/CKWCB-12-170_NKHA_CCExec_meetin

NHS KIRKLEES

Minutes of the NKHA Clinical Commissioning Executive Meeting held on Wednesday 25th April 2012, Board Room, Broad Lea House Present: Valerie Aguirregoicoa Ajit Mehrotra Nadeem Ghafoor Khalid Naeem Rachael Kilburn Tony Gerrard Carol McKenna Steve Brennan Farhad Kohi Imran Patel Kathryn Greaves In attendance: Merran Mcrae (From agenda item EC12/109) Helen Severns Natalie Ackroyd Rachel Carter Jackie Holdich Jan Randall

Non-executive Associate and Chair CCG member CCG Member CCG member CCG member Non-executive Director Chief Operating Officer Head of Finance CCG member Non-executive Associate CCG member

Director for Well-being & Communities Head of Service Improvement Business Performance Reporting and Manager Deputy Director of Commissioning & Strategic Development Head of Practice Support and Development Head of Strategic Development & Business Planning

Minutes: Natasha Brown

Personal Assistant to NKHA CCG

EC/12/106

Welcome & Apologies

David Kelly Yasar Mahmood

CCG Chair CCG member

EC/12/107

Accuracy of minutes from last meeting 28th March 2012 All CCE members accepted the minutes as a true and accurate record with noted amendments.

Update on action points from last meeting, 28th March 2012 EC/12/90 – Carol confirmed that David had fedback to the LMC via the LMC Interface Meeting regarding the discussions at the last CCE meeting.

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The LMC are to confirm if NKHA CCE can view their minutes. This will be clarified at their next meeting.

LMC interface meetings – Carol informed the group that minor changes have been made to the TOR. It has been confirmed that the PCT representatives need to be members who are on the Primary Care contracting team. It was confirmed that Mark Jenkins will be chairing future LMC Interface meetings.

Quoracy – frequency of LMC meetings and minutes have been discussed. 2 clinicians and 1 manger will be present from NKHA CSG. David Kelly and Jackie Holdich will be present at future meetings. Carol requested another member to be present from the CSG. The meetings currently run on the 2nd Tuesday of each month. Jackie suggested this can be discussed at the next CSG meeting.

Action – Natasha to put on CSG agenda for 9th May 2012.

Action - Carol to check the punctuation on the TOR. All CCE accepted the TOR for the LMC Interface.

EC/12/92 – David has now given feedback regarding the discharging of Cataract patients at the Mid Yorks Meeting. Mid Yorks are producing a leaflet and this will be sent out to patients who have been discharged and a better system will be in place by June 2012.

Action - ? Letter to be sent to practices to clarify procedure.

Khalid entered the meeting.

EC/12/98 – The Primary Care Incentive Scheme has now been approved and has been distributed to Practices throughout North Kirklees.

Declarations of Interest EC/12/109 - 24 hour blood pressure - All Practice representatives except Kath Greaves Local Medical Committee (LMC) – Ajit Mehrotra as Practice Representative and Chair of LMC. EC/12/113 – Finance - All practice representatives EC/12/108

Clinical Chair of CCG and Chief operation officer update Carol gave an update on the David Nicolson visit. Members who attended the session gave positive feedback and Carol thanked those CSG members who were involved in the process. Farhad attended the afternoon session on behalf of the CSG. They was a lot of discussion regarding Mid Yorks, Quality and QIPP. David Nicholson is very fixed and fully understands what the impact on quality of services are. Carol

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stated that the CCE need to focus on the Quality agenda in preparation for authorisation.

Farhad gave feedback regarding QIPP, quality and the afternoon session. It was highlighted at the session regarding the concerns around the financial situation that Mid Yorks. They are going to carry out review on the consultant salary and are going to look at the structures within Mid Yorks.

Farhad confirmed that Pontefract are going to open A&E short term. At present the 3 main Mid Yorks sites are going to remain open and this will be reviewed in the near future, by looking at moving departments across the 3 sites.

Carol informed the group that the Cluster Board has had a time out session where they focused on the way that they currently work. They are wishing to step away from the day to day work (performance, Contracting and Finance etc) as this is role of the CCGs. This is going to commence as of May 2012. Any major issues will be escalated to the Cluster Board. Carol is producing a report for exceptions from the Subgroups for the Cluster Board and emphasized the importance of the subgroups and that CCG members do need to be present at these.

The Cluster Board are keen to have another Board to Board meeting in May and more information will be circulated with dates and times.

Sarah Crossley entered the meeting.

Health and Wellbeing board are looking at joint health and wellbeing strategies and CCG input is needed. Carol stated that a session is to be set up in May for CSG members and this is to look for the 16th May in the morning. A formal invitation will be sent out in due course.

Merran entered the meeting.

EC/12/109

24 hour BP Business Case Sarah stated that this business case went to the F&P in March. This business case was reviewed in March 2012 at F&P committee and has been recommended to the CCE to consider approval. 3 options were presented to the CCE which are available for funding and a decision was needed by the committee as to which option should be approved.

Jackie asked about the rational regarding the LES for 12 months and the costing behind this. .

Farhad stated his view on how this service could be run. The average funding per patient in NKHA is approx ÂŁ65 which is significantly smaller in cost that GHCC. A discussion took place regarding PMS and GMS systems.

Nadeem and Jan informed the CCE that the BP machines have been purchased and non approval may result in practices not utilising the equipment.

Levels of activity will rise in line with NICE guidance and MYHT charge ÂŁ84 per patient.

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It was agreed that doing this as a LES could be reviewed and evaluated in 12 months time which will then prove whether this is being cost effective.

All agreed to implement NICE Guidance. Steve confirmed that this is currently affordable for NKHA and feels that it is reasonable to fund this out of this financial year budget. However, due to financial pressure that may arise this year, the financial position may change.

Helen and Tony stated that we need to look at the overall resource and what the implications are to the workforce and what the impact will be on individual practices and also nursing homes.

Rachael Kilburn stated that member practices would take this business case on board and would welcome this business case as this has been in the pipeline for some time.

Valerie stated that the business case potentially impacts on Cardiology activity and questioned if the 24hour BP would free up resources on waiting times.

All agreed to do the business case for 1 year as a LES which will be reviewed and evaluated in 1 year. Rachael stated that communication needs to be clear and practices need to be kept informed.

Helen stated that papers have to be clear in future to state the costs etc.

Action – Sarah to update the papers.

CCE approved this scheme to run for 1 year as a LES with amendments noted.

EC/12/110

Endorsement of unscheduled Dental Care Specification Rachel presented these papers which links with the out of hours 111 services.

The current Urgent Care Contract arrangements will cease in March 2013 and the decision has been made that Unscheduled Dental Care Services will be procured separately from Urgent Medical Services as the NHS Commissioning Board will become responsible for the commissioning of all dental care pathways.

The paper highlighted that currently call handling, triage and in some cases appointment booking is provided by NHS Direct across West Yorkshire. This will transfer to the provider of the new 111 service from March 2013 covering Yorkshire and the Humber. The new 111 service will triage calls and only those identified as in need of urgent dental care will be put through to this service.

The service Specification is cluster wide.

The service will cover the „treatmentâ€&#x; of patients only.

The group was asked if members were content with this specification.

Valerie questioned the qualifications regarding the need for CRB checks, and this was confirmed that this is needed.

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When this service is closed, Rachel stated that patients will be re-directed to the correct place. Jan raised her concerns regarding patients being sent to A&E. Rachael stated that practices need to be made aware of the process in which they need to follow. Ajit supported this.

Action – Papers to be amended to state 2012 All endorsed this specification EC/12/111

Authorisation and Development Terms of Reference The terms of reference was circulated for approval. It was agreed that an amendment needs to be made to amend job titles and to state roles and not specific individual names. Steve to be included in the TOR and LMC representative.

Action – Jan/Natasha to amend the TOR All agreed the Authorisation and Development TOR subject to amendments.

EC/12/11

Contracting report Rachel presented the contract report which covers Feb 2012. The intension is that an in detail report will be taken to F&P and a smaller and more concise report will then come to CCE meetings.

Midyorks have had funding for access money and have achieved their target in March 2012. We have now slipped back on the 18 week waiters and Valerie feels that we need to be smarter with targets. Rachel informed the group that we will see a decrease in 18 week waiters in April. Tony suggested that F&P could look at this closely.

Action – 18 week waiters to be discussed at F&P. Natalie Ackroyd entered the meeting, Valerie questioned if penalties were given if breaches were made in 18 week waits. All financial penalties will be acted upon where necessary and this is going forward to the finance contracting team.

Action – Rachel to clarify if penalties are given in 18 week waits was breached.

AQP – Rachel confirmed that the advert will be going out on Friday for the Adult Hearing Services. Diagnostics will be advertised on 15th May. Both on track to commence for 30th Sept 2012. Service specifications will be going with the national process and slight amendments have been made by David as CSG Member and Jan as Head of Strategy and Business Development.

All approved the finer detail given by David and Jan.

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EC/12/113

Finance Steve Brennan gave a verbal update on 2011/2012 – figures for 2011/2012 have been submitted and to SHA and DOH last Friday. All targets have been met. We have underachieved by capital resource by spending 241m. KCHS (now known as Locala) had achieved financial target. NHS Kirklees had £1000 left in the bank account at year end. The accounts are being audited at present and some of the members of the CCE will be involved in the signoff of the accounts.

2012 Management allowance - A budget for this year (2012/13) is £452.880.

Members have to be mindful of the changes that may be made later this year.

Jan stated that the Nurse payment is missing off the breakdown of payments and this will be amended.

Action – Steve to amend the breakdown of the management allowance to state the Nurse payment.

Jan informed the CCE that Rachel will be increasing her sessions to 3 sessions a week and David will be increasing his sessions to 6 as of 1st May 2012. Jan stated that a separate discussion needs to take place regarding the board members and the sessions that are currently being undertaking.

Steve stated that the budget is what the PCTs were asked to make available which will help the CSG to carry work forward. When costing the structure for the NKHA going forward, the lay members, nurse etc have been costed into this. Steve stated that the budget that is available, board members will have the opportunity to increase their session even though the contingency is -£11,710. Steve emphasized the need to move into the phase of worrying less of the money we spend as a CCG and we need to concentrate on how the board is running and how effective the board is.

Action – Jan to update the document to state the CSG and not consortium.

It was acknowledged that even though the board is one member down, we do not have the funding to fill this vacancy.

Jan explained that board members have the responsibility to complete their hours worked for CCG for 2011/2012 and send to Jan. Action – ALL board members to submit their hours to Jan Randall for 2011/2012.

All CCE members approved this budget/allowance and also approved an extra session for David and Rachael.

EC/12/114

Performance Natalie presented the performance report.

In February and March 2012 there were no further cases of MRSA. We have had 12 cases year to date across NHS Kirklees.

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C. Diff – 11 cases for Kirklees in February. 8 for NKHA and 3 for GHCC. March data shows a further 9 cases, 6 to NKHA and 3 to GHCC. 137 cases for NHS Kirklees YTD. 15 of these cases were residents who received treatment out of this area and 15 were Care Home cases. Analysis is taking place on the Nursing Homes and GP Practices cases. This will be feedback at a later date Mixed sex – 3 cases at Mid Yorks. March data no further cases. YTD data shows 119 cases for NHS Kirklees.

18 weeks – invalidated data for March is 89.3%.

A&E – Quarter 4 position is under 95% threshold. A detailed report will be feedback to the Cluster Board and a full explanation as to actions that need to be taken.

The performance annual report data for 2011/2012 will be available in May 2012 and will be brought back to the CCE meeting in June 2012.

Imran requested a quarterly report for smoking quitters and infant mortality and Natalie confirmed that these figures will be available in the near future.

Valerie has concerns relating to activities that have not been achieved even though NKHA has given funding to reduce activity.

Action – Steve to feed this back to Executive Contract Board tomorrow to see how we can clear the back log of 18 weeks.

Carol stated that ECB has had a discussion regarding how they fund for Plastic Surgery as they is a shortage of consultants. It was agreed that the ECB would concentrate on this.

Future process of reports – 2012/13 national indicators will be brought to the CCE to address any concerns. As and when things change, the indicators will be built into this report to make it more specific to NKHA. Jan stated that the NKHA priorities to be added to this report to state that we are meeting the priorities.

Natalie confirmed that the lead managers stated within the report will be changed/amended to match NKHA. All CCE noted the performance report and approved the reporting process for 2012/2013.

EC/12/115

Risk Register Terry Service presented a paper on the risk report and high level risk log. Terry informed the CCE that this report is currently at Cluster level.

All risks on this register are risks that are scoring 15 and above.

As of May 2012, the CCG will be able to access the risk register system.

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Terry stated we need to start to capture these risks as they arise and add them to the register. Terry agreed the need for training the managers on the system.

Action – Terry to arrange training sessions for the managers on the Risk Register System.

Carol stated that it is not just the manager‟s responsibility to highlight risks and that it is everyone‟s responsibility to voice risks that arise.

The risk register is purely to manage risks and will be reviewed by managers on a monthly basis.

All members noted this report.

NHS Transition Carol informed the group of the Authorisation and Development group who are meeting tomorrow. The main agenda items for this group is to cover the applicant pack which included the names and the authorisation journey. This group will have a detailed look at this. We are still working towards wave 3 and this has been fed up to the Cluster, however this has not yet been confirmed by the Cluster Board.

The tenure of board members – a letter has now been sent out to practices regarding the Governing Body and responses have to be back to Karen Gallagher by today.

Carol does not have the results from the ballot as yet as this will be picked up at the Authorisation and Development meeting.

Three subgroups are currently ongoing across NKHA and GHCC. These are Finance & Performance, Audit & Governance and Quality &Safety. Carol proposed that the 2 CCG‟s split their subgroups as of September 2012. Steve agreed to this proposal and thinks that Finance & Performance don‟t have enough time in the meeting to concentrate on issues that are only appropriate to 1 CCG. Steve also mentioned that we need to be clear how these will run as separate subgroups.. Jackie suggested that the Primary Care Quality Steering Group could be merged in to the Quality and Safety Subgroup in the near future. Kath supported this.

Jan informed the group on the importance of the “Heads of” working together across both CCGs. Valerie expressed her concerns regarding the attendances at the subgroups from the CSG members as they have been poorly represented in the last few weeks and the need for sufficient input into the Subgroup meetings.

Carol informed the CCE that Alison Hughes is now in post. Alison Hughes is Managing Director – West Yorkshire Commissioning Support Services Action – Natasha to invite Alison to a future CCE meeting.

Merran informed the group that Public Health will be merging with the Local Authority.

The date is which this will happen has yet to be confirmed.

Action – Helen? To be invited to the CSG meeting.

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People Transition – work is ongoing with Calderdale and Wakefield on the structures that will be below the “heads of”. The “Heads of” are working on what they require to work effectively.

Carol informed Rachael that Medicines Management will be a shared post across NKHA and GHCC. How this will work has yet to be discussed.

EC/12/116

Naming Convention Jan informed the group the need to change the name of NKHA as a result od guidance from the centre. Jan recommends that as of 1st May, we are called NHS North Kirklees Clinical Commissioning Group. This will be fedback at the GP forum.

Action – Jan to inform the Practices at the GP Forum of the change of name for the CCG. All members present approved this to take place as of the 1st May 2012.

EC/12/117

Risk Register No new risks were identified in this Clinical Commissioning Executive.

EC/12/118

Receipt of Minutes All members received, noted and approved the CSG minutes and noted the contents of the minutes as listed below: Leads of each group gave a brief update. 

Cluster Board – 6th March 2012 Tony gave an update regarding QIPP.



Audit and Governance – 7th March 2012 All CCE members noted the minutes.



NKHA Authorisation and Development meeting – 22nd March 2012 Carol gave an update to the CCE regarding the discussion at the last meeting.

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Quality and Safety Subgroup – 4th April 2012 Members of the CCE do not feel the minutes are a true reflection of the meeting and do not show the full discussion and actions. Jackie informed the group that they have been admin cover issues for this meeting. Carol informed the group that this has been addressed.

Valerie highlighted issue that Q+S wanted raising at CCE 2 dental practices have been operation whilst not having CQC registration. This has now been addressed and systems put in place to ensure there is no repeat.

CQC maternity report for MYHT was discussed

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Shadow Health and Wellbeing Board – 4th April 2012

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The strategy has been discussed in detail. The next steps are to agree who the stakeholders are and a consultation process will be undertaken. After consultation, this will be fedback in December 2012. 

Finance and Performance - 21st March 2012 Nothing to feedback.

They were no matters to escalate to the Cluster Board.

EC/12/119

Any Other Business No other business was discussed.

EC/12/103

Dated and Time of Next Meeting Wednesday 23rd May 2012 9.00am – 12.30pm Rowan Suite, Woodlands Conference Centre

This concluded the content of the CCE meeting and the Chairman declared the meeting CLOSED at approximately 12.17pm.

Chairman’s Signature: ……………………………………………. Date: ………………….

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