Primary Care Commissioning Committee 29th May 2018 Local Quality Scheme – GP Federations Julie Wilson, Assistant Director

2017/18 Quality Scheme Four elements to the scheme: Quality standards (CQC themes, infection prevention control) Quality – improved consistency in a clinical area Referral variation Medicines Optimisation Payment monthly to support investment in resources to deliver Ability to withdraw / claw back funding if insufficient evidence of attempts to make improvements

2017/18 Quality Scheme Two assurance meetings per year Mid-year review End of year review Meetings completed by Wednesday 23rd May 2018 (data required not available at end of year) Overall, all have demonstrated good progress, although some areas awaiting evidence / potentially insufficient evidence Assessment is triangulation of discussion at meeting, information on outcomes (i.e. target achievement), and evidence provided.

Quality requirements Quality Area Federation 1 Federation 2 Quality standards (CQC themes, infection prevention control) Infection Control practice check list developed and adopted across all practices Employment check list developed and adopted across all practices Fridge temperature monitoring – standardised protocols and monitoring equipment developed and adopted across all practices DBS checks – standardised process developed and adopted across all practices(nominated member of staff responsible & audit of staff recruited in past year Safety Alerting – standardised process developed and adopted across all practices FP10 blank scripts – development of Prescription Protocol, which includes this and other areas to promote consistency across all Practices Quality – improved consistency in a clinical area Sepsis Audit against NICE guideline Learning Disabilities health checks audit (focus on Downs Syndrome) Epilepsy audit against NICE guideline

Referral Management Federation 1 Federation 2 Federation 3 Demonstrated understanding of areas requiring focus at assurance meetings and review across Federation and analysis of issues (backed up by documentation) Total outpatient attendances (from GP referrals) for 2017/18 are lower than 2016/17 Demonstrated understanding of areas requiring focus at assurance meetings and review across Federation (backed up by documentation) Total outpatient attendances (from GP referrals) for 2017/18 are lower than 2016/17 Unable to demonstrate understanding of areas requiring focus at assurance meetings or review across Federation and analysis of issues* Developed proposal for future demand management schemes, currently being considered by Federation (very recent development, not 17/18) *potential for further evidence to be submitted Total outpatient attendances (from GP referrals) for 2017/18 are higher than 2016/17

Safe and effective use of medicines Safe and effective use of medicines. Improving the safety and consistency of approach to medicines management and optimisation; sharing best practice in relation to adherence to guidelines and formulary and establishing consistent systems. Achieving most effective use of resources.   Measured through variance from prescribing budget. Expectation of achievement of prescribing target at federation level (with 1.1% above target tolerance). Federation 1 Federation 2 Federation 3 Actual outturn position of 0%* Actual outturn position of 13.16%* underspend Actual outturn position of 3.12%* overspend Prescription Protocol developed * CCG has deducted impact of No Cheaper Stock Obtainable and drug tariff increases

Need to provide evidence for this Evidence required Federation 1 Federation 2 Federation 3   Audit report relating to required areas of improvement as identified through local CQC inspections, practice audits and National Reports √ Clinical audit report for NICE/Royal College guidelines – report to be shared with CCG at end of audit Evidence of peer review of medicines optimisation, including findings and intended actions to be implemented/actions that have been implemented to improve quality and consistency and evidence that each individual practice has engaged Evidence of peer review of outpatient activity, including findings and intended actions to be implemented/actions that have been implemented to improve quality and consistency X Need to provide evidence for this Other supplementary information provided: Standard operating procedures / checklists /templates for audits and/or new systems that have been established

Payment Payment made throughout 2017/18 on a monthly basis (provision within agreement to withdraw/clawback) Proposal to clawback as follows: Federation 3 – 24.5 pence per head for lack of evidence on peer review of referrals and 24.5 pence per head for final outturn overspent position on prescribing budget The referral element will be reviewed subject to further evidence received by Friday 8th June 2018. * If each of the 4 areas of the scheme are viewed as equal, then they equate to 49p of overall £1.98 per head investment. Therefore propose Federation retaining 24.5p to reflect work that has happened but clawback 24.5p for each area above.

2018-19 Scheme Meeting 18th June to finalise draft Quality aspects to be agreed Referral and Prescribing elements to remain Pre-requisites (e.g. Declaration of Interest forms up to date, attendance at COM) Requirement to share learning between Federations at Protected Learning Time event Monitoring End of year report to include how funding has been spent Mandatory evidence to be specified Potential to split payment – 80% up front, and 20% retained as premium for achievement of targets / demonstration of evidence