Clinical Commissioning Group (CCG) Governing Body

Transcription

1 Clinical Commissioning Group (CCG) Governing Body Date of Meeting: 20 th July 2012 Agenda Item: Paper 27 Subject: Reporting Officer: GM Clinical Strategy Board Dr Chris Duffy Purpose of the Paper: To provide an update from the GM Clinical Strategy Board on 12 th June 2012 and 3 rd July Governance: Link to PCT Strategic Objectives Resolution: To approve To support Recommendation The CCG Board is asked to note the content of the report. Key implications for the following: Key Financial Implications: Financial Has this paper been approved by the Finance Department? If YES: Name and Job Title of member of the Finance Department Yes / No / N/A Value for Money Risk Legal Workforce Equality Impact Assessment: If NO what process has been agreed for financial sign off? Page 1 of 17

2 Included in Paper yes no n/a Comments Patient and Public Involvement Clinical Engagement Parties/ Committees consulted Page 2 of 17

3 Greater Manchester Clinical Strategy Board Tuesday 12 th June 2012 Summary Briefing Paper 1. Introduction The purpose of this briefing paper is to outline the agenda items considered and key decisions taken by the GM Clinical Strategy Board at its meeting on Tuesday 12 th June Attendance: Raj Patel (Chair) Terry Atherton Tim Dalton Stephen Liversedge Jerry Martin Chris Duffy Mike Eeckelaers Paul Bishop Nigel Guest Clare Watson Kate Ardern Phil Harris Warren Heppolette Leila Williams Helen Stapleton Hilary Garratt Anne Talbot Jenny Scott / T&G CCG ALW CCG Bolton CCG Bury CCG HMR CCG Central Manchester CCG Salford CCG Trafford CCG T&G CCG NHS ALW/DPHs Specialist Commissioning 1.1 Apologies: Martin Whiting Ian Williamson Bill Tamkin Ian Wilkinson Hamish Stedman Ash Patel Steve Allinson Claire Yarwood In attendance: Sue Gibson Paul Laker Neil Jenkinson Keith Hyde Mike Deegan Brian Benetar Hugh Mullen David Pearson Jonathan Martin Heather Lewis Sabrina Fuller Craig Harris Andrew White Andrea Dayson Yvonne Rispin Allan Jude North Manchester CCG Central Manchester CCG South Manchester CCG Oldham CCG Salford CCG Stockport CCG Tameside and Glossop CCG (PA to Chair - Minutes) HMR CCG Pathology Network Pathology Network CMFT PAT PAT CMFT Children, Young People, Families Network Independent Financial Advisor NHS Manchester GMMMG GMCCSN NHS Blackpool NHS Blackpool Page 3 of 17

4 1.2 Minutes and action log of the meeting held on 1 May The minutes of the meeting held on 1 May 2012 were accepted as an accurate record. The action log was reviewed and updated. 1.3 Clinical Strategy Board Forward plan The Clinical Strategy Board forward plan lists the planned key decisions that the Clinical Strategy Board is currently due to take during the following months. Board noted the plan. 1.4 Matters arising a. Partnership agreement Board members signed the partnership agreement where it had been considered and agreed by CCG Boards. Signatures are outstanding from North Manchester and Stockport CCGs. 2 Policy and Strategy 2.1 Service Transformation Work programme update Board received a paper detailing the progress of the work programmes of the Service Transformation Directorate of. (i) Noted the contents of the report. (ii) Acknowledged the achievement of the delivery of 32% of the QIPP target across Greater Manchester in 2011/12, which equates to 410m of the total required QIPP savings. 2.2 Transformation of Pathology Services a. Transformation of Pathology Services in Greater Manchester Board received a paper detailing the necessary steps to assure the delivery of the transformation of Pathology services in GM, to contribute to delivery of QIPP and achieve safe and sustainable pathology services. (i) Noted the progress to secure stage 1 of the transformation of pathology services across Greater Manchester through the delivery of: 7m QIPP savings from August 2012 further 1.5m savings from % improvement in measurable quality for users Safe and Sustainable services Collaborative services (ii) Considered the resources required to move from block contracts and deliver new activity based contracts and the request to reinvest 1.5m in a transformation fund to deliver this. Board approved the proposal in principle subject to additional scrutiny and approval of the Director of Finance NHS Greater Manchester (iii) Confirmed that the next steps to assure provider delivery of stage 2 would be driven by commissioners, delivered by providers and facilitated by the Network. Page 4 of 17

5 b. Safe and Sustainable Laboratories Beyond 2020 a Greater Manchester Approach Board received a paper prepared jointly by Central Manchester Foundation Trust and Pennine Acute Hospitals Trust briefing the Clinical Strategy Board on their joint proposal for the comprehensive delivery of the Greater Manchester Pathology Strategy, and the realisation of a full range of quality and efficiency benefits, through a strategic rationalisation of Pathology Services. (i) Noted the content of the paper and the proposals outlined within it and reiterated the intention of GM CCGs and NHS Greater Manchester to commission a consolidated direct access pathology service across GM to deliver the vision for pathology services across GM as agreed by Greater Manchester PCTs in (ii) Requested that the Pathology Network collate the provider plans to deliver commissioner requirements and evaluate them against finance and quality criteria as outlined in the pathology vision and present recommendations back to the Clinical Strategy Board based on this evaluation. (iii) Requested that the Network also evaluate the proposals against innovation and service improvement criteria. (iv) Requested that providers are required through the feedback from the Board to demonstrate a collaborative approach to provide consolidated pathology services across GM to include all providers and the proposed governance arrangements to do this. QIPP 2.3 (a) Driving Improvements in QIPP in NW Specialised Commissioning 2011/12 QIPP Programme Board received a paper outlining the specialised elements of work undertaken during 2011/12 as part of the agreed North West Specialised Commissioning Group (NWSCG) Quality Innovation Prevention and Productivity (QIPP) programme and to highlight the impact of that work on quality and productivity in order to provide assurance to the North West Specialised Commissioning Operational Group (NWSCOG). 2.3 (b) NW Specialised Commissioning 2012/15 QIPP Programme Board received a paper which was originally used to brief North West Specialised Commissioning Operating Group (NWSCOG) on the Quality Innovation Productivity Prevention (QIPP) programme for 2012/13, and beyond transitioning into the NHS Commissioning Board. (i) Noted that it was in receipt of papers prepared for other Boards and noted the content of all 3 documents. (ii) Recognised that the scope of the GM Safe and Sustainable programme had been widened to include primary care due to the impact of the programme on that sector and requested that the scope of the Safe and Sustainable programme is considered to include the interdependancies of social care. (iii) Requested a discussion at the July Clinical Strategy Board on the role of Networks and their alignment to the delivery of service transformation programmes. 3 Performance 3.1 GM Contract Steering Group Contract Review & Process 2012/13 Page 5 of 17

6 Board received a paper updating the Board on the outcome of the GM contract review process workshop on 14 May 2012 and the recommended principles and timetable for contracting in 2012/13 to ensure signed contracts for 2013/14. (i) Noted the contents of the report. (ii) Approved the contract principles to manage the process to deliver signed contracts for 2013/14, but requested that the work to develop GM CQUINs for 2013/14 is developed in the context of GM service transformation programmes. (iii) Approved the contract timetable to manage the process to sign contracts for 2013/14, but echoed the concerns raised by the Contract Steering Group of the capacity within CCGs to deliver the actions within the timelines stated and requested that the timetable is converted into a work plan clarifying accountability and responsibility for delivery. (iv) Noted that all CCGs had nominated a senior contract lead to attend the Contract Steering Group and that the Contract Steering Group would nominate a new chair from the CCGs by September. 3.2 Update on transition of specialised services Board received a verbal update on the migration of specialised services from Jenny Scott. 3.3 Financial Support for Provider Cancer Network Team to oversee revised tumour group care pathways The Clinical Strategy Board considered a proposal to approve a 100K contribution from GM commissioners to support the implementation of the proposal to establish a Provider Cancer Network Team to oversee the implementation of revised tumour group care pathways, necessary for the sustainable achievement of important national cancer access standards. Board noted that the overall cost of the proposal is 300k and that funding would be required for 12 months and is non-recurrent. The proposed funding for the proposal was: 100k / GM CSB commissioning contribution 100k Greater Manchester & Cheshire Cancer Network 100k Greater Manchester & Cheshire Acute Provider Director of Operations (c. 10k per NHS Trust in the Network). Approved the proposed approach in principle, subject to the agreement of locality Directors of Finance on the availability of funds for the commissioner contribution. 4 Commissioning business 4.1 Improving Outcomes for People with Dementia The Board received a paper setting out the role of CCGs, as commissioners and clinical leaders, in improving outcomes for people with dementia while using limited resources more effectively. The paper outlined the DH expectation that primary care will improve identification and assessment rates of people with dementia from 2013/14. The paper recommended Clinical Strategy Board endorsement for a GM-wide approach to establishing commissioning standards for Later Life Psychiatric Liaison and Memory Services in order to support primary and acute care in the delivery of better outcomes for people with dementia. The paper suggested that the identification of CSB and CCG clinical leads for dementia would contribute to and support this process. It proposes that dementia is considered as a potential Page 6 of 17

7 theme in the development of new models of enhanced care and increased investment in primary care capacity. (i) Noted the progress of the GM dementia work programme to date to deliver: - The GM dementia CQUIN, which has been included in all contracts for 2012/13 to incentivise acute Trusts to identify dementia patients and refer them onto appropriate services. - The establishment of demonstrator sites across GM. (ii) Endorsed the plans to: - Agree standards for provision of effective psychiatric liaison and memory services across Greater Manchester - Map existing provision against agreed standards and identify gaps, but requested that the totality of public sector investment in this area is included within this work - Develop a commissioning and investment plan for Clinical Strategy Board approval to ensure that the necessary services are in place to support primary care in improved identification, assessment and management of patients with dementia in line with emerging national requirements. (iii) Agreed that all GM CCGs would consider nominating their dementia lead to contribute to and provide leadership on the development of commissioning and clinical quality, supporting preparedness for DH expectations for improved performance on dementia from 2013/14. (iv) Approved the recommendation to advise the Direct Commissioning Board to use dementia care as a potential theme for the commissioning of a new model of enhanced capacity in primary care, as this would offer the potential to meet the increasing needs of people with dementia cost-effectively in line with the Safe and Sustainable primary care work-stream. 4.2 GMMMG/GMCCSN Proposal regarding anti platelet usage in Cardiology across Greater Manchester Board received a paper from the Cardiac Formulary Joint working group (CFJWG) - GM Medicines Management Group (GMMMG) and GM and Cheshire, Cardiac and Stroke Network (GMCCSN). A major area of work for the group has been new anti-platelet drugs - ticagrelor and prasugrel. An agreed hybrid pathway which was felt to be a pragmatic, affordable compromise, allowing the use of more potent new therapies, while being cost neutral or cost saving for the health economy was agreed at the joint group. This was originally intended to be implemented in October 2011, but was delayed due to one key GM trust refusing to authorise the protocol. Due to the inability to gaining a whole system approach to implementing a hybrid protocol, the April meeting of the GMMMG withdrew support, on the basis of the uncertainty of implementation and the prospect of unacceptable variation and consequently unsafe care. (i) Considered 4 proposed regimens: 12 months ticagrelor for PPCI patients only GMMMG APPROVED - Used instead of prasugrel. Prasugrel is more expensive than clopidogrel so extra costs of switching to ticagrelor ~100k extra - Restricting the patient group means mortality benefits of ticagrelor will be limited. 3 months ticagrelor, 9 months clopidogrel for PPCI and planned PCI in ACS - Saves health economy 300k in current Prasugrel regime. - Not approved by UHSM; approval from GMMMG withdrawn, not strictly evidence based 12 months Ticagrelor for all stented patients PREFERRED OPTION - This would cost approximately 750,000 extra based on the NICE costing tool. Page 7 of 17

8 - This is evidence based and NICE approved however there is an increased cost associated with this option. Approved by the GM CFJWG and the option most other regions have recommended. 12 months Ticagrelor for all ACS patients - This would cost approximately an extra 3.3 million (based on the NICE costing tool) - The clinical trial showed benefit in all patients however this option would increase costs substantially as is not affordable. (ii) Supported the preferred option of the Cardiac Joint Formulary working group. (iii) Supported the reduction in the use of Omacor and Ezetimibe to make this anti-platelet usage affordable. 4.3 Any Qualified Provider Implementation Briefing for GM Board received a paper clarifying the next steps for CCGs and the GM implementation team to ensure the implementation of Any Qualified Provider across Greater Manchester by September (i) Noted and approved the contents in the report and endorsed the role of the CCGs to deliver the actions to implement the policy by September (ii) Agreed the actions and responsibility for delivery as nominated in the paper. (iii) Approved the process to manage the implementation of the actions through the bi weekly ops meeting and Clinical Strategy Board on a monthly basis. (iv) Approved the recommendation that NHS Greater Manchester coordinate the delivery of AQP through nominated CCG leads. 4.4 Summary of NHS 111 Procurement Strategy for Clusters/CCGs The 111 Programme Board received and approved a Procurement Strategy paper incorporating the 111 Service Specification at its meeting in February This summary paper presented to Board was intended to provide Board with the information required to enable CCGs include the 111 Service within their business plans for 2013/14 and to share the expected financial impact / business case. (i) Noted the contents of the paper, particularly the financial assumptions, risk profile, procurement, evaluation and award processes as outlined. (ii) Approved the request for all CCGs to include the 111 service in their financial plans and business modelling for 2012/13 onwards and the estimated required system savings. (iii) Requested that all CCG Boards should consider the paper and ensure they are represented at the extraordinary Clinical Strategy Board on 24 th July (iv) Noted and accepted the role for CCG Boards to support the 111 Programme in the North West through continued engagement with the Programme and through support for development of the infrastructure required to deliver the identified system savings. Page 8 of 17

9 4.5 Greater Manchester Out of Hours Patients Transport Service Board received an updated paper following discussion at May Board outlining the future options for the commissioning and procurement of a dedicated out of hours patient transport service for patients who meet a locally defined eligibility criteria, and for system management reasons need to have supported transport home following on-the-day discharge. (i) Noted the contents of the paper (ii) Approved the next steps for the NHS Blackpool ambulance commissioning team to finalise the specification and procurement documentation to be completed and signed off by end July 2012 to ensure mobilisation before 31 March (iii) Approved the outline membership of the procurement and design groups. (iv) Considered the involvement of others in the procurement process. The Board did not strongly advocate for another clinical representative on the programme, but it was agreed that if anyone wanted to take part, they should inform Raj Patel, Jerry Martin or Yvonne Rispin. 4.6 The Future of Ambulance Commissioning Board received an updated paper from that presented to May Board outlining the considerations to inform a Board decision on the future of ambulance commissioning in the context of the concerns raised by May Board. The May Board acknowledged the benefits of collaborative commissioning for ambulance services in line with agreed arrangements for organising dedicated contracting teams around main providers. However, the Board emphasised the importance of ensuring associates to the lead commissioning arrangement had reliable and agile opportunities to address performance issues. Such arrangements would include the opportunity of face to face meetings between the provider and associate commissioners, supported by the lead commissioner and the support team to the lead. (i) Supported the proposal that Blackpool CCG will serve as the lead commissioner for ambulance service commissioning. (ii) Supported the offer from Blackpool CCG that they will host a single commissioning and contracting support team. (iii) Reaffirmed the view expressed by the Board in May that the governance arrangements for collaborative commissioning of ambulance services should be agile enough to allow CCGs or the Cluster (on CCGs behalf) to support effective performance management of the provider. (iv) Supported the requirement for a senior representative from GM to attend the NWAS GM group on a consistent basis. (v) Supported the proposed approach on the condition that the arrangements are reviewed in 6 months time at the December Board. Page 9 of 17

10 5 AOB There were no items of any other business tabled. 6 Date and time of next meeting Tuesday 3 rd July 2012, 9 12:30pm. Page 10 of 17

11 Greater Manchester Clinical Strategy Board Tuesday 3rd July 2012 Summary Briefing Paper 2. Introduction The purpose of this briefing paper is to outline the agenda items considered and key decisions taken by the GM Clinical Strategy Board at its meeting on Tuesday 3 rd July Attendance: Raj Patel (Chair) Terry Atherton Tim Dalton Jerry Martin Chris Duffy Mike Eeckelaers Bill Tamkin Denis Gizzi Hamish Stedman Gaynor Mullins Nigel Guest Steve Allinson Kate Ardern Warren Heppolette Leila Williams Helen Stapleton Anne Talbot Jenny Scott / T&G CCG ALW CCG Bury CCG HMR CCG Central Manchester CCG South Manchester CCG Oldham CCG Salford CCG Stockport CCG Trafford CCG T&G CCG NHS ALW/DPHs Specialist Commissioning 1.1 Apologies: Stephen Liversedge Martin Whiting Ian Wilkinson Ash Patel Hilary Garratt Claire Yarwood Phil Harris In attendance: Sue Gibson Annette Johnson Jonathan Martin Andrew White Siobhan Fahey Sean Greer Dominic Arkwright Bolton CCG North Manchester CCG Oldham CCG Stockport CCG (PA to Chair - Minutes) Salford CCG Children, Young People, Families Network GMMMG GM HCVS CMFT Sound Doctor 2.2 Minutes and action log of the meeting held on 12 June The minutes of the Clinical Strategy Board held on 12 June 2012 were accepted as an accurate record. Board noted that no response had been received to date from CMFT and Pennine Acute following their attendance at the June meeting. The action log was reviewed and updated. Page 11 of 17

12 2.3 Clinical Strategy Board Forward plan The Clinical Strategy Board noted the forward plan. 2.4 Matters arising b. Ratification of decision of the June CSB regarding the NWAS items: Summary of NHS 111 procurement strategy for Clusters/CCGs GM Out of Hours Patient Transport Service Proposal for the Future of Ambulance Commissioning The June Clinical Strategy Board considered the 3 items above, but was not quorate when the decisions were taken. The July Clinical Strategy Board was asked to ratify the decisions taken. (i) Approved the decision of the June Clinical Strategy Board on the 111 procurement strategy update. (ii) Approved the decision of the June Clinical Strategy Board for NHS Blackpool to finalise the specification and procurement documentation for the GM Out of Hours patient transport service. (iii) Approved the decision of the June Clinical Strategy Board on the arrangements for ambulance commissioning and noted that a Board to Board had been arranged between NWAS and for week commencing 9 July Policy and Strategy 2.3 Service Transformation Work programme update The Clinical Strategy Board received a paper updating on the progress of the work of the Service Transformation Directorate of. The Board currently receives a report on a monthly basis updating on progress and any issues to be discussed and/or resolved in respect of the following work programmes: Safe and Sustainable Making it Better Healthy Futures New Deal for Trafford Major Trauma QIPP (i) Noted that the final case for change documentation will be presented to the September Clinical Strategy Board prior to the consideration by the Board of NHS Greater Manchester. (ii) Noted the development of exemplar health and social care projects through the whole place budgets pilot, generating government interest in the GM reconfiguration agenda, which should help support a discussion with the public on the future of health and social care in GM. Page 12 of 17

13 (iii) Noted that the GM Cancer Summit will take place on 24 and 25 September (venue tbc) and that GM CCGs should be represented. (iv) Recommended that work is undertaken to understand and clarify the revenue stream for service transformation post April (v) Noted that the current understanding is that service transformation will be a function of the National Commissioning Board, but that consideration will need to be given as to how the outcomes of a public consultation on safe and sustainable will be implemented. (vi) Noted the Service Transformation Portfolio Management Office is reporting monthly to the SHA on the progress of QIPP milestones and that CCGs will need to consider how this function is carried out in the future. 2.4 QIPP Update There was no detailed QIPP update to provide to Board and this item was replaced by a short presentation by Steve Allinson on the progress of the CCG led work stream to determine the scope and scale, leadership and architecture for collaboration up to and beyond April The Clinical Strategy Board noted that following the clarification of the role of the Local Area Teams, the relationship between CCGs and the NCB will become much clearer. (i) Noted that the case for collaboration has been updated and shared with the GM GP Council. (ii) Noted that the CCG Chief Operating Officers have mapped and shared the current areas of collaboration and that the next step will be to prioritise where collaboration would deliver the most benefit, and be sustainable, given NCB and CCG operating cost envelopes and then to identify CCG leadership support. (iii) Agreed that the priority area for focus would be the collaborative contracts (district/tertiary cardiac, neurology, stroke, The Christie), but that it would also be important to review the networks, nascent NCB transformation programmes (S&S, and QIPP) and other strategic CCG alliances. (iv) Approved the proposal to build the CCG governance framework from existing collaborative governance (building on the CSB partnership agreement) (v) Approved the next steps to: Develop the supporting workflow and operational arrangements and clarify what sits with and is funded by the NCB, and what sits with and is funded by CCGs (to be taken forward at weekly operations meeting on 6 July) Appraise and agree the preferred option for CCG arrangements for resourcing collaboration including a Portfolio Management Office (to be complete by 20 July) Develop a proposal to introduce shadow NCB and CCG operational arrangements as soon as possible (where 2012/13 arrangements are as closely aligned with proposed future arrangements as possible) Page 13 of 17

14 3.3 Scope of the Safe and Sustainable Project Board The Clinical Strategy Board received a paper proposing a revision to the scope of the Safe and Sustainable Project Board, which is accountable to the Clinical Strategy Board, in order to bring coherence to the portfolio of service transformation projects and programmes. (i) Supported the proposal to revise the scope and function of the Safe and Sustainable Project Board, in order to ensure the coherence to the portfolio of GM service transformation. (ii) Requested that a detailed governance proposal including Terms of Reference for the revised Board be brought back to the next CSB meeting. 3.4 Role of Networks and their alignment to the delivery of service transformation A verbal update was given to the Clinical Strategy Board on the role of the networks and their alignment to the delivery of service transformation. (i) Noted that Janet Ratcliffe had been appointed as the Director of Clinical Networks. (ii) Noted that Clinical Networks will be hosted by National Commissioning Board from April 2013, but that clarity was awaited on the number and type of Networks that would be hosted. (iii) Noted that the geography for the Clinical Senates had been confirmed; that there would be two for the NW and that GM would be part of one of the Senates with Lancashire and South Cumbria. 3.5 Building a Case for Change Liver Disease in Greater Manchester The Clinical Strategy Board received a paper describing the issues that are emerging regarding liver disease across GM and identifying the drivers for change. The paper described the processes that have started to build a case for change for the prevention, identification and management of liver disease, which are: building a case for change communicating the case for change. An invitation was extended to the Clinical Strategy Board and CCG members to an event on 2 October 2nd where this work will be launched. (i) Noted the case for change for prevention, identification and management of liver disease (ii) Noted the formation of a Greater Manchester clinical group for Liver Disease (iii) Supported the attendance of Clinical Strategy Board and CCG members to the event - Building a Case for Change (Liver Disease) on 2 October 2012 (iv) Noted the need to ensure that the work is aligned to local alcohol strategy developments. 3.6 Improved Patient Education for Long Term Conditions The Clinical Strategy Board received a presentation about a web-based application to improve selfcare. Page 14 of 17

15 (i) Concluded that it was not the place of the Clinical Strategy Board to endorse a third party web application. (ii) Noted the work taking place across the country to develop the application and establish the evidence base for the intervention provided. (iii) Agreed that it is for individual CCGs to consider the application and its use and seek further information from the provider as required. 4 Performance 6.1 GM Contract Steering Group Contract Review & Process 2012/13 The Clinical Strategy Board received a paper detailing the discussions of the June meeting of the GM Contract Steering Group. (i) Noted and approved the contents of the paper. (ii) Approved the work plan as attached at appendix one and noted the actions to be delivered by CCGs. (iii) Noted the receipt of revised terms of reference for the Contract Steering Group and its subgroups to the August Board meeting. (iv) Noted that a proposal would be presented to August Board to seek the views of the Board on GM CQUINS for 2013/14 as well as any KPIs that they would like to be included in all contracts 2013/14. (v) Requested an update on the Christie 62-day KPI penalty proposal following consideration at the August Contract Steering Group and requested that it is made clear that commissioners expect providers to meet the performance standards as set out to ensure that the patient pathway and patient care is not compromised. (vi) Requested that an update is provided to the August Clinical Strategy Board detailing the collaborative commissioning intentions that were negotiated into all 2012/13 contracts. 6.2 Update on transition of specialised services Jenny Scott provided a verbal update to Board on the transition of Specialised Commissioning. It was agreed that the Specialised Commissioning Operational Group (SCOG) minutes would be circulated to Clinical Strategy Board for information. It was noted that work had begun to align specialised commissioning QIPP work programmes with those of the GM Clinical Networks, with particular emphasis on neurosciences. It has been confirmed that the Local Area Team of the NCB that will host Specialised Commissioning for the NW will be Cheshire, Wirral and Warrington. 7 Commissioning business 7.1 Financial Impact across Greater Manchester re: the Proposed Treatment of Hepatitis C Infection A paper was presented to the February 2012 meeting of the GM Clinical Commissioning Board. The paper was presented jointly by GMMMG and the Hepatitis C Treatment Strategy Group, which considered the two newer agents for Hepatitis C which have recently been launched, to develop a coordinated approach to outline those patients that will benefit most. The costs of treatment with Page 15 of 17

16 these newer agents may be high as they are in addition to current costs and the paper presented options to reduce costs. The February Clinical Commissioning Board: (i) Approved the Hepatitis C recommendation and treatment pathway proposed in the paper. (ii) Approved the proposed next steps to follow a GM procurement process to ensure the best deal on price for Greater Manchester, but requested additional financial scrutiny from Greater Manchester Directors of Finance on the Hepatitis C proposal before Board can endorse movement to procurement. The paper presented updated Board on the recommendations of the locality Directors of Finance - in summary: 1. To enter into a GM wide drug procurement process to gain the best value for money for the local population in the use of these therapeutics. The GMHCVS will manage the procurement process on behalf of the GM health economy. Decision required regarding how to ensure savings are returned to commissioners and not retained by the Provider. GM DoFs Response: on the basis that it is highly probable that NICE will approve these treatments, we support entering into a GM wide drug procurement process to gain best value for money for the local population. We would also request GM DoFs are represented on the group leading the procurement process. Effective communications need to be implemented to ensure patient numbers are identified by CCG to enable costs to be tracked appropriately. 3. Endorsement of decisions by GMHCVS and GMMMG is requested to allow early use of the new therapies prior to full endorsement by NICE in May/June GM DoFs Response: In any business case presented such as this one, the GM DOFs would recommend that a cost benefits analysis be requested by the lead commissioner in putting forward any commissioning proposal to assess the potential impact, both on finances and service delivery across GM. This analysis would expect to include staff from all areas deemed appropriate including Finance, Business Intelligence, Commissioners, Prescribing, Public Health, and any other relevant functions. Only then can we be assured of a whole system review to anticipate the impact of changes across the whole system e.g. Implementation of new prescribing therapies such as the Hep C ones could lead to a reduction in expected hospital activity later on, both in volume and complexity. This impact needs to be modelled to ensure that informed decisions can be made when agreeing to cap activity etc. It may be worth trying to raise the cap if the future benefits of this proposal increase value for money, or improve quality or the patient experience. Without this information available we feel unable to recommend the early adoption of these therapies. 3. Decision sought on how the DoF group will be informed of future use of the new HCV therapies. GM DoFs Response: could this be reported to CCGs and the Network by Acute Trusts in a process similar to the use of high cost PbR excluded drugs for which there is a commissioning minimum dataset included within the NHS contract? (i) Noted the paper (ii) Approved the recommendation that the conversations to advance the GM wide drug procurement process to gain the best value for money for the local population in the use of these therapeutics should continue. (iii) Considered recommendations 2 and 3 and were unable to fully endorse the decision taken by the GMHVCS strategy and requested further information in the form of a full Page 16 of 17

17 commissioning case outlining the progress and next steps for the GM hepatitis C strategy to be presented to a future Board. (iv) Requested a proposal is presented back to Board to outline how collaborative resources can be prioritised in a fair and effective manner, based on collaboratively agreed priorities. 8 Reports Thresholds for recommendations from GMMMG to become GM Policy or Guidance: Omacor Challenge Following the presentation to the Clinical Commissioning Board in March, detailing scenarios where the need for a strong GM medicines management position to be agreed is necessary; a live issue has developed for which the view of the Clinical Strategy Board is sought, to inform future decisions on delegated authorities. The need for GMMMG to make decisions in a timely fashion, while being aware of delegated authority is necessary. The Omacor case study will allow Board to recognise the levels of decision making GMMMG is comfortable with, to allow assurance of delegated limits. (i) Considered the attached correspondence and supported the letter on Omacor to be sent to Abbott on the basis that this is advice from the GM Medicines Management Group at which all CCGs are represented. (ii) Provisionally approved the recommendation to reduce inappropriate prescribing of Omacor. CCGs have been given an opportunity to test this recommendation with their local medical management advisors and Clinical Strategy Board will review feedback at the next meeting (iii) Noted the need to clarify the future governance arrangements for medicines management and requested that this is considered as part of the collaborative work stream. 6. AOB There were no items of any other business tabled. (i) Considered the items that had been presented to Board and a number of issues arose that Board members agreed warranted further detailed discussion. (ii) Agreed that one of the Clinical Strategy Board sessions would be extended to include a development session and Board members would be advised of the date as soon as possible. 7. Date and time of next meeting Tuesday 14 th August 2012, 9am 12:30pm. Page 17 of 17