with secondary care, communication and working together in primary care. Marina Muirhead commented that as there was slippage money within One Care, NHS England were keen to exploit this by getting them trial initiatives that supported the five year forward view and ten high impact actions for general practice, as a number of these initiatives would support practices. 7. CCG Report Out of Hours & 111 Jo White explained that NHS England had asked for feedback on GP Out of Hours services and 111. A report on these services was circulated. Jo White asked if NHS England could confirm what information they wished to see on a regular basis. The 111 report was discussed. It was agreed that this information would need to be presented in a different format for future meetings. The Out of Hours contract for BNSSG was discussed and it was Action Minutes Page 8 of 10

8. AOB explained that the service was struggling to fill clinical shifts. There was an improvement on the previous month; however the report stated they were at 89% achievement. It was noted that the EMIS Web read only aspect was fully rolled out to clinicians in the Out of Hours service. Marina Muirhead agreed to review the report for future meetings. Strategic Estates Plan This was discussed at item 5 under section 5. PPI Issue in relation to Primary Care Commissioning Tara Mistry explained that nationally there was a framework around patient and public involvement in Primary Care Commissioning and asked for a discussion at the next meeting around how this could be addressed at the co-commissioning stage. Tara Mistry asked if NHS England had templates of what they were doing around PPI and suggested that Bristol CCG should work with this towards this prior to them taking on full delegation.. Marina Muirhead confirmed that there were workshops taking place for staff groups around PPI. Marina Muirhead agreed to find out the dates for these workshops and would recommend that individuals attend. Tara Mistry agreed to discuss this with Marina Muirhead outside of the meeting. Action: Marina Muirhead/Tara Mistry Primary Care Strategy Jill Shepherd explained that it was agreed at the last member s event that Bristol CCG would start to develop a Primary Care Strategy. Jill Shepherd commented that Bristol CCG would like to build on what was happening in NHS England and asked if a paper could come to the next meeting about the transformation themes and the work that NHS England have carried out. Marina Muirhead agreed with this and confirmed that the workplan for 2016/17 could also go to the next meeting. Action: Marina Muirhead 9. Dates of Future Meetings 19 July 2016, 2-4pm, CCG Conference Room 13 September 2016, 3.30-5.30pm, CCG Conference Room Action Minutes Page 9 of 10

20 December 2016, 9-11am, Lower Ground Boardroom, South Plaza Action Minutes Page 10 of 10

NHS Bristol CCG Primary Care Joint Commissioning Committee Meeting Action Log for 19 July 2016 Date of Meeting agenda item Subject Action Required RO (s) Deadline Date of Update Update 15/03/16 4 Minutes of the previous meeting 15/03/16 5 Report to Bristol Co-Commissioning Group Section 2 It was agreed that the NHS England logo would be added to joint papers. Marina Muirhead to provide the CCG with NHS England s logo Marina Muirhead to share Terms of Reference for the Quality Hub with the committee MM MM 15/03/16 5 Report to Bristol Co-Commissioning Group Section 2 It was asked if transition arrangements would be available for practices that become unsustainable - Marina Muirhead agreed to raise this MM 1

at the national heads of primary care meeting 15/03/16 5 Report to Bristol Co-Commissioning Group Section 2 15/03/16 5 Report to Bristol Co-Commissioning Group Section 2 15/03/16 5 Report to Bristol Co-Commissioning Group Section 4 Alison Moon asked what Bristol CCG s day to day relationship with NHS England was in terms of access to data - it was agreed to clarify this outside of the meeting Marina Muirhead to explore if there is any governance/it issue around Bristol CCG accessing the GP dashboard. Marina Muirhead agreed to arrange a meeting across NHS England, One Care and all three CCGs JW MM MM 2

15/03/16 8 AOB PPI Issue in relation to Primary Care Commissioning 15/03/16 8 AOB Primary Care Strategy Marina Muirhead to find out when PPI workshops are taking place and recommend individuals to attend Tara Mistry & Marina Muirhead to discuss this outside of the meeting Marina Muirhead confirmed that the workplan for 2016/17 could go to the next committee meeting MM/ TM MM RO Responsible Officer MJ Martin jones SJC Sarah Carr TM Tara Mistry JW Jo White LP Linda Prosser MM Marina Muirhead 3