Title of Meeting:
Primary Care Sub-Committee
Time:
9am
Date:
1st April 2015
Venue:
Willow, Oak House – Rotherham
Reference:
JT / JB
John Barber
Chairman:
Present
John Barber
Leonard Jacob
Richard Cullen
Phillip Moss
Dawn Anderson
Keely Firth
Sue Cassin
Jacqui Tuffnell
Karen Curran
Nathan Batchelor
Garry Charlesworth
Sarah Whittle
Chris Barnes
JB
LJ
RC
PM
DA
KF
SC
JT
KC
NB
GC
SW
CB
Rotherham CCG Lay Member (Acting Chair)
GP Members Committee Representative
Lead SCE GP for Finance and Governance
Rotherham CCG Lay Member
Head of Primary Care Quality
Chief Finance Officer
Chief Nurse
Head of Co-Commissioning
Head of Primary Care NHS England
Healthwatch
Senior Primary Care Manager NHS England
Assistant Chief Officer
Primary Care Contracts Officer (Minutes)
Action
1.
Apologies
Apologies were noted for Chris Edwards and Jason Page
2.
Declarations of Conflicts of Interest and Pecuniary or NonPecuniary Interest
RC is a GP in Rotherham and identified conflicts of interest with
Agenda items 6, 7 and 8. LJ arrived later that the declarations item but
declared his interests at the agenda items for 6, 7 and 8.
3.
Patient & Public Questions
There were no public questions raised.
4.
Minutes of the last meeting and matters arising
The minutes of the meeting 11th March 2015 were agreed as accurate.
An Action Log will be created and brought to the next meeting.
CB
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Matters Arising
The Terms of Reference have been updated to reflect the changes
from the previous meeting.
JT has arranged a Primary Care session with JB and is in the process
of arranging a session with PM.
5.
Delegation of co-commissioning responsibilities sign off
JT presented this paper and explained briefly how much the final
version changed from the original document which was received midMarch. Significant bureaucracy and CCG reporting requirements of
papers already readily available publically have been removed from the
original agreement. A late change was made on 31 March to amend
the wording in relation to a local memorandum of understanding at
Schedule 7; this clarifies the current workforce arrangements with NHS
England.
In accordance with the primary care sub-committee’s agreement to
delegate signing to the Chief Officer of the CCG, the final document
was agreed and signed by Chris Edwards on 31st March 2015.
6.
PMS Review update
JT provided the committee with a brief update on the PMS (Personal
Medical Services) review process. Currently 50% of practices have
had their contract review, which is a joint process with NHS England.
The PMS review is a National Program, where GP practices are moving
towards equitable funding. JT explained that these are difficult
discussions, with some practices losing a significant amount of money
and the impact on small practices will be substantial.
The CCG’s responsibility at these meetings is to identify to practices
where the PMS premium monies will be reinvested. The methodology
of this re-investment will be taken to LMC Officers to be agreed and
shared with the GP members committee for information. It is hoped
that the primary care sub-committee will be in a position to sign off the
year 1 proposals at its next meeting. The PMS re-investment will be
staged over 4 years beginning in October 2015; the plan for year two
will be drafter in the near future. It is hoped to have an understanding of
the full programme of reinvestment by October but acknowledged that
full work up is only feasible for the first 2 financial years.
7.
Developing the Primary Care Workforce
JT presented this paper, seeking endorsement from the group. The
understood skill shortage within Primary Care has been identified and
this paper explores some solutions but is just one element of a wider
piece of work in relation to the primary care workforce. The CCG need
to act now for the Advanced Practitioner roles as for the first time, the
courses will be available in Sheffield (these courses are already
oversubscribed).
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JT explained that it is not proposed that the CCG will fund these
courses; the individual trainees will be responsible for this. GP practices
in Rotherham will need to support these roles, offer placements for
training and then advertise vacancies when available in the future.
LJ questioned if only training practices could support the Advanced
Practitioner roles. JT stated that all practices could offer the training
roles, however non-training practices would need to be supported by a
training practice.
Rotherham Foundation Trust are currently exploring options about how
they could utilise these roles, and it is possible the CCG could work
with them regarding this in the future to develop combined roles to
improve the breadth of role for retention.
Action – JT to share the Hallam University Syllabus for the Advanced
Practitioners, with the committee.
JT
JT explained more about the Advanced practitioner roles;
 They are Band 7 or 8a
 They currently cannot prescribe (the course in the future is
being expanded to incorporate this)
 They cannot order x-rays
 They are not currently covered by a Regulatory Body, but it is
assumed that by the end of 2015 they will be covered by the
GMC
 Carry out effective 10 minute appointments
Action – JT to ensure that enhanced services in the future will specify if
Advanced Practitioners or Advanced Nurses can complete the required
clinical tasks
JT stressed the importance of communications for the new roles, a pilot
site in Skipton have had significant success using Advanced
Practitioners, largely due to a strong communication plan they
implemented for patients.
The Committee were happy to endorse the principles of this paper.
8.
Case Management LES
DA explained that this was the 4th year of this LES (Local Enhanced
Service) and the funding is already agreed recurrently. A full evaluation
of the LES was undertaken in October 2014. It was identified that Care
Home patients are the most complex. The proposed changes to this
year’s specification had been made as a consequence of feedback
from the evaluation event in October and had been discussed at a
Practice-wide meeting where GPs had suggested increased funding for
two elements of the scheme due to the complexity of the patients, the
group had agreed that the care home patients were the group that
needed this. It was also agreed that Nurses with relevant qualifications
would be able to carry out the yearly reviews of over 75’s which could
lead to an up skilling of nurses.
DA explained that she will be looking at a Care Home LES in the future,
which may require a variation in the current agreement.
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JT
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A discussion took place about the evidence of the success of this
LES. RC explained that it was very hard to evidence direct results but
felt that the health of the patients concerned has been improved. The
current LES will be evaluated again in October.
The Committee supported the changes to the scheme, understanding
the difficulties practices had in evidencing the outcomes.
9.
Items for escalation / reporting to the Governing Body
A verbal update around the Delegated Agreement will be presented
and the case management changes at the Governing Body on
01.04.2015.
10.
Any Other Business
The amended Terms of Reference will be forwarded to the Governing
Body.
The committee discussed the anticipated draft primary care strategy
principles and identified that sufficient time should be enabled for this
item at the next meeting.
11.
Date and time of the next meeting
To confirm the date, time and venue of the next Public Meeting as
Wednesday 20th May at 1pm in Elm/Birch at Oak House, Moorhead
Way, Bramley, Rotherham S66 1YY.
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