Appendix 1 GPFV Plan Stage 2 Review CCG(s) Cambridgeshire and Peterborough CCG Rating Comments/recommendations Green Green Green Green Amber/green

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1 Appendix 1 GPFV Plan Stage 2 Review CCG(s) Cambridgeshire and Peterborough CCG Rating Comments/recommendations Model of care Green The plan illustrates clearly how the different models of care will be implement over the next 2 years and how this will meet population demand and be beneficial to general practice. The CCG have aligned the plan at an STP level and clearly show how a mixed skill workforce, technology and selfcare will be an integral part of the new models of care it plans to deliver. A collaborative approach across the 3 GP Federations that have been created will be taken such that backoffice, workforce and other functions will be shared across the GP practices leading to the implementation of best practice in all the practices. Clear strategies for how long-term illness, care for patients in care homes and self-care will be provided with access to relevant specialists if needed. This is a good overall strategy which also takes into account interdependencies with other transformation programmes and therefore it was rated a green. Access Green The plan provides a current baseline for extended GP access, as well as a clear trajectory of how the CCG plans to continue increasing extended GP access by integrating with other providers, and using the new online tool to measure patient demand and GP capacity. Overall the CCG have a good vision on how to increase extended GP access and is aligned with the key criteria. The plan has been rated as a green as a robust plan is in place, however the plan should clearly highlight how increased access will reduce inequalities and the implications it has on estates. Workforce Green The CCG have determined their current workforce baseline having identified gaps in workforce. The plan shows how the CCG plans to reduce this gap by increasing their workforce mix and how skills and services will be shared amongst the GP Federations. The CCG have new recruitment, retention and training schemes in place that will encourage GPs and other medical professionals to stay as well as come to the locality. This plan was rated a green as it shows clear innovative strategies on how the CCG will achieve a workforce mix that is aligned at a STP level and the timescales in which plans will be implemented. Workload Green The plan shows the strategy the CCG will use and the timescales within which it will implement the 10 High Impact Actions. Although the plan is rated a green, more clarity around how practices identified for resilience support will be supported should be mentioned. Infrastructure Amber/green The plan outlines the estates strategy and how this will accommodate new models of care and increased extended access. However it is not clear from the plan in addition to wifi access what other technology schemes will be implemented and how they will be funded. Transformation Green The plan clearly shows how Transformational Fund will be utilised over the next 2 years and how the c. 2.8m will be allocated between primary care at scale, workforce, workload and contingency. Expected outcomes are detailed. Investment Green Online consultations 1

2 Leadership, governance and programme arrangements Green Plan outlines that funding will be used to build on current practice development that has occurred in Greater Peterborough. Clear indication of use and funding available. Would benefit from further detail of the current scheme (whereby 20% of patients across the CCG are using online services) Training receptionist/clerical staff (care navigator training) Plan outlines the intention to develop a local rolling care navigator training programme and Medical Assistant role. Plan outlines key milestones (programme to be developed by June 2017) and considerations. The CCG have also developed strategies on how other funding streams will be utilised. A governance structure is in place in the forms of delivery groups that ensure the implementation of the GPFV. A risk plan and a resourcing strategy is being implemented by engaging with multiple stakeholders. Overall rating Green Overall this is a good plan aligned at the STP level with most areas addressing the key critical deliverables of the GPFV. Some areas in the sections above have been rated as an amber/green as more clarity is required on some of the schemes. However this is a good plan well aligned with the GPFV guidelines and therefore it is rated as a green. Notes on this template Definition of ratings Rating Green (4) Amber/green (3) Amber/red (2) Red (1) Interpretation Satisfies the requirements set out in the GPFV Planning Guidance. Demonstration that all key elements have been carefully considered. Satisfies the requirements set out in the GPFV Planning Guidance with some reservations. Some reservations that some the key elements have not been fully considered or fully articulated. Partially satisfies the requirements set out in the GPFV Planning Guidance but with major reservations. Major reservations that a number the key elements have not been fully considered or fully articulated. Does not meet the requirement set out in the GPFV Planning Guidance. Few of the key headline themes have been considered or articulated. 2

3 Actions following ratings to sections of plan (eg. Workforce): Rating Next Steps Green (4) Amber/green (3) Amber/red (2) Red (1) No further action required. CCGs/STPs to receive feedback and advised to make amendments as required to plan section based on recommendations. CCGs/STPs to receive feedback/recommendations. Further Ad-hoc support from subject matter experts to be provided and agreed with DCO teams to develop plan further CCGs/STPs to receive feedback/recommendations. Further Ad-hoc support from subject matter experts to be provided and agreed with DCO teams to develop plan further Note: Where a plan has received an overall rating of Amber/Green or Green, but an individual section of the plan (eg. Workforce) has been rated Amber/red or Red, this section may need to be revised further Review areas Model of care The primary care vision should be supported by a detailed care model, which improves both patient outcomes and general practice capacity and sustainability. It should include the ways in which greater use will be made of self care, technology and a wider workforce skill mix. The plan should demonstrate an assessment of patient pathways that lend themselves to primary care settings, and show how the new model differs from historical and current models. It should specify the proposed end state, and provide clarity on service offer, including: the clinical services to be provided and from where; the expected benefits of service offer; what the model of care will mean for patients; the health needs or priorities improved on by the model; how primary care access will be improved, including reducing inequalities in access; implications for the workforce requirement and skill mix in primary care; the role of secondary care specialists in multi-disciplinary primary care teams and primary care access to specialist opinion; and any major service changes involved in implementing the model, including the requirement for public consultation. 3

4 The plan should describe how the proposed future model of primary care will support optimal out of hospital services, and the delivery of more services closer to home. Key interdependencies with other transformation programmes within your STP should be highlighted, such as with new models of secondary and community care, e.g. vanguards, integrated urgent care services, and integrated health and social care services. The engagement of providers, patients and other stakeholders in developing the model of care should be described, including any plans for further engagement. Access Provide an accurate baseline for current extended GP access, including extended hours DES provision; Detail how extended GP access services will be provided and from where (e.g. hub locations); Articulate how the extended access model will alter pathways, including how this supports optimal out of hospital services; Show how patient demand has been assessed; Show how improved access will reduce inequalities; Articulate the estates, technology and workforce implications of improved access plans; Make use of evidence from best practice and any local pilots; Show how the funding for extended GP access will be invested, and outline plans for recurrent funding; Reference to extended GP access trajectory submitted as part of the Unify CCG operational plan submission, updating this as appropriate. Workforce Outline how the approach to workforce planning within the STP footprint, including how the CCGs/STP are working with NHS England, Health Education England, Local Workforce Advisory Boards, Community Provider Education Networks, Local Medical Committees, GP federations, practices and education providers; Describe the current workforce, including key risks and issues; Describe the workforce implications of your model of care, including changes in skill mix to make effective use of other clinicians within primary care, e.g. pharmacists, mental health therapists, physicians associates, nurses and allied health professionals; Provide an assessment of the gap between the projected and current workforce, and your view as to how this aligns to the modelling provided at Appendix 4; Describe your approach to recruit, retain or train the necessary workforce, including any local initiatives in place or planned and how you will make best use of national schemes, e.g. GP Induction and Refresher, GP Retainer Scheme, international recruitment; Set out plans to maximise sharing of back office functions within general practice; 4

5 Outline the approach to developing clinical leadership, to support at-scale provision and multi-disciplinary team development. Workload Outline plans for the use and monitoring of GP resilience programme funding in 2017/18, including the approach to identifying practices or groups or practices, numbers of practices or groups identified for support, the type of support required and any contact with them and key milestones to commit and allocate funding; Set out how practices will be identified to participate in the resilience programme and planned outcomes of support; Describe plans to implement the 10 High Impact Actions, including the promotion of self-care, new consultation types, development of a multi-disciplinary team, partnership working, process improvement and productive workflows; Show your approach to and engagement with the general practice development programme, including local development schemes and learning sets established and engagement with the Sustainable Improvement Team development programmes (Time for Care; productive general practice; practice manager development programme) Infrastructure Outline the primary care estates strategy, showing how estates have been considered across the whole system making effective use of whole system assets; Outline plans for estates developments, including rationale and source of funding and how value for money will be achieved; Provide a clear narrative on the use of technology in primary care and demonstrate how the estates and technology investments will support delivery of the model of care and extended GP access, including shared and integrated care records, insight and intelligence to support decision making and patient empowerment; Identify the supporting IM&T requirements to deliver the vision, how will this interface with other systems, e.g. 111, OOH, integrated services, agile working, telephone and online consultation; Detail planned technology projects, including including any local pilot, roll out and mainstreaming plans with key milestones, phased costings, population coverage, procurement strategy, linkages across the STP and public engagement. This should include: - the implementation of wi-fi in general practice - to consolidate existing capability and increase Patients Online utilisation via digitisation and interoperability strategies; - GPIT developments in accordance with the national GPIT Operating Framework;and - approaches for delivering against the agreed, national Universal Capabilities, including electronic referrals, patient online and providing access to GP record information in wider urgent care settings 5

6 Investment The GPFV includes the additional investment in general practice, as set out below. Increase general practice funding by at least the % increase in core CCG allocations, to fund core contract changes 3 per head (option to split over 2017/18 and 2018/19) non-recurrent transformation support funded from CCG allocations to stimulate development of at scale providers, implementation of 10 high impact actions and secure sustainability; 15m devolved to CCGs in 2017/18 and 20m in 2018/19 to fund online GP consultation software in line with national specification; 10m devolved to NHS England local teams or delegated CCGs in each 2017/18 and 2018/19 to fund training for care navigators and medical assistants for all practices in line with national specification; and 8m funding in each 2017/18 and 2018/19 to support practice resilience (NHS England) 6 per weighted patient for GPAF sites and Transformation Area CCGs in both 2017/18 and 2018/19, and 3.34 per head for all remaining CCGs in 2018/19 Plans should describe how this investment will be used locally to achieve transformation in general practice, and deliver the overall vision. The following sections specify the planning requirements by investment area. The plan should be clear about the maturity of investment plans, including business case development and approvals, and set out the procurement strategy. It should make a clear statement as to whether all investments planned in primary care are reflected in STP and operational plans. Transformational support Outline the priorities for use of the 3 per head and the phasing of funding, aligned to the CCG s operational financial plan; Specify the investments in practices or supporting services, e.g. access hubs, federation development; Identify the expected outcomes from investment across the 2 year period and how this will be measured. Ring-fenced devolved funding On-line consultation software The national specification for online consultation software is expected to be published shortly. In anticipation of this guidance, plans should: Outline intentions for online-consultation technology; Identify where a system is being piloted locally, including details of costs and contractual arrangements; Clarify the procurement strategy, roll out and mainstreaming plans with phased costings and population coverage; Outline linkages across STP footprint and how consistency will be checked cross borders; Outline patient and public engagement plans to maximise impact; 6

7 Describe the transformational change at practice level to respond to on line consultations and how this will be promoted. Training for reception and clerical staff Plans should: Show how the CCG intends to deliver the programme; Demonstrate any collaborative delivery with other CCGs or across STP area and fit with other development activity e.g. GP development programme; Describe how the delivery plan has been developed with practices; and Outline the outcomes and impacts expected. Other investment Other investments in general practice will be made via funding either held nationally or devolved to NHS England local offices these include: General practice resilience programme Estates and technology transformation fund (ETTF) Increases in funding for GP trainees (HEE) Increases in funding for GPIT Increases in funding for public health services (section 7A) Fully funded practice based mental health therapists The plan should set out how the CCG/STP is working with NHS England and Health Education England on delivery of these programmes and investments. In particular stage two GPFV plans should: Outline how the funding available via co-commissioning will be allocated to primary care and how this will contribute to the delivery of the aspirations set out in the STP and GPFV; Provide assurance that revenue impacts of any ETTF projects delivering in are planned, achievable and affordable; Outline any plans for investment in primary care workforce, including increases in staffing and development of new roles; Outline plans to invest the PMS premium, where applicable. Leadership, governance and programme arrangements The stage two GPFV plan submission should set out the local governance arrangements for the GPFV programme, including how this aligns to existing CCG and STP governance and Local Digital Roadmaps. It should describe how key stakeholders are engaged within the programme governance. The plan should describe the programme management arrangements and how these are resourced currently and over the years of the plan. A high level programme risk register should be provided. 7

8 The plan should articulate how primary care professionals, patients and the public and their representative bodies have been and will be engaged in the development and delivery of the GPFV plan, including any plans for public consultation. Overall rating The overall rating summarises the ratings of each element of the plan but will also be based on whether there is a strong and coherent narrative throughout. The plan should set out at the beginning the overall vision for primary care, including how this will improve primary care quality and sustainability. It should be clear how this supports the transformation described in the STP, and contributes to closing the system quality gap. The plan should demonstrate how it relates to other local plans, and supports delivery of the 9 must dos, identified in the operational planning guidance, and related national programmes. The plan should also tell the story of local primary care in an early section, setting out the baseline and identifying challenges and priorities for action. This should include an analysis of population need and an assessment of the current landscape including service provision, workforce, estates, IT and existing at-scale provider collaborations. It should provide an assessment of current outcomes vs peers, and inequalities in outcomes. The plan should identify areas of particular risk including vulnerable practices, recruitment and CQC status, with details of mitigation where available and evidence sign off by the STP Lead. 8