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GHCCG & NHS E Joint Commissioning Committee 13.05.2015 Item 4

Purpose of Report

To seek approval from the Joint Commissioning Committee about the priority of objectives for practices receiving more than £5 funding per weighted patient

2.0 Background

As part of the national move to equitable funding for GP practices, a 4 year plan to reduce the so-called PMS premium has been set out by the NHS England Area Team. 2015/16 is year 2 of the 4 years. In 2015/16 PMS practices will be eligible to earn back 87.5% of the PMS premium in return for meeting a number of objectives. The other 12.5% is available for GHCCG and has been the subject of another paper.

3.0 Detail

GHCCG has 23 PMS practices, of which 22 have so-called premium funding. The level of funding per registered patient varies between these practices.

The Area Team has set out that, to earn back the 87.5% in 2015/16, practices need to achieve a number of objectives. The number of objectives they need to meet is set out below:

£ per weighted patient

Number of objectives Number of GHCCG practices affected

Less than £85 0 8

£85-£95 1 7

£95-£105 2 3

Over £105 3 4

The objectives are in the areas of access, long term conditions management and health improvement – attached as appendices.

The proposal is that all practices who are required to work on objectives (14 practices) should work on the access objectives. The national patient survey demonstrates that patient

satisfaction with access continues to fall both across England and in GHCCG. Having a specific focus on access will also support other CCG initiatives around urgent care.

Four practices will be asked to work on all three objective areas.

For the 3 practices who will be asked to work on 2 objectives, the proposal is that, in addition to access, the practices can select themselves which one of the other two they wish to work on. 4.0 Next Steps

4.1 Notify the practices of the decision of the Joint Commissioning Committee 5.0 Recommendations

It is recommended the Joint Commissioning Committee:

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Support the proposal that all practices with PMS funding of over £85 per weighted patient work on the access objectives

Support the proposal that practices who need to work on two objectives are given the choice of the other objective (in addition to access) that they wish to work on.

6.0 Appendices PMS draft objectives (3)

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GHCCG & NHSE Joint Commissioning Committee 13.05.2015 Item 4 Appendix 1

 Ensure practice staff have access to appropriate guidance and tools to support on line access  Evidence improvements to NHS England Patient on line by :

o Making available to patients appropriate information and support to;  Increase numbers of patients booking GP appointment on line  Enable and increase patient access to GP Records

 Increase repeat prescriptions ordering on line  Increase EPS links

3. Performance Reporting

Practices must report against the following requirements at the start of the objective and at the end of the

reporting year. Data will be triangulated with the data from the national GPPS and the DES for on line access for evaluation purposes

Access to GP Surgery

Practices will be required to report on the following at the commencement of the objective and at the end of the financial year

 Number of nurse sessions offered  Number of appointments attended  Number of appointments DNA  Times of sessions offered  GP/Patient ratio based on WTE

 Evidence of annual Survey and action plans formulated as part of the Survey results.  Evidence of patient forum minutes and dates of meetings

Baseline position will be taken from GP Patient Survey July-September 2014 and January-March 2015, published July 2015

Patient On line

Practices will be required to report on:

o Baseline position to include: No of appointments available for on line booking as at April 2015 o Number of patients accessing on line ordering of repeat prescriptions as at April 2015

o Number of patients accessing patient records as at April 2015

4. Key

Performance Levels

Practices must achieve the following key performance measures:

Practice to submit an annual report to include as a minimum the requirements in the performance reporting section for both GP Access and Patient on Line.

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Access

 Practices must demonstrate continuous improvements in patient experience and access to GP practice evidenced by GPPS results. Practice must achieve equal to or in excess of CCG mean.

 Improve GP patient survey results, specifically the following indicator measures; o Overall Experience of GP Surgery and

o Overall Experience of making an appointment

 Practices to demonstrate through the submission of an action plan ongoing improvements in access / patient experience through the measures outlined in national GPPS and through regular capacity and demand audits and implementation of agreed actions discussed at PRG.

 Practices to ensure minimum number of appointments offered for GP and Nursing is based on evidenced patient demand

Patient on line Services

 % increase in the availability of on line access – (increase from baseline) o Increase numbers of patients booking GP appointment on line o Enable and increase patient access to GP Records

o Increase repeat prescriptions ordering on line o No of appointments to include access Mon-Friday

5. Achievement of Indicators

Non- compliance against all elements of any one objective will result in Formal Remedial Action. Failure to submit performance data and or report as indicated will result in Breach (unless exceptional circumstances)

2 Breach notices cumulated in any one financial year may result in non-recurrent funding allocation review for subsequent years

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o Practices to become Dementia Friendly organisations. Reception staff to have “dementia friends” awareness and take Health Education England “Tier One” learning online

o Practice to create an action plan for improved diagnosis and post diagnostic support o Practice to appoint a Dementia Lead

3. Asthma

Practices must follow guidelines and apply the key recommendations of National Review of Asthma Deaths (NRAD) https://www.rcplondon.ac.uk/sites/default/files/why‐asthma‐still‐kills‐full‐report.pdf

Management

All people with asthma should be offered a personal asthma action plan (PAAP) that details their own triggers and current treatment, and specifies how to prevent relapse and when and how to seek help in an emergency. Asthma patients who do not have a PAAP should have the reasons why not clearly recorded

o People with asthma should have a structured review by a healthcare professional with specialist knowledge and skills

o Factors that trigger or exacerbate asthma must be elicited routinely and documented in the medical records and personal asthma action plans (PAAPs) of all people with asthma, so that measures can be taken to reduce their impact.

o An assessment of recent asthma control should be undertaken at every asthma review. Where loss of control is identified, immediate action is required, including escalation of responsibility, treatment change and arrangements for follow-up.

o All asthma patients who have been prescribed more than 12 short-acting reliever inhalers in the previous 12 months should be invited for urgent review of their asthma control, with the aim of improving their asthma through education and change of treatment if required.

o People who received treatment in hospital or through out-of-hours services for an acute exacerbation of asthma are followed up by their own GP practice within 2 working days of receiving notification of treatment.

Training

o Each primary care practice should have a named health professional responsible for the maintenance and improvement of standards of asthma care in the practice and these professionals should engage in:

o additional training and updating in respect of this role, specifically;

o Practice staff and clinicians in primary care need to have systems in place and the appropriate

expertise to recognise serious asthma attacks, and initiate immediate treatment. Reception staff need

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to be trained to recognise when an individual with asthma needs to be seen urgently

o Health professionals must be aware of the factors that increase the risk of asthma attacks and death, including the significance of concurrent psychological and mental health issues.

4. AF

o Practices to increase the diagnosis of AF from practice baseline to national average

o Every patient >70 years of age to be regularly risk scored and anti-coagulated if appropriate in

accordance with NICE guidelines. A discussion should be had with the patient quantifying the relative risk of treatment against no treatment

o Practices to identify a champion for expert resource 3. Performance

Reporting

 Monitored annually using the baseline position at the onset of the objective.

 Practices must submit an annual report to include detailed plans for addressing the specific domains and actions for achievement of Performance Metrics

 Demonstrate through audit if required delivery against Nice Quality standards in Dementia, Hypertension, and NRAD for Asthma

 Reporting for QOF monitored by NHS England or the CCG through CQRS 4. Key

Performance Indicators

Practice to submit an annual report to include a minimum baseline position and action plans to meet and improve on the following indicator measures:

 Achievement of QOF clinical points between 95 – 100% of available points  Achievement of disease specific thresholds equal to or exceeds CCG mean  Must inform NHS England of the named MH Capacity Act Lead in the practice

 Practices to report that as part of chronic disease management clinics the % of patients that has received a MH assessment from appropriately trained clinician.

 Practices to achieve /maintain 67-80% national dementia target

 Number and % of asthmatic patients in receipt of personalised care plan

 No and % patients followed up with GP within two working days of treatment for acute exacerbation  Practice to demonstrate upon request significant event review – Asthma

 AF Diagnosis equivalent to or exceeds CCG mean

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5. Achievement of Indicators

 Non- compliance against all elements of any one objective will result in Formal Remedial Action.  Failure to submit performance data and or report as indicated will result in Breach (unless exceptional

circumstances)

 2 Breach notices cumulated in any one financial year may result in non-recurrent funding allocation review for subsequent years

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GHCCG & NHSE Joint Commissioning Committee 13.05.2015 Item 4 Appendix 3 Improve Screening Uptake

Cervical Screening:

 Improve the % screening uptake of female patients in relevant age cohort during relevant period that have had cervical screening.

Diabetic Eye Screening:

 GP Practices to ensure 95% of diabetics are referred to the relevant Diabetic Eye Screening Programme within 3 months of the date of confirmed diabetes diagnosis.

Performance Reporting Practices must submit an initial annual report/action plan (by May 2015) clearly setting out cohorts and plans for achievement of the KPI metrics where practices are not achieving required performance.

Uptake will be measured at the end of the financial year as follows:

Child Immunisation - Data to be reviewed annually taken from child health systems quarterly COVER data (not WYCSA data)

Cytology - Data to be reviewed over an annual period and using national OPEN EXETER cytology data (not QOF data performance

Influenza - Immform

Diabetic Eye - Measured using programme data.

Shingles – campaign starts September 2014 – known patients identified then. Have 12 months to immunise Key Performance levels Practices must submit an initial annual report/action plan (by May 2015) clearly setting out cohorts and plans for

achievement of the KPI metrics where practices are not achieving required performance. Practices must achieve/sustain the key performance measures below (measured quarterly)

 95% coverage for target immunisations (2 and 5 year olds) – measured quarterly.

 75% Influenza for over 65s  75% Influenza at risk

 Childhood Flu - Achievement must be equal to or exceed CCG mean  Pregnant women - Achievement must be equal to or exceed CCG mean

 80% uptake in both age 25-49 (attended for screening in the last 3 years) and aged 50-64 (attended for screening in the last 5 years) would expect a 5% increase in uptake.

 Where practices fail to achieve national targets for Flu, Childhood Immunisations and Cytology practices

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must achieve thresholds equal to or in excess of the mean value established for all GP practices located in the CCG (but below the national target threshold)

Where no national target exists practice achievement must be equal to or exceed CCG mean Achievement of

Indicators

 Non- compliance against all elements of any one objective will result in Formal Remedial Action.  Failure to submit performance data and or report as indicated will result in Breach (unless exceptional

circumstances)

 2 Breach notices cumulated in any one financial year may result in non-recurrent funding allocation review for subsequent years

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Page 2 of 3

1.0 Purpose of Report

To seek approval for use of the PMS premium money available to the CCG in 2015/16 2.0 Background

GHCCG has 38 practices. 22 have PMS contracts, 16 have GMS contracts and 1 (The Whitehouse as part of Locala) has an APMS (Alternative Provider Medical Services) contract. NHS England set out the process for moving all GMS and PMS practices to equitable funding. The intention is that, by 2020, all practices will be paid the same amount of money per weighted patient for the core contract.

To achieve equitable funding, both GMS and PMS practices core budgets are being reviewed. NHS England published their “Framework for Personal Medical Services (PMS) agreements review” (September 2014) which set out some key principles to support this movement. This included the principle that any resources freed up from PMS reviews should always be reinvested in general practice services.

3.0 Detail

3.1 Impact on PMS Practices

21 of the 22 PMS practices in GHCCG will see a reduction in their funding to bring them to a level with GMS practices. This is being phased over 4 years with year one being 2014/15. Year one is without a reduction to funding. Thereafter the reduction of the so-called PMS premium is phased so that the amount of the premium paid by the Area Team is reduced as follows:

• 2015/16 12.5% reduction – NOTE: the original intention was that year one would have a 25% reduction

• 2016/17 50% reduction • 2017/18 75% reduction • 2018/19 100% reduction

Some GMS practices are also being affected by the removal of the Minimum Practice Income Guarantee (MPIG). This money is not available to GHCCG.

3.2 Funding to GHCCG

The finalised PMS premium amounts were sent to the CCG in February 2015, GHCCG will receive an increasing percentage of the premium each year..

The funding available to GHCCG is set out as follows:

Year £ 2015/16 242,343 2016/17 986,968 2017/18 1,481,229 2018/19 1,975,692 2019/20 1,969,556 2020/21 1,913,331 3.3 Proposals for 2015/16

The proposal is to use the money non-recurrently in 2015/16 and to develop recurrent proposals for 2016/17 and beyond.

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Page 3 of 3

This proposal supports practices in their delivery of the Primary Care Assurance Framework (the Framework). The Framework is a national quality assurance and quality improvement approach which is used to assess all practices across England.

The proposal will support practices to improve quality in areas which will be of most benefit to patients.

3.3.1 Aims of the Proposal

• To improve quality and reduce variation in agreed areas

• To support practices use of and regular review of their position of the Primary Care Assurance Framework

• To encourage practices who are in the “high achieving” category to share good practice with others

3.3.2 Detail of the Proposal

Practices review the toolkit and earn the quality payment by taking action on GP Higher Level Indicators (GPHLI) and GP Outcome Standards (GPOS).

All practices will work on three indicators from either the GPHLI or the GPOS or a mixture of both.

Where practices do not have three indicator areas as outliers, they will be asked to work on the number of outliers that they do have and to support other practices with examples of best practice.

All practices will be eligible to take part in this scheme.

Practices meeting their target indicators and sustaining their performance in all other indicators will earn the quality payment using the formula below:

Each practice will be eligible to earn £0.91 per registered patient at January 2015.

Where practices do not achieve the indicators and/or do not sustain performance in all other indicators, the amount payable will be reduced by 1/3 for each indicator that they do not achieve unless it is agreed with GHCCG that this is not due to circumstances outside their control

3.4.3 Additional Proposal

GHCCG Practice Managers’ Reference Group suggested that £20,000 of the funding is top sliced to support all practices with training. This option was supported by member practices at the April business meeting.

4.0 Next Steps

4.1 To agree indicators with each practice in May 2015 4.2 To assess performance and payment at March 2016

4.3 To develop proposals for longer term use of the PMS premium funding

5.0 Recommendations

It is recommended the Joint Committee:

1) Approve the proposals for the non-recurrent use of the 2015/16 PMS premium 2) Note the need to develop further, recurrent proposals for 2016/17 and beyond