NHS TRAFFORD CLINICAL COMMISSIONING GROUP GOVERNING BODY 27 February 2018

Transcription

1 Part 1 X Part 2 NHS TRAFFORD CLINICAL COMMISSIONING GROUP GOVERNING BODY 27 February 2018 Title of Report Purpose of the Report and key highlights Committee Key Issue reports To provide the Governing Body with a copy of the key issues from the Public Reference and Advisory Panel held on 7 December 2017; Clinical Committee held on 21 November and 19 December 2017; Primary Care Commissioning Committee held on 30 November 2017; Quality, Finance and Performance Committee held on 13 November, 12 December, 2017 and 9 January 2018 and Audit Committee held on 5 December Actions Requested Decision (Decision and discussion required) Discussion (No decision required. Discussion only which may lead to actions ) X Information (no discussion required) Strategic Objectives Supported by the Report Recommendations Trafford Coordination Centre Implications Discussion history prior to the Governing Body Financial Implications Continually improve engagement with member practices, patients, the public, carers, providers, our staff and other partners to effectively contribute to and influence the work of Trafford G. Working with health and social care partners deliver the transformation plan for Trafford including an increasing proportion of services from primary care and community services in an integrated way. Through effective integrated commissioning improve the quality of services and reduce the gap in health outcomes between the most and least deprived communities in Trafford. To be a sustainable economy both in terms of clinical services and finances. The Governing Body is asked to note the key issues from the Public Reference Advisory Panel; Clinical Committee, Primary Care Commissioning Committee, Quality, Finance and Performance Committee and the Audit Committee. N/A N/A N/A X X X X

2 Risk Implications Equality Impact Assessment Communications Issues Public Engagement Summary Prepared by Responsible Director N/A N/A None Local citizens have not been required to be involved in discussions around this paper. Liz Walker, Governance Support Officer Cameron Ward, Interim Accountable Officer

3 KEY ISSUES PUBLIC REFERENCE ADVISORY PANEL Meeting Date: 7 December, 2017 Agenda PRAP 1718/99 PRAP 1718/100 PRAP 1718/102 PRAP 1718/103 Nursing and Quality update The panel were presented with an update in relation to challenges and complaints in the system around Continuing health care (CHC). Mary Moore went on to advise the changes to the process which had been made to improve and to become more streamlined in order to bring in line with the national requirements. It was questioned as to the capability and qualifications of the CHC nurses undertaking the assessments and assurance was provided that they were capable and had the appropriate qualifications to do this. New Models of Primary Care (NMoPC) Mark Jarvis provided the panel with an update on the current situation in relation to the NMoPC. The panel were advised Dr Nigel Guest had been seconded into the organisation as Programme Director, and would be committed to the development of the organisation to manage current GP practice and deliver the new models of care within Trafford. The panel commented it would be an opportunity to provide services within Trafford for GPs and would also improve the standards and quality of care provided to the area. Falls strategy Brooks Kenny presented the panel with an update in relation to the falls strategy advising work was currently being undertaken with Trafford Council around this. A strategy had been produced by the council. The panel noted Dr Liz Clarke was the clinical lead for falls within the G and a steering group had been set up to look at what services are currently provided in Trafford and who provided those services in order to address the issues and areas of concern. Stretford Masterplan This was presented for noting by the panel. No decisions or actions were taken in relation to this No decisions or actions were taken in relation to this No decisions or actions were taken in relation to this No decisions or actions were taken in relation to this Report Date Prepared by: Liz Walker 18/02/18 Verified by: Priscilla Nkwenti 20/02/18 NOTE: A copy of the minutes are available on request by contacting Liz Walker, Governance Support Elizabeth.walker4@nhs.net

4 KEY ISSUES CLINICAL COMMITTEE Meeting Date: 21 November, 2017 Agenda 1718/ / / / /52 Greater Manchester Medicines Management Group (GMMMG) recommendations The committee were presented with a report from GMMMG to consider the recommendations made in relation to i) GMMMG becoming a clinical standards board ii) items not routinely prescribed in primary care iii) process for GPs accepting patients for shared care iv) macular pathways and v) communication support for GMMMG decisions. QIPP programme scheme update The committee were provided with the current financial position of the G and an update on the QIPP programme savings. The following areas were discussed i) QIPP 2017/18 and 2018/19 ii) QIPP timelines iii) financial plan summary and delivery of 2017/18 schemes and iv) details of clinical task and finish groups and recommendations. A full detailed report would be presented to the Governing Body on 28 November There were some concerns raised around mandatory use by GPs for referrals into the Trafford Coordination Centre (T). It was important that members supported this and to advocate at every opportunity the savings to be made in using the services of the T. Continuing health care (CHC) The committee were presented with an overview of the processes in relation to CHC and around the clinical case management of the cases. Mental health update An update was presented to the committee which highlighted the work being undertaken in relation to Trafford s mental health investment framework and identified a number of areas. The committee agreed the work to date was excellent however it would be important to ensure the work be considered as part of the whole commissioning landscape in relation to transformation. Primary care standards The committee were presented with the quality standard proposal for Trafford and this included i) NMoPC work stream ii) GM standards iii) Salford standards and iv) The Clinical Committee supported the recommendations of GMMMG.

5 Agenda 1718/ /54 proposed Trafford standards which were to determined. Mark Jarvis went on to explain that the Salford standards had been used as a guide as these would be a good starting point, however the challenge would be about deciding on the Trafford standards. The timeframe in relation to this work would be having the standards available from 1 April AGG clinical reports A verbal update was provided on the highlights from the recent AGG meeting and the papers were presented for information. G Medicines Management Group minutes The minutes were presented for information purposes only. Report Date Prepared by: Liz Walker 18/02/18 Verified by: Chris Tower 20/02/18 NOTE: A copy of the minutes are available on request by contacting Liz Walker, Governance Support Elizabeth.walker4@nhs.net

6 KEY ISSUES CLINICAL COMMITTEE Meeting Date: 19 December, 2017 Agenda 1718/ / / /63 Antibiotics guidance update The committee were presented with a summary of the antibiotic prescribing guidance which focused around the prescribing of antibiotics for the treatment of urinary tract infections (UTI), which would support GPs with triage and treatment of UTIs. Patient medication leaflet The committee were asked to review, approve and support the use of the leaflet for a period of 3 months. The leaflet would be available for patients who have their medication reviewed and optimised and it had been created with support from Midlands and Lancashire Commissioning Support Unit (MLCSU). It was advised that currently practices would inform patients of medication and optimisation reviews in their own way, however by using the leaflet this would give a coordinated approach to the work. Comments were suggested around amendment of the wording to make it easier to understand and some of the information was confusing. Proposal for Medicines Management Group governance Ann Harrison advised the committee that the Medicines Management Group would be relaunched and renamed to Medicines Optimisation sub-group and would help to inform some of the work of the Greater Manchester Medicines Management Group (GMMMG). Low priority prescribing funding The committee were advised of the work being undertaken in order to inform the decision around the restriction of prescribing over the counter medicine (OTC) in primary care. Patients and the public had been involved in discussions around this and had been supportive. NHS England is now working to develop further guidance to Gs for a consultation in early Questions were raised over GPs continuing to prescribe OTC medications and whether the message should include prescribing in special circumstances and Leigh Lord would look at the wording which could be used. There were a number of drugs which had been suggested to be formally placed on the blacklist which included such drugs as Co-proxamol, Glucosamine and Chondroitin. The Clinical Committee supported the recommendations and agreed the guidance would be communicated to GP practices. The committee approved the leaflet, after amendments to the wording had been made. The medicines optimisation team would review the impact of the leaflet after a 3 month period and report back to the committee. The committee approved the changes to the format of the meeting. The Interim Medical Officer would attend future meetings. The committee agreed to patient engagement commencing around ceasing gluten free food and OTC medication. The committee agreed to support decommissio9ning of those medicines on the GMMMG DNP list. The committee agreed to communicate to Trafford Out of Hours and Walk in Centre around non prescribing of OTC medication. The committee agreed for MLCSU to undertake an audit of patients who are on medication where there may be a suitable alternative.

7 Agenda If these drugs were put on the blacklist they would not be able to be prescribed by GPs and pharmacies would be not reimbursed if dispensed. The committee were advised that these drugs were already contained within the GMMMG Do not prescribe list. 1718/ / / There was further discussion around other types of drugs or medication, which included gluten free foods, that could be included and further work would be undertaken to look at additional drugs to be included. Primary Care Reform programme Chris Tower declared an interested in the discussion as he undertakes sessional work for Trafford Provider Health. Rebecca Demaine presented to the committee on the transformation funding and primary care reform funding, which were two separate funding streams. The report explained about the funding granted to extend 7 day access under the New Models of Primary Care (NMoPC) funding. An extended model had been presented, however concerns were raised as to whether it was correct process for governance. It was suggested this would be circulated for wider input in order to work up costings and to go through due process and have further discussions around the wider commissioning services. BAF and Operational Risk Register Mark Jarvis advised the committee there had been minor changes to titles and details in the risk register, however there had been no major changes to the risks for which the committee had oversight. Primary care locality engagement presentation The committee were informed of discussions which had taken place at the last meeting in relation to capacity and resource in the communications and engagement team in order to make follow up phone calls to practices to inform the data quality work being undertaken. Mark Jarvis advised primary care engagement would form part of the QIPP scheme programme, and data would be collated and circulated to each member practices for further discussions and peer reviews, which would be taking place within individual practices to discuss quality data. QIPP commissioning scheme update The committee were advised of the current status of the QIPP programme and additional schemes which had been identified. Chris Tower declined to take part in the discussion as he had a declared interest in the item. The committee agreed for further discussion to take place. 718/68 Do not prescribe list

8 Agenda Leigh Lord advised the committee of information which highlighted GP practices were still prescribing from the Do not prescribe list. The medicines management team would be speaking to individual practices in relation to this. Report Date Prepared by: Liz Walker 18/02/18 Verified by: Chris Tower 20/02/18 NOTE: A copy of the minutes are available on request by contacting Liz Walker, Governance Support Elizabeth.walker4@nhs.net

9 KEY ISSUES PRIMARY CARE COMMISSIONING COMMITTEE Meeting Date: 30 November, 2017 Agenda PC 1718/50 PC 1718/51 PC 1718/52 PC 1718/53 PC 1718/54 Risk Register The committee were presented with details of the 2017/19 Board Assurance Framework (BAF) and the Operational Risk Register (ORR). No changes had been made, however updates had been made to the narrative for risks 5, 7 and 11. The report had been presented to the Governing Body in October however there was still linking work to be done around the primary care risks. A question was raised in relation to risks identified as part of the New Models of Primary Care (NMoPC) and as it develops where would the risks sit. It was advised the risks would still sit within the G. Applications to the Policy for the support to General Practices The committee were asked to review and approve the recommendations in the report to award a fair and equitable level of support to those practices which may be impacted as a result of list dispersal. It was recommended that an additional payment of 10 per patient be paid for associated costs and the additional work it would involve. Model whistleblowing for general practice The committee were asked to approve the model whistleblowing policy for general practice. It would ensure the safety around whistleblowing and enable people to raise serious issues/concerns in an appropriate way. It was questioned as to whether there was national guidance around whistleblowing and whether there was a need for a G policy. Primary care financial performance as at 31 October 2017 The committee received an update in relation to the current position as at October An overspend of 476k for delegated primary care and an underspend of 40k for local commissioning services were reported. There was also risk implication around the Mastercall service and ongoing discussions were taking place to review the current service. Primary care update report The committee were advised that CQC inspections had been undertaken for the practices within Trafford. From the 32 practices, 28 were deemed good, 2 outstanding, 1 inadequate and 1 requiring improvement. Primrose Hill practice had been identified as requiring improvement and an action had been put in place with The committee approved the recommendations within the report The committee approved the policy Primary care team to review the national guidance LMC to communicate the clinical notes audit to the primary care team when available. PMS Contract review paper to be presented to

10 Agenda PC 1718/55 PC 1718/56 assurance these actions would be progressed. Brooks Bar practice which had received inadequate would be relocating to Limelight, and were awaiting a date for re-inspection. The committee were advised that Dr Pathak s practice had closed and this would impact on around 540 patients. As part of this process the LMC would undertake a clinical notes audit and this would be sent to the primary care team once available. Jason Bamford-Swift advised the committee that GM Health and Social Care Partnership had made contact with the G in relation to progressing the PMS contract review in Trafford. Currently 7 practices hold these contracts and variations onto new conditions had not been signed. A full paper would need to be presented to the January committee in order to review. New Models of Primary Care (NMoPC) A verbal update was provided on the current situation regarding NMoPC. Work was progressing well and further updated would be provided to each meeting. Primary Care Estates Strategy update Tim Baker presented an update on the primary care estates strategy to the committee for consideration of the latest position and to be informed of the next steps prior to producing an estate document at the end of the financial year. An updated version of the estates strategy would be presented to the committee in March. the January meeting. Estate strategy paper to be presented to the committee in March Report Date Prepared by: Liz Walker 18/02/18 Verified by: George Kissen 20/02/18 NOTE: A copy of the minutes are available on request by contacting Liz Walker, Governance Support Elizabeth.walker4@nhs.net

11 KEY ISSUES QUALITY, FINANCE & PERFORMANE COMMITTEE Meeting Date: 14 November 2017 Agenda 1718/ / / / / /56 Declarations of interest Declarations were received from Dr Chris Tower with regards to agenda item 1718/52, as his wife is a Consultant Obstetrician & Clinical Director at CMFT. Maternity Services Review Ric Taylor presented a report on the maternity services and asked the committee to support further work in the establishment of a maternity local implementation group. The committee request key performance indicators (KPI) to be included for flu jabs as part of the report and this would be added to any further reports being presented to the committee. Finance position and QIPP update An updated was presented to the committee on the current financial position and a QIPP update. A number of key areas were highlighted which included QIPP timelines; financial summary plan of 2017/18 schemes; delivery of the schemes at month 6; QIPP 2017/18 and 2018/19 progress to date; recommendations by the task and finish group and 2018/19 QIPP schemes. Cancer quality and performance update Ric Taylor presented a report which summarised the key messages relating to cancer performance in Trafford and following an analysis of the most recently published data in October There was discussion around the challenge in terms of the direction of travel and a need for the dashboard to highlight local services and determine how the G could influence these services. Mental health quality and performance update Ric Taylor presented a report which provided members with assurance regarding the mental health framework scorecard. It was advised at a recent meeting a 200k contract variation had been agreed with Greater Manchester Mental health NHS Foundation Trust (GMMH) which allowed the provider to accept responsibility for procurement and management of services. Palliative care and end of life position Alex Cotton provided a report which summarised the key messaged relating to palliative care and end of life performance in Trafford, following analysis of the most recently published data as at October The Chair took the appropriate course of action at the point the item was discussed and it was agreed that as no decision was to be made, both were in attendance for the discussion. The committee supported the establishment of a maternity local implementation group. It was agreed the information would be presented on a quarterly basis to the committee. No decisions/actions were taken in relation to this Alex Cotton to include Sam Sherrington in the invites to the workshops. Feedback to be presented to the committee when available. Workshops were being organised in order to inform the ongoing development of the

12 Agenda 1718/57 programme. There would be 3 workshops, and Sam Sherrington expressed an interest in being involved. Once the workshops had taken place feedback would be presented to the committee. Small provider update Kate Proven provided an update in relation the small providers and concerns around quality and performance. A number of issues had arisen, one being in relation to the dermatology service provided by Concordia. A remedial action plan had been put in place; however the action received by the G gave rise to further concerns and would write to the provider. An update to be provided to a future committee. A risk assessment of the service to be undertaken. 1718/59 It was suggested and agreed a risk assessment be undertaken around the service. Pennine Care Foundation Trust outcomes framework update An outline was provided around the steps being taken to develop and outcomes framework and covered the following areas; i) progress to date ii) phase one measures iii) challenges iv) next steps. As part of the discussion in relation to reporting it was agreed a number of areas would be reported on a monthly basis and would include k) KPIs ii) quality standards and iii) outcomes based standards on a quarterly basis. Agreed on areas to be included as part of the monthly reports. Arrange a meeting with the trust and the G. 1718/ /61 Concerns were expressed around agreement between the trust and the G in terms of KPIs and a meeting would be organised to discuss further. Stroke update A report was presented to provide an update on the current performance around stroke which had continued to improve since the centralised stroke model was implemented in Trafford Coordination centre update (T) Tim Weedall presented an update to the committee which highlighted i) current priorities, ii) care coordination tasks and interventions, iii) risk stratification, iv) details of high risk patients amongst practices, v) benefits realisation, vii) key performance indicators (KPIs), viii) patient feedback, ix) engaging with GP practices and x) priorities from November 2017 April Key areas identified in terms of care coordination 1722 patients had declined the service, and it would be a priority to understand why they had declined the service. A number of these patients were high risk and therefore work was needed to understand this further. No decisions/actions were taken in relation to this No decisions/actions were taken in relation to this

13 Agenda 1718/ /63 It was also highlighted the importance of GPs engaging with the T to use the service as much as possible. Quality dashboard The quality dashboard provided the committee with an update in relation to i) the purpose of the dashboard, ii) 7 themes, iii) governance, iv) safety, v) effectiveness, vi) intelligence gathering and vii) assurance and challenge. Serious incident update The committee were presented with a report on serious incident themes and trends pertaining to Trafford residents. This included slips/trips and falls; pressure ulcers and diagnostics, which remained the main themes at Manchester University NHS Foundation Trust (MFT). For Pennine Care NHS Foundation Trust the reported incidents were suspected self-inflicted harm incidents. There would additional resources involved in undertaking deep dives into key lines of enquiries and contracts, including key performance indicators (KPIs) and as a result of this action plans would be developed and future reports would include this information. No decisions/actions were taken in relation to this No decisions/actions were taken in relation to this Report Date Prepared by: Liz Walker 18/02/18 Verified by: Mark Jarvis/Sam Sherrington 20/02/18 NOTE: A copy of the minutes are available on request by contacting Liz Walker, Governance Support Elizabeth.walker4@nhs.net

14 KEY ISSUES QUALITY, FINANCE & PERFORMANCE COMMITTEE Meeting Date: 12 December 2017 Agenda 1718/ / /72 Declarations of Interest Declarations were received from Dr Chris Tower with regards to agenda item 1718/74, as a sessional GP for the organisation. Matters arising Mark Jarvis, Medical Officer suggested it would be more appropriate for a Lay member to chair the meeting. It was agreed that Sam Sherrington, Governing Body Nurse Member take on the role from the next meeting January and Dr Kate Clark, Governing Body, Secondary Care Clinician would take on the role as Vice Chair. Risk update A number of amendments were highlighted, specifically around Risk QP004 A&E standards as the trust had failed to meet its trajectory. Financial risks were identified as needing to be reviewed. It was also suggested that further training be undertaken within the quality and performance team around risk and risk management. Finance position and QIPP update A finance update was provided in relation to the current position for 2017/18; 218/19; QIPP financial plan summary 2017/18 original schemes, and QIPP additional schemes. The Chair took the appropriate course of action at the point the item was discussed and it was agreed that as no decision was to be made, both were in attendance for the discussion. It was agreed that amendment to the terms of reference would be reviewed to reflect the changes of the Chair and Vice Chair. It was agreed Ruth Riddell would arrange for additional training for the quality and performance team. No decisions or actions were made in relation to this 1718/ /74 The list of QIPP schemes for 2017/18 would work alongside the New Models of Primary Care (NMoPC) and to ensure the focus was around the resource and effort needed to ensure the planned changes are appropriate and would maximise the most in cost savings. MSK referrals were discussed and it was advised a letter had been sent to all GP practices asking to ensure the MSK referral pathway was used appropriately, as this would support the cost savings needed to be made in relation to the MSK service. Performance and Quality update There were a number of areas discussed as part of the update and these included contract quality and performance and system resilience. There was discussion around the winter pressures and a delayed transfer group which had been established to develop and urgent care control hub. The hub receives data No decisions/actions were taken in relation to this

15 Agenda 1718/ / /77 4 times a day and therefore enables a real time picture of what urgent care looks like on a daily basis. There was discussion around the agreement to make minor changes to the key performance indicators (KPI) as part of the contact with the acute trust, along with minor changes to the quality standards to ensure consistency. Weekly meetings were taking place and would be completed by the end of December. CQUINS remained the same as they have been however a meeting to review these would take place on 13 December Additionally a number of hotspots were identified; however the full list would be presented to the Governing Body formal meeting in February. A number of areas of concern were raised which include A&E wait times; delayed transfer of care (DToC); CMFT had failed a number of cancer standards including 31 day wait and the 62 day wait. However in terms of 2 week waits the performance had much improved, along with 7 day and 62 day waits. Improvement and Assessment Framework (IAF) An update was provided on the current position in relation to the IAF, with some concerns around maternal smoking at delivery. There were no other major areas of concern raised in relation to this Patient experience matters activity 1 JUL SEP 17 An update on the position of in relation to the work around patient experience, engagement, complaints, PALS and incidents was provided. The key area to highlight was around the recent Patient, people and patient experience of continued healthcare (PEACH) pilot which had concluded, and had agreed it would continue in Trafford and was being progressed. The G calendar of engagement had been approved at the Governing Body in July along with a budget of 15k which would fund the continued work in relation to the Trafford Talks Health and other events in the calendar. Further information was provided in relation to PALS and complaints which had been around CHC, communication and failure to follow processes. Personalised care team performance update An outline review was provided on the CHC which had been conducted in accordance with the 2017/18 internal audit plan as approved by the Audit committee. 6 recommendations had been made, which had agreed to be completed by the end of No decisions/actions were taken in relation to this No decisions/actions were taken in relation to this No decisions/actions were taken in relation to this

16 Agenda 1718/ /79 December/ Nursing Home quality status A report was presented on the current quality of support offered t nursing homes in Trafford which also highlight the current RAG status of those homes. The main areas of concern had been around quality of care, leadership and it being a well led organisation Q2 SAFEGUARDING UPDATE The committee were presented with a number of key highlights in relation to safeguarding in terms of Pennine Care NHS Foundation Trust (PCFT). The number of supervision complaints had risen, however more staff were now undertaking training which would hopefully reduce these numbers. It was also identified the number of health assessments for children had dropped to 91%, however this relation to out of area assessments and were small numbers in terms of provision by PCFT. University Hospital South Manchester NHS Foundation Trust (UHSM) had reported issues around level training and Central Manchester University Hospital NHS Foundation Trust (CMFT) had not reported any date due to staff sickness. It was however identified these concerns would be raised with the new head of GM Mental Health, and in particular around level 2 and 3 training. Assurance was provided in that the areas of work which needed to be progressed/improved were part of the work plan. It was suggested that Mark Jarvis write to the providers outlining the requirement to receive the data to be reported on a quarterly basis. No decisions/actions were taken in relation to this It was agreed Mark Jarvis would write to the acute providers outlined the reporting requirements on a quarterly basis. Report Date Prepared by: Liz Walker 18/02/18 Verified by: Mark Jarvis/Sam Sherrington 20/02/18 NOTE: A copy of the minutes are available on request by contacting Liz Walker, Governance Support Elizabeth.walker4@nhs.net

17 KEY ISSUES QUALITY, FINANCE & PERFORMANCE COMMITTEE Meeting Date: January, 2018 Agenda 1718/85 Processing request for continuing healthcare (CHC) The committee were presented with information relating to CHC which provides individualised care, based on the needs of the individual. There had been some challenges around the complaints received which had been around the decisions made, with around 200 people in the system eligible. Trafford G had not previously been responsible for the management of the CHC process, however they now were and had taken great steps to improve the process to become more streamlined in order to bring in line with national dictate. There was further discussion around higher acute placements and those patients with learning difficulties, complex mental health issues and dementia as there were diverse approaches to these patients. It was noted that the quality of the work around CHC had improved dramatically. Finance position and QIPP programme update The committee were advised on the current financial position of the G which included QIPP planned savings. 18.6m of savings had been identified, however this would not be delivered within 2017/18, with around 8 9m of savings being realised, leaving 10.6m of savings to which would not be achieved. 1718/86 Further information was highlighted in relation to the acute provider overspend, which current stood at 1.7m at month 1, and if this continues would create a significant challenge, and could result in an overspend of 11m. 1718/87 It was questioned as to what may be causing the overspend in the acute sector; however there was no one specific thing that could be attributed to this. There would be further work undertaken to review the contracts for the services provided and would give an opportunity to identify where further savings could be made. Performance and quality update The committee were presented with an update on the current risks relating to performance and quality and advised there was further work to be undertaken to update the risks.

18 Agenda Key areas were highlighted in relation to performance issues which included urgent care, ambulance targets, A&E pressures and delayed transfers of care. KPIs, contracts and CQUINS were also discussed along with the quality premiums. The hotspots around quality and performance were highlighted which included diagnostic test results, pressure ulcers, discharge summaries and mortality. Trafford Coordination Centre (T) Tim Weedall (TW) provided an update around the latest position of the T. The committee were advised there had been a number of changes to staff and a new Programme Director had been appointed, along with a Clinical Lead and Service Director. TW would circulate data in relation to GPs referring into the service 1718/88 The plan to achieve 2,000 patients by April was still on track and patients had been identified using the risk stratification process, frailty index score and through GPs. Detailed benefits realised showed the T was behind in the projected savings against a revised target of 1.86m. A draft programme plan would be presented to the stakeholder meeting in January. It was advised that the contract had been renegotiated and the payments were agreed to be split over a 2 year period. Work now needs to be undertaken to ensure the GPs were aware of the pathways that had been developed and TW advised the information was now available on the GP portal and further work with GP practices was being undertaken. A question was raised as to whether data was available on the referrals from each practice and if so could it be made available. TW advised it was available and he would pull together some data to be circulated. Report Date Prepared by: Liz Walker 18/02/18 Verified by: Mark Jarvis/Sam Sherrington 20/02/18 NOTE: A copy of the minutes are available on request by contacting Liz Walker, Governance Support Elizabeth.walker4@nhs.net

19 KEY ISSUES AUDIT COMMITTEE Meeting Date: 5 December, 2017 Agenda 2017/ / / / / / / /089 Clinical Member replacement It was agreed further discussion should take place at Governing Body. Grant Thornton Audit progress report sector update & G key issues The committee received an outline plan of work for the 2017/18 audit timetable, and a more detailed accounts plan would be provided at the next meeting with value for money conclusions included. Internal Audit progress report The committee received a progress report against the 2017/18 internal audit plan. MIAA Audit committee update report The committee received a summary of events taking place, and in particular highlighted the Health and Social Care Innovation showcase which was taking place in February, the Quality Improvement Network (QIN) offer and the support available from MIAA in relation to General Data Protection Regulation (GDPR) compliance. MIAA AUDIT committee benchmarking/insights report An update was provided to the committee which include benchmarking reports on the G assurance framework and also fraud investigations. Finance Report To inform members of the committee of the following : Losses and Special Payments Tenders and Tender Waivers Debtor and Creditor Balances Running Costs A verbal update was provided to the committee which highlighted a significant amount of spend to the bring forward agenda both for transformation and the recovery plan but emphasised the need to adhere to SFI s rules of engagement and to be open and transparent. Risk and assurance update report To provide assurance to the audit committee regarding the management of risks recorded on the Board Assurance Framework (BAF), and to report progress against internal audit recommendations and revised target date changes if required. Item to return after discussion at Governing Body The committee noted the contents of the report The committee noted the contents of the report The committee noted the contents of the report The committee noted the contents of the report The committee noted the contents of the report The committee noted the contents of the update and were made aware of further discussion at Governing Body regarding resilience. The committee considered the assurance provided to demonstrate risks identified were being managed appropriately. Review the internal audit action summary and note date changes for action 056, 066, 051 and

20 Agenda 2017/090 The committee were advised work was currently being undertaken with risk owners in order to update the report for the Governing Body meeting in December. Gaps in control were highlighted in relation to Risk 6 (secondary care) and optimisation of the Trafford Coordination Centre (T) but there was no indication of actions to address. Conflicts of Interest Q2 assurance To provide members with details of the Q2 Assessment for conflicts of interest and highlight those conflicts raised at G committees between 1 October 31 December Review Risk 6 with risk owner The committee noted the contents of the report. Report Date Prepared by: Paul Kelly 18/02/18 Verified by: Alan Foster 21/02/18 NOTE: A copy of the minutes are available on request by contacting Liz Walker, Governance Support Elizabeth.walker4@nhs.net