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NHS Wakefield Clinical Commissioning Group CLINICAL COMMISSIONING EXECUTIVE Minutes of the meeting held on 23 October 2012 Boardroom, White Rose House, Wakefield Present
Dr Phil Earnshaw
Chair, Clinical Leader NHS Wakefield Clinical Commissioning Group (CCG) GP, Lupset Health Centre GP, Kings Medical Centre GP, Pinfold Surgery GP, Outwood Park Medical Centre GP, Queen Street Surgery GP, College Lane Surgery Practice Manager, Stuart Road Surgery Nurse Representative Chief Officer Designate, NHS Wakefield CCG Director of Public Health Wakefield Council Non Executive Director Non Executive Associate Corporate Risk Manager, NHS Wakefield District (NHSWD) Communications Manager, NHSWD Lay Member, Public and Patient Involvement Independent Consultant Member, Rotherham NHS Foundation Trust Head of Strategy and System Reform Head of Service Development and Transformation, NHS Wakefield CCG Head of Finance, Governance and Risk, NHS Wakefield CCG (Minute 12/226 only) Performance Improvement Manager, NHSWD (Minute 12/227 only) Senior Commissioning Manager, NHSWD (Minute 12/230 only) Commissioning Manager NHSWD (Minute 12/230 and 12/232) Commissioning Manager NHSWD (Minute 12/230 only) Stroke Programme Manager NHSWD
Dr Adam Sheppard Dr David Brown Dr Avijit Biswas Dr Ann Carroll Dr Paul Dewhirst Dr Ivan Hanney Stephen Bryan Sandra Greenwood Jo Webster Dr Andrew Furber
In Attendance
Sandra Cheseldine Rhod Mitchell Adam Bassett Katie Lister Stephen Hardy Dr Hany Lotfallah Lee Beresford Linda Driver Gill Wainwright
Karen Tooley
Julie Thorpe
Simon Rowe
Karen Robinson
Gillian Richardson 1
(Minute 12/231 only) Head of Safeguarding NHSWD (Minute 12/233 only) Commissioning Manager NHSWD (Minute 12/235 only) Senior Engagement Manager NHSWD (Minute 12/236 only)
Mandy Sheffield
Michelle Green
Jeanette Miller
12/220 Apologies Apologies were received from Dr Clive Harries and Jim Hayburn. 12/221 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. There were no interests declared. 12/222 Chairs Opening Remarks Dr Earnshaw welcomed both Dr Hany Lotfallah and Stephen Hardy to their first meeting of the Clinical Commissioning Executive (CCE). Dr Earnshaw noted that Sam Pratheepan, Elaine McHale and Jan Power had now stood down from their roles on the Clinical Commissioning Executive. On behalf of the CCE Dr Earnshaw offered his thanks to the support they had given to NHS Wakefield Clinical Commissioning Group and wished them well for the future. 12/223 Minutes of the meeting of the NHS Wakefield Clinical Commissioning Executive Meeting held on 18 September 2012 It was RESOLVED that i)
The minutes of the meeting of the NHS Wakefield Clinical Commissioning Executive Meeting held on 18 September 2012 were agreed as a correct record with the following amendments. Both Sandra Greenwood and Dr Brown were present. Minute 12/158 be amended from Crime Reduction Partnership to Community Safety Partnership.
12/224 Matters Arising from the Minutes of the Meeting of the NHS Wakefield Clinical Commissioning Executive held on 18 September 2012 Adam Bassett updated the Clinical Commissioning Executive (CCE) on progress of the actions discussed at the meeting on 18 September 2012. 2
12/225 Chief Officer Designate Update Jo Webster introduced this report noting the following: a) NHS Wakefield Clinical Commissioning Group (CCG) Authorisation Members were advised of a timetable of the national process for Wave 1 CCGs which was outlined within the report. Jo Webster advised that the CCG would have 10 days following the Conditions Panel to submit and additional documented evidence that was required following moderation. Where it is considered that sufficient evidence has been provided a recommendation would be made for the proposed condition to be removed. b) NHS Wakefield CCG Constitution Members were advised that following receipt of the site visit report the Standing Orders of NHS Wakefield CCG Constitution had been amended to include clarification on the eligibility assessment of the leadership potential of candidates. In addition, in agreement with the Local Medical Committee, Standing Orders had been further amended to include a new paragraph on the management of a vote of no confidence on the CCG Board. c) Commissioning Support It was reported that the Commissioning Support Bulletin had confirmed that CCGs and Commissioning Support Units (CSUs) were required to ensure that they were clear about what level of resource was available for commissioning support services by the end of October 2012. Work had been undertaken locally to identify any anomalies in order for the Service Level Agreement to be agreed. d) Mid Yorkshire Utilisation Review The CCE was advised that the utilisation review of Pinderfields Hospital had taken place and the utilisation review of Dewsbury hospital was due to commence shortly. The findings of these reviews would be discussed at two workshops in November and December. It was RESOLVED that i) 12/226
the report be noted.
Finance Report Month 6 Gill Wainwright introduced a report which presented the financial position of Wakefield CCG for September 2012 and the year end forecast outturn position based on this. It was reported that NHS Wakefield CCG was on target to achieve each of its key financial performance indicators. It was noted that the revenue surplus remained as rated green mainly due to the inclusion of the latest 3
prescribing data from the Prescription Pricing Authority which was reflecting a significant forecast year-end outturn underspend position. QIPP remained amber due to the Primary Care Transformation Scheme. The report advised that as at the end of September 2012 NHS Wakefield CCG had generated a surplus of £1,836K which was made of a planned surplus of £1,548k and underspend of revenue budgets of £288k. Appendix 4 to the report outlined the 2012/13 capital planning position. It highlighted that a forecast outturn had been included which showed the underspend against the development at Stanley Health Centre. It was noted that this position had been discussed with the SHA around the reprovision of funding to complete the scheme during 2013/14. It was RESOLVED that i)
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the capital and revenue financial positions at the end of September be noted.
Performance Report against key performance indicators for 2012/13 Karen Tooley introduced a report which informed the Clinical Commissioning Executive (CCE) of performance against the 2012/13 NHS Operating Framework outcome measures together with other identified national and local priorities CCE members gave details consideration to the following areas of performance: • • • • •
Cancer Waiting Times Transient Ischaemic Attack 2012/13 Fast Track Performance Referral to Treatment Waiting Times Accident and Emergency Waiting Time Standards
Attached to the report was an update on the Primary Care Transformation Scheme (PCTS) which had previously been considered by the Finance and Performance Group. Jo Webster highlighted that a PCTS clinical summit was due to take place that evening and that any outcomes of this would be reported to the next Finance and Performance Group. Attached as an appendix to the report was summary position of performance against key indicators using a matrix tool which demonstrated the actual year to date and forecast outturn and the direction of travel. It was RESOLVED that i)
the NHS Wakefield Clinical Commissioning Group performance against key national and local priority measures for 2012/13 be noted;
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ii)
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the additional actions outlined within the report required to address areas of under performance be agreed.
Quality and Patient Safety Report Laura Elliott introduced a report which provided the Clinical Commissioning Executive (CCE) with an update on key quality and patient safety issues across Wakefield. The Executive Summary listed the key highlights, areas of risk and current quality and patient safety issues. The report had originally been presented to the Quality Group on 11 October 2012, but had been supplemented with additional information. Laura Elliott highlighted that a number of high level meetings, which were outlined with the report, were shortly to take place to address NHS Wakefield Clinical Commissioning Group’s concerns around quality and patient safety at the Mid Yorkshire Hospitals NHS Trust. The report further outlined the proposals for a 111 Quality Group as part of the quality governance arrangements for this service. Dr Sheppard noted that he would be chairing the local group covering the Mid Yorkshire Health Economy. Laura Elliott drew attention to the new Friends and Family Test which would be a requirement from April 2013 and the proposals to take this forward. She further noted that that the Quality Group had received the first draft of Quality Handover and Quality Report. It was RESOLVED that
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i)
the Quality and Patient Safety report be noted for information;
ii)
the actions and associated meetings being held to address the Clinical Commissioning Group’s concerns around quality and patient safety at the Mid Yorkshire Hospitals NHS Trust be endorsed;
iii)
the proposed local contract quality governance arrangements for the new 111 / West Yorkshire Urgent Care Service be approved;
iv)
the development and next steps for the national Friends and Family Test be noted;
v)
it be noted that the Quality Group received the first draft of the Quality Handover document and Quality Report.
Health and Wellbeing Strategy Dr Andrew Furber provided a presentation to the Clinical Commissioning Executive (CCE) to introduce the final draft of the Health and Wellbeing Strategy for Wakefield 2013-2016. The CCE was advised that the Health and Wellbeing Strategy had been developed based on the six key health and wellbeing priorities identified 5
within the Joint Strategic Needs Assessment (JSNA). The final strategy would be published at the end of November following a formal consultation period. The presentation covered the priorities and objectives of the strategy together with the approach to be undertaken and how engagement would be undertaken with local partners including NHS Wakefield Clinical Commissioning Group (CCG). Dr Furber highlighted that CCG members could provide any comments on the strategy up until the end of the consultation period on 9 November 2012. It was RESOLVED that
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i)
the development of the strategy be supported;
ii)
the delivery of the strategy be supported through the development of commissioning and delivery plans that addressed the outcomes, objectives and approaches within the strategy.
Integrated Bereavement Service Dr Earnshaw declared an interest in this matter as he was a former chair and provider of Bereavement Support and Counselling, which had been undertaken on a voluntary basis. Sandra Cheseldine also declared an interest in this matter due to her role with the Citizen’s Advice Bureau, which referred clients on to this service. Julie Thorpe, Linda Driver, Simon Rowe and Karen Robinson attended the meeting to present a briefing paper and business case on the Integrated Bereavement Service. The Clinical Commissioning Executive was advised that the Bridge Bereavement model had been developed following a two year pilot project. The Planned Care Clinical Commissioning Unit (PC CCU) had met to consider the Integrated Bereavement Service business case proposal on 8 March 2012 and had agreed that it was important to ensure the local population continued to have access to high quality cost effective bereavement services. It was reported that the cost associated with the set up of the pilot was £55k per annum and the cost of providing the service in 2012/13 was £75k per annum. It was further noted that the cost of the bereavement service would be £75k per annum. Jo Webster requested that this scheme be approved by the Clinical Commissioning Executive. Dr Earnshaw noted that he felt that it was important that further analysis was undertaken to examine the value for money aspects of this proposal and whether support should also be provided to other groups. The Clinical 6
Commissioning Executive also noted that it would like to see further information with regard to the patient pathway. It was RESOLVED that
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i)
the key findings of the 6 monthly evaluation report from April to September 2012 be noted;
ii)
the Business Case and procurement recommendations be approved (full tender for a contract term of up to three years), noting the risks associated with procurement time scales and the impact if this was not supported at this stage;
iii)
Further work to be undertaken to examine the value for money aspects of this scheme.
Stroke Association Wakefield Stroke Support Service Gillian Richardson attended the meeting to present a report which highlighted that the contract with the Stroke Association for the Stroke Support Service, although agreed for three years from 2011, was subject to annual review before renewal. It was noted that this was a joint contract with Wakefield Council and this was the first review cycle. The report requested the Clinical Commissioning Group to support the contract renewal in preparation for final sign off by the Joint Strategic Commissioning Board. It was reported that the annual contract value was ÂŁ80k with equal contribution from each organisation. The report outlined the activity and performance of the scheme and highlighted that the service currently had around 50 patients on its caseload. Dr Earnshaw noted that he would like to see some evidence from the users of this service that it was welcomed and required. It was therefore agreed that more assurance would be requested and that a performance update would be provided in six months time. It was RESOLVED that
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i)
The Joint Strategic Commissioning Board decision to renew this contract for a further year be noted and confirmed;
ii)
The renewal of the contract for a further year be approved;
iii)
A performance update on this service to be provided in six months time.
The Winter Plan for the Mid Yorkshire Hospitals NHS Trust Linda Driver and Simon Rowe introduced a report which introduced the 2012/13 Winter Plan for the Mid Yorkshire Hospitals NHS Trust area. 7
The Clinical Commissioning Executive (CCE) was advised that the attached winter plan had been forwarded to NHS North of England and so far, no comments had been received. Therefore the plan would be changed at a later date to account for this and for comments received following stakeholder engagement. Dr Carroll highlighted that three local GP practices were concerned at the workload generated by a winter pressures scheme involving a local care home. Jo Webster highlighted that she would also be discussing these issues with both the Mid Yorkshire Hospitals NHS Trust and the Yorkshire Ambulance Service and would also be meeting with the practices to discuss the issues raised. Jo Webster thanked Simon Rowe for the work he had undertaken on producing the Winter Plan. It was RESOLVED that
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i)
the content and structure of the winter plan be approved;
ii)
the winter plan be approved.
Safeguarding Children and Vulnerable Adults Commissioning Policy and Mental Health Capacity Act Policy Mandy Sheffield introduced a report which presented the final draft policies for the Safeguarding Children and Vulnerable Adults Commissioning Policy and Mental Capacity Act (2005) Policy and Guidance for NHS Wakefield Clinical Commissioning Group (CCG). The Clinical Commissioning Executive advised that NHS Wakefield CCG had rigorous governance structures in place to ensure that the statutory requirements for safeguarding children were met. It was noted that approval of these policies were required as part of the authorisation process for NHS Wakefield CCG. It was RESOLVED that i)
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the Safeguarding Children and Vulnerable Adults Commissioning Policy and Mental Capacity Act (2005) Policy and Guidance be approved.
Compact Agreement between NHS Wakefield Clinical Commissioning Group (CCG) and NHS North Kirklees CCG Jo Webster introduced a report which presented for approval the Compact Agreement between NHS Wakefield CCG and NHS North Kirklees CCG which underpinned the commitment of both CCGs to work collaboratively in the commissioning of services which were necessitated by patient flow.
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Jo Webster highlighted that the ratification of this agreement would also fulfil one of the sub criteria rated ‘red’ in the Outstanding Issues report received following the authorisation site visit on 26 September 2012. The Compact Agreement was attached to the report and had been reviewed and updated by NHS Kirklees CCG. Jo Webster noted that further work would be undertaken to examine collaboration on a wider West Yorkshire basis. It was RESOLVED that i)
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the Compact Agreement between NHS Wakefield CCG and NHS North Kirklees CCG be approved.
Integrated Musculoskeletal Assessment and Treatment Service (IMAT) Linda Driver and Michelle Green attended the meeting to present a report which provided Clinical Commissioning Group members with an overview of: • • •
the approach adopted to develop the proposed service model for the IMAT service the planning assumptions, financial implications, risks and benefits associated with implementation the procurement options and Planned Care Clinical Commissioning Unit (CCU) recommendations
To accompany the report Linda Driver and Michelle Green provided a presentation to the CCE which focused on the following areas: • • • • • • • •
Overview Model of Care Workstreams Workstream Outputs Service Specification Comparison with current MSK services Business Case Procurement
The CCE was advised that a Procurement Options evaluation had been completed and it had been agreed that a contract variation to the current Mid Yorkshire Hospitals NHS Trust contract was the preferred mechanism to take this forward. The contract variation would stipulate a number of conditions and if these were not met by the provider termination of the contract would be proposed and the remaining procurement options would be evaluated. Appendix 2 to the report outlined the detailed activity and financial implications of this proposed approach.
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CCE members agreed with the proposal to implement a contract variation to the current provider within the current financial envelope. It was agreed that this would be reported back to the CCE if this was not achievable. Dr Sheppard highlighted that he felt that psychology played a major role in relation pain management for these conditions and he would like to see further evidence as to the extent which this would play a part in the provision of these services. It was agreed that this should be included in the negations regarding this contract. It was further noted that the contract variation would require demonstrable improvements within six months and it was therefore felt important that the services involved would need to be made aware what they were being reviewed against. It was RESOLVED that
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i)
the contents of the report be noted;
ii)
the model of care and the proposed Integrated Musculoskeletal Assessment and Treatment Service be approved;
iii)
the recommended procurement route and contract variation be approved;
iv)
the mandate to proceed to the implementation phase of the project be approved.
NHS Calderdale, Kirklees and Wakefield District Consultation Report Jeanette Miller introduced a report which advised that primary care trusts had a statutory responsibility to report annually on engagement activities relating to commissioning decisions. The report outlined all consultations carried out across the Calderdale, Kirklees and Wakefield District Cluster (CKW) between 1 April 2011 and 31 March 2012. The report further detailed activity planned for 2012-2013. It was noted that this report had been considered by the CKW Board. The CCE was asked to note the report and pay particular attention to the breadth and depth of consultations carried out in the previous year and the consultations which had already begun, including the large transformation programme; the Mid Yorkshire Clinical Services Strategy. Dr Earnshaw highlighted that he had found this an interesting report and noted its contents. It was RESOLVED that i)
the report be noted, with particular attention paid to the breadth and depth of consultations carried out in the previous year and the consultations which had already begun, including the large 10
transformation programme, the Mid Yorkshire Clinical Services Strategy. 12/237
Minutes of the NHS Calderdale, Kirklees and Wakefield District Cluster Board meeting held on 3 July 2012 It was RESOLVED that i)
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the minutes of the NHS Calderdale, Kirklees and Wakefield District Cluster Board meeting held on 3 July 2012 be noted.
Minutes of the Shadow Health and Wellbeing Board held on 13 September 2012 Dr Andrew Furber introduced these minutes and highlighted that the Terms of Reference of the Health and Wellbeing Board would be brought back to a future meeting of the Clinical Commissioning Executive. It was RESOLVED that i)
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the minutes of the Shadow Health and Wellbeing Board held on 13 September 2012 be noted.
Minutes of the Finance and Performance Group held on 11 October 2012 It was agreed that consideration of these minutes would be deferred until the next meeting. It was RESOLVED that i)
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consideration of the minutes of the Finance and Performance Group held on 11 October 2012 be deferred to the next meeting.
Minutes of the Audit and Governance Group held on 11 October 2012 Sandra Cheseldine introduced these minutes and highlighted that, following advice from the Cluster Governance Committee, the Audit and Governance Group had requested the Clinical Commissioning Group to have the Risk Register Reporting System – High Level Risk Log as a standing agenda item in Part 2 of the Clinical Commissioning Executive. It was RESOLVED that
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i)
the minutes of the Audit and Governance Group held on 11 October 2012 be noted;
ii)
It be agreed that the Risk Register Reporting System – High Level Risk Log be a standing agenda item in Part 2 of the Clinical Commissioning Executive.
Minutes of the Quality Group held on 11 October 2012 11
It was noted that this meeting was not quorate, but that there was an issue with membership of this group which was being addressed. It was noted that this meeting had approved the following items: Patient Group Directions (PGD):• Levonorgesterel Emergency Hormonal Contraception in Community Pharmacy • Petrussis vaccine for pregnant women It was also noted that the Quality report was to be updated prior to consideration by the Clinical Commissioning Executive. It was RESOLVED that i)
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The Minutes of the Quality Group held on 11 October 2012 be approved.
Clinical Commissioning Units Update It was RESOLVED that i)
The Clinical Commissioning Units Update be noted.
12/243 Clinical Commissioning Executive (CCE) decisions for Inclusion in the Legacy Document There were no items highlighted for inclusion in the Legacy Document. It was RESOLVED that i)
there be no items highlighted to be included in the legacy document.
12/244 Items for referral to the Cluster Board or any of the Sub Groups There were no items referred to the Cluster Board or any of the Sub Groups. It was RESOLVED that i)
There be no items referred to the Cluster Board or any of the Sub Groups.
12/245 Items for the next meeting Jo Webster advised that the following items would be considered future meetings: • •
Outline Business Case – Mid Yorkshire Hospitals NHS Trust Service Strategy Quality Risk Summit Feedback 12
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Primary Care Transformation Scheme CCG Spending Planning Framework Developing our Strategic Vision
12/246 Any Other Business There was no additional business 12/247 Date and Time of Next Meeting Tuesday, 27 November 2012, 1.00 pm Boardroom, White Rose House
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