PGB Board of Directors Minutes

Transcription

1 Board of Directors Minutes 1 of 13

2 NHS NENE CLINICAL COMMISSIONING GROUP BOARD OF DIRECTORS TUESDAY 3 rd DECEMBER 2013 AT 2.30 PM BOARD ROOM, FRANCIS CRICK HOUSE Present: Dr Darin Seiger (DS), GP Chair (Chair) Richard Alsop (RA), Chief Commissioning Officer Peter Boylan (PB), Director of Nursing & Quality Dr Emma Clancy (EC), Clinical Director, South Northants Dr Matthew Davies (MD), Assistant Clinical Chair & Clinical Director, Daventry North Lisa Durant (LD), Director of Performance Ben Gowland (BG), Chief Executive Kathryn Moody (KM), Director of Contracting and Procurement Dr Roger Perry (RP), Clinical Director, Wellingborough Dr Raf Poggi (RaP), Assistant Clinical Chair & Clinical Director, Kettering Stuart Rees (SR), Chief Finance Officer Dr Glyn Williams (GW), Clinical Director, East Northants In attendance: Neil Boughton (NB), Head of Planning & Commissioning (Item 10 only) Caroline Capell (CC), Senior Locality Manager Northampton Central, Northampton West and Northampton South & East Richard Cohen (RC), Senior Manager, Ernst & Young LLP (Item 9 only) Pat McCarthy (PMC), Head of Joint Commissioning (Item 9 only) Marianne Phillips (MP), Corporate Secretary 1. Apologies for Absence Apologies were received from Dr Kamal Sood; Dr Tom Evans and Dr Rick Byrne however it was noted that Caroline Capell was attending as Proxy for these Clinical Directors. DS confirmed that as BG would need to leave the meeting before the close DS would be Chairing. DS confirmed that the meeting was quorate according to the Terms of Reference and that the meeting could proceed. 2. Declarations of Interest All Clinical Directors present declared a conflict of interest in Item 11 Commissioning Primary Care Services in their role as GPs but after discussion the Executive Directors agreed that as the item would only be for discussion, and approval would be sought from the Governing Body, it would not be necessary for the Clinical Directors to absent themselves from the meeting or discussion. 3. Minutes of the Previous Meeting BOD The Minutes of the meeting held on 12 th November 2013 were agreed as an accurate record. 4. Action Log BOD Finance Key Issues Statement of current financial situation RA confirmed this is in progress. 2 of 13

3 Ophthalmology Glaucoma Management Finance /activity proposal received from NGH. The team met to consider this and the aim is to agree the model by week commencing 9 December and for implementation to commence in January Quality & Performance Report Information on actions LD confirmed that work will be undertaken with CC to detail key messages and what Localities can do to support them and this will be presented with future reports. It was agreed that this action be closed. Potential Commissioning Intentions MP will chase DM/SG to see if this action is complete. Key Issues Quality & Performance 3 Week time lag in MRI reporting at KGH KM has raised this with KGH but is awaiting feedback. Planned Care QIPP Amber to Red Procedures LD will make sure a process is worked up to ensure PID data can be included (sent straight from GEM to GPs). Quality Premium Funding Proposal This action is closed. The remaining completed actions were noted. Standing Items / Items for Discussion / Approval 5. Finance Report Month 7 BOD SR confirmed that the CCG is officially in Financial Recovery and that the run rate must improve by 8.6m by year end in order to break even. A Financial Recovery Group has been set up and meets on a weekly basis. At Month 7 the CCG s underspend is short of target and the main causes of this are CHC and QIPP delivery. Mitigating actions are in place by way of data challenges; vacancy control; ceasing investment; and recouping incorrect allocations. Discussions are to take place with Corby CCG regarding historical CHC patients (prior to April 2013) and the amount they will pay. Acute performance is a risk, particularly at KGH where activity continues to rise. SR confirmed that the CCG had received its cash allocation at the end of the previous week and that it fell short of the amount needed to ensure the Trusts can be paid. SR suspects this will be an issue for many CCGs and SR will raise this with the Area Team. The Board of Directors discussed the issues and agreed that Clinician to Clinician conversations would be helpful with Corby CCG around the historical CHC allocations, especially in light of Healthier Northamptonshire. ACTION: CLINICAL DIRECTORS 6. (Item 9 On Agenda) Financial Recovery Plan BOD SR drew the Board of Director s attention to the latest draft of the Plan which had been circulated the previous day. The Financial Recovery Plan had been submitted and additional work was undertaken in order to operationalise the plans more; to highlight clinical engagement and leadership; and to ensure the plan was coherent. This further draft was submitted to the Area Team on 2 nd December The Board of Directors discussed the Plan and agreed that focus should be on moving the run rate and the actions to be taken. SR noted that the Prior Approval work on the Amber to Red process would have 3 of 13

4 a positive outcome; that contract challenges would be undertaken; and that clinical support is needed to scrutinse the data challenges. SR confirmed that the next workshop session (and thereafter on a fortnightly basis) would focus on financial recovery and the full action plan. ACTION: SR The clinical support needed for appropriate contract challenges was discussed and it was agreed that in order to start the process quickly, MD and any other available Clinical Directors would meet with KM on Thursday 5 th December from KM will draw up a process for clinical challenge going forward and bring this back to a workshop session for discussion. ACTION: KM/MD BG left the meeting. 7. (Item 5 on Agenda) Quality & Performance Report BOD LD and PB took the Board of Directors through the report presented. CC requested that the papers from these meetings be sent as routine to all SLMs to ensure they are aware of the information contained within. ACTION: MP PB noted that Dr. Foster s Good Hospital Guide will be published on Friday 6 th December and one of the main themes that the media will focus on is Drugs and Alcohol. PB will circulate via the data reports concerning the Northamptonshire area. ACTION: PB The Board of Directors noted the report. 8. (Item 6 on Agenda) Contracting Update BOD KM introduced the new style report and highlighted key points including the overspend on contracts which is most evident in regard to NGH; excess bed days which are up and being investigated; and concerns around the patient transport provider where an unannounced visit revealed issues with license records and financial stability. The Board of Directors discussed the report and queried whether the poor performance of EMAS was putting patients at risk. KM confirmed that although of course longer wait times could potentially be detrimental, there is no evidence that patients are being harmed through the delays. Performance will continue to be monitored closely. The Board of Directors noted the report. PMC and RC joined the meeting. 9. (Item 7 on Agenda) Healthier Northamptonshire BOD (Item 10 on Agenda) Integration Workstream Update BOD RA updated the Board of Directors on the progress of Healthier Northamptonshire noting that the programme had a significant challenge to re-engineer the way the health economy operates but that many of the changes being identified are changes which should have been made years ago as they will deliver the best quality service for patients. PMC and RC took the Board of Directors through the slides which provided an update on the Integration Workstream explaining that it focused on Community Beds; Crisis Hubs; Discharge to Assess; a patient 4 of 13

5 centered system; and self-management of conditions. The aim is to make best use of existing community assets and Community and Voluntary services. Due to an important MAC meeting, RaP, MD, RP and GW left the meeting. DS confirmed that the meeting was still quorate and would continue. The Board of Directors discussed the update and agreed that it was imperative that workstreams are integrated effectively to ensure work is not duplicated. It was agreed that a workshop session should be given over to Healthier Northamptonshire and focus on Urgent Care; Primary Care; Frail & Elderly; Integration; and Care Pathways Workstreams. Nicki Price and Jonathan Hill should be invited to attend. ACTION: RA/ PMC It was further agreed that communications around Healthier Northamptonshire and Financial Recovery should be managed in conjunction. ACTION: RA PMC and RC left the meeting. NB joined the meeting. 10. (Item 11 on Agenda) Commissioning Primary Care Services BOD NB presented the paper to the Board of Directors noting that it was seeking support and not approval as this would be sought from the Governing Body. The Board of Directors discussed the paper and agreed that more work was needed before it could be presented to the Governing Body. ACTION: NB/RA NB left the meeting. 11. (Item 12 on Agenda) Future Provision of Payment & Monitoring Services for people with direct payments for their Personal Health Budgets BOD RA took the Board of Directors through the paper presented and the Board of Directors approved Option 1 for the future provision of direct payment and monitoring services for 2014/ (Item 13 on Agenda) Commissioning for Quality and Innovation (CQUIN) Process for 2014/15 BOD PB explained that the paper outlines at high level the process for 2014/15 and that a meeting is scheduled with the three Providers in January to discuss schemes which Providers will then work up and bring back to be agreed by the Board of Directors. The Board of Directors discussed the paper and agreed that the CCG should have input into ideas for the schemes to assist in achieving outcomes. PB asked for ideas to be submitted to him ASAP. ACTION: PB/ALL 13. (Item 14 on Agenda) TUPE Transfer of Carers Support Staff BOD RA explained that Carers Support Staff were to be transferred out of Nene CCG to Northamptonshire Carers which was approved at NCDE. Northamptonshire Carers have agreed this transfer subject to Nene CCG agreeing to indemnify them against a rise in employer pension contributions for a period of 2 years. RA explained that as Nene would have to bear this cost if the staff were to remain in the CCG anyway, it would have no additional impact if the proposal were agreed. After due discussion, the Board of Directors agreed the proposal. 14. (Item 8 on Agenda) Top Risks / BAF BOD of 13

6 Due to restricted time, this item was not discussed in detail and SR requested that feedback to the questions raised in the paper be ed after the meeting. There being no further business the meeting closed at 5.35pm. 6 of 13

7 NHS NENE CLINICAL COMMISSIONING GROUP BOARD OF DIRECTORS TUESDAY 7 JANUARY 2014 AT 8.00 AM BOARD ROOM, FRANCIS CRICK HOUSE Present: Ben Gowland (BG), Chief Executive (Chair) Dr Rick Byrne (RB), Clinical Director, Northampton East & South Dr Emma Clancy (EC), Clinical Director, South Northants Dr Matthew Davies (MD), Assistant Clinical Chair & Clinical Director, Daventry North Lisa Durant (LD), Director of Performance Kathryn Moody (KM), Director of Contracting and Procurement Dr Roger Perry (RP), Clinical Director, Wellingborough Stuart Rees (SR), Chief Finance Officer Dr Darin Seiger (DS), GP Chair Dr Kamal Sood (KS), Clinical Director, Northampton Central Dr Philip Stevens (PS), Clinical Director, South Northants In attendance: Richard Bailey (RB), Deputy Head of Joint Commissioning Sue Davis (SD), Administrative Assistant Dr Yassir Javaid (YD), (Item 6 Cardiology Update Only) Tim O Donovan (ToD), Service Redesign Manager (Item 6 Cardiology Update Only) Nisha Patel (NP), Planned Care Commissioning Manager (Item 6 MSK Update Only) Marianne Phillips (MP), Corporate Secretary 1. Apologies for Absence Apologies were received from Richard Alsop, Peter Boylan, Dr Raf Poggi, Dr Tom Evans and Dr Glyn Williams. BG confirmed that the meeting was quorate. BG noted that the Better Care Fund Paper (BOD-14-12) had been withdrawn. 2. Declarations of Interest All Clinical Directors and the GP Chair declared an interest in Item 11, Commissioning Primary Care Services and Item 6 Care Home QIPP Review. BG confirmed that after discussion with the Audit & Risk Committee Chair Kevin Thomas, and in his role as Chair of the Board of Directors and the Accountable Officer, it had been agreed that a waiver be applied to allow those with a conflict of interest to participate in the discussions but not vote on any decision. BG further confirmed that as the meeting would not be quorate without the GP Chair and Clinical Directors, no decision would be made in regard to item Minutes of the Previous Meeting BOD The Minutes of the meeting held on 3 rd December 2013 were agreed as an accurate record. 7 of 13

8 4. Action Log BOD Healthier Northamptonshire Communications around Healthier Northamptonshire and Financial Recovery BG and SR are meeting with Communications Team to discuss. Finance Report Month 7 Clinician to Clinician discussions with Corby DS is arranging a meeting. Finance Key Issues Statement to support Clinical Directors communication of the financial situation- DS confirmed that a paper was sent to all Practices. This action is complete. Ophthalmology- Glaucoma Management RB explained the update given on the action log and confirmed that discussions were underway. Planned Care QIPP Amber to Red Procedures KS will provide an update at item 6 of the Agenda. The remaining completed actions were noted. 5. Q2 Assurance Review Area Team Letter BOD BG explained that the formal assurance category which applies for quarter three is assured with support. Amongst other actions this will involve the introduction of an external support brought in by the Area Team to assist in the financial recovery process. With RA currently away from the office ill, discussions are underway with the Area Team to ascertain whether the incoming support might be able to assist with the work necessary for the Healthier Northamptonshire plan which is due to be submitted by the end of January. BG noted the considerable work and effort undertaken by LD and the Urgent Care team which has resulted in a stable (although still challenging) situation in urgent care, particularly at NGH. BG took the Directors through the other actions outlined in the letter and emphasised the need for the Board of Director meetings to be utilized effectively and to ensure clear focus on actions to be taken which will affect the run rate and improve urgent care immediately, whilst putting plans in place for the next five years. Agendas for all Board of Directors meetings will be badged against the three main areas of focus Financial Recovery; Urgent Care; and Healthier Northamptonshire. ACTION: MP/BG 6. Finance Report Month 8 BOD SR took the Board of Directors through the main points of the report noting that agreements had been made with NHFT and NGH for end of year and discussions are underway with KGH. CHC needs to be kept under control and discussions are ongoing in regard to recouping incorrect allocations. All CCGs are required to complete a template to clarify what is needed in terms of cash allocations (which currently fall short of the necessary amount) and these will be reviewed by NHS England. The Finance, QIPP and Contracting Committee are monitoring the progress of this carefully and will request that the issue is escalated if it is not resolved by the end of January Guidance on plans for next year was released on Christmas Eve, and a plan is required to be submitted on 28 th January Financial Recovery Prioritisation 8 of 13

9 The potential projects have been ordered into outcome focused areas and within these areas management directors have been identified. Clinical Leads need to be identified for each area and LD and MD will meet to resolve this and bring back to the next Board session. ACTION: LD/MD The Board of Directors discussed the process and agreed that it was imperative that whilst this was resolved focus must be maintained on the priority areas which will affect the run rate - CHC; Amber to Red Procedures; Discharge to Assess; Contract Challenges; and Access to Specialist Care Centres and Community Beds. Agendas will be set to ensure update reports on these five areas are provided at all Board sessions. ACTION: MP/BG NP Joined the meeting. MSK Update BOD NP explained that at the Board of Directors request the Planned Care Team had looked at three possible areas by which savings could be accelerated. After due deliberation, the Board of Directors recognised and agreed that there is no opportunity to realise savings in AQP MSK or Nerve Conduction Test provision in 2014/15 without a risk of over-spending against NHFT MSK contract or elsewhere in the system. The Board of Directors approved the fast track of the whole pathway transformation. NP left the meeting. YD and ToD joined the meeting. Cardiology Update BOD ToD and YJ took the Board of Directors through the paper, outlining the proposals. After due discussion the Board of Directors approved the use of prior approval for elective PCI subject to audit, stakeholder management and ensuring proper testing of the costs and savings involved. The Board of Directors approved the commissioning of an independent review to assess reconfiguration and re-design of pathways. The Board of Directors delegated authority to approve the move towards a post discharge tariff for cardiac and pulmonary rehabilitation and discussion around NGH s Counting and Coding proposal to a sub-committee of KM and KS in order that further discussions can be undertaken with Contracting and Finance teams. ToD and YJ left the meeting. Amber to Red Procedures BOD KS tabled a report updating the Board of Directors on progress of the move from Amber to Red procedures. A draft to all Practices to provide further information on some prior approval requests needs a sentence to clarify the reason for the request. ACTION: KS BG noted the staffing issues in the Northern Localities due to illness. DS will meet with RP, RaP, the deputy for GW, LD and the SLMs to ensure appropriate cover is in place. ACTION: DS 9 of 13

10 7. (Item 8 on Agenda) Quality & Performance Report BOD The report was taken as read and LD highlighted the immense scrutiny placed on Urgent Care currently. The situation although high risk, is stable and conference calls are held daily to manage it. The GP input in A&E has been highly valued and there is appetite to expand on this programme. Clarity is needed over the Clinical Leads and process for Community Beds and DS will all Clinical Directors with this information and test it at the next Board session. ACTION: DS Due to an Urgent Care Conference Call LD left the meeting. The Board of Directors noted the report. 8. (Item 7 on Agenda) Contracting Update BOD KM took the Board of Directors through the report and noted that additional areas of challenge have been identified and will be reported against going forward. The Board of Directors noted the report. 9. (Item 11 on Agenda) Commissioning Primary Care Services Local Enhanced Services Contracts BOD Local Access Monies BOD BG reminded the Board of Directors of the waiver agreed and applied to enable the Clinical Directors and GP Chairs to participate in the discussion despite their conflict of interest and in light of the fact that no decision would be made. LD returned to the meeting. The Board of Directors discussed the paper and made the point that both issues need to be addressed in the context of the Primary Care Transformation Plan. RB will work with Nicki Price (who is leading the workstream) on this and complete it within two weeks. ACTION: RB 10. Item 9 on Agenda) Planning Guidance BOD BG introduced the Planning Guidance and encouraged all Directors to read the full guidance. MP will send the guidance to all Leads. ACTION: MP Due to the meeting overrunning the scheduled time, BG had to leave the meeting to participate in a conference call and KS had to leave to attend another meeting. DS took over as Chair and confirmed that the meeting was still quorate. VH joined the meeting. 11. (Item 6 on Agenda) Financial Recovery Care Home QIPP Review BOD VH explained that the ANP led model was not delivering the outcomes as expected and therefore it was recommended that notice be served on the contract with NHFT. 10 of 13

11 The Board of Directors discussed the recommendations and agreed that notice should be served to NHFT in regard to the ANP model but that further investigation should be undertaken into the metrics identified in the planning guidance and the possibility of the utlisation of the 5 per patient over 75 monies. ACTION: LD/VH 12. (Item 14 on Agenda) Top Risks/BAF BOD The Board of Directors noted the report. 13. (Item 12 on Agenda) Patient Transport BOD KM explained that an offer had been made to NSL and a response is awaited. An alternative strategy for patient transport is needed in the event that the negotiations are unsuccessful. The Board of Directors noted the report. 14. (Item 10 on Agenda) Healthier Northamptonshire Strategy BOD The Board of Directors discussed the strategy and agreed the recommendations set out. In order to attend another meeting MD left. DS confirmed the meeting was still quorate. RB joined the meeting. 15. Re-commissioning Community Services for Children and Young People BOD RB took the Board of Directors through the paper and explained that due to the extensive work required and the tight timescales the recommendation was to extend the notice period to NHFT and NGH for a further 6 months to 1 April After due discussion the Board of Directors agreed the recommendation subject to clarity on any blocks to progress to ensure no further extensions are needed. Any other business There being no further business the meeting closed at 12.20pm. 11 of 13

12 BOARD OF DIRECTORS WORKSHOP DECISION LOG MEETING HELD: PRESENT Ben Gowland Chief Executive & Accountable Officer (Chair) Dr Rick Byrne Clinical Director Northampton East & South Dr Emma Clancy Clinical Director South Northants Dr Matthew Davies Assistant Clinical Chair & Clinical Director Daventry Lisa Durant Director of Performance Kathryn Moody Director of Contracting & Procurement Dr Roger Perry Clinical Director Wellingborough Dr Raf Poggi Clinical Director Kettering Dr Darin Seiger GP Chair Dr Kamal Sood Clinical Director Northampton Central APOLOGIES Richard Alsop Chief Commissioning Officer Peter Boylan Director of Nursing & Quality Stuart Rees Chief Finance Officer Dr Philip Stevens Clinical Director South Northants Dr Glyn Williams Clinical Director East Northants IN ATTENDANCE Marianne Phillips Corporate Secretary QUORACY APPROVALS / DECISIONS Amber to Red Procedures Amber to Red Procedures BG confirmed that the meeting was quorate. APPROVED: 2 weeks of additional clinical time from Dr James Findlay to accelerate the addition of other conditions to the prior approval process. APPROVED: To use the Clinical Network to aid engagement with consultant colleagues only if the escalation process has been followed in the first instance. 12 of 13

13 BOARD OF DIRECTORS WORKSHOP DECISION LOG MEETING HELD: PRESENT Ben Gowland Chief Executive & Accountable Officer (Chair) Peter Boylan Director of Nursing & Quality Dr Rick Byrne Clinical Director Northampton East & South Dr Emma Clancy Clinical Director South Northants Dr Matthew Davies Assistant Clinical Chair & Clinical Director Daventry Lisa Durant Director of Performance Dr Tom Evans Clinical Director Northampton West Kathryn Moody Director of Contracting & Procurement Dr Raf Poggi Clinical Director Kettering Stuart Rees Chief Finance Officer Dr Darin Seiger GP Chair Dr Kamal Sood Clinical Director Northampton Central Dr Philip Stevens Clinical Director South Northants APOLOGIES Richard Alsop Chief Commissioning Officer Dr Roger Perry Clinical Director Wellingborough Dr Glyn Williams Clinical Director East Northants IN ATTENDANCE Lola BanJoko Head of Planned Care Dr Chris Ellis Clinical Lead MSK Marianne Phillips Corporate Secretary Linda Dunkley Commissioning Lead, Planned Care Team Nisha Patel Commissioning Manager Nicki Price Project Manager, GP Transformation Workstream, Healthier Northamptonshire QUORACY DECLARATIONS OF INTEREST APPROVALS / DECISIONS North Northamptonshire Urology Establishment Control Form BG confirmed that the meeting was quorate. BG noted the waiver applied by the Chair of the Audit Committee & BG as AO and Chair to allow the Clinical Directors to discuss Item 7 LES. Clinical Directors also declared a conflict of interest for Item 9 although this item was deferred and not discussed. Nicki Price declared a conflict of interest in regard to her role as Managing Partner at Woods End Medical Practice. AGREED: Contract Variation to be utilised subject to a Nene Pilot. Community Model at reduced tariff. AGREED: Clinical Director to overlap with Dr Roger Perry to facilitate handover. 13 of 13