Primary Care Commissioning and Assurance Committee

15 December - papers 

As a result of the announcement that a by-election will be held in the Mid Beds constituency on 19 October 2023, the ICB will hold the September Primary Care Commissioning and Assurance Committee (PCCAC) meeting in Private. This is because the ICB is responding to the rules which surround the activity that can take place in public before an election. Any decisions will be shared following the election to ensure we continue to be transparent with residents about the services we are delivering locally.

16 June - papers 

17 March 2023 - Papers 

Extraordinary Meeting 11 January 2023 – Papers 

Resolutions:

On the 11 January 2023, an extraordinary meeting of the Primary Care Commissioning and Assurance Committee took place to discuss a prioritisation programme of primary care estates across Bedfordshire Luton and Milton Keynes. The decision of the Primary Care Commissioning and Assurance Committee will not be reconsidered or discussed at the next Integrated Care Board meeting on 27 January 2023.

The Committee meeting was held in public and was well attended by elected officials and residents. You can see the papers that went to the Committee here. The Committee made the following resolutions. It:

• Received the outcome of the primary care estates prioritisation process.
• Approved the recommended list of schemes to be supported in principle, including the schemes with marginal revenue impact, even though the scores for some of these were lower than others, noting that individual business cases are required for final approval to be given and should the revenue impact become higher than expected it may not be possible to ultimately approve the business case for these schemes.
• Approved the recommended indicative budget of £1.95m to invest recurrently in primary care estates. £1.54m of this cost relates to schemes already committed / operational.
• Supported the alternative funding approach for the £1m revenue shortfall for the schemes as outlined by the Chief Financial Officer in the meeting and that primary care budget will be spent on primary care.
• Noted that these proposals enable circa £468k and £472.5k of the BAU capital to be directed towards primary care estates in 2022/23 and 2023/24 respectively (but note the risk that delays to concluding the prioritisation process may cause some slippage with capital spend between years).
• Requested the Board and Finance and Investment Committee of the ICB to consider making additional revenue available for primary care estates as part of the 23/24 resource allocation process, noting that a Board seminar on primary care and the development of Fuller neighbourhoods will include discussion of primary care estates as an enabler of neighbourhood working and is planned for 24 February 2023.
• Recognised that there are other primary care providers with estates needs who are not within the 23 and we are committed to working with them and system partners on their needs.

9 December 2022 – Papers

Brief summary:

• Confirmation of Mahesh Shah as the Deputy Chair of the Committee
• The ongoing work to progress the safe delegation of Community Pharmacy,
  Optometry and Dental (POD) contracts to the ICB; ICB expected to take delegation from 01 April 2023; the national timeline for NHS England (NHSE) to approve and ICB commissioned an internal audit for additional assurance of the ICBs readiness
• Actions being taken and contingency arrangements for The Village Medical Centre
• The deep dive review to take place in January at Cauldwell Medical Centre, Bedford further to whistleblowing complaint. Findings will be shared with the Primary Care Delivery Group to help inform assurance levels on quality of care and be considered when looking to invoke a potential two-year extension in April 2023. Assurance provided to ICB by East London Foundation Trust (ELFT) Medical Director and Executive Director that a review of the whistleblowing concern had been undertaken and mitigations put in place which will be reviewed as part of the deep dive
• The update and actions taken since previous meeting for Ashcroft Practice Luton further to inadequate Care Quality Commission (CQC) report. Remedial notice served 02.12.22. with 28-day turnaround. Assurance given that majority of actions required had been resolved or being actively worked through
• A branch closure form submitted for Ampthill Road Branch Surgery further to patient engagement and assurance this would not impact number of appointments available or service provided. Report to go to Primary Care Delivery Group Chairs Action Group for formal approval to close the site
• Applications to close lists received from Leagrave Surgery (Luton), Great Barford Surgery, Bedfordshire, Greensands (Ampthill) and Cobbs Gardens (Olney). Cobbs Gardens and Greensands applications will be presented to Primary Care Delivery Group Chairs Action Group in December. Assured that primary care policy guidance manual process was followed and both patient and practice engagement had taken place. Great Barford and Leagrave currently at application stage
• Discussed and noted payments and cashflow issues for practices and outlined actions taken by ICB
• Request for boundary change by Conway Medical Centre, Luton
• Application to incorporate and novate contract by Malzeard Road, Luton
• The current position across BLMK for refugees, evacuees and asylum seekers
• Updates on GP Alternative Provider Medical Services (APMS) Contracts Reprocurement:
  - re-procurement exercise for Brooklands Heath Centre, Milton Keynes and Kingsway Health Centre and Bramingham Park Medical Centre, Luton will be taking place from January 2023
  - plan to offer Neath Hill Health Centre and Kingfisher Surgery in Milton Keynes as branches with patient lists in the new year
  - forward planning and ongoing contract monitoring for the other APMS contracts continues
• Status update of
  (i) programme of work for the Universal Offer Personal Medical Services (PMS) reinvestment proposal and principles for 2022-24/2025;
  (ii) phase 1 services implementation (January 2023) and
  (iii) phase 2 in development implementation planned for April 2023
• Risks relating to the primary care directorate are being identified and managed appropriately. Risk registers presented separately for Digital and Estates. All risks logged and monitored in the 4Risk system
• The Primary Care Estates Report highlights:
  - Risk raised by King Street Surgery (Kempston) in relation to their premises, and the mitigating actions being considered/taken forward
  - Risk raised by the developer of Biddenham New Surgery that scheme may not be viable to go ahead due to increase in borrowing rates. Mitigation includes consideration of increase to the previously agreed rent reimbursement levels
  - An addendum to the North Bedford Hub Full Business Case was submitted to NHSE in line with end of November deadline previously reported to the Committee and the risk of approval delay by NHSE
• Estates Prioritisation Process highlights:
  - Outcome of the scoring to-date of the 53 current/proposed primary care estates schemes across BLMK
  - Review of affordability next step in the process (revenue and capital), risks and delivery factors, to agree a final list of schemes expected to be supported in 2022/23 and 2023/24, subject to individual business cases and that
  - Final list to be signed-off virtually by members of the Primary Care Delivery Group and ratification by chairs action from PCC&AC (see Extraordinary PCC&AC Chairs Report)
• Discussed under review of meeting effectiveness how as the Committee develops it can also provide assurance on patient experience rather than just outcomes 
• Reviewed the annual business cycle.

27 September 2022 – Papers

The Committee:

• approved terms of reference for Primary Care Delivery Group and updates to PCC∾ noted that both would continue to be developed during 2022-23
• noted progress against the Primary Care Workforce Programme strategic workstreams
• endorsed progress on North Bedford Primary Care Hub project; outcome and response rate to the Patient Engagement exercise and actions being taken to mitigate concerns of the population in relation to availability and cost of parking on site
• noted process, criteria and timeline agreed by the Estates Working Group for prioritising primary care estates schemes
• endorsed the proposed BLMK Fuller Programme to implement national recommendations; supported the approach for the principle of subsidiarity
• noted primary care access oversight group update and next steps. Requested focus on digital developments in terms of telephony and wider digital offer as future agenda item for the Primary Care Delivery Group
• accepted that risks relating to the primary care directorate and digital transformation programme were identified and managed by the relevant teams; all risks continue to be logged and monitored in the 4Risk system
• noted the July 2022 delegated primary care financial position
• reviewed the draft annual business cycle