1. Introduction Action. 1.1 Apologies for Absence

Transcription

1 Minutes Meeting of the Haringey Clinical Commissioning Group Clinical Cabinet Thursday 4 th December 2014, 1.00pm Room 4&5, Hornsey Central Neighbourhood Health Centre Present: Dr Belinda Agoe BA GP Dementia Lead Dr Daijun Tan DT GP and Clinical Lead for Diabetes Dr David Masters DM GP Queenswood Practice, West Collaborative Dr Gino Amato GA GP Governing Body Member, North East Collaborative(Chair of Meeting) Dr J Pandya JP GP JS Medical Practice Dr Kaine Ikwueke KI GP Grove Rd Practice LMC Representative Dr Naz Akunjee NA GP, West Green Surgery Dr Richard Taylor RT GP Partner, Highgate Group Practice Dr Will Maimaris WM LBH Public Health Kate Rees KR Macmillan Cancer & EOL GP Lead move to present section Parita Shah PS Optometrist Local Optical Committee Sarah Timms ST Governing Body Member, Nurse Member In attendance: Aisling Bowman (part) AB Assistant Director QIPP/Contracts Andy Graham (part) AG Interim Executive Director of Patient Services BEH-MHT Cassie Williams CW Head of Quality and Performance, Haringey CCG Dr Jonathan Bindman (part) JB Clinical Director BEH-MHT Dr Katrin Edelman(part) KE Clinical Director for Haringey-MHT Dr Sam Shah (part) SS Clinical Lead NCL CCGs Dr Therese Shaw (part) TS Consultant Psychiatrist Older Peoples Services BEH-MHT Efa Mortty EF Deputy Head of Medicines Management Jennie Williams JW Executive Nurse and Director of Quality and Integrated Governance, Haringey CCG move to in attendance section Jill Shattock JS Director of Commissioning, Haringey CCG Karishma Purshotam KP Haringey CCG Senior Administrator Pauline Taylor PT Head of Medicines Management Sarah Hargreaves SH Haringey Clerking Services (minutes) 1. Introduction Action 1.1 Apologies for Absence Apologies for absence were received from Dr Nick Jenkins, Dr John Rohan, Dr Helen Pelendrides, Dr Sherry Tang, Dr Simon Caplan, Dr Peter Christian, Dr Christina Aride, Gerald Alexander, Moaz Nanjuwany.

2 1.2 Declarations of Interest None declared. 1.3 Chair s Introduction and Opening Remarks Dr Gino Amato welcomed everyone to the meeting and said he would be taking the Chair in Dr Tang s absence. He noted that there had been several apologies for absence, but considered that the business of the meeting could still be undertaken effectively. 1.4 Minutes of the previous meeting These will be taken at the next meeting due to the length of today s agenda. Chair, Clerk to note 1.5 Matters arising and Action Log These will be taken at the next meeting due to the length of today s agenda. Chair, Clerk to note 2. Clinical Discussion and Presentation 2.1 BEH-MHT Update Dr Jonathan Bindman introduced himself and provided an update of key new initiatives at the trust. The new access arrangements have been running since November 4 th Since that time referrals have been made through two routes, the crisis resolution and home treatment team (CRHTT) or the Triage service (which sees people within 25 days). However, many calls have been made to the CRHTT service which the Trust thinks should have gone to triage; therefore since 30 th June 2014 all referrals are received by a single telephone hub (same numbers as before) and are then allocated by BEHMHT to the crisis resolution home treatment team (CRHTT) or to triage A large number of calls are received by the hub, currently averaging 400 calls a week from Haringey residents and GPs. Average time to answer calls is 17 seconds and the number of dropped calls is low (including both those who drop immediately on getting the standard message and those who are unable to hang on to be answered). Satisfaction with the service is monitored and 100% of callers (including GPs) are reporting satisfaction with the call response Dr.Bindman noted that BEH is unusual among London mental health providers in offering open access to the general public. The very large number of calls suggests most are not people with severe mental illness, and the service is probably overlapping with other accessible services such as 111, the Samaritans, and GP out of hours services..

3 2.1.5 The caseload for CRHTTs is high, often between for Haringey; similar services across London aim at cases. There is some concerns that the triage service and CRHTT may be overwhelmed with the amount of cases coming through and maintaining the quality of response is a challenge The BEH services have up to now been organised along condition specific service lines (eg psychosis) which broke up the borough based services present up to 2010; this brought some advantages, such as being able to share expertise across areas although it lost the borough focus and accountability. Shortly the service will revert to borough based boundaries. Dr Katrin Edelman was introduced to the meeting as the new Clinical Director for the BEH Haringey service line (having worked as a clinician with Haringey residents at St.Ann s for many years) Dr Amato commented that GPs now get feedback on what has happened to their patient and where they have been sent, after the triage; for which they are thankful Dr Taylor commented that he is pleased that the phones are now answered so quickly, but disappointed that staff cannot always answer the query and frequently refer cases on, eg. to the complex care team. He felt that not all GPs get sufficient feedback on their patients There was consensus that there is a lack of clarity as to whether the Quality Alerts are working effectively. High risk patients need immediate action Dr Akunjee said he receives many referrals from the Police, who state that around 40% of their work has a mental health element to it. He would like to see GPs involved earlier on, rather than waiting for the Police to arrest or caution people to eliminate the chances of missing information from notes The group discussed the idea of sending discharge summaries via , it was however noted that in order to do this, the list of GPs s will need to be updated as currently not all GPs have addresses. The intention is to contact the GP within 24 hours and then send out the discharge summaries. It was agreed to use practice s, rather than individual GPs in case of holidays etc. It was agreed to use ICD codes at discharge time It is likely that the home treatment teams could distribute cases more effectively Sarah Timms gave a brief update on her visit to St Ann s Hospital. Sarah reported that the physical condition of the wards is still not good.. Patients are staying for longer so it was important to keep in mind quality of the physical environment within wards. She enquired the possibility of any refurbishment or re-decoration taking place within wards, whiel acknowledging the longer term plan for the site. Andy Graham confirmed the planning application has been made to re-develop the site, possibly to include housing alongside a rebuild of the wards. so there is little appetite

4 or cpapacity to patch up the wards. The hospital however need to provide a balanced 5 year business plan before capital funds would be available. 1.50pm Dr David Masters left the meeting.. 3. Primary Care Items 3.1 PM Challenge Fund Cassie Williams updated on the PM Challenge Fund discussions. Camden and Islington have decided not to pursue. Cassie confirmed that she has contacted local GPs to gauge the amount of interest and whether they want to go ahead as a single borough. 18 responses have been received with a 60/40 split in favour. It was noted that The bidding process would entail lots of work and any funding is likely to have multiple strings attached; eg 8am-8pm opening including weekends. The GPs present were not generally in favour Alternative funding could come via the 256m available over 2 years for the NHS, including 8m for CCGs. It is not clear as to what the restrictions would be. Cassie stressed that this is not new money but money which has been transferred from acute to primary services Members commented that money should be allocated and used on the basis of need, not politics. Local needs should be the first consideration. 2pm Cassie Williams left the meeting, 2. Clinical Discussion and Presentation cont., 2.2 GP Out of Hours/NHS 111 Service Dr Sam Shah, clinical lead for NCL CCGs presented a short update on the GP Out of Hours/NHS 111 Service and stated that there are 21.7m attendances at A&E a year; 47% of whom require no follow up treatment. This is concern particularly with mental health cases; they need to be followed up on so that they attend appointments they are referred to. It also leads to questions on how urgent many presenting cases are There are 1m calls to 111; 60% of which end up going to their GP. The intention is to join up 111 and out of hour s services. The aim is to get the public to use 111 rather than 999. It is assumed that many people use ED because there are no other services available at night It was questioned If GPs are open 8am-8pm should out of hours services be primary care or urgent care based? A 24/7 schedule is needed for the delivery of unscheduled care. A federation of providers could be possible. There are three contracts currently in NCL, all of which end at the same time. 111 is a referral based service only; apart from home case advice.

5 2.2.4 Data from mental health, ambulances, acute and primary care needs to be linked better. This might prevent multiple ambulances and cars attending incidents. Notes of cases should also be available to all practitioners If clinical intervention is to be accessed early on there is a need for a greater range of skills and options If an out of hours booking system was available for GP practices patients may not attend ED as they could be assured of a GP appointment the next day. The 8am-8pm model would not require all practices to be open all the time; they could cover for each other An up to date directory of services is required so that all clinicians know what is available in their local area. 2.20pm Dr Naz Akunjee left the meeting A clinical workshop will be held in January to start developing a clinical model and service specification which will then be piloted. 2.30pm Sam Shah left the meeting. 4. Commissioning items 4.1 Dementia Update Dr Therese Shaw clarified that GPs do not have to do blood screening, ECGs and scans before referral, but it does help if they do so. The information exchange between GPs and mental health services could be better. Her service only accepts referrals for the over 65 s, the under 65 s should go to the national hospital for neurology and Neurosurgery at UCLH The average is 13 weeks between referral and obtaining an appointment. There are no home visits and all appointments are held at St Ann s although the community mental health teams do go out into the community. Biological, psychological and social interventions are all offered A dementia cafe, education and work in conjunction with Age UK are offered They are not able to undertake Court of Protection or LPA work. Cases have to be discharged because of the volume of work Members felt that a good service was offered and they liked being able to refer without having to go via the dementia services; although they feel under pressure to refer all cases to them. Dan Harwood is the clinical network lead for the DoH. Action 1: The Primary Care Academy information to be circulated. Therese Shaw It was highlighted that GPs were often unsure what local services, such as day centres, were available to support people with dementia. It was

6 suggested that some kind of signposting service or easily accessible directory would be useful so that GPs would have knowledge of what is around locally. Will Maimaris said that there were plans to develop some kind or signposting resource to deal with this issue as part of the Better Care Fund, but this was not happening over the short term 4.2 QIPP Update Aisling Bowman outlined the approach that was being proposed for the 2015/16 QIPP programme. It was noted that the financial context for 2015/16 was challenging and that there was a likely 10-12m funding gap. A 15m QIPP was proposed to militate against any slippage in relation to QIPP schemes It was noted that there were projected savings of 7m in 2014/15 comprised of Acute Services productivity ( 3m), CCG budget schemes including Quality Premium, Medicines Management and corporate schemes ( 2.5m), specialty pathway changes ( 1m) and Whittington Health ambulatory care changes ( 600k). It was noted that for 2015/16 there were further opportunities in relation to ambulatory care, urgent care and assessment models at NMUH, There were also a number of transformational schemes including Value based commissioning and the Better Care Fund programme It was noted that providers had signalled repatriations and service transfers as part of their intentions for 2015/16 including a proposal from NMUH regarding Paediatric surgery It was noted that some procurements that had been undertaken in previous years may need to be re-procured in-year for example stroke rehabilitation, non-stroke rehabilitation and community ophthalmology services Members were asked for their suggestions regarding new potential QIPP areas. It was noted that there were costs associated with extending services in primary care. Members noted the proposal to repatriate paediatric surgery to NMUH and also highlighted that Paediatric neurology is not covered by the Whittington or NMUH and patients have to go to the Royal London. This is inconvenient for families and expensive for GPs Concern was expressed over poor cancer outcomes; patients are tested for one thing, referred back to the GP, referred for another test, tested, sent back to the GP. This is time consuming; patients do not necessarily attend all appointments etc. It is unclear as to why services cannot be commissioned on an outcome basis to get round the clinical boundaries. The abdominal service at NMUH was discussed as an example of good practice. They will test all possibilities within the relevant area until the problem is diagnosed Aisling was thanked for her useful summary. 5 Medicine Management Items 5.1 Draft PQSS 2015/16

7 5.1.1 EM talked through the draft PQSS for 2015/16. She explained that although there were new indicators on the scheme some of the indicators from the previous year had been left the same as they were still topical. She asked the cabinet to rank the indicators in order of preference. Suggestions were made on how to improve the COPD indicator. Further suggestions were made on how the document could be improved so GPs would find it easier to participate in the ranking exercise. It was agreed that after updating the document with the advised changes EM would the draft scheme to all GPs in Haringey for a wider participation in the process of prioritising. The Scheme will be brought back to the cabinet following the consultation process and after it had been worked up further. 5.2 Guidance on the prescribing of medicines that are available for purchase over the counter There are significant variations in the volume and spend on GP prescribing of medicines available over the counter and there may be potential to reduce the variation by providing guidance to support GPs in encouraging patients to self-care and purchase medicines for common conditions. Members stated that they prescribe on the basis of need and already encourage self-care; they are often not in a position to decide who is in a position to buy medicines and who isn t. 3.30pm Efa Mortty leaves the meeting GPs said that they are unhappy with pharmacists who, although they have discretion as to what they can charge for a private prescription, sometimes charge considerably more than it would cost on an NHS prescription It was agreed that it could be useful to put information about purchasing medicines available over the counter onto TV screens in surgery waiting rooms. Guidance might be helpful for some practices in addition to leaflets and posters. Action 3: PT to feedback the clinical cabinet comments to the Medicines Management Committee. Pauline Taylor 6. Any Other Business 6.1 Further to the BEH-MHT presentation above, Dr Taylor said that he felt that they were not listening to GPs. Dr Edelman said she would look into this. Dr Taylor reminded members that MHT is a commissioned service and he feels they are a failing service and not delivering what is required. 6.2 Members requested that at future meetings there are no more than 2 external presentations so that the meeting can be completed within 2 hours. 7. Date of next meeting

8 7.1 8 th January pm Hornsey Neighbourhood Health Centre, Rooms 4&5 The meeting ended at 3.40pm.