Report to the Sutton Clinical Commissioning Group Governing Body

Transcription

1 Report to the Sutton Clinical Commissioning Group Governing Body Date of Meeting: 5 th November 2014 Agenda No: 8.0 Attachment: 16 Title of Document: Minutes of Committees for Note Report Author: As per details on each attachment Purpose of Report: For Note Lead Director: As per details on each attachment Contact details: As per details on each attachment Executive Summary: 8.1 Executive Committee ; ; ; Quality Committee ; Finance Committee ; Charitable Funds Committee (s): The Sutton Clinical Commissioning Group Governing Body is requested to note the minutes.

2 MINUTES OF THE SUTTON CLINICAL COMMISSIONING GROUP EXECUTIVE COMMITTEE MEETING Wednesday 13 th August pm Meeting Room 1, Priory Crescent Present Jonathan Bates JB Chief Operating Officer, Sutton CCG (Chair) Geoffrey Price GPr Chief Finance Officer, Sutton CCG Dr Farhan Rabbani FR Wallington Locality Lead / GP - Wallington Medical Centre Dr Jonathan JC QIPP Lead-Urgent Care/ GP - Chesser Surgery Cockbain Dr Jeffrey Croucher JJC Locality Lead, Sutton & Cheam / GP - Benhill & Belmont Surgery Dr Dino Pardhanani DP QIPP Lead-LCCs & Service Redesign / GP - Mulgrave Road Surgery Dr Chris Keers CK QIPP Lead-Mental Health / GP - Wrythe Green Surgery Dr Simon Elliott SE QIPP Lead-Medicines Management In attendance Sue Roostan SR Director of Commissioning & Planning Adrian Davey AD AD Commissioner for Mental Health Corinna White CW Mental Health Project Manger Mary Hopper MH Director of Quality Ian Gordon IG Senior Acute Contracts Manager, SLCSU Neil McDowell NMcD Acting Head of Contracts for SWL, SLCSU Sam Jacobson SJ Joint Commissioner for Carers Respite and Support Services (Item 4.4) Jonathan Williams JW Head of Quality Assurance, LBS (Item 4.1) Jane Stark JS Commissioning Manager, LBS (Item 4.1) Apologies Dr Chris Elliott CE Chief Clinical Officer / GP - Benhill & Belmont Surgery (Chair) Karol Selvey KS QIPP Lead /Nurse Practitioner & Partner - Dr Grice & Partners Dr Ash Mirza AM Carshalton Locality Lead / GP - Faccini House Surgery Dr Mark Wells MW QIPP Lead-Acute Contracts / GP - Wrythe Green Surgery 1 Welcome and Apologies The Chair welcomed everyone to the meeting advising that due to clinical commitments 4 GP members were delayed and the meeting was therefore not quorate until 2 had arrived. The Chair proposed to start the meeting, deferring decision making until such time as the meeting was quorate. 2 Declarations of Interest The Chair asked the Executive Members to confirm that the Register of Interest attached was a correct and accurate record of interests.

3 FR advised a further interest as a Board Director of SELDOC (South East London Doctors on Call) to be added to the register. YH to update the Register. YH In relation to items on the meeting agenda no further interests were declared. 3 Minutes of the meeting held on 9 th July 2014 The minutes were approved without amendment. Log The action log was reviewed and will be updated and re-circulated to the Committee. Matters arising not on the agenda:- - Key Performance Indicators (Att.1c). This paper was presented to today s meeting for note prior to full discussion at the meeting on 10 th September. FM/YH to add to the September agenda. - GP IT Refresh Update. (Att.1d) SH provided a written update detailing the roll-out to GP Practices. GPr then informed the Committee that following a successful bid for funding the CCG had received an additional 160k funding which would be used to support the GP IT Refresh. FM/YH 4 London Borough of Sutton specification for Tier 2 CAMHS services reprocurement The Chair welcomed Jonathan Williams, Head of Quality Assurance and Jane Stark, Commissioning Manager from the London Borough of Sutton (LBS) to the meeting. JW introduced the draft service specification for the re-procurement of Tier 2 CAMHS commissioned by LBS. The aim of the service is to the outcomes for children and young people in Sutton with emotional, behavioural and mental health problems. The 2014/15 budget has been identified for re-tendering Tier 2 services with a SCCG contribution of 165k and LBS of contribution 118,300. In addition LBS are decommissioning some existing services and re-investing an additional 65k into Tier 2 CAMHS provision, providing a financial envelope of 348k. The final service specification will be approved by the One Sutton Collaborative Commissioning group in August with the tender process beginning in September with PQQ and ITT in October and November. The contract will be awarded in December 2014 allowing 3 months mobilisation with go-live for the new service in April SR informed the Committee that Carol Lambe had provided SCCG input and worked closely with LBS in developing the service specification. Comments FR raised a concern on the referral criteria. In response JS said that by commissioning different elements of the service in two Lots as described on Page 8 of the specification this would help referrers to assess patients and refer them to the correct service. Lot 1 is for those children and young people with known mental health needs, with Lot 2 focused on providing emotional support. MH asked how outcomes and benefits for patients will be evidenced and where

4 the biggest impact is expected. JS said that one of the largest impacts is expected in the increase in school attendance, however the overall impact of the service will be measured by quantifiable data and feedback from service users and providers. Dr Jeff Croucher arrived. AD asked about the link with the development of a Children s IAPT service in Sutton and JS confirmed that this would be discussed with the successful bidder. In response to a question on the strength of the market place, JW said that the market was strong with a large variation of service providers, both large and small providers. JB referred to the membership of the Joint Commissioning Panel. JW said that Carol Lambe was on the panel and welcome to invite colleagues from the CCG to join the panel. The Chair thanked JW and JS for presenting to the Committee. The Executive Committee was asked to approve the LBS service specification. JB said that as the meeting was not quorate at this point the Committee would note the LBS service specification and defer the decision making until the meeting was quorate. JW and JS left the meeting On the arrival of Dr Chris Keers (CK) the meeting was quorate. (Subsequently the Executive Committee approved the LBS service specification). 5 Community Paediatric Service Level Agreement 2014/15 SR introduced this item. The paper detailed a Community Paediatric SLA proposal with ESH for 2014/15. SR advised that the SLA is between SCCG, MCCG and ESH and will be hosted by SCCG. The SLA is to provide medical support to vulnerable children. The 2013/14 SLA value is 896,482 with an additional 209,462 for community paediatric audiology with a contract value of 1,105, In 2013/14 the contract has been closely monitored with CCGs working closely to improve the statutory requirement to complete Initial Health Assessments (IHAs) for Looked After Children within 28 days of the child entering care. Despite close contract management performance was slow to improve with 41% IHAs completed in Q1-Q2 in 2013/14. In response to a letter from the CCG Chair ESH put in place a number of actions to improve performance including a tracking database resulting in improved performance detailed on Page 2.

5 As part of the SLA negotiations for 2014/15 ESH have maintained that without additional resource they are unable to meet the statutory requirements including completion of IHAs within 28 days and have asked for an increase to the SLA value of 160k to reflect the additional staffing costs. ESH have offered a phased increase 80k for 2014/15 and 80k 2015/16 split between SCCG and MCCG, resulting in a 40k cost pressure for SCCG this year. As statutory KPIs are the responsibility of the Local Authority, SCCG will submit a business case to the Health and Social Care Integration Project for additional funding which will if successful would result in a reduced cost pressure for the CCG. The Executive Committee were asked to agree the increase in funding to the SLA: 40k 2014/15 and 40k 2015/16 to support sustained achievement of the statutory KPIs. Comments In response to a question from FR on the need for a revised KPI, SR advised that the KPI is a statutory target. As part of the performance management Carol Lambe will be working closely with the team.. GPr said that the cost pressure is manageable subject to robust performance measures, and recognising that for 2015/16 is it proposed that the SLA will be incorporated within the main contract with the associate contractual requirements including the application of the NHS deflator. IG asked if agreement to support in 2014/15 commits the CCG to 2015/16. JB responded that by agreeing the recommendation the CCG are committed to 80k over 2 years recognising that for 2015/16 the SLA will be incorporated into the main contract with the tariff deflator applied to mitigate the risk. JJC said that it was an opportunity to apply robust performance management, adding that the number of looked after children in Sutton has increased significantly. MH highlighted a concern that as the SLA is outside of the main contract more support will be needed for example in the requirement to supervise professionals to identify where the expertise will be provided. SR recognised this and offered a meeting with MH/Carol Lambe and the CCG s Safeguarding Lead to talk through. SR JB asked that the contract be highlighted to the CQRG and subjected to the same robust arrangements as the main contract. MH agreed to take this back. The Executive Committee was asked to support the SLA with ESH including the increase in funding of 80k over 2 years to meet the KPI. The recommendation was agreed on the basis that it will be incorporated within the main contract for 2015/16 with the NHS deflator applied to mitigate the risk for the CCG. Dr Padhanani arrived. 6 System Resilience Plan Recent changes to national guidance have seen the scope of resilience and capacity planning extended from winter planning to full year planning with the inclusion of non-elective urgent care. As a result System Resilience Groups

6 now hold responsibility for the sign off and performance of both elective and non-elective activity plans with ultimate responsibility held with the Executive Committee. The paper presented to the Committee described the on-going work of Sutton s main providers of health and social care and details how providers will work together to ensure resilience throughout the winter months and beyond. Non-Elective (Urgent Care) SCCG have been allocated 1.1m to fund non-elective (urgent care) initially to SR advised that discussions have taken place with the Trust this year and bids have been submitted. A meeting to access the bids and allocate funding is planned for 19 th August. Successful bidders will be notified after the 19 th August meeting. Comments GPr said that the CCG and CSU have worked closely to mitigate the risk of double counting. JB said that A&E performance at ESH is very good. The Trust have been rated Green by the National Tripartite Panel (ADASS [Association of Directors of Adult Social Services], Monitor, NTDA and NHSE) providing full autonomy to the CCG. RTT 18 week target SCCG have also been allocated 1.3m to enable Trusts to achieve the 18 week target, with the focus on patients who have been waiting for 16 weeks. The funding provided is intended to clear the backlog and sustain performance. Comments SR advised that targets were relaxed over July/August recognising the difficulty in increasing activity during this period, however increases in activity were reported over both months by ESH. In response to questions on performance management, SR said that RTT is closely monitored and Trusts are fined for non-achievement of the target. The Executive Committee is asked to: Approve the Operational resilience plans for elective and non-elective activity; Delegate full authority for the distribution and monitoring of system resilience funding to the Sutton Urgent Care Working Group; Delegate full authority for the distribution and monitoring of Referral To Treatment (RTT) funding to the Sutton Planned Care Working Group The recommendation was agreed noting that activity/outcomes will be reported to the Executive on a quarterly basis. 7 Carers Strategy Consultation Process The Chair welcomed Sam Jacobson, Joint Commissioner for Carers Respite and Support Services to the meeting.

7 SJ introduced two papers for approval by the Committee:- - Joint Carers Strategy Consultation - Mental Health Carers Service Contract SCC with LBS Joint Carers Strategy Consultation The paper presented details the proposed approach to consulting on the Joint Strategy for Carers, including the timescales for consultation and how key partners will be engaged in the consultation process for approval by the Executive Committee. The following approach to consultation has been formulated with a 12 week consultation process, involving an initial 4 week consultation period which commenced on 28 th July and will run until 24 th August, following by an 8 week formal consultation period commencing in September. The initial consultation will consist of 4 focus groups to be held at Sutton Civic Offices, an on line consultation and a paper based questionnaire. The aim of this initial consultation is to co-produce the direction of travel and sense check the key priorities. It is proposed that the Executive will receive a draft version of the strategy for consultation in September, prior to the commencement of the formal consultation. SJ advised that it is proposed that the Joint Carers Strategy is a Joint Commissioning Strategy between SCCG and LBS as opposed to a multiagency strategy as it will form part of the BCF next year. Comments GPr said that that 350k funding was agreed as part of the Better Care Fund and he was meeting with SJ to agree individual funding lines. In response to the need to manage expectations, SJ said that the message that the funding was within existing resources had been carefully framed in the initial consultation with stakeholders. The Committee were supportive of a Joint Commissioning Strategy with LBS/SCCG rather than a multi-agency approach, subject to robust performance management of the quality of services provided and cost effectiveness. AD recognised the contribution made at a local level and said that as Personal Health Budgets are introduced the strategy would provide a platform to build upon. In relation to the flight-path, JB said that formal approval would be made by the CCG Board in Public Meeting and therefore asked SJ to check the flight-path was aligned to the CCG meeting dates. SE asked about the initial consultation and if the 4 focus groups were representative of Sutton as a whole and whether GPs had been engaged with. SJ said that the focus groups did reflect the population of Sutton and he has met with Carolyn Reynolds regarding GP engagement. The Executive Committee is asked to:- - Approve the draft consultation plan - Approve the proposed approach to stakeholder and partner engagement - Agree that the strategy should be a joint commissioning strategy

8 - Agree the draft governance flight path - Agree for the draft strategy to be taken to Sutton Governing Body for approval to formally consult from September The Committee agreed the recommendations, with an amendment to the flight path to align with the CCG Public Board meetings for formal approval Mental Health Carers Strategy The Executive Committee were informed of the commissioning intention for LBS to enter into a contract with Sutton Carers. Historically the service had been managed by a PCT contract which LBS opted into. The latest PCT contract lapsed in April The proposed contract with SCC will be backdate to April 2013 and run to 2015 with an option to extend for up to a year. The aim of the joint specification is to commission a service against the shared priorities and to seek better outcomes that LBS and SCCG want to achieve, with service outputs for SCC to deliver against. Comments SJ informed the Committee of an error in the paper relating to the contribution from SCCG which will be corrected from 62k to 51k. No other comments were received.. The Committee was asked to approve the Joint SCCG/LBS Service Specification and the intention of LBS to enter into an agreement with Sutton Carers Service. The Committee approved the recommendation and welcomed the opportunity to demonstrate quality outcomes for Carers. 8 Primary Care Mental Health Service Procurement AD introduced the paper and welcomed Corinna White, Project Manager to the meeting. In line with the Primary Care Mental Health model agreed by the Executive Committee in June 2014, four service specifications describing the four service components of the model was presented to the Committee. 1. A mental health referral centre (single point of access) 2. An enhanced Improving Access to Psychological Therapies (IAPT) service 3. A primary mental health care service 4. A coordinated well-being service It is intended that the service will go to procurement on 29 th September 2014 and the Committee were asked to consider the 4 service specifications and to delegate to the Chair responsibility to make any amendments up until the 29 th September. Comments JJC said that feedback said that following the engagement event with GPs, the service model had been very well received and supported by all 27 Practices.

9 AD thanked Corinna for her hard work and support in development of the service model. No other comments were received. The Executive Committee were asked to delegate responsibility to the Chair in respect to amendments to be made up until 29 th September. The Committee agreed the recommendation AD/CW left the meeting Dr Jonathan Cockbain arrived 9 Acute Commissioning Review Plan (SR/N McDowell) SR introduced the revised action plan. Following discussion at the Executive in July the plan had an additional column to denote the CSU responses and CCG actions to date as follows:- - 5 contract queries/challenges have been made - Changes to QIPP reporting - Update re working with Surrey Downs CCG - Review ToR for Contract Management Group including membership - Executive to Executive meeting on 8 th October - Comments IG said there is a noticeable change in negotiations with the Trust which is very welcome, with detailed and timely responses now being received. FR welcomed the feedback adding that the approach reflects well on the CCG. An Executive to Executive is planned on 8 th October. JB said that agenda items are welcome and should be forwarded to him. The Executive Committee was asked to receive and note the updated action plan Noted. 10 Locality Lead Update JJC advised that all SCCG Practices have signed up to the GP Engagement Plan for 2014/15. Each Practice will be allocated a Commissioning Lead to highlight any issues to the Locality Leads to influence and encourage GP Engagement. JB referred to the feedback from Foresight on GP Engagement as a potential agenda item on the Governing Body meeting on 3 September. JB/JJC to confirm. JB 11 Performance Report Month 3 The report presented performance of services for the CCG for the period to 30 th June 2014.

10 The key issues were reviewed and discussed. Comments In response to a question on LAS failing to meet the target, JB advised that this is a London-wide target, however does reflect the position in Sutton. SR commented on A&E performance advising that one of the contract queries with the Trust is to cross check this with the increase in zero length stay of admissions which is being reported. SE commented on the Dementia Diagnosis rates in Sutton which are much lower than expected and it was agreed that as part of NHSE top 8 priorities, to bring this back to the September meeting for further review. SH to action Comments The Committee noted that LAS is reported London-wide, however figures for Sutton are similar. SR advised that a contract query on the increase in zero length stay of admissions is being crossed check with A&E good performance. SE referred to Dementia Diagnosis rates where SCCG Practices performance is much lower than the expected prevalence for the population. It was agreed to bring this back to the Committee on 10 th September as part of an overview of NHSE top 8 priorities. SH The Committee were asked to receive and note the performance report. Noted 12 Finance Report Month 4 GPr provided verbal update advising that a written report will be presented to the Committee on 20 th August. Key Points:- SCCG is reporting on plan for both year to date and full year forecast and this was reported to NHSE on 11 th August. Acute Services shows a net under-spend on acute contracts both year to date and full year forecast and this is largely due to a significant under-spend on the EOC contract. In terms of individual providers:- ESH has a forecast 270k overspend (0.3%) largely driven by A&E and Non- Elective GSTT has a forecast 270k overspend (25%) largely due to critical care Kings has a forecast 350k overspend (93%) largely due to critical care All other areas are reporting on plan. Risks The main areas of risk remain acute activity and prescribing. There is an ongoing funding issue between the community services provider

11 and NHSE. This may impact on the CCG but this is still unclear and the CCG has stated it is not its issue. The Executive will be kept informed. Comments GPr commented on the media interest in NHS spend with non-nhs Providers advising that for Sutton this equates to 18m and is relation to areas such as 111 contract, Out of Hours Provider, Local Authority, Private and Voluntary Providers and Continuing Care. DP asked if the reported financial position factored in the Risk Pool Payments and GPr confirmed that it did. In response to questions on whether the repayment period could be reduced, GPr said that a reduction in the repayment period would need to be agreed by all CCGs and it is unlikely that this would be agreed. SE referred to acute spends in relation to critical and specialist care. NMcD advised that for all high costs interventions there are very clear pathways, In summary GPr said that whilst reporting is good at this point, the CCG still faces significant financial challenges. 13 SL Commissioning Support Unit Heads of Terms (JB) JB introduced this item. SCCG proposes to change a number of contractual arrangements for the period October 2014 to March The changes included the decommissioning of services with some service to be brought in-house. A list of the service changes proposed were outlined in the paper. The paper was brought to the Executive for final comment prior to formal approval by the CCG Board on 3 rd September. Comments In response to a question from JC on the rational for an 18 month contract. JB said that there were 3 options. - 6 months with no price reductions - 18 months with a 5% reduction in 2014/15 and a further 10% reduction in 2015/16-5 year contract. However this was not supported by CCGs as a viable option. The Committee was asked to note the proposed contract arrangements and feedback any comments before 3 September. The recommendation was noted 14 Any Other Business 111 Re-Procurement SR informed the Committee that two performance notices had been issued to the current provider, adding that if improved performance is not demonstrated in August a formal warning notice will be issued.

12 Jubilee Health Centre Programme Board SR advised that the JHC Programme Board has been asked to stand-down at this point in the programme and the implementation work will now be continued through a Task and Finish Group. GP IT Refresh JC alerted the Committee to the loss of all Templates as a result of the IT upgrade. JB asked that he contacts the IT Team to resolve the issue. JC Date of Next Meeting Wednesday 20 th August 2014, Priory Crescent, Sutton

13 MINUTES OF THE SUTTON CLINICAL COMMISSIONING GROUP EXECUTIVE COMMITTEE MEETING Wednesday 20 th August pm Meeting Room 1, Priory Crescent Present Dr Chris Elliott CE Chief Clinical Officer / GP - Benhill & Belmont Surgery (Chair) Geoffrey Price GPr Chief Finance Officer, Sutton CCG Karol Selvey KS QIPP Lead /Nurse Practitioner & Partner - Dr Grice & Partners Dr Ash Mirza AM Carshalton Locality Lead / GP - Faccini House Surgery Dr Jeffrey Croucher JJC Locality Lead, Sutton & Cheam / GP - Benhill & Belmont Surgery Dr Dino Pardhanani DP QIPP Lead-LCCs & Service Redesign / GP - Mulgrave Road Surgery Dr Mark Wells MW QIPP Lead-Acute Contracts / GP - Wrythe Green Surgery Dr Simon Elliott SE QIPP Lead-Medicines Management In attendance Sue Roostan SR Director of Commissioning & Planning Mary Hopper MH Director of Quality Apologies Jonathan Bates JB Chief Operating Officer, Sutton CCG (Chair) Dr Farhan Rabbani FR Wallington Locality Lead / GP - Wallington Medical Centre Dr Jonathan JC QIPP Lead-Urgent Care/ GP - Chesser Surgery Cockbain Dr Chris Keers CK QIPP Lead-Mental Health / GP - Wrythe Green Surgery 1 Welcome and Apologies The Chair welcomed everyone and advised of apologies. 2 Declarations of Interest The Chair asked the Executive Members to confirm that the Register of Interest attached was a correct and accurate record of interests. Dr Mark Wells and Dr Chris Keers to be changed to Wrythe Green Surgery. YH 3 Minutes of the meeting held on 13 th August 2014 The minutes were approved without amendment. Log GP Engagement Foresight Feedback Locality Leads to attend the SCCG Board to give an update as part of the improved communications between practices and the Board.

14 GP IT Refresh JC not at the meeting to update. 4 For decision 4.1 Infertility Commissioning Intentions (M Well/S Roostan) Output from Clinical Effectiveness Group The CCG is currently using a predecessor organisations policy to govern the commissioning of assisted conception services. As a result the CCG does not routinely commission assisted conception from acute trusts locally. The Executive Committee is asked to approve the revised clinical policy for assisted conception and to be assured that the clinical requirements for the service have been taken into account of and approved by clinicians. The Clinical Effectiveness Group (CEG) has approved the documentation following a meeting in July. The CEG have agreed the effectiveness of the policy and that its associated criteria are acceptable clinically. MW advised that there is a 350k budget for this service and therefore have had to put stringent criteria in place. The CEG met in July and approved this. CE stated the Executive Committee have now been advised that a process has taken place via the CEG and asked the meeting for comments. DP asked what happens if the budged is breached. SR advised that this won t happen in the current year as we are half way through and a review will take place near the end of the year once it has been ascertained how many patients are being put forward for this treatment. JJC advised that the localities felt it was a recommendation they can work with. Meeting agreed this could now be put forward to the Board for approval with the minutes from the CEG meeting. SR 4.2 SWL Effective Commissioning Initiative (S Roostan) SR advised that with the development of South West London Effective Commissioning Initiative 2013/14 was led by the Public Health Department of Croydon PCT. In February 2013, Croydon PCT ceased the co-ordination role and no receiving organisation was identified to carry on this role. In October 2013 the constituent CCGs (Croydon, Kingston, Merton, Sutton, Richmond and Wandsworth) agreed to fund the CSU to take on the co-ordination role on behalf of the CCGs. In the interim, an extension of the ECI 2013/14 policy was agreed by the CCGs from April 2014 until September 2014 with the expectation that a refreshed ECI Policy would be available in August The ECI Policy was amended to include necessary updates and NICE recommendations. The Policy was agreed by the ECI Group on 28/05/14. This is now the final draft for the Executive Committee to approve to go to the Board for approval to go live across South West London. CE stated that as the current one had lapsed and therefore we didn t have a current one. CE asked what the process would be if other CCGs had requested changes from their meetings. SR advised that they would be highlighted to the Board MW requested data for future meetings. SR advised that this would be the responsibility of the ECI group to view the data. SR advised that Nicola Howe would be presenting this to the Board. Executive Committee supported the paper to go to the Board. SR

15 4.3 SCCG Board Agenda The Executive Committee agreed the agenda with the Locality Leads update to be added. 5 Standing Items 5.1 Deferred 5.2 Locality Lead Update no update for August 6 For Discussion 6.1 Finance Report (Month 4) (G Price) GP advised that SCCG is reporting on plan for both years to date and full year forecast. Acute Services shows a net under-spend on acute contracts both year to date and full year forecast and this is largely due to a significant under-spend on the EOC contract. Guys and Kings overspend may be paid by NHSE. In summary GP said that whilst reporting is good at this point, the CCG still faces significant financial challenges and should remain cautious. There is an ongoing funding issue between the community services provider and NHSE. This may impact on the CCG but this is still unclear and the CCG has stated it is not its issue. The Executive will be kept informed. The new CSU contract and services to be provided is nearly completed. The amount isn t as low as originally wanted. Looking at taking over the occupancy of the whole of the LBS building and any requests for space need to be submitted to GP. JJC requested more hot desks. SE advised that prescribing is currently reporting a of 600k underspend and practices have been really compliant. 7. For Note No items for noting 8. Any Other Business Community Services District Nurses KS advised that at the Nurse Forum it was raised that there are serious issues with provider services for the provision of District Nurses and KS has asked the Nurses to provide her with full details. The initial feedback was that there is a lot of agency staff and recruitment is not happening. SR stated that Marguerite McFarlane had been asked to raise a quality alert regarding this.

16 MINUTES OF THE SUTTON CLINICAL COMMISSIONING GROUP EXECUTIVE COMMITTEE MEETING Wednesday 10 th September Meeting Room 1, Priory Crescent Present Dr Chris Elliott CE Chief Clinical Officer / GP - Benhill & Belmont Surgery (Chair) Geoffrey Price GPr Chief Finance Officer, Sutton CCG Karol Selvey KS QIPP Lead /Nurse Practitioner & Partner - Dr Grice & Partners Dr Ash Mirza AM Carshalton Locality Lead / GP - Faccini House Surgery Dr Jeffrey Croucher JJC Locality Lead, Sutton & Cheam / GP - Benhill & Belmont Surgery Dr Dino Pardhanani DP QIPP Lead-LCCs & Service Redesign / GP - Mulgrave Road Surgery Dr Mark Wells MW QIPP Lead-Acute Contracts / GP - Wrythe Green Surgery Jonathan Bates JB Chief Operating Officer, Sutton CCG Dr Farhan Rabbani FR Wallington Locality Lead / GP - Wallington Medical Centre Dr Jonathan Cockbain JC QIPP Lead-Urgent Care/ GP - Chesser Surgery In attendance Sue Roostan SR Director of Commissioning & Planning Mary Hopper MH Director of Quality Ian Gordon IG Contracting Manager, SLCSU Aliya Ahmed AA Senior Commissioning Manager, South East CSU Sam Jacobson SJ Joint Commissioner for Carers Respite and Support Services (Item 4.1) David Jobbins DJ Better Care Fund Manager (Item 4.2) Apologies Dr Simon Elliott SE QIPP Lead-Medicines Management Dr Chris Keers CK QIPP Lead-Mental Health / GP - Wrythe Green Surgery 1 Welcome and Apologies The Chair welcomed everyone to the meeting. 2 Declarations of Interest The Chair asked the Executive Members to confirm that the Register of Interest attached was a correct and accurate record of all interests held and to declare any further interests in relation to items on the agenda. The Register was confirmed as an accurate record and no additional interests were declared. 3 Minutes of the meeting held on 20 th August 2014 The minutes were approved without amendment. Log

17 The action log was updated and will be re-circulated to the Committee. 4 For decision 4.1 Carer s Strategy - Public Consultation The Chair welcomed Sam Jacobson, LBS to the meeting. SJ introduced a revised paper, following discussion at the meeting in August, on the proposed approach to consulting on the Joint Strategy for Carers, including the timescales for consultation and how key partners will be engaged in the consultation process. SJ talked through the paper advising that the purpose of the Joint Strategy is to ensure that LBS and the CCG are prepared for the implementation of the Care Act requirements relating to carers. As part of developing the strategy an initial consultation with carers took place between July and August. In total 48 carers took part. The overriding feedback was the need for high quality timely and easily accessible information and advice, early identification, emergency covering care and support to access financial support and benefits for which they may be entitled. SJ said that in Sutton there are approximately known carers, although this may be considerably higher and the strategy will aim to address the issues faced by carers with a view to preventing carer breakdown by making the most effective use of available resources. Comments CE referred to the wording Carers are equal partners explaining that for GPs the patient is the primary concern. SJ responded that this is a local LBS term but agreed that the joint document should reflect health priorities. The Committee commented on the use of negative language under Item and asked that this is re-worded. In response to a comment on all stakeholder engagement, SJ agreed to include a list within the document. JB referred to the Membership section and asked that SJ work with the Locality Leads to agree the wording. JB commented that the Joint Health & Social Care Strategy, a key driver for the Better Care Fund must be reflected in the document. GPr highlight a point of explanation around the 350k funding commitment by SCCG, which may be raised by carers groups, advising that although this is less than the previous commitment made by the PCT ( 500k), SCCG has set aside additional funds to support any increase in funding requirements. MH commented on the large amount of information to be consulted on. SJ responded that the Consultation will be on 2 or 3 specific questions and confirmed that it would be accessible on both the CCG and LBS web-sites. The Chair thanked SJ for a very comprehensive presentation. The Executive Committee were asked to:- - Approve the Consultation Plan and Flight path;

18 - Approve the Draft Carers Strategy and Consultation Advertisement, and allow the Joint Carers Commissioners to commence the formal consultation subject to review by the CCG Communications Team. The Executive Committee approved the recommendation above with the inclusion of the comments and document changes requested by the Committee and follow-up actions with the Locality Leads. 4.2 Better Care Fund Re-Submission The Chair welcomed David Jobbins to update the Committee on the Better Care Fund Re-submission. All CCGs and Local Authorities working through their respective Health & Wellbeing Boards have been required to make an additional submission to NHS England to confirm what level of reduction in non-elective admissions they are targeting in 2015/16 and to provide assurance on the quality of plans to achieve this target. DJ outlined the key points for note: - The overall strategic direction and model of locality based integrated teams has not changed from the April submission; - This submission places much greater emphasis on reducing non-elective admissions. The recommended target for non-elective admissions reduction is 3.5% which is largely in line with what the CCG has previously set out in the 2 and 5 year plans; - The submission is being produced under very tight timescales and therefore is not complete at this date hence why it is not attached and the Executive is being asked to delegate sign off to either of the Chief Clinical Officer or Chief Operating Officer in time for the submission date of 19th September; - The submission will also be discussed at the Health & Wellbeing Board (HWB) on 15th September and it is the HWB which needs to approve the percentage reduction in non-elective admissions. The timescale means that they will not see the full draft and will also be asked to delegate their final decision in order that the submission date is met; - Within the CCG the details of the BCF plans will be worked through at a range of meetings including the QIPP meeting; and - The CCG and Local Authority have made full use of any and all support offered by NHS England and the SW London Collaborative Commissioning team in the work to produce the submission. Based on the advice received from NHSE to date the requirements will not expose the CCG to any greater level of financial risk than the previous April submission. SR assured the Committee that the Transformation work is progressing. Two Programme Board meetings have taken place, and the work is being tested by 3 Practices, one from each Locality. Feedback from the Practices to date is very positive. GPr said that achievement of the 3.5% reduction is achievable and any risk sharing arrangements agreed will be reflected in the CCG commissioning intentions. SR advised that the Committee that whilst SCCG have remained at 3.5%, Surrey Downs have agreed a target of 13% over 2 years. CE commented that it is important for the CCG to understand any impact across ESH in terms of the need to protect Sutton patients.

19 JC asked if there was a process agreed for working and learning from other CCGs. DJ said not a formal process, however SCCG have worked with the MCCG Lead on an informal basis. It is anticipated that going forward there will be more opportunity to work and learn from other CCGs, as well as other joint partners for example LBS. The Executive Committee is asked to delegate to the CE approval of the BCF plan to meet the deadline for submission to NHSE by Friday 19 th September. The recommendation was agreed. DJ and SJ left the meeting 5 Standing Items 5.1 Finance Position Month 5 GPr provided a verbal update. Acute is reporting a 1.2m over-spend at Month 5, compared to on plan at Month 4 This is broken down as:- - ESH 1% over-spend relating to A&E and non-elective admissions - RMH 12% increase relating to breast procedures - G&ST 30% increase relating to critical care costs GPr said that over-spend is activity driven and therefore not subject to challenge. All other areas are reporting in plan. GPr said that it should be noted that whilst the position has deteriorated from Month 4 the position is still good when compared to 2013/14; and will be closely monitored by the CCG/SLCSU. A full report will be presented to the Committee on Comments Following discussion on the over-performance, particularly at G&ST and RMH which has seen the biggest increase, CE advised that G&ST related to a low number of patients requiring high cost treatment. IG added the SLCSU are investigating the over-performance at RMH. The Executive Committee is asked to note the update. Noted 5.2 Feedback from Localities JJC introduced this item. The paper was presented to the Governing Body meeting in September to provide an over of engagement in 2013/14 and the direction and priorities of the engagement scheme for 2014/15. CE said that feedback from the GB was positive including the suggestions for further GB engagement with Localities.

20 The Executive were asked to note the feedback from the Localities Noted 5.3 Acute Commissioning Review - Plan SR tabled and introduced the Plan for review and discussion. Comments JB advised that an ESH/CCG Executive to Executive Meeting will take place on 8 th October at Sutton Arena. SR advised that there have been 5 contract queries:- - Zero length of stay - Unwell babies - Coding Ophthalmology (to be closed subject to final sign-off) - Maternity Pathway reporting (closed) - Non-pre booked outpatient attendance In the case of unwell babies it is likely that an audit will take place and for the purposes of the investigation it has been agreed that both GPs and Consultants will have sight of the data. IG advised that deadline for finalising Month 3 (Q1) position is 11 th September. In response to questions on the detail behind the contract queries, SR offered to circulate a spreadsheet to the Committee to provide this information. JB asked for a rapid conclusion on closing KPIs for 2014/15 with the Trust. In addition, at the suggestion of the Chair it was agreed to add Acute Commissioning Month 3 final position to the agenda for discussion on 24 th September under matters arising for discussion by the Committee supported by the spreadsheet information. SR SR/SLCSU The Executive Committee were asked to note the report. Noted 6 For discussion/note 6.1 ESHT Contract Levers and KPIs IG introduced this item to inform the Committee of the Contract Levers available to the CCG. In line with all NHS organisations, the CCG s contract with ESH is based on the Mandatory NHS Standard Contract, with a number of schedules for local completion. The National contract limits the total financial penalties per quarter to a total of 2.5% of the Actual Contract Value. In addition it has been agreed with ESH as part of the contracting round that the value of penalties will not be more than 1.25% and not less than 0.75%. IG advised that in the case of some KPIs, for example Referral to Treatment Cancer Waits automatic financial penalties can be applied if the Trust fails to meet the target.

21 In addition there are some other areas, for example failure to comply with the monthly reporting process where an automatic penalty can be applied. There is a strict timeframe which must be adhered to and guidance relating to how an investigation is conducted with investigations resulting in 1 of 3 outcomes:- - Withdrawal of the contract query - Remedial Plan - Joint Investigation Comments DP asked if contract levers varied from Trust to Trust IG responded no, as all contracts are based on the Standard NHS Contract all levers are the same for both Commissioners and Providers. In response to a question on the process for contract queries to CCGs, IG confirmed that it was the same process for Provides and Commissioners via the SLCSU. In response to discussion on Cancer Waits, CE advised that all Patients who breach the target are tracked to ensure they are seen quickly. SR added that a meeting with the ESH Cancer Lead to discuss the Cancer Pathway is due to take place on 19 th September. The Executive was asked to note the report. Noted 6.2 NHSE Q1 Performance Report JB introduced this item. NHS England populate a delivery dashboard each quarter to monitor CCG performance against the metrics in the NHS Constitution and Everyone Counts, along with monitoring progress against Better Care Fund metrics and management of finances. Details of those areas where the CCG is not meeting trajectories or targets were presented in the Month 3 Performance and Quality Report and will be discussed at the CCG s Quarter 1 Assurance meeting with NHS England on 16th September. The areas on this dashboard where the CCG did not meet targets in Quarter 1 are: - 52 week waiters - 62 day cancer waits - London Ambulance response times - Healthcare Acquired Infections (MRSA and C-Difficile) The Executive Committee is asked to note the contents of this report, and further detail and action plans will be provided in the next Performance and Quality Report Noted 6.3 Commissioning Intentions 2015/16 SWLCC Letter/Post Awayday Plan

22 (SR/JB) SR/JB introduced this item which was in two parts:- SWLCC Letter The draft SWL Commissioning Intentions Letters was presented. JB advised that it is in progress and will come back to the Executive Committee on for consideration and to consider how SCCG specific plans will be finalised. MH asked if there has been any benchmarking for Trusts, recognising that this varies from Trust to Trust and is important for Commissioners to understand the stretch required. SR said that this has been discussion with all Providers which has looked at how Trusts can work together to deliver the required changes for example in Urology. CE added that discussion has also taken place with all Providers and the SWL Commissioning Collaborative at Chief Executive level to discuss the sharing of plans and risks across all CCGs. Final SWLCC Letter to come back to the Committee on , along with details of the Sutton CCG specific Commissioning Intentions for 2015/16. SR SCCG Awayday Plan Feedback from the Awayday held on 4 th September and actions for review were presented to the Committee. CE said that the Awayday had been very successful and thanked everyone involved in organising the day. Following brief discussion it was agreed to give consideration to extending an invite to a Patient Representative Group, such as HealthWatch and the Local Authority to the next SCCG Awayday. Executive Committee were asked to review the actions outside the meeting and feedback comments to JB. ALL The Executive was asked to discuss the report. The Executive discussed the report and noted that a revised SWLCC Letter would be brought back to the meeting for further discussion on /15 Investment Priorities GPr introduced this item. The financial position of the CCG means that it may be in a position to spend reserves held in mitigation of commissioned services overspend. A review indicates these reserves are of the order of 2 to 3 million though this will be kept under review in light of the developing financial position. A list of suggestions, developed by the Operations Team was presented to the Committee to agree which suggestions to take forward, those for removals and any new suggestions to be considered. GPr said that the aim is that the Executive agree 3-5 priorities to take forward. Following short discussion it was agreed that GPr would circulate the list of suggestions to the Executive for review outside the meeting to feedback comments to GPr to develop a short-list for consideration by the Executive on

23 GPr to circulate the spreadsheet; - Executive to review and feedback comments to GPr - GPr to bring a short-list back to the Committee on GPr/ALL The Executive was asked to review and discuss the suggestions for 2014/15 investment priorities. The Executive discussed the report noting that full review and approval will take place in October. 6.5 SCCG Annual General Meeting The Agenda and Annual General Meeting summary were brought to the Committee for review. CE advised that invitations to the AGM, Public and Staff to attend the event on 11 th September have been issued. A copy of the AGM summary will be circulated to all SCCG Practices. The Committee received and noted the paper. No comments were received. 6.6 Community Service Re-Procurement GPr provided a verbal update as follows:- : - Programme Board Meetings are taking place; - Terms of Reference have been agreed; - Programme Board reports to Executive Committee; - GP Programme Board Member is still vacant. Carol Lambe is actively taking this forward and will escalate to Executive Committee if not resolved; - Project Manager is now in post and working the MCCG Project Manager (Sue Howson) to draft service specifications which are expected to be available in December 2014; - A one year contract with all 4 partners (SCCG, LBS, MCCG and LBM) has been agreed (with negotiations) for the final year The Committee was asked to receive and note the update Noted 6.7 Primary Care Transformation CE introduced this item to advise the Committee that CCGs are asked to provide support for the proposed direction of travel in:- - Recognising the importance of transforming primary care - The importance that primary care has in developing your five year strategies - Jointly developing a Strategic Commissioning Framework to support local primary care transformation - At the end of November initiating the next phase of local engagement to further refine the development of the Strategic Commissioning Framework

24 The Committee was asked to note that SCCG is asked to submit a response by 10 th October prior to full engagement planned for November Any Other Business 7.1 SMCS Flu Vaccinations KS highlighted a concern regarding the decision making for flu vaccinations in 2014 which had been made without discussion with SCCG. The decision was subsequently overturned and the process will revert back to that used in 2013, however KS was concerned at the decision making process. For 2015 discussion is due to take place at the CQRG meeting in November. KS will keep the Committee updated.

25 MINUTES OF THE SUTTON CLINICAL COMMISSIONING GROUP EXECUTIVE COMMITTEE MEETING Wednesday 24 th September pm Meeting Room 1, Priory Crescent Present Dr Chris Elliott CE Chief Clinical Officer / GP - Benhill & Belmont Surgery (Chair) Dr Ash Mirza AM Carshalton Locality Lead / GP - Faccini House Surgery Dr Jeffrey Croucher JJC Locality Lead, Sutton & Cheam / GP - Benhill & Belmont Surgery Dr Dino Pardhanani DP QIPP Lead-LCCs & Service Redesign / GP - Mulgrave Road Surgery Dr Mark Wells MW QIPP Lead-Acute Contracts / GP - Wrythe Green Surgery Dr Farhan Rabbani FR Wallington Locality Lead / GP - Wallington Medical Centre Dr Jonathan JC QIPP Lead-Urgent Care/ GP - Chesser Surgery Cockbain Dr Simon Elliott SE QIPP Lead-Medicines Management Dr Chris Keers CK QIPP Lead-Mental Health / GP - Wrythe Green Surgery In attendance Sue Roostan SR Director of Commissioning & Planning Mary Hopper MH Director of Quality Ian Gordon IG Contracting Manager, SLCSU Megan Milmine MM QIPP Programme Director Mike Conlon MC Service Redesign Manager Dr Brendan Hudson BH Chair Paul Sarfaty PS SCCG Board Lay Member - Governance and Audit Mark Dowell MD Head of Finance and Business Apologies Geoffrey Price GPr Chief Finance Officer, Sutton CCG Karol Selvey KS QIPP Lead /Nurse Practitioner & Partner - Dr Grice & Partners Jonathan Bates JB Chief Operating Officer, Sutton CCG 1 Welcome and Apologies The Chair welcomed everyone to the meeting. 2 Declarations of Interest The Chair asked the Executive Members to confirm that the Register of Interest attached was a correct and accurate record of all interests held and to declare any further interests in relation to items on the agenda. The Register was confirmed as an accurate record and no additional interests were declared. 3 Minutes of the meeting held on 10 th September 2014