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ITEM: 8.1
South Gloucestershire Clinical Commissioning Group
Membership Meeting
Tuesday, 7th January 2014
13.30 – 15.30
Bristol and Bath Science Park
Attendees: Dr Jon Hayes (JH), Hanham Health / Clinical Chair (Chair)
Dr Martin Lockyer (ML), Almondsbury Surgery
Dr Norman Douglas (ND), Bradley Stoke Surgery
Sandra Lloyd (SL), Bradley Stoke Surgery
Dr Luke Parker (LP), Close Farm Surgery
Linda Marshall (LM), Close Farm Surgery
Dr Imran Hamid (IH), Concord Medical Centre
Dr Ian Paul (IP), Coniston Medical Practice
Dr Andrew Appleton (AA), Courtside Practice
Dr John Foubister (JF), Dr Burney and Partners
Dr Chris Boelling (CB), Emerson’s Green Medical Centre
Dr Felicity Fay (FF), Hanham Health
Dr Catherine Buckley (CB), Kennedy Way Surgery
Dr Neil Kerfoot (NK), Kingswood Health Centre
Dr Jon Evans (JE), Leap Valley Surgery
Dr Amanda Ramshaw (AR), Northville Family Practice
Dr Alison Wint (AW), Pilning Surgery
Dr Mary Harrison (MH), St Mary Street Surgery
Dr Graham Deakin (GD), Stoke Gifford Medical Practice
Dr Ann Sephton (AS), The Oaks Medical Centre
Dr Richard Berkeley (RB), The Orchard Medical Centre
Dr Sue Frankland (SF), The Park Medical Centre
Mike Lodge (ML), The Three Shires
Dr Hannah Richmond (HR), The Willow Surgery
Dr Mark Thompson (MT), Thornbury Health Centre
Dr Kate Mansfield (KM), Wellington Road Family Practice
Ann Magham (AM), Wellington Road Family Practice
Martin Wilkes (MW), West Walk Surgery
Jane Gibbs (JG), Chief Officer, South Gloucestershire CCG
Sharon Kingscott (SK), Chief Finance Officer, South Gloucestershire CCG
Melanie Green (MG), Head of Medicines Management, South Glos CCG
Eszter Kormendi (EK), PA, South Gloucestershire CCG [notes]
In attendance: Janet Rowse, Chief Executive, Sirona Care & Health (for Item 5 only)
Jenny Theed, Director of Operations, Sirona Care & Health (for Item 5 only)
Pauline Chinnick, Matron, Yate MIU (for Item 6 only)
Sue Parris, Locality Lead for South Gloucestershire, Yate MIU (for Item 6 only)
Welcome and Apologies
Jon Hayes welcomed everyone to the membership meeting and
thanked everybody for their attendance.
Apologies were noted from:
 Dr Tharsha Sivayokan (TS), Christchurch Medical Centre
 Dr John Seddon (JS), The Three Shires
 Dr Rebecca Fowler (RF), West Walk Surgery
Declaration of Interests
Minutes of the Previous Meeting
NHS England and LMC facilitated discussion on Primary Care
The feedback summary was forwarded to all membership practices
and practice managers. JH has not received any feedback yet.
ACTION: If anybody wishes to comment please email JH.
Report from the November session was circulated to attendees.
ACTION: Please send any comments/feedback to JH.
The minutes were approved for accuracy.
Members’ Briefing
Future of Frenchay Hospital
The Health Overview and Scrutiny Committee of South
Gloucestershire Council challenged the CCG’s proposals for both the
interim rehabilitation beds and for the Frenchay Health and Social
Care Plans. The proposals have been referred to the Secretary of
State for Health for external scrutiny and validation. The CCG is
awaiting the Secretary of State’s reply. It is acknowledged that the
decision to refer might have been of a political nature. The Secretary
of State’s reply is likely to focus on whether the CCG has followed a
fair and appropriate process and if he feels the CCG needs to do
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anything further. The CCG continues to be committed to rehabilitation
services being located on the Frenchay site eventually (i.e. in 2016).
It is worth noting that out of around 200,000 outpatient appointments
every year, the 2010 proposals for the Frenchay site envisaged only
5,700 appointments (100 per week approximately). Now that
Emerson’s Green Treatment Centre and Cossham Hospital are open,
services are offered there which cannot be duplicated on Frenchay.
Members of the group asked JH if the group could do anything to help
politicians understand the CCG’s proposals. JH said that at this stage
there is nothing the group could do other than if GPs hear any
negative comments from their patients, they can express their support
for the plans. Members were thanked for their support.
Funding allocation
Funding allocations were announced before Christmas. The CCG has
been given a higher level of growth above the baseline level of 2.14%
which everyone received, to 3.7% which equates to an increase in
funding above the expected value of £3.7m for 2014/15.
The CCG also already knows the allocation for 2015/16 with a growth
level of 3.33% which again is higher than the baseline level of 1.7%
which everyone will receive, which equates to an additional £3.9m.
This is great news for the CCG and will enable us to make progress on
the significant financial operational challenge we inherited.
For 2013/14 the CCG will report a deficit of £3.3 million on top of the
£2 million non-recurrent allocation the CCG had to close the funding
gap. Pay back terms of the deficit are being negotiated with NHS
England. The CCG’s overall budget is £240 million.
SK explained that the reason for the CCG receiving an increase to the
national uplift is that it is acknowledged that the CCG is underfunded.
The higher level of allocation helps to close the inherited funding gap.
The funding allocations formula is very complex and it has to take into
account all CCGs around the country.
Weekend working pilot
AS thanked the Membership Group for their positive approach to this
pilot which is now underway. Patients are reviewed on Friday to see
who is at risk of being admitted to hospital.
There is a Prime Minister’s Challenge Fund which invites bids for
innovative ways of working within primary care. On behalf of the
practices, the CCG is submitting a bid on an innovative 7-day working
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project. The pilot would fit in with this.
The group raised concerns over the fact that not enough patients are
being referred to the weekend working pilot. NBT’s MAU and ED
departments claim they have not been aware that the service was set
up and could be used to help discharges.
NBT’s ED and MAU agreed to provide ambulatory care services but
when GPs talk to NBT they are not aware that this service exists.
ACTION: GPs to let the CCG know via
[email protected] when they are told by
NBT that they do not provide ambulatory care services.
AS confirmed that COG is still in existence. Possible options are being
considered as of April 2014. The CCG is working on this with Harmoni.
Feedback from Practice Managers’ meeting
The Area Team will no longer be sending out flu letters for over 65s. It
will be up to practices to decide how they invite their patients to attend
for a flu vaccine in order to meet the national requirements.
Sirona Care & Health
Janet Rowse and Jenny Theed from Sirona Care & Health attended
the Membership meeting to introduce the organisation, their model of
care and to answer any questions the group may have. Sirona Care &
Health is taking over the provision of community health services from
NBT in April 2014.
Sirona formed out of the provider arms of Bath and North East
Somerset PCT and Bath and North East Somerset Council. It is a
small organisation of 1700 staff. 450 staff will transfer from NBT.
Sirona has a budget of £50 million.
Sirona aims to provide tailor-made community health services and
aims to grow into a market which they can add value to, e.g.
domiciliary care. Their model of care is orchestrated around primary
care and will be a bespoke model for South Gloucestershire.
Patients are getting more complex and more have long-term
conditions. Sirona’s aim is to help stabilise these patients in the
Their model includes 4 types of patients:
Low complex & stable: core work, majority of patients
Low complex & unstable: temporary state only
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High complex & stable: more complex needs from community
nurses’ point of view
High complex & unstable: urgent work needed to prevent
hospital admissions
Early intervention is essential to prevent escalation. Keep more
complex patients stable. Sirona will create MDT working with primary
care for high complexity patients in the form of a regular, weekly
meeting to help patients stay stable in the community.
Practices can expect the following from Sirona:
Dedicated district nurses
Clusters of practices to share resources (cluster aligned staff)
Locality and county-wide staff
Key to these will be relationship-building to ensure practices know
their community staff.
Sirona’s contract starts in April but there are ongoing discussions to
assess the feasibility of taking over the contract earlier. Sirona is keen
to work with practices to ensure their model of care is fit for area and is
most effective.
South Gloucestershire GP practices have now been divided into
clusters by Sirona. Clustering was based on GIS modelling to
minimise staff travel time.
ACTION: Practices to contact Jenny Theed ([email protected]) if they see any problem with their cluster allocation.
Caseload waiting model is in use in BaNES and will be applied in
South Gloucestershire too. Caseload allocation is weighted on current
weekly caseload.
Resource is limited but could be varied across the patch to ensure
demand is met. Resource allocation tool is shared with practices. It is
re-run every 6 month to ensure it is up-to-date and resources are in
the right place. Allocation is based on the demographic of practice
Sirona wants to ensure transparency between the clusters to facilitate
the redistribution of resources in time of need. A clinical manager and
director for each cluster will be identified. The use of the risk
stratification tool is expected to be rolled out.
There will be the equivalent of 4 whole time health visitors for the
elderly working across South Gloucestershire. They will be supported
by band 3 support staff targeting 80-85 year olds to help with falls,
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long-term conditions and dementia.
Sirona aims to facilitate discharge and help with avoidance of hospital
admissions by identifying at risk patients and allocating a therapist to
Jenny Theed will send practices the service specification
for practices to see what Sirona will be contracted to do.
Jenny Theed to meet with practices towards the end of
February to discuss individual needs.
JH thanked Janet Rowse and Jenny Theed for attending the meeting.
Yate MIU
Pauline Chinnick and Sue Parris attended for this item.
Yate MIU opened in May 2010. Attendance has been going up
steadily. All patients seen at the MIU are within the agreed criteria and
patients not meeting the set criteria are redirected to other services,
e.g. pharmacy, own GP, out of hours GP, A&E and self-help.
It is worth noting that very few patients are sent to Frenchay A&E for
X-ray out of hours. The majority of the patients go back to Yate MIU
radiology services “in hours”.
Yate MIU is open at 8.30am-7.30pm on Monday-Friday and at 10am2pm on weekends and Bank Holidays.
It is acknowledged that the opening of the MIU has not resulted in a
reduction in A&E attendances by patients of Yate GP practices. The
reception triage decides who to see and who to send to alternative
places. There is a leaflet they give to patients signposting them to
other services. This also includes the complaints process.
Practices raised the importance of knowing if any of their patients
visiting the MIU is turned away and with what type of issue they
Yate MIU has access to urgent care slots within GP practices,
however, uptake of these appointments has been fairly low.
The closure of Frenchay will also have an effect on Yate MIU. Given
that children will be only seen at the Children’s Hospital as of May,
more children are expected to go to Yate MIU.
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Any other business
7.1 GP Local Enhanced Services
For the past year, NHS England has provided the contracting
mechanism for delivery of CCG commissioned local enhanced
services for primary care. As of April 2014, this will become the
responsibility of the CCG.
MG informed the group that there are four programmes to be reviewed
by the CCG and determine a way forward by 1st April 2014, these are
as follows:
Anti-coagulation (adaptation of a national NES)
Care Homes
Near Patient Testing
GP Basket
The CCG will also have to consider the following areas:
Learning Disabilities
Urgent Care/Extended hours
Mark Hayman (CSU) is presenting a paper on this at the January
Board meeting to agree a way forward and a contracting process.
Having obtained procurement advice, the CCG could choose to
continue with the current LES’s and review them in the next 12
Public Health LES’s are being reviewed too. Quarter 1 and Quarter 2
invoices have now been paid but the process had been slowed down
by Local Authority rules and regulations.
MG reassured the group that the same process is happening in other
CCGs. The CCG will keep practices up-to-date and will make it clear
whether payment will be received from the CCG or NHS England. The
importance of primary care building good relationship with Public
Health and Local Authority was emphasised.
Some practices asked what happens to the money which had been
allocated to practices in the 2012/13 and 2013/14 LES’s.
ACTION: SK to look into this.
7.2 Advice and Guidance
Practices are encouraged to use Choose and Book for Advice and
Guidance. Currently vascular and CATS are available on Advice and
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7.3 Tests at NBT
Practices raised the issue that the results of tests done at NBT are not
routinely sent back to the practices. Practices therefore have to send a
“GP to chase” letter to obtain these results.
ACTION: Practices to send any specific cases to
[email protected] to inform the CCG.
7.4 CCG Intranet
The CCG is redeveloping its website and is looking at enhancing its
Intranet so that it is accessible to all South Gloucestershire GP
practices. There is planned to be an option for practices to “attach”
their own practice Intranet onto the site. There will be a presentation at
the PLT in February on this to share the plan with practices.
7.5 Instant feedback to practices
The group spent some time to agree a few action points which
members can feed back to practice colleagues. Points for “instant
feedback” will be agreed at the end of every meeting and emailed to
group members.
Date of next meeting
12th March 2014, 1.30-3.30pm, Bristol and Bath Science Park.
[Please remember to sign in at the front desk]
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