Recovery Programme W est Sussex CCG W est Sussex CCG Brighton and - - PowerPoint PPT Presentation

West Sussex CCG 

Brighton and Hove CCG  East Sussex CCG

West Sussex CCG 

Brighton and Hove CCG  East Sussex CCG

Primary Care and Community Services Restoration and Recovery Programme

West Sussex CCG 

Brighton and Hove CCG  East Sussex CCG 2 |

General Practice Restoration & Recovery Framework

The SE Regional vision

In restoring & recovering services we will take the opportunity to lock in the positive gains made during the response phase and drive transformation at pace to deliver high quality, clinically and financially sustainable services, improving outcomes for our populations, driving down health inequalities, with a focus on the most vulnerable

We will focus on 5 strategic

• bjectives

To achieve

• ur
• bjectives

we will work across a number of priority areas

Deliver access to safe, high quality & effective services, through innovative service models that consider national & international best practice, appropriately reflect local need & factor in the ability to manage future surge pressures (Covid-19, Seasonal Flu) Delivering access to safe, high quality & effective services 1.Consider how and when to safely reinstate General Practice services that were suspended during Phase 1; in particular, through LCSs or not, patients with: a) Long-term conditions; and b) Those on the shielded list 2.Monitor activity in ‘hot sites’ and create a plan for there continued usage during Phase 3 and beyond 3.Ensure a seamless transition of the current elements of the Covid Care Home Support into full specification delivery of the Network DES from October Six systems delivering world class, place based health & care Six high performing systems, with their constituent organisations working seamlessly to provide world class, place based health & care for their populations, focusing on the vulnerable.

1.Deliver the early cancer diagnosis and SMR specs of the Network DES 2.Continue focus on Population Health Management (PHM) via the Aspirant ICS PHM Development Programme 3.For Phase 3, plan and ensure there is a Network approach to meeting Health Inequalities challenges 4.Once available, support implementation of recommendations of the Access Review 5.Support Systems with their PCN Development Support approaches for 20/21, ensuring continued investment against 19/20 ‘top 3 priorities’ 6.Take an integrated approach across health & care, particularly partners in primary care, to the delivery of services e.g. homelessness & hard to reach communities

Capturing & building on innovation & transformation Capture and build on successful innovations implemented in the response phase & fast track planned LTP transformation where appropriate to support system recovery 1.Continue to closely review Digital First Primary Care (e.g. Total Triage and Remote Working) progress, and consider long-term implications

• f innovations

2.Share learning and best practice of Network-based approaches during Phase 1 3.Ensure Primary Care, Digital and Estates colleagues are strategically aligned in regards to long-term planning 4.Share learning and best practice to inform longer-term

• perating models as Networks
• f Practices

Resilient & supported health & care workforce Develop a resilient, flexible, inclusive and well supported health and care workforce who feel valued and optimistic about a career in the NHS.

1.Continue to focus on PCN development, both the Clinical Directors and wider PCN teams, as part of PCN Development Support Programme 2.Continue to encourage PCNs to uptake ARRS roles 3.Map the wellbeing & resilience

• ffers available to General

Practice through Covid-19 4.Continue to support BAME workforce 5.Support Systems and Networks to convert seasonable GPs to substantive roles 6.Support Systems to develop and utilise their Training Hubs to support PCN workforce development

Financially sustainable systems Build financially sustainable systems, maximising the efficient use

• f resources to deliver

affordable, high quality,

• utcome focussed

healthcare 1.Introduce adjusted QOF payment for reminder of 20/21 2.Continue with GPFV investment 3.Once available, support Systems and their constituent CCGs with the implementation of the Covid Management Fund for General Practice

SRO: TBC Lead: TBC SRO: TBC Lead: TBC SRO: TBC Lead: TBC SRO: TBC Lead: TBC SRO: TBC Lead: TBC

West Sussex CCG 

Brighton and Hove CCG  East Sussex CCG 3 |

General Practice Restoration & Recovery Framework

Sussex Primary Care and Community Services Workstreams

Delivering access to safe, high quality & effective services

1.General Practice consolidation

• f hot sites

2.LCS Service reintroduction 3.Population based care and management of long term conditions 4.Flu programme to support Primary Care

• 5. Primary care

strategy

Six systems delivering world class, place based health & care

1.Shielded and High risk patients 2.Additional General Practice support to Care Homes 3.Primary Care Networks 4.Population based care and management of long term conditions 5.Pharmacy and medicines support to care homes 6.Early Cancer Diagnoses DES

Capturing & building on innovation & transformation

1.Prevention (LD and Screening services) 2.Technology to enable care (Implementing the Covid Age Algorithm) 3.Quality education and sharing good practice 4.Membership engagement

Resilient & supported health & care workforce

1.BAME LCS 2.Quality education and sharing good practice 3.Membership engagement

• 4. Staff information

and condition specific webinars

Financially sustainable systems

1.LCS Service reintroduction 2.Prescribing QIPP plan recovery 3.Prescribing incentive schemes re-introduction 4.Re-instigation of QoF reviews

West Sussex CCG 

Brighton and Hove CCG  East Sussex CCG

Restoration and Recovery Phases

Phase One 31 July

• Implementation of the BAME

LCS

• Implementation of Care Home

LCSs

• Implementation of a High Risk

LCS (to include shielded patients)

• Consolidation of Hot Sites

and/or zoning.

• A plan for the additional Roles

in PCNs to support the identified workforce gap In doing this we will work with or PCN Clinical Directors and have a weekly forum for this to happen

Phase Two 30 September

• Development of a sustainable

model for general practice

• An impact assessment of

general practice in delivering a new model of care

• The harmonisation of multiple

current care homes LCS’

• The reinstatement of some LCS
• Reinstatement of protected

learning time to share best practice

• Support in the delivery of LD

Health Checks In doing this we will engage with

• ur PCN Clinical Directors and our

membership

Phase Three From 1 October

• Delivery of the Enhanced

Health in Care Homes DES

• Delivery of the Early Cancer

Diagnosis

• The roll out of the MOCH

service across Sussex

• Support implementation of

PCN DES for structured medication reviews

• The delivery of screening

In doing this we will engage with

• ur PCN Clinical Directors and
• ur membership

1 2 3

The Primary care restoration and recovery process takes three distinct phases, as illustrated on the diagram with specific activities to be delivered to ensure the aims and objectives of the 3 programmes are met. In response to the pandemic, following local discussion and national guidance a number services deemed non-essential were suspended. This will be detailed in a Strategic Plan for each CCG, reflecting the national, Sussex wide, and CCG specific demands. The primary care team has identified specific resource in the form of three senior managers focused solely on the delivery of these plans. As part of the restoration and recovery programme the team will consider which services need to be brought back in which order to their original specification, which need to be amended in response to the need to manage confirmed or suspected C19 patients as part of core General Medical Services; and over what timescale. The next slide details these changes which have been made to primary care during the initial phases of the pandemic.

West Sussex CCG 

Brighton and Hove CCG  East Sussex CCG

Recovery and Restoration Programme

• A. Primary Care & Community Services Joint Working
• B. General Practice
• C. Medicines Optimisation

Purpose / Description Of Programme Enhance the current joint ways of working across Primary Care and Community Services. In addition, design and implement new joint ways of working as would be beneficial, initially with a focus on enhancing the system response to COVID. The programme will work with colleagues across multiple

• rganizations involved in delivering these services, in particular

with general practice, SCFT and ESHT. To develop a framework that describes a new model of care for general practice to consider. This will be based on what went well during phase 1 of COVID-19 and the guidance as set out in Simon Stevens letter. This programme recognises the interdependencies of other programmes and risks associated with the delivery of the programme. To work with system partners to restore Medicines Optimisation Programmes and support delivery of the Medicine Optimisation through the new pharmacy workforce in Primary Care Networks Key Objectives

• Enhance existing joint ways of working between Primary Care

and Community Service teams.

• Explore opportunities to add additional joint working

arrangements for the benefit of the system as a whole.

• Ensure a consistent and joined up response to Shielded

Patients across Primary Care & Community Services.

• Take forward the implementation of the national Care Homes

specification against the revised timelines requested by NHSE.

• To describe a new norm in ways of working based on local

best practice for general practice with general practice

• To be clear on expectations for patients in accessing services
• Engaging the Primary Care Networks on the implementation of

the Medicine Optimisation elements of the DES from 1st October 2020.

• The suspended QIPP programmes and prescribing incentives

will be reviewed to agree appropriate levels of restoration (Oct – Mar 21)

• Aiming to have an aligned Integrated Medicines Optimisation

Strategy from 1st April 2021. Expected Outcomes / Benefits

• Enhanced health and care outcomes, more efficiently

delivered across Primary Care & Community Services.

• Consistent implementation of national guidance across

Sussex.

• Future, sustainable benefits beyond the COVID response as a

result of joined up team working enhancing service delivery.

• General Practice supported to deliver Phase 2 of the national

COVID response.

• General Practice setup to deliver effective and efficient care in

the context of the ‘new normal’ model of operation.

• Improved Primary Care quality and resilience
• Improved patient safety and outcomes.
• Improved efficiencies to the Primary Care Prescribing budget

Lead

• Sally Smith / Sarah Henley
• Sarah Henley
• Eileen Callaghan / Sue Carter

West Sussex CCG 

Brighton and Hove CCG  East Sussex CCG

General Practice

West Sussex CCG 

Brighton and Hove CCG  East Sussex CCG

General Practice

Workstream w/c 4th May w/c 11th May w/c 18th May w/c 25th May June July August September October November Programme Mobilisation General Practice consolidation of hot sites (local) BAME (local) Shielded Patients (national) High Risk Patients (national) Prevention Work (national) Technology To Enable Care (national) LCS – Service Reintroduction (local) Quality, Education & Sharing Good Practice (local)

Initial review session w/ clinicians (5th) Programme Approach, Team & Stakeholders Initial Programme Team & Stakeholders Identified (15th) Refine Scope, Principles & Workstreams (scope) Finalise scope, team & setup initial session Initial Scope & Work streams Finalised (22nd) Agree Approach & Delivery Plan TBC – Deliver Workstream (18 - 24 months) TBC – Refine, Adjust, Plan & Deliver Further Work As Needed 11/6 – Mobilisation Session Operating Model Design for General Practice (in the context of the ongoing & post pandemic response) TBC - Workstream plan complete LCS Mobilised / Go-live (17th) Finalise scope, team & setup initial session Mobilisation Session (13th) Finalise scope, team & setup initial session 11/6 – Mobilisation Session Scope & Plan For Delivery (15th) Finalise scope, team & setup initial session Finalise team & setup initial sessions Finalise scope, team & setup initial session Agree Approach & Delivery Plan TBC – Delivery TBC – Refine, Adjust, Plan & Deliver Further Work As Needed TBC – Delivery Delivery TBC – Refine, Adjust, Plan & Deliver Further Work As Needed Plan Key:

Delayed Off-Track / Risk of Delay On-Track Milestone (complete) Extended Complete Dependency

Finalise scope TBC – Refine, Adjust, Plan & Deliver Further Work As Needed TBC – Delivery Define Plan Agree Approach & Delivery Plan EMT Paper (20th) LCS Signoff @ EMT (25th) Implementation Of LCS Implement Initial Areas Of Joint Working Identify Additional Workstream Scope Workstream Mobilisation Session (7th) Agree Joint Approach (14th) Workstream closed / transition scope to ‘high risk patients’ (1st) Scoping session LCS Re-introduction Principles (29th) PCN Digital Facilitator (2nd) Scoping session (19th) Finalise scope TBC – w/c 1st 2x scoping ssessions Define Plan Agree Approach & Delivery Plan Patients identified & contacted by participating practices (12th) Agree Approach & Delivery Plan (5th) Scoping session Clinical kick-off session Today Implementation Of LCS Plan agreed Agreed Plan

Primary Care & Community Services: General Practice

Executive Lead Karen Breen SRO Wendy Carberry PMO Lead Dee Kelly Reporting Period Overall status QIAs Milestones Risk & Issues Resources w/e 17 July 2020 G G G A R Update Issues for escalation

• Work in progress: the scope of the programme work streams and the approach / plans / milestones to support the mobilisation of

each of them are currently progressing over the next couple of weeks.

• First multi provider collaboration of LD leads with Sussex wide representation with good engagement, with a scope to improve uptake

and access to LD Health Checks.

• Agreement between Primary Care and Digital to approve support for effective implementation of the Digital First Programme.

Including technology support for patients, making it easier for clinicians to deliver high quality care and to support the introduction of the new PCN Digital Facilitators.

• LCS Restoration: Paper going to PCCC recommending extension of LCS protection based on historic averages and not current

activity, and also seeking funding for clinically vulnerable LCS.

• Hotsites panel established for next week to review plans and financial consequences of consolidation of hotsites
• Approximately 66% of practices signed up to BAME LCS so far (ES = 64.5%, WS = 67%, B&H = 68.5%)
• No escalations

Key actions or milestones achieved since last report

• BAME LCS. Heat maps created for each CCG

Top two risks Mitigation Workforce: There is a risk that there will not be enough workforce resource to provide and implement the envisaged revised and enhanced services in General Practice. The CCG has several initiatives in place to encourage more uptake of positions within General Practice, including links with PCNs and training hubs. Funding streams relating to C19 will cease at the end of July. It is not yet clear on how items such as consolidation of hotsites will be funded Ensure ongoing communication with finance colleagues. Critical path milestones remaining Date Date 1 General Practice Operating Model – Codesigned plan agreed 30 June 20 4 LMT Agreement of recommended process for Quality, Education & Sharing Good Practice. 07 July 20 2 High Risk Patients – Extremely Clinically Vulnerable patient visiting LCS launched 07 July 20 5 Reintroduction of LCSs Complete 30 Nov 20 3 Prevention guidance issued to practices 07 July 20 6 Technology to enable care (Remaining objectives to be defined) TBC

West Sussex CCG 

Brighton and Hove CCG  East Sussex CCG

Work stream: BAME LCS

Risks Mitigation Date Added Date Reviewed Risk Capacity in high BAME community areas may be more stretched. Practices will be incentivised to collaborate and support populations whose primary care provider is not providing components of this LCS. 28/05/20 General Practice Clinicians are not usually asked to record the time they spend on activities. Felt not to be viable for remuneration purposes. Agree preferred option including moving back to standard cost depending on who does review (GP, HCA, etc.). 28/05/20

Actions Completed since previous report

• Explanatory notes and sign up instructions sent out to practices
• EMIS/S1 template for searching for BAME patients created
• Continue to monitor sign up – new deadline set for 17July
• Heat maps created for each CCG

Highlights and Areas for Escalation

• The work stream will identify vulnerable BAME population, with a

view to increasing support and potential shielding for these groups.

• Expected benefits include improved safety, wellbeing and reduction

in risk of harm to those in the BAME cohort

• Work is in progress to scope the work stream and the approach,

plans & milestones to support the mobilisation are currently progressing over the next couple of weeks.

• The LCS wording and the associated suite of documents including

instructions for practices on how to sign up agreed at EMT June.

• LCS rolled out to practices mid-June.
• Go Live ACHIEVED and launched at LMC webinar 16/6
• Launch webinar took place 22/6
• QIA signed off
• Continuing to monitor sign up with approximately 66% of

practices signed up so far (ES = 64.5%, WS = 67%, B&H = 68.5%) Milestone Date Owner Training for Clinicians

• ngoing

AH / TG Patients identified and contacted by participating practices Delayed due to LCS launch delay and extension to sign up period now due 31/07/2020 31/07/20 AH Collate monitoring information and conduct 1st ¼ review 30/09/20 And monthly

• ngoing

AH Monitor engagement plan in line with practice take up and review with primary care teams 31/07/20 JS

Workstream Tasks on Track Workstream Delivery

R&R Workstream: General Practice Orientation: System SRO: Wendy Carberry Silver Lead: Sarah Henley PMO Support:

West Sussex CCG 

Brighton and Hove CCG  East Sussex CCG

Work stream: Prevention work

Risks Mitigation Date Added Date Reviewed Risk If some services have been stopped, there may be practical difficulties restarting them. Convene small working group to look at this including aligning health checks. 04/06/20 There is a risk that practices will be unable to meet 2wkwaits due to current estates and protocols reconfigurations (hot sites / zoning) Federations in conversation with CDs. This is interdependent with GP Operating Model programme. 30/06/20

Actions Completed since previous report

• First scoping session complete
• First multi provider with Sussex wide representation task and finish

group achieved

• LD health check webinar last week for primary care

Highlights and Areas for Escalation

• The work stream will ensure as much routine and preventative work

is provided as can be safely including vaccinations immunisations, and screening. LD Screening Programme and Health Checks

• Collaboration of leads across Sussex underway with good

engagement

• Overarching plan of Sussex wide services being pulled together

(Penny) Imms & Screening

• Scoping and engagement commenced.

Milestone Date Owner Workstream documentation, risks and issues, etc. complete (LD element). w/c 29/06/20 AD Caroline Vass working on imms & screening. w/c 29/06/20 CV Guidance for practices for LD 17/07/2020 AD

Workstream Tasks on Track Workstream Delivery

R&R Workstream: General Practice Orientation: System SRO: Wendy Carberry Silver Lead: Sarah Henley PMO Support:

West Sussex CCG 

Brighton and Hove CCG  East Sussex CCG

Work stream: Technology to enable care

Risks Mitigation Date Added Date Reviewed Risk

Workforce: There is a risk that there will not be enough workforce resource to provide and implement the envisaged revised and enhanced services in General Practice. The CCG has several initiatives in place to encourage more uptake of positions within General Practice, including links with PCNs and training hubs. 28/05/20 Actions Completed since previous report

• Review which LCSs are open to moving over to digital solutions.

(e.g. follow up health checks).

• Whzan kits being distributed to some care homes to enable remote

working, with discussions ongoing to roll out wider.

• Further project support aligned from primary care
• Initial Resource portal scoping document completed 01/07 – shared

with Digital and Primary Care teams for process/design feedback. Follow up meeting to be arranged by Digital colleagues Highlights and Areas for Escalation

• The work stream will identify and deliver technology to enable care,

supporting practices to deliver remote patient care where appropriate.

• Benefits include a reduction in wait times to 'see' a GP, supporting

the primary care workforce to work flexibly increasing staff satisfaction and work/life balance, and supporting the culture shift/change by increasing access for patients to embrace the new normal whilst improving confidence and timely clinical intervention.

• A process is being scoped to review technology solutions, assess

(including cost / benefit). This has both a covid and non-covid focus.

• The larger providers' intentions around digital will be checked to

enable a common platform to be found.

• A task group will be convened to maintain a link between digital and

primary care.

• Work is in progress to scope the work stream and the approach,

plans & milestones to support the mobilisation are currently progressing over the next couple of weeks. PCNs are being contacted regarding their needs. Milestone Date Owner PCN engagement complete 15/06/20 HL/JL Agreement between Primary Care and Digital to approve support for effective implementation of the Digital First Programme. Including technology support for patients, making it easier for clinicians to deliver high quality care and to support the introduction of the new PCN Digital Facilitators. 26/06/20 HL/LS Rollout Virtual MDTs from Brighton PCNs to rest of Sussex – using the

• n-going learning and feedback from
• ur Primary Care colleagues.

On-going HL/GC Establish Resource portal for referral forms and other clinical guidance. To be designed by Digital team in order to support the variety ways of working & expectations across Sussex. Commenced 01/07/20 Digital Liaise with Primary Care colleagues to collate feedback on the recent introduction of new technology to enhance consultation methods and new ways of booking appointments 14/08/20 LS/PH

Workstream Tasks on Track Workstream Delivery

R&R Workstream: General Practice Orientation: System SRO: Wendy Carberry Silver Lead: Sarah Henley PMO Support:

West Sussex CCG 

Brighton and Hove CCG  East Sussex CCG

Work stream: Quality Education and sharing of good practice

Risks Mitigation Date Added Date Reviewed Risk

Availability of an appropriate on-line platform that offers appropriate security and functionality. Consultation with subject matter experts to monitor and

• ffer guidance

09/07/20 Funding: There is a risk that the recommendation from the group exceeds the available funding which may result in practices being unable to close to attend training. Recommendation going to LMT on 07/07 23/06/20 Actions Completed since previous report

• Shared understanding of project ask
• Prioritised some key clinical areas requiring immediate thought
• Started to identify areas of good practice within the training process
• Pre C19 training scoping completed
• Phase

1 report discussed at LMT 08/07/2020; partially agreed; Clarification required. To be resubmitted 22/07/2020;

• Timescale and initial scope of phase 2 agreed

Highlights and Areas for Escalation

• With the aim of enhancing business-as-usual GP Operations (in the

'new normal'), this work stream will develop and instil a process to enable the principle of practice - practice sharing of successful ways of working.

• Benefits include practice sharing of knowledge, and ways of

working to raise the minimum standard of service provided across Sussex.

• A suite of both covid and non-covid related areas of good practice

are being scoped to adapt and apply across Sussex

• Paper presented at LMT on the 8th July. Further information

requested on the following issues:

• Scoping of GP federations to see if they have events management

expertise

• Exploration of potential funding streams for PLT funding
• Exploration with clinicians about timing of re-instigation of training.
• Agreement from LMT to set up Sussex Wide Group.

Milestone Date Owner Agree mechanism and process by which training is delivered 30/06/20 AS Work stream delivery 31/08/20 AS Phase 1: Recommendation process to LMT 07/07/20 SH Phase 1: LMT agreement and funding streams agreed 22/07/20 SH Phase 2: Recommendation on training content TBC (July-Aug) TBC (July –Aug)

Workstream Tasks on Track Workstream Delivery

R&R Workstream: General Practice Orientation: System SRO: Wendy Carberry Silver Lead: Sarah Henley PMO Support:

West Sussex CCG 

Brighton and Hove CCG  East Sussex CCG

Work stream: LCS Reintroduction

Risks Mitigation Date Added Date Reviewed Risk

Workforce: There is a risk that there will not be enough workforce resource to provide and implement the envisaged revised and enhanced services in General Practice. The CCG has several initiatives in place to encourage more uptake of positions within General Practice, including links with PCNs and training hubs. 28/05/20 Clinical lead (BA) no longer available Assign a senior clinical lead from the Sussex Primary Care team 08/06/20 Actions Completed since previous report

• Initial scoping meeting took place
• Principles for reinstating agreed
• 3

high priority time sensitive LCSs agreed (COPD, Diabetes & Care Homes) agreed to be added to the top of the priority list

• Clinical lead to replace BA in place (17/06/20)
• Letter sent to primary care re payment arrangements Q2 and outlining next steps
• Diabetes task and finish group met on 3 July,

Highlights and Areas for Escalation

• The work stream will consider the possible reintroduction of core LCSs to include:
• Mobilisation of service reintroduction & financial arrangements. Implementation
• f agreed / published interim specifications (if applicable).
• LCS Restoration: Paper going to PCCC recommending extension of LCS

protection based on historic averages and not current activity, and also seeking funding for clinically vulnerable LCS.

• Benefits will include alignment of LCS across Sussex, fair access to locally

determined Primary Care services across Sussex, affordable and comparable service provision across Sussex and meeting the needs of patients delivering care close to home.

• Work is in progress to scope the work stream and the approach, plans &

milestones to support the mobilisation are currently progressing over the next couple of weeks.

• Agreement for the prioritisation of LCS reached, LMC approval granted

Milestone Date Own er Communication of strategic intent and approach to practices Letter drafted and agreed by LMC, basis to pay Q2 and outlining next steps 05/06/20 (26/06/20) SH Second letter to practices (to confirm approach and timescales of reintroduction) 03/07/20 SB PCCC agree payment on historical basis to end March 21, and practices to return activity data 22/07/20 SB Work stream delivery 30/11/20 SH Diabetes LCS Launch TBC SB COPD LCS Launch TBC SB Heart Failure LCS Launch TBC SB

Workstream Tasks on Track Workstream Delivery

R&R Workstream: General Practice Orientation: System SRO: Wendy Carberry Silver Lead: Sarah Henley PMO Support:

West Sussex CCG 

Brighton and Hove CCG  East Sussex CCG

Workstream Tasks on Track Workstream Delivery

Work stream: High Risk Patients

Highlights and Areas for Escalation

• The work stream will support practices to stratify and proactively contact their

high-risk patients with ongoing care needs, to ensure appropriate ongoing care and support plans are delivered through multidisciplinary teams.

• Scope of the work stream discussed – progressing the approach, plans &

milestones to support the mobilisation

• Agreement reached on ‘scope’ of work stream – including agreement for patient

groups not included

• Clinical Leads in place, membership of work stream to be reviewed as plan

progresses

• Definitions and scope have been agreed with clinical colleagues
• To remove the risk of the shielded patients launch being delayed LCS separated

into two – see risk belows

Actions Completed since previous report

• Initial scoping meeting took place and Clinical Leads subsequently joined

Agreement to produce an LCS to enable home visiting service for CEV patients (otherwise dependent on public transport)

• Meeting with LMC. Agreed separate LCS required for shielded patients and for

this to go to LMT

• Minor amendments made to LCS following feedback from LMC
• Mapping of current services to inform patient group stratification
• Proposed tiered model to support patients, endorsed by group
• Electronic Repeat Prescription Service – Information received – only 12/176

practices unable to use EPS Meds Optimisation have assured that mitigating actions continue to be addressed

• SCFT have provided numbers of patients receiving home care services who

therefore do not require the LCS

• Proposal to form a sub group focussing on support for patients with heart failure

R&R Workstream: General Practice Orientation: System SRO: Wendy Carberry Silver Lead: Sarah Henley PMO Support:

Milestone Date Owner Outline Plan 15/06/20 RR / CK LMC Meeting (Agreement from LMC). Achieved 16/07/20 delayed (prev 26/06) LMT Agreement w/c 16/07/2020 delayed KS/SH Launch LCS 06/07/20 delayed Launch ‘Age Tool’ (algorithm to calculate ‘covid age’ and associated risk factor of patients) in clinical systems 31/08/20 Risks Mitigation Date Added Date Reviewed Risk

There is a risk that the number of eligible high risk patients will exceed practices capacity to provide proactive care Exploring ways of prioritising using accredited tools and methodology.. Recognising the interdependencies across workstreams. Agreement to pursue pilot algorithm .There is a risk that CEV patients who are shielding at home and unable to access their practice due to not using public transport, are not being attended to due to a delay in implementation of the LCS to address this Practices are aware of their CEV patient list and not aware that an LCS to enable home visiting service is due to be implemented therefore practices should be managing this risk at a local level 08/07/20

West Sussex CCG 

Brighton and Hove CCG  East Sussex CCG

Work stream: General Practice Consolidation of hot sites

Risks Mitigation Date Added Date Reviewed Risk

Funding streams relating to C19 will cease at the end of July. It is not yet clear on how items such as consolidation of hot sites will be funded Ensure ongoing communication with finance colleagues. 02/07/20 Financial risk of extended use of C19 related estates (e.g. portakabins on provider estate) beyond July as c19 funding will have ceased. Seek LMT decision on extension of temporary service 02/07/20 Business continuity risk of primary care services provided in temporary estates (such as leisure centres) as the estate owners wish to reclaim for their business purposes. Consolidation of hot-sites plan 02/07/20 Actions Completed since previous report

• Comprehensive engagement undertaken across primary care.
• Federation proposal received by the CCG; currently undergoing

review Highlights and Areas for Escalation

• The work stream will establish the operating model design for

General Practice moving forward in the context of the ongoing pandemic response.

• An initial meeting will be held with thee 'heads of' and work stream

lead once identified.

• Engagement to take place with GP federations.
• Reconvening West Sussex Clinical Director forums will be

considered.

• Work is in progress to scope the work stream and the approach,

plans & milestones to support the mobilisation are currently progressing over the next couple of weeks.

• Support to hot sites is ongoing.. A Plan for the consolidation of Hot

Sites underway alongside the PCN Clinical Directors

• Comprehensive engagement undertaken across primary care.

Engagement feedback now being collated and reviewed to ensure

• perating model is meaningful to those who have engaged.

Findings from the engagement being costed. Milestone Date Owner Full costing of findings from gap analysis and engagement sessions 03 July 20 SS Agreement on how primary care manage patients with covid 17 July 20 SH Plan in place for consolidation of Hot Sites 31 Aug 20 SH A wider plan for general practice TBC

Workstream Tasks on Track Workstream Delivery

R&R Workstream: General Practice Orientation: System SRO: Wendy Carberry Silver Lead: Sarah Henley PMO Support:

West Sussex CCG 

Brighton and Hove CCG  East Sussex CCG

Community Joint Working

West Sussex CCG 

Brighton and Hove CCG  East Sussex CCG

Primary Care & Community Services Joint Working

Workstream w/c 20th Apr w/c 27th Apr w/c 4th May w/c 11th May w/c 18th May w/c 25th May June July August September Programme Mobilisation Care Homes Primary Care Networks Population Based Care & Mgmt Of LTCs Record Sharing (enabler) Membership Engagement

Initial workshop Session w/ SCFT (28th) Agree Programme Approach, Programme Team & Stakeholders Plan Key:

Delayed Off-Track / Risk of Delay On-Track Milestone (complete) Extended Complete

Initial scope of joint working finalised (8th) Today Initial Programme Team & Stakeholders Identified (30th) Propose Place / Locality Split (29th) Refine Scope, Principles & Areas Identified For Joint Working (scope)

Dependency

ESHT Engagement Agree Approach & Delivery Plan For Enhanced Care Home Specification (Oct) Enhanced Care Home Spec- Implementation Of Immediate Requirements Workstream Mobilisation Session (7th) Finalise scope, team & setup mobilisation session (as needed – agree link with Pop Health Dev Programme) Review Call w/ Digital Team (5th) Review Call w/ Population Health Development Programme (6th) Confirm workstream close / remove this programme of work (5th) PCN Plans In Place (31st) NHSE Target (18th) NHSE Initial Sit Rep Submission (13th) Analysis Of Requirements & Gap Assessment of Full Specification (Oct Requirements) Immediate Requirements 100% In Place (rollout complete) (29th) Enhanced Care Home Specification Delivered (1st Oct) Deliver Plan (based on agreed clinical model & gaps to address) Review Scope For Potential Additions Handover From Paul Wilson (20 & 21st) PCN DES Signup Deadline (29th) ARRS workforce plan due (tbc) MO & SMR (tbc) TBC – EHCH TBC – Follow on session to confirm scope of programme involvement PCN Forward Plan(5th) Agree Approach & Delivery Plan (5th) Workstream planning Membership team established 17 June E Sx – Webinar 30 June B&H – Webinar 7 July W Sx – Webinar 5 August ESx – Webinar 18 August WSx – Webinar TBC August B&H – Webinar

Primary Care & Community Services: Joint Working

Executive Lead Karen Breen SRO Wendy Carberry PMO Lead Dee Kelly Reporting Period Overall status QIAs Milestones Risk & Issues Resources w/e 17 July 2020 G G G A R Update Issues for escalation

• Work in progress: the scope of the programme work streams and the approach / plans / milestones to support the mobilisation of

each of them are currently progressing over the next couple of weeks.

• Cross-mapping
• f

Care Homes LCS's across Sussex complete. Gap analysis

• f current

LCS provision, against DES requirements complete. Early indications are that there is similar provision to the DES currently, with the exception of Advanced Care Plans.

• Logistical process for extracting data to inform on the number of carehomes in place (and gaps) being agreed today
• Information Governance / data-sharing agreement for extraction of ACP coverage numbers being presented to clinical leads
• n Tuesday
• Membership webinars held. Regular communications on programme released in the Primary Care Update and plan to

establish membership engagement page on Sussex CCG Intranet

• Ongoing work to clarify for PCNs the limitations and flexibility of the ARRS scheme and the constraints and scope of the

different roles.(especially pharmacy technicians)

• Sub group established to draft Business Case to consider Integrated MDT model / current LCS’s
• Clarified process for drawing down additional ARRS funding from NHSE
• No escalations

Key actions or milestones achieved since last report

• 1st webinars for East Sussex 17/6/20 and B&H 30/6/20 held – WSx webinar 7/7/20.
• Guidance on completing NWRS returns and workforce planning templates shared with PCNs via Primary Care bulletin.
• Cross-mapping of Care Homes LCS's across Sussex complete. Gap analysis of current LCS provision, against DES requirements complete

Top two risks Mitigation Risk that existing contractual obligations and available funding will delay agreement of the preferred EHCH option outlined in the business case and potentially result in missing the national deadline for implementation. Existing services supporting care homes already meet many of the DES requirements. There is a risk of staff capacity reduction in our GPs (practices) due to Track and Trace function, where numbers of NHS staff affected by Covid-19 were asked to self-isolate for 14 days by the track and trace contact team. This will have a potential impact on Cervical screening services should the recommences as planned in the coming weeks, thus affect the referrals rates (the impact could also be reduced via virtual consultations) Risk has been transferred to the primary care workstream and is being worked into plans Critical path milestones remaining Date Date 1 EHCH Business Case Agreement (Draft Model agreed in principle. Meeting this week to agree business case timelines and next steps) 31 July 20 4 National Deadline: EHCH Model is live across all care homes 1 Oct 20 2 National Deadline: EHCH Simple Model agreed (Plan on a page) including pharmacy support 31 July 20 5 National Deadline: PCNs have detailed arrangements with community mental health providers and community pharmacy 31 Mar 21 3 Initial round of new locality meetings taken place, and ongoing meetings established 30 Sep 20 6 National Deadline: Protocols established between the care homes and with system partners for information sharing, shared care planning, use of shared care records and clear clinical governance 31 Mar 21

West Sussex CCG 

Brighton and Hove CCG  East Sussex CCG

Work stream Care Homes

Risks Mitigation Date Added Date Reviewed Risk

Risk that existing contractual obligations and available funding will delay agreement

• f the preferred option outlined in the business case and potentially result in missing

the national deadline for implementation. Existing services supporting care homes already meet many of the DES

• requirements. Business Case being jointly drafted with SCFT for LMT

– detailing needs / options for each CCG 24/06/20 updated 08/07/2020 The requirements of the EHCH framework will create a change in the services being

• ffered to care homes – in some cases this will strengthen and in others reduce.

Review of LCSs is underway. Completed 08/07/2020. Business Case will consider options / implications. 24/06/20 Updated 08/07/2020 Delivery of the integrated EHCH model may be delayed due to the lead in time required for recruitment to roles Business Case will consider an incremental approach to the introduction of the Model , potentially phasing recruitment based on current gaps in service provision across Sussex. 09/07/202 Actions Completed since previous report

• EHCH IT group met 2/07/20 . Initial focus on solutions for shared access to anticipatory care
• plans. Paper being produced presenting IT solutions (following consultation with Care Homes.)
• Agreed communication paper for PCN’s – updating on current position would be drafted and
• circulated. Update via PCN Webinar date tbc
• Sub group established to draft

Business Case to consider Integrated MDT model / current LCS’s Highlights and Areas for Escalation

• EHCH DES programme plan with deliverables and milestones in place
• May NHSE care homes additional requirements fully met.
• Foundations being laid for MDT: Care homes informed of their named clinical lead (pan Sussex);

named District Nurses aligned to Care Homes in East Sussex (ESHT); Frailty Practitioners also aligned in East Sussex. Pharmacy support aligned to PCNs and work stream mobilised to remodel support to meet DES requirements, community matrons being repurposed in West Sussex to support care homes.

• Draft model will be presented at PCN Webinar – date TBC.
• Workforce modelling and realignment underway aiming to produce a Business Case to address

any workforce gaps.

• Review of existing LCSs against EHCH service spec and gap analysis completed. Current LCS

contractual timescales confirmed to further inform.

• Data extraction process identified / reviewed (to inform on the number of Advanced Care Plans

in place and gaps)

• IT search capability solutions being presented to clinical leads for comment / approval date-

tbc Milestone Date Owner All Care Homes aligned to PCNs and GP Lead 31/07/202 SS EHCH Simple Model agreed (Plan on a page) Achieved SS EHCH Model agreed by interface group (Detailed, Costed and Funding arrangements agreed); then LMT 17/07/20 SS Signup to EHCH LCS and resolution agreed for any gaps TBC SS Business Case Agreed Draft Business Case produced by 17/07/2020 31/07/20 SS EHCH Model is live across all care homes 01/10/20 SS/ME/ ESHT

Workstream Tasks on Track Workstream Delivery

R&R Workstream: Primary Care & Community Services System SRO: Wendy Carberry Silver Lead: Sally Smith PMO Support: Dee Kelly

West Sussex CCG 

Brighton and Hove CCG  East Sussex CCG

Work stream PCNs

Risks Mitigation Date Added Date Reviewed Risk

ARRS is not well understood by PCNs, which could lead to PCN staff being employed but not eligible for reimbursement, funds may not be fully utilised, and roles not applied appropriate to PCN needs. Simplify ARRS guidance and share with PCNs and PCN DMs – by 09/07 02/7/20 As a result of urgent redeployment of staff into covid-supporting roles, at a time so soon after restructure, induction process for some primary care management staff has been delayed resulting in a lack of role clarity. Induction and on-going training programme being introduced to support PCN Delivery Managers in their new roles starting 10/07/20 15/6/20 PCN development programme is short-staffed impacting on the capacity to develop workplan and initiate required sub stream projects Recruitment to 8d post is taking place – post could be filled by end July / early August 8/7/20 Actions Completed since previous report

• Met with B&H MDT Development leads - identified dependency with EHCH - both

workstreams need protocol for sharing anticipatory care record with community and wider partners.

• Slide-set produced to clarify ARRS limits and flexibility.
• Slide-set for Primary Care Lunch and Learn
• updating information on PCNs

status and DES requirements.

• Meeting with Training Hubs to confirm support in place for PCNs to develop Plans

for 20/21 and up to 23/24.

• Clarified process for drawing down additional ARRS funding from NHSE

Highlights and Areas for Escalation

• The work stream will ensure there is governance and oversight of the PCN

development programme covering: the PCN configuration and governance arrangements; integration and partnerships, implementation of the Network DES; PCN development and planning; system working and alignment to the ICS priorities; primary care estates; digital and client records across providers and ensuring there is an adequate and appropriate PCN workforce. All practices are now signed up to DES

• Meetings taking place with co-dependent work stream leads to go through plans

and ensure a common understanding.

• Working with PCN Delivery Managers to understand what support they require

and set up processes to gather assurance re PCN milestones.

• N.B. Early Cancer DES is covered on separate slide

Milestone Date Owner Workforce planning template 20/21 returned by each PCN 31/8/20 SH PCN detailed the arrangements with its local community services providers 30/9/20 SH ARRS Unclaimed funding and process to bid for this to be confirmed 30/9/20 SH Supporting Early Cancer diagnosis requirements implemented 1/10/20 SH Workforce indicative planning template for 21/22 -23/24 submitted by each PCN 31/10/20 SH PCNs have detailed arrangements with community mental health providers and community pharmacy 31/03/21 SH

Workstream Tasks on Track Workstream Delivery

R&R Workstream: Primary Care & Community Services System SRO: Wendy Carberry Silver Lead: Sarah Henley PMO Support: Dee Kelly

West Sussex CCG 

Brighton and Hove CCG  East Sussex CCG

Work stream Membership Engagement

Risks Mitigation Date Added Risk Limited membership engagement in membership webinars to inform plans for future locality meetings Pro-active communication and engagement by CCG and locality representatives – primary care update, intranet, targeted emails

14/06/20

Required management and admin support for locality meetings may exceed what is available in directorate Hold locality discussions with representatives to understand requirements for their CCG and agree mutually acceptable plans

16/06/20 Actions Completed since previous report

• 1st webinars for ESx 17/06/20, B&H 30/06/20 and WSx 07/07/20

held

• Recruitment of 2 x membership managers underway
• Dates for 2nd webinars set for ESx and WSx

Highlights and Areas for Escalation

• Temporary senior manager for membership engagement in post
• Membership team established
• CCG membership email accounts arranged for communication
• 1st webinars for ESx 17/6/20, B&H 30/6/20 and WSx 7/7/20
• 2nd webinars set for ESx 5/8/20, WSx 18/8 and B&H

TBC Reintroduction of locality meetings – discussions taking place with Locality Representatives to inform 2nd round of webinars and plans for future locality meetings

• Regular communications on programme released in the Primary

Care Update and plan to establish membership engagement page

• n Sussex CCG Intranet

Milestone Date Owner Initial membership webinars to have taken place for West Sussex, Brighton & Hove and East Sussex 07/07/20 KH Locality meeting next steps meetings completed with Locality Representatives for each area 31/07/20 SHu 2nd round of membership webinars 30/08/20 KH Plans for initial round of new locality meetings agreed 30/08/20 KH Initial round of new locality meetings taken place 30/09/20 KH Review of the new format for locality meetings 01/01/21 TBD

Workstream Tasks on Track Workstream Delivery

R&R Workstream: Primary Care & Community Services System SRO: Wendy Carberry Silver Lead: Hugo Luck PMO Support: TBC

West Sussex CCG 

Brighton and Hove CCG  East Sussex CCG

Work stream Flu

Risks Mitigation Date Added Risk

Actions Completed since previous report

Highlights and Areas for Escalation New Workstream report from next week w/c – 13/07/20 Report in process of being compiled 09/07 Milestone Date Owner

Workstream Tasks on Track Workstream Delivery

R&R Workstream: Primary Care & Community Services System SRO: Wendy Carberry Silver Lead: Hugo Luck PMO Support: TBC

West Sussex CCG 

Brighton and Hove CCG  East Sussex CCG

Work stream Flu

Actions Completed since previous report

• First Primary Care Flu Task & Finish Group

held 08/07/2020

• First Flu Programme Board held 1st July 2020
• Development of Influenza Plan with PMO

support to enable monitoring, reporting and evaluation across ICS Highlights and Areas for Escalation New Workstream to be reporting from next week w/c – 13/07 MUST DO Milestone Date Owner Develop National Influenza Vaccination Programme – Patient groups tba Hugo Luck/Mandy Catchpole Develop National Influenza Vaccination Programme – Staff groups tba Hugo Luck/Mandy Catchpole Manage Vaccination supplies tba Hugo Luck/Mandy Catchpole Manage PPE developments tba Hugo Luck/Mandy Catchpole Roll out System- wide Flu testing tba Hugo Luck/Mandy Catchpole Measure system resilience tba Hugo Luck/Mandy Catchpole Outbreak Management and reporting tba Hugo Luck/Mandy Catchpole Coordinate Health Promotion / Prevention tba Hugo Luck/Mandy Catchpole Develop Influenza communication strategy tba Hugo Luck/Mandy Catchpole Influenza local and regional reporting tba Hugo Luck/Mandy Catchpole Facilitate In and Out of hours outbreak services management tba Hugo Luck/Mandy Catchpole Promote Prevention of all Winter Viral Infections tba Hugo Luck/Mandy Catchpole

Workstream Tasks on Track Workstream Delivery

R&R Workstream: Primary Care & Community Services System SRO: Wendy Carberry Silver Lead: Hugo Luck PMO Support: TBC

West Sussex CCG 

Brighton and Hove CCG  East Sussex CCG

Work stream Flu

Risks Mitigation Date Added Risk If the mode of delivery of the National Vaccination programme, to comply with social distancing guidance remains unchanged, there is a risk of low compliance of uptake of vaccination rates again National

• bjectives.
• 1. Development of a mixed model for vaccination delivery with PCNs, Community Providers

and Pharmacies. (sept)

• 2. Contractual arrangements to be developed with NHS Community Providers for

housebound patient groups. (Sept)

• 3. Establish vaccination model for homeless populations. (Nov)
• 4. Review of NHS Provider vaccination programme for long stay patients and pregnant
• women. (Nov)
• 5. Additional National funding to support PCNs in the delivery model.

09/07/2020

16 If there is an extension of the national vaccination programme, there is a risk that there will be insufficient supply of vaccine and resource to deliver.

• 1. PHE to provide additional information on possible extensions to national vaccination
• programme. (July)
• 2. Review vaccination stocks across the system and ability to order more.

09/07/2020

12 If there is low uptake rates of the national Vaccination programme for health and social care providers, there is a risk of high workforce sickness rates that may impact on operational (management)

• 1. Early implementation of vaccination clinics for healthcare providers. (Sept)
• 2. Assurance that peer Vaccination approach to be adopted across all Providers (Aug)
• 3. Sharing or best practice across Sussex providers (Aug)
• 4. Early implementation of vaccination clinics for social care providers (Sept)
• 5. Communication campaign with all providers to promote uptake (Sept)
• 6. National CQUIN target of 90% for NHS Acute Mental Health and Community Providers

(Oct)

09/07/2020

12 If there an increased demand for Vaccination, there is a risk of insufficient supply of vaccine and resource to deliver.

• 1. Complete NHSE sitrep submission for Sussex Practices to review vaccination supply
• rdered. (completed June)
• 2. Review vaccination stocks across the system and ability to order and store more. (Aug)
• 3. Review of additional skilled staff resource to deliver programme.(Aug)

09/07/2020

12 If there are delays in provision of vaccination stocks by manufacturers there is a risk to programme delivery

• 1. Communication via Flu Programme Board (Monthly) to highlight any potential risks to

provision.

• 2. Contingency plan to be developed. (Aug)

12 Availability of additional PPE to support delivery of programme Actions/mitigations to be agreed tba

Workstream Tasks on Track Workstream Delivery

R&R Workstream: Primary Care & Community Services System SRO: Wendy Carberry Silver Lead: Hugo Luck PMO Support: TBC

West Sussex CCG 

Brighton and Hove CCG  East Sussex CCG

Work stream Early Cancer DES

Risks Mitigation Date Added Date Reviewed Risk

PCNs do not have the clinical capacity to implement new protocols. Work digital on decision support and patient communication tools, and support admin staff to more effectively manage process e.g. safety-netting 8/7/20 There are no metrics associated with this DES, so will be difficult to assess progress Encourage participation in National Cancer Diagnosis Audit - deadline 31/8/20 Possible task for communities of practice to develop local metrics / ways to share progress 8/7/20 Actions Completed since previous report

Scoping meeting 23/6 with Primary Care Clinical Implementation group agreed following actions:

• Investigate whether PCN Delivery Manager have capacity to work with PCNs to establish

their readiness to start work required, (Support is available from Cancer UK Facilitators)

• Focus on “ECD priority” PCNs where low levels of screening / early referral
• Consider how to engage with PCN Clinical Directors
• Hold workshop with Primary Cancer Leads to identify what digital tools need to be

developed to support improved referral processes and screening uptake. Highlights and Areas for Escalation LTP sets ambitions for improving cancer outcomes:

• by 2028, the proportion of cancers diagnosed at stages 1 and 2 will

rise to 75 per cent.

• From 2028, 55,000 more people each year will survive their cancer

for at least five years after diagnosis. The Network DES ECD service requirements for PCNs are to;

• review referral practice
• improve screening uptake
• establish local communities of practice

PCNs to begin work on the Early Cancer Diagnosis specification from 1 April unless work to support the COVID-19 response intervenes. Dependency with Technology Enabled Care re development of digital tools for ECD decision support and patient communications Milestone Date Owner Digital workshop to understand what tools need to be developed 15/8/20 BG Engagement with PCN CDs 30/7/20 BG Baseline Assessment with PCNs 30/9/20 BG Early Cancer DES implemented 01/10/20 SH

Workstream Tasks on Track Workstream Delivery

R&R Workstream: Primary Care & Community Services System SRO: Wendy Carberry Silver Lead: Sarah Henley PMO Support: TBC

West Sussex CCG 

Brighton and Hove CCG  East Sussex CCG

Medicines Optimisation

West Sussex CCG 

Brighton and Hove CCG  East Sussex CCG

Medicines Optimisation Timeline

Workstream w/c 4th May w/c 11th May w/c 18th May w/c 25th May June July August September October November Programme Mobilisation Pharmacy & Medicines Optimisation

Initial review Session w/ clinicians (5th) Plan Key:

Delayed Off-Track / Risk of Delay On-Track Milestone (complete) Extended Complete

Today Refine Scope, Principles & Workstreams (scope)

Dependency

Initial Scope & Workstreams Finalised (29th) NHSE&I 1st May Request Actions Complete (12th) Provide urgent assistance to Care Homes as part of May 1st request from NHSE&I Develop PCN ‘offer’ for MO elements of the PCN DES for Structured Medication reviews and Enhanced Health to Care Homes PCN DES start (1st) Agree Long Term MO Strategy by March 21 Assess impact of new ways of working on QIPP delivery and Prescribing Incentive Schemes reviewed for (Oct 20 to Mar 21) Sussex MO Governance approved

West Sussex CCG 

Brighton and Hove CCG  East Sussex CCG Primary Care & Community Services: Medicines Optimisation

Executive Lead Karen Breen SRO Wendy Carberry PMO Lead Dee Kelly Reporting Period Overall status QIAs Milestones Risk & Issues Resources w/e 17 July 2020 G G G A R Update Issues for escalation

• Awaiting confirmation that we can recruit to key vacancies; particularly AD for ESx and large gaps in MM team members in CWS
• MM teams in constituent areas deliver or commission differing scope of Medicines Optimisation function with varying resources so

mapping exercise undertaken to identify all historic workstreams and staff/stakeholder engagement on restoration plans has begun

• Engagement with primary care clinical teams on medicines optimisation priority advice and information has been initiated – virtual

meetings chaired by clinical leads due in July

• SHCP Medicines Optimisation Board relaunched to oversee cross-system MO policy, collaboration and co-operation
• Engagement with system partners on local decision making / area prescribing committee governance and structures initiated
• Sussex CCGs response to Pharmacy & Medicines Support to Care Homes national call to action is on track and reporting via PMO
• None

Key actions or milestones achieved since last report

• Engagement with the Sussex MO Team has been initiated and is on-going. Sussex-wide MM team meeting held in June to outline key elements of the phased restoration and recovery of the

Medicines Optimisation work streams

• Sussex CCGs MO Bronze Team established to oversee and steer progress.
• Paper on interim structure for APCs discussed at SHCP MO Board, whilst national guidance on ICS Integrated Pharmacy and Medicines Optimisation awaited
• Draft best practice clinical model developed for MOCH support to PCN delivery of Enhanced Health in Care Home DES

Top two risks Mitigation ‘New normal’ ways of working in general practice impedes the restoration of many practice based MO activities Assessing impact through team huddles and 1:1s for Bronze team to consider with clinical leads Workforce shortages will make it difficult to recruit to MM team vacancies and PCN roles Working with partners to develop system-wide Workforce strategy including cross-sector roles and training opportunities Critical path milestones remaining Date Date 1 Phase 1: Command and Control

• Electronic Prescriptions Service/eRD
• EoLC medicines supply
• COVID MO prescribing guidance –FAQs/Websites
• Community pharmacy support – Deliveries/Hot sites
• POD business continuity

Start: 30th Apr 2020 3 Phase 3: Delivery and planning for long term MO Strategy

• Support implementation of PCN DES for EHCH and SMR
• Implementation of appropriate elements of the QIPP programme/incentive

schemes

• Engagement and development of MO Strategy 2021-24

Start: 1st Oct 2020 2 Phase 2: Planning for recovery

• Pharmacy and Medicines support to Care homes
• Engagement with PCNs on MO ‘offer’ for EHCH and SMR
• Recruitment to key vacant posts
• Sussex-wide MO Governance/Area Prescribing Committees
• Identifying and responding to local needs
• Assessing impact of new ways or working and impact on QIPP

restoration Start: 1st June 2020 4 Phase 4: Implementation of MO Strategy 2021-24 Start: 1st Apr 2021

West Sussex CCG 

Brighton and Hove CCG  East Sussex CCG

Work stream: Medicines Optimisation Restoration Programme 10/07/2020

Risks Mitigation Date Added Date Reviewed Risk

‘New normal’ ways of working in general practice impedes the restoration of many practice based MO activities Assessing impact through team huddles and 1:1s for Bronze team to consider with clinical leads 10/07/20 Workforce shortages will make it difficult to recruit to MM team vacancies and PCN roles Working with partners to develop system-wide Workforce strategy including cross-sector roles and training

• pportunities

10/07/20 Financial budgeting and expenditure position for 2020/21 unknown, creating challenges in developing effective recovery plan Meeting sought with Finance Lead to progress budgets and account management. 10/07/20 Actions Completed since previous report

• Phase 1 has been completed successfully through Command and Control.
• Engagement with the Sussex MO Team has been initiated and is on-

going.

• Bronze Team is set up to oversee and steer progress.
• Current structures are being utilised to communicate and engage.

Highlights and Areas for Escalation

• The work stream will be focussed on restoration and recovery of the Medicines

Optimisation work streams following the response to COVID19

• This is a phased approach which provides clarity to internal and external

stakeholders and key partners such as providers and primary care. Survey developed to engage Meds Mgt team members in priorities for restoration and recovery.

• Expected benefits include responding to local demands, needs of the business

and alignment of MO Services across Sussex CCGs.

• A key element will be engaging the Primary Care Networks on the implementation
• f the Medicine Optimisation elements of the DES from 1st October 2020.
• The suspended QIPP programmes and prescribing incentives will be reviewed to

agree appropriate levels of restoration Oct – Mar 21.

• Sussex ICS Medicines Optimisation Board has relaunched on 25.6.20
• Aiming to have an aligned Integrated Medicines Optimisation Strategy from 1st

April 2021.

Milestone Date Owner

Phase 1: Command and Control

• Electronic Prescriptions Service/eRD
• EoLC medicines supply
• COVID MO prescribing guidance –FAQs/Websites
• Community pharmacy support – Deliveries/Hot sites
• POD business continuity

30/04/20 achieved EC/SC/JV

Phase 2: Planning for recovery

• PMSCH (see separate slide)
• Engagement with PCNs on MO ‘offer’ for EHCH and SMR
• Recruitment to key vacant posts
• Sussex-wide MO Governance/Area Prescribing

Committees

• Identifying and responding to local needs
• Assessing impact of new ways or working and impact on

QIPP restoration 30/10/20 EC/SC/JV

Phase 3: Delivery and planning for long term MO Strategy

• Support implementation of PCN DES for EHCH and SMR
• Implementation of appropriate elements of the QIPP

programme/incentive schemes

• Engagement and development of MO Strategy 2021-24

31/03/21 EC/SC/JV

Phase 4: Implementation of MO Strategy 2021-24

01/04/21 EC/SC/JV

Workstream Tasks on Track Workstream Delivery

R&R Workstream: Primary Care Orientation: System SRO: Wendy Carberry Silver Lead: Eileen Callaghan PMO Support: Harry Whitburn

West Sussex CCG 

Brighton and Hove CCG  East Sussex CCG

Work stream: Pharmacy & Medicines

Support to Care Homes (PMSCH) 10.7.20

Risks Mitigation Date Added Date Reviewed Risk

There is a risk that there will not be the available workforce resource or structures to deliver a consistent high quality meds opt service to all care homes across Sussex. Pan-Sussex joint working, review of service model, common ‘offer’, development of business case for additional resources. 10/07/20 There is a risk that the proposed clinical model does not meet the expectations of the PCN Clinical Directors. Work to engage Primary & Community Care leads in the development of the clinical model. Explore new ways of working to facilitate integrated working 10/07/20

Actions Completed since previous report

• Draft clinical model developed.
• Stakeholder communication plan developed.
• System wide MOCH operational reference group formed.
• Training/signposting to national support and resources for CCG staff who have

been refocussed to support the Covid-19 PMSCH call to action

• Workstream team established including clinical lead GP.

Highlights and Areas for Escalation

• Work in progress: the scope of the programme work streams and the approach /

plans / milestones to support the mobilisation of each of them are progressing and

• n track
• 100% coverage of named Care Home pharmacist point of contact per practice

across Sussex with work ongoing to further develop and provide greater consistency of provision

• A system-wide clinical model for the Sussex system is being identified and agreed
• Mapping of current service provision has been undertaken to support the

development of the clinical model

• First draft of clinical model being finalised for consultation in June/July
• A stakeholder communications and engagement plan has been drafted.
• Existing MOCH service provision will be assessed against the agreed clinical

model, gaps identified, investment case will be developed

• Training delivered
• To understand if people with a learning disability are in or out of the scope of

this work stream

Milestone Date Owner

Develop clinical model for gold standard medicines optimisation and pharmacy support service to care homes across Sussex. 31/07/20 EC/SC First draft clinical model developed for consultation 22/06/20 ACHIEVED EC/SC Clinical model to be agreed by Regional Chief Pharmacist 17/07/20 EC/SC Mobilisation of agreed clinical service model aligned with Enhanced Health in Care Homes and PCN DES 31/10/20 EC/SC

Workstream Tasks on Track Workstream Delivery

R&R Workstream: Primary Care Orientation: System SRO: Wendy Carberry Silver Lead: Eileen Callaghan / Sue Carter PMO Support: tbc

West Sussex CCG 

Brighton and Hove CCG  East Sussex CCG

Risks & Issues

Snapshot as at 11th June 2020 ID

Type (Risk / Issue) Programme / Workstream Alignment with CCGs Risk reg Title Cause & Impact Description Mitigating Actions Owner Target Resolution Date RAG Rating C1 Risk

• C. Medicines

Optimisation

N/A

Variance and gaps in dedicated MOCH resources and ways of working across Sussex There is a risk that there will not be the available workforce resource or structures to deliver a consistent high quality MO service to all care homes across Sussex. Pan-Sussex joint working, review of service model, common ‘offer’, development of business case for resources. Sussex ICS Medicines Optimisation Board leadership to pool and co-ordinate pharmacy MOCH resources Prioritise services that will provide the most benefit to the care homes/patients EC/SC End May Closed – 100% coverage C2 Risk

• C. Medicines

Optimisation

n/a

MOCH integration with MDTThere is a risk that the MOCH service will not be able to work in an MDT approach which would provide the best patient outcomes Work to engage PCN CDs in the development of the common ‘offer’ Explore new ways of working to facilitate integration of MOCH teams e.g. VPN access to GP IT systems, hospital discharge information, etc. EC/SC End May Closed – 100% coverage B1 Risk

• B. General Practice

SX005 2-BH

• Ver. 6

General Practice Engagement There is a risk that practices will not wish to implement the measures proposed in the way or at the pace envisaged by the CCG. They may not wish to work as closely with community .Without the co-operation and engagement of General practice the plan will be difficult to implement The Primary Care Network DES encourages patients to work more closely through PCN's. This means that practices feel less isolated and are more willing to make changes if neighboring practices are seen to be doing so. The CCG has nurtured a good working relationship with the LMC who can help address any practice concerns. Most practices belong to a federation which are also able to support practices through change. the CCG and the LMC will continue to hold weekly webinars for questions and answers SH October 2020 Amber B2 Risk

• B. General Practice

Pace of Change There is a risk that General practice will not be able to implement new ways of working within the required time frame. The independent nature of the 178 practices means that there will be many questions and issues which will need to be addressed before the changes can be made. All practices now belong to Primary Care Networks (PCNs) which allow a forum within which individual practices can express concerns, but which also provides a place for plans for implementation of new ways of working can be agreed. The PC Federations are also able to assist in implementing changes at a faster pace than has previously been possible. within each workstream we will adopt a plan. do, review approach to ensure the project is realistic in terms of achieving SH October 2020 Red B3 Risk

• B. General Practice

BH0011

• Ver. 12

Workforce There is a risk that there will not be enough workforce resource to provide and implement the envisaged revised and enhanced services in General Practice There is a national shortage of workforce across Primary Care. The CCG has several initiatives in place to encourage more uptake of positions within General Practice. The CCG has PCN leads in place for each PCN area who can support practices. The CCG will continue to work with the training hubs to address recruitment, retention and skill mixing opportunities. SH End Sept 20 Amber AB1 Issue

• A. PC & CS Joint

Working & B. General Practice ESHT Engagement The programme has had limited engagement with ESHT and they are not currently represented in the working groups.

• Urgent engagement being progressed.

SS 05-Jun Red B4 Issue

• B. General Practice

Uncertainty of the 'New Demand' Practices will be unclear as to the impact the new ways of working will have on their practice in terms both of how they will need to work within the practice in terms of staffing level and logistics, and there will also be uncertainty in terms of patient demand and uptake of the services. This will remain an issue and it is for the CCG to work closely with the PCNs, federations and LMC to understand any issues or demands as they arrive and to adapt and flex to help alleviate these. A new activity tracker has been implemented to measure demand on Hot Sites and Zoning and a weekly SITREP developed for care home support. The CCG also has a role in ensuring patients are aware of new ways in which they can access primary care. SH Ongoing Amber

West Sussex CCG 

Brighton and Hove CCG  East Sussex CCG

Support slides

West Sussex CCG 

Brighton and Hove CCG  East Sussex CCG

33

West Sussex CCG 

Brighton and Hove CCG  East Sussex CCG

Primary Care Services: Changes Due To CV-19 (1 of 4)

Service Area Services Changed As A Result Of C-19 Details Of Key Change(s) Implementation Progress General Practice GP Services (including access & service provision at GP sites)

• Delivery of essential services only.
• Screening of patients for viral symptoms, with diversion of symptomatic patients to the appropriate next step in the clinical

pathway (e.g. NHS 111 / hot site / secondary care).

• Zoning of practices into low / high likelihood COVID areas to allow patient cohorting.
• Preparation of isolation room(s).
• Suspension of online appointment booking for F2F appointments (telephone / video triage appointments only to prevent

symptomatic patients attending practice).

• Implementation of infection control & prevention measures.
• Template for each practice to develop and

implement a COVID-19 plan issued 17th March.

• Deadline – Fri 10th April.

General Practice GP Appointments

• Routine appointments held via telephone or video consultation (as well as essential appointments where possible).
• Electronic prescribing where possible (including repeats), where not, paper prescriptions collected by pharmacy.
• Med3 notes to be posted or scanned and emailed to patient (rather than collected at practice).
• Part of practice COVID-19 plan.

General Practice Nursing Appointments

• Coordination of 6-8 week baby checks with first immunisation appointment.
• Use of telephone triage wherever possible.
• Restriction on siblings attending appointments.
• Part of practice COVID-19 plan.

General Practice Home Visiting

• Home visits continue to be provided, in & out of hours for COVID-19 symptomatic patients.
• For these visits, guidance is issued on the use of PPE, as well as screening of members of the household on arrival.
• Expected to be increased activity due to introduction of shielded patients concept which may require home visits.
• Red and green teams are to be established to cohort patients by attending clinicians.
• Triage will be used to ensure the right clinician attends, and to ensure that a face-face visit is essential.
• Part of practice COVID-19 plan.
• Red & green team working yet to be

established. General Practice Support To Care / Nursing Homes (in hours)

• Visits to only proceed where deemed essential to exclude life- threatening illness.
• Full PPE to be worn on visits.
• Use of telephone or video consultation where an option.
• TBC – support to temporary care homes.
• Part of practice COVID-19 plan.

West Sussex CCG 

Brighton and Hove CCG  East Sussex CCG

Primary Care Services: Changes Due To CV-19 (2 of 4)

Service Area Services Changed As A Result Of C-19 Details Of Key Change(s) Implementation Progress General Practice Opening Hours

• Opening to cover Easter Bank Holidays (Fri / Mon) – providing normal practice hours (nationally mandated).
• Request to practices to staff at the anticipated level of demand.
• In progress & on track.

General Practice Staff Management

• Appropriate work scheduling based around risk to staff (older colleagues, pregnant colleagues, etc…) e.g. these colleagues

focus on virtual consultations.

• Monitoring of staff levels by management to enable mitigations where needed (e.g. staff moving between practices).
• Staff with viral symptoms to follow national guidance (self isolation, use NHS 111, etc…)
• Coordination & knowledge share across PCNs / wider CCG networks.
• Part of practice COVID-19 plan.
• SurveyMonkey tool setup to monitor staff levels by
• practice. Latest figures circulated to all practices at

1100 daily. General Practice Patient Management

• Increased communications to patients to cover relevant advice and how to access healthcare if needed.
• Patient Participation Group meetings to be held virtually or cancelled.
• Complaints addressed by standard response delaying formal response to post the COVID-19 outbreak.
• Part of practice COVID-19 plan.

General Practice Financial & Practice Management

• No claims or contract monitoring – locally enhanced services and incentive schemes to be paid based on historic averages.
• The financial stability of all practices will be maintained with no reduction in income streams which are a consequence of

shifting activity from enhanced and target driven work to that essential to manage the present and ongoing situation.

• Locality and membership meetings suspended until end of May.
• One-off resilience payment - £0.30 per head of population to practices.
• Key changes as documented have been

implemented.

• Sussex contract for Locum staff being investigated.

Guidance re locums receiving NHS benefits required from NHSE.

West Sussex CCG 

Brighton and Hove CCG  East Sussex CCG

Primary Care Services: Changes Due To CV-19 (3 of 4)

Service Area Services Changed As A Result Of C-19 Details Of Key Change(s) Implementation Progress General Practice Advanced Care Planning

• Advanced care plan templates and guidance issued – should be completed on a case by case basis by GPs in consultation

with patients and carers.

• Patients at increased risk of severe illness from COVID-19 should be encouraged to consider updating or putting in place an

advanced care plan.

• As a result, anticipation is for an increased volume of work in this area.
• Part of practice COVID-19 plan.

General Practice Palliative Care

• Care should be provided remotely where possible.
• Where necessary, the number of healthcare professionals visiting a patient’s home should be minimized.
• GP teams should liaise with community services and specialist palliative care teams to coordinate multi-disciplinary team

input.

• Additional changes TBC - awaiting national guidance.

TBC - awaiting national guidance. General Practice Death Certification

• Changes to the certification of death prior to a cremation is to be confirmed by the MoJ and GPC.
• Currently the Ministry of Justice requires doctors to view a body in person after death & before a cremation.

TBC - awaiting national guidance. General Practice Contraceptive Services

• Consider extending pill prescriptions for low risk patients without review.
• Consider whether IUCD / contraceptive implants can be deferred and replaced with oral contraception.
• Part of practice COVID-19 plan.

Dentistry Essential Dental

• Initial triage via telephone by patients’ practices will determine whether a patient needs essential dental care. Face – face

appointments will be scheduled as appropriate.

• NHSE have identified 35 sites in the South East to provide essential dental care.
• 20 of these are community dental providers which will be specifically for shielded and vulnerable people.
• 15 of these are high street practices which will implement zoning for ‘hot’ and ‘cold’ patients if essential to be seen.
• The essential dental care site locations won’t be shared but uploaded on the DOS for 111 to direct patients as needed. In

addition patients will be directed as needed if a face-face appointment is scheduled following triage by their dentistry practice.

• The Hampshire site will be up and running by

10th April with Sussex following in the next two weeks.

West Sussex CCG 

Brighton and Hove CCG  East Sussex CCG

Primary Care Services: Changes Due To CV-19 (4 of 4)

Service Area Services Changed As A Result Of C-19 Details Of Key Change(s) Implementation Progress Medicines Management & Optimisation General Practices

• Ceasing delivery on MO QIPP projects as teams refocussed on COVID

19 response.

• Supporting practices and other providers on implementation of electronic

prescribing (EPS) and electronic repeat dispensing eRD).

• Support to care homes on access to medicines through NHS mail/proxy
• rdering etc.
• MO support to care pathways e.g. hot sites, EoLC pathways, diabetes

pathways.

• Advice on high risk drug monitoring during COVID-19.
• All staff redeployed to either electronic prescribing, supporting care homes, or communications.

Some staff e.g. MO dietitians have been redeployed to support the providers.

• All relevant staff trained on eRD and the team are directly supporting 56 practices with
• implementation. National dashboard expected soon to measure progress.
• CCG MM staff redeployed to support surge in call demand.
• EOLC symptom control pathway in place and LCS for medicines access from community

pharmacy being finalised.

• Interim arrangements agreed with diabetes specialist service for Ketone testing strips.

Medicines Management & Optimisation Community Pharmacy

• Expansion of EoLC LCS; one pharmacy per PCN to supply COVID 19

EOLC medicines.

• LCS to allow for emergency supply to ‘hot’ sites, and other non –EPS

sites e.g. virtual outpatient emergency prescribing.

• TBC – support to temporary care homes.
• List of pharmacies agreed and published on the website. Not all have formal SLAs yet but have

agreed to maintain stocks

• Service spec drafted for hot sites. In discussion with LPC, SPfT and Queen Vic re community

dispensing service for virtual outpatients.

• Awaiting national specification. In the meantime draft guidance agreed with LPC.
• Liaising with LPC and voluntary groups on implementation of delivery services for community

pharmacy.

• Note, pharmacies do not have a supply of PPE.

Medicines Management & Optimisation System-wide Work

• Hosting of senior MO leads across the ICS.
• Sussex CCCG Director for MM representing system on NHSE/I regional

call. Ongoing forum for:

• Issues escalated to NHSE/I as appropriate.
• Mutual aid in terms of sharing MO policies and staff redeployment.
• Interface issues addressed.

West Sussex CCG 

Brighton and Hove CCG  East Sussex CCG

Primary Care Services: New Services Due To CV-19 (1 of 3)

Service Area New Services As A Result Of C-19 Details of Service(s) Implementation Progress General Practice GP Practice – Hot Sites

• Patients showing clinical symptoms of COVID-19 or in self-isolation due to possible exposure access

essential GP services via a ‘hot’ site.

• These maybe patients who require a face-face appointment because of their COVID-19 symptoms or

because of other health reasons (but are not able to attend the usual GP practice due to COVID-19 symptoms).

• A funding agreement has been put in place - £1 per head of population – to cover hot sites.
• Note – any required locum contracts should be funded out of this money in the first instance.

All data as of 1000 on 8th April

• Total number of hot sites = 38
• East – 14
• West – 22
• B&H – 2
• Implementation status of hot sites:
• Green (open or ready to open by 10th Apr) – 21
• Amber (mobilisation in progress, won’t be ready by 10th) – 15
• Red (hot site location not yet agreed) - 2

Full details on the current status of hot sites provided in the appendix for reference (separate document). Key challenges (for further detail see ‘key risks & issues’ section):

• Provision of PPE - issue #1
• Provision of other clinical equipment (O2 / defrib) – issue #2
• IT Provisioning – issue #3

General Practice GP Practice - Cold Sites

• Currently ‘cold’ patients are being seen in practice if essential.
• Some PCNs are looking to setup specific ‘cold sites’ for patients to access essential GP services

where they do not show any clinical symptoms of COVID-19 and are not self- isolating due to possible exposure.

• Expected that one in a group of GP practices will be designated as a cold site for this purpose (for

example one practice per PCN).

• Additional requirement that will be setup in the next two weeks as needed

per PCN. General Practice Rapid Discharge

• This is a proposed locally commissioned service (LCS) under consideration.
• Details to be provided once available (Ruth Allan leading).
• Not started (proposal stage).

General Practice Hospital Discharge For Patients With Symptoms of COVID- 19

• Community health services will take overall responsibility for ensuring the effective delivery of the

discharge service working with other delivery partners where appropriate including GPs.

• For example, GPs may receive a request to follow up with patients in some circumstances.
• This has commenced – refinement of the process is on-going.

West Sussex CCG 

Brighton and Hove CCG  East Sussex CCG

Primary Care Services: New Services Due To CV-19 (2 of 3)

Service Area New Services As A Result Of C-19 Details of Service(s) Implementation Progress General Practice Support To Care / Nursing Homes (out of hours)

• New locally commissioned service to help care homes deal with COVID-19 patients.
• This has been offered to practices – sign-up is in progress, with 10

practices signed up to date (as of Wed 8th April).

• As the majority of care homes are not aligned to practices, this may be

acting as a blocker to sign-up. Issue being investigated with proposal to resolve under development. NHS 111 C-19 Patient Pathway

• Addition of a new clinical pathway to direct patients into one of three cohorts: self-isolation, urgent

hospital admission or referral to Covid Clinical Assessment Service (for further assessment and onward triage into self-isolation, urgent hospital admission or General Practice via the ‘speak to’ disposition).

• National implementation of 111 pathway – complete.
• NHS 111 Directory of Service updated to recognise BH Fri / Mon over

Easter.

• National implementation of CCAS – underway.
• Including national rollout of the ability of CCAS to book directly to

practices via GP Connect.

• Note- EMIS & System One functionality is available.

NHS 111 ‘Speak to’

• Service to link in with the national CCAS to allow referral of patients to GPs.
• In hours, patients will be referred to GP services direct.
• Out of hours, patients will be referred to the IC24 ‘speak to’ service for triage. Any patients requiring a

face-face appointment will be referred to the appropriate GP out of hours service as call-back referrals.

• Sussex IC24 ‘speak to’ service implemented.

Primary Care Procurement Support

• Provision of PPE
• The team have moved to an online tool using SurveyMonkey.
• This is being used for real time stock monitoring, with snapshots taken at 11:00 daily.
• Practices only need to update on a daily basis if they have more or less stock.
• This data is used to prioritize allocation of new PPE stock, in conjunction with the mutual aid process

(to share existing / new PPE stock system wide).

• Note PPE support is to be expanded to support emergency dental sites.
• Provision of IT
• Work on IT provisioning for hot sites, remote visits and remote consultations.
• Provision limited to availability of resources (global supply and staff availability).
• PPE procurement support process implemented.
• 1200 VPN laptops being procured to support IT need.
• Some laptops have not been delivered despite having been ordered &

there is no residual stock remaining. This is being activity chased.

• See also issue numbers 1 & 3.

West Sussex CCG 

Brighton and Hove CCG  East Sussex CCG

Primary Care Services: New Services Due To CV-19 (3 of 3)

Service Area New Services As A Result Of C-19 Details of Service(s) Implementation Progress Primary Care Green & Red Teams

• For out of hospital services (such as home visiting – full scope tbc), setup:
• Green teams (for working with patients with no COVID-19 symptoms and who are not self-

isolating due to possible exposure).

• Red teams (for patients showing clinical symptoms of COVID-19 or in self-isolation due to

possible exposure).

• To be setup jointly with community healthcare provider.
• Not yet setup – to be commissioned in the next phase of activity – timeline

tbc. Primary Care Staff Testing – PCR (currently has COVID-19)

• Staff testing service for staff showing symptoms of COVID-19 or in self-isolation due to possible

exposure.

• Full pathway under development. Used to determine which staff are safe to return to work.
• Heat map based on staff availability levels (as captured daily in the SurveyMonkey tool) produced

to assess which practices are in greatest need of testing (of staff showing symptoms or in self- isolation).

• Availability of PCR reagents limiting volume of testing – national issue.
• ‘Swabulance’ in place as an interim (& mobile) measure to test staff.
• Gatwick drive through centre (for staff that can drive) live as of 8th April.
• Online booking for testing to be available by 10th April.
• 80 members of staff are reported unavailable due to COVID-19 related

reasons (as of 8th April). Primary Care COVID-19 Testing – Antibody (has had COVID-19) TBC – placeholder as not yet available.

• Not yet available.

Primary Care Shielded (‘at risk’) Patients

• Nationally, these patients have been written to (where they have been identified) in order to give

advice and guidance on how they should shield themselves, and the care arrangements in place.

• These patients will be impacted by the setup of green and red teams to administer out of hospital

care.

• A national volunteer network is being setup to support, e.g. by delivery groceries. TBC, but

expectation that this is run by central government.

• List of at risk / vulnerable patients are being sent to practices to verify. Next
• ne due 9th April.
• Some patients will be known and some unknown to community services.

Work ongoing to determine who these patients are.

• Pathway under development to confirm how and who will provide these

patients with GP services. Primary Care Membership Engagement

• PCN and practice engagement webinars in place for two way communication platforms with the

membership

• Membership managers in place to support practices and to be the conduit between practices and

the CCG

• Round one for all 3 webinars taken place
• Round two webinars underway
• Recruitment process for the membership managers in place and

progressing

West Sussex CCG 

Brighton and Hove CCG  East Sussex CCG

Primary Care Services: Paused Services Due To CV-19

Service Area Services Paused As A Result Of C-19 (in line with national guidance) Details Of Any Exceptions / Caveats / Points To Note General Practice Travel clinics None General Practice Minor surgery / steroid injections None General Practice Social prescribing None General Practice NHS health checks None General Practice Phlebotomy

• INR, Lithium, DMARD monitoring
• Essential diagnostic tests (clinician determined)
• Essential management of patients in non-stable conditions (clinician determined)

General Practice Chronic disease reviews

• Patients whose condition is not stable

General Practice Routine cervical smears

• Should be deferred

General Practice PSA monitoring

• Deferrals up to 3 months only

General Practice Ear syringing

• None

General Practice Ring pessaries

• None

General Practice Other Non- Essential Activity Includes:

• Target related activity: LCS work, DES, including extended hours
• Insurance and DVLA reports
• Medicals
• Non-urgent paperwork
• Non-urgent occupational medical examinations
• DVLA examinations where licence is required by a key worker

Dentistry Dental Practices

• Dental practices are closed for routine appointments.
• Dentists are being repurposed to help communities wherever possible.

Eye Health Opticians

• TBC - Opticians are closed, but no official guidance published as yet.
• A Sussex wide NHS working group is being setup to provide guidance (currently recruiting clinicians to sign up

to the working group).