Sussex Brighton and Hove Clinical Commissioning Group (CCG) Primary Care Commissioning Committee (PCCC)
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Sussex
Clinical Commissioning Groups
Brighton and Hove Clinical Commissioning
Group (CCG) Primary Care Commissioning
Committee (PCCC)
Primary Care Quality Report - January 2020Primary Care Practice Visits
Primary Care Support
Priority has been given to three Practices in Brighton and Hove following publication of CQC inspection reports. Two practices have received the CQC rating of
‘Requires Improvement’ and one practice has been rated ‘inadequate’ and is currently under CQC special measures.
Practices identified for support visits during 2019/20 are those who meet the following criteria:
• CQC rating of Requires Improvement or Inadequate
• Have a closed or capped practice list and
• Those with significant change in workforce.
Local Resilience Group (LRG)
Members of the quality team and primary care team meet bi-monthly to discuss triangulation of data in relation to practice performance and “soft intelligence”
which is sometimes passed to CCG members about member practices. This meeting feeds into the Primary Care Operational Group (PCOG).
The primary care team have created a resilience tool kit which includes where appropriate joint visits from the quality and primary care team to support resilience.
Summary of GP Patient Survey Brighton and Hove (2019)
Key points to note include:
• There has been an overall improvement in the positive feedback rate for Brighton & Hove practices in 2019. 20 practices showed an improved
score compared to 2018. The CCG average (85.4%) is also higher in 2019 compared to the England average (82.9%) and the comparator CCG
average (83.9%).
• In response to the question “How easy is it to get through to someone at your GP practice on the phone?”, 20 practices saw a higher rate of
satisfaction for this question in 2019 compared to 2018. The CCG average is also higher than the national average (by 7.9%) and the average of
B&H’s comparator CCGs (by 4.2%).
• Satisfaction with general practice appointment times is higher in Brighton & Hove in 2019 (69.4%) compared to the national average (64.7%) and
the average of our comparator CCGs (66.7%).
• The CCG average for “Offered a choice of appointment” in 2019 is 6.9% higher than the England average and 5.2% higher than the comparator
CCG average. In response to the question “How would you describe your experience of making an appointment?”, the CCG average in 2019
(74.6%) was higher than the England average (67.4%) and the comparator CCG average (68.2%).
• Generally, the responses to whether the patient had a preferred GP were lower in 2019 compared to 2018, with 23 practices reporting lower
values in 2019.
• Results for the question “During your last general practice appointment, did you feel that the healthcare professional recognised and/or
understood any mental health needs that you might have had” have generally got worse in 2019 compared to 2018. Twenty four practices in the
city reported a lower positive response rate compared to 2018. However, three practices achieved 100% (Pavilion, University of Sussex and Arch).
• There has been an increase in positive responses for patients having confidence and trust in the healthcare professional that they saw or spoke to
compared to 2018,with 19 practices showing an improved score in 2019.
2Primary Care Quality
Primary Care Workforce Development
The key points to note for Brighton and Hove and High Weald, Lewes and Havens since the publication of the last iteration of this report include:
• Two Trainee Nurse Associates (TNA) confirmed and funded with SCFT transfer of levy starting Feb 2020. Presented with many challenges around primary care
accessing TNA training, working hard to resolve these problems.
• Supporting practices to upskill staff - there has been an increased interest from practices to develop reception staff to become Health Care Support Workers (HCSW)
• Supported 18 new Practice Nurses with an induction programme to help aid retention and reduce attrition; this included lead nurse visits, University module and
clinical skills training
• Clinical Skills training delivered in 2019, and whole year of training planned for 2020, for HCSW, Practice Nurses and Advanced Clinical Practitioners (ACPs)
• Transitioning nurse mentors to practice supervisors and practice assessors, as per the new NMC recommendations.
• Student nurse shadowing event and workshop was very successful, with planning to role this out across Sussex.
• Two BSc Nurse Practitioners (NPs) qualified in 2019 and working in practices. Three further nurses are currently training.
• One NP was supported to credential through the RCN process and has been awarded Advanced Nurse Practitioner (ANP) status. Workshop arranged in Jan 2020 to
support other NPs to complete this process and work towards being awarded Advanced Nurse Practitioner status.
• Three Practice Nurses qualified as MSc Advanced Clinical Practitioners in 2019 and working in the system. Three further Nurses and one Paramedic is currently in the
ACP MSc programme.
• Developed and delivering ACP Learning sets and advanced clinical skills training to support these new advanced roles. This is a continuation of their development as
12 Practice Nurses have been funded to train to become ACP/ANPs over the last four years
• Engagement from practices keen to recruit more ANP’s informed they are difficult to recruit, so keen to train their own. Bid for funding for next year to support this.
• 10 Point Action Plan to re-introduce a clinical supervision model to the workforce; face to face or more flexibly as a digital experience.
• The Sussex CCG team attended a University of Brighton career fayre on 26th November aiming to recruit into Primary Care. The team was approached by more than
30 student nurses interested in working in Primary Care; they will be contacted regularly with updates and practices informed of their interest.
• Close working with University of Brighton as the final stages of registered nurse training as an apprenticeship are finalised.
• Development of a draft proposal for Nurse fellowships, as per the long term plan. This has been submitted to the STP along with a model for GPs.
• A GP retention scheme is being delivered to new GPs who have qualified in last 3 years; these action learning sets started in September.
• The GP mentorship scheme is available across Sussex, due to work by the Workforce team in Coastal CCG who have shared this opportunity.
• Locum conference held to help engagement of GP locums to take up salaried posts; there has been some success stories of locums taking on some sessions in
various practices. Planning a follow on event in 2020.
• Workforce and training Information offered to PCN Clinical Directors at a recent event. Meetings planned in the new year to follow up on this.
• Workforce solutions brochure created and shared to help PCNs understand new reimbursement roles offered in long term plan.
• Presented at Transforming Care Workshop on recruitment, retention and Psychological Safety in the workplace.
• Part of a Sussex wide ‘Delegation Task and Finish Group’ looking at a Sussex wide process to delegate clinical skills to support workers in social care
• A Sussex wide ‘ Celebrating Practice Nursing’ event is planned for 12th May 2020, as it is the ‘Year of the Nurse’. Student nurses and HCSW will also be invited to
encourage career development.
• Working closely with PCNs who are keen to develop local training hubs to support integrated training and development, with community and social care.
• Training hub members planning to engage with PCNs and develop education leads for each PCN
• Supporting the Stop Look Care Team with the Stop Look Care project, sharing the concept with other areas and finalising a mental health version of the booklet
3Primary Care Quality (Continued)
Infection Control: Infection Control Champions
The key points to note include:
• Infection Prevention link champion forums are being convened bi-annually in five locations across the seven Sussex CCGs.
• There has been a high level of attendance at the November forums hosting a variety of practitioners working within primary care.
• The November forums focused on the links role within the practice and how this meets the 10 criteria outlined in the Health and Social Care Act (2008),
Code of Practice on the prevention and control of infections and contributes to the five key CQC domains.
• The forum allows for student directed learning and an opportunity to share best practice and provide feedback.
Brighton and Hove CCG Goldstone Cluster Integration Update
The key points to note in relation to this integration include:
• Multi-disciplinary Teams (MDTs) have been established rotating around the three practices every two weeks. MDT members and practice clinicians bring
cases for discussion and a plan is drawn up for each case.
• Criteria for referral are aligned to the HWLH multi-agency criteria, i.e. ‘patients that keep you awake at night.’
• During MDT meetings, issues that arise that are not within the gift of the MDT to solve, are collated and escalated to a working group. The working group is
comprised of lead operational practitioners from the stakeholder organisations who drive the development of the model.
• A monthly steering group ensures the stakeholder organisations executive leaders can input expertise and experience and link the pilot to relevant work
streams across the city.
• Multi-disciplinary team working /integrated working models are ways of working that have evidenced the Goldstone cluster approach to this project. The
GP forward view and the Long Term plan both describe this way of working across systems.
• The Pilot has demonstrated that it is possible to bring together an effective, integrated MDT across primary care, community care, social care, mental health,
public health, housing and voluntary organisations and will be rolled out across other Brighton and Hove PCN’S in the coming months.
4Brighton and Hove CCG Care Quality Commission (CQC) GP Inspection Update (as of 03 December 2019)
Organisation Overall Safe Effective Caring Responsive Well Last report published
Rating Led
All Practices (apart from the below) “Good” overall for 31 Practices and one ‘Outstanding’ Practice Various
Saltdean and Rottingdean Medical June 2019
Practice
The key issues relate to systems for the safe management of all high-risk medicines, in particular patients were being prescribed Warfarin
without the prescriber having enough information to determine if it was safe to prescribe. There was no risk assessment for emergency
medicines, systems for the recording and action of safety alerts and no process to effectively learn from mistakes and improve service
delivery. In addition to this, the practice were unable to demonstrate that staff had the skills, knowledge and experience to carry out their
roles. There were gaps in training for some clinical staff in relation to basic life support, safeguarding and infection control and no systems in
place to monitor the overall governance arrangements of the practice. The CCG Quality management team are supporting the practice to
develop a robust improvement plan in response to CQC findings.
Allied medical practice November 2019
The practice did not have comprehensive safeguarding systems, environmental risk assessments, and safety checks in place. There was a lack of equipment
for dealing with medical emergencies and processes for the effective management of medicines and infection control. There was evidence of some
monitoring and improvement to patient outcomes, however long term conditions, cervical screening and mental health indicators were below average. The
practice did not have clear and effective processes for managing risks, issues and performance, however there was evidence of systems and processes for
learning, continuous improvement and innovation. The practice will be inspected again within six months. The CCG Quality management team are
supporting the practice to develop a robust improvement plan in response to CQC findings.
The Haven Practice October 2019
The practice did not have comprehensive safeguarding systems, environmental risk assessments, and safety checks in place. There was a lack of equipment
for dealing with medical emergencies and processes for the effective management of medicines and infection control. There was evidence of some
monitoring and improvement to patient outcomes, however long term conditions, cervical screening and mental health indicators were below average. The
practice did not have clear and effective processes for managing risks, issues and performance, however there was evidence of systems and processes for
learning, continuous improvement and innovation. The practice will be inspected again within six months. The CCG Quality management team are
supporting the practice to develop a robust improvement plan in response to CQC findings.
Themes from recent CQC inspections
• The CCG Quality team have reviewed the themes following recent CQC inspections of General practice and disseminated findings via the monthly
newsletter.
• Further details of identified themes and trends requiring improvement can be found under Appendix Two.
5Appendix One: Brighton and Hove CCG Goldstone Cluster Integration Background
In the autumn of 2018, GP practices in Cluster 6 (Brighton Health and Wellbeing Centre, Charter Medical Centre and Trinity Medical Centre) came together
with partners including community nurses, Occupational Therapists, physios, social workers, pharmacists, mental health practitioners, representatives from
the housing and healthy lifestyles teams, community navigators, the carers centre, BSUH and the CCG with the following objectives
• To design a model of integrated working at cluster level that integrates primary, community, mental health, social care, healthy lifestyles, voluntary
sector and secondary care where possible and pilot in Goldstone cluster.
• To work within the overall strategies of the constituent organisations
• To seek feedback from operational staff working at cluster level on operational practical challenges
• To agree solutions to these as part of developing a new model of integrated care.
6Appendix Two: Identified CQC Learning for General Practice following review of inspection reports
Safe Domain Focus on Safety Alerts
Medications management – repeat Rx, antibiotic Rx Circulating and acting on medical and safety alerts (CAS Alerts or other
relevant local or national reports), in order for staff to adapt working
Systems for recording fridge temperatures practices if necessary. An auditable log should be kept and a nominated
clinician should be responsible as a lead for considering GP relevant CAS
Safe storage of prescription forms alerts – these should be signed up for by contacting
safetyalerts@mhra.gov.uk or cascaded vis NHS England or via your CCG
Sepsis recognition training for all levels of staff (please note this will be a requirement from 1st October 2019).
Infection control, fire safety, environmental and health and safety audits
The Medicines and Healthcare products Regulatory Agency (MHRA) also
Recruitment checks (DBS, follow-up on references, checking of release monthly drug safety newsletters which may cover alerts not
qualifications etc.) included in CAS - GP practices can also sign up to at:
On-going registration of nursing staff https://www.gov.uk/government/publications/drug-safety-update-
monthly-newsletter)
Safeguarding training compliance – with staff trained to correct levels
Circulating and acting on clinical guidance - The latest NICE guidance
Staff appraisal compliance
should be monitored on a regular basis with an auditable log kept to show
Risk assessments for emergency and high-risk medications compliance – as before a nominated clinician should be responsible as a
lead for considering. Links for obtaining regular updates can be found via
Ability to deal with a medical emergency (including emergency these links: https://www.nice.org.uk/guidance and/or
medication) https://www.guidelinesinpractice.co.uk/
Safety alerts- recording of actions and systems to disseminate alerts to
staff
Immunisations and vaccinations
Patient specific directives for B12 injections
Review and improve monitoring of adults and children considered to be at Recent trends from CQC inspections have also shown that one of the areas
risk by the creation of formal registers they are looking at in some detail is how the practice manages their
immunisation status.
Well Led Domain
What is their call/recall process for all vaccinations and immunisations,
what are their immunisation figures and what plans do they have to
Mandatory training compliance increase uptake.
Documentation and learning from significant events
Source: Review undertaken by NHS Brighton and Hove CCG
Following up actions from audits and national safety alerts Quality Team, Quarter Three 2019 7Appendix three : Medicines Management input into Sussex PCCC Primary Care & Quality Report
“The Heads of Medicines Management (HMM) across Sussex and we agreed that for the remainder of
2019/20, we will continue to provide local updates on the quality improvement initiatives relating to Primary
care e.g. clinical audit, medication reviews etc.
The HMM will review this in the New Year when there is more information available on the Primary Care
Network’s Medicines Optimisation service specifications for 2020/21. It is likely then that a proposal will be
submitted to include the addition of one or two quality metrics that it would be appropriate to monitor through
the Primary Care Commissioning Committee.”
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