NHS Greater Huddersfield Clinical Commissioning Group
Minutes of the NHS Greater Huddersfield Clinical Commissioning Executive (CCE) Meeting held on Wednesday 3rd October 2012, 1.30 – 4.30pm, Board Room, Broad Lea House, Bradley, Huddersfield Present: Dr Steve Ollerton (SO) Dr Dil Ashraf (DA) Dr Judith Parker (JP) Dr David Hughes (DH) Dr Paul Wilding (PaW) Dr Jane Ford (JF) Carol McKenna (CM) Julie Lawreniuk (JL) Dr Irving Cobden (IC) Angela Monaghan (AM) Vanessa Stirum (VS) Rob Millington (RM) Nicky Hoyle (NH)
CCG Clinical Leader and Chair GP Practice Representative GP Practice Representative GP Practice Representative GP Practice Representative GP Practice Representative Designate Chief Officer Chief Financial Officer Consultant Advisor Nurse Advisor Non-executive Associate Non-executive Associate Public Health Consultant
In attendance: Martin Pursey (MP) Jan Giles (JG) Vicky Dutchburn (VD) Kath Woodford (KW) Lynsey Warwick Giles (LWG) Esther Silva (ES) Sarah Cowman (SC) Julie Tolhurst (JT) Sarah Muckle (SM) Debi Hemingway (DebH) Rob Willis (RW)
Head of Contracting Head of Practice Support & Development Head of Strategic & Business Planning Business Reporting Manager Research Analyst Graduate Management Trainee Head of Communications Public Health Consultant Public Health Consultant Lead Commissioner, CAMHS Finance Manager
Minutes: Kelly Chadwick (KC)
Personal Assistant to Greater Huddersfield CCG
EC/12/186
Welcome, Introductions and Apologies for Absence SO opened the meeting and welcomed the CCE members. Apologies for absence were received from; Dr Anuj Handa (AH) Dr Karen Dean (KD) Penny Woodhead (PeW) Mehboob Khan (MK) Merran McRae (MM)
GP Practice Representative GP Practice Representative Head of Quality & Safety Non-executive Director Director of Wellbeing, Kirklees Council Page 1 of 14
Declarations of Interest No declarations of interest were noted. Research LWG informed the members that her research was starting to come to an end and she would need to interview some CCE members. She advised she would making contact shortly and asked if everyone was happy for her to do this. All AGREED. EC/12/187
Accuracy of Minutes of 5 September 2012 EC/12/172 – Clinical Leader/Designate Chief Officer Report It was noted that the section titled “CSS” was incorrect and should be amended to read “West Yorkshire LAT” CM advised that the Director post was still vacant but a number of other posts have now been filled. EC/12/172 – Clinical Leader/Designate Chief Officer Report – Maternity Triage It was noted that this section was incorrect and that GHCCG had AGREED that the service could commence in its new form. EC/12/173 – Finance, Contracting & QIPP Report It was noted that the new Tier 2 Pain Service starts in January and not November as stated in the last minutes. EC/12/180 – Strategic Review update It was noted that SO was one of 2 Vice-Chairs of the SR Board and not “the Vice-Chair”. EC/12/184 – Any Other Business – YAS Report It was noted that this item needs to be amended to read as follows; “CM informed the CCE members that this has been discussed again recently at F&P and it had been AGREED that the performance figures for YAS at overall and locality level would be kept under review through F&P. Given that detailed consideration had been given to the performance shortfalls in some localities, and a number of actions taken, this level of detail would not need to be reported to the CCE on a regular basis as had previously been the case. The minutes were AGREED as accurate with the amendments as noted above. Action: KC to make amendments as noted.
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Matters Arising EC/12/169 – Action Log – Mapping of Subgroups CM confirmed that this had been presented at the last Audit & Governance Subgroup meeting and a paper will be presented to a future CCE. EC/12/169 – Action Log – Accountability of Chair CM confirmed there was no further information available regarding this at present. EC/12/172 – Clinical Leader/Designate Chief Officer Report - Public Meetings CM advised that Ilse Newsome had proposed to bring the Board observations report to the next OD & Authorisation Subgroup for formal feedback. It has now been AGREED that the CCE will start to meet in public from January onwards after authorisation. EC/12/172 – Clinical Leader/Designate Chief Officer Report – Mid Yorkshire update CM advised that Neil Goodwin had produced a report for further discussion with the SHA/NHSCB and commissioners. Action Log EC/12/169 - Accuracy of Minutes of 8 August 2012– Stroke Rehab Patients CM advised that CHFT have advised that they had discussed their proposals with the Overview & Scrutiny Panel who had requested some further information. This has been submitted and a response from the OSC is now awaited. Jonathan Webb from CHFT will be keeping GHCCG informed on the developments. EC/12/169 - Accuracy of Minutes of 8 August 2012– Locala Budgets for Health Checks An action was noted as follows; RC to provide further information on the figures for the Locala budget for this service. JL confirmed she would pick this up and feedback next month. Action: JL to provide information relating to the Locala budgets for Health Checks. EC/12/173 – Finance, Contracting and QIPP Report JL confirmed that the Contract report will now show information relating to all providers. This will be seen for the first time at the October F&P Subgroup before being reported to the November CCE.
EC/12/178 – Estates Page 3 of 14
JL advised that Keith Geldard had provided a report that included agreement on the next steps of this programme. JL confirmed she would share the report with CCE. SO asked how we could influence areas like this. JL suggested this is something we need to build on in the future. JL informed the CCE that Keith Geldard is moving to NHS Property Services but will be the CKW lead. EC/12/178 – Receipt of Minutes – Audit & Governance Subgroup An action was noted as follows; “PeW to review Complaints Report and present in more detail at future Audit & Governance Subgroup.“ It was AGREED to bring forward the action for PeW due to her apologies at the CCE meeting today. Action: PeW to feedback on this action next month. All other actions were confirmed as complete. EC/12/188
Clinical Leader/Designate Chief Officer Report CM highlighted some key points from the report. Lay Members CM confirmed that two new lay members have now been appointed and will commence on 1st November. CM formally thanked both VS and RM for their continued support and work for the CCG and confirmed that they will still be involved with the CCG and PCT Cluster until the end of March. PaW also thanked them both for their ongoing advice during their time as CCE members. NHS 111 CM informed the CCE that no formal confirmation has been received regarding the lead contractor CCG and advised that GHCCG have expressed an interest in becoming this lead. The Programme Board are due to meet on Friday 5 October and JL confirmed an update would be available next month. Action: JL to provide an update on the NHS 111 lead contract at November CCE. Staff Awards – Friday 30 November CM invited CCG members to attend this event and advised it will be the final PCT awards and a chance to thank staff formally. Authorisation Site Visit CM explained that a number of staff are working extremely hard at present in relation to our upcoming site visit. CM advised that once the visit has taken place, the team will be in a better position to prepare the CCE papers further in advance and tidy up formatting and presentational issues. SO highlighted some further points to note from the report. Page 4 of 14
Troubled Families SO noted that there was an inaccuracy in the text of the report and it should read that Kirklees Council are aiming to find 310 troubled families across both CCGs to be able to provide support to them. AQP JG provided a brief update on how and when this information was being shared with practices. SO asked IC if he had any comments on AQP. IC advised that in his experience, as long as the service was efficient in meeting a need for patients then there was every reason to use this service. SO advised that this was something we felt we had to undertake, and it wasn’t specifically to meet patient needs. JG informed the CCE that there are no actual guidelines for the service yet but they would be useful. DA advised that each of the specialties have guidelines to be followed. Referral Pathway Software SO advised the CCE that further discussion had taken place regarding the referral pathway software and how this was progressing. JL AGREED to ask Debbie Graham at Calderdale for an update on this and feedback next month. Action: JL to speak with Debbie Graham to receive an update regarding the referral pathway software. The CCE RECEIVED and NOTED the contents of the report and thanked SO/CM. EC/12/189
Chronic Pain Tier 2 Service Contract JT/SM were in attendance to provide an update. The contract has been awarded to InForm and as this is over £500k over 3 years it will need to go to Cluster Board for approval. JT advised that the CCE needs to recommend approval to Cluster Board. JT explained the pain service and the management programme to the CCE. SO asked if there was any further information available on the site for the provision of the service. SM informed the CCE that there wasn’t anything to report at the moment other than it will be a central site. SM informed the CCE that there has been a delay due to the processes in place regarding reporting the information to both CCE and the Cluster Board. A meeting has been arranged for the 4 October with InForm to discuss issues regarding the contract.
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DA suggested setting up a database of potential sites for premises for these types of services. MP advised this would need to be developed via a CCG profile and could be advertised on our website. Discussion took place about how to progress this and DA suggested speaking to practices, as well as other organisations such as the local authority, to ascertain who is interested. JL suggested asking the Estates team for help with this initially. IC asked if there had been clinical input into this and SM confirmed that there has been clinical involvement all way through the tender process and we also have a clinical pathway in place if we need it. AM asked if there is to be a break between the current service ending and the new one starting. SM confirmed that there will be a break of 3 months but there are only 5 patients currently left on the waiting list and provision has been made for them. Discussion took place regarding the dissemination of information to practices and it was noted that some of the information would be put on to the website. The CCE RECOMMENDED approval to the Cluster Board. The CCE thanked JT/SM for their attendance. EC/12/190
Developing Our Strategic Objectives VD informed the group that this report followed on from the OD Day held on 29 August 2012 where various exercises were carried out. VD had reviewed all feedback received and found 23 overall objectives. VD explained the slide she had produced and how they are link together. The Triple Aim framework was discussed and VD explained the framework to the CCE. VD asked for agreement on the next steps which are; • Take this to practice visits for discussion with practice representatives. • Agree for SMT to link with Ilse Newsome to develop an assurance framework. VD confirmed she is currently working on a piece of work for QIPP with Natalie Ackroyd from the Performance Team and this will be built into our business case proformas and will be used as our profile. CM suggested exploring this further during future OD session. CM asked about how we will engage with our practice population on our strategic objectives. VD explained that there are various ways to engage with patients but we need to agree on the best and most suitable route to pursue.
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JG confirmed we can work with practices and patients on this but would potentially need a script to ensure consistency. It was AGREED that VD would link with JG to look at engagement with practices in more detail. AM asked how to ensure we involve nurses as well as other practice staff. VD confirmed this could be picked up via PDRs or training sessions. AM suggested it needs to be individual as well as localised. PaW commented that this links to the SR very well. The Strategic Review Board is also building on development around the triple aim objectives. Discussion took place about monitoring the objectives and knowing whether it has been successful. JL advised that the assurance framework will ensure this happens. Further discussion took place regarding the accuracy and the content of some of the objectives and whether it could be read differently by different people. It was AGREED to change the wording of 3c but keep the rest of the document as it stands. VD thanked the CCE for their comments and advised the changes would be made accordingly. It was AGREED to bring this back in January for further review. Action: VD to make amendments as suggested and give consideration to how best to share with our population Action: Strategic Objectives to be included in practice visit packs. JG to action. Action: Strategic Objectives to be reviewed at January CCE. KC to action. The CCE RECEIVED and NOTED the contents of the report and thanked VD. EC/12/191
Membership Report JG explained that a discussion has recently take place at SMT regarding what type of reports should be submitted to CCE. It was AGREED that the membership report would be brought for approval. JG explained the sections of the report; • 360 survey feedback • Member involvement activities • Issues relating to the NHS Commissioning Board and LAT • Research - JG advised that she had recently received an update that there had been 5 expressions of interest for this programme and that the shortlisting was on Monday 8 October. JG is to be involved along with Karen Gallagher.
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JG asked the CCE for any comments or questions. PaW suggested using the practice issues log more regularly. This needs to be brought to CSG for more detailed discussions. All AGREED. Action: Practice Issues log from practice visits to be added to CSG agenda for further discussions. JP asked about other areas to be included such as practice quality and development and queried whether this should be picked up via the Quality & Safety Subgroup. RM suggested showing this report to the public, VD suggested the newsletters were also an option. CM advised that we need to think about how we engage with the media going forward. JG asked how often the CCE wanted to see this report and if the format was suitable. It was AGREED the format of the report was suitable and it should be brought back on a quarterly basis to tie in with practice visits. The CCE RECEIVED and NOTED the contents of the report and thanked JG. EC/12/192
CAMHS Tier 3 Specification Debi Hemingway presented the report and advised this was still in draft format. Debi apologised for the report being shared with CCE members late and advised that any comments would need to be sent back to her by Monday 8 October. Debi explained that this is shared service between Kirklees and Calderdale. The contract for the Tier 2 service has been awarded to Northorpe Hall. The Tier 3 service focuses on children with severe mental health problems. GP referrals will go to the Tier 2 service initially and triaged before being referred onto Tier 3 if required. The process can also be reversed if needed. There is also a Tier 4 service which is for in-patient beds. Debi explained that the service specification also included looked after children, adopted children and children with learning disabilities. It has been developed in consultation with the company “Young Minds�. JP asked about the current gaps in service and children having to go to other services away from the Kirklees area. Debi confirmed this should now be picked up via this service.
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CM confirmed that this specification should have gone into CSG for further debate but due to constraints within the September meeting cycle this was not possible. CM suggested that CCE members take the time to read the specification properly and forward any comments to SO by the end of the week. SO has the authority to sign the specification off on behalf of the CCG. SO AGREED to feed any comments he receives to Debi by Monday 8 October. The CCE RECEIVED the report and thanked Debi Hemingway for her attendance. EC/12/193
Risk Register CM explained the report and advised that this is usually an online format. SMT look at the register on a regular basis but this will also be picked up via the Subgroups. The report does show GHCCG but all the current risks are tagged to NHS Kirklees. We have identified Health Checks as a new risk to be added and there are potentially one or two others It was AGREED to only report high level risks over level 15 only to CCE. It was noted that the Strategic Review objectives need to be added and VD confirmed there is also a separate risk register for the SR. VD advised she is working with Debbie Graham to capture a consistent risk report for the SR which will include Calderdale and Greater Hudds CCGs information.
EC/12/194
NHS Transition People Transition CM advised that the HR Transition microsite was now available and this holds information relating to the timelines, role content specifications, and guidance. CM advised that there is also a functions based timeline on the microsite which showed how each specific area/team was mapped to a function. CM reiterated the need to have clinicians involved in interview processes where possible and highlighted this will be at short notice. CM informed the CCE that an event is being planned for late November involving the CCE and all new GHCCG staff. Further information will be shared once agreed. Preparation for Authorisation JG confirmed that we are expecting the desktop review report to be received on 4 October. There will be a 2-day turnaround to correct any factual errors. The final version will then be shared. Page 9 of 14
JG advised that the self certification questions would be discussed in SMT. A briefing has been pulled together and each question will have an SMT member assigned to it along with a clinical lead. This will be shared with the clinical leads as soon as possible. SO thanked everyone involved for their ongoing commitment and work. EC/12/195
Strategic Review update PaW gave an update and highlighted some key points; • • •
There was a partnership update given at the Steering Group Gateway one review for the Carestreams has taken place. The critical path was discussed. The programme lost 9 weeks in the early days and the timeline has been changed to accommodate this. However no more slippage can be afforded now. The SR is scheduled to commence public consultation approximately April 2013.
The CCE RECEIVED and NOTED the progress and thanked PaW for the update. EC/12/196
Finance & Contracting Report JL informed the CCE that a detailed report was presented to F&P a week previous and this was a high level overview only. The key points to note are; • NHS Kirklees are on track to meet their controlled total forecast. • GHCCG are slightly underspent overall but slightly overspent at CHFT. However we won’t be charged or have to pay the overtrade due to the fixed contract. • QIPP information has been provided but more information will be presented next month. A further meeting has been arranged w/c 8 October to look at QIPP in detail. • Non-recurrent spending plan – GHCCG have £3 million to spend quite quickly. JL noted there is a risk with spending non-recurrently. • NHS Kirklees financial duties are reporting green across the board. SO queried the activity variance on the outpatient first attendances as they are high figures. DA advised this is because they are being paid more in some areas. SO asked how QIPP will be reported. JL reiterated this would be discussed in more detail at the next F& P subgroup meeting on 17 October. Page 10 of 14
Practice Budgets RW was in attendance and presented the information relating to practice budgets. RW explained that this had been discussed at the recent F&P subgroup meeting and he would only highlight key points; • The methodology behind the practice budgets is that they are based on weighted capitation. The prescribing budgets are based on fair share. • It had been AGREED at F&P not to send all the information out to practices but to advise them it would be available on the web browser from 9 October onwards. This would also show actual spend. • It was also AGREED that the information would be presented to practices at the December plenary. Action: Tabletop on finance to be included on December plenary agenda. Discussion took place about the need to hold a “so-what” type of conversation with practices regarding how to manage the practices that continually overspend. JG asked how the fair share figures were arrived at. RW confirmed this was based on last year’s figures as there is no new toolkit as yet. The CCE RECEIVED and NOTED the contents of the report and thanked JL. EC/12/197
Performance Report KW was in attendance and presented the report. The key themes to note are; • Unplanned hospitalisation for both adults and children • Emergency conditions • Cdiff • Other referrals Unplanned hospitalisation KW explained the unplanned hospitalisation for adults and advised that asthma was included in the figures. Discussion took place about how to tackle the performance issues. JL advised that nonelective care would be added to the CSG agenda for 24 October for a more detailed discussion. Discussion took place about the Carestreams and liaising with Rachel Carter regarding Planned Care to avoid any duplication. It was AGREED that the actions already in place should be noted and further agreement be reached on what information need to be reviewed further. Page 11 of 14
VD explained that the CSG on 10 October was focussing on the Strategic Review and the Carestreams and this would then feed into a more detailed discussion at the CSG on the 24 October around non-elective care in particular. NH suggested analysing the data in advance of the CSG on 24 October. It was AGREED to take this into SMT on 9 October for further discussion on how to take this forward. Action: Non-elective care to be included on SMT agenda for 9 October for agreement on how to take forward at CSG. KW explained that unplanned hospitalisation for children was in the same position as the adults. Cdiff Activity is currently above what was planned for the entire year. If the activity remain as they are, both Cdiff and MRSA will exceed the yearly planned figures. JP confirmed that there are different types of the Cdiff bug being reported. Contract and Activity There has been a huge increase in non-elective and other referrals. Initial investigations are showing this as NT scans. There has been erratic fluctuation regarding elective and GP referrals. Choose & Book A brief discussion took place and it was noted that the figures need to improve for GHCCG but we are above average overall in the Yorkshire & Humber area and have been since February. JG advised that Choose & Book was going to be on the November agenda for a more detailed update. ENT DA highlighted that both referrals and activity are increasing and feels this needs picking up and discussing in detail via the Planned Care Carestream. The CCE RECEIVED and NOTED the contents of the report and thanked KW for her attendance. EC/12/198
Quality & Safety Report PeW had sent apologies and JP provided an update. JP highlighted the key points from the report; • Mixed sex accommodation – no issues • CQC activities ongoing • Ongoing work regarding VTE and this will be discussed at the next CQB. One red area noted is regarding the sensitivity of breaking news to cancer patients. Page 12 of 14
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MRSA – JF advised that an infection control team from Leeds are carrying out some work to manage this.
The CCE RECEIVED and NOTED the contents of the report and thanked JP. EC/12/199
Receipt of Minutes The CCE RECEIVED and NOTED the minutes of the following meetings; • Shadow Health and Wellbeing Board (05/09/12) • OD & Authorisation Subgroup (18/09/12) • PCT/LMC/CCG Interface Meeting Shadow Health and Wellbeing Board It was noted that a timeline had been agreed for the tender evaluation panel for Healthwatch and VD would be attending this along with Gill Bell. JHWS – a governance structure has been put in place for implementing this. CM advised that the HWBB signed off the JHWS and it was AGREED this would be brought to the November CCE for endorsement. Action: JHWS to be added to November agenda. Rachel Spencer-Henshall to be invited to present. OD & Authorisation Subgroup It was noted that this meeting had been held jointly with SMT on this occasion. LMC Interface It was noted that one of the flu vaccine companies have experienced a delay and vaccines won’t be sent out for another month. This will have an impact on primary care.
EC/12/200
Any Other Business Future Meetings CM advised that the Board Room isn’t available for the dates of our November and December meetings. This is due to the recent change of dates for our CCE and the Board Room already having existing bookings in place. The dates and venues were noted as; • Wed 7 November – The Textile Centre, Leeds Road • Wed 5 December – venue TBC Care Pathways DH raised a concern regarding the YAS Bypass pathway and advised that practices need to know about this. It was agreed that an extension would be given for practices to respond to uptake on the pathway. Page 13 of 14
Action: Claire Sibbald to send YAS Bypass pathway figures to DH as soon as possible. KC to action. Matters to escalate to Cluster Board No matters noted. EC/12/201
Date and time of the next meeting The date of the next scheduled meeting is Wednesday 7 November 2012, 1.30 – 4.30pm.
This concluded the content of the CCE meeting and the Chair declared the meeting closed at approximately 4.30pm.
Chair’s Signature: ........................................................ Date: .......07.11.12...................
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