/CKWCB-12-171c_GHCCE_mins_25.04.

NHS KIRKLEES

Minutes of the Greater Huddersfield Clinical Commissioning Executive (CCE) Meeting held on Wednesday 25th April 2012, 2.00 – 5.00pm in the Board Room at Broad Lea House, Bradley Business Park, Huddersfield Present: Vanessa Stirum (VS) Rob Millington (RM) Dr Steve Ollerton (SO) Dr David Hughes (DH) Dr Dil Ashraf (DA) Dr Karen Dean (KD) Dr Jane Ford (JF) Dr Paul Wilding (PaW) Carol McKenna (CM) Penny Woodhead (PeW) Julie Lawreniuk (JL)

Non-executive Associate and Chair Non-executive Associate CCG Clinical Chair CCG member CCG member CCG member CCG member CCG member Shadow Accountable Officer Head of Quality & Safety Shadow Chief Financial Officer

In attendance: Merran McRae (MM) Rachel Carter (RC) Joanne Crewe (JC) Jan Giles (JG) Vicky Dutchburn (VD) Nicky Hoyle (NH) Kath Woodford (KW) Terry Service (TS)

Director of Wellbeing, Kirklees Council Head of Contracting Head of Wellbeing & Integration Head of Practice Support & Development Head of Strategic & Business Planning Public Health Consultant Performance Reporting Manager Assistant Director of Corporate Services

Minutes: Kelly Chadwick (KC)

Personal Assistant to Greater Huddersfield CCE

EC/12/112

Welcome, Introductions and Apologies for Absence VS welcomed JL to the CCE and introductions were made from CCE members.

Apologies for absence were received from; Mehboob Khan (MK) Dr Judith Parker (JP) Dr Anuj Handa (AH)

Non-executive Director CCG member CCG member

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Declarations of Interest Declarations of Interest were noted from all GP’s present with respect to Agenda Item No 9 – 24 hour BP as this will be a service within Primary Care.

PaW also advised the CCE of some changes to his declarations of interest. He is currently on a year long sabbatical from his practice and has no current decision making responsibilities there. PaW also advised he has recently resigned from his post of Director of Huddersfield Medical Services Ltd which is the service provider for the Kirklees Community Hand Surgery Contract.

EC/12/113

Accuracy of Minutes of 14 March and 28 March 2012 The minutes from the meeting held on 14th March 2012 were AGREED as accurate.

An amendment was noted to page 7 of the minutes from the meeting held on 28th March 2012 under agenda item EC/12/104.

Action: KC to make the amendment as noted before confirming the minutes as ratified.

NHS Constitution It was AGREED that this would need further detailed discussion at a future meeting.

Action: KC to add to agenda for future meeting.

Keith Griffiths attendance It was noted that Keith Griffiths would be attend a Clinical Strategy Group meeting in May for discussions current and future challenges between CHFT and GHCCG. Action: Summary of Keith Griffiths’ report to be shared with the CCE. The minutes were then AGREED as accurate.

Action Log All actions complete.

EC/12/114

Clinical Chair/Chief Operating Officer update CM gave brief feedback regarding the visit of David Nicholson on Friday 20 April 2012.

CM advised that she attended the morning session along with DA/SO. There was positive feedback overall and David Nicholson was been impressed with the developments to date, in particular the work around the Transformation and QIPP. Page 2 of 13

CM advised that an invite only session took place in the afternoon attended by SO. This part of the session focussed on both the Mid Yorkshire project and the Calderdale & Huddersfield Strategy Refresh.

Further discussion took place around the content of some of the discussions from the morning session, in particular the savings from QIPP. CM advised that there would face to face handovers from the Cluster to the CCGs in last 6 months of 2012. At this stage, the detail of this is unclear and CM advised she would seek clarity on this and feedback.

Action: CM to seek clarity on face to face handovers between Cluster and CCGs. CM thanked everyone involved for their efforts, both on the day of the event and during the preparation beforehand. The Weekly Talk will be used to share feedback.

LMC Terms of Reference The final version of the Terms of Reference was discussed. CM advised that Mark Jenkins and Suzanne Howarth from the Primary Care team will be the PCT representatives.

The Terms of Reference were APPROVED by the CCE. Cluster Board CM advised that a timeout had been held recently. The Cluster Board will be slowly distancing themselves and allowing the CCGs to start taking responsibility. The shadow Accountable Officer for each CCG will produce a monthly report for Cluster Board from May onwards. CM advised that the CCE needs to ensure any items of importance are reported into Cluster Board.

Shadow Health & Wellbeing Board The Joint Health & Wellbeing Services (JHWS) draft strategy is now available. CCGs need to have strong input into this strategy. There is going to be a workshop held on 16th May (date to be confirmed) for further explanation/discussion and the CCE were invited to attend.

Leading Large Scale Change CM advised that a team from NHS Kirklees have been successful in gaining a place on this course which commences mid-May. There are 8 people on the team. Information will be fed in from the Transformation and the Health and Social Care workstream areas.

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Healthchecks It was noted that Locala use the cardiac specialist nurses for health checks which isn’t necessary. A 6 month notice period will be required to terminate the service.

DA advised that there are still issues with the pain consultant and current service.

The CCE RECEIVED and NOTED the contents of the report and thanked CM/SO. EC/12/115

Risk Register TS explained the risk register. The brief provided shows high level risks across the Cluster. As CCGs develop, they will begin to take on board the management of the risk system.

SO questioned whether training would be available on the system.

TS confirmed that Ian Wilkinson from NHS Calderdale is the management lead for the system and will provide training as and when required.

PeW advised that the risks associated with quality that are attached to GHCCG have been reviewed and will be discussed further at the Quality & Safety subgroup.

DH questioned whether reports can focus on key points only. TS informed the CCE that the risks are managed by an individual risk owner and any gaps need to be addressed directly with that person.

CM explained that risks need to be duplicated at present to ensure they feed into both CCGs. RM advised that the Risk Register should be fed into the Board Assurance Framework.

It was suggested that this item should be discussed in greater detail via both the SMT and the Audit & Governance subgroup and agree on any further actions.

Action: CM to raise at SMT/Audit & Governance Subgroup to determine how to manage any gaps and ensure all risks are suitably managed.

Training on use of the system was discussed further and it was AGREED this would be picked up via the OD Subgroup for further discussion.

Action: Training for Risk Register system to be discussed further in OD Subgroup. JG to action.

The CCE RECEIVED and NOTED the contents of the report and thanked TS for his attendance.

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EC/12/116

Quality & Safety Report PeW provided a brief overview of the key points from the report; Mixed sex accommodation – 2 further breaches at NHS Calderdale since the report had been produced.

CQC – general dental inspections update. PeW advised that discussion on actions following the inspection have been followed up with the Dental Team.

Outpatients survey – this has been discussed at the Clinical Quality Board. Various issues have arisen through this survey and an action plan will be shared and followed up through the CQB. The CCE RECEIVED and NOTED the contents of the report and thanked PeW.

EC/12/117

Contracting Report RC advised that a more detailed report will be provided for the Finance & Performance subgroup with a high level overview brought into CCE in the future.

RC provided a brief overview of the key points from the report; The data is end of the financial year data, based on February activity.

Discussions are about to start for the 2013/14 contract negotiations.

RC informed the CCE about a nationally mandated piece of work taking place to clinically review 30 day re-admissions for the first quarter. This is going to be an intensive piece of work integrated with the provider. Further discussions will need to take place to agree the details of this piece of work. This will need to involve primary care, Locala and district nurses.

The deadline for completion is the end of June. It was AGREED a report could be brought into CCE in August for feedback on the exercise. RC advised further discussion would be required in order to identify further support from within the CCE. Action: RC to discuss support from CCE with DA and identify further members to assist with this piece of work.

AQP RC advised that the advert for the Adult Hearing Services has now gone out. The closing date is the 27 April 2012. The advert for the Diagnostic Service is due to go out on 14 May 2012.

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RC advised she felt that a final check on the process for reviewing the specifications was required and this proved to be acceptable.

Unscheduled Dental Care RC advised that the report will be going into Cluster Board on 8 May and the Dental Team wanted to ensure the CCGS were cited on the specification beforehand.

RC confirmed that the specification is exactly the same as the current service but endorsement of the service is formally required.

There are 2 elements to this specification – a generic specification and a Kirklees one. RC advised that if any changes are to be made to the generic specification, it would need to be submitted at Cluster for re-approval.

RC confirmed there were some concerns raised from North Kirklees CCG with respect to safeguarding, CRB checks and checking if the patient is appropriate for unscheduled dental care.

There was further discussion regarding the current service and how it works. Discussion regarding the in-hours/out of hours services took place and it was AGREED that some clarity was required on the timings of these services.

Action: RC to clarify both the in-hours and out of hours timings for both the generic and the Kirklees specifications for unscheduled dental care.

The dental nurses for the 111 service were discussed and it was AGREED that these need to be included in the Directory of Services.

Action: RC to ensure the dental nurses for 111 is picked up with Pat Andrewartha for it to be included in the DOS. It was AGREED that the Unscheduled Dental Care specifications were APPROVED subject to the comments around the in-hours/out of hours timings being clarified and amended as appropriate.

The CCE RECEIVED and NOTED the contents of the report and thanked RC. EC/12/118

Performance Report KW gave a brief overview of the performance report.

KW advised that a meeting has taken place on 25 April with YAS and some actions have been agreed. Further feedback will be given at a later date. A further meeting has been planned for approximately 6-8 weeks.

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KW noted the actions as follows; YAS are going to approach Skelmanthorpe and Slaithwaite Fire Stations with a request to train on-call firemen to be first responders for YAS. YAS are to advertise for voluntary community first responders. Discussion took place about the kit and equipment required and it was agreed that more kit would be bought in.

YAS are to look at where their staff live and consider being on-call off duty. Payment to be considered for this.

KW advised that YAS have achieved overall for the last financial year.

KW highlighted other key areas from the report.

4 hour A&E waiting times – quality indicator assessed overall.

The Acute Trust will achieve the quality indicators overall but will still be monitored regularly. Discussed using CQUINS to target this area.

18 weeks – no issues 6 weeks waiting times – backlog cleared due to recent access monies Stroke – local priority – this was left in the report in order to flag up with the CCE. Early indication of data is that we have exceeded on performance but that there are still issues regarding the TIA element.

GP referrals to first outpatient appointment – there isn’t enough data specifically for this audit.

The actions noted from YAS have been included in the report.

CM confirmed she would flag up the YAS/IAPT/Healthchecks issues in the May monthly report to Cluster Board.

KW advised the second report included in the pack highlights the commissioning priorities for 2012-13. KW advised that approval is needed for proposed changes. CM advised she would take the changes back to F&P for approval.

Discussion took place regarding provided an annual performance report to the CCE. CM advised she would raise this for further discussion at SMT. Action: CM to raise at SMT the suggestion of annual performance report being brought to CCE. The CCE RECEIVED and NOTED the contents of the report and thanked KW for her attendance.

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EC/12/119

Finance Report JL gave a verbal update on the key financial points; Financial accounts were submitted on 20 April 2012. JL confirmed that all financial duties have been met.

JL and SB working on looking to split the calculation of monies for GHCCG and NKHA. The CCE formally thanked JL and the Finance Team for their hard work and efforts during the past financial year.

The CCE RECEIVED and NOTED the contents of the verbal update and thanked JL. Management Allowance The figures were discussed and JG explained the breakdown in more detail.

The training and development allowance will cover all the OD work.

Any additional sessions should now be minimal due to the changes in the number of sessions the GPs are now doing.

Any additional sessions must be agreed with CM/SO. All invoices must be submitted within 2 months. There is a quarterly deadline for submission. If there is no submission, there will be no payment.

RM asked for clarity on the payments for the NED/NEAs. CM confirmed this was covered under a different budget.

The CCE APPROVED the paper subject to the changes as noted.

EC/12/120

24 Hour BP JG explained that this scheme had been presented at LMC on 24/04/12. The LES had been agreed by LMC. The proposal is for 12 months, and there will be a review starting after 9 months.

Discussions took place regarding the current activity and finances.

RC explained this was a block contract arrangement this year. SO explained that this would become part of core business in the future but this LES is a way to ensure practices are providing the service on a regular basis.

Further discussions were held regarding decommissioning the current service at CHFT to ensure practices continue to do this themselves. RC confirmed this would be part of future contacting discussions.

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A concern was raised about the current NICE guidance and how it would be interpreted. It was suggested that some education for practices could be beneficial. It was also suggested that the report to be amended to be clear that payment will only be for newly diagnosed patients.

Action: 24 hour BP LES to be amended regarding payment. JG to feedback to SC. It was AGREED that the scheme would be approved with the following caveats; An agreed budget of ÂŁ159k Monitor the claims for the scheme closely over the first quarter.

The LES must stipulate that the payment is only for newly diagnosed patients with hypertension.

The CCE APPROVED the scheme.

EC/12/121

Practitioners with Special Interest PeW explained that this was a Cluster wide policy, written specifically to unify the existing policies across the Cluster. The purpose is to monitor the approach to the PwSI process.

PeW advised that a draft version had been submitted to Cluster Governance Committee in February, who had requested that CCE review it. It will then be resubmitted to Cluster Governance Committee for final sign off.

A point was raised regarding Any Qualified Provider and it was clarified that they would need to follow the standard NHS contract.

Further discussion took place regarding this policy and whether it was should be subject to approval. The CCE felt that the content of the policy was unclear and PeW agreed to feed comments back to Matt Walsh for further clarity.

Action: PeW to discuss PwSI policy with Matt Walsh and feedback next month.

EC/12/122

NHS Transition External Nurse/Consultant Role CM informed the CCE that the current DH advice is to wait before recruiting to these roles. The SHA is proposing a generic advert for the whole of North of England. CM informed the CCE she would feedback as and when any more information becomes available.

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Subgroups There are currently 3 shared subgroups with NKHA. CM informed the CCE of a proposal to separate the Finance & Performance and the Quality & Safety subgroups so there will be one per CCG. This would include separate memberships, TORs etc. This would take effect from 1st September 2012. The Audit & Governance subgroup would continue to be a joint group until March 2013.

The CCE AGREED to the separation of two of the subgroups.

CCG Name CM advised that guidance has recently been published regarding the names of individual CCGs. They will all have to use NHS at the front of their CCG name. The geographical areas also need to be in line with the ones held by the Local Authority. Some discussion took place about this. MM advised that the Local Authority would prefer to have the name amended slightly but would be happy to support if GHCCG preferred to keep the name as it is.

The CCE AGREED that they will keep the name of Greater Huddersfield CCG but will now begin to use NHS at the beginning.

People Transition CM informed the CCE that the SMT leads will shortly start looking at roles that would be CCG/CSS specific. There is currently no HR guidance available on this as yet so this work won’t commence until the guidance is available.

NH advised that the Public Health core offer dialogue is to continue.

Action: CM to pick up and discuss what is required with NH. CSS Update CM advised that Alison Hughes, Interim Managing Director of the West Yorkshire CSS will be attending the May CCE for introductions and an update on the CSS. The CSS is developing well. They have recently gone through checkpoint 2 which went well and feedback will be received at a later date.

Authorisation CM informed the CCE that the OD & Authorisation Subgroup met on 24th April. The CCG will be applying for authorisation in wave 2. An expression of interest has been submitted and we will find out in a few weeks if we have been successful. If we have, the submission date is 1st September 2012.

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The 360° survey was discussed. This will need further explanation with practices before its released. This will need to happen through practice visits. An “idiots guide� on how to complete the survey will be developed.

A proposal for an all stakeholder event in early July was discussed.

CM advised that practices would be advised of this during the Q1 practice visits.

The risk log was discussed and CM advised that there is a need to identify someone to pick up the governance elements of the CCG work. CM advised that there is also a need to start having names against the different areas of the workplan to support the ongoing work.

EC/12/123

Calderdale & Huddersfield Clinical Strategy Refresh PaW advised that he is the Chair of the Steering Group for this programme. Some objectives have recently been agreed at the Steering Group. Some of these are as follows; To produce a high level vision for the refresh programme Establish an early programme office. There is a programme director in place and office resource is being sourced via CHFT. There are also some issues regarding resource for the Steering Group.

Recommendations to be made to the Programme Board about the changes/scale of changes.

The scope of the work is currently being developed. JC is involved in this. JC advised there is a business case being submitted to the Transformation Board on 1st May for the Programme Office.

PaW advised that we are moving into the next stage of the programme and looking at what is actually wanted/required of the workstreams going forward. There are workstreams starting approximately around 1st June.

PaW advised that the CCE have a responsibility to ensure the member practices are fully involved and/or have the opportunity to be involved as and they wish.

It is also important that we have a means of communicating information. GP link and the Communication Strategy will be used to make sure everyone is aware of any important factors. There is engagement/involvement group already attached to the Board/Programme. There will be a monthly update on GP Link.

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It was AGREED that the Programme should be added to the May agenda with more time allocated to enable further detailed discussions with the CCE. This will help map out what is required and when.

Action: JL/PaW/JC to meet to discuss and agree detail prior to next meeting.

Action: KC to add to May agenda.

It was AGREED that a one page brief would be provided to take to practice visits to keep practices updated.

Action: PaW to discuss outside the meeting and provide this document to AP. EC/12/124

Receipt of Minutes The CCE RECEIVED and NOTED the minutes of the following meetings; Cluster Board meeting Shadow Health & Wellbeing Board OD & Authorisation Subgroup Finance & Performance Subgroup Quality & Safety Subgroup Clinical Strategy Group

EC/12/125

Any Other Business Board to Board meeting SO asked for availability for attendance at the next Board to Board meeting. Discussion took place about the most suitable date. It was AGREED that 23 May was most suitable.

Action: KC to clarify that 23 May is available for GHCCG Board to Board meeting.

Action: KC to confirm attendance as follows; CM/SO/VS/JF/KD PDP meetings SO confirmed that KC would be setting up individual one to ones between himself and the other GPs mid June.

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EC/12/126

Date and time of the next meeting The date of the next scheduled meeting is Wednesday 23rd May 2012, 2.00 – 5.00pm.

This concluded the content of the CCE meeting and the Chair declared the meeting closed at approximately 5.30pm.

Chair’s Signature: ........................................................ Date: ..................................

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