Agenda item

(To receive a report from Sarah Newton (Chief Operating Officer, Lincolnshire West Clinical Commissioning Group) which provides an update on the activities of Lincolnshire West Clinical Commissioning Group (LWCCG) and includes information on the lead commissioning arrangements undertaken by LWCCG; APMS (Alternative Provider of Medical Services) practices, financial and performance information; and patient engagement activity.  Sarah Newton (Chief Operating Officer, LWCCG) and Dr Sunil Hindocha (Chief Clinical Officer, LWCCG) will be in attendance for this item)

Consideration was given to a report by Sarah Newton (Chief Operating Officer, Lincolnshire West Clinical Commissioning Group) which provided an update on the activities of Lincolnshire West Clinical Commissioning Group (LWCCG) and included information on the lead commissioning arrangements undertaken by LWCCG; APMS (Alternative Provider of Medical Services) practices, financial and performance information; and patient engagement activity.

Sarah Newton (Chief Operating Officer, LWCCG), Dr Sunil Hindocha (Clinical Chief Officer, LWCCG) and Richard Childs (Lay Chair, LWCCG) were all in attendance for this item.

Lincolnshire West CCG had a registered population of 234,594 patients, was in its fourth year of commissioning health services and was experiencing increased demand for healthcare, prescribing and hospital services.  The CCG had fully delegated authority for Primary Medical (General Practice) services, the commissioning of which was managed through the Primary Care Co-commissioning Committee (PCCC), constituted to minimise any conflict of interest with GPs as members of the CCG.  The PCCC also included representatives from Healthwatch Lincolnshire and the Health and Wellbeing Committee as observers. 

Five of the 37 practices were operated under APMS when the CCG took over delegated responsibility in April 2015.  Since then the company running the University Practice APMS contract went into liquidation in March 2016.  Following a successful procurement process, the contract to run this practice was awarded to the Nottingham University Health Service, rated by the Care Quality Commissioning (CQC) as Outstanding. 

In July 2016, the CCG was given one month's notice of an intent to apply for voluntary liquidation by Universal Health, who held the remaining four APMS contracts (Burton Road Surgery, Lincoln; Pottergate Surgery, Gainsborough; Arboretum Practice, Lincoln; and Metheringham Surgery).  The services of a Caretaker Manager for these practices, whilst undergoing a consultation process for an alternative provider, was sought and, despite a number of expressions of interest, only one single bid was received for three practices.  Pottergate Surgery received two bids.  The bids were independently evaluated and a determination made that neither bidder met the minimum criteria to make a contract award.  It was therefore decided by the PCCC to close the practices.

The four surgeries formally closed to patients on 13 January 2017 and all patients who had not registered with an alternative practice by 6 January 2017 had been contacted to advise automatic registration with the GP practice closest to their existing provider.

In addition to the content of the report, the Committee was advised that the closure was not as a result of finances but the lack of a suitable provider to take over the contracts.  It had, however, cost over £50k per month over the baseline funding to keep these surgeries open whilst a new provider was sought.  Universal Health also went into liquidation owing a considerable sum to the CCG.  Disappointment at the failure of the private sector to be held to account was expressed as some of these contracts had been inherited from NHS England and not awarded by the CCG.

Lead commissioning arrangements of all CCGs had also been reviewed over the last year and LWCCG had been appointed as the lead commissioner for Lincolnshire Community Health Services, East Midlands Ambulance Service, Non-emergency patient transport, NHS 11 services and other smaller contracts.

The following achievements of the CCG were reported to the Committee.  The CCG had:-

·       Commissioned a hospital liaison service for mental health and funded a primary care service to help people with mental health problems attend health checks;

·       Continued to develop four neighbourhood teams and frailty pathways;

·       Delivered above average Bowel screening rates;

·       Supported Primary Care International Recruitment Campaign, which had resulted in a scheme to deliver 25 extra GPs to Lincolnshire;

·       Delivered a local target of 95% of practices having implemented a pre-diabetic register to support patients at high risk of developing type 2 diabetes to receive lifestyle support;

·       Procured a new, more comprehensive, non-emergency transport service for Lincolnshire;

·       Launched consultation on over the counter medication and third party prescribing;

·       Supported the development of a new Clinical Assessment Service;

·       Procured a new 111 service provider;

·       Improved dementia detection and support; and

·       Led work to improve cancer pathways such as Find Out Faster cancer pathway.

In relation to finances, the CCG received £310m during 2015-16 to commission healthcare.  48% of the expenditure was used to buy services from Acute NHS trusts, 25% on primary care (including prescribing costs), 10% on mental health, 7% on community services and 6% on continuing health care.  Less than 2% was spent on corporate running costs.

Although the CCG received an increase in funding for 2016-17, increased demand for services in a time relative funding constraint had led to some significant pressures on budgets.  The CCG was reacting to this pressure by taking measures to improve productivity and to focus on services which had the highest priority. 

In 2015-16, LWCCG was rated overall as 'Requires Improvement' and performance on each of the assessment framework areas was:-

·       Well led:                                 Good

·       Delegated Functions:         Good

·       Finance:                                            Good

·       Performance:                        Requires Improvement

·       Planning:                              Requires Improvement

92 CCGs nationally were given this rating which principally referred to the performance of the system in meeting constitutional standards for patients.

Clinical priority baselines had also been published for the first time and the CCG performed as follows:-

·       Cancer:                                  Needs Improvement

·       Dementia:                              Needs Improvement

·       Diabetes:                               Top Performing

·       Learning Disabilities:          Needs improvement

·       Maternity:                               Performing Well

·       Mental Health:                      Performing Well

Whilst pleased with the higher performance ratings, the Committee was assured that work had been ongoing to improve the dementia detection rates and was pleased to report that these now met national expectations.  Significant improvements had also been made in respect of learning disabilities with the number of patients in hospital significantly reducing.  Although the rating for cancer survival rates was similar to the national average, problems locally with cancer staging data which was a measure of the degree of progression seen in a cancer at the time of diagnosis.

Patient engagement continued by Listening to the Patient Voice and having an effective Quality and Patient Experience Committee (QPEC), a sub-committee of the CCG Governing Body which met quarterly.  A Stakeholder Communication and Engagement report was presented to the CCG Governing Body in November 2016 which described the key achievements in the first half of the year and included:-

·       Over 1014 separate engagement interactions outside of 'routine' business function;

·       50 press releases, 98% of which were used by local media;

·       Increase in social media following by 67% (Twitter) and the launch of a new CCG Facebook page which reached an audience of 23,000 in October 2016;

·       National TV coverage of Diabetes Prevention Programme, regional TV coverage of new Find Out Faster cancer pathway, a monthly column in the Lincolnshire Echo and Molly's Guide magazine in addition to a regular slot on Siren FM to promote mental health, diabetes and cancer;

·       The Health Involvement Network was launched in September 2016 and had provided more opportunities for patients, groups and organisations to engage in the decision-making of the CCG.

In addition to the lead commissioning role for a number of contracts, the CCG was also the lead commissioner for planned care and cancer across the County.  Within the STP and LHAC programmes, the CCG had led on these areas, proactive care, primary care and estates.

The Committee was asked to note that the STP was not a draft plan and was, in fact, a live document which would continue to evolve throughout the implementation of the two year operational plans and any major changes made only after full public consultation.

The critical steps for the future of the STP included:-

·       An Options Appraisal Event on 25 January 2017;

·       A Clinical Senate Review on 20 February 2017;

·       Submission of the Pre-Consultation Business Case to NHS England at the beginning of March 2017; and

·       It was anticipated that the 12-week public consultation would commence in May 2017.

Members were invited to ask questions, during which the following points were noted:-

·       GPs had a responsibility to keep patients lists up-to-date and as part of this to remove patients from lists when they passed away as the practices were paid per patient.  There was a process to ensure that every patient was captured, even those who registered temporarily.  However, it was acknowledged that there was a challenge in keeping track of temporary patients but the process was generally successful;

·       Approximately 40% of patients from the Burton Road surgery had not yet registered with an alternative GP.  The CCG were in the process of allocating these patients to other GPs and assured the Committee this would be done, electronically, within the week;

·       Concern at the additional strain on existing GPs to take these patients was noted but explained that some part-time GPs in those surgeries had agreed to increase their hours to full-time in order to fully support all patients;

·       GP practices would be unable to open for longer hours as there was not the workforce available at the present time to support that.  The increase in housing would mean that capacity would have to increase as opening new surgeries would be difficult to maintain;

RESOLVED

1.    That the information presented by Lincolnshire West Clinical Commissioning Group be noted; and

2.    That the outcomes of the procurement exercise undertaken by Lincolnshire West Clinical Commissioning Group in relation to the four APMS (Alternative Provider of Medical Services) practices be noted.