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NHS Wakefield Clinical Commissioning Group CLINICAL COMMISSIONING EXECUTIVE Minutes of the meeting held on 28 June 2012 King’s Medical Practice, Normanton Present
Dr Phil Earnshaw Dr Adam Sheppard Dr Ivan Hanney Sandra Greenwood Sam Pratheepan Elaine McHale Jan Power Jo Webster
Jim Hayburn
In Attendance
Sandra Cheseldine Adam Bassett Matt England
Elaine Horder
Lee Beresford
Cat de Jonge
Jayne Beecham
Chair, Wakefield Alliance GP, Lupset Health Centre GP, College Lane Surgery Nurse Manager, Ferrybridge Medical Centre Wakefield Council Wakefield Council LINks Representative Shadow Accountable Officer NHS Wakefield Clinical Commissioning Group (CCG) Chief Financial Officer, NHS Wakefield CCG Non Executive Director Corporate Risk Manager, NHS Wakefield District (NHSWD) Head of Contracting and Commercial Strategy, NHS Wakefield Clinical Commissioning Group (Minute 12/124 only) Quality Improvement Facilitator, NHSWD (Minute 12/124 and 12/125) Head of Strategy and Strategic Planning, NHS Wakefield Clinical Commissioning Group (Minute 126 and 127 only) Senior Commissioning Manager, NHSWD (Minute 126 and 127 only) Senior Communications Manager, NHSWD (Minute 127 only)
12/117 Apologies Apologies were received from Dr Andrew Furber, Dr Avijit Biswas, Dr Ann Carroll, Dr David Brown, Dr Dewhirst, Dr Clive Harries, Rhod Mitchell and Stephen Bryan.
12/118 Declarations of Interest Dr Earnshaw reminded members of the requirement to declare any interests which related to any items on the agenda. This could either be undertaken at this point or when the matter was considered on the agenda. Dr Earnshaw declared an interest in item 9, appendix 6, Letter of Support for the Chair. 12/119 Chair’s Update Dr Earnshaw highlighted that a meeting would be taking place on 12 July 2012 between the Board of the Mid Yorkshire Hospitals NHS Trust (MYHT) and Dr Sheppard, Rhod Mitchell, Jo Webster and himself, as representatives of the Clinical Commissioning Executive. This meeting would be to share the outcome of a meeting MYHT would be having with the Department of Health to consider the future development of the Trust. 12/120 Minutes of the meeting of the Wakefield Alliance Clinical Commissioning Executive Meeting held on 22 May 2012 It was RESOLVED that i)
The minutes of the meeting of the Wakefield Alliance Clinical Commissioning Executive Meeting held on 22 May 2012 were agreed as a correct record.
12/121 Matters Arising from the Minutes of the Meeting of the Wakefield Alliance Clinical Commissioning Executive held on 22 May 2012 Adam Bassett updated the Clinical Commissioning Executive (CCE) on progress of the actions discussed at the meeting on 22 May 2012. The following item was also discussed: 12/94g
Shadow Accountable Officer’s Report: Report to the CCE on Adult Community Nursing
Jo Webster advised that work had been undertaken to develop the fairshares formula for Adult Community Nursing. However a decision had been made to pause slightly and reflect on this piece of work due to developments taking place elsewhere as part of the transformation agenda, such as the ‘5 a day’ project relating to hospital discharge. Jo Webster advised that it was therefore important not to redevelop the service in a manner which was not sustainable in the longer term. She advised that a wider report would be brought to a future meeting once available. 12/122 Shadow Accountable Officer Update Jo Webster introduced this report noting the following:
Board to Board meeting It was highlighted that a NHS Wakefield CCG and NHS Calderdale, Kirklees and Wakefield District (CKW) Cluster Board meeting had taken place on 23 May 2012. The focus of the meeting had been to review the progress made by NHS Wakefield CCG, since a previous meeting in December 2011, in terms of establishment and preparation for Authorisation. It was highlighted that the approach was developmental and aimed to identify how the Cluster could best support NHS Wakefield CCG. Attached as appendix 1 to the report was a letter from Angela Monaghan, Chair of NHS CKW to Dr Earnshaw providing feedback on the meeting in which she described the meeting as productive and enjoyable. Jo Webster also noted her thanks for the staff who had been involved helping to provide and present at this meeting the analysis of NHS Wakefield CCG’s position on progress made in preparation for authorisation. It was RESOLVED that i)
the report be noted.
12/123 Finance Report Jim Hayburn introduced a report which presented the financial position of NHS Wakefield District for May 2012 and the forecast year end position based on this position. It was reported that at the end of May NHSWD was showing a small underspend of ÂŁ202K with a forecast year end position of break even. It was noted that NHS Wakefield District and NHS Wakefield Clinical Commissioning Group (CCG) were on track to achieve each of its key financial objectives. Appendix 4 to the report showed the 2012/13 capital planning position. It was reported that there was no direct allocation this year but that any capital expenditure would be funded from the sale of Knottingley Health Centre land. Appendix 5 to the report outlined QIPP projects and achievement against planned efficiencies. It was noted that there would be a QIPP report presented at the next meeting and this would be followed by regular quarterly updates. QIPP would continue to be monitored by the Finance and Performance Group on a monthly basis Appendix 6 contained information relating to the commissioned services which would be devolved to NHS Wakefield CCG. Following a discussion it was agreed that in future this report would be amended to provide a more strategic overall view. More detailed practice budget information would be received every six months, and the method for this would be determined by Jim Hayburn.
Sandra Cheseldine noted that the report identified areas of financial risk and enquired whether these areas needed to be updated. In reply Jim Hayburn advised that these were required at this stage in the financial year but that the areas identified would be reviewed after the end of quarter 1. It was RESOLVED that i)
the revenue financial position at the end of May be noted;
ii)
the position on the capital allocation for 2012/13 be noted.
iii)
a full QIPP update be provided to the next meeting and thereafter on a quarterly basis;
iv)
the NHS Wakefield Clinical Commissioning Group finance report be updated to provide a more strategic view and that detailed information on practice budgets be provided on a six monthly basis in a manner to be determined by the Chief Financial Officer.
12/124 Performance Report Matt England introduced a report which informed the Clinical Commissioning Group of NHS Wakefield District’s closing performance position against the 2011/12 NHS Operating Framework outcome measures, together with a comparison between 2010/11 and 2011/12. Appendix A of the report set out a summary year end position detailing actual activity against plan. Appendix B of the report demonstrated a comparison between the 2010/11 outturn and 2011/12 for 24 indicators where previous monitoring had taken place. The CCE received detailed information regarding the following areas: • • • • •
18 weeks referral to treatment target Accident and Emergency Waiting Time Standard Cancer Waiting Times – 62 Day Wait Stroke: Transient Ischaemic Attack Choose and Book
As had been requested at the previous meeting information was provided regarding NHS Health Checks. The CCE was advised that for 2012/13 a trajectory of NHS Health Checks received was reduced to 8,000 but the offer target remained high at 22,000. During 2010/11 26,992 health checks were offered against a target of 19,800. However the number of checks received underperformed at 9.8% against a local target of 13.6%. It was highlighted that a second Health Equity Audit was to be undertaken to understand the delivery of the programme and a patient satisfaction questionnaire was to be undertaken to identify any areas that patients felt required improvement.
The CCE noted the disparity between high number of NHS Health Checks which had been offered and the number which had been taken up, acknowledging the difficulties this involved. CCE members highlighted work which had been previously been undertaken by GP practices to increase uptake and discussed suggestions for taking this work forward. Sandra Cheseldine noted that a meeting was taking place with the Yorkshire Ambulance Service and representatives of NHS Wakefield CCG on 4 July 2012 which would cover performance issues. It was RESOLVED that i)
NHS Wakefield Clinical Commissioning Group’s performance against key national and local priority measures for 2011/12 be noted;
ii)
the additional actions outlined within the report to address areas of under performance be agreed.
12/125 Quality and Patient Safety Report Elaine Horder introduced a report which provided members with an update on key quality and patient safety issues across Wakefield District. The executive summary of this report listed the key highlights, areas of risk and current quality and patient safety issues. It was further highlighted that this report had been presented to the Quality Group on 14 June 2012. The report provided information on how quality would be maintained during the transition period and how this area would be handed over to clinical commissioning groups. It was also noted that the outcomes from the review commissioned in healthcare acquired infections at the Mid Yorkshire Hospitals NHS Trust be received at a future meeting The Clinical Commissioning Executive noted the information presented regarding the Hospital Standardised Mortality Ratio (HSMR) and noted that the 2011/12 rebasing of HSMR was likely to flag the Mid Yorkshire Hospitals NHS Trust as a significant negative outlier. A number of reasons for this were outlined within the report however Jo Webster noted the complexity of this issue and advised that a more detailed report on this would be presented at the next CCE meeting. It was RESOLVED that i)
the Quality and Patient Safety report be noted for information, particularly the quality handover responsibility of the Clinical Commissioning Group as a receiving organisation;
ii)
the work of the respective Quality Boards in holding providers to account for delivering safe, effective and quality services be acknowledged;
iii)
the outcomes from the review commissioned in healthcare acquired infections at the Mid Yorkshire Hospitals NHS Trust be received at a future meeting;
iv)
A report on the Hospital Standardised Mortality Ratio be provided at the next meeting.
12/126 Preparing for Authorisation Dr Earnshaw declared an interest in Appendix 6 to the report, Letter of support for the Chair. During consideration of appendix 6 Dr Earnshaw left the room and did not participate in the discussion. Dr Sheppard undertook the role of Chair, for consideration of appendix 6 only. Lee Beresford and Cat de Jonge introduced a report which advised that NHS Wakefield Clinical Commissioning Group (CCG) had been approved by the NHS Commissioning Board to proceed with first wave authorisation. The Clinical Commissioning Executive (CCE) was advised that there were three phases to the CCG authorisation process; pre-application, application and panel assessment. NHS Wakefield CCG was currently approaching the start of the second phase with the opportunity to submit evidence in its application by midnight on 2 July 2012. The second phase was a document based exercise and the procedure required the CCE to approve the following documents, which were attached to the report: •
CCG application form, attached as appendix 1 to the report.
It was noted that the application form was a public document and it was agreed that this would be placed on NHS Wakefield CCG’s section of NHS Wakefield District’s (NHSWD) website. It was further highlighted that there was some inconsistency of terminology in the application and it was therefore agreed that this would be amended prior to submission. •
NHS Wakefield CCG draft constitution and plan, attached as appendix 2. This set out the arrangements made by NHS Wakefield CCG to meet its responsibilities for commissioning care and described the governing principles, rules and procedures the group would establish to ensure probity and accountability.
It was highlighted that it was proposed that the draft constitution would be accepted as a working model that was adopted until anticipated authorisation in October 2012. It was anticipated that it would take a few months before this could be finalised due to the intention to consult with member practices, take account of anticipated secondary legislation and to engage with the Local Medical Committee. •
Organisational Development Plan, attached as appendix 3. This described NHS Wakefield CCG’s progress so far and set out an
organisational development plan for the next stage of the development journey towards authorisation and beyond. •
Case studies, appendix 4. Three studies were attached: Whole system transformation Prescribing QIPP Primary Care Transformation Scheme
The CCE considered the case studies and agreed there should be increased usage of the word ‘partnership’ within these documents. •
Equality and Diversity strategy, appendix 5. This outlined the CCGs approach to meeting its future statutory responsibilities for equality.
It was highlighted that in order to deliver the strategy an action plan had also been developed which was outlined within the report. Following discussion it was also agreed that the strategy would also be placed on NHSWD’s website. •
Letter of Support for Dr Phillip Earnshaw, Chair from Rhod Mitchell, Vice Chair, appendix 6.
During consideration of this item Dr Sheppard noted the high level of support from member practices for Dr Earnshaw as Chair. This letter of support was agreed unanimously by those present. However it was noted that as Dr Earnshaw was not present during discussion of appendix 6 the meeting was not at this point quorate. It was therefore agreed that Jo Webster and Dr Sheppard take this forward outside of the meeting to confirm this decision with sufficient members of the Clinical Commissioning Executive. •
Integrated Risk Management Framework, appendix 7. This integrated risk management framework outlined the way in which NHS Wakefield CCG has effective governance arrangements in place to manage, clinical, financial and corporate risk.
Following a suggestion from Sandra Cheseldine it was agreed that Internal and External Audit be added to the list of key sources of information to check the completeness of risk capture, outlined in section 2.1.1 of the report. •
Running costs of CCG and Commissioning Support Service (CSS) including Order Book, appendix 8. This updated the CCE of the progress made to date on the identification of the running costs of the CCG and to ensure that the sum of these running costs stayed within the allocation of £24.68 per head of population and £8,689k in total.
Jim Hayburn acknowledged that the information contained within the report reflected a current point in time and could be subject to change following ongoing negotiations with the West Yorkshire Commissioning Support Service.
•
Response to Stakeholder survey, this document was tabled at the meeting.
It was highlighted that a further key document, the Communications and Engagement Strategy, would be addressed under a separate item on the agenda. It was RESOLVED that i)
the CCG application form be approved, subject to amendments to ensure consistent terminology and placed on NHS Wakefield District’s website;
ii)
the draft constitution be noted and the timescales for finalisation be approved;
iii)
the organisational development plan be approved;
iv)
following amendments, the case studies to be submitted in support of the application be agreed;
v)
the Equality and Diversity Strategy and Action Plan be approved and placed on NHS Wakefield District’s website;
vi)
the letter of support for the Chair be noted and supported and that Jo Webster and Dr Sheppard confirm this decision with sufficient members of the Clinical Commissioning Executive outside of this meeting;
vii)
the integrated risk management framework be approved;
viii)
the running cost model and Order Book be approved, noting that this reflected a point in time;
ix)
the CCG response on the stakeholder survey be noted.
12/127 Communications and Engagement Strategy Jayne Beecham introduced a report which advised that the Communications and Engagement Strategy was based on an analysis of NHS Wakefield Clinical Commissioning Group’s stakeholders and workshop feedback about engagement. It identified actions that took the organisation through authorisation and establishment. The strategy also outlined the functional, legislative and local context which demanded that the organisation actively engaged and involved a range of stakeholders. Attached to the report was a summary document which outlined the following points: • • • •
What does our strategy aim to achieve? Who are we communicating and engaging with? Guiding principles and key messages Next steps
The full strategy was attached to the report. Following discussion of this item it was agreed that Communications and Engagement Strategy would be placed on NHS Wakefield Clinical Commissioning Group’s section of NHS Wakefield District’s (NHSWD) website. It was RESOLVED that i)
the Communications and Engagement Strategy be approved and placed on the NHS Wakefield District website.
12/128 Minutes of the NHS Calderdale, Kirklees and Wakefield District Cluster Board meeting held on 8 May 2012 Sandra Cheseldine introduced these minutes and noted that this meeting had considered a presentation on the tobacco plain packaging consultation and an update on tobacco control. The Clinical Commissioning Executive also noted and discussed the reference in these minutes to the opening of Accident and Emergency at Pontefract Hospital. It was RESOLVED that i)
the minutes of the NHS Calderdale, Kirklees and Wakefield District Cluster Board meeting held on 8 May 2012 be noted.
12/129 Minutes of the Health and Wellbeing Board held on 10 May 2012 It was RESOLVED that i)
the minutes of the NHS Calderdale, Kirklees and Wakefield District Cluster Board meeting held on 10 May 2012 be noted.
12/130 Minutes of the Finance and Performance Group held on 14 June 2012 Jim Hayburn presented these minutes to the Clinical Commissioning Executive (CCE). Jo Webster noted that concerns regarding MRSA performance at the Mid Yorkshire Hospitals NHS Trust had been discussed at this meeting and that Stephen Eames had requested an independent review in relation to this matter. The Finance and Performance Group had highlighted that a QIPP report would be presented to the CCE in July and that MRSA healthcare acquired infections would considered at this meeting of the CCE. It was RESOLVED that
i)
the minutes of the Finance and Performance Group held on 14 June 2012 be noted.
12/131 Minutes of the Audit and Governance Group held on 14 June 2012 Sandra Cheseldine introduced these minutes and advised that the meeting had considered the Annual Report on Complaints and the Annual Risk Management Report. This was noted by the Clinical Commissioning Executive as requested by the Audit and Governance Group. It was RESOLVED that i)
the minutes of the Audit and Governance Group held on 14 June 2012 be noted.
12/132 Minutes of the Quality Group held on 14 June 2012 Elaine Horder introduced these minutes and advised that this meeting had considered the Quality and Safety report which had also been considered by the Clinical Commissioning Executive. It was noted the Terms of Reference to the Quality Group had been referred to the Clinical Commissioning Group for approval but as these were due to be further amended it was agreed that these would be brought back to a future meeting with further information. It was RESOLVED that i)
the minutes of the Quality Group held on 14 June 2012 be noted;
ii)
the revised Terms of Reference be brought to a future meeting of the Clinical Commissioning Executive for approval.
12/133 Clinical Commissioning Units Update It was RESOLVED that i)
the Clinical Commissioning Units Update be noted.
12/134 Clinical Commissioning Executive (CCE) decisions for Inclusion in the Legacy Document There were no decisions for inclusion in the legacy document. It was RESOLVED that i)
There be no decisions for inclusion in the legacy document.
12/135 Items for referral to the Cluster Board or any of the Sub Groups Jo Webster advised that the she would raise the issue of the Hospital Standardised Mortality Ratio for the Mid Yorkshire Hospitals NHS Trust in her next Shadow Accoutable Officer’s report to the Cluster Board. There were no items referred to the Cluster Board. It was RESOLVED that i)
There be no items referred to the Cluster Board.
12/136 Any Other Business It was RESOLVED that There was no additional business. 12/137 Date and Time of Next Meeting 1.00 pm on 24 July 2012 at White Rose House.