1. INTRODUCTION Action 1.1 Apologies for Absence Apologies were received from Helen Pelendrides, Gerald Alexander and Rachel Lissauer.

Transcription

1 Minutes of the Meeting of the Haringey Clinical Commissioning Group Clinical Cabinet Thursday 5 September 2013 at 1.00pm Hornsey Central Neighbourhood Health Centre Present: Muhammad Akunjee MA GP, Governing Body Member, Lead GP South East (Chair) Alison De Metz ADM Commissioning Support Manager, Haringey CCG/CSU David Masters DM GP, Governing Body Member, West Denise Pettit DP Senior Primary Care Support Manager Dina Dhorajiwala DD GP, Governing Body Member, West Gabriella Callimandri GC Cabinet Practice Manager representative Jackie Mansfield JM GP, Primary Care Lead Central Jill Shattock JS Director of Commissioning John Rohan JR GP, Governing Body Member, Lead GP North East Kate Rees KR GP, Cancer and End of Life Lead, Marion Lombardelli ML Cabinet Practice Manager representative Nazmul Akunjee NA GP Primary Care Lead South East Neil Sanghvi NS Pharmacist, LPC member Nicole Klynman NK Assistant Public Health Director Peter Christian PC GP, Governing Body Member, Lead GP West River Calveley RC Commissioning Lead, Haringey CCG Sherry Tang ST GP, Governing Body Member, Central In Attendance Buena Cordero BC Safeguarding Administrator, Haringey CCG (Minutes) Jackie Liveras JL Assistant Director for Crisis Resolution & Home Treatment Service, BEH-MHT Mina Epelle ME QIPP Programme Manager Sei Nishimura SN Public Health trainee (observing) Tamara Djuretic TDj Associate Director Public Health Tim Deeprose TDe QIPP Director Tristan Brice TB Adult Commissioning Manager (MH and LD) 1. INTRODUCTION Action 1.1 Apologies for Absence Apologies were received from Helen Pelendrides, Gerald Alexander and Rachel Lissauer. 1.2 Declarations of Interest There were no declarations of interest. Page 1 of 6

2 1.3 Chair s introduction and opening remarks Muhammad Akunjee welcomed everybody and initiated the introductions. He also introduced himself as also being the Mental Health Lead for Haringey. 1.4 Minutes of the Previous Meeting The Committee agreed the minutes of the 1 August 2013 meeting as an accurate record. 1.5 Action Log Update on the cap on referrals to lymphedema service:- Rachel Lissauer met with the District Nursing management lead who agreed to investigate and establish discharge processes for the lymphedema service. An audit of case notes will be carried out involving a GP and the Primary Care Nurse Lead, to develop a shared understanding of which patients would be suitable for discharge back to primary care Update on Data Quality issues relating to acute providers: - Alison De Metz provided an update from Denise Tyrell to the Cabinet on some of the contractual issues. Alison De Metz reported that UCLH identified specific issues in their maternity pathway. UCLH are working to resolve these issues. Denise Tyrell to provide a full update at the October meeting with regards to Data quality and data access issues. 1.6 Matters Arising Update on Medicines Use / Review Service from Community Pharmacists: Pauline Taylor reported that discussions took place with Community Pharmacies two weeks ago resulting in the creation of a draft project outline. Find out timescale for this to come back and add to work plan DT PT Update on the patient consent issues relating to new guidelines on person identifiable information: ME said that the new NHS England guidelines regarding information governance in relation to patient identifiable data are causing some operational difficulties for CCGs as patient data cannot be shared without prior consent. Two options are currently being explored. In the interim, a consultation strategy is underway. A draft letter has been sent out to a number of over 65 year old groups for feedback. A draft EIA has also been completed to assess impact on EIA protected groups and other non-english speaking groups. The EIA is currently being reviewed by the CSU Equalities Team. Letters will not be sent until HCCG has clarity on options and outcomes. Mina Epelle noted that the CSU Information Governance Lead, Peter Conoulty, will be working at NHS England for two days a week to work on resolving the information governance issues. Page 2 of 6

3 2. Clinical Discussion and Presentations 2.1 Mental Health and Wellbeing Tamara Djuretic presented the Haringey Local Authority Statistics on Mental Health and Wellbeing. In terms of the burden of mental health illness in Haringey, there were 61.3% of adults in contact with secondary mental health services and living independently compared to 54.6% for England. Most patients with mental and behavioural disorders were unemployed, claiming benefits and living in the East. 74% of these go on to commit criminal damage. There were high rates of suicides in single males in the East. According to the figures, people living in deprived areas are more likely to be diagnosed with depression and there are high hospital admissions from residents in the east. In terms of access to IAPT services for mild to moderate depression and or anxiety, 4112 patients were referred; 2271 received treatment and 1620 completed treatment. It was noted that Haringey is the London borough with the third highest access to mental health services for psychotic disorders. 684 people are recorded on the QoF register as suffering with dementia. This figure is thought to be half of what is believed to be in Haringey. There were almost 100,000 community contacts and 632 patients were admitted to hospitals via BEH MHT with an average stay of 40 days Service Transformation Project Jackie Liveras presented the BEH MHT s Service Transformation project following the closure of St Ann s ERC. The aim is to ensure the right services for service users using a single point of entry. The transformation of the referral pathway is now being piloted in Haringey. Jackie Liveras observed that the INTAKE Service was not fit for purpose as it created delays in accessing services. There was a need to overhaul the referral pathway. After a series of workshops, a new model was redesigned in August The project was piloted in Barnet and therefore a Shadow service is operating in Haringey. The new model introduced: 3 x Triage Services (Barnet, Enfield and Haringey) 3 x Crisis Resolution & Home Treatment Services Creating an Integrated Bed Management Team Night CRHT Manager integrated into Night (H@N) service. Staffed by Nurse assessors Legacy resource to SCNPD Page 3 of 6

4 Legacy resource to Psychosis Intake, PCMHT, HTT, AAC, 136 Suite, and the A&E Liaison Bed Management Team will be replaced by the Triage and Crisis Resolution & Home Treatment (CRHT) Services. Routine and non-urgent cases will go to Triage. Crises and Urgent cases will be dealt with by CRHT. The Triage Service will be operating 9am 9pm, and available during GP opening hours while the CRHT will be 24/7 and follow the NICE guidance on 4 hours response time. However, concerns were raised by some GPs that some service users may not get to speak to a psychiatrist on the telephone and the person who picks up the call may not be a clinician. There was also concern that feedback and responses may also arrive hours after surgery closing time. One example was cited of an acutely psychotic patient with a very calm mother supervising was unable to contain them at home. The Practice was unable to provide support and the patient ended up in A&E. Jackie Liveras advised that CRHT should be informed in such circumstances and the patient be sent home to meet the CRHT team. John Rohan asked if there will there be enough staff to response to call outs and Jackie Liveras advised that CRHT will have a prioritisation process in place to deal with it. CRHT will respond and contact A&E liaisons appropriately. Jill Shattock added that additional roll out will follow in October to include CRHT going 24/7. The Triage Service will be staffed by Clinicians and Psychiatrists. ACTION: TB to re-circulate the telephone numbers for Triage and Crisis. TB 3. DISCUSSIONS 3.1 Personal Health Budgets Tristan Brice from 1/08/13 the PHB is a new way for clients receiving money for continuing health care. All CHC clients will be receiving PHB. A support tool questionnaire will be used to determine how much they are entitled. This shift gives the money directly to individual client so they can control how to spend it. They can employ their own carer directly rather than through an agency, so they know when carer is due to come in. From 2015, all CHC clients will be offered PHB. Tristan Brice will meet with colleagues in London to discuss how to market and publicise PHB. Tristan Brice also advised that enquires about advocacy service for vulnerable patients to go to NHS England. Page 4 of 6

5 3.2 Draft proposal for annual review of patients on anticoagulant medication The draft business case and service specification LES for annual review of patients on anticoagulant medication were presented for review and comments. The business case requires GPs to collate and review information required to assess whether the continued prescribing of anticoagulants outweigh risks. The proposed remuneration is 40 per review. There were some concerns about whether GPs would feel confident to stop anticoagulation. PT highlighted that if a GP, after completing the review, was unsure, the consultant leads for the clinics at North Middlesex and Whittington Hospitals have agreed that they should be contacted by telephone to discuss each case. The consensus was to support the LES as it would improve patient safety. Jackie Mansfield asked if funding had been identified. PT said that funding had not been identified yet. The LMC would also need to be formally consulted if the LES is taken forward. The Cabinet supported the proposal, with a caveat that funding should be clearer. 4. COMMISSIONING ITEMS 4.1 Dyspepsia pathway River Calveley presented a flowchart of the Dyspepsia pathway for discussion to finalise; and for approval by the Clinical cabinet before publishing. Feedback and comments have been received from GPs. DASH is also happy with it as alcohol is prominent. Action Points : River Calveley to revise the document to include the following: Whittington Hospital and NMH logos to be added. A list of drugs to be added to make decisions easier when prescribing. Under Alarm features and should be emphasised in bullet point Recent onset and Progressive Consider age towards the top, no referrals for <25s To include H.Pylori test results when referring <55 RC 5. PRIMARY CARE ITEMS None discussed at this meeting 5.1 Collaborative meeting overload This was not on the agenda, but Nazmul Akunjee highlighted that there is a heavy burden on GPs to attend meetings with HCCG. Nazmul Akunjee suggested encouraging the surgeries who do not attend the collaborative Page 5 of 6

6 meetings to do so in order to help to reduce the amount of duplication at different meetings. The Cabinet supported better communication with surgeries. 6. ANY OTHER BUSINESS 6.1 Theme for next meeting Jill Shattock reminded the cabinet that the theme for discussion at the October meeting will be Paediatrics. 6.2 Review of Council Commissions on Sexual Health Nicole Klynman mentioned that Susan Otiti is doing a review of Council commissions on Sexual Health and would like to contact GPs for input and feedback. 6.3 Gastro workshops River Calveley informed the group of the dates for the gastro workshops 1. 10/09/13 on IBS 2. 24/09/13 on Anemia 3. 10/10/13 on Constipation 4. 5/11/13 on Review of 4 pathways 05 Nov 2013 was suggested as an ideal launch date. 6.4 Dementia There are on-going plans to commission a Dementia Lead. Details will be communicated in due course. 6.5 Commissioning Intentions In 2014/15, six months notice will be given to providers if there are changes. 7. DATE OF NEXT AND FUTURE MEETINGS October pm 3.00pm Page 6 of 6