NHS North East Hampshire & Farnham Clinical Commissioning Group Delegated Primary Care Commissioning Committee Meeting in Public - PCTs 03,04,05 ...
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NHS North East Hampshire & Farnham Clinical
Commissioning Group
Delegated Primary Care Commissioning Committee Meeting in
Public
PCTs 03,04,05 - Aldershot Centre for Health
12 February 2020 09:30 - 12 February 2020 11:00
Overall Page 1 of 57Delegated Primary Care Commissioning Committee
Wednesday 12th February 2020 between 09:30 and 11:00
Room PCTs 03,04,05, 4th Floor Aldershot Centre for Health, Hospital Hill, Aldershot, GU11 1AY
Meeting in Public
Ite
Time m Item Lead Type Purpose
no.
09:30 1 Welcome and Apologies Chair Verbal
2 Quoracy Chair Verbal To note
The Terms of Reference require:
1 Lay Chair/Vice-Chair, 1 GP member, 1
Executive member and 1 other clinical
member (voting members)
3 Declarations/ Conflicts of Interest Chair Paper To note
To note any changes to the Register of
Interest and for Members to declare any
conflicts of interest for agenda items
09:35 4 Draft Minutes of the meeting held on 15th Chair Paper To approve
February 2020 and Action Tracker
5 Matters Arising Chair Verbal To note
09:40 6 Risk Register Chair Paper To note
Items affecting all aspects of primary care functions
09:45 7 Estates Projects Lessons Learnt Claire Gunn Paper To discuss
10:05 8 Frimley ICS GP Transformation Steering Lauren Paper To discuss
Group update Pennington
10:10 9 Referral Management Service update – Lauren Verbal To discuss
Farnham primary care network Pennington
10:15 10 Development of primary care networks Lauren Paper To discuss
and priorities for 2020/2021 Pennington
10:35 11 Quality in Primary Care Steve Clarke Paper To note
10:40 12 Primary Care Finance Report Dan Williams Paper To note
10:45 13 Any items for escalation from Primary Lauren Paper To discuss
Care Operational Group Pennington
10:50 14 Forward Work Planner Chair Paper To note
10:55 15 Any other business Chair Verbal To discuss
11:00 16 Close
Date of the next meeting:
Wednesday 11th March 2020
0. Agenda DPCCC Public 12.02.20 v2.docx
Overall Page 2 of 57Delegated Primary Care Commissioning Committee
Conflicts of Interests Register (as at 4 February 2020)
First Name Surname Role Declared Interest - Name and Nature of Business
Martin Ballard Clinical Director SALUS shareholder
GP Advisor - Clare Park
FICS Director
GP Partner at Downing Street Group Practice, Farnham
OOH
Karl Bennett Governing Body Clinical Director and Caldicott Shareholder in SALUS
Guardian Wife is senior partner at Station Road surgery, part of Surrey Heath CCG
GP Partner at Oakley Health Group (previously GP Partner with Hartley Corner
Surgery since 01/04/01).
Governing Body Clinical Director for IT, Community and New Models of Care,
End of Life
Melanie Bessant Deputy Director of Quality and Nursing No interests to declare
Peter Bibawy Clinical Chair Cambridge Practice (D2A) Discharge to Assess Bed assessor in Ticehurst
Nursing Home, Aldershot and Hampshire. Contracted from Salus Medical.
GP at the Cambridge Practice, Aldershot - Self employed
Private practice with an interest in Shock Wave Therapy
Wife is a psychiatrist working for Southern Health
Shareholder in Salus GP Federation
Emma Boswell Executive Director of Development and Patient at Jenner House Surgery
Improvement
Steven Clarke Governing Body Clinical Director Wife is shareholder in InsideVue – company providing ultrasound services in
Farnham
Lead GP for Fleetwood Lodge Care Home, Fleet
Shareholder in Salus, GP Federation
Financial interest in Lloyds Pharmacy, on-site pharmacy at Branksomewood
Healthcare Centre
Partner at GP Practice, Branksomewood Healthcare Centre
Wife is a salaried GP, River Wey Medical Practice, Farnham Health Centre
Steve Clarke Senior Head of Quality Board Advisor - CSL, Health Data Analysis
Ann Cooper Deputy Director of Governance No interests to declare
Peter Cruttenden Chairman of the Partnership Board Parish Councillor, Steep, near Petersfield, Hampshire
Joanne Green Governance Manager Patient of Cambridge Practice
3. COI register (04.02.20).xls
Overall Page 3 of 57Hanne Hoff Clinical Director for Planned Care, Reducing In-reach/frailty GP at Frimley Health Foundation Trust (since 2016)
Variation and Prescribing Salaried GP in Crondall New Surgery, Farnham
Husband is a senior GP Partner in Crondall New Surgery
OOH GP for North Hampshire Urgent Care (NHUC) (occasional)
Husband is a member of the Salus GP Federation
Locum GP at Upper Gordon Road Surgery, Camberley (Surrey Heath CCG
and provider of the Surrey Heath Community Pain Clinic)
Clinical Auditor of North Hampshire Urgent Care
Honorary tutor in the department of Therapeutics at the University of Cardiff
Husband is a Medical Director for NHUC
Ed Palfrey Secondary Care Clinician Provides advice to Secondary Care issues
Daughter is a Palliative Care Trainee
Lay Member at North East Hampshire and Farnham CCG
Lauren Pennington Head of Commissioning No interests to declare
Margaret Scott Non Executive Director (Primary Care) Patient at the Grange Surgery
North East Hampshire CCG Primary Care Commissioning Committee
Sharon Ward Deputy Director of Communications and No interests to declare
Engagement
Oliver White Executive Place Managing Director (interim) No interests to declare
NEHF
Daniel Williams Head of Financial Management & Reporting Wife is a GP but works outside of the CCG boundary
3. COI register (04.02.20).xls
Overall Page 4 of 57Delegated Primary Care Commissioning Committee (DPCCC)
Meeting in Public
Held on Wednesday 15th January 2020
10:30 to 11:45
PCT06 Aldershot Centre for Health, Hospital Hill, Aldershot GU11 1AY
Present: Margaret Scott (MS), Convenor and Non-Executive Director of the Hampshire and Isle of
Wight Partnership of CCGs – Chair
Lauren Pennington (LP), Head of Commissioning - Primary Care and Prevention
Peter Cruttenden (PC), Non-Executive Director
Ruth Colburn-Jackson (RCJ), Managing Director of North East Hampshire and Farnham
CCG
Ollie White (OW), Deputy Managing Director
Dr Steven Clarke (SnC), Chair of the Clinical Transformation Group and Clinical Director for
Primary & Planned Care
Dr Hanne Hoff (HH), Clinical Director for Planned Care and Reducing Variation, Acute
Services Pathways, Medicines Management Prescribing
Dr Martin Ballard (MB), Clinical Director (Mental Health, PPE, Patient Engagement and
Workforce, Surrey Health and Wellbeing Board, Reducing Variation - Gastroenterology),
deputising for Dr Peter Bibawy
Dan Williams (DW), Senior Management Accountant
Dr Laura Edwards (LE), Wessex LMC Medical Director
Sarah Bellars (SB), Director for Quality & Nursing, Frimley Collaborative
Apologies: Emma Boswell (EB), Executive Director of Quality & Nursing
Dr Peter Bibawy (PB), Medical Director & Clinical Director for Urgent & Emergency Care
Dr Nigel Watson (NW), Chief Executive Wessex LMC
Dr Clare Sieber (CS), Medical Director, Wessex LMC
Dr Ed Palfrey (EP), Secondary Care Consultant
Lisa Harding (LH), Wessex LMC
In Attendance: Steve Clarke (SC), Senior Head of Quality Improvement – Item 11
Joanne Green (JG), Governance Manager
Tom Allinson (TA), Delivery Team Administrator – minutes
1 Welcome and Apologies
MS welcomed members of the committee and apologies were taken as detailed above.
Introductions were made to Sarah Bellars, Director for Quality & Nursing, Frimley Collaborative.
2 Quoracy
The meeting was deemed to be quorate.
It was noted that the committee Terms of Reference were in need of review.
3 Declarations / Conflicts of Interest
No declarations were made.
4 Draft Minutes of the meeting held on 20th November 2019 and Action Tracker
The minutes of the previous meeting were taken as accurate and approved without amendment.
Action Tracker
The action tracker was then reviewed as follows:
Page 1 of 5
4a. Draft Minutes DPCCC Public 15.01.20 v3 MS.DOCX
Overall Page 5 of 57September ’19 – PMS premium 2020/2021 investment consideration
LP reported a positive change of direction, with Ian Pinkney working alongside locality IT leads
to explore possible solutions. The possibility of looking at outsourcing work to IT companies
was being explored. Action ongoing.
September ’19 – Farnham Referral Management Service
Action ongoing. Update in February.
October ’19 – Primary Care Finance Update / Property Services Pressures
DW informed members that a letter from PropCo regarding the invoicing of additional charges
had been received. A risk value of around £1m was noted; however, this was mostly mitigated
by the CCG’s contingency fund. DW confirmed that Finance were not prepared to pay over and
beyond what was felt to be appropriate. It was agreed that the action could now close.
October ’19 – Primary Care Finance Update / Projects’ Dashboard
Action ongoing. Update in February.
5 Matters Arising
None.
6 Risk Register
Lauren Pennington led the review of the risk register, highlighting the following:
Risk ID 00013
Risk was due to be fully mitigated and removed by the end of January 2020 following the
successful mobilisation of online consultations in both remaining GP practices. Risk to be
recommended by closure at next committee
Risk ID 00016
Addition of risk regarding the ongoing Fleet Integrated Care Centre project. Due to delays
caused the slow transfer of funds from HM Treasury; the project was now expected to finish in
March 2021 (originally expected October 2020). The total value of the project was given to be
approximately £2 million including IT costs.
It was agreed that an update on progress made would come to the next meeting in February.
The committee noted the update.
7 Primary Care Finance Principles
LP presented the paper, asking the committee to consider approving a set of principles for use in
deciding when to allow PCNs access to the forthcoming “Innovation Fund” as agreed at the previous
DPCCC meeting in December 2019. These principles had been created alongside the Finance Team
with the aim of creating a fair process whereby only PCNs able to demonstrate that they had met all
currently commissioned projects and priorities would be able to apply for Innovation funding.
SnC held that there should be an expectation that all PCNs fully utilise their estates assets before
applying for funding, stressing that the Innovation Fund was not just a question of available budget but
also of principle.
LP further confirmed that PCNs would need to submit a formal application as part of the process.
It was felt that the approval process for applications would come to the Primary Care Operational
Group first, with anything contentious being escalated the DPCCC.
The committee approved the principles as set out in the paper.
Page 2 of 5
4a. Draft Minutes DPCCC Public 15.01.20 v3 MS.DOCX
Overall Page 6 of 578 Frimley ICS FP Transformation Steering Group update
LP introduced the update on the above, highlighting the following achievements made since the last
committee:
Clinical Pharmacists appointed in 4/5 primary care networks; social prescribing link workers
appointed in 5/5 primary care networks;
Discussions about extending first contact practitioner workforce in 2020 had commenced with
PCN clinical directors and would now commence with existing providers;
Draft service specifications released for consultation from NHS England; and
Organisational development allocations for 2019/2020 had been confirmed for PCNs
This was felt to be an area of risk, with PCNs not yet drawing down on the organisational development
funding. The item was confirmed to be a priority focus over the following weeks.
The committee discussed the clinical pharmacist roles, noting that some individuals would require
further training before they were able to fully undertake these new roles
PC voiced concerns over PCNs being required to set up a governance structure, questioning the
amount of formal support they have available. It was confirmed that the committee would wait for the
DES specs and the exact asks being made of PCNs going forwards to arrive first before taking any
further action.
The committee noted the update.
9 LCS update
IP gave a verbal update on the Locally Commissioned Services – A 3 year contract comprising 19
optional services not covered by core GP contract with a budget of £2.2 million. IP confirmed that
almost all of the CCG’s 20 practices had signed up and that newly commissioned services for 19/20
included a new diabetes service and improved practice reporting via a new EMIS module.
The committee requested that IP share some slides to help understand the information more fully.
IP further reported on current LCS issues, noting that staff coding and template was resulting in a
significant expected underspend of around £250k. The Primary Care Team were currently working with
the practices to update these templates and to help support the reporting process, in addition to
looking back over previous erroneously submitted activity.
The committee noted the update.
10 Online Consultations utilisation update
IP gave a verbal update on the above, reporting that E-consult was currently live in 18 out of 20 GP
practices, with the remaining two expected to go live by the end of January 2020.
Members were informed that River Wey had ceased to use E-consult and were currently trialling “Ask
My GP”. It was agreed that more work was needed to support practices using their currently
commissioned E-consult, as there was a risk of money loss for the CCG if more practices followed
suite and switched to alternate options.
It was agreed that an update would come to the committee in March once more intel was available.
The committee noted the update.
11 Quality in Primary Care
Page 3 of 5
4a. Draft Minutes DPCCC Public 15.01.20 v3 MS.DOCX
Overall Page 7 of 57SC presented the Quality Report, and key updates were highlighted as follows:
Jenner House Surgery
Care Quality Commission Report Published – Good overall and Good in all domains
LP and SnC were to hold meeting with practice the following week.
The Cambridge Practice
Care Quality Commission Report Published – September 2019; Requires Improvement overall
Significant turnover in GPs (partners & salaried)
Mayfield Medical Centre
Care Quality Commission Report Published: Good overall
SALUS now fully operational and CQC compliant
The committee noted the paper.
12 Primary Care Finance Report
DW gave a brief update on the above due to time constraints. Members reviewed the contents of the
paper, noting an overall unmoving forecast from the previous meeting.
DW further informed the committee that a 3rd appendix had been added which broke down PCN DESs.
The committee noted the paper.
13 Any items for escalation from Primary Care Operational Group
DPCCC decision not to support Fleet Medical Centre’s historic claim regarding care home
patients (as detailed in the minutes of the meeting in public taking place 20th November 2019)
had been reported back to the practice, who were in turn attempting to gather more evidence
to bolster their claim. The committee agreed that the onus was now on the practice, but that
the process couldn’t be allowed to go on ad infinitum and so a deadline would need to be set.
The committee agreed to monitor the situation for the time being.
14 Forward Work Planner
The committee noted the paper.
15 Any Other Business
None.
16 Close
MS closed the meeting in public at 11:45.
Date of Next Meeting
12th February 2020, PCT07, Aldershot Centre for Health
Page 4 of 5
4a. Draft Minutes DPCCC Public 15.01.20 v3 MS.DOCX
Overall Page 8 of 57Delegated Primary Care Commissioning Committee – Attendance Log 2019/20
8 May 2019 (Cancelled)
18 September 2019
20 November 2019
12 February 2020
16 October 2019
15 January 2020
December 2019
11 March 2020
19 June 2019
17 April 2019
17 July 2019
August 2019
Margaret Scott (Chair) A A A
Peter Cruttenden A
Maggie MacIsaac A D A A A A
Ruth Colburn-Jackson (or Deputy) A A A A D
Roshan Patel (or Deputy) A D D D D D
Emma Boswell (or Deputy) A
Dr Ed Palfrey A A A
Dr Peter Bibawy (or Deputy) D A A A D D
Dr Steven Clarke D
Dr Martin Ballard A A A
Dr Hanne Hoff A A A
Dr Laura Edwards (Wessex LMC) A D D D
A = Apologies for absence
D = Nominated Deputy
Page 5 of 5
4a. Draft Minutes DPCCC Public 15.01.20 v3 MS.DOCX
Overall Page 9 of 57North East Hampshire & Farnham Clinical Commissioning Group
Quality
Delegated
Improvement
primary Care
Committee
Commissioning Committee - Meeting in Public
Rag Rating: Not Due Not Started Progressing Complete
RDate of Agenda Title Summary of Action / Issue Update Assigned To Progress report / Update from RAG
eMeeting Item Due previous meeting Rating
fIssue
NOriginally
oRaised /
.Updated
Sep-19
18/09/2019 8 PMS premium LP to clarify intentions for the structure and Feb-20 Lauren Ongoing - struggling to recruit.
2020/2021 investment funding of the five new Digital Transformation Pennington Update in January 2020.
consideration Project Manager roles before bringing back to
committee for approval by Christmas.
18/09/2019 14 Farnham Referral FICS to give formal assurance to the Feb-20 Lauren Update in February 2020.
Management Service committee that an alternative to the service Pennington/
would be put in place before its termination on Steven Clarke
the 31st of March 2020.
Nov-19
20/11/2019 9 Quality in Primary SC to organise workshop / seminar to TBC Steve Clarke Update in February 2020.
Care showcase Quasar tool to Governing Body
GPs.
Jan-20
Do not insert rows below this line. Do not use this line to insert rows.
4b. Draft Action Tracker DPCCC Public 15.01.20 v1.xlsx
Overall Page 10 of 57Delegated Primary Care Commissioning Committee
Title of Paper Risk register
Agenda Item 6 Date of meeting 12th February 2020
Exec Lead Oliver White Clinical Sponsor Dr Steven Clarke
Author Lauren Pennington, Head of Commissioning – Primary Care and Prevention
To Approve
To Ratify Strategic
Purpose To Discuss Y Objective
Number
To Note
n/a
Risk
Unique Risk
n/a
ID
Executive Summary
This report provides a copy of all risks under the primary care programme as stored on Verto.
The following updates should be noted:
Risk ID 00012 – Primary care vulnerability An additional GP practice has been added to the list
of those the CCG is concerned about; bringing the total up to 12. The causes for concern are
categorised as:
Premises (affecting 2 GP practices)
Quality (affecting 3 GP practices)
Workforce (affecting 7 GP practices)
Risk ID 00016 – Fleet Integrated Care Centre delay to delivery date There is no further clarity
on a revised approval date for the full business case and additional work is required to agree
elements of the project such as financial risk mitigation during construction stage and building
ownership
To note the updates on the risks
Recommendations
Publication Public Website Staff Website (intranet)
Governance and Reporting- which other meeting has this paper been discussed
Committee Name Date discussed Outcome
Delegated Primary Care
Monthly Risks reviewed as routine agenda item
Commissioning Committee
Please provide details on the impact of following aspects
Equality and Quality
N/A
Impact Assessment
Version 20 Sept 2016
6. Coversheet Risk register.docx
Overall Page 11 of 57Patient and Stakeholder
N/A
Engagement
Financial Impact and
N/A
Legal implications
Version 20 Sept 2016
6. Coversheet Risk register.docx
Overall Page 12 of 57North East Hampshire and Farnham CCG Corporate Risk Register
Primary Care Programme
Last Updated: 03/02/20
Risk ID Risk Name Description Baseline Controls in Place and Gaps in Controls and Current Direction of Mitigating Actions, Updates Target Risk Owner Next Review
Assurance Assurance Travel and Additional Risk Reduction (Lead Executive) Date
Plan
1) Quality, Performance & Finance
06/01/2020 - Frimley ICS has
confirmed that the VAT and IT site
The project costs have been brought wide upgrade costs will be met
back within the £1.5m + VAT from the wave 2 funding pot. This
envelope as stated in the OBC,
has reduced the project funding
which was approved by Frimley ICS
risk to the project. The risk will
in February 2019. There is a risk
however remain open until final
around securing the £300k VAT as
the ICS is suggesting that this is an FBC approval has been received
additional amount being requested from the Treasury.
from the original STP bid. The cost of the project has been
brought back to the original The FBC has been submitted to
[PR000027] There is also an amount of £282k for £1.5m + VAT budget stated in the Frimley ICS for approval, which is
Fleet Integrated Care Centre project costs 16 This risk is being addressed. 3 Improving 3 Oliver White 10/01/2020
- [00017] upgrading the IT site wide. The Fleet OBC which was approved by the expected on 9th January, but will
ICC Project Team was advised, and Frimley ICS Estates Strategy be subject to Frimley Health
it has been minuted that this would Group in February 2019. approval. It is on the agenda for the
be funded from a separate pot of 21st January Frimley Board meeting
money as it is a Frimley ICS for approval. It will then pass
initiative to upgrade IT in healthcare through the NHSI/E and DH and
facilities, including Fleet Community Treasury approvals process. Frimley
Hospital. It now transpires that this ICS anticipate full FBC approval by
may not be the case and the funding
July 2020.
for the IT may need to come from
the original STP bid.
2) Implementing New Models of Care
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Overall Page 13 of 5731/12/2019 - Average utilisation
has been consistent at just above
70% at a CCG level for the months
of October and November 2019.
Monthly activity reports are
received from the providers of the
Utilisation trends are not changing
improved access service to The remedial action plans significantly between localities.
If utilisation of the improved access monitor utilisation: agreed with providers do not
appointments does not improve then appear to be having an impact on Locality Total utilisation % Pre-
the aims of the service will not have • In Farnham locality the utilisation rates in lower
booked utilisation % Same day
been met. provider is FICS performing localities. This may be
utilisation % DNA % Farnham 78 78
• In Yateley locality the because the remedial action
0 10 Aldershot 70 74 56 8
The service aims include: provider is Oakley Health Centre plans are not focussing on the
Farnborough 57 63 42 8 Fleet 59 59
[PR000027] Utilisation of improved access
• In Aldershot, Farnborough correct actions or it may be that
58 5 Yateley 94 96 92 2 NHUC
- [00011] appointments
1. Increasing capacity in primary 12 and Fleet localities the provider is they have not yet been 12 Improving 4 Ruth Colburn-Jackson 29/02/2020
implemented. Sunday service 91 91 n/a 12
care through the introduction of Salus
additional appointments The new contract with a 85%
• The Sunday service is
2. Reducing the demands on Individual localities do not utilisation rate is now active and is
provided by North Hampshire
core primary care services, therefore appear to routinely be provided being managed through the model
Urgent Care Service
contributing to the sustainability of with their utilisation rates by the of care contract meetings with
GP practices contracted providers and do not Salus and FICS. It has been
Bi-monthly contract review
3. To commission a value for meetings are in place with engage in the conversations proposed that another review of
money service provider representatives where about how these could be the service model will be
utilisation rates are discussed improved. undertaken with providers to put
and remedial action plans are into place the actions required to
agreed. meet the utilisation rate target.
Discussions are ongoing with 29/02/2020 - There is little further
Although planning consent has now clear information on the revised
Frimley ICS to gain clarity over
been granted, there is a risk of a expected approval date for the
the FBC approvals process. Up
delay to the delivery of the Fleet FBC. An amended template is
until now there has been
Integrated Centre due to a proposed
contradicting advise from the ICS required to be completed and a risk
10 month FBC approval process There is lack of clarity around the
and NHSI/E. The Programme sharing workshop has been set up
[PR000027] Fleet Integrated Care Centre delay to from when the FBC is tabled at the FBC approvals process. The
12 Director Ian Greggor has been 6 Improving for February where providers will 3 Oliver White 29/02/2020
- [00016] delivery date Estates Strategy Group meeting on Estates Programme Director has
asked to clarify the FBC consider how to mitigate
9th January. been asked for this clarity.
approvals process. unexpected financial risks during
the life of the project.
3) People, Systems, and Partnerships
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Overall Page 14 of 5731/12/2019 - The previously
Method/Group/Activity identified engagement
opportunities with primary care
Frequency continue. These include newly
formed routes that are now
Key Discussion items business as usual:
Email 1. Monthly meeting with
Network Clinical Directors
Weekly
2. Monthly internal Network
Operational Group with CCG team
Sent to Practice Managers and
3. Regular bulletin for Network
Lead GPs
Clinical Directors with news stories,
If there is insufficient engagement
with GP practices in their role as training opportunities and
Specific purpose of channelling
members of the CCG then they will deadlines
[PR000027] Insufficent Engagement with Member communication from CCG
be unable to exert the influence our 9 through one source; focusing on None perceived 4 Improving 4. Monthly Network Alliance 4 Ruth Colburn-Jackson 31/03/2020
- [00004] Practices meeting with PCNs in Frimley
CCG constitution provides them with business
and sufficiently participate in Health and Care ICS
shaping commissioning decisions. 80% of the content is from The next two months will include
Commissioning Team and is focussed engagement with GP
business tool and not clinically practice members on the proposed
focused changes as the CCG becomes part
of the Frimley CCGs collaborative.
Weekly email was changed on
request of practices, changes
made and then overwhelming
response from the practices that
they did not like the changes
Some medicines management
content – e.g. Flu which is
business as well as clinical
In line with the launch of the GP
Intranet – the weekly email can
change to give links to Intranet
rather than attach and embed
documents in to the email
Could link in with a monthly
Clinical e-news
Question: Does the weekly
email need to go to all GPs?
Target
Bi-monthly
Specific purpose of education,
therefore focus on clinical issues
E-News
Page
3-4 times a year – on average 3
of
6. Committee Risk Register
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GP Practice Forum Overall Page 15 of 5729/02/2020 - An additional GP
The following overarching
If GP practices are unable to practice has been added to the list
functions and programmes have
mitigate areas of identified of those identified as being of
been put in place by the CCG to
vulnerability or risk this may have concern to the CCG. This brings the
provide proactive support for GP
an impact on the delivery of total to 12 GP practices.
practices:
commissioned services. This may
mean that patients will not be able These areas of vulnerability or risk
to access primary care services 1. Ongoing actions identified
in the GP Practice sustainability
are different for each GP practice
or may be provided with a poorer and are categorised as follows:
quality service. plan
A regular dashboard that • Premises (affecting 2 GP
2. Access to NHS England
provides up to date and relevant practices)
There are currently 12 individual GP resilience programme through
information; demonstrating an • Quality (affecting 3 GP
practices identified as of concern to nomination by CCG – an
improvement, or reduction, in
additional GP practice has been practices)
the CCG. These areas of statistics.
vulnerability or risk are different for participating in the programme; • Workforce (affecting 7 GP
each GP practice and are funding has been secured for the practices)
[PR000027] 2019/2020 programme The QUASAR dashboard,
Primary Care Vulnerability categorised as follows: 9 commissioned by NHS England 16 Same 4 Ruth Colburn-Jackson 29/02/2020
- [00012] 3. Quality framework for As a whole two localities have
Wessex, is currently under
• Premises (affecting 2 GP primary care – managed through multiple areas of identified risk.
development and will fulfil this
PCOG; GP practices escalate the
practices) required function. Until this is fully
framework as levels of concern The level of risk currently remains
• Quality (affecting 3 GP available a local dashboard has
are met triggering additional the same for this area although
practices) been created with captures
support functions from the CCG
• Workforce (affecting 7 GP changes in published data and good improvements continue to
4. Practice support
practices) known challenges within each GP have been achieved with multiple
programme visits – annual
practice. individual GP practices throughout
programme of visits to each GP
As a whole two localities have January. For example the contract
practice where individual
multiple areas of identified risk. for delivery of services at Mayfield
concerns are discussed
Medical Practice commenced on
5. Proactive adhoc support
These risks are identified and a the 1st January 2020 with Salus
when issues arise
mitigating course of action agreed at Medical Services Limited. Each GP
each months Primary Care practice has an associated action
Additional support is available
Operational Group using a GP against the identified risk which is
from organisations such as
practice assessment framework. being managed through
Wessex Local Medical
Committee. the primary care operational group.
PCOG discusses each GP
practice that has been identified
as being of concern. Updates are
provided on any change in
situation and decisions made
about next steps or further
actions
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Overall Page 16 of 57If there are significant workforce 31/12/2019 -
changes in individual GP practices
or localities then they may not be ICS Level
able to continue to deliver
commissioned services or be able to Workforce projects that have
implement the five year forward view commenced at ICS level for
and the primary care strategy of the
2019/2020 are currently being
CCG.
reviewed and evaluated for
Controls are now in place as part success. A number (such as Next
There are 3 common scenarios
of the GP Transformation Generation GP for newly qualified
where this may occur:
workstream of the Frimley ICS to GPs) have proven very successful
identify the workforce risk in with an excellent evaluation and
Scenario one - If individual GP
primary care and to put in place next steps clearly identified. Others
practices or localities are unaware
actions to support GP practices in (such as the Maternity returners
of short term and immediate
mitigating this risk. Identification
workforce risks and are therefore workshop) have proven less
of workforce risk is limited to what Risk 1 will prove challenging to
[PR000027] unable to predict and plan for successful and will not be
Primary Care workforce model 12 can be predicted with particular mitigate as the risk is unknown 16 Same 6 Ruth Colburn-Jackson 29/02/2020
- [00014] them GP practices may not be able recommissioned in 2020/2021.
reference to retirement ages of and unpredictable in nature
to continue to deliver commissioned
current staff.
services or be able to implement the Areas of renewed focus are:
five year forward view and the
The Primary Care Programme
primary care strategy of the CCG
Board and Delegated Primary
Care Committee will continue to • Use of apprenticeship levy
Scenario two - If individual GP
receive reports on the progress of • Use of advanced clinical skills
practices or localities are aware of
implementing these actions on a training fund
short term and immediate
regular basis. • Implementation of new
workforce risks but are unable, or
unwilling, to mitigate them in time Frimley Training Hub due to be
GP practices may not be able to operational April 2020 - Training
continue to deliver commissioned hubs are designed to meet the
services or be able to implement the educational needs of the
five year forward view and the multidisciplinary primary care
primary care strategy of the CCG team, and bring together NHS
organisations, community
There are 5 GP practices that providers and local authorities
currently have 50% or more of their • New to practice - The NHS
staff currently over the age of 55: Long Term Plan committed to
offering newly qualified doctors
Southwood Practice 67% The Ferns and nurses entering general
Medical Practice 59% River Wey practice, a two-year fellowship.
Medical Practice 57% The This would offer a secure contract
Wellington Practice 55% Fleet
of employment alongside a
Medical Centre 51%
portfolio role tailored, where
possible, to the aims of the
There are 6 GP practices that will
individual and the needs of the
have 50% or more of their staff
local primary care system. The New
currently over the age of 55 in 2
to Practice Programme responds to
years time:
key areas of feedback from newly-
qualified GPs/GPNs:
Southwood Practice 72% The Ferns
Medical Practice 69% River Wey ◦ Desire for a supportive
Medical Practice 68% The transition into General Practice
Wellington Practice 64% Fleet ◦ Opportunities to work
Medical Centre 60% Richmond in a portfolio way
Surgery 55% ◦ Learning wider skills for
Scenario three - If individual GP future ways of working
practices or localities are aware of Page • Aspiring leaders programme
longer term workforce risks but 5 • Introduction of fully funded
do not act to mitigate them in time of NB medical hot topics courses
6. Committee Risk Register 07-06-19 (6).xls
Report produced from Verto on : 03/02/20 at 14:19 GP practices may not be able to 6 • New resource focussing on
continue to deliver commissioned
services or be able to implement the the GPN 10 point plan Overall Page 17 of 57
five year forward view and the31/12/2019 - Online consultations
If the changes outlined in the GPFV are now offered by 18 of our 20 GP
are not implemented, then it is practices. 2 GP practices are yet to
possible that the current model of go live (Holly Tree, and Downing
primary care will not be Street Group Practice).
sustainable in the future. Mobilisation is due in January 2020.
There are four main elements to the Monthly utilisation is steadily
GPFV that the CCG is responsible
increasing and there were 4361
for delivering:
• Attendance at visits in November 2019 saving an
conferences, webinars and local estimated 891 appointments in
• Implementation of care
commissioning forums to ensure primary care.
navigation and workforce
the CCG understands each
optimisation training
component of the GPFV and how
• Implementation of online it can be best delivered Regularly updated project plan
consultations • Monthly GPFV assurance
[PR000027] Delivery of the General Practice Five Year for the implementation and
• Workforce initiatives (covered 9 6 Same 4 Ruth Colburn-Jackson 29/02/2020
- [00013] Forward View - Online consultations returns to NHS England maximisation of online
in another risk) • Review of progress at consultations technology
• Implementation of improved Primary Care Programme Board
access (covered in another risk) • Monthly dashboard of
online consultation usage
There are other elements of the produced and presented to GP IT
GPFV that NHS England (or other working group
organisations) are responsible for
delivering. For example, changes to
the premises cost directions. The
CCG is unable to influence the
delivery of these components.
The particular area of risk that has
been identified for the CCG to focus
on is the implementation of online
consultations in all GP practices.
Page
6
of
6. Committee Risk Register
Report produced 07-06-19
from Verto on : 03/02/20 at 14:19 (6).xls 6
Overall Page 18 of 57Lessons report
• Fleet Integrated Care Centre
• Farnborough Centre for Health (Voyager House)
• Giffard Drive Surgery
• NEHF CCG GP Practices
7. Lessons report 100120.PPTX
Overall Page 19 of 57Introduction
This report has been produced at this time, as there have been a
number of ‘what did not go well’ lessons logged. These lessons need
to be acknowledged and addressed in order to ensure that they are
learned from.
7. Lessons report 100120.PPTX
Overall Page 20 of 57Scope of the report
• The report looks at the lessons which apply to each of the
projects named, together with lessons which have affected a
number of Primary Care Premises projects. It also includes
lessons in relation to general GP Practice projects underway
within the NEHF CCG.
• The lessons fall into a number of categories including project
management, technical advice, scope, finance and
communications & engagement.
7. Lessons report 100120.PPTX
Overall Page 21 of 57Lessons - What did not go so well - Project Management
Lesson –
• Clarity around CCG Project Manager (PM) and Hampshire LIFT (HLL) roles
Impact -
• Stakeholders confused as to who is leading the project
• HLL taking lead on the design, resulting in the project not remaining within
scope and budget.
Recommendation –
• Agree clarity of each role
• A project has one project manager
• HLL role is that of Technical Advisor and appropriate ID is worn to that effect
7. Lessons report 100120.PPTX
Overall Page 22 of 57Lessons - What did not go so well – Project Scope
Lesson –
• Lack of clear definition of the project scope with a clear defined area being
signed off, e.g. design an ICC from which to deliver an Integrated Care
Service model.
Impact –
• Scope creep resulting in project budget creep and delay in project delivery.
Recommendation –
• Define the scope of the project at an early stage. Understand what is on the
provider's wish list/nice to haves. Scope differs from an objective - i.e.
deliver an ICC.
7. Lessons report 100120.PPTX
Overall Page 23 of 57Lessons - What did not go so well - Finance
Lesson Impact Recommendation
Accuracy of project costs - Project going over budget, hidden costs. All financial decisions to be agreed by a committee,
Commitments made to funding Transparency is lost. Finance is overcommitted. explicitly, for pre-construction/design costs, incl.
by individuals not by a VAT & fees.
committee
HLL management of project fees PM reliant on SBS system to keep track of PM to hold spreadsheet of project finances. A
and invoicing finances template has been provided by finance team.
Lack of understanding of costs Architect produces designs which are outside of Estates Advisor/Technical Advisor to provide
of design features, fees the project budget. advice. QS to ensure estimated budget is on track.
Legitimate extra costs i.e. VAT & Unless all costs are identified early in the project Committee to consider project costs before
IT not identified early enough in there is a risk that the project may need to be funding bid made. Clarity needed around whether
the project aborted due to lack of funding. net or gross figures are used in a funding bid.
Lack of understanding around Results in misunderstanding when submitting bids. Finance team to provide support before a bid is
reclaiming VAT Also affects the project budget planning. submitted.
Architectural aspirations versus Architectural designs which are unaffordable to Emphasis should be placed on delivering designs
economic challenges deliver for the most economical price.
7. Lessons report 100120.PPTX
Overall Page 24 of 57Lessons - What did not go so well - Finance contd.
Lesson Impact Recommendation
Tender costs have all returned above the Value engineering has had to be carried out, Estates Advisor/QS/Relevant Person to
expected costs resulting in the need for additional design support the design stage. Architects to be
costs to redraw plans. given a clear remit to provide the best
possible design for the lowest price.
GPs reveal they cannot make the financial Project completion is put at risk. CCG having Never assume a practice can afford a project.
commitments, including new charges as a to source additional finance to support the Reach early understanding of practice
result of a building move or extension, too project once money has been spent on financial commitments.
late in the project architects drawings etc.
Never assume, should it be required, The existing building owner would be Support should be provided to building
existing buildings will sell when owners are responsible for the mortgage and running owners to help them assess their estate
moving to a new healthcare facility. costs of the existing building, even if they financial position.
move into a new building.
7. Lessons report 100120.PPTX
Overall Page 25 of 57Lesson - What did not go so well - Technical Advice
Lesson –
• The challenge of implementing Industry Standards in existing buildings
Impact –
• Expensive and challenging to implement industry standards in an existing and,
or old building. This impacts the project budget and delivery timescale.
Recommendation –
• Work with a QS/Technical Advisor and Lead Designer to understand the
implications and any possible effect on the project budget. We need scheme
and design first to feel more confident on the required budget as a standard
£2k per sq m for refurbishment may not be sufficient.
7. Lessons report 100120.PPTX
Overall Page 26 of 57Lessons - What did not go so well - Change Requests
Lesson –
• Changes to any element of the project including scope not documented
throughout the project
Impact –
• Project incurring scope creep and over budget
Recommendation –
• Define scope carefully.
• Log each change to scope, use identification, implication and
implementation methodology.
7. Lessons report 100120.PPTX
Overall Page 27 of 57Lessons - What did not go so well - Planning Application
Lessons –
• Challenges by Conservation Officer
• Surveys can take longer than expected
• Limited informal/formal pre-planning engagement with Council led to delay in
achieving planning approval
Impact –
• A delay in the planning application process
• Changes to design plans
Recommendations –
• Consider pre-planning consultation.
• All surveys to be commissioned with sufficient time. Check previous planning
applications on a property for previous experience.
7. Lessons report 100120.PPTX
Overall Page 28 of 57Lessons–What did not go so well – IT Requirements
Lesson –
• Funding not guaranteed for IT requirements of a new build/extension with an
increase in staff members involved in the outcome of the project
Impact –
• It is not possible to add additional staff to an IT system which is already at
maximum capacity. IT upgrade maybe required site wide as it is not viable to
just upgrade a specific area in an existing building.
Recommendation –
• Funding to be agreed by a committee and written confirmation of this logged.
7. Lessons report 100120.PPTX
Overall Page 29 of 57Lessons - What did not go so well - Communication & Engagement
Lesson –
• Providers not prepared for changes to services and business.
Impact –
• Patients complaining about lack of communication around changes
• Providers receiving complaints from patients
Recommendation –
• Keep providers well informed of any changes to service or likely changes to
business at an early stage.
• Keep communications with patients up to date.
7. Lessons report 100120.PPTX
Overall Page 30 of 57Delegated Primary Care Commissioning Committee
Frimley Integrated Care System GP Transformation Steering Group update
Title of Paper
Primary Care Network Update
Agenda Item 8 Date of meeting 12th February 2020
Exec Lead Oliver White Clinical Sponsor Dr Steven Clarke
Author Lauren Pennington, Head of Commissioning – Primary Care and Prevention
To Approve
To Ratify Strategic
Purpose To Discuss Y Objective
Number
To Note
n/a
Risk
Unique
n/a
Risk ID
Executive Summary
Frimley Integrated Care System (ICS) GP Transformation Steering Group update
1. Primary Care Network Update (PCN)
The Network Contract Directed Enhanced Services (DES) commenced on the 1st July 2019.
Since the last update to this Committee the following has been achieved:
Population health management training for PCNs has commenced with each PCN sending
representation;
Response to draft service specifications released for consultation from NHS England submitted;
Continued engagement and mobilisation of the Mental Health Integrated Community Services in
Aldershot and Farnham PCNs; and
Organisational development allocations for 2019/2020 have started to be accessed by PCNs.
Common themes when accessing this allocation are:
Leadership, planning and partnerships; and
Integrating care
Areas that are not yet being focussed on are:
Managing resources
Working with people and communities
Version 20 Sept 2016
8. Frimley ICS update.docx
Overall Page 31 of 57Recommendations
To review the contents of this update
Publication Public website Staff website (intranet)
Governance and Reporting- which other meeting has this paper been discussed
Committee Name Date discussed Outcome
Delegated Primary Care Regular update provided to Committee
Monthly
Commissioning Committee members
Please provide details on the impact of following aspects
Equality and Quality
N/A
Impact Assessment
Patient and Stakeholder No new updates
Engagement
Financial Impact and No new updates
Legal implications
Version 20 Sept 2016
8. Frimley ICS update.docx
Overall Page 32 of 57Delegated Primary Care Commissioning Committee
Title of Paper Development of primary care networks and priorities for 2020/2021
Agenda Item 10 Date of meeting 12th February 2020
Exec Lead Oliver White Clinical Sponsor Dr Steven Clarke
Author Lauren Pennington, Head of Commissioning – Primary Care and Prevention
To Approve
To Ratify Strategic
Purpose To Discuss Y Objective
Number
To Note
n/a
Risk
Unique
n/a
Risk ID
Executive Summary
The NHS Operational Planning and Contracting Guidance 2020/2021 continues to emphasise the growing
role of primary care networks (PCNs) in successful health and care systems.
This brief presentation aims to trigger the Committee to consider the Clinical Commissioning Groups role
in supporting the achievement of this national aspiration; along with a broader consideration as to our role
in supporting the resilience of primary care.
To review the contents of this presentation and provide a steer on next
Recommendations
steps
Publication Public website Staff website (intranet)
Governance and Reporting- which other meeting has this paper been discussed
Committee Name Date discussed Outcome
Delegated Primary Care Regular update provided to Committee
Monthly
Commissioning Committee members
Please provide details on the impact of following aspects
Equality and Quality
N/A
Impact Assessment
Patient and Stakeholder No new updates
Engagement
Version 20 Sept 2016
10. Networks future.docx
Overall Page 33 of 57Financial Impact and No new updates
Legal implications
Version 20 Sept 2016
10. Networks future.docx
Overall Page 34 of 57DELEGATED PRIMARY CARE COMMISSIONING COMMITTEE
Title of Paper Monthly Primary Care Quality Update
Agenda Item 11 Date of meeting 12 February 2020
Exec Lead Clinical Sponsor Dr Peter Bibawy
Author Steve Clarke, Senior Head of Quality Improvement
Purpose To Approve Strategic
To Ratify Objective
To Discuss X Number 1
To Note
Risk Quality in Primary Care
Unique
CR-31
Risk ID
Executive Summary
Please see below key GP practice updates for November 2019;
Jenner House Surgery – Level 3
• Care Quality Commission Report Published – Good overall and Good in all domains
• List Size Update - Reduction continues to slow but registered numbers still reducing
• GP Patient Survey 2019 – 73% describe their overall experience of this GP practice as good
(CCG 85%, National 83%)
• Practice escalated to Level 3 on the Practice Assurance Framework
• January 2020 – CCG Primary Care leads met with partners & practice manager.
Requested evidence regarding process improvements and have instigated a monthly
meeting to support and assure progress.
Cambridge Practice – Level 2
• Care Quality Commission Report Published – September 2019; Requires Improvement
overall
• List Size: 1% reduction 2018 to 2019 (202)
• Significant turnover in GPs (partners & salaried)
• January 2020 – CCG quality lead meeting with Practice Manager and Deputy Practice
Manager. Good progress and almost complete on all areas highlighted by CQC.
Focus on describing a practice governance structure.
Mayfield Medical Centre – Level 2
• 31 January 2019 – Care Quality Commission Report Published: Good overall
• GP Patient Survey 2019 – 52% describe their overall experience as good (CCG 85%,
National 83%).
• The Clinical Commissioning Group continues to support the practice in seeking a
sustainable model for delivery of primary care via the Operational Management Board.
• November 2019 – Operational Management Board continues to support work leading in to
new contract start in January 2020 and future planning. Progressing well.
• January 2020 – Transfer of contract has taken place with Salus now responsible.
Operational Management Board continues on a monthly basis with Salus now
chairing
Version 20 Sept 2016
11. DPCCC Primary Care QualityFeb 2020.docx
Overall Page 35 of 57Holly Tree Surgery – Level 2
• Care Quality Commission Report Published 20th December 2018 – Rated as ‘Requires
Improvement’ overall and ‘Requires Improvement’ for Safe, Effective & Well-led. Practice
have submitted action plan to Care Quality Commission.
• January 2020 – Practice receive ‘Good’ overall Care Quality Commission report (with
Requires Improvement for Well-led)
• Practice Support Programme Visit 12th February 2020
Wellington Practice – Level 2
• Care Quality Commission Report Published 23rd October 18: Practice now rated Good
overall with Requires Improvement for Effective (with an improvement notice). To monitor
and support on-going work to address requirements in this domain.
• January 2020 – Registered as new provider with Care Quality Commission; to carry
over previous rating due to continuity of existing partner
Recommendations Review
Publication Public Website Staff Website (intranet) X
Governance and Reporting- which other meeting has this paper been discussed
Committee Name Date discussed Outcome
PCOG 05/02/2020 Update report to DPCCC
Please provide details on the impact of following aspects
Equality and Quality
N/A
Impact Assessment
Patient and
Stakeholder N/A
Engagement
Financial Impact
and Legal N/A
implications
Version 20 Sept 2016
11. DPCCC Primary Care QualityFeb 2020.docx
Overall Page 36 of 57Delegated Primary Care Commissioning Committee
Title of Paper Primary Care Finance Report
Agenda Item 12 Date of meeting Wednesday 12th February 2020
Exec Lead Ollie White Clinical Sponsor N/A
Purpose To Approve Strategic
To Ratify Objective
To Discuss Number D – Financial Sustainability
To Note X
Risk None stated
Unique
N/A
Risk ID
Executive Summary
The Primary Care Finance Report is a monthly report that details the current financial position for
the Delegated Primary Care Commissioning function, as well as all other Primary Care budgets.
This is the report for month 9 19/20, and the key points to note are as follows:
As at month 9 the CCG is reporting a YTD favourable position of £334k and a forecast
underspend for 19/20 of £361k for all Primary Care budgets. Prescribing is showing a YTD
overspend of £483k and a forecast adverse variance of £371k which is driven from potential
pressures in Cat M and NCSO.
The delegated budget is currently showing a YTD underspend of £98k which is attributable
to the Network DES due to the Social Prescribing and Clinical Pharmacist posts being
currently vacant. However, it is forecasted that the delegated budget will breakeven due to
uncertainty regarding locum costs and premises expenditure, so it has been deemed
prudent to take this into account and assume a breakeven position at this stage.
There is a lot of flexibility built into the delegated budget, particularly around QOF, list size
growth and enhanced services which could present the CCG with an opportunity that maybe
realised in future months. This would help mitigate risks within this budget such as
maternity/sickness claims and premises costs.
The Locality Contract budget is forecasted to underspend by (£380k) due to delays with the
Same Day Access Service in Aldershot, Farnborough and Fleet.
It has been reported that there could be a large underspend on LSCs for 19/20 based on
low levels of activity. However, due to some data quality concerns a prudent approach has
been taken not to report an underspend of any sort until a data exercise/audit has been
completed.
As requested at the last Committee meeting there is a new table included in the paper
(Appendix 3) which shows a breakdown of the PCN DES.
Prescribing is now showing a YTD overspend of £483k, which is a deterioration from the
previous month. However, this is due to an issue with budget profiling, as the month 7
expenditure was in line with forecast expectations and therefore the year end forecast has
remained in the same region to what was reported in month 7 (M7: £350k overspent vs M9:
£371k overspent). It is worth noting that the forecast still includes a prudent amount of risk
regarding anticipated Cat M cost pressures and potential winter pressures/growth rate. Due
to the uncertainty with prescribing and the fact that the data is 2 months in arrears there is
every possibility that this may fluctuate, but £371k feels sensible to note at this stage and
will only be reduced once we have further certainty regarding these potential pressures.
Further GP Forward View allocation has now been received and these additional amounts
are included in table 3. The additions relate to Admin & Clerical Training, Infrastructure and
Resilience, and Primary Care Networks.
Page 1 of 9
12. Primary Care 2019-20 (Month 10).doc
Overall Page 37 of 57 A £2.8m QIPP has been set for prescribing in 2019/20, but it is too early in the year to
predict whether or not this will be achieved. However, the YTD trend would suggest that this
will be challenging due to the anticipated pressures, particularly regarding Category M.
Recommendations The DPCCC are recommended to note the content of this report
Publication Public Website X Staff Website (intranet)
Please provide details on the impact of following aspects
Equality and Quality
None stated
Impact Assessment
Patient & Stakeholder
None stated
Engagement
Following the 18/19 year end audit no issues were raised regarding our controls,
Financial Impact and
processes and procedures, as well as our accrual methodology regarding
Legal implications
delegated primary care commissioning.
Governance and Reporting- which other meeting has this paper been discussed
Committee Name Date discussed Outcome
N/A N/A N/A
Page 2 of 9
12. Primary Care 2019-20 (Month 10).doc
Overall Page 38 of 57Primary Care Monthly Finance Report
Summary
Month 9 reporting reflects the current 19/20 performance and forecast outturn for each
element of the Primary Care Delegated budget, as well as all the other Primary Care
Commissioning budgets and Prescribing.
The CCG is currently reporting an underspend of (£98k) from the Primary Care Delegated
budget, with a favourable variance of (£284k) from within the other Primary Care Budgets
and an adverse variance of £483k in prescribing. The forecasted outturn of £390k
favourable for Primary Care, nearly all comes from the Locality Contracts due to delays
regarding Same Day Access. The £371k forecast overspend in prescribing is as a result of
anticipated Cat M cost pressures in particular.
Summary of all Primary Care Budgets
Table 1
Primary Care Budgets 2019/20
YTD Full Year Full Year
Full Year YTD YTD
Variance Forecast Forecast
Budget Budget Actual
(Under)/Over Spend (Under)/Over
£000K £000K £000K £000K £000K £000K
Delegated Primary Care 28,665 21,013 20,915 (98) 28,665 0
Local Service Contracts 2,159 1,619 1,617 (3) 2,159 0
Primary Care Development 434 325 322 (3) 424 (10)
31,258 22,957 22,854 (104) 31,248 (10)
GP IT 832 581 629 48 832 0
Locality Contracts 3,091 2,318 2,066 (252) 3,091 (380)
GP Forward View Investments 2,387 1,524 1,498 (26) 2,387 0
6,309 4,423 4,193 (230) 6,309 (380)
Out Of Hours 2,273 1,683 1,683 (0) 2,273 0
2,273 1,683 1,683 (0) 2,273 0
PRIMARY CARE: GRAND TOTAL 39,841 29,063 28,730 (334) 39,831 (390)
Prescribing 31,548 23,658 24,141 483 31,919 371
Page 3 of 9
12. Primary Care 2019-20 (Month 10).doc
Overall Page 39 of 57You can also read
