Brent Teaching PCT...2021/04/27 · Bill Secondary Care Clinician John Gateshead HWB representative on Primary Care Commissioning Committee Costello Butler Georgina Clincal Director

Primary Care Commissioning Committee

Tuesday 27 April 2021, 5 pm - 6 pm Microsoft Teams video-conference

(please note the meeting will be recorded)

Agenda

No Timing Item Papers Presenter

1 Welcome and Apologies for Absence - Chair

2 Confirmation of Quoracy - Chair

3 Declarations of Interest Enc Chair

4 Draft Minutes of Previous Meeting – 30 March 2021 Enc Chair

5 Action Log Enc Chair

6 5:10 Primary Care Co-Commissioning Budget Update Verbal Jill McGrath

7 5.20 Annual Health Checks for People with a Learning Disability – update on CCG achievement level Verbal Dominic

Slowie

8 5.25 Internal Audit – Primary Medical Care Commissioning Enc Ros Goode

9 5.35 NGCCG Primary Care Network DES 2021-22 Sign up Enc Philippa Dodds

10 5:45 Covid Vaccination Programme Update Verbal Jackie Cairns Lynn Wilson

11 5:50 Any Other Business - All

Date of next meeting:

Tuesday 25 May 2021, 5 pm

Declaration of Interest Register 2020/21

EMPLOYEES: Declaration completed by employees

Fina

ncia

l Int

eres

t

Non

-Fin

anci

al

Prof

essi

onal

Inte

rest

Non

-Fin

anci

al

Per

sona

l Int

eres

t

From To

Gov

erni

ng B

ody

QSR

Audi

t Com

mitt

ee

Prim

ary

Care

Co

mm

issi

onin

g Co

mm

ittee

Rem

uner

atio

n

Exec

Com

mitt

ee

Nor

ther

n CC

G Jo

int

Com

mitt

ee

Staf

f

Clin

ical

Lea

d /

Drie

ctor

Hos

ted

Dec

isio

n M

aker

SelfSt Albans Medical

Greoup, GP practiceY Y N Direct

Partner at GP surgery in NGCCG

area. Enhanced Service to provide

GP cover to Intermediate Care

in Gateshead

Jan-20 OngoingI will declare at meetings when

requiredY Y 07.10.20

No change for 2020/21

SelfGP Trainer with Northumbria GP

Training ProgrammeN Y N Direct I am a GP trainer Jan-20 Ongoing

I will declare at meetings when

requiredY Y 07.10.20


Cairns JackieDirector for Newcastle

PlaceDaughter

Newcastle Gateshead Clinical

Commissioning Groupno

Non Financial Professional

Interests

Non Financial Personal Interests

In direct Daughter Apr-18 OngoingWill declare at meetings

as requiredY Y Y Y Y 07.10.20

Amended with daughters details

SelfSibling is GP whose

practice is a member of CCG

NoWill declare in meetings

where relevantY Y Y Y Y Y 05.07.19


Spouse Care Navigator at

Oxford Terrace and Rawling Road

Yes IndirectCare Navigator at

Oxford Terrace and Rawling Road

29.09.20 OngoingWill declare in meetings

where relevantY Y Y Y Y Y 29.09.20

Updated to reflect wife's employment

status

self Gateshead Council Yes Direct Senior Officer ongoingWill declare if needed at

meetingsY

spouse NHS England Yes Indirect employee ongoingWill declare if needed at

meetingsY

SelfCare Quality

CommissionerNo

Member of CQC Inspection Team

01.04.17 Ongoing Y Y Y Y Y Y 19.06.2020Updated to reflect medical examiner

role

Self Medical Examiner YesMedical Examiner,

Northumbria FT01.06.2020 Ongoing Y Y Y Y Y Y 19.06.2020

Updated to refelct medical examiner

role

Dodds PhilippaPortfolio Manager -

Primary Care DeliverySelf Nothing to declare Y Y 14.10.20


JoeCorrigan Chief Finance Officer

BillSecondary Care

Clinician

John

Gateshead HWB representative on

Primary Care Commissioning

Committee

Costello

Butler GeorginaClincal Director for

Transformation (Gateshead)

Cunliffe


Committees

14.10.20

Declared interest- (name of

organisation and nature of business)

Is the interest direct or indirect?

Type of Interest

DOI/StatusSurname

Com

men

ts

DECISION MAKERS: Declarations completed by Governing Body; members of Governing Body committees; staff grade 8d and above; joint committee members; members of advisory groups which contribute to direct or delegated decision making on the commissioning or provision of tax payer services

Dat

e Co

mpl

eted

Nature of Interest Action Taken

Date of Interest

ForenameCurrent Position(s) in

CCG

Gertig PaulLay governing body

memberdaughter Indirect

My Eldest daughter is on the GP core

training programme in our area. Her 1st 6 months is with a

GP practice in Gateshead

Aug-19 Aug-22

I will declare at meetings as required and comply with the

standards of buisness conduct and

declarations of interest policy.

Y Y Y Y Y 24/09/19 Updated

Goode Rosalind CCG Employee PartnerNorth of England Commissioning Support Unit (NECSU)

NoNon Financial Professional

Interests

Non Financial Personal Interests

IndirectBusiness Process Automation Lead

01.06.20 No conflict Y Y 14.09.20 Added

SelfNorthumberland CCG - providing governnace support and advice

N Y N Direct

Northumberland CCG - providing

governnace support and advice

01.07.2020 OngoingI will declare at

meetings as required. Y Y Y Y Y Y Y Y 01.07.20

Updated to reflect N'land CCG role and wife's role at NCC.

SpouseNorthumberland County Council

N N N Indirect

Northumberland County Council -

Assistant Director for Policy

01.07.2020 OngoingI will declare at

meetings as required. Y Y Y Y Y Y Y Y 01.07.20

Updated to reflect N'land CCG role and wife's role at NCC.

Newcastle YMCA. The YMCA hold public health funding for

anti-obesity programme.

Yes Directchief Executive

Officeron-going

will declare at meetings if necessary

Y Y Y Y

Personal friend with Dr D Howarth and

family, Senior Partner, Denton

Turret Medical Group. Friendship started 15

years ago.

No No Yes IndirectClose Personal

friendship dating back 15 years.

On-goingwill declare at meetings

if necessaryY Y Y Y

McGrath Jillian Head of Finance spouseWorks for North East Ambulance Service

No Yes Yes Indirectemployed in

organsiation which the CCG contracts

Pre-dates CCG present no conflict Y Y Y Y 09.10.20No change for

2020/21

Self

Association of Directors of Public

Health - Board Member and

Honorary Treasurer

Yes Yes No Sessional payments 2006 PresentUnlikely to be a conflict -

will declare as necessary

Y Y

SelfAdvisory Committee

on Resource Allocatiotn

No Yes No Advisory

Committee Board Member

2017 Present No conflct Y Y

Self Newcastle University No Yes No

Academic honorary status (and Vice-

Chair of FUSE strategy board)

1999 PresentUnlikely to be a conflict -

will declare as necessary

Y Y

Wife

Queen Elizabeth Hospital Gateshead /

City Hospitals Sunderland

IndirectConsultant

Histopathologist1997 Present

Will declare at meetings as required Y Y

Hawkins NeilHead of Corporate

Affairs

Hurst

Milne Eugene

Newcastle Wellbeing for Life Board

representative on Joint Commissioning

JeffLay Member and

Deputy Chair

Removed lines - no longer has an

involvement with NICE or the Journal of

Public Health

13.11.20

17.12.19

Self

Self

Operating Theatre. Takes commissions for plays on health

themes for a number of professional,

student and general audiences

No Yes Yes Direct Trustee OngoingI will declare at

meetings as requiredY Y Y Y Y Y

Self

WeCan Enable. A Hexham based

charity, that receives some funding from

Northumberland County Council and

raises funds

No Yes Yes DirectTrustee/Board

MemberOngoing

I will declare at meetings as required

Y Y Y Y Y Y

SelfSessional GP at Bridges Medical

PracticeYes No No Direct

Sessional GP, no permanent or

business influencing role in

the practice

OngoingI will declare at

meetings as requiredY Y Y Y Y Y

SelfBritish Academy of

Childhood DisabilityNo Yes Yes Direct GP representative Ongoing

I will declare at meetings as required

Y Y Y Y Y Y

Wilson LynnDirector for

Gateshead Systemself

Foster Carer Durham Council

indirect Nov-13 current No conflict Y Y Y Y Y 11.11.20No change for

2020/21

Be Wellbeing (providing training

and wellbeing services, subsidiary of

Tyneside and Northumberland

Yes Direct Director 2019 OngoingWill declare at meetings

as appropriateY Y Y Y Y

Northumbria University

Yes Direct Employee 2019 OngoingWill declare at meetings


Think Ahead (Charity training mental

health social workers)Yes Direct Employee 2019 Ongoing

Will declare at meetings as appropriate

Y Y Y Y Y

Northen Youth Theatre Project

Yes Direct Trustee/Director 2019 OngoingWill declare at meetings


O'Neil Siobhan Healthwatch North East Child Poverty Trust

No No Yes Direct Trustee 2020 ongoing I will declare at meetings as required

N N N Y N N N N N N

04.03.21

Wood


08.10.20

Oliver Lay Member Self 23.09.20Updated to add PCCC

responsibility

Slowie Dominic Medical Director

Page 1 of 3

D R A F T

Minutes of a meeting of the Primary Care Commissioning Committee

Tuesday 30 March 2021

Due to Covid-19, the PCCC met via a video conference Present:

Members: Mr Jeff Hurst Lay Member (Chair) Dr Georgina Butler GP Clinical Director Ms Jackie Cairns Director of Newcastle System Dr Bill Cunliffe Secondary Care Clinician Ms Jill McGrath Head of Finance Dr Dominic Slowie Medical Director Dr Lynn Wilson Director of Gateshead System Mr Oliver Wood Lay Member In attendance:

Mr John Costello Gateshead Health and Wellbeing Board Ms Philippa Dodds Portfolio Manager – Primary Care Delivery Ms Ros Goode Commissioning Project Lead, Primary Care Ms Siobhan O'Neil Newcastle Gateshead Healthwatch Mr David Steel NHS England

03/21 01 Welcome and Apologies for Absence

There were no apologies for absence.

03/21 02 Confirmation of Quoracy

The Committee was confirmed as quorate.

03/21 03 Declarations of Interest

Declarations of interest documentation had been circulated with the agenda. Dr Butler, a GP in Gateshead, declared an interest regarding item 7 Annual Health Checks for People with a Learning Disability. It was agreed no action was required as the item is for information. There were no further declarations of interest relating to items on the agenda.

03/21 04 Draft Minutes of the Previous Meeting held on 23 February 2021 The minutes of the previous meeting were agreed as an accurate record.

03/21 05 Action Log

There were no outstanding actions.

Page 2 of 3

03/21 06 Risk Register Report

The PCCC receives the Primary Care Risk Report every two months to consider whether it accurately reflects the CCG’s Primary Care risk profile. Dominic Slowie presented the summary, as at 11 March 2021, on behalf of Neil Hawkins.

Four risks, one rated Extreme, two High and one Low, were outlined in the

report along with actions to mitigate the risks. With regard to the Extreme-rated risk, this reflects the national priority

regarding sustainability of Primary Care with the proposed expansion of the Primary Care workforce outlined in national Planning Guidance recently issued. Until the additional workforce is in post this remains a significant risk.

It was noted:

• There are regular meetings and skilled teams working on Primary Care Quality, Estates, Digital Enablement and wider development providing robust systems and processes to ensure quality and contractual adherence.

• CCG level support systems for Primary Care are moving to Place-based teams and the need, therefore, to recognise and articulate the systems at Place and in Primary Care Networks (PCNs) supporting Primary Care.

• Covid-19 has affected PCN development plans for 2021 but has resulted in positive development in different ways of working.

• Collaborative Newcastle and Gateshead Cares have strengthened the position in the system of Primary Care via the PCNs and therefore help to mitigate the risks around the success of PCNs.

• The CCG, as a commissioning entity, will end from April 2022 and the commissioning of Primary Care will move to the Integrated Care System (ICS) for North East and North Cumbria. The CCG is in a strong position to handover systems and processes to the ICS.

The Committee agreed the risks and mitigations are sufficiently captured in

the Risk Register Report and the scoring is appropriate, noting the need to continually revisit and review the risks.

03/21 07 Annual Health Checks for People with a Learning Disability

Dominic Slowie presented the summary report, on behalf of Catherine

Richardson and Clare Scarlett, describing the current state of the programme to promote annual health checks for people with a learning disability.

The challenge issued by the Committee to improve performance on delivery of the annual health checks has led to the CCG working with Practices and other healthcare providers, social care, third sector organisations and groups of people with learning disability to promote annual health checks. The improvement plan that was developed was further catalyzed by the Covid-19 pandemic with poorer outcomes for those with a learning disability, highlighting the need to prioritise health checks.

Page 3 of 3

The national target of 75% of registered disabled aged over 14 years to receive annual health checks was adjusted to 67.5% this year as a result of additional challenges due to Covid-19. At the end of February 2021, the overall CCG achievement was 66% (Gateshead 74% and Newcastle 59%). It is expected that the CCG will exceed the 67% national target when the final outturn for the year is available representing the success of the positive and proactive work in Primary Care in Newcastle and Gateshead for this vulnerable group of patients. The Committee acknowledged those involved in developing the strategic plan – Clare Scarlett, Claire Dovell and Catherine Richardson, and the facilitators – Nicola Gannon (Newcastle) and Tracey Hutchinson (Gateshead). The facilitators have been proactive, engaging with PCNs and Practices and the relationships built between the Practices and facilitators has been key to the success of the plan.

The Committee received the report for information and requested an update on the end of year results at the next meeting.

Action: End of year data update for April PCCC

03/21 08 Covid Vaccination Programme Update

Gateshead:

• 113,000 first and second dose vaccinations expected to be completed by the end of the week

• The 5 vaccination sites remain in operation and are now providing for Cohorts 10 – 12

• Continuing to reach the homeless and other harder to reach groups via the mobile unit

• The infection rate continues to reduce – currently 37 per 100,000

Newcastle: • 80,000+ first dose vaccinations completed • Second dose vaccinations completed in all care homes • Second dose vaccinations for the housebound will begin next week • Continuing to reach the homeless and other harder to reach groups via

the mobile unit A positive picture overall with infection and death rates reducing in correlation with the vaccination programme. The Committee received the update for information and congratulated all those involved on the success of the vaccination programme.

03/21 09 Any Other Business There was no further business.

Agenda item 5

Primary Care Commissioning Committee – April 2021

Action Log

Meeting

date Minute

reference Action Lead Due

Status

30/03/21 03/21 07 Annual Health Checks for People with a Learning Disability Update on end year data

Dominic Slowie

April 2021 Due

Purpose (click one box only) Decision ☐ Information ☒

Classification (delete as appropriate) Official

Meeting Primary Care Commissioning Committee

Date 27 April 2021 Agenda Item 8

Report Title Internal Audit – Primary Medical Care Commissioning

Lead Director & Report Author

Director: Dominic Slowie Title : Medical Director

Author: Ros Goode Title: Commissioning Project Lead

Synopsis

The 2020/21 Compliance Review of Primary Medical Care Commissioning by Internal Audit was issued on 30 March 2021 which concluded that governance, risk management and control arrangements provide substantial assurance that the risks identified are managed effectively. Compliance with the control framework was found to be taking place.

This assurance level aligns to the NHS England Assurance category of ‘full assurance’. Only one low priority finding was identified relating to private PCCC minutes not being presented to private Governing Body meetings.

Implications and Risks

If responsibilities for commissioning primary care are inadequate the CCG performance and services to the public will not be met.

Recommendation The Primary Care Commissioning Committee is asked to receive and note this report for information.

Benefits to patients & the public / link to strategic objectives

• Achieving statutory duties • Through the regional Integrated Care System (ICS), engage in strategic

planning relating to the commissioning of high-quality health services and organisational development.

• Make effective financial decisions which balance individual, local, strategic and population needs.

Resource implications (finance; HR)

None

2

Legal / equality & diversity / sustainability implications

None

Report history Notification of audit to PCCC in July 2020

Next steps The one low priority recommendation will be passed to the Governance Lead for action.

Appendices Internal Audit Report NGA 2020-21/04 Compliance Review of Primary Medical Care Commissioning

Submission checklist – to be completed by author ahead of inclusion on meeting agenda

Has the paper been cleared by the lead Director? Yes ☒ No ☐

Does the covering paper clearly state what the Committee are asked to do – i.e. clear recommendations?

Yes ☒ No ☐

Have the CCG finance team been consulted about any resource implications? Yes ☐ No ☐ N/A ☒

Person(s) consulted:

Are there any wider implications that require consideration – HR, contracting, procurement, etc? If so, have CCG leads been consulted?

Yes ☐ No ☒ N/A ☐


Does the proposal realise any savings that could be captured through QIPP – if so have the PMO been consulted?

Yes ☐ No ☒ N/A ☐


Newcastle Gateshead CCG Internal Audit Report Ref: NGA 2020-21/04 Date: 30 March 2021

Compliance Review of Primary Medical Care Commissioning

Page 4

Contents 1 Executive Summary ..................................................................................................................................................................................... 6 1.1 Introduction .............................................................................................................................................................................................. 6 1.2 Conclusion ............................................................................................................................................................................................... 6 1.3 Scope of the audit .................................................................................................................................................................................... 6 1.4 Corporate significance & risk profile ......................................................................................................................................................... 7 1.5 The key findings ....................................................................................................................................................................................... 8 1.6 Recommendation summary ...................................................................................................................................................................... 8 1.7 Acknowledgement .................................................................................................................................................................................... 9 2 Action Plan .................................................................................................................................................................................................. 9 Appendix A - Findings ....................................................................................................................................................................................... 10 Appendix B - Primary Medical Care Commissioning and Contracting: Internal Audit Framework ...................................................................... 12 Appendix C - Findings Prioritisation and Assurance Definitions ........................................................................................................................ 16

The matters raised in this report are only those which came to our attention during our internal audit work and are not necessarily a comprehensive statement of all the weaknesses that exist, or of all the improvements that may be required. Whilst every care has been taken to ensure that the information in this report is as accurate as possible, based on the information provided and documentation reviewed, no complete guarantee or warranty can be given with regards to the advice and information contained herein. Our work does not provide absolute assurance that material errors, loss or fraud do not exist. This report is prepared solely for the use of the Board and senior management of Newcastle Gateshead CCG. Details may be made available to specified external agencies such as external auditors, but otherwise this report should not be quoted or referred to in whole or in part without prior consent. No responsibility to any third party is accepted as the report has not been prepared, and is not intended for any other purpose. Freedom of Information Notice In the event that, pursuant to a request which Newcastle Gateshead CCG has received under the Freedom of Information Act 2000, it is required to disclose any information contained in this report, it will notify AuditOne promptly and consult with AuditOne prior to disclosing such report. Newcastle Gateshead CCG agrees to consider any representations which AuditOne may make in connection with such disclosure and Newcastle Gateshead CCG shall apply any relevant exemptions which may exist under the Act to such report where it concurs that they are appropriate. If, following consultation with AuditOne, Newcastle Gateshead CCG discloses this report or any part thereof, it shall ensure that any disclaimer which Audit One has included or may subsequently wish to include in the information is reproduced in full in any copies disclosed. AuditOne is hosted by Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust. Our processes are designed to meet the PSIAS and IPPF.

Page 5

Key Dates and Report Distribution Debrief meeting 25 March 2021 Audit team Carl Best, Director of Internal Audit

Alyson Williams, Group Audit Manager Nicola Hearn, Senior Auditor

Draft report issued 30 March 2021

Responses received Client sponsor Dr Dominic Slowie, Medical Director

Final report issued Report distribution Draft report: Philippa Dodds, Portfolio Manager (Primary Care) Jill McGrath, Head of Finance Neil Hawkins, Head of Corporate Affairs and Audit Liaison Officer Final report: Dr Dominic Slowie, Medical Director Philippa Dodds, Portfolio Manager (Primary Care) Jill McGrath, Head of Finance Neil Hawkins, Head of Corporate Affairs and Audit Liaison Officer Joe Corrigan, Chief Finance and Operating Officer Martyn Tait, Counter Fraud Specialist, AuditOne Karen Wass, Technology Risk Assurance Manager, AuditOne Diane Harold, Senior Manager, Mazars

Page 6

1 Executive Summary

1.1 Introduction

A compliance audit of primary medical care has been undertaken as part of the 2020-21 internal audit plan. The CCG has taken on delegated functions from NHS England for primary care commissioning. As part of this, the CCG now has responsibility for ensuring that general practice in Newcastle and Gateshead is sustainable and provides high quality, safe care to the local population within the available budgetary envelope. NHS England issued an internal audit framework for delegated Clinical Commissioning Groups in August 2018 covering Primary Medical Care Commissioning and Contracting. The scope of our audit has been designed to ensure that it aligns with NHS England's assurance requirements as well as the requirements of the CCG. Compliance with section a of the Internal Audit Framework: Commissioning and procurement of primary medical services was covered during the 2018-19 audit under audit reference NGA 2018-19/16, with an assurance level of substantial assurance given. One low priority recommendation was made. Compliance with section b of the framework was covered during the 2019-20 audit under audit reference NGA 2019-20/04 with an assurance level of good assurance given. Two medium and one low priority recommendations were made.

1.2 Conclusion

Governance, risk management and control arrangements provide substantial assurance that the risks identified are managed effectively. Compliance with the control framework was found to be taking place. This assurance level aligns to the NHS England Assurance category of ‘full assurance’.

1.3 Scope of the audit

The objective of the audit is to provide assurance around the effectiveness of the arrangements put in place by the CCG to exercise the primary medical care commissioning functions of NHS England as set out in the Delegation Agreement in the following areas set out in the Internal Audit Framework: Primary Medical Care Commissioning and Contracting, issued by NHS England in 2018:

Page 7

c. Primary Care Finance i. Overall management and the reporting of delegated funds - processes for forecasting, monitoring and reporting ii. Review of financial controls and processes for approving payments to practices iii. Review of compliance with coding guidance on a sample basis iv. Processes to approve and decisions regarding 'discretionary' payments (e.g. Section 96 funding arrangements, Local Incentive Schemes) v. Implementation of the Premises Costs Directions d. Governance i. Operation and oversight of the Primary Care Commissioning Committee (or alternative committee with responsibility for the delegated function) in regard to commissioning and procurement of primary medical services, contract oversight and management functions and primary care finance (sections a-c within the Internal Audit Framework (but not in relation to the management of Conflicts of Interest). Compliance with section a of the Internal Audit Framework: Commissioning and procurement of primary medical services was covered during 2018/19 and section b covered during 2019/20. Limitations to the scope of the audit The following limitations were agreed in advance of the audit: The audit will not provide assurance in relation to outsourced services that do not sit within the CCG, for example those sitting within Capita or within NHS England. Assurance in respect of any controls outsourced to Capita will be via a Service Auditor Report (SAR) issued by the auditors of that organisation. The audit will not provide any assurance in relation to those elements of the internal audit framework that are not explicitly covered in this audit. Assurance against those areas will be provided on a cyclical basis.

1.4 Corporate significance & risk profile

The CCG is required to provide annual assurance to NHS England on the functions delegated to it in relation to primary medical care commissioning. The 2020-21 budget for primary medical care commissioning amounts to around £73m (the budget was also £73m last year). Consequently, the area is material in the context of the organisation's activities. The audit provides an independent source of assurance against the management of the identified risks around the following CCG corporate objectives:

Page 8

• Corporate Objective 2. Engage In Strategic Planning Relating To The Commissioning Of High-Quality Health Services The audit, therefore, provides an independent source of assurance against the following risks identified in the Assurance Framework: • Risk 1300: Inability of CCG to establish, manage robustly and provide assurance of formal primary care commissioning arrangements, which could result

in failure to commission primary care effectively and efficiently.

1.5 The key findings

Our review confirmed that the CCG was compliant with the Primary Medical Care Commissioning and Contracting: Internal Audit Framework for delegated Clinical Commissioning Groups in the areas reviewed. A detailed assessment against each area in the Framework is given in Appendix B. The key findings from the audit are as follows: Design of the control framework • No issues were identified with the design of the control framework. Compliance with the control framework • One low priority finding was identified relating to private PCCC minutes not being presented to private Governing Body meetings.

1.6 Recommendation summary

Priority

High Medium Low

Design of the control framework 0 0 0

Compliance with control framework 0 0 1

Total 0 0 1

Page 9

1.7 Acknowledgement

We would like to thank management and staff for their help and cooperation during the course of this audit.

2 Action Plan

Ref Recommendation Priority Accepted (Y/N)

Management Response Target Implementation

Date

Manager Responsible

1.1 An update from Private PCCC meetings should be added to the agenda of the Private GB meetings as a standing item and consideration given to sharing minutes from private PCCC meetings after taking into account any conflicts.

Low

Page 10

Appendix A - Findings

This report has been produced by exception. Therefore, we have included in this section only those areas of weakness in control or failure to apply controls identified from our testing and not the outcome of all testing undertaken. The prioritisation of our recommendations is explained at Appendix C. Risk 1: D. Governance i. Operation and oversight of the Primary Care Commissioning Committee (or alternativee committee with responsibilty for th delegated function) in regard to commissioning and procurement of primar medical services, contract oversight and management functions and primary care finance.

Actual Control Design Adequate

(Y/N)

Test result and implication Recommendation Ref

Priority

Di. 3 The PCCC reports to the CCG's Governing Body.

Y We reviewed the CCG's public Governing Body minutes and confirmed that public Primary Care Commissioning Committee (PCCC) meeting minutes are presented to the GB members for their information. However, when we reviewed the private Governing Body minutes, we could not confirm that private PCCC minutes had been presented although our work has confirmed that private PCCC meetings were held during the 2020/21 financial year. We were informed that the CCG do not currently share the private PCCC minutes at the Private Governing Body meetings due to the sensitive nature of some of the discussions and concerns around any potential conflicts of interest. Instead, we were informed that the Chair of the PCCC has the opportunity to inform the private Governing

1.1 Low

Page 11

Actual Control Design Adequate

(Y/N)

Test result and implication Recommendation Ref

Priority

Body meetings of any relevant discussions that had taken place at the private PCCC meetings and their outcomes, although we could not evidence this from the private Governing Body minutes reviewed. Unless there is appropriate reporting through the CCG's governance structures, including in relation to private meetings, there remains the risk that the CCG's Governing Body is not kept informed of all decisions or that matters are not appropriately escalated to them to manage.

Page 12

Appendix B - Primary Medical Care Commissioning and Contracting: Internal Audit Framework The assurance level provided in this section is in line with the assurance levels set by NHS England within its Primary Medical Care Commissioning and Contracting: Internal Audit Framework for delegated Clinical Commissioning Groups and supports the overall assurance level given.

Element of Framework Covered Outcome Internal Audit

Framework Assurance

Level Given

c. Primary Care Finance

i. Overall management and the reporting of delegated funds - processes for forecasting, monitoring and reporting

• Minutes and meeting papers examined evidence that the Primary Care Co-Commissioning budget for 2020/21 was approved by the Primary Care Commissioning Committee (PCCC). The minutes and meeting papers also evidence that an update on the financial position of the PCC budget was provided to the Committee members at the majority of their monthly meetings during the 2020/21 financial year.

• Finance reports are produced on a monthly basis by NHSE and provided to the CCG. The finance reports are discussed between the CCG and NHSE at their monthly budget holder meetings. Notes are maintained of the budget meetings.

Full

ii. Review of financial controls and processes for approving payments to practices

• The CCG receive an e-mail from NHSE every quarter regarding the Global Sum checker and highlighting any variances. The CCG are invited to raise any queries.

• A transaction report was provided from the CCG which listed all GP practice activity claims processed by NHSE on behalf of the CCG for the period April to December

Full

Page 13


Framework Assurance

Level Given

2020. A sample of 3 payments was selected from the 'YTD Review Medical' worksheet and a copy of the corresponding payment schedule from the GP practice along with proof that the CCG has approved for the payments to be processed obtained supporting the values paid.

iii. Review of compliance with coding guidance on a sample basis

• Coding to individual sub-codes within primary medical care commissioning is carried out by NHSE on the CCG’s behalf. Within the CCG’s ledger, primary medical care payments are coded to one cost centre. A copy of the Newcastle & Gateshead CCG Primary Care Financial Report for 9 months up to 31 December 2020 was provided by the CCG and reviewed. This report captures all costs coded to the cost centre for Primary Care Delegated Co-Commissioning up to 31.12.20, and our review confirmed that all costs coded to that cost centre related to primary medical care.

Full

iv. Processes to approve and decisions regarding 'discretionary' payments (e.g. Section 96 funding arrangements, Local Incentive Schemes)

• Discretionary payments require sign off by the CCG before payment can be processed.

Our review confirmed that discretionary payments had been made in the year under review, and our testing on a sample basis confirmed that these payments had been appropriately approved by the PCCC, with this approval being recorded in the minutes of the private PCCC meetings.

A report detailing payment variations during 2020/21 was also provided by NHSE. The values in this report were agreed to 'GMS / PMS Summary Statement of Payments' and our testing confirmed that the amounts paid corresponded with the amounts approved by the PCCC.

Full

Page 14


Framework Assurance

Level Given

v. Implementation of the Premises Costs Directions

• The CCG’s Primary Care Group, a sub-group of its PCCC, is responsible for overseeing grants and requests for funding. Our review of the minutes for the Primary Care Group meetings confirmed that these were comprehensive and recorded details regarding requests for grants / funding to complete amendments to premises. The minutes also documented that while there has been uncertainty regarding the availability of funding, the group have been kept informed of the Improvement Grant and ETTF (Estates and Technology Transformation Fund) bid process and progress with applications. The PCCC minutes do not demonstrate that developments / amendments to premises are discussed at each of their meetings, however, occasions when financial decisions are required to be made regarding the development / amendment to a property are clearly documented, which appears appropriate for the Committees reviewed.

• Our testing confirmed that the CCG were notified by NHSE that Premises Improvement Grants were available for the 2020/21 financial year. There is evidence that the CCG cascaded this information to the GP practices, including via a letter which explained the process and an expression of interest form which was required to be completed by practices interested in claiming.

• A list of Expression of Interest forms received was provided from the CCG. The list

was reviewed and a sample selected for detailed testing. Our testing confirmed that for the sample reviewed the application forms submitted corresponded to the Improvement Grant Expression of Interest form template e-mailed to the practices by the Estates Department. Entries in the forms supported that the GP practices had met the criteria and documented in each instance the CCG’s approval of the

Full

Page 15


Framework Assurance

Level Given

application. d. Governance

i. Operation and oversight of the Primary Care Commissioning Committee (or alternative committee with responsibility for the delegated function) in regard to commissioning and procurement of primary medical services, contract oversight and management functions and primary care finance (sections a-c within the Internal Audit Framework (but not in relation to the management of Conflicts of Interest).

• The PCCC Terms of Reference were reviewed and approved by the Governing Body in November 2020. The document clearly sets out the responsibilities and governance arrangement of the Committee.

• The PCCC minutes reviewed support that regular PCCC meetings have been held during 2020 and that the meetings have been quorate and attended by appropriate representatives. The minutes were comprehensive and adequately recorded items discussed and decisions granted on primary care commissioning issues.

• We reviewed the CCG's public Governing Body minutes and confirmed that public PCCC meeting minutes are presented to the GB members for their information.

However, when we reviewed the private Governing Body minutes, we could not confirm that private PCCC minutes had been presented although our work had confirmed that private PCCC meetings were held during the 2020/21 financial year. This issue has been raised as a low priority finding within Appendix A (1.1).

Full

Page 16

Appendix C - Findings Prioritisation and Assurance Definitions

Findings Prioritisation

High A fundamental weakness in the system that puts the achievement of the systems objectives at risk and / or major and consistent non-compliance with the control framework requiring management action as a matter of urgency.

Medium A significant weakness within the system that leaves some of the systems objectives at risk and / or some non-compliance with the control framework.

Low Minor improvement to the system could be made to improve internal control in general and engender good practice, but are not vital to the overall system of internal control.

Assurance Definitions

Substantial Governance, risk management and control arrangements provide substantial assurance that the risks identified are managed effectively. Compliance with the control framework was found to be taking place.

Good Governance, risk management and control arrangements provide a good level of assurance that the risks identified are managed effectively. A high level of compliance with the control framework was found to be taking place. Minor remedial action is required

Page 17

Reasonable Governance, risk management and control arrangements provide reasonable assurance that the risks identified are managed effectively. Compliance with the control framework was not found to be taking place in a consistent manner. Some moderate remedial action is required.

Limited Governance, risk management and control arrangements provide limited assurance that the risks identified are managed effectively. Compliance with the control framework was not found to be taking place. Immediate and fundamental remedial action is required.

Page 18

The assurance definitions used by AuditOne map to the required categories of assurance set out in the Primary Medical Care Commissioning and Contracting: Internal Audit Framework for delegated Clinical Commissioning Groups issued by NHS England as follows:

Primary Medical Care Commissioning and Contracting: Internal Audit Framework Assurance Definitions

AuditOne Assurance

Full • The controls in place adequately address the risks to the successful achievement of objectives; and,

• The controls tested are operating effectively.

Substantial

Substantial • The controls in place do not adequately address one or more risks to the successful achievement of objectives; and / or,

• One or more controls tested are not operating effectively, resulting in unnecessary exposure to risk.

Good

Limited • The controls in place do not adequately address multiple significant risks to the successful achievement of objectives; and / or,

• A number of controls tested are not operating effectively, resulting in exposure to a high level of risk.

Reasonable

No • The controls in place do not adequately address several significant risks leaving the system open to significant error or abuse; and / or,

• The controls tested are wholly ineffective, resulting in an unacceptably high level of risk to the successful achievement of objectives.

Limited

Purpose (click one box only) Decision ☐ Information ☒

Classification (delete as appropriate) Official

Meeting Primary Care Commissioning Committee

Date 27 April 2021 Agenda Item 9

Report Title NGCCG Primary Care Network DES 2021-22 Sign up

Lead Director & Report Author

Director: Dominic Slowie Title : Medical Director

Author: Philippa Dodds Title: Portfolio Manager – Primary Care

Synopsis

The Network Contract Directed Enhanced Service was first introduced in 2019 and will remain in place until at least 31 March 2024. One objective was for primary medical services contractors to establish and develop Primary Care Networks. For 2021/22, the Network Contract DES Directions come into force on 1 April 2021. Practices who participated in the Network Contract DES in 2020/21 are considered as Core Network Practices of a Previously Approved PCN and will be automatically signed up to the Network DES 21/22 unless they inform the commissioner that they wish to opt out by the 30th April 2021 The paper outlines the current known changes to PCNs in terms of Core Network Membership changes as well as any other relevant changes.

Implications and Risks

There is a very limited risk that a practice will ask to opt out of the DES but this risk is being mitigated by open dialogue and requests that any significant issues be raised in a timely manner.

Recommendation Primary Care Commissioning Committee is asked to note the contents of the paper and the sign-up status of the PCNs listed in Appendix 2.

Benefits to patients & the public / link to strategic objectives

Care focused on local needs Joined up system approach to patient care and service provision Supports all of the strategic objectives

Resource implications (finance; HR) Finance, HR, Legal, NHS England resource

Report history NGCCG Primary Care Network DES 2020-21 Sign up PCC May 2020

Official

NGCCG Primary Care Network DES 2021-22 Sign up PCCC – 27/04/21 P. Dodds 14th April 2021 2

Submission checklist – to be completed by author ahead of inclusion on meeting agenda

Has the paper been cleared by the lead Director? Yes ☒ No ☐

Does the covering paper clearly state what the Committee are asked to do – i.e. clear recommendations?

Yes ☒ No ☐

Have the CCG finance team been consulted about any resource implications? Yes ☒ No ☐ N/A ☐

Person(s) consulted: Phil Argent

Are there any wider implications that require consideration – HR, contracting, procurement, etc? If so, have CCG leads been consulted?

Yes ☐ No ☐ N/A ☒


Does the proposal realise any savings that could be captured through QIPP – if so have the PMO been consulted?

Yes ☐ No ☐ N/A ☒


Next steps CCG to formally acknowledge to the PCNs that they meet the eligibility and participation criteria for the 2021/22 Network Contract DES. .

Appendices 1: Brief introduction to the Network Contract DES specification 2021/22, requirements and financial entitlements 2: 2020/21 Network Contract DES sign up status as at 14.04.21

Official


NGCCG Primary Care Network DES 2021-22 Sign up

Background

The Network Contract Directed Enhanced Service (the “Network Contract DES”) was first introduced in the Directed Enhanced Services Directions 2019 and will remain in place until at least 31 March 2024. As such it placed obligations on practices and commissioners and granted various entitlements to practices with effect from 1 July 2019. One objective was for primary medical services contractors to establish and develop Primary Care Networks (“PCNs”).

For 2021/22, the Network Contract DES Directions come into force on 1 April 2021 and, following participation in the DES, the requirements on practices and Primary Care Networks (PCNs), as outlined in the Network Contract DES specification, will apply from that date.

For a brief introduction to the Network Contract DES specification, requirements and financial entitlements please see Appendix 1.

Eligibility for and participation in the Network Contract DES

Practices who participated in the Network Contract DES in 2020/21 are defined as Core Network Practices of a Previously Approved PCN. In 2020/21 there was a simple reconfirmation process for these Previously Approved PCNs to continue without changes.

In 2021/22 all Core Network Practices are considered to be signed up to the Network DES 21/22 unless they inform the commissioner that they wish to opt out of the DES by the 30th April 2021.

To be eligible to be a Core Network Practice the following must be in place:

• the practice must hold a primary medical services contract; • the practice has a registered list of patients which means that persons are

recorded in the registration system approved by NHS England as being registered with the practice; and

• the practice’s primary medical services contract must require the practice to offer in-hours (essential services) primary medical services

A practice wishing to participate in the Network Contract DES from April 2021 can fall into one of six possible scenarios.

However, for NGCCG all practices fall into only one of three possibilities as outlined below:

1. A practice is a Core Network Practice of a Previously Approved PCN and there have been no changes to the following, the:

• identity of the Core Network Practices,

Official


• Nominated Payee, • Clinical Director; and • Network Area

2. A practice is a Core Network Practice of a Previously Approved PCN and there

have been changes to the information listed above

3. A practice that has not previously participated in a Network Contract DES but wishes to become a Core Network Practice of a Previously Approved PCN

As at the date of writing, no practice has informed the CCG of a wish to opt out of the Network DES.

The CCG has been informed of a number of material changes to 5 of the PCNs including changes to Core Network Practice membership.

Core Network Practice membership Changes

Of the 12 PCNs across NGCCG, 9 have no changes to their Core Network Practice Membership.

Of the three remaining, two (Central South PCN and Birtley - Oxford Terrace PCN) are as a result of the move of Second Street as agreed by PCCC in December 2020.

The other is the inclusion of Newcastle Medical Centre into Newcastle East PCN following acceptance by the Newcastle East PCN board mid -2020.

Appendix 2 outlines the sign-up scenarios for all NGCCG PCNs.

Other PCN Changes

Three PCNs have made changes to their Clinical Directors.

• Newcastle Inner West – Dr Tofique Pathan replaces Dr Jane Carmen from April 2021.

• GH Outer West – Dr Helen Ryan replaces Dr Sameena Hassan from April 2021. • GH B-OTRR – Dr Alex Moore replaced Dr Jeremy Watson / Dr Peter Young in

October 2020.

One PCN (West End Family Health PCN) has moved its nominated payee from Cruddas Park surgery to Elswick Family Practice to enable financial management by NGPS.

The CCG is not expecting any further changes to the PCNs but will bring an update paper to PCCC in May if any occur after the 30th April 2021 deadline.

Official


Risks

As the deadline for practices to opt out is the 30th April 2021 there is a very small risk that there may be further changes to the PCN structure. This risk is being mitigated by open dialogue and requests that any significant issues be raised in a timely manner.

The CCG has a responsibility to ensure that patients at a practice not signed up to the DES are still able to take advantages of the DES benefits. So should any practice decide to opt out the CCG will have to work with the remaining PCNs, Federation and the LMC to find suitable hosting arrangements in a manner similar to that for Newcastle Medical in the past.

Recommendation

Primary Care Commissioning Committee is asked to note the contents of the paper and the sign-up status of the PCNs listed in Appendix 2.

Next Steps

Once the 30th April 2021 deadline has passed and all sign-ups are confirmed the CCG will formally acknowledge to the individual PCNs that they meet the eligibility and participation criteria for the 2021/22 Network Contract DES.

An update paper will be brought to PCCC in May 2021 if there are any further PCN changes once the April deadline has passed.

Official


Appendices

Appendix 1: Brief introduction to the Network Contract DES specification, requirements and financial entitlements

Network DES edited highlights 21-22.docx

Appendix 2: 2020/21 Network Contract DES sign up status as at 14/04/21

Gateshead

NetworkPractice

Code Practice NamePop on

Jan 2021 Network DES Sign up StatusA85005 Oxford Terrace & Rawling Road Medical GroupA85008 Birtley Medical GroupA85021 Second Street SurgeryA85001 Fell Tower Medical CentreA85002 Bensham Family PracticeA85007 Fell Cottage SurgeryA85012 Metro Interchange Surgery A85013 Millennium Family PracticeA85016 Wrekenton Medical GroupA85017 Bewick Road SurgeryA85019 Central Gateshead Medical GroupA85026 Beacon View Medical CentreA85614 Bridges Medical CentreA85004 Longrigg Medical CentreA85009 Crowhall Medical CentreA85011 St. Albans Medical GroupA85611 Pelaw Medical CentreA85006 Glenpark Medical CentreA85010 Chainbridge Medical PartnershipA85020 Whickham Health CentreA85023 Teams Medical PracticeA85617 Sunniside SurgeryA85003 The Medical Centre (Rowlands Gill)A85014 Crawcrook SurgeryA85018 Oldwell SurgeryA85024 Chopwell Primary Health Care CentreA85616 IJ Healthcare (Ryton / Hollyhurst)A85620 Grange RoadY02658 Blaydon GP Practice & Minor Injuries / illness unit

Previously Approved PCN with changes in Core Network

Practices for 2021-22



Previously Approved PCN without changes in Core Network






45,553Inner West

31,734Outer West

36,080Birtley /

OTRR

65,932Central -

South

29,955East

Official


Appendix 2 cont

Newcastle

NetworkPractice

Code Practice NamePop on

Jan 2021 Pop on Jan 2021

Central A86003 Saville Medical Group 38,846Previously Approved PCN without

changes in Core Network Practices for 2021-22

A86010 Biddlestone Health GroupA86011 Walker Medical GroupA86023 Benfield Park Medical GroupA86024 Heaton Road SurgeryA86027 Newcastle Medical CentreA86029 Thornfield Medical GroupA86040 St Anthony's Health CentreA86008 The Park Medical GroupA86028 Regent Medical CentreA86033 Brunton Park SurgeryA86035 Broadway Medical GroupA86036 Gosforth Memorial Medical CentreA86006 Roseworth SurgeryA86007 Avenue Medical PracticeA86018 The Grove Medical GroupA86020 Jesmond Health PartnershipA86004 Prospect House Medical GroupA86030 Betts Avenue Medical GroupA86031 Fenham Hall SurgeryA86037 Grainger Medical GroupY00184 Dilston Medical CentreA86013 Denton Park Medical GroupA86022 Parkway Medical CentreA86025 Westerhope Medical GroupA86026 Throckley Primary Care CentreA86038 Newburn SurgeryA86601 Denton Turret Medical CentreA86012 West Road Medical GroupA86017 Cruddas Park SurgeryA86021 Holmside Medical Group













51,555Outer West

29,945West End

Family

36,425North

Gosforth

34,129

Jesmond - Lower Gosfort

h

52,133Inner West

80,652East

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