GHCCE_mins_23.05.12-kjc-RATIFIED_27.06.12

NHS Greater Huddersfield Clinical Commissioning Group

Minutes of the NHS Greater Huddersfield Clinical Commissioning Executive (CCE) Meeting held on Wednesday 23rd May 2012, 2.00 – 5.00pm, Bradley Golf Club, Bradley, Huddersfield Present: Vanessa Stirum (VS) Rob Millington (RM) Dr Steve Ollerton (SO) Dr David Hughes (DH) Dr Dil Ashraf (DA) Dr Karen Dean (KD) Dr Jane Ford (JF) Dr Judith Parker (JP) Dr Anuj Handa (AHa) Dr Paul Wilding (PaW) Carol McKenna (CM) Penny Woodhead (PeW) Julie Lawreniuk (JL)

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

In attendance: Merran McRae (MM) Rachel Carter (RC) Jan Giles (JG) Vicky Dutchburn (VD) Sarah Muckle (SM) Andrew Parker (AP) Alison Hughes (AHu) David Boothroyd (DB)

Director of Wellbeing, Kirklees Council Head of Contracting Head of Practice Support & Development Head of Strategic & Business Planning Public Health Consultant Graduate Management Trainee Transitional Managing Director of the WYCSS Senior Contracts Manager

Minutes: Kelly Chadwick (KC)

Personal Assistant to Greater Huddersfield CCE

EC/12/127

Welcome, Introductions and Apologies for Absence VS welcomed the CCE members and opened the meeting.

Apologies for absence were received from; Mehboob Khan (MK) Joanne Crewe (JC) Nicky Hoyle (NH)

Non-executive Director Head of Wellbeing & Integration Public Health Consultant

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Declarations of Interest Declarations of Interest were noted from all GP’s present with respect to Agenda Item No 5 – Health Checks LES and No 6 – DDimer LES as these will be services provided within Primary Care.

A declaration of interest was noted from CM regarding a discussion within the Chair’s report about the recruitment to the Accountable Officer role.

EC/12/128

Accuracy of Minutes of 25 April 2012 24 hour BP A discrepancy was raised in the minutes with respect to the roll out and review of the scheme. This doesn’t accurately reflect what has been written into the LES and sent out to practices. JP explained that the proposal is for 12 months and that a review of the scheme will start after 9 months. It was AGREED that one of the caveats also be amended to reflect that the claims would be monitored over the first quarter.

Action: KC to amend previous minutes as noted.

The minutes were agreed as accurate with the amendments as noted above.

Action Log EC/12/117 – Contracts Report (Unscheduled Dental Care) RC confirmed that the amendments have now been made to the specification as requested.

EC/12/121 – PwSI CM confirmed this item was on the agenda for the Cluster Governance Committee on 20 June and CM will provide feedback after the meeting.

EC/12/122 – NHS Transition (Public Health MoU) SO and PaW confirmed they had met with NH today (23/05/12) to discuss the Public Health Memorandum of Understanding. It was AGREED that NH would circulate this to SMT and then present at CSG next month.

Action: NH to circulate Public Health MoU to SMT and present at CSG in June. KC to add to June CSG agenda.

All other actions were confirmed as complete.

Estates CM confirmed this would be added to the CCE agenda in June for a detailed discussion. It was AGREED that JL would discuss the detail with SB. Page 2 of 11

Action: JL to discuss Estates with SB to agree what level of detailed information to present at CCE. EC/12/129

Clinical Chair/Accountable Officer update CM gave a brief overview of the AO report.

Changes to the Cluster Board have been made recently. CM advised that AO’s now need to provide a report each month on progress of CCGs. CM advised that a standing item will be added to the CCE agenda to collate any matters that need to be escalated to the Cluster Board.

SO informed the CCE that the recruitment of the Accountable Officer role has been discussed and this is now moving forward.

SO noted that the letter from Cameron Ward regarding the appointments to CCGs had been missed from the report.

Action: KC to circulate letter from Cameron Ward.

JG questioned what the outcome of the Safe & Sustainable Court of Appeal’s judgement would mean in relation to the CCG. It was noted that the SCG can now consider the responses for consultation.

CM advised she had attended a recent Cluster/SHA event and gave a brief update on the content. CM emphasised one of the key points in particular was lots of emphasis on CCGs being sighted on the bigger issues going forward.

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

EC/12/130

Risk Register CM provided an update on the register. CM advised that the Kirklees wide register is currently being updated. The report advises on the current process for each risk. The final sign off will now take place at SMT. This will take place before the risk register comes into CCE for information. The brief breakdown shows the risks that are tagged to GHCCG. There are risks around finance, staffing etc that are not showing on the current register but are valid risks.

CM advised that from July 2012 we need to have a risk assurance framework in place. This needs to be developed at a high level to show the risks and what we can do to achieve them. This is an annual piece of work. A draft version will be brought into July’s meeting before final sign off in August. CM informed the CCE that a piece of work is being carried out across the Cluster to identify a lead for governance for the CCGs. Page 3 of 11

The CCE RECEIVED and NOTED the contents of the report.

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Health Checks LES SM was in attendance and provided an update on the LES. This scheme has recently been presented at both LMC and Finance & Performance Subgroup and was recommended for approval. The CCE now need to formally approve it before it commences.

SM informed the CCE that there will be a period of implementation but in place and there are some minor issues to rectify.. There is also an issue regarding the notice period for Locala, which could potentially be 12 months.

Action: SM to organise the decommissioning of this service from Locala as soon as possible.

Discussion took place regarding the promotion and implementation of the scheme. RM advised that this would have a knock on effect in a positive way for other services. JG advised that our Practice Managers Reference Group will have an important role in the implementation of this scheme.

Action: SM to meet with SO and Sally Rees to work through the implementation issues.

Discussions took place regarding the lead-in time in practices and it was AGREED that a start date of 1st July would be set. This should enable sufficient time to get the any issues worked out and the scheme to be sent out to practices.

Action: SM to circulate LES to practices.

Financial implications were discussed. It was recognised that if uptake is high this will have implications for the CCE budget going forward.

The CCE APPROVED the scheme and thanked SM for her attendance.

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D-Dimer LES AP was in attendance and provided an update on this LES. This scheme has recently been presented at both LMC and Finance & Performance Subgroup and was approved. The CCE now need to formally approve it before it commences.

AP confirmed the scheme will cost ÂŁ21,547 which will bring a potential saving of around ÂŁ36k. It will be based on payment by non-recurrent funding for 12 months and will then be reviewed.

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KD raised an issue with pre-test scoring and explained this to the group with a recommendation that some rules were included within the LES for patient safety. It was AGREED that this should also be raised within the Training & Education Group.

KD will liaise with AP about Wells testing which will be added to the Di-Dimer LES. The CCE APPROVED the scheme with the amendments as noted above and thanked AP for his attendance.

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Calderdale & Huddersfield Services Strategy Review (SSR) PaW provided an overview of the report and asked the CCE members if there were any questions.

PaW confirmed the Programme Board will agree the name of the Board at the next meeting, which will be the Services Strategy Review (SSR). PaW advised he is the Chair of the Steering Group which meets weekly.

PaW advised that there are currently 4 work streams; Planned Care, Unplanned Care, Children’s and Long Term Conditions.

These work streams will be meeting regularly over the new few months and these work streams will take precedence over other areas of work. VLD explained that the 4 work streams will be crossreferenced with the current work streams to be able to agree what areas of work can be stopped, changed or continued.

PeW advised that this will have an impact on Quality & Safety for the CCG and it needs to be factored into discussions. VLD advised that it hasn’t been decided yet if a member of the Quality & Safety group should sit in each work stream. JL confirmed that the formal decisions will come from the CCE but the SSR will need to be able to develop these pieces of work.

MM questioned whether this programme has been linked with the similar one at MYHT and any others that may be in place at the moment. JL confirmed that this has been discussed and that the Programme Director could be that link. PaW advised that it is useful that both programmes run together so we can learn from each other but that also holds a risk across Kirklees with respect to management of the two programmes.

A question was raised around the tight timescales and whether there was a view on how this will work. PaW confirmed that the discussions about what the whole agenda of the programme may include has had input from both Calderdale and Huddersfield.

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PaW advised that updates would be given out during practice visits, plenary and SMT meetings and the team are also looking at using resource elsewhere. VLD confirmed that there are also phased updates planned via the Comms team.

VLD asked the CCE to hold the date of Wednesday 4th July in diaries as this is potentially going to be used for an event to launch the SSR. SO advised CCE members that this was also the date of the development session for those involved in the Shadow Health and Wellbeing Board and these two events would follow on from each other.

Action: KC to send email out to CCE members asking to hold 12.00 – 5.00 on Wed 4 July in diaries for SSR event.

It was AGREED that the TORs for the SSR would be added to the CCE agenda in June for review.

Action: KC to add SSR Terms of Reference to June CCE agenda.

It was agreed that the SSR would become a standing agenda item for an update at CCE each month.

Action: KC to add SSR as standing agenda item.

The CCE RECEIVED and NOTED the contents of the report and thanked PaW. EC/12/134

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

AHu 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 big part of the last checkpoint. The next part of the assessment regarding delivery and finances of the CSS. The operating model is based on principles such as working closer together, specialist 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. The next event is on 28 May with over 200 people booked on. There is a mix of PCT/CSS/CCG staff attending.

AHu explained the current situation with regard to structures. AHu advised that she will know by June if her own job is to become permanent. Other staff will start to be put into place by September.

The CSS will operate in shadow form as of 1st October 2012.

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AHu advised that there will be plenty of opportunities to change what is already in place but this will take time. It was agreed that a level of trust would be required between the CCGs and the CSS in order for the relationship to work. AHu 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. A similar question was raised with respect to the models of customer services and whether these had been compared with other sources. AHu confirmed that all these areas need to be worked through in further detail.

The CCE thanked AHu for her attendance.

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NHS Transition Authorisation The draft Communications & Engagement Strategy was discussed.

The vision & values are now included. The draft needs to be approved by the CCE. SO advised that the national Communications Service have not passed the checkpoint so the report will need to be amended to include this.

It was noted that the PPE section required to be updated and PeW AGREED to discuss this with Dasa Farmer.

Action: PeW to discuss changes to PPE section of Comms strategy with Dasa Farmer.

It was AGREED that the final version would be circulated once available.

The CCE RECEIVED and APPROVED the contents of the report.

Report on Ballot for Member Practices JG explained that this report was a summary of the results of the ballot at the recent plenary. Discussions took place regarding ensuring member practices are kept informed of progress of the governing body and JG explained that this was covered by practice visits, Practice Managers Group, Practices Nurse Group etc.

JG confirmed that the questions on the ballot paper will be revisited prior to the next elections to ensure they are accurate at that time.

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360 Survey JG explained the survey and the list of stakeholders. We have named representatives to contact for the SHWB and are seeking named reps for both the LOC and the LMC. There are tight timescales for comments regarding the stakeholders and JG requested any comments be sent directly to her as soon as possible.

The CCE RECEIVED and APPROVED the contents of the stakeholder list.

Board to Board meeting CM advised that the meeting had gone well. The main focus was around actions and development since the last meeting in December. There were specific comments on the operating plan in relation to engagement with patients and health inequalities.

A question was asked with respect to when the CCE might begin to have public meetings and it was AGREED that this did need further discussion.

CM advised that the formal feedback will be shared with the CCE when it is received.

People Transition CM advised that there are currently regular meetings in place across the Cluster to populate the structures. There are two main items that need to take place first; the ideas for the CSS and what is needed and HR then need to map out the timelines and guidelines for the actual transfer of staff.

CM advised that the SMT were looking at around the end of June to start to share structures more widely, then a period of consultation will take place before the pooling/job matching begins. It is expected that confirmations will be given to staff by early September.

EC/12/136

Quality & Safety Report PeW presented the report. The key points are; 1 breach at CHFT in April. No further information available at present so a further update will be brought back next month.

Draft CHFT action plan received at CQB – this will become a regular item.

Risk assessments for VTE discussed. CQUINS reporting will show the outcomes for these areas.

SI’s – CHFT is a low reporter of SI’s. All open SI’s have been reviewed with Sue Cannon.

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PeW informed the CCE that there has recently been some guidance regarding how CCGs are to take control of Quality areas. PeW advised this will be discussed in more detail at the next OD day.

Discussion took place regarding the issues raised at CQB and PeW confirmed that good quality and timely papers were presented on the information requested. Actions have been put in place to address the issues around the outpatients report.

The CCE RECEIVED and NOTED the contents of the report and thanked PeW. EC/12/137

Contracting Report DB was in attendance and provided an overview of the report. DB confirmed that the year end position data is not available yet and this will be included next month along with Month 1 data.

The key points are; 30 day readmissions audit – results could be contentious but work is ongoing with the CHFT, Kirklees Council and Locala to come to an agreement on what admissions could have been avoided.

Waiting list effect – this information relates to Feb/Mar 2012.

The numbers of waits has increased and it has been agreed at CMB to set up a task and finish group to focus on incomplete pathways and waiting lists.

Through monitoring and validation of invoices the contracting team have received over £5.5 million in credit notes to date from providers. This includes correcting invoice errors, wrong billing, challenges, patients who are not ours and underperformance against a contract.

RC informed the CCE that there will be some changes to the report going forward. A review of all groups relating to Contracts will be undertaken and feedback will be provided in due course.

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

EC/12/138

Performance Report VLD advised that KW had sent apologies and she would be presenting the report.

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The key points are; Ambulance response times – YTD position giving no significant concerns although it is showing red for month end data.

Mixed sex accommodation – there is an error in this data as there are actually 2 breaches in NHS Calderdale but the report for CHFT is showing as 0. The information relating to GHCCG is correct.

Cancer waits – Kirklees wide there has been 3 breaches but the patients have now been treated.

Stroke/TIA – we have not met the national standard for 2012 due to the lack of consultants in post.

Dentistry – the DH have not signed off the demand plan for 2012 yet. However there are currently no waiting lists.

Mental Health – actions plan in place to look at achieving the figures.

Smoking quitters – this is Kirklees wide data but it is 2 months out of data so isn’t an accurate picture.

Breastfeeding 6-8 weeks prevalence targets - achieved 42.8% compared to the national average.

Contracts figures – shift of activity from elective to day case and outpatient procedures. VLD advised that the figures are out of date as this information was provided before the Contracts were signed.

Health Visitors – initial recruitment stage has taken place but there are still some issues. There are some action plans in place and this will be rectified by September.

PeW noted the Stroke performance as an issue and suggested picking this up via the Quality and Safety subgroup for further discussion and action. This was AGREED. Action: PeW to add Stroke performance to agenda for Quality & Safety subgroup.

The CCE RECEIVED and NOTED the contents of the report and thanked VLD. EC/12/139

Finance Report JL provided a verbal update on this occasion. JL explained that we are currently in between financial years. The accounts for 2011/12 have been submitted and are currently being audited. A plan for 2012/13 will be brought to the next meeting.

JL informed the CCE that GHCCG have £1 million to spend nonrecurrently. Some of this has started being used on business cases and LES’s. There will be a review of this in September.

The CCE RECEIVED the verbal update and thanked JL. Page 10 of 11

EC/12/140

Receipt of Minutes The CCE RECEIVED and NOTED the minutes of the following meetings; OD & Authorisation Subgroup (draft version) 24/04/12 Clinical Strategy Group (draft version) 02/09/12 PCT/LMC/CCG Interface Meeting (including TORs) 10/04/12 It was AGREED that the SCG minutes should be included for information.

Action: KC to source these minutes from Amanda Jenkinson.

EC/12/141

Any Other Business Items for escalation to the Cluster Board SSR update Items for informing the Comms Team Health Checks LES D-Dimer LES SSR update

EC/12/142

Date and time of the next meeting The date of the next scheduled meeting is Wednesday 27 June 2012, 2.00 – 5.00pm.

This concluded the content of the CCE meeting and the Chair declared the meeting closed at approximately 5.00pm.

Chair’s Signature:

Date: 23/5/12

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