CKWCB-12-196a_NKCCE_mins_23rd_May_2012_-_final

NHS KIRKLEES

Minutes of the North Kirklees Clinical Commissioning Executive Meeting held on Wednesday 23rd May 2012, Woodlands Conference Centre, Heckmondwike Present: Farhad Kohi Nadeem Ghafoor Khalid Naeem Rachael Kilburn Tony Gerrard Steve Brennan Imran Patel Kathryn Greaves Yasar Mahmood In attendance: Helen Severns Natalie Ackroyd Rachel Carter

CCG member (Chair) CCG Member CCG member CCG member Non-executive Director Head of Finance Non-executive Associate CCG member CCG member

Deborah Turner

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 Head of Quality and Safety

Minutes: Kelly Chadwick

Personal Assistant

EC/12/122

Welcome & Apologies

Jackie Holdich Jan Randall

David Kelly Valerie Aguirregoicoa Merran McRae Chris Dowse Ajit Mehrotra

EC/12/123

CCG Chair Non-executive Associate and Chair Director for Well-being & Communities Accountable Officer CCG Members

Accuracy of minutes from last meeting 25th April 2012 All CCE members accepted the minutes as a true and accurate record with noted amendments.

Update on action points from last meeting, 25th April 2012 EC/12/90 – Carol confirmed that this item was still ongoing and Natasha is currently awaiting a reply from the LMC.

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EC/12/92 – Action complete.

EC/12/110 - Action complete.

EC/12/111 - Action complete.

EC/12/112 – Rachel confirmed that a fixed sum has been paid to MYHT and the process has been appropriately performance managed. There will be no actual penalty as it will be sanctioned within the contract.

EC/12/113 – Jan advised that Board members need to keep a record of their hours.

Only 2 claims have been submitted recently. A policy has been sent out with further reminders. Rachael advised she had developed a template to record her own hours and this can be shared. Steve confirmed this does need to be recorded for auditing purposes. It can also be used as a record of development.

Action: Steve/Jan to discuss further regarding template to use.

EC/12/114 - Action complete. Khalid requested further information on the 18 weeks areas. It was suggested this could be incorporated into an OD day in 2-3 months time.

Action: Jan to pick this up for OD agenda.

EC/12/115 – Item on agenda EC/12/116 – It was agreed that the subgroups will begin to pick up more detailed discussions on items such as contracts. The group was informed that the F&P and Q&S subgroups will become separate as of 1st September 2012. However the A&G subgroup will remain a joint one until the end of this financial year.

EC/12/117 - Action complete.

Declarations of Interest EC/12/128 – Incentive Scheme - All Practice representatives in attendance.

EC/12/130 – Health Checks - All Practice representatives in attendance.

EC/12/124

Clinical Chair of CCG and Chief Operating Officer update Chris has given apologies for the meeting. Steve provided the update on her behalf.

A discussion took place regarding the information provided on the Safe and Sustainable: Court of Appeal’s Judgement. Helen advised that an outcome is still awaited on this case, after which it will be picked up by SCG.

EC/12/125

Contracts Report Rachel provided an overview of the Contracts Report. Rachel confirmed that the detailed reports will start to feed into the Finance & Performance Committee with a high level summary coming to CCE. The report provided was discussed at the F&P earlier this month but not in great detail.

Rachel advised that the information is only current to the end of February as year end data is not yet available. Rachel will seek further detail on the referrals information.

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Some of the access monies were used for this but the 18 weeks waiting list is still increasing. Specific specialties have also seen increases in waiting lists.

Action: Rachel to source the relevant information relating to referrals and provide update at a future meeting.

Overall performance figures for MYHT were discussed and Rachel advised that day cases have gone up and elective has gone down. Discussions took place regarding possible shift in activity to explain this. Questions were raised regarding where to submit any challenges and Rachel confirmed this should be done via the Contract Management Board and/or Contract Quality Board.

EC/12/126

Cataract Pathway Sue Richardson advised that a business case went to the CCE in March for 3 Local Enhanced Services, of which 2 of the schemes were approved. There were some issues raised around the Cataract Pathway. This has since been discussed in detail at the CSG meeting and brought back to the CCE for final sign off.

Sue advised that this had been discussed at SCG and some dialogue had with consultants at MYHT. SCG have recommended that it be approved. The start date has moved and will now be approximately end of July/early August and all 3 schemes will start at the same time.

Sue advised that the LES’s will need to be marketed to practices and also highlighted at forums. A question was raised regarding whether there were any age limits to any of the schemes. Sue advised she would clarify that point and feedback.

Action: Sue to clarify if there are any age limits to the Ophthalmology LES’s and feedback to CCE. All approved the Cataract Pathway.

EC/12/127

Quality & Safety Report Deborah presented the report to the CCE. Deborah asked for feedback on the content of the report including the level of data/information provided. The CCE AGREED the content was suitable.

The breaches at MYHT were discussed and Deborah advised the CCE to acknowledge the work undertaken on these breaches. MYHT are taking steps to deal with them.

Cdiff – there is an action plan in place to deal with the numbers of cases recently reported.

Serious incidents - Deborah provided an update on the Endoscopy SI detailed in the report. There has been an action plan put in place and increased infection control visits. Deborah recommended that Jane O’Donnell be invited to the next CCE to provide a further update.

Action: Infection Control update to be added to June agenda.

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CQC have recently given an inspection at MYHT in relation to the staffing of maternity services. There is lots of work taking place around the specification for this which will include midwifery ratios and appraisals. The specification still needs to be signed off.

Rachael highlighted concerns with community staff being stretched across practices.

Helen suggested looking into the numbers of births against midwife ratio.

Farhad highlighted that he had recently attended an annual review by the SHA on behalf of the Cluster which has changed his perspective of the Quality & Safety Report. This has highlighted the need, as commissioners, to be aware of these issues, going forward. Deborah recommended inviting MYHT to a future meeting to explain/assure the CCE that this issue could be prevented in the future.

Action: Deborah to speak with Chris/David to agree how to pick this up with MYHT. Steve confirmed he is working on a piece of work with Chris to coordinate the different workstreams and advised the CCE this would be shared with them in due course.

Asthma in A&E figures was discussed and Helen advised that work is ongoing around managing children with asthma. Deborah agreed to look at sourcing further information.

Action: Deborah to source more information regarding the asthma in A&E figures and feed back to the CCE. The CCE thanked Deborah for her report.

EC/12/128

Incentive Scheme Jackie advised that a decision was required from the CCE about the scheme. 30 out of 31 practices had responded at the last forum in agreement to the scheme. The options were discussed and Jackie advised that the preferred option would be No 3, which would give practices the choice to remain with the current cohort and funding or reduce them by 50% as the outcome of the payments will remain the same.

Discussion took place around giving the appropriate level of trust to practices with the scheme. All practices are in support of the scheme but there is an issue around the quality aspect of it.

Jackie advised she would need to write out to practices as soon as possible as Murray Forrest will need to adapt the cohort. Another option would be to review the cohort with a view to running the scheme for 11 or 12 months.

All agreed that Option 3 was the most viable and that it should be kept at 11 months.

EC/12/129

CSS Update Alison Hughes introduced herself and advised that she has been in post for around 6 weeks now. Introductions were made from the CCE members.

Alison informed the CCE that an outline business plan was submitted at the end of March. The CSS has recently passed Checkpoint 2, the next Checkpoint being in August. Customer engagement was a nig part of the last checkpoint. The next part of

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the assessment regarding delivery and finances of the CSS. It is expected that 50% of the staff will be embedded into CCGs with 50% of the support coming from the CSS. The operating model is based on principles such as working closer together, specialists subjects etc.

A draft order book has been developed and will be finalised by the end of May. There was a staff engagement event recently which went very well with around 130 attendees. 50 questions were developed into small workshops called an “open space” event. The next event is on 28 May with over 200 people booked on. There is a mix of PCT/CSS/CCG staff attending.

Alison provided an example in order to explain how the services of the CSS could work. IM &T will be provided by CSS for the 10 CCGs across the patch. Although other areas of the SHA could be included. There will be sub-contracting mechanisms used to provide these services to CCGs. Further discussion took place about the current level of service provided by THIS, and how this could be developed/progressed in the future.

It was agreed that a level of trust would be required between the CCGs and the CSS in order for the relationship to work. Alison advised that the role of CSS is to provide the support that CCGs require, which may not necessarily fall within the CSS’s remit. It was agreed that both CCGs and the CSS need to develop and evolve and there needs to be a degree of flexibility in the services provided.

Further questions were raised around the contracts that are in place with certain services now, and also any new contracts that need to be developed. Alison confirmed that all these areas need to be worked through in further detail.

The CCE thanked Alison for her attendance.

EC/12/130

Health Checks Sarah Muckle provided a brief update.

This scheme has previously been to the CSG for detailed discussion. It has also been fully supported by the LMC and the Finance & Performance Committee.

Sarah highlighted the key points; • This is a 5 year rolling programme, practices will therefore need to manage the patients carefully.

• There will be possible financial implications in the future for the CCG if uptake is high but some of the costs will be recovered via a combination of the existing Locala budget and finances agreed via the Finance and Performance Committee.

• Discussions have taken place regarding the Phlebotomy LES currently in place.

Steve confirmed that this is a robust scheme and any future financial implications have been noted by the finance team.

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Sarah advised that this scheme will fall within the remit of the Local Authority in the longer term.

Sarah confirmed that for the 3 practices who declined to take part in this scheme, their patients could be picked up via inter-practice referrals. The start date is yet to be conformed but it is expected to be July. Sarah has attended the Practice Manager meeting to discuss the implementation of the scheme.

All CCE members approved this scheme.

EC/12/131

GPwSI Deborah advised that the Cluster wants CCE approval for this specification. Farhad informed the CCE that this is a reasonable specification. Jan informed the group that there is currently a dermatology service which needs to be regulated using this policy.

Resource was highlighted as an issue.

All CCE approved the specification.

EC/12/132

Performance Report Natalie presented the key points from the report; • The information reported around A&E and 18 weeks relates to March year end data. These areas have caused problems for most of the year and detailed action plans are now in place.

• The YAS data is still awaited.

• Next month will be an exception report of year end which will highlight any under-performances and issues.

• Staff sickness levels at MYHT was discussed and Natalie agreed to source further data. Deborah advised she would include the information from the recent surveys for staff, in-patient and out-patients.

Action: Deborah to include survey data in report.

Further discussion took place regarding how patients are selected for the different surveys and Natalie advised that she was happy to discuss this outsider the meeting.

An amendment was noted within the report relating to a practice name stating Kirkheaton which is a GHCCG practice. Natalie to amend.

Dentistry was discussed and Tony raised a question about the figures that were reported. Natalie informed the CCE that the Department of Health provided toolkit to show these figures, however they don’t add up. There hasn’t been a formal sign off from the DH so the report will show as an underperformance unless the DH clarifies this point. Natalie confirmed that there isn’t a backlog of patients.

Steve advised that dentistry will pass to the Commissioning Board and he has discussed this with Mark Jenkins to ascertain if there are any gaps across the Cluster.

There is a new recall programme being developed for dentally fit adults to enable them to be seen every 2 years, rather than 6 months as it currently stands.

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Maternity & breastfeeding - Natalie informed the CCE that the target for attendance at 12 weeks hasn’t been met. The coverage for breastfeeding in this area is worsening.

The CCE thanked Natalie for her report.

EC/12/133

NHS Transition Board to Board Tony informed the CCE that this meeting had been positive and there was a sense of the team operating together. However it was noted that there wasn’t much clinical representation on this occasion.

Discussion took place around the positive areas and what can be focused on going forward. Areas of learning can be taken from other CCGs. Authorisation Jan confirmed that the interviews for the Authorisation post were taking place week commencing 28 May and that there had been 34 applicants. Jan advised that the candidate will hopefully be in place in the next 4 weeks.

Jan advised that the minutes submitted from the Authorisation & Development meeting on 26 April were only in draft format and therefore need to be removed.

Action: Minutes to be removed from CCE papers and removed from agenda.

Action: CCE members asked to shred/delete any copies of the minutes they have.

It was noted that the Authorisation group recommended the application for authorisation be submitted into Wave 3, however we have been approached with a request to move to Wave 4. The 360 survey will still go out to practices in September.

This just means that the dates are moving forwards by 4 weeks. The submission will now be 1st November instead of October and the result will be available on 31 January 2013. It was acknowledged that there was some benefit of knowing how the other 3 waves have proceeded.

People transition Steve advised that this is progressing and staff are now becoming aligned with CCGs and CSS. HR are developing a timeline starting backwards from March 2013 showing how to align staff. Guidance is still awaited from the DH but there is increasing pressure to make a start on this. The Role Content Specification process is very important and will help to model the function mapping.

Steve advised that the CCGs now have an SMT in place. The CSS have almost finalized their own SMT. The next steps will be the job descriptions for the structures.

Following that will be the pooling/matching to jobs. It is anticipated that this will take place over the summer months. Steve informed the CCE that a slight amendment has been made to the banding of the Head of Finance and Head of Contracts.

EC/12/134

Receipt of Minutes All members received, noted and approved the contents of the minutes as listed below:

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

Kirklees Local Medical Committee – 14th March 2012 The midwife flu training was discussed at this meeting. It was noted that midwives don’t currently have the time to undertake the training. This needs to be discussed further with practices and they need to encourage uptake with their midwives in practices.

A concern was raised regarding the number of enhanced services. Jackie confirmed that a piece of work is currently being developed to review the schemes. A further concern was raised regarding where the LMC may sit in the future.



EC/12/134

NKHA Authorisation and Development meeting – 26th April 2012 It was requested that these minutes be removed from circulation.

Any Other Business Mid Yorkshire Quality Account Deborah requested that the CCE scrutinise the report and comment if appropriate.

There is a letter included from Steven Eames with a list of priorities and Deborah requested confirmation from the CCE that this fits with our priorities. Discussions took place regarding how to collate comments to formulate a response.

Action: Deborah to collate comments from CCE members and feedback.

Risk Register Deborah provided an update on the paper on behalf of Terry Service. This is currently a corporate risk register but some risks are tagged to North Kirklees. A piece of work is being carried out to ensure this is reflected accurately. Steve confirmed that the risks will then be reviewed to see what is appropriate and will be linked to a CCG Manager.

There will be a further review at CCE in 3 months time.

It was agreed that Imran, Jan and Deborah would meet to discuss the content of the risk register before reporting back to CCE. Action: Jan, Imran and Deborah to arrange a meeting to discuss risk register further.

Management Allowance Steve confirmed an increase in sessions for David, Yasar and Rachael have been included in the management allowance.

Admin Support Jan confirmed that Nikki Gibson would be the maternity cover for Kelly Singleton and will be starting immediately.

OD Day It was agreed that a brain storming session would be required to review the roles of the CCE members. Apologies for the session were noted from Yasar, Rachael, Imran and Khalid.

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EC/12/135

Matters to escalate to Cluster Board Nothing to report this month.

EC/12/136

Date and Time of Next Meeting Wednesday 27th June 2012 9.00am – 12.30pm Board Room, Broad Lea House

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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