Clinical Strategy Group

Transcription

1 Clinical Strategy Group April 2016 This paper is for: Governing Body Recommendation: To note the report from the Clinical Strategy Group For further information or for any enquiries relating to this report please contact: Richard Segall Jones, Company Secretary Reporting Officer: Dr Sanjay Singh, Chair of the Clinical Strategy Group and Chief GP Commissioner Lead Director: Dr Sanjay Singh, Chair of the Clinical Strategy Group and Chief GP Commissioner Date: 26 th April 2016 Agenda Item: 81/16 Version: FINAL Report Summary: This report provides an update to Governing Body on the items discussed at the Clinical Strategy Group (CSG) on 12 th April Also attached are the approved minutes of the meeting on 8 th March FOI status: This paper is disclosable under the FOI Act Strategic objectives links: All strategic objectives are served by the work of the Clinical Strategy Group Board Assurance Framework links: Identified risks & risk management actions: Resource implications: Legal implications including equality and diversity assessment The work of the Clinical Strategy Group links to all BAF components. Not applicable. Not applicable. Not applicable. NHS West Kent CCG

2 Report history: Monthly report to Governing Body Appendices Report from the meeting on 12 th April 2016 Minutes of the meeting on 8 th March 2016 Next steps: N/A NHS West Kent CCG

3 Clinical Strategy Group (CSG) report: April 2016 Dr Sanjay Singh Chief GP Commissioner Patient focused Providing quality, improving outcomes

4 Dr Sanjay Singh Chief GP Commissioner, West Kent CCG The Clinical Strategy Group (CSG) met on Tuesday 12 th April 2016 and the following items were discussed. Chair s Report Work has commenced on the development of the musculoskeletal strategy. Ambulatory care will be reviewed over the next few months, including the GP in A&E part of the contract. Kent Emotional Wellbeing and Mental Health Services for Children and Young People (0 25 years) The CSG approved the service specifications for the Kent Emotional Wellbeing and Mental Health Services for Children and Young People (0 25 years) and noted that the specifications may be subject to minor amendment as they progressed through the competitive dialogue process. The Health Overview and Scrutiny Committee had agreed that, although the specifications did represent a major change in service, it was not necessary to go out to full public consultation due to the amount of engagement that had already been undertaken in the development of the specifications. The Governing Body will be required to approve the final service specifications at its meeting in May End of Life Care Additional Primary Care Service 2016/17 The CSG reviewed and discussed the proposed changes to the End of Life Care Additional Primary Care Service for 2016/17. The CSG was supportive of the direction of travel, but asked for the proposal to be revised to place greater emphasis on the outcomes for the patient, rather than the process. Due to the conflict of interest for GP members, the final proposal will need to be scrutinised by the Audit Committee and final approval will be by the non-gp members of Governing Body. Clinical Strategy Group Governing Body report - July

5 Frail Elderly Strategy Concept Paper The CSG supported the direction of travel as set out in the Frail Elderly Strategy Concept paper, which will inform the development of the strategy and full business case. The CSG asked for prevention and self-care to be incorporated into the strategy and for there to be clear performance indicators linked to the objectives of the strategy. Development of the Kent and Medway Sustainability and Transformation Plan The CSG received an update on the governance arrangements supporting the development of the Kent and Medway Sustainability and Transformation Plan and an outline structure of the plan. The CSG noted that the primary care strategy needed to be aligned with the sustainability and transformation plan to ensure a whole system approach. Project Initiation Document for the Acute Service Review A21/A229 Corridor The CSG was supportive of the approach as set out in the Project Initiation Documentation (PID) for the Developing sustainable acute hospital care in North Kent, West Kent and Medway programme. The programme will enable parties across Kent and Medway to work together to review the secondary care services provided at each site. The programme will require clinical engagement from the GP community. Operational Resilience and Capacity Planning 2016/17 The CSG approved the proposed schemes to be funded through Operational Resilience and Capacity Planning 2016/17. It was suggested that that next year CSG members could form part of the evaluation panel. PRGC Policy Recommendations The CSG approved the following PRCG Policy Recommendations: PR : Grommets PR : EXOGEN Ultrasound bone healing system for long bone fractures PR : Teriparatide for Osteoporosis PR : In vitro fertilization (IVF), with or without intra-cytoplasmic sperm injection PR : Insulin degludec for type 1 diabetes in adults PR : Insulin degludec for type 2 diabetes in adults Date of the next meeting The next Clinical Strategy Group meeting is scheduled for Tuesday 10 th May Clinical Strategy Group Governing Body report - July

6 MINUTES OF THE CLINICAL STRATEGY GROUP MEETING HELD ON TUESDAY 8 th MARCH 2016 IN MEDWAY ROOMS, WHARF HOUSE Date approved: 12 th April 2016 Present: Dr Sanjay Singh Steve Beaumont Dr Bob Bowes Dr Andrew Cameron Dr Nick Cheales Dr David Chesover Dr Tony Jones Reg Middleton Dr Andrew Roxburgh Dr Stefano Santini Dr Garry Singh Malti Varshney Dr Mark Whistler Dr Meriel Wynter In attendance: Sally Allen Natalie Ayles Francesca Guy Dave Holman Jan Jayatilake Priscilla Kankam Louise Matthews Sarah Overton Rachel Parris Richard Segall Jones Sara Trimmer Apologies: Gail Arnold Caroline Becher Mr Nic Goodger Dr Tim Palmer Ben Wright Chair, Chief GP Commissioner & Governing Body Member Chief Nurse Chair of the Governing Body Chief Finance Officer Governing Body Member, Public Health Head of System Wide Commissioning Project Manager, Surgical Elective Deputy Company Secretary (minutes) Head of Mental Health Commissioning Commissioning Manager, Surgical Elective Head of Medicines Optimisation Deputy Chief Operating Officer Head of Strategy, Maidstone and Tunbridge Wells NHS Trust Frailty and Medical Commissioning Programme Lead Company Secretary and Head of Corporate Services Senior Medicines Optimisation Technician Project Coordinator Chief Operating Officer Independent Nurse of the Governing Body Governing Body Member Head of Programme Management Office 1

7 37/16 Welcome and Introductions The Chair welcomed everyone to the meeting. 38/16 Apologies for Absence Apologies had been received from the following members: Gail Arnold, Caroline Becher, Nic Goodger, Dr Tim Palmer. Apologies had been received from the following non-members: Ben Wright. 39/16 Quorum The Chair confirmed that the meeting was quorate. 40/16 Declaration of Members Interests No new declarations of interest were declared. 41/16 Minutes from the previous meeting held on Tuesday 9 th February 2016 The minutes from the meeting held on Tuesday 9 th February were approved, subject to the following amendments: 28/16: Dr Bowes commented that this would link to a wider discussion about whether it was right to disproportionately invest in areas based on deprivation, rurality and the number of care homes. 28/16: Dr Whistler s suggested that there could be a benefit to having a register and care plan for mental health patients presenting frequently. 31/16: The CSG noted that the use of the word compulsory was incorrect and that all elements were optional. 42/16 Actions arising from the previous meeting held on Tuesday 9 th February 2016 The updates against the actions were noted. 43/16 Matters arising from the meeting held on 9 th February 2016 not covered elsewhere on the agenda There were no matters arising that were not covered elsewhere on the agenda. 44/16 Chair s Report The Chair reported that the event that had been held on 10 th February to promote women 2

8 in clinical leadership had been successful and had received positive feedback. A number of the attendees had expressed interest in participating in CCG projects and work shadowing at the CCG. The Chair reported that two project groups had been established: one for the musculoskeletal (MSK) strategy and the other for new primary care. The MSK project group had been tasked with developing the MSK concept paper and its membership comprised representatives from the CCG, the two west Kent GP federations, Maidstone and Tunbridge Wells NHS Trust (MTW) and Kent Community Health Foundation Trust (KCHFT). The new primary care project group would help to shape the vision as set out in Mapping the Future and would require input from CSG. The Chair reported that MTW and the GP federations in West Kent were actively in discussion with regards to the diabetes service. A further update report would be provided to the CSG in April. The Chair reminded CSG that any project ideas that were put forward by GP practices should go through due process and be discussed by the relevant Programme Oversight Group (POG) to ensure that it was aligned with the CCG s strategy before it was presented to CSG. Dr Bowes added that this should also apply to ideas put forward by NHS England and providers. 45/16 Local Incentive Scheme 2016/17 Priscilla Kankam and Sara Trimmer joined the meeting to present the Local Incentive Scheme (LIS) for 2016/17. Ms Kankam noted that the LIS had been discussed by the Practice Engagement Committee and the comments had been incorporated. The LIS had also been discussed by the Audit Committee which had been supportive of the scheme. The CSG discussed each of the three elements of the LIS in turn. Element 1 (COPD) The CSG supported this element conceptually, but Ms Kankam was asked to undertake further work to analyse the amount of work required, specifically: Element 1, Component 2 The CSG asked for greater clarification on what was meant by the development of an improvement plan. Analysis to identify how many patients would require spirometry. Action: Priscilla Kankam Element 2 (IGR) The CSG recommended, given that continuity was more likely to help embed behavioural change, that the CCG should continue with last year's impaired glucose regulation (IGR) LIS (including the use of the IGR management protocol) with a number of additions as follows: 3

9 Diagnostic criteria should be amended to include face to face appointment with an appropriate clinician with prescribing powers; Incorporation of referral to the National Diabetes Prevention Programme. However, recognising that it was unlikely that the prevention programme would have sufficient capacity, this component should not have any targets assigned. Action: Priscilla Kankam Element 3 CSG was supportive. CSG requested that the remuneration for all schemes, in principle, should be evidencedbased in terms of manpower, administration and overheads and should at least be cost neutral to the practices on those terms. This would ensure that the CCG had a standardised method to how elements within schemes were priced to encourage practice uptake and to achieve desired outcomes. Dr Bowes urged that the final scheme was reviewed to ensure that there was no ambiguity in the wording of the scheme. Subject to these comments, the CSG supported the LIS and recommended its approval by Governing Body. 46/16 Mental Health Concept Paper The Chair introduced this item and stated that this paper set out the conceptual plans for mental health services in the community and mental health crisis services. CSG s input was requested to inform the strategy in the long-term. Dr Chesover explained that the concept paper had been informed by feedback from practices, as well as external drivers for change such as the Five Year Forward View. In the discussion that followed, CSG members made the following comments: The proposal assumed that 600 patients could be discharged from KMPT and therefore the services in the community needed to be strong enough to prevent patients being readmitted to KMPT; The strategy should address the lack of continuity between the different services that made up mental health and ensure a completely co-ordinated service that covered all aspects of mental health. For example, the concept paper should make reference to maternal mental health, CAMHS and eating disorders; Known mental health patients who were in remission should have access to mental health services without the need to make an appointment with their GP. Dr Chesover responded that open access was difficult to get right and the proposal was to start with open access for psychiatric consultant support; 4

10 A co-ordinated approach was needed for patients with dual diagnosis eg substance misuse or alcoholism; Social prescribing and self-care could make a significant difference to preventing people from escalating up the system; The proposal to have a single point of access was welcomed; Better integration between physical and mental health diagnosis was required. It was suggested that assessments could be integrated and treatment run at the same time. It was suggested that MHAT could be part of ICAMS or vice versa; Electronic care planning could support this strategy. The Chair summarised the discussion by stating that the CSG supported the direction of travel as outlined in the concept paper, subject to a number of suggestions. The Chair noted that the concept paper would help to inform the primary care project. Dr Wynter left the meeting. 47/16 Kent and Medway Eating Disorder Service Redesign Mr Holman noted that this paper provided a progress report on the Eating Disorder Service (EDS) redesign across Kent and Medway and options for future development. The CSG was asked to discuss the options as set out in the paper and support the recommendation to procure an aged 8 to adult all age eating disorder service across Kent and Medway in contract lots. Mr Holman commented that the current service was inconsistent and not fully compliant with NICE guidelines. The proposed model was aligned with the Five Year Forward View and would meet the new access and wait time standards. The new model also had a greater focus on early intervention and prevention. The CSG agreed the recommended option 5 to procure an aged 8 to adult all age specialist eating disorder service. The CSG agreed to contract in two lots: west Kent together with north Kent; and east Kent as a separate lot. 48/16 Fracture Liaison Service Developing a Virtual Fracture Clinic (VFC) Service Ms Jayatilake introduced this item and outlined the proposal to pilot a virtual fracture clinic (VFC) liaison service. The proposal had been written jointly with MTW s orthopaedic team and was based on the model currently operating in Brighton. The aims of the VFC pilot included a reduction in the number of follow up appointments needed and a reduction in the number of patients having to travel to follow up appointments. The service also had a lower tariff and was expected to deliver recurrent savings in the region of 170k. The proposal was to pilot the service for a period of 6 months to determine whether the expected outputs were correct and whether this was a viable commissioning intention for the future. In response to a question from Dr Roxburgh about whether the proposal would have a detrimental impact on registrars training, Ms Jayatilake stated that registrars would still see complex fractures and would have training time in theatres which they were not currently receiving. 5

11 The Chair asked whether the proposal would require additional investment. Ms Jayatilake responded that the pilot would not require additional investment, however investment would be required if the service was agreed on a long-term basis in order to deliver the recurrent savings of approximately 170k. Ms Allen suggested that it would be worth seeking the views from Brighton CCG. Dr Chesover asked whether there were any vulnerabilities in the system. Ms Jayatilake responded that these would be picked up as part of the evaluation of the pilot. Ms Varshney urged for the pilot evaluation to also take into account patient experience. The CSG agreed the development of the proposed pilot of a virtual fracture clinic liaison service, as a proof of concept, to establish whether this was a feasible future commissioning intention to link to the wider MSK Strategy. 49/16 Dermatology Diagnostics Uncertainties Clinic Proposal Ms Ayles explained that the business case for the Dermatology Diagnostic Uncertainty Clinic (DUC) had been updated to address the questions raised by the CSG. The CSG agreed that the wording at the top of the proforma needed to be changed from if strong suspicion to if suspicion. Subject to this amendment, the CSG approved the proposal to pilot a dermatology DUC in west Kent. The CSG asked for the evaluation of the pilot to be presented to a future CSG meeting. 50/16 Medicines Optimisation Group The CSG noted the summary reports from the Medicines Optimisation Group meeting. The CSG approved the following policy recommendations: PR : Teriparatide for osteoporosis PR : Insulin degludec for type 2 diabetes in adults PR : Insulin degludec for type 1 diabetes in adults 51/16 Summary reports from POG meetings The CSG noted the summary reports from the Programme Oversight Group (POG) meetings. 52/16 Approved minutes from POG meetings The CSG noted the minutes from the Programme Oversight Group meetings. 6

12 53/16 Any other business Lymphoedema Service Rachel Parris explained that Hospice in the Weald had served notice on the contract for the lymphoedema service 6 months ago. There was no other lymphoedema service in west Kent and therefore this proposal was to commission Kent Community Health Foundation Trust (KCHFT) to provide this service via the current contract round for 1 year to ensure that there was no gap in the provision of this service. The CSG discussed the proposal and agreed in principle that there should be no gap in service, however they asked for further clarification from the Senior Executive Team about whether there would be any legal challenge in not going out to open tender for the service. Action: Rachel Parris Date of the next meeting The date of the next meeting is on Tuesday 12 th April