b) Clinical Scrutiny Committee The unconfirmed minutes of a meeting held on 25 October 2017

Transcription

1 GOVERNING BODY Agenda Item No. 23 Reference No. WSCCG Date. 29 November 2017 Title Lead Chief Officer Author(s) Purpose Minutes of Meetings Amanda Lyes, Chief Corporate Services Officer Jo Mael, Corporate Governance Officer The report incorporates for endorsement, minutes and decisions from the following meetings; a) Finance and Performance Committee The confirmed minutes of a meeting held on 18 October b) Clinical Scrutiny Committee The unconfirmed minutes of a meeting held on 25 October 2017 c) West Suffolk CCG Primary Care Commissioning Committee The unconfirmed minutes of a meeting held on 27 September d) West Suffolk CCG Commissioning Governance Committee Decisions from meetings held on 27 September 2017 and 3 October 2017 Applicable CCG Priorities 1. Develop clinical leadership 2. Demonstrate excellence in patient experience & patient engagement 3. Improve the health & care of older people 4. Improve access to mental health services 5. Improve health & wellbeing through partnership working 6. Deliver financial sustainability through quality improvement Action required by Governing Body: To endorse the minutes as attached to the report whilst noting that unconfirmed minutes remain subject to change by the relevant Committee/Group. Page 1 of 17

2 Minutes of WS CCG Financial Performance Committee held on Wednesday 18 October from Training Room 2, Green Duck, Technology House PRESENT: Dr Zohra Armitage, GP Governing Body Member Chris Armitt, Deputy Chief Finance Officer Dr Simon Arthur, GP Governing Body Member Steve Chicken, Lay Member (Chair) Geoff Dobson, Lay Member Governance Andy Eley, Deputy Chief Operating Officer Dr Andrew Hassan, GP Governing Body Member Amanda Lyes, Chief Corporate Services Officer Jane Payling, Chief Finance Officer Dr Bahram Talebpour, GP Governing Body Member Jan Thomas, Deputy Chief Officer/Chief Contracts Officer Kate Vaughton, Chief Operating Officer Dr Firas Watfeh, GP Governing Body Member APOLOGIES: Kevin Bernard, Governing Body Member Dr Christopher Browning, GP Governing Body Member and CCG Chair Chris Hooper, Interim Chief Nursing Officer Jo Finn, Lay Member Patient and Public Involvement Ed Garratt, Chief Officer Dr Emma Holland, GP Governing Body Member Dr Sarah Hughes, GP Governing Body Member Richard Watson, Chief Transformation Officer IN ATTENDANCE: Ameeta Bhagwat, Head of Financial Planning and Management Accounts Gabby Irwin, Head Of Clinical Quality And Patient Experience Chris Singleton, Head of PMO MINUTES: Jo Wyatt, Office Manager and EA to Chair, COO & DCOO Item 1. WELCOME & APOLOGIES Action The Chair welcomed all to the meeting and apologies were noted. 2. DECLARATIONS OF INTEREST There were no new declarations of interest expressed. 3. MINUTES OF PREVIOUS MEETING 21/09/17 The minutes of the Financial Performance Committee held on 21/09/17 were reviewed and agreed as a true and accurate record of the meeting. 4. MATTERS ARISING There were no matters arising from the minutes of the 21/09/ ACTION LOG 21/09/17 The Chair presented the Action Log, and the following updates were provided: Action 32 Property Services Update The DCFO advised that the NHSPC Strategic Estates Advisor met with the local team on 11/10/17. The vacant space could not be located on the floorplan so a site visit has been arranged to see if the floor space can be found. The outcome of this site visit is being awaited. The DCFO advised that it is hoped that the funding will

3 be returned, although nothing has been paid to date. The DCFO warned that the danger is that the charges may just be re-categorised. It was noted that Mark Game is to follow up on this action. Action 49 PMO Report GIC mark 3 The DCO/CCO advised that the next iteration of the GIC is being worked on to align with the allocation. It was noted that the agreement will be on the basis that all partners will be responsible for managing demand and cost. Action 51 Financial Position Month 5 Comms to Practices The COO advised that conversations need to take place in regards to the governance process in respect of how we react to the loss of the 1.4m. It was noted that discussions have taken place at the Executive, and that the recommendations will be ratified by the Governance Committee and the Governing Body on 29/11/17. The CFO advised that conversations need to take place to find savings/headroom to allow the scheme to continue. Action 52 Financial Position Month 5 Prescribing Rebates It was noted that discussions in respect of the prescribing rebates took place at the Prescribing Workstream and that SA was present for the discussions. LL was able to provide the assurance required that the rebate scheme is above board. It was noted that some of the medications that the CCG receives rebates go against some of our prescribing recommendations. It was also noted that the schemes have been signed off by appropriate governance nationally. Action 53 TPP Update The DCO/CCO advised that conversations have taken place with Dawn Scofield, the Executive Lead in respect of TPP. She is open to discussion on provision of TPP across the STP. Different conversations would need to take place in respect of the contract for 2018/19 as there will be STP wide discussions in regards to pathology services. It was noted that the action regarding guidelines and guidance from TPP, which arose from the Executive, has been noted and this is to be raised through the formal contract meeting. The Committee noted the updates. 6. Financial Position Month 5 The CFO presented the latest financial position. The following headlines were noted: Variance from Plan At the end of month 6, the financial performance was on plan. Key adverse variances from plan are Acute Services ( 0.9m), Community ( 0.3m), Prescribing ( 0.1m), Mental Health ( 0.1m) and Other Primary Care ( 0.1m). These are mitigated by the use of Contingency ( 0.8m) and underspends in Other Programme Services ( 0.3m), Running Costs ( 0.2m), Continuing Care ( 0.1m) and Primary Care Delegated Commissioning ( 0.1m). Forecast Risks and Mitigations The CCG currently has reported a balanced position to NHS England. Identified risks are QIPP under delivery, additional contract risks, potential Continuing Healthcare historical claims and delegated Primary Care budget overspends. These are mitigated by contingency, reserves and quality premium. In order to fund an estimated cost of 400k for GP Access and GP streaming a further 142k worth of mitigations will need to be identified in order to meet the financial targets. However, this would leave no headroom to accommodate new risks.

4 Underlying Surplus / (Deficit) Key drivers are non-recurrent expenditure of 4.7m offset by any mitigations in the current year deemed to be non-recurrent such as quality premium plus potential under-delivery of QIPP shown as a risk in the current year and therefore at risk recurrently ( 2.0m). QIPP Delivery At month 06, the CCG has delivered 5.01m of QIPP against a target 5.19m (96% delivery). This is mainly delivered through QIPP from WSFT GIC, Corporate QIPP, CHC QIPP and Prescribing QIPP. M5 delivery was 94%, the increase is mainly due to increase in prescribing QIPP. Full year forecast is 91% delivery. It was noted that there was a formatting issue in regards to the condensed I&E report; the CFO advised that a correct version will be circulated to members after the meeting. Members noted the top 10 variances, in particular the key movements. It was noted that work is to take place in regards to Children s CHC. With regards to Adult CHC and Children s CHC, it was noted that Children s CHC is treated differently as it is part of the SCH contract. It was agreed that this need to looked at in regards to governance and process, particularly in relation to high cost packages. JP/JT It was noted that the prescribing data is not good, with a 168k - 200k overspend in month. The data is currently being worked on. With reference to the claw-back letter in regards to the reduction in price of category M drugs, it was noted that the money is to be kept centrally. This means the position will be lower position of 80k in Q2 and between 200k and 300k in Q3. The COO reminded members that the Clinical Pharmacists are currently undertaking discharge summary reviews and are therefore not able to undertake their normal work. This will ultimately have an impact on our QIPP. The CFO commented that this is to be monitored as there are issues with pharmacist capacity and that this needs to be identified quickly. It was noted that both AH and FW sit on the Prescribing Workstreams and advised members that visits with Practices are taking place and that it is hoped that these visits will have an impact. With regards to Discharge Summaries reviews, it was noted that there have been a significant number to undertake and that GPs are not prepared to undertake the reviews. It was agreed that there be a report presented to the Committee from the Prescribing Workstream to provide the granular detail and to provide assurance. AH/FW Discussions took place in regards to concerns over the drop in QIPP. AB commented that the Practice visits will help, but if not, an alternative needs to be sought. The COO advised that there has been a change in culture and tone in the West, which will have a cumulative effect. Chief Officers are attending the Practice Visits with GPs Executive members and a lot of data is being provided at these meetings which include easy wins for Practices. CS advised that the QIPP schemes for prescribing are being monitored.

5 The CFO updated the Chair on GP+/GP Streaming, advising that Executive members had agreed to support option 3 which will mean a 87k cost pressure. It was noted that the financial pack assumed that members would opt for option 2. It was noted that the CFO had suggested at the Executive prior to the Committee that an urgent workshop/meeting take place to discuss potential savings that can be made elsewhere to fund this service. It was agreed that the COO, the DCO/CCO, the CFO and the DCFO are to meet to discuss a way forward. EG/JT/JP /CA Members noted the risks and mitigations and the underlying position. The Chair thanked the CFO for the update. The Committee noted the update. 7. PMO REPORTS The DCO/CCO presented the PMO reports. Members noted the following: YTD we have achieved 96% of planned QIP savings Forecast to NHS England now identifies over 89% of required QIPP. 48% of QIPP achieved at current YTD position CHC and Corporate continue to significantly over perform Increased CHC and Corporate reported to NHSE The Chair thanked the DCO/CCO for the update. The Committee noted the update. 8. SYSTEM WIDE VIEW The CFO presented the system wide view report for the month ending 30/09/17. The CFO presented the draft STP Finance Summary for month 5. It was noted that the STP DoFs meeting is to include representation from social care going forward. The CFO drew attention to the in-year control total, stressing the importance of this total. It was noted that the majority of the deficit is within the Acutes. However, WSFT is looking positive in terms of its current position. The CFO advised that the FD at WSFT is optimistic of achieving their controlled totals. It was agreed that further iteration be added to the summary to provide a clearer picture. Members noted the following key challenges: One off non-recurrent hits in relation to level of loss from TPP in regards to the stretch targets they were given. WSFT wanting more escalation beds over winter NSFT being in special measures and potentially requiring support. It was agreed that the DCFO would provide details of support that has been previously been given to NSFT in Suffolk. JP Members noted the updates in regards to the system. The Chair thanked the ACFO for the update. The Committee noted the update. 10. ANY OTHER BUSINESS There were no further items of business discussed meeting closed. 11. DATE AND TIME OF NEXT MEETING Wednesday 22 November 2017, , Room 14, Ground Floor, West Suffolk House

6 Unconfirmed Minutes of WSCCG Clinical Scrutiny Committee held on Wednesday 25 October 2017 from hrs Training Room 2, Green Duck, Technology House, Western Way, Bury St Edmunds, IP33 3SP PRESENT: Dr Christopher Browning Simon Arthur Kevin Bernard Steve Chicken Geoff Dobson Andy Eley Dr Andrew Hassan Chris Hooper Amanda Lyes Jane Payling Dr Bahram Talebpour Jan Thomas Richard Watson IN ATTENDANCE: Jo Mael Vicki Newberry GP Governing Body Member and CCG Chair (Chair) GP Governing Body Member Governing Body Member Lay Member Lay Member for Governance Deputy Chief Operating Officer (Part) GP Governing Body Member Deputy Chief Nursing Officer Chief Corporate Services Officer Chief Finance Officer GP Governing Body Member (Part) Chief Contracts Officer Chief Redesign Officer Corporate Governance Officer Clinical Assurance and Professional Lead, CHC (Part) 17/035 WELCOME AND APOLOGIES FOR ABSENCE The Chair welcomed everyone to the meeting and apologies for absence were noted from; Dr Zohra Armitage Jo Finn Ed Garratt Dr Emma Holland David Kanka Kate Vaughton Dr Firas Watfeh GP Governing Body Member Lay Member Public and Patient Engagement Chief Officer (Chair) GP Governing Body Member (Part) Assistant Director of Public Health Chief Operating Officer GP Governing Body Member 17/036 DECLARATIONS OF INTEREST No declarations of interest were received. 17/037 MINUTES OF PREVIOUS MEETING The minutes of the meeting held on 16 August 2017 were reviewed and approved as a correct record. 17/038 MATTERS ARISING & REVIEW OF ACTION LOG There were no matters arising and the action log was reviewed and updated. 17/039 INTEGRATED PERFORMANCE REPORT The Committee was in receipt of the Integrated Performance Report, with key points highlighted during discussion being;

7 Clinical Quality and Patient Safety Infection control West Suffolk Hospital was below trajectory in respect of C.difficile and there had been no reported cases of MRSA. There had been no infection control reports from Suffolk Community Healthcare. The year to date cases for the CCG were 22 against a trajectory of 19. There had been one MRSA case reported which NHS England was investigating for possible reassignment to a third party. Harm free care Suffolk Community Healthcare s (SCH) performance remained above the national benchmark. Feedback from a recent deep dive exercise was currently being collated with early indication being that a policy update and more robust review programme was required. Pressure Ulcers West Suffolk Hospital had reported three during the month although there were 10 awaiting review. Suffolk Community Healthcare had reported an average number with the majority being at lower grade two. Patient experience Friends and Family test scores at West Suffolk Hospital had been generally positive. Suffolk Community Healthcare had not reported any complaints. Transforming care the CCG was ahead of trajectory. Cancer breaches there had been 10.5, 62 day wait breaches and 3 reported 104 day wait breaches. No indication of patient harm had been reported. Having noted that Care UK had received eight complaints in July 2017 the Committee was reassured that the Clinical Quality Group would review the complaints and identify any trends. Finance The CCG was on plan at month six and risks and mitigations were balanced. The underlying surplus position was 1.0m and QIPP delivery was at 96% with a yearend forecast of 91%. The Chief Finance Officer reported that agreed work on prescribing was underway. Following a decision by the Commissioning Governance Committee and its endorsement by the Governing Body in relation to GP Streaming, work would commence to ensure that costs could be absorbed with a report back to the Executive next week. Transformation Integrated Care; A&E performance was 0.8% below plan with non-elective admissions 0.4% below plan. EIT performance was positive with more referrals being received from primary care and the community, than the hospital. The frailty assessment unit had been launched. Buurtzog recruitment continued. The focus was on achieving the four hour target over winter. Planned Care; Outpatient activity was 3.1% below plan, with elective activity at 0.1% better than plan. The Ophthalmology business case had been signed off and the service was due to go live mid November The CCG had been successful in being selected by NHS England to run the 100-day challenge. ENT, Cardiology and Urology were the three specialties that had been identified for re-alignment as part of the challenge. Mental Health and Learning Disabilities

8 Dementia diagnosis rates were improving. The financial strategy for the psychiatric liaison business case was being discussed with Norfolk and Suffolk NHS Foundation Trust and if no agreement could be reached an alternative option with West Suffolk Hospital would be explored. Children and Young People and Maternity The maternity strategy was due for submission to NHS England next week and the CAMHS plan required at the end of the week. Feedback on the draft plan was awaited. There was to be a meeting regarding ADHD next week and the need for school nurses to be involved was emphasised. It was suggested that ways of facilitating mental health updates to the Executive should be explored. (Dr Bahram Talepour left the meeting) Contracts West Suffolk Hospital A&E performance had deteriorated to below 90%. A recovery plan was in place. 18-week referral to treatment remained a concern and was an agenda item for today s service level agreement meeting with the Trust. Suffolk Community Healthcare there was a need for increased focus on delayed transfers of care. East of England Ambulance Service Trust (EEAST) the reporting of ARP standards had commenced. Actions from the service review were being progressed. Red 1 category response had been held although demand was below that of last year. Handover delays were being closely monitored. Primary Care A learning disability MDT will be established to support delivery of the 75% target going forward. The CCG s Financial Performance Committee was to carry out a deep dive of prescribing in November Visits to practices continued in an attempt to improve engagement. The Committee noted the content of the report. (Andy Eley left the meeting and Vicki Newberry joined the meeting) 17/040 GOVERNING BODY ASSURANCE FRAMEWORK The Committee was in receipt of the current version of the CCG Governing Body Assurance Framework (GBAF) that was reviewed by the Chief Officer Team every month and by the Governing Body and Audit Committee at each of their meetings. Points highlighted included; The GBAF currently contained eight risks. In light of previous discussion and West Suffolk Hospital s poor A&E performance, the risk would be added to the GBAF. Risk 27a (Potential impact of service quality delivered by Norfolk and Suffolk NHS Foundation Trust) the Committee was informed that the risk required update following publication of the Care Quality Commission s report. A Project Oversight Group had been established. Risk 36 (CCG will not be able to meet its statutory duties to safeguard children and adults in Suffolk) the Committee was advised that options continued to be explored to facilitate recruitment to the designated doctor role. Following question as to how West Suffolk Hospital was reporting risks attributed to its A&E and Referral to Treatment time performance, the Chief Contracts Officer agreed to take the matter forward via the service level agreement meeting later that

9 day. The Committee approved the GBAF as presented. 17/041 BMI ST EDMUNDS HOSPITAL CARE QUALITY COMMISSION QUALITY REPORT The Committee was in receipt of a report from the Chief Contracts Officer, which detailed the outcome of a quality report published by the Care Quality Commission (CQC) on the 26 September 2017 following its inspection of BMI St Edmunds Hospital on the 16 and 20 of March The Committee was advised that an action plan was expected mid November 2017 and that further information would be reported to the December 2017 meeting. The Committee expressed serious concern at the outcome of the CQC report and welcomed a further update in December /042 POLICIES FOR APPROVAL The Committee was in receipt of the following policies for approval; a) Policy for the Management of Serious Incidents The Committee was advised that since presentation to its previous meeting the Policy had been circulated to providers and the CCG s Policy Development Group for further comment. That feedback had been incorporated into the revised Policy with changes including, increased clarification of thresholds, assessment of the quality of root cause analysis and the stress testing of action plans. The Policy for the Management of Serious Incidents was approved. b) Suffolk NHS Continuing Healthcare and Adult Social Care Joint Working Policy The Committee was advised that the Policy had been co-produced with Suffolk County Council. The existence of a process for ensuring adherence to the policy was questioned. It was explained that whilst there was uncertainty as to whether formal governance existed across boundaries, the action plan appended to the policy could be revised to help address the issue. The Suffolk NHS Continuing Healthcare and Adult Social Care Joint Working Policy was approved. c) Personal Health Budgets and Integrated Personal Budget Policy It was explained that the continuing healthcare team had taken back responsibility for personal health budgets and in order to allow time for a review of the existing policy, a six-month extension was being sought. The Clinical Scrutiny Committee subsequently approved an extension of the current policy for a period of six months. 17/043 DATE OF NEXT MEETING Wednesday 20 December 2017, hrs, Room 14, West Suffolk House, Western Way, Bury St Edmunds, Suffolk, IP33 3SP

10 Unconfirmed Minutes of a meeting of the West Suffolk CCG Primary Care Commissioning Committee held in public on Wednesday, 27 September 2017 at Conference Room, West Suffolk House, Western Way, Bury St Edmunds, Suffolk, IP33 3SP (Inquorate meeting) PRESENT: Geoff Dobson Chris Armitt Ed Garratt Jane Payling Kate Vaughton Simon Jones Stuart Quinton Andy Yacoub IN ATTENDANCE: Ameeta Bhagwat Dr Christopher Browning Andy Eley Amanda Lyes Jo Mael Lois Wreathall Lay Member: Governance and CCG Vice Chair, WSCCG (Chair) Acting Chief Finance Officer Chief Officer, WSCCG Chief Finance Officer, WSCCG Chief Operating Officer, WSCCG Local Medical Committee Suffolk Primary Care Contracts Manager, NHS England Healthwatch Head of Financial Planning and Management Accounts, WSCCG WSCCG, Chair Deputy Chief Operating Officer, WSCCG Chief Corporate Services Officer, WSCCG (Part) Corporate Governance Officer, WSCCG Head of Primary Care, WSCCG 17/28 WELCOME AND INTRODUCTIONS The Chair welcomed everyone to the meeting. 17/29 APOLOGIES FOR ABSENCE Apologies for absence were noted from: Jo Finn, Lay Member for Patient and Public Involvement, WSCCG Steve Chicken, Lay Member, WSCCG Jan Thomas, Chief Contracts Officer, WSCCG 17/30 DECLARATIONS OF INTEREST No declarations of interest, other than those already published, were received. 17/31 MINUTES OF THE PREVIOUS MEETING As the meeting was inquorate approval of the minutes of the last meeting of the Primary Care Commissioning Committee held on 26 July 2017 was deferred until the November 2017 meeting. 17/32 MATTERS ARISING AND REVIEW OF OUTSTANDING ACTIONS There were no matters arising and the action log was reviewed and updated.

11 17/33 PRIMARY CARE WORKFORCE Those present were in receipt of a report which provided an update on progress in respect of the workforce element of the GP Five Year Forward View. Key points highlighted included; The workforce plan was due for submission to NHS England on 29 September There were 11 areas of focus detailed within the plan as identified within the report. Those included; o International GP recruitment a joint bid with Gt Yarmouth and Waveney had been successful. It was hoped to recruit 26 GPs and the CCGs had recently been encouraged to place a further bid in respect of the Wave 3 funding. o Retention Legacy of Experience courses were underway. o GP Fellowships there had been a successful bid for six GP Fellowships and two Physician Associate Fellowships. o Nurses the CCG had secured funding for learning beyond registration and the CEPN nursing sub-group was to focus on nurse training and up-skilling. o Physician Associates the CCG had engaged with Anglia Ruskin University to promote primary care. o Care Navigators 100 had enrolled for wave 1 of training which had commenced in August The Committee was advised that the CCG had already commenced work with Suffolk County Council in respect of retention and hoped to extend the work further with large Suffolk employers such as British Telecom. Health Education England was to make funding available to practices that were interested in developing the role of Medical Assistants. The funding would not be to support recruitment to the role but to assist the design and organisational development. It was hoped that an East of England Primary Care Workforce Conference could be organised for February/March 2018 to further communicate the workforce plan. Concerns raised by Healthwatch included; The appropriateness of the training of Care Navigator s by some practices and how the role was communicated to members of the public. The need for Patient Participation Group representation on the Workforce Plan Steering Group. Difficulty in explaining the role of Physician Associates to members of the public. The Chief Corporate Services Officer confirmed that PPG representation on the Steering Group would be granted, and agreed to investigate the concern raised in respect of the Care Navigator role and share literature with Healthwatch in respect of the Physician Associate role. The Committee noted the report. 17/34 GP FORWARD VIEW INVESTMENT Those present were in receipt of a report which provided an update in relation to the investment of 3 per head of practice populations to increase surgery resilience. NHS England had written to CCGs requiring them to invest 3 per head in local practices to support the implementation of 10 High Impact Actions as set out within the report, and work together at scale to ensure increased practice

12 resilience. The CCG had written to all practices on the 24 May 2017 setting out the broad details of the funding available and the eligibility criteria. Practices had been asked to submit proposals by 30 June 2017 setting out how they would utilise the funds to meet the criteria. Proposals from the practices had been considered at the Commissioning Governance meeting on 12 July 2017 and at a subsequent meeting held on the 23 August Decisions made by the Commissioning Governance Committee in respect of the proposals were detailed within Section 2 of the report. There were a number of proposals covering ICT, website redesign, new staff, and workflow optimisation where it was considered prudent for the Committee to agree overarching approval (delegated to CCG Officers) without further reference back to the Committee. Those would be called universal bids and were detailed within paragraph 3.5 of the report. Those present noted the content of the report. (Amanda Lyes left the meeting) 17/53 GENERAL PRACTICE CONTINGENCY PLAN NHS England s Suffolk Primary Care Contract Manager reported that the General Practice Contingency Plan had been presented to the Local Medical Committee for comment on 14 September Feedback was currently being incorporated into the plan prior to its presentation to the Committee in November /54 PRIMARY CARE DELEGATED COMMISSIONING FINANCE REPORT Those present were provided with an overview of the month five, Primary Care delegated commissioning budget. At the end of month five, the GP delegated budget spend was 75k below plan, Local Enhanced Services (LES) budget showed an adverse variance of 9k and the GP Forward View Funding received year to date was fully committed. There was a risk around receipt of 1.4m of GPAF and the CCG was awaiting confirmation from NHS England. Forecast risks and mitigations- key risks at month five were over achievement of Quality Outcomes Framework (QOF), Care Quality Commission costs and additional primary care postal/transport costs that had not been budgeted for. Those were mitigated by the use of contingency and reserves. Those present noted the content of the report. 17/55 PRIMARY CARE CONTRACTS AND PERFORMANCE MONITORING Those present were in receipt of a report which provided an update to the Committee relating to; List Closures No West Suffolk practices had applied to close their lists Local Enhanced Services The enhanced services specifications had been amended for the new financial year and approved by the Commissioning Governance Committee. A peer review enhanced service had been created by the contract team and submitted to the Local Medical Committee for approval at its meeting on 14 September

13 2017. Clements & Christmas Maltings Surgery, Haverhill Suffolk GP Federation had become responsible for the management of Christmas Malting & Clements practice in Haverhill on 3 July 2017, with a key focus being stabilisation of the practice. A new appointment system had been introduced, a practice board formed and a staff recruitment programme initiated. The Federation had received a Section 25 notice from the owners of Christmas Maltings building which meant it would need to leave by 19 January 2018 or negotiate a lease to remain. It was currently planning to consolidate into Clements and Keddington sites. There had been significant progress overall, but many challenges remained. Those present noted the report. 17/56 CARE QUALITY COMMISSION (CQC) Those present were in receipt of a report that sought to inform about Care Quality Commission (CQC) inspections of West Suffolk GP practices. The CQC had now finished its inspections of GP practices in West Suffolk and the outcomes were detailed within paragraph 2.1 of the report. The CQC s reports to date continued to show that the quality of primary care services in West Suffolk was good or outstanding in 95% of practices. One practice had been put into special measures and rated inadequate and the CCG was working with the practice to improve its rating. The practice had a successful interim inspection in May 2017 and was due to have a full inspection in September The CCG had mapped all the 24 reports into a single learning document which was being shared with the practices. The CCG had contacted any practice that had scored less than a good in any particular area and was working to support them to make the necessary improvements The Committee would be alerted to any significant issues or concerns between meetings and provided with on-going analysis of learning. The Head of Primary Care reported that Haverhill Family Practice had been visited by the CQC on 26 September 2017 and early indication was that the visit had gone well. There had been recent movement of 4/5 practices that had previously been rated as requires improvement being given good ratings. The Head of Primary Care agreed to include ratings for sub-themes within future reports, together with an indication as to where there had been movement and changes to ratings. Practices were welcoming of advice to support compliance. Those present noted the content of the report. 17/57 CLINICAL WASTE PROCUREMENT FOR GENERAL PRACTICE NHS England s Suffolk Primary Care Contract Manager advised that the paper had been reported to the previous meeting and there was nothing further to add. NHS England had halted the procurement until the lessons learnt review had been completed. 17/58 GP PATIENT SURVEY 2017 The GP Patient Survey was an England-wide survey (administered by Ipsos MORI), providing GP practice-level data about patients experiences of their practices. Latest data was published in July 2017 and based on fieldwork

14 undertaken between January and March Randomly selected participants were sent a postal questionnaire with the option of completing it online or via the telephone. The GP Patient Survey measured patients experiences across a range of topics, including: Access to GP services; Making appointments; Waiting times; Perceptions of care at appointments; Practice opening hours. Across the West Suffolk CCG area, 5,733 questionnaires had been sent out, and 2,922 completed which represented a response rate of 51% (up from 47% in 2016). A summary of the performance was detailed within paragraph 202 of the report and indicated that the CCG performed better than the national average across all key measures. The CCG intended to develop a number of initiatives to increase patients awareness of the programme of work underway to support improved access to GP services, making appointments, and increasing opening hours, through local delivery of the GP Forward View. Those initiatives would be primarily targeted in localities where results of the GP Patient Survey were below the CCG or national averages. The need to carry out targeted communications supported by patient participation groups and the Community Engagement Group was recognised. It was noted that Question 18 (how would you describe your experience of making an appointment?) was aligned to the quality premium target and whilst it had been achieved in the current survey, due to the nature of the way the survey was carried out, there was no guarantee of achievement in future. It was questioned whether services for vulnerable groups were being captured and suggested that comments received by Healthwatch be added to next year s report. It was highlighted that performance in some areas was not as anticipated and it was felt that routes of access, other than by telephone, should be explored in future surveys. Those present were pleased to note the high levels of patient satisfaction and experience as reported in the GP Patient Survey. 17/59 PRIMARY CARE ESTATES RENT REVIEW PROCESS As the meeting was inquorate the Chair advised that whilst the item could be discussed, a decision would be requested virtually from members outside of the meeting. As part of the CCG taking on delegated commissioning functions, the CCG was now required to approve GP practice rental increases that had previously been undertaken by NHS England. It was set out in the Premises Costs Direction 2013 that practices would be reimbursed the Current Market Rent (CMR) or actual rent, whichever was the lower, as valued by the District Valuer. NHS England continued to undertake the reviews on behalf of the CCG although CCG approval was required before NHS England altered any practice payments. Rent reviews were conducted every three-five years dependent upon the terms of the lease or as set out in the Directions.

15 Increases would happen if a practice improved its premises or received an improvement grant, although some of the increase was initially offset by applicable abatement. Any new build could result in an on-going cost pressure as new premises commanded an increased m2, combined with increased floor area of a new build. To streamline the process and avoid lengthy delays that could result in delayed practice payments, the CCG planned to adopt an approach whereby if the increase was less than 5k per annum that could be approved by the Head of Primary Care. Where the increase was more than 5k per annum that would be jointly approved by the Finance and Primary Care team. In response to questions as to whether the 5k limit was appropriate, the Acting Chief Finance Officer advised that the limit was in line with the CCG s Scheme of Delegation and at 37k further Chief Officer or Committee approval would be required. Those present noted the approach in respect of rent increases and that the report would be circulated to members for approval. 17/60 ANY OTHER BUSINESS No items of others business were received. 17/61 DATE OF NEXT MEETING The next meeting of the Primary Care Commissioning Committee was scheduled to take place, in public, from 1.30pm 3.30pm, Wednesday, 29 November 2017, Edmund Room, St Edmundsbury Cathedral 17/62 QUESTIONS FROM THE PUBLIC There were no members of the public present.

16 Decision from a meeting of the West Suffolk CCG Commissioning Governance Committee held on 27 September 2017 Commissioning Governance Committee Members: Geoff Dobson, Lay Member for Governance (Chair) Chris Armitt, Acting Chief Finance Officer Ed Garratt, Chief Officer Jane Payling, Chief Finance Officer Jan Thomas, Chief Contracts Officer Declarations of Interest No declarations of interest were received. Community Services (Constructive Dialogue) Report No: WSCCG/CGC Decision That the request to proceed to signature of the community services contracts, be approved Peer Review Enhanced Service Report No: WSCCG/CGC Decision To ratify the ES and payment of 70p per head of population.

17 West Suffolk CCG Commissioning Governance Committee (via ) 3-6 October 2017 Decision Record Community Pain Management Service West Suffolk To consider and approve a waiver from the Chief Contracts Officer Report No: IESCCG/CGC Commissioning Governance Committee Members: Geoff Dobson (Chair), Governing Body Lay Member for Governance Ed Garratt, Chief Officer Jane Payling, Chief Finance Officer Jan Thomas, Chief Contracts Officer Declarations of Interest No declarations of interest were received. Decision That a two year extension to the current contract held with Suffolk GP Federation for the Community Pain Management Service in West Suffolk, be approved.