Minutes - South Gloucestershire CCG

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report in Avon Business Intelligence (ABI) system. ABI contains almost all of ... Interviews have been held for a diabet
South Gloucestershire Clinical Commissioning Group Clinical Operational Executive Meeting Date: Time: Location:

Tuesday 16th July 2013 13.30 The Cullimore Room, Emerson’s Green Village Hall

Minutes Attendees:

Dr Jon Hayes, Clinical Chair Dr Ann Sephton, Deputy Clinical Chair Sharon Kingscott, Chief Financial Officer Dr Nick Kennedy, Consultant CCG Board Member David Jarrett, Director of Operations Lindsay Gee, Head of Commissioning – Children, Young People and Maternity Martin Wilkes CCG Board Member Dr Jon Evans, Long Term Conditions Lead Louise Rickitt, Head of Strategic Planning and Service Redesign Thomas Manning, Head of Information and Performance Planning Dr Kathryn Hudson, Head of Partnerships and Joint Commissioning Dr Andrew Appleton, CCG Board Member Dr Kate Mansfield, Children and Maternity Lead Dr Peter Bagshaw, Mental Health and Dementia Lead Dr Wendy Bonn, CCG Board Member Kate Lavington, Community Services & Vulnerable Adults Manager Mel Green, Head of Medicines Management

JH AS SK NK DJ LG MW JE LR TM KH AA KM PB WB KL MG

In Attendance: Rachel Robinson, Healthwatch Dr Stephen Illingworth, Clinical Lead Frenchay Health and Social Care Project Ann Magham. Practice Manager, Wellington Road Family Practice Sue Pratt, Communications Lead, South West Commissioning Support Claire Beynon, Head of Threshold Management, South West Commissioning Support Richard Smale, Deputy Director of Transformation, South West Commissioning Support Rachel Anthwal, Programme Manager, South West Commissioning Support John Shaw, Head of Commissioning Partnerships and Performance, Adults, Children and Health, South Gloucestershire Council Apologies: Jane Gibbs, Chief Officer Martin Gregg, CCG Board Member Dr Tarsha Sivayokan, Elective Care Lead Steve Rea, Commissioning Delivery Manager Dr Mark Corcoran, Clinical Chair, LMC

RR SI AG SP CB RS RA JS

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Dr Alison Wint, Cancer Lead Kate Archibald, Mental Health and LD Manager

Action 1.

Welcome JH welcomed all to the COE meeting. Introductions were then made around the table. JH explained that he would have to leave the meeting at 1500 hours and that AS would take the Chair.

2.

Declarations of Interest Agenda Item 9.2 Quarterly Update Report – Children and Maternity, Dr Kate Mansfield declared she was Chair of Governors at Chipping Sodbury School.

3. 3.1

Minutes of Previous Meeting/Matters Arising To receive the Minutes of the previous Meeting (June 2013) The minutes were APPROVED as a true record of the meeting Matters Arising – see Appendix 1 Matters arising not on the Agenda Item 4.1 NHS111 DJ and AS have a meeting scheduled with Harmoni w/c 22 July 2013 and AS has written to the Chief Executive of Care UK. JH reiterated how key communication is. KH informed the COE that a report is due to go to the Scrutiny Committee in September and is keen to capture the views of local GPs. AS confirmed the CCG is being increasingly robust with the pressure it is applying to the service provider and that a communication will go to practices reiterating this and thanking them for their patience.

3.2

Item 4.2 Work Programme – see Agenda Item 3.4. Item 5.2 Elective Care – DJ confirmed this was still on track to report back in September

DJ

Item 6.1 Compact with Voluntary Section Sector – this is still outstanding

3.3

Item 6.5 Adastra Proposal – proposal from Brisdoc was not acceptable and a further response is awaited from them . To note the Forward Work Programme The Forward Work Programme was NOTED. There was discussion about the CSU timetable for the commissioning cycle for contract negotiation and to invite GPs to engage with the process in terms of capturing feedback and experience of patients. JE to set up a meeting with Jo Whitehead.

4.

Chair’s Update JH updated the COE on the acute services review for NBT and UHBT that had come out of the recent PWC report. This would be discussed at the CCG Partnership meeting on 23 July 2103 and then at the Healthy Futures Programme Board in September 2013.

5.

Presentation “How Healthwatch South Gloucestershire will work with the CCG” – Rachel Robinson, Healthwatch JH welcomed Rachel Robinson from Healthwatch, South Gloucestershire.

JE

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Action RR presented an overview of the Healthwatch to the COE: Healthwatch has three key functions: Patient and public involvement Information and signposting NHS Complaints Advocacy. Local Healthwatch will provide authoritative, evidence-based feedback to organisations responsible for commissioning or delivering local health and social care services. Healthwatch is different to LINk in that it has a statutory place on the Health and Wellbeing board and is provided by a corporate body. JH thanked RR on behalf of the COE for her presentation. JH left the meeting at 1500 hours and AS took the Chair. 6. 6.1

Summary of Performance – QIPP Reporting and Programme Updates Contract Performance Practice Level Review of 2012/13 Activity TM presented a report, entitled Analysis of Outpatients and Emergency Admission 2012-13 for NHS South Gloucestershire, to illustrate areas of increased activity as report in Avon Business Intelligence (ABI) system. ABI contains almost all of the centrally located datasets as reported for CCG monitoring and analysis and is available to practices, at patient level, for analysis. The report highlights the practice variation across the CCG of acute activities in 2012-13 when compared to 2011-12 and would enable the CCG Clinical Leads to target areas for in-year improvement. The report illustrates the variances in graphical form and provides a basic quantification of the QIPP potential attributable to each variable. The emergency, Out of Hours (OOH) and outpatient data was taken from the ABI database and reflects data as submitted by acute providers. The reports demonstrate to practices what can be obtained from ABI in order that the information can be used as part of their Membership Commitment. There was discussion about how this information would be received by practices and concern was expressed that as this was a potentially sensitive issue, there was a need to put some context to the information. Further thought would need to be given to a sign off process and whether this should be by the clinical leads, or in a corporate context, by JS or AS. It was agreed that more data is required in terms of individual performance and ranking per weighted population. TM to seek further clarification around using this information as QIPP data for 2013/14.

6.2

TM

2013/14 QIPP Programme Summary DJ presented the QIPP Executive Update paper and updated the COE on progress overall. The unidentified QIPP value reduced to £157k with new of addition of ‘Quality of Care in Nursing Homes’ line. This is now operational and aimed at emergency admission reductions from care homes with nursing. The year to date and forecast outturn QIPP delivery position is now available based on month 2 data. The CCG had received positive feedback from the Area Team regarding our QIPP Programme, wishing to share our plans with other CCGs as a measure of good practice. Quarter 1 reviews undertaken of each of the CSU programmes have been a positive process and given the CCG greater assurance around delivery and progress against key projects. Planned savings for 2013/14 of £6m, with an actual 2013/14 forecast savings of £3.9m. Year to date plan saving of £0.7m with an actual year to date saving of £0.5m. A detailed plan has been reviewed and a number of schemes are not up and running yet. Page 3 of 7

Action 6.3

Clinical Leads Update on QIPP Delivery Children and Maternity - KM reported that the maternity tariff of high, medium and low, should provide some savings and that work was on-going into reviewing this further. Long Term Conditions - JE reported on the need for BNP testing to be based on clinical information in order to utilise the test appropriately. Awaiting reply from secondary care advisors regarding clinical questions raised by clinical leads within BNSSG. Once these are forthcoming guidance to be released to practices in anticipation of implementation of the test. Interviews have been held for a diabetic specialist nurse. Diabetic strategy to be presented to next COE following appointment to clarify roles and responsibilities of post.

JE

End of life care (EOL) – JE reported that BNSSG steering group holding regular meetings and attendance from the clinical leads from within BNSSG has been assured. Work is on-going around the provision of a specific EOL discharge summary which is being utilised within UHB as part of their CQUIN incentives. Mental Health and Dementia - PB reported on the AWP business plan and that Bristol were re-tendering. The new AWP senior management appears to be much more focussed on local representation. Dementia – South Gloucestershire CCG is recognised as a leader in terms of the dementia pilot and is one of five CCGs to have pathways assessed. Paul Frisbee undertook a Dementia Roadshow, with no extra funding, which was attended by 40 people. It was reported that LIFT is nearly at capacity and there is a requirement for GPs to direct patients into group therapy rather than one to one counselling. Elective Care - DJ reported on behalf of TS about key schemes including advice and guidance pilot, community dermatology service and that the BCC service was still in development. ISTC - SK confirmed that the Emersons Green contract was £105k under-utilised. There is a need to look at how the CCG can utilise the contract more efficiently and how NBT can transfer patients over to Emersons Green. Medicines Management – MG reported that £250k of savings in the prescribing budget had been identified; however, financially it is going to be a very tough year as no growth was allocated in the budget. Urgent Care – AS reported that the Tepid Clinic is going ahead and NBT will confirm a start date once the new Geriatrician has started in September, although the “day hospital” is now being used for tepid patients. A meeting with domiciliary providers is to be held to review how to reduce urgent admissions. Virtual wards continue to be promoted within practices. The DES requires this to happen on a quarterly basis, which is considered to be inadequate, and MW understood the Practice Compact requires this to happen monthly. An urgent care liaison psychiatrist has been appointed and work is being undertaken to increase mental health cover in the ED seven days a week. NBT’s ambulatory care plans are behind schedule and progress is slow. Informal feedback from the Front Door pilot is good, which suggests that community matrons are helping improve care and Page 4 of 7

Action facilitating faster discharge of patients. The Extended Care Practitioners (ECP) have started and been welcomed by the REACT team, ED doctors and staff. ECPs provided the following feedback: promoting ECPs seeing patients are home rather than in the ED. Domiciliary workers are dialling 999 rather than calling the GP. Incidents when GP does not speak to the patient and receptionist may tell patient to dial 999. Ambulatory care still happening in the Acute Assessment Unit rather than ED. AS noted that two pinch points in ED were 92% of breaches due to not enough hospital beds and a lack of senior doctors are weekends and nights. AS reported the wait for Rapid Access Clinics for chest pain was now 8 weeks and over, which is not acceptable. JH to follow up. It was noted that DJ was working on integrating the CCGs Emergency Plan with NBT’s patient flow plans to have one overall plan. 7 7.1

Papers for Decision Commissioning Advisory Forum (CAF) Replacement Claire Beynon presented this paper which recommended the replacement of the Commissioning Advisory Forum (CAF) with new treatment policy review arrangements. The recommendation was based upon all proposals for the new uses of medicines and drugs be considered by the Joint Formulary Group, that a New Interventions Review Group be established to consider service development proposals from providers and that a new Clinical Policy Review Group be established across BNSSG CCGs to consider and review policies governing access to planned care treatments. The COE discussed the implications of this and the need to be very clear that if a new intervention is required it has to go through the Operational Planning Process. The COE deferred agreement to this paper until JG has had an opportunity to consider the recommendation.

JG

Amendment of Selected Interventions Not Normally Funded (INNF) Policies Claire Beynon presented this paper which recommended amendment of selected INNF Policies from requiring Prior Approval to allowing patients access to treatments where it is confirmed they meet the criteria for treatment by referring and treating clinicians. The recommendation was based upon the following INNF policies moving from “Prior Approval” to “Criteria Based Access”: Carpal tunnel Surgery Dupuytrens Contracture Release Surgery Haemorrhoid Surgery Assessment for Surgery for Cataracts. The Individual Funding Request team carry out a series of audits to assess compliance with Criteria Based Access and these procedures would be considered under this audit programme. The COE discussed the implications of amendment of these selected INNF policies and agreed that there needed to be very clear communication to GPs about meeting criteria for treatment. There was further discussion around the impact this would have on the use of the ISTC. The COE AGREED to the Amendment of the Selected INNF Policies subject to quarterly audits. 7.2

Remote Care Monitoring (Preparation) DES JE presented this paper following a request from the COE to develop proposals to provide the Membership with guidance to support the achievement of the Remote Care Monitoring (Preparation) DES. JE presented the proposals developed, requested feedback from the COE and their approval for the submission of this Page 5 of 7

Action proposal to NHS England Area Team. The COE discussed how these proposals would be communicated to practices as this would be a very different message to what they were expecting. Remote care monitoring is not telehealth and there was concern that practices may have been expecting to receive tele-monitoring equipment. The DES has to be agreed with the membership, included what conditions are going to be monitored. The COE requested further clarification is sought from the Area Team in terms of interpretation of the Remote Care Monitoring (Preparation) DES. 7.3

Community Service Resource Allocation Locality Fair Shares Follow Up 2: Implementation and Risks KL introduced Anne Magham, Practice Manager, Wellington Road Family Practice, who presented this paper which following the finalisation of the funding model, examined the consquences of any actions the CCG requires the SGCHS to undertake to reallocate resources in line with its contract. Three options for implementation and their associated impact were outlined: Shift resources opportunistically as vacancies arise during 2013/14 Devise and implement a resource sharing agreement between Yate and Severnvale Do nothing The COE AGREED with the recommendation to do nothing at the present time and wait until March/April 2014 when the changes to the contract are effective and communication to practices will form part of the transition programme. KL expressed thanks on behalf of the COE to AM for her input and help over the past 18 months.

8 8.1

Papers for Discussion Rehabilitation Review SI gave a presentation on the Rehabilitation Snapshot Audit and the Snaphot Audit Report to the CEO which detailed the results of the bed utilisation snapshot audit undertaken across general and acute hospital beds with BNSSG over the period 13 May-3 June 2013. The audit was undertaken in order to gain an understanding of the potential for additional rehabilitation to be undertaken in a community setting and the requirement for non-acute rehabilitation beds. The conclusions drawn from this work were: There is currently a need for non-acute capacity to provide rehabilitation. Some of this will need to be in a bedded environment with on-going medical supervision. Currently capacity in acute hospitals is being used to support clinically stable patients who could be discharged from hospital if there were appropriate therapy and support services available in the community. Given the age profile of patients awaiting discharge, a greater degree of support discharge and increased community services may impact on the use of the current bed capacity Further work is planned between NBT and community services to improve the transfer of patients. In the medium term, work is taking place to develop a service specification for an interim rehabilitation model of care to ensure services are provided appropriately when Frenchay Hospital closes. There is extensive work taking place to plan for the longer term model of care for health and social care services for the Frenchay site. KH noted that the Rehabilitation Review is significant for the Frenchay Health and Social Care service model and the CCG is now looking to implement the

JE

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Action rehabilitation strategy within South Gloucestershire starting with our commissioning intentions for 2014/15. The COE NOTED this report. 9 9.1

Papers for information Quarterly Update Report: Partnerships and Joint Commissioning KH raised her concern that the quarterly report for Partnerships and Joint Commissioning should not be treated as a paper for information only and should be included in the Performance Updates. It should be noted that Partnerships and Joint Commissioning represents a significant proportion of commissioning for the CCG. The COE NOTED this report.

9.2

Quarterly Update Report: Children and Maternity Paper deferred for presentation at next COE meeting on 15 August 2013.

9.3

Acute Mental Health Liaison Service Update The CEO NOTED this report

9.4

Primary Care Foundation – Improving the management of access and urgent care in General Practice in South Gloucestershire 2012-2013 The CEO NOTED this report and the contribution from all the South Gloucestershire GP practices.

10

Any Other Business KH advised the COE of the plans to develop and Integrated Transformation Fund for 2014/15 and 2015/16 that would require a transfer of NHS funding to local authorities and would represent approximately 3% of the CCG’s funds. KH agreed to present a paper to the next COE meeting.

KH

DJ confirmed that arrangements for the move to Corum were still on schedule for 19 July 2013. 10.1

Update of proposed Consultant Link arrangements As advised that the Consultant Link Telephone contract ended in June 2013 and that arrangements were being sought to facilitate a similar service.

11

Dates for future meetings The CEO NOTED the dates for future meetings to be held at Emersons Green Village Hall.

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