Primary Care in North Somerset

Number of GP practices by contract : General Medical Services (GMS) 6 Personal Medical Services (PMS) 16 Alternative Medical Services (APMS) 2 Total number of practices 24 Registered population 215,266 WTE GPs/Pts per WTE 111/1929 Overview

GP Patient Survey: March – Sept 2014 (published Feb 2015) ED1 – Satisfaction with the consultation at the GP surgery (range – 458.8) Bristol 437.7; S.Glos 435.4; Somerset ED2 – Overall satisfaction with the care received at the surgery expressed as a percentage 83.9% (range 71.4% – 92.4%) Bristol 85.6%; S.Glos 84.1%; Somerset 88.6% ED3 – Satisfaction with primary care expressed as a percentage 73.7% ( range 56.1% %) Bristol 72.8%; S.Glos 70.7%; Somerset 79.8% Patient Experience in North Somerset

Implementation of the 2015/16 contract Continued implementation of the Single operating framework for managing primary medical care contracts Developing quality indicators for General practice Working with CQC GP practice sustainability through transformation Working on development through patient satisfaction surveys and Friends and Family Test Priorities for managing GP contracts in North Somerset:

Directed Enhanced Services/number of practices providing the service: Avoiding Unplanned admissions/21 Extended Hours/19 Facilitating timely diagnosis of Dementia/24 Minor Surgery/17 Learning Disability Health Checks/22 Contraceptive Devices IUCD/LA commissioned Violent Patient Scheme/commissioned across BNSSG cluster from a single provider 15/16 contract

Global sum funding and uplift Named accountable GP for all patients (by 30 June 2015 for patients on the registered list prior to April 2015 and within 21 days for all new registrations and advertised on the practice website and leaflet by 31 March 2016) From 1 April 2015 all practices must publish on their website the mean earnings for all GPs for the previous year (2014/15) Seniority payments will be phased out from this financial year until /16 contract requirements

Military personnel will be able to register with a GP practice in certain circumstances with permission from the Defence Military Services Reimbursement for GP practices for parental leave – maternity/paternity/adoption leave The alcohol risk reduction enhanced service and patient participation enhanced service ceased on 31 March 2015 and the funding forms part of the global sum Patient on line access to their medical record – all practices must offer this from 1 April This includes the opportunity to book on line appointments. contacts/general-medical-services/gms-contract-changes/gms- contract-changes http:// contacts/general-medical-services/gms-contract-changes/gms- contract-changes /16 contractual requirements cont

All primary care budgets split to match CCG indicative allocation, whether delegated or not Draft finances attached based on payments direct to practice and those that are not, are split on weighted list size Allocation needs to be split to CCG based on initial allocation and additional items apportioned QIPP is included in Other GP services line Headroom allocated to CCG Contingency is ring fenced for central reserve Finance working group needs to be set up to understand budget and spend apportionment Overview - Draft Finance Report

South West Primary Care Governance

Responsibility remains with NHS England At all levels of co-commissioning, NHS England will retain a role in supporting delivery of commissioning and contracting functions. Also the following responsibilities will remain with NHS England and will not be included in joint or delegated committees: Continuing to set nationally standing rules to ensure consistency and delivery goals outlined in the Mandate set by government. The terms of GMS contracts and any nationally determined elements of PMS and APMS contracts will continue to be set out in the respective regulations/ directions. Functions relating to individual GP performance management (medical performers’ lists for GPs, appraisal and revalidation). Administration of payments to GPs. Patient list management will remain with NHS England. Capital expenditure functions Complaints management Decisions relating to the Prime Minister’s Challenge Fund (PMCF)

Functions decided in the JCC (1) - determination of key decisions or requests FunctionJCC decision needed Decision possible under existing approved policy Potential Need for urgent decisions List closure Practice merger/moves Boundary changes Securing services /APMS PMS (reviews etc) Discretionary payments Remedial breach notices Contract termination Contractual changes (contentious) Contractual changes (transactional) Monitoring of contractual performance

Functions decided in the JCC (2) – financial processes FunctionJCC decision neededDecision possible under existing approved policy Potential need for urgent decision Ensuring budget sustainability Management accounting

Functions decided in the JCC (3) – strategy and policy FunctionJCC decision needed Decision possible under existing agreed policy Potential need for urgent decision Securing quality improvement Developing and agreeing outcome framework – 16/17? Development of DESs/utilisation of QOF points Premises plans including discretionary funding Commissioning of enhanced optometry and pharmacy services to align with CCG objectives Collaboration with stakeholders to assess health needs and decide strategic priorities Design of local contracts such as APMS, PMS and NHSE enhanced services Commissioning new providers and managing procurements

Governance and Membership Committee constitution and Terms of Reference While much of the decision-making processes will be determined by the JCC and aligned with existing governance processes, the constitution of the Committees have been approved by NHSE as a condition of co-commissioning. In the interests of transparency and the mitigation of conflicts of interest, the North Somerset CCG has a lay chair and vice chair. In addition a representative from Health Watch and The People of Communities Board are non-voting attendees. This will help to support alignment in decision making across the local health and social care system.

Voting in the Joint Committee The JCC will be quorate when 5 pay and executive members are present – including one NHSE and one CCG member. The Committee should aim wherever possible to make decisions by consensus. However, where this is not achieved, a voting method will need to be used. The voting process will determined by a simple majority of members present. Absent members will not be allowed to vote – unless agreed with the Chair beforehand. Each voting member of the JCC will have one vote except in the following circumstance: NHSE functions – votes of NHSE members will be weighted to have parity with CCG members In cases where the vote has not determined an outright decision, the Chair will have a second, deciding vote except in respect of: NHSE statutory functions – 1 NHSE member to have deciding vote CCG statutory functions – 1 CCG member to have deciding vote

Voting Process in a Joint Committee Except for NHSE/CCG statutory functions when NHSE/CCG holds casting vote Weighting may apply