NHS CUMBRIA CLINICAL COMMISSIONING GROUP MINUTES OF THE COPELAND LOCALITY EXECUTIVE Thursday 28 May 2015, 13:30 Cleator Moor Health Centre

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1 NHS CUMBRIA CLINICAL COMMISSIONING GROUP MINUTES OF THE COPELAND LOCALITY EXECUTIVE Thursday 28 May 2015, 13:30 Cleator Moor Health Centre Present: In Attendance: Eric Bater, GP Distington EB Kathryn Illsley, GP Seascale KI Graham Ironside, GP Queen Street GI Juliet Rhodes, GP Lead Fellview HC JR (Chair) Anita Barker, West Network Lead AB Ray Beale-Pratt, West Business & Performance Lead RBP Mel Bradley, Primary Care Lead MB Brenda Bragg, Administrator (minute-taker) BB Bernard Courtney, Patient Rep BC Barbara Fleary, Senior Commissioning Manager BF Allison Graham, Workington Specialist Care Home Nurse AG (agenda item 8b) Linda Haig, Commissioning Manager LH Claire King, Public Health representative CK Janet Toole, Practice Manager Westcroft Surgery JT Chris Wood, Patient Rep CW COE 56/2015 AGENDA ITEM 1: Welcome and Apologies Apologies were received from Caroline Rea, Dr Fiona Ironside, Dr Tom Ickes, Dr Judith Spencer, Dr Celia Heasman, Dr Rick Tranter, Melinda Hughes Welcome to Janet Toole, Practice Manager representative, Claire King, Public Health and Allison Graham, Specialist Care Home Nurse COE 57/2015 AGENDA ITEM 2: Declaration of Interest None declared. COE 58/2015 AGENDA ITEM 9: Primary Care Report MB gave a detailed report and presentation updating the Executive on how the locality is performing and future developments which aim to ensure more ownership at locality level: prescribing budgets (Copeland and Cumbria-wide) PMM savings Antibiotic prescribing Benzos (good progress being made in reducing prescribing) 1

2 COE 59/2015 COE 60/2015 COE 61/2015 Antipsychotics/dementia (a difficult one to tackle but progress is being made) Glargine Initiative (locality reduction of 11%) QIPP Q3 data 2015/16 Work Plan (and support plan) Graphs were tabled to support the presentation. Action: Antibiotics figures MB to check clindamycin includes topical preparations. Action: Primary Care Foundation Audit: MB to speak to David Carson re event to pull together audit results. AGENDA ITEM 10: Finance and Performance update The purpose of the report is to provide a summary of performance matters relating to the Locality. The meeting is asked to note the report and the actions needed to support the CCG plans for 2015/16. A new locality dashboard is being developed and would be available for the July Executive. Action: RBP would supply further data on A&E data by age and time of attendance (whether in or out of hours). Non-elective admissions by top 5 or 6 HRGs Workington Minor Injuries Unit: It was reported that Copeland patients are being told their attendance was inappropriate. Action: AB to check on what message is given to Copeland patients attending Workington MI unit. AGENDA ITEM 11: Pathfinder Update AB will have an update for the next meeting. Practices at Queen Street and Westcroft reported that patients picked up by NWAS crews (coded blue or amber) have been appropriate. Action: Advanced paramedics: AB to investigate with NWAS what has happened to this role. AGENDA ITEM 8b: Care Homes Allison Graham Specialist Nurse Frail Elderly Assessment Team (Workington). AG gave an overview of her role. Allison has been in post since August 2014 and succeeded Dr Rebecca Qualtrough. There are 10 residential and nursing homes in Workington and the team is the first point of call for these homes every morning. Duties of the role include: Providing proactive discharge facilitation. Advanced Care Planning making sure it is communicated. Attend primary health care teams meetings weekly. Weekly meetings in homes with CHESS colleagues Over 75s are picked up from Practices before they start bouncing in/out of hospital. MB MB RBP AB AB 2

3 There was a brief discussion about the use of Telehealth in Copeland care homes. Action: Telehealth review data to establish usage. Action: LH to pull together care home schemes currently provided across Cumbria and numbers of GP callouts to care homes by Practice in Copeland. LH/RBP LH COE 62/2015 COE 63/2015 COE 64/2015 COE 65/2015 AGENDA ITEM 8a: Primary Care Community Update BF updated the Executive. Eight practices were now on line with the Single Point of Access. GPs were asked if they had any issues or problems. There had been a cross over for bloods but this should settle down (if not, then please make BF aware). EB asked how soon it would be before the SPA talked to the discharge team. BF explained that this would be part of the roll out which would include care navigators notifying practices of all patients being discharged from WCH. BF had a list of comments from Seascale but KI replied to say that as Seascale were not part of the SPA then it would not be relevant to go through the list. BF stated that she could not guarantee that Seascale would not be affected by opting out of the scheme, as district nurses were CPFT staff and a shared resource, but work would be undertaken to address this. AGENDA ITEM 3: Minutes of previous meeting / matters arising Minutes of 23 April: Graham Ironside and Kathryn Illsley to be added to list of those present and then the minutes were accepted as an accurate record. AGENDA ITEM 4: Action Log Action log updated and circulated to all GPs. Public Health Healthy Weight Referrals: Claire King to arrange for posters / flyers to be sent out to Practices to promote. Actions completed: General Practice Summit 16 April PLT afternoon. Encourage attendance. Training & Education Update: Breakdown of training on Bluestream. Explore other options for training fund. Invite John Roebuck to Executive. Patient Text Alerts: EB to discuss with Dale Shackley Elderly Care Co-ordinators Procurement Strategy: out copy of declaration of interest form to Practices for signature Procurement Strategy: Follow-up with contracts and inform Executive of confirmed figure re on cost percentage. AOB: Invite GPs to PLT session on dermatological conditions AOB: Full Council of Members 13 May. Practices to let Locality Office know who will represent them. Spire/Spinecare Contract: No need to re-refer. Spire and Spinecare will be picking this up based on original referrals. AGENDA ITEM 5: New Models in Primary Care Paper presented by LH. This had been prepared as research review for the GP Development Session held on 13 May hence there are no recommendations. CK 3

4 COE 66/2015 COE 67/2015 COE 68/2015 AGENDA ITEM 6: Primary Care Development Event GPs were extremely positive about the Council of Members primary care development event, felt there was a lot of energy generated and would be very keen to continue the work started. It was also expressed the need to involve younger GPs (due to future retirements). It was agreed to use the June PLT session (18 th ) starting later in afternoon (suggested 16:00 hours) so that Practices could potentially deliver any internal training first. It would be expected to have representatives from each Practice. Further discussion concluded that Allerdale GPs should be invited to look at a plan for the West, also operational partners such as CHOC, NWAS, Federation reps. The Executive GPs decided against having representation from the LMC as Peter Higgins is organising a separate event. BF explained that opportunities for local development, eg capital bids should be worked up separately in preparation for any future opportunities arising to apply for funding. AGENDA ITEM 7: Clinical Leads Update JR updated from Clinical Leads meeting of 21 May. 1. Medical Directors Update There is a national mandate for 111 to take out of hours calls from October Anxiety from general practice has been acknowledged. There are significant concerns with some care homes, particularly in South Lakes, with regards to funding and recruitment. CCG have requested an urgent visit to WCH from the College of A&E Medicine in response to a letter of concern raised by A&E Consultants. 2. CCG Stakeholder survey results Highlighted issues for leadership and communications. There is a plan to address issues raised and ongoing audit of progress. 3. Review of CCG Structure There will be implications for a small number of CCG staff although uncertain as to what changes will affect Copeland. More details should be available very soon. 4. General Practice Development Session Very positive feedback and followed the next day by a meeting with the 3 Cumbrian Federations which was similarly positive. Ongoing work now to collate and develop themes to form a definitive structure for the September FCM meeting. 5. Cost Improvement Programme Details of plans for prescribing/referral support from April 2016 focusing on best practice and reducing unwarranted variation. Localities are to discuss proposals and engage with practices. AGENDA ITEM 12: Clinical Co-ordination Centre at CIC Briefing note provided by CPFT. The Clinical Co-ordination Centre is currently based at Hilltop Heights in Carlisle and has brought together resources from ASC, CPFT and NCUHT. It 4

5 has been operational for approximately 18 months and comprises 3 units: Professional Point of Access (PPA) Older Persons Assessment Team (OPAT) Integrated Discharge Team (IDT) Following a recent review of service development options the CCG have agreed service levels based upon the available finances and current priorities around admission avoidance. A period of formal consultation with the current staff has recently been completed. COE 69/2015 COE 70/2015 AGENDA ITEM 13: IT Update Dr William Lumb provided 2 briefing papers for the Executive s information: End of Life (update for the Cumbrian Health Economy) it is expected that Cumbria will have a full EoL information system up and running by autumn 2015 (with the exception of NWAS). Electronic data transfer (documents and clinical information) Inbound documents Outbound Clinical Views Map of Medicine Referrals Strata Pathways IT Practice Support staff: 2 out of 6 jobs had been recruited to. The remainder were back out to advert. John Roebuck would attend the June Executive and would take any questions around IT systems and implementation. AGENDA ITEM 14: Any Other Business a) Lead GP for Copeland: JR again asked GPs to go back to Practice to ask for expressions of interest in the Lead GP role. b) Review of ECG/ABPM across North Cumbria. As part of an exercise looking at the future provision of 24 hour ECG (electrocardiogram) and 24 hour ABPM (ambulatory blood pressure monitoring) service in North Cumbria NHS Cumbria CCG will be undertaking a scoping exercise to look at how services are currently organised and provided to inform future commissioning and procurement. It is clear from the initial work looking at these services that they are provided very differently across North Cumbria. Existing services are to be continued until end of March 2016 meanwhile Teresa Taylor would be contacting Practice Managers to request information about how your practice organises such support for patients. c) NuGen Moorside Project: Bernard Courtney drew the Executive s attention to the project to build 3 nuclear reactors on the Moorside Site to the west and north of the Sellafield site which, if given the go ahead, will require temporary accommodation for the 4,000 new workforce. Areas identified for accommodation are Corkickle, Mirehouse, Cleator Moor and Egremont. Claire King (Public Health) reported that in Somerset a similar full health impact assessment was undertaken for the Hinkley Point C Nuclear Reactors which grossly under estimated areas such as sexual health requirements and the impact on roads. NuGen are planning to hold a number of public exhibitions at locations Exec GPs 5

6 close to the Moorside Search Area and proposed Associated Development Sites. Caroline Rea is drawing up a joint response with Public Health CEO Colin Cox and Practices are asked to respond individually by letter with their concerns for General Practice (before 25 July) to: FREEPOST MOORSIDE HAVE YOUR SAY d) Cancer Referrals: Chris Wood asked why there has been a 50% drop in referrals to CIC for general radiotherapy. RBP would check with specialist commissioning to ascertain and AB would raise at the Cancer meeting. e) PAS Lowther Street, Whitehaven: BF to check what this service is about, who operates and how to refer in. She would also check how it is being advertised and whether there are any posters or leaflets available. f) Seascale Practice: KI informed the Executive that Seascale are losing another partner. Dr Sheena Jay has resigned with effect from 1 September. The Practice are now facing significant challenges in recruiting GPs. COE 71/2015 AGENDA ITEM 15: Date and Time of Next Meeting Thursday, 25 June 2015 at 13:30 hours Cleator Moor Health Centre 6