Notes of the High Weald Lewes Havens Operational Leadership Team meeting held on Wednesday 10 July 2013, Boardroom, Friars Walk, Lewes

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1 Notes of the High Weald Lewes Havens Operational Leadership Team meeting held on Wednesday 10 July 2013, Boardroom, Friars Walk, Lewes Present: Dr Elizabeth Gill Clinical Chair of the Governing Body (EG) Dr Howard Wright LH Locality Chair (HW) (joined meeting from item 58/13) Frank Powell HW Locality Practice Management Lead (FP) Michael Schofield Chief Finance Officer (MS) Dr Sarah Richards Chief of Clinical QPI (SR) Ashley Scarff Head of Commissioning and Strategy (AS) (Chair) Dr David Roche HW Locality Chair (DR) Action In attendance: Hugo Luck Peter Finn Dee Kellett Ritva Selfe Corporate Development Manager (HL) Head of Contracting & Performance (PF) Lead Nurse Practitioner - Aligned to EHS H&R HWLH CCGs for item 56/13 (DK) PA to Chair and Chief Officer (Note taker) (RS) 52/13 Apologies were received from Frank Sims, Karen Ford, Wendy Carberry and Dr Peter Birtles. Ashley Scarff chaired the meeting in Frank Sims absence. 53/13 Declarations of Interest There were no declarations of interests declared prejudicial to the items on the agenda. 54/13 Notes of the last meeting 26 June a. Accuracy The notes of the last meeting were accepted as an accurate record. b. Matters arising from the minutes & Action log 48/13 Joint Commissioning AS reported that the CCG s position has been made clear that we wish to review the Health in Mind service given the levels of utilisation and will need to be part of a joint commissioning review. PF is validating the number of referrals made by practices to the service. 49/13 QIPP Delivery EG reported that GPs of the Governing Body have discussed potential savings and will continue to do so at their monthly meetings. EG reported that money received to support dementia screening by GP practice will be a major change in how dementia is dealt with. 55/13 Action logs of the Governing Body and Committees (Standing Item) for information a. Governing Body b. Clinical Executive Committee c. Quality & Performance Committee The action logs were noted. Outstanding or due items were reviewed with the exception of the CEC actions since the CEC meeting was immediately following the OLT.

2 2 56/13 Policy for X-Ray referral by Qualified Nurse Practitioners (NP) working in General Practice Dee Kellett, Lead Nurse Practitioner, attended the meeting to present an updated policy for X-Ray referral by Qualified Nurse Practitioners for review. DK explained that the policy, which has been accepted by the Radiology department, is required to enable Nurse Practitioners in general practice to continue to request x-ray examinations for patient with undifferentiated and undiagnosed conditions where x-ray is needed as part of the patient s clinical management. Members noted the referrals were small in numbers. The updated policy was agreed, with no need to refer further to Clinical Executive Committee. 57/13 CCG Assets and Liabilities Hugo Luck informed OLT that the CCGs have been asked to review the latest lists of assets and liabilities following a due diligence process by the Department of Health (DoH) into the transfer of assets and liabilities from Primary Care Trusts. It was noted that the original list was compiled by NHS Sussex prior to 1 April and that the list has been reviewed by the CCG and DoH was informed of no changes. Members noted the contents of the report. 58/13 Statutory and Mandatory Training Ashley Scarff presented the proposal from Surrey and Sussex CSU for statutory and mandatory training to all staff, asking members to note the delivery mechanisms for training, e.g. e-learning options and staff groups, i.e. determine whether GP members were included in these proposals. It was noted that there was a legal obligation for all employers to provide fire training to all staff; any additional mandatory training is for each employer to determine locally. The proposal contains the recommendation for mandatory training that should be covered within the NHS. The meeting agreed the proposal for delivery of mandatory training to staff, to be refined as necessary following clarification of training requirements and good practice for members of the Governing Body. Hugo Luck will clarify. 59/13 Update on MSK Procurement Ashley Scarff gave a verbal update on developments with MSK procurement since the extensive discussion at the last meeting. Work is progressing to get ready for advertising and there have been discussions at locality meetings. Evaluation work is being carried out together with EHS CCG and also aligning with the Brighton & Hove CCG procurement process. This will not compromise the ability to meet the particular requirements for HWLH area. A paper setting out the procurement approach will go to the July Public Governing Body for ratification. 60/13 Update on CSU Ashley Scarff gave a verbal update on Commissioning Support Unit transition. The CCG was in discussions with Kent & Medway CSU discussing the detailed level of services and costs. Michael Schofield informed that there have been conference calls to discuss queries, such as staffing structure. Peter Finn added that few services are commissioned together with Brighton & Hove, making a saving. AS asked whether Kent & Medway CSU will cover 111, 999 and PTS. PF confirmed that this is the case. HL AS MS confirmed the Governing Body is aware of the new host of services and if necessary, delegated authority will be sought for the Chair and Chief Officer to sign off the agreement which may be required between meetings.

3 3 61/13 Any Other Business 3Ts Business Case meeting MS informed he would attend a meeting arranged for 11 th July by BSUH for CCG Accountable Officers and CFOs to determine planning assumptions for 3Ts business case are still aligned and consistent with those signed off by NHS Sussex. EG reminded that the HWLH CCG had not supported the business case. It was agreed to circulate and review the previous correspondence on this sent out by Chris Gurtler. Mayfield contract FP wanted to clarify the position of the new contract at Mayfield practice and whether the practice will be a separate member of the Council of Members. HL will clarify. Feedback from Council of Members FP followed up discussion at the Council of Members last night regarding a proposal to relook at the strategic approach to commissioning community services. This was seen as one of the key issues for member practices. He proposed that the CCG commission a piece of work on the feasibility of retendering community services. There was an extensive debate on how to approach this, and it was agreed that an A4 size manifesto on what community services the CCG wants to commission including headline service specifications, should be prepared with the intent of approaching ESHT for comments on delivery. AS will action this as a first step in describing the developing clinical strategy. Engagement money FP asked about how practices can claim their share of engagement money. HL to action with June Telford. 62/13 Date of Next Meeting Wednesday, 24 July following the Governing Body meeting at Uckfield Civic Centre TO BE CONFIRMED. MS HL AS HL

4 Notes of the High Weald Lewes Havens Operational Leadership Team meeting held on Wednesday 24 July 2013, Boardroom, Friars Walk, Lewes Present: Dr Elizabeth Gill Michael Schofield Dr Sarah Richards Ashley Scarff Dr David Roche Frank Sims Clinical Chair of the Governing Body (EG) Chief Finance Officer (MS) Chief of Clinical QPI (SR) Head of Commissioning and Strategy (AS) HW Locality Chair (DR) Chief Officer (FS) (Chair) Action In attendance: Hugo Luck Corporate Development Manager (HL) (notes) 61/13 Apologies were received from Karen Ford, Wendy Carberry, Dr Peter Birtles, Frank Powell, Dr Howard Wright, Dr Vince Elliot. The quorum was queried. With five members (at least one clinical and one non-clinical) attending, the meeting was quorate. 62/13 Declarations of Interest There were no declarations of interests declared prejudicial to the items on the agenda. 63/13 Notes of the last meeting 10 July Accuracy The notes of the last meeting were accepted as an accurate record. Matters arising from the minutes & Action log 56/13 Policy for X-Ray Referral by Qualified Nurse Practitioner (NP) working in General Practice SR suggested that the policy had been approved and did not need to go to Clinical Executive Committee. This was agreed. HL was asked to inform Katie Merrien to ensure it was removed from the CEC agenda. This has been done. The action log was updated with actions: o All IM&T related actions were agreed as completed. o 36/13 A presentation by Bev Hone to CEC had been received. More details on clear milestones in the action plan had been requested. Action to be followed up at the 28 August OLT. o 48/13 Joint Commissioning - Health in Mind. Actions were updated, marked as complete and subsumed into the Clinical Strategy work which is on-going. 64/13 Action logs of the Governing Body and Committees (Standing Item) for information a. Governing Body b. Clinical Executive Committee c. Quality & Performance Committee Deferred to the next meeting. 65/13 Feedback from the Governing Body Deferred to the next meeting. 66/13 Any Other Business None. 67/13 Date of Next meeting Wednesday, 14 August, 1-3 pm, Boardroom, Friars Walk, Lewes.

5 Notes of the High Weald Lewes Havens Operational Leadership Team meeting held on Wednesday 14 August 2013, Boardroom, Friars Walk, Lewes Present: Dr Elizabeth Gill Michael Schofield Dr Sarah Richards Dr David Roche Frank Sims Frank Powell Dr Vince Elliott Dr Howard Wright Karen Ford Dr Peter Birtles Clinical Chair of the Governing Body (EG) Chief Finance Officer (MS) Chief of Clinical QPI (SR) HW Locality Chair (DR) Chief Officer (FS) (Chair) HW Locality Practice Management Lead (FP) Planned Care Lead (VE) Locality Chair (Lewes Havens) LH Locality Practice Management Lead (KF) Clinical Lead (PB) Action In attendance: Wendy Carberry Head of Delivery (WC) 68/13 Apologies were received from June Telford, Ashley Scarff 69/13 Declarations of Interest There were no declarations of interests declared prejudicial to the items on the agenda. 70/13 Notes of the last meeting 24 July Accuracy The notes of the last meeting were accepted as an accurate record. Matters arising from the minutes & Action log On-going actions looked at and update provided. o 36/13- Action to be followed up at next OLT Meeting on 28 th August o 61/13- The Manifesto and the Green Triangle workshop are currently in the process of being set up. It was agreed by the group that a simple message should be sent to the practices to advise of a one-off payment in recognition of engagement. On-going item, HL to take forward. 71/13 Action logs of the Governing Body and Committees (Standing Item) for information a. Governing Body b. Clinical Executive Committee- It was raised that Diabetes is not on the action log. Concern to be taken to the CEC meeting. c. Quality & Performance Committee- Item 2 action completed- To be closed. 72/13 Quality Premium Action Plan Paper noted- action plan to be brought to the next OLT meeting ( ). It was agreed that each practice will take forward NHS Health Checks as they feel would be appropriate for the practice. FP commented that there should be a lower payment for practices that are employing someone to take forward checks. HL The question arose regarding the possibility of going into large companies/shopping centres and offering NHS Health Checks. WC to feed back to June Telford and Cynthia Lyons. 73/13 Delivery a. Finance MS talked through the finance report and advised that there is no change with regards to the CCG s financial position. The budget review is on-going to add to QIPP savings. WC

6 The next steps are- 1. To confirm planning assumptions 2. Perform a robust assessment of 13/14 schemes e.g. MSK 3. Make up savings targets The Social Care Integration Transformation Plan (ITF) has identified 6.5m to be transferred to Local Authorities. The CCG is able to specify delivery and use of money but the Local Authorities must provide the Services. The CCG must also ensure that BSUH and MTW are included within the plan. b. Performance Performance report included for information. WC advised that BSUH achieved their A&E targets for June and July but failed to meet targets in August. BSUH have advised that this is due to many factors including- Busy weekends, a flood in one of the operating theatres, Brighton Pride and new GP s starting with the trust. ESHT are also experiencing high A&E attendances. FS advised that 60% of patients that are taken to A&E by ambulance are not admitted. Potential diagnosis is available within Community Hospitals. The Communications team is currently working with B&H CCG on a large scale communications project to try to cut A&E attendances- Is A&E the right place for you? This is due to be launched in September. WC confirmed HWLH were to receive 279k from the Brighton economy as part of the winter pressure monies. WC confirmed a bid had been placed for increasing community therapy in line with CCG strategy. Bids were discussed at the Integrated Care Meeting. WC to provide update once bids are released. 74/13 Feedback from Key Meetings a. ESHT Clinical Leaders b. Joint ES CCG Governing Body Seminar c. Feedback on Large Scale Change Discussed within item 75/13. 75/13 Integrated Care- draft briefing for discussion A paper outlining CCG Integrated Care Funding engagement was provided to the group. FS advised that the CCG need to be involved in the bigger picture. Any feedback on the paper should be sent to FS. FS advised that short listing requires a presentation from a GP. It was decided that Dr Peter Birtles would attend the meeting to represent the CCG. 76/13 Any Other Business a. Phlebotomy All changes approved. WC All b. CCG Litigation claims report Paper attached for information. c. New to follow up ratio Clinical Lead A new to follow up clinical lead is required to attend meetings. to be sent to WC to confirm availability. All d. Case J WC updated the group on Case J. Patients family are unhappy with the process of patient transferring from CHC to ASC. Family have requested that the CCG are taken to judicial review. CCG are working closely with Capsticks on the matter. 77/13 Date of Next meeting Wednesday, 28th August, 3-5pm, Boardroom, Friars Walk, Lewes. 2

7 Notes of the High Weald Lewes Havens Operational Leadership Team meeting held on Wednesday 28 August 2013, Boardroom, Friars Walk, Lewes Present: Dr Elizabeth Gill Michael Schofield Dr Sarah Richards Ashley Scarff Karen Ford Dr Peter Birtles Ashley Scarff Wendy Carberry Clinical Chair of the Governing Body (EG) Chief Finance Officer (MS) Chief of Clinical QPI (SR) Head of Commissioning and Strategy (AS) LH Locality Practice Management Lead (KF) Unplanned Care Clinical Programme Lead (PB) Head of Commissioning and Strategy (AS) Head of Delivery (WC) Action In attendance: Amisha Koria Hugo Luck Ritva Selfe Senior Communications Manager (AK) Corporate Development Manager (HL) PA to Chair and Chief Officer (Note taker) (RS) 79/13 Apologies were received from Dr Elizabeth Gill, Dr Vince Elliot, Dr David Roche and Frank Powell. 80/13 Declarations of Interest There were no declarations of interests declared prejudicial to the items on the agenda. 81/13 Notes of the last meeting 14 August Accuracy The following amendments were made: Dr Howard Wright s title was corrected to: Locality Chair (Lewes Havens) Apologies were also received from Ashley Scarff. Item 73/13 Delivery a) Finance The wording on the third paragraph was corrected to read The Social Care Integration Transformation Plan (ITF) has identified 6.5m to be transferred to Local Authorities. Matters arising from the minutes & Action log Item 36/13 Neighbourhood Support Teams (NST) AS noted that this has moved on from the actions recorded. Following Beverly Hone s presentation at the Clinical Executive the value and impact of NSTs and how they fit into DNs work is better understood. The newly appointed project managers will have an impact in the future. Joint Commissioning will take this forward and the action was marked as complete. Item 61/13 Community Services Manifesto AS noted that there had been a discussion at the last Governing Body meeting regarding the Green Triangle and the manifesto. A steering group has been set up to develop community strategy. It was agreed to that it would be timely to have the community services manifesto on the agenda for the locality meetings next week to gain GP support. AS and KF to action and update FP on his return from annual leave for High Weald. AS/KF Item 61/13 Engagement money HL has circulated a letter to all practices regarding dissemination of clinical engagement money. Action complete.

8 Item 72/13 Quality Premium Action Plan This will be an item for the next OLT on 11 September. Item 73/13 b Delivery Performance Report WC updated the meeting on ESHT/BSUH have bid 5m for the A&E situation. Wendy will provide a brief once the results are known. Item 75/13 Integrated Care Action complete. Item 76/13 c. Follow up ration clinical lead. Action complete. 82/13 Action logs of the Governing Body and Committees (Standing Item) for information a. Governing Body b. Clinical Executive Committee c. Quality & Performance Committee All outstanding actions were noted and it was agreed to send updates to the relevant committees as soon as possible. 83/13 CCG Communications Plan Amisha Koria, Senior Communications Manager, attended the meeting for the communications plan which has been drafted to support the CCG to deliver its objectives. The paper focuses on the following areas: development of the HWLH identity through the development of the public facing website; outlines the proposed approach to stakeholder communications; and the development of digital and social media communication. It also makes a case for the financial investment required. The paper outlines a suggested approach for the CCG to engage in targeted communication activities in response to specific needs of various CCG communities e.g. the Havens population. KF stated that any comms plan and key messages should ensure that existing work be added to, recognising the good practice already in place, emphasising that localities were not starting from scratch. ALL AK explained that the communications team is currently reviewing proposals from external providers to provide these services, including Kent and Medway CSU and the paper outlines the approach to making a recommendation to the CCG. Members had an opportunity to ask questions: KF felt that from practice point of view, the CCG website has served the purpose it was created for but we need to take into account the work that has already been done at practice level, e.g. DXS contract and ensure we build on that work. KF thought it would be helpful to have contact with the patient groups locality patient forums as a channel for communications. The use of outpatient letters for feedback to patients was suggested by WC as was done at B&H CCG. PB commented on the specific needs for the Havens population WC commented on the need to promote 111 as the point of contact. Members asked about the financial implications. AK tabled a separate paper on the cost analyses. K&M CSU have quoted 36K per year + an ongoing cost to maintain licences. This includes the technical build of the website and design work, but not printing costs of materials. Noting the comments from members, it was agreed to approve the K&M CSU proposal. AK to take forward with K&M CSU. AK also to link with KF Amisha Koria 2

9 and HW regarding a separate conversation concerning the needs of the Havens population. 84/13 Update on Beechwood Unit FS updated the meeting on the Beechwood Unit. The patient with complex needs has now moved onto a more appropriate placement and a new placement has been found for the other patient who was on one to one observations. WC reported that it was felt appropriate to transfer one patient from the Conquest Hospital to the Unit. 85/13 Any Other Business Replacement for Dr Elliot on the Governing Body. The closing date for nominations is 30 August and to date one nomination has been received. Reminders have been sent to practices. Head of Quality post. The closing date for applications is 8 September. FS reported that there have been a number of enquiries about the post. Remaining conditions for CCG authorisation. HL reported that the authorisation window has been brought forward and updated on the remaining conditions. The CCG Assurance meeting with the SoE takes place on 3 September. 86/13 Date of Next meeting Wednesday, 11 September, 1-3 pm, Boardroom, Friars Walk, Lewes. 3