Minutes of the Primary Care Board Part 1

Transcription

1 ITEM NO: 2a Minutes of the Primary Care Board Part 1 Wednesday 1 st November 2017, 4.00pm 5.15pm Beethoven/ Mozart Room, Boundary House, Cricket Field Rd, Uxbridge UB8 1QG Present In Attendance Apologies Trevor Begg (TB) HCCG PCB Natasha Harnett (NH) HCCG Dr Steven Shapiro (SSh) Chair Primary Care Development HCCG GP GB Member Dr Ian Goodman (IG) HCCG Chair/GP Governing Body member Caroline Morison (CM) HCCG Chief Operating Officer HCCG Manager- Minutes Kathleen Sadler Hillingdon Confederation Chief Operating Officer Dr Martin Hall Hillingdon Confederation Chair Dr Kuldhir Johal (KJ) HCCG GP GB Member Diane Jones (PS) BHH Director of Quality & Safety Jonathan Tymms (JT) HCCG Deputy Director of Finance John Riordan (JR) - GP Member Secondary Care Mukesh Panchal (MP) Associate Lay Member Clare Lamb (CL) HCCG Quality Lead Graham Hawkes (GH) Healthwatch Hillingdon Steve Hajioff (SH) Director of Public Health Hillingdon Council Dr Venothan Suri (VS) Patient Rep Rigo Pizarro (RP) HCCG Head of Primary Care Julie Sands (JS) NHS England representative Eleanor Scott (ES) LondonWide LMC Dr Satesh Sehdev (SSe) London Wide LMC Nyssa Paige (NP) CCG Senior Primary Care Commissioner Katrina Watson (KW) CCG Senior LTC Commissioner Abigail Garraway (AG) CCG Community Commissioner Lola Samuel (LS) HCCG Primary Care Coordinator Hillingdon CCG, Primary Care Board Part 1, Page 1

2 No. Item 1. Apologies As noted above, Claire Lamb to be added to the formal distribution list. 2. Minute of the last Meeting and Action Log A) Minutes The minutes of the last Primary Care Board Meeting Part 1 held on the 27th September 2017 were agreed. B) Action Log The following items were closed and can be removed from the action log: 1. Confederation Development Support Plan 2. Extended Hours Business Case 3. North West London Health App 4. Operating Model 5. Update Minutes 6. Hub update 7. APMS 8. Diabetes 9. Primary Care Board Meetings 10. ISA C) Primary Care Decision Log Minutes to be reviewed to ensure all decisions are reflected in the log. D) Ratification/E-Governance There were no e-governance items that needed to be ratified. E) Decision Making Trees/Part 2 Decisions There were no decision making trees from the last part 2 meeting to be ratified. Declaration of Interests The Chair reminded committee members of their obligation to declare any interest they may have on any issues arising at committee meetings which might conflict with the business of Hillingdon Clinical Commissioning Group. Declarations declared by members of the Primary Care Board are listed on the CCG Register of Interests. All Registers are available either via the Business Manager or the CCG website at the following link: IG is a GP at Mountwood Surgery. The practice is member of the Hillingdon primary Care Confederation (HPCC), IG is also Chair of the CCG. SSe is a GP at The Pine Medical Centre. The practice is member of HPCC, SSe is also a member for the LondonWide LMC. TB advised that NHS England published revised statutory guidance on managing conflicts of interest for CCGs. This replaces the 2016 version of the guidance. Hillingdon CCG, Primary Care Board Part 1, Page 2

3 The guidance has been updated to ensure it is fully aligned with the recently published cross system conflicts of interest guidance, a small number of changes have been made. It was noted that the GP members present at today s Board (Dr Ian Goodman) would not be able to vote on the following agenda items: Diabetes underspend plan / multi morbidities Extended hours Update Increasing clinical capacity contract (Cis for PMS) Commissioning intention Arial Fibrillation Clinical Pharmacist Proposal Commissioning Contract/Component 3 Due to commercial sensitive information guests will be excluded from the APMS discussion. Items for Decision 3. Diabetes underspend plan / multi morbidities update The Board chair advised the group that the paper had been discussed earlier in the day at the OD Seminar which included six GB GP members for discussion and comment. Those GPs in attendance were: Dr Nilesh Bharakhada, Dr Steve Vaughn-Smith, Dr Ian Goodman, Dr Angela Joseph, Dr Mitch Garsin and Dr Mayur Nanavati. KW went through the paper informing colleagues of the key content elements against the underspend. KW advised that following the OD discussion earlier there had been some slight amendments to the content as follows: Component one PreDM Lift the Cap for the remainder of the year and review at Q3. Finance queried what we expected activity to be, KW advised this was difficult to determine at this time but had taken the decision at the Diabetes CWG against the risk of a possible overspend against this was an important area to target. IG also informed that we need to focus more on prevention and supported this cap removal regardless of spent. We will review at Q3 and inform the group. We will include in the 18/19 contract referral to appropriate programmes such as MyHealth and NDPP, to also include attendance of. Also review of PreDM and measure against improvement or reversal of PreDM. Component 2/3 The insulin initial project is going ahead, there is a small allocation of underspend funds against this pilot. This isn t an area that we should focus on in future contracts due to the small numbers of initiation being done by Primary Care. The pilot will help us determine numbers and work up a model for initiation confederation wide. Medicines Optimisation BGTS Investment into the pharmacist will work towards a reduction in spend in this area and consistency across Hillingdon of the correct prescribing of BGTS. There was a query around expected patient Hillingdon CCG, Primary Care Board Part 1, Page 3

4 numbers, KW didn t have this information to hand but will report back against progress and also forecast number to end of March at Q3. YOC Training backfill The backfill arrangement will also be included within the wider rollout proposal. MM Pilot Backfill KW advised the group that the original scope of the pilot was considerably more than originally anticipated. Important work where we need to keep momentum. WSIC Training - This element will also include an additional sum from the underspend to demonstrate use of the tool. MSDI Rollout - This will now become stratification tool as we may decide to utilise another resource or infrastructure to support the wider rollout. Finance queried if the spend would be in this financial year if the pilot was up to March. KW advised that we are planning a phased approach to the rollout and will need to consider tools and resources for the wider rollout prior to the pilot phase ending. The Board agreed the underspend proposals. ACTION: KW to report back to the board against the underspend following Q3 s contract data. 4. Information Sharing Agreement (ISA) The Information Sharing Agreement has been drafted to ensure that the sharing of records follows appropriate information governance standards and is governed by the NW London Information Sharing Protocol which has already been signed by all Hillingdon practices and providers. This will give access to the summary of the patient s medical record held in EMIS Web or SystmOne Community. The board agreed and endorsed the proposed information sharing agreement as detailed in the paper 4.a. 5. Extended hours Hillingdon Primary Care Confederation currently provides three Extended Access Hubs across the borough from 6.30pm 8pm on weekends and 12 hours of extended access on Saturdays and Sundays from 8am 8pm. The proposal is to provide an additional 60 appointments per week via the Extended Access Hubs during the winter period from November 2017 to March 2018.This would help to build capacity within the primary care setting to meet the increasing demand and help to reduce the burden on the UCC and A&E. It was noted the UCC slots went live yesterday across all three hubs, it was suggested to have one hub open from 8am to 8pm to minimalize costs. This would require a funding allocation of 38,280 for the period. Hillingdon CCG, Primary Care Board Part 1, Page 4

5 GH advised pre bookable appointments will not reduce those patients going to the UCC. It was noted the two un networked practices that also have number of attendances at the UCC want access the extended access hubs as there is not agreement signed to support information sharing of patient s records. The Confederation has been unsuccessfully in meeting with the two un networked practices. The Primary Care Board was recommended to approve the requested funding of 38,280 to provide a 5 month additional component to the GP Confederations existing Extended Access Hub contract. The Primary Care approved the funding request of 38,280. ACTIONS Un-networked practices - joint draft letter from the board/nhse to the practices - RP LMC to have an informal conversation with the practices - ES Feedback to the board an overview on the operational hours at week 11 - KS 6. Increasing Clinical Capacity In Primary Care Commissioning Contract The Increasing Capacity in Primary Care Commissioning Contract also known as ICCPC is designed to offer Hillingdon CCG practices support with their ongoing building and development of resilience and design of new ways of working within a changing primary care landscape. The CCG aims to support practices development to meet the challenges within the local healthcare economy and would like involvement from the LMC. The initial first draft of the main specification outlines the general detail of the commissioning contract. The specific elements of each year are currently in develop and underpin this specification. The funding for this commissioning contract is planned to be contributed from the CCG headroom and the PMS Premium. Year 0-250,000 from the CCG Headroom which is approximately 1.23 per patient. There are key goals under pinned within the contract around resilience, innovation, upfront investment into Primary Care and a phased re-investment of the PMS premium following the PMS review. Years 1 to 4, there will be up to 900,000 per annum. By year 4 there will be a combination of CCG headroom investment and PMS Premium until year 4 when PMS premium may cover the whole cost. The development of Year 0 demand and capacity exercise is currently in development and will be presented to the Primary Care Board in December It was noted NP will be on annual leave for the December board RP will present on NP s behalf. This specification will be further developed with the individual requirements of each year s specific elements between now and during year 0. It was noted the CCG hasn t decided on transitional arrangements. The Increasing Clinical Capacity In Primary Care Commissioning Contract was discussed at the OD seminar where GB members attend. Hillingdon CCG, Primary Care Board Part 1, Page 5

6 The CCG was advised the LMC needs at least two weeks in order to comment on the proposal, however this was discussed at an LMC meeting here 5 weeks ago. The agreed for a specification to be worked up in detail with level of investment, proposal to be cover four years linked to PMS premium. 7. Arial Fibrillation The AF spec was brought to the board in August 2017 with a request for funding to support practices undertaking audits to identify at risk patients. However the KPIs have since been amended to ensure that they align with the searches in the audit tool. The board was asked to approve the revised KPIs. It was noted the KPI s had been presented to the Primary Care Transformation Group on the 10 th October 2017 and the group recommended the Primary care Board approve the Specification. The exception rate was raised and it was highlighted Ealing CCG is querying the exception rate as they are leading on right care. It was noted the NWL exception rate is 5%. The chair advised for the purpose of the minutes IG will be excluded from voting as this is a contract to general practice. The board approved the spec and agreed GP s will be paid for KPI 5 as long as they record exceptions. 8. Clinical Pharmacist Proposal Hillingdon CCG and the Hillingdon Primary Care Confederation worked together to prepare a bid for NHS England funding and the Primary Care Board approved the proposal to provide match funding for a model of 3 Clinical Pharmacists in May The approval was for a three year CCG financial commitment of 348,000 with a (or Year One) commitment of 81,000. Subsequently, NHS England provided informal feedback was that the initial application was unlikely to be successful due to the approach taken in the model. Therefore, a second application was developed with a revised model. However, informal feedback at this stage was that NHS England would not support a proposal for less than the ten clinical pharmacists required for the population size of the borough. Hillingdon were not able to support the match funding for ten posts and the Hillingdon proposal needed further consideration and consultation. Hillingdon were unable to submit a bid for Wave 3 funding. Hillingdon CCG and Hillingdon Primary Care Confederation will further develop a strategy and plan for implementation of clinical pharmacists in Primary Care to be submitted to the December 2017 Primary Care Board. This will include consideration of developing an application for Wave 4 NHSE funding. Potential Models developed locally to date with positive outcomes are: Hillingdon CCG, Primary Care Board Part 1, Page 6

7 Model 1 - Integrated Care Pharmacists/ Care Home specific pharmacist Model 2: Clinical Pharmacists in General Practice The board was requested to allow for 81,000 to be utilised for a revised 2017/18 Clinical Pharmacist Proposal to: Recruit a WTE pharmacist to support the Falls Assessment and Medicines Reconciliation Project managed by the HCCG Care Home Pharmacist Pilot the use of a specialised clinical pharmacist as part of the Care Connection Team ACTION: The board fed back it is happy with model 1 and agreed model 2 needs to be worked up and in terms of details with clear outcomes and brought back to the December 2017 board. The board approved the use of 81k, release of years 2 and 3 is subject to new proposal 9. Component 3 Item to be carried forward, not discussed due to timing of agenda. Items for Discussion 10. PC Strategy Item to be carried forward, not discussed due to timing of agenda. 11. Primary Care Delivery Work Plan The draft Primary Care Delivery Work Plan was noted by the board. It was agreed there needs to be a discussion with the central team to shape the plan. ACTION: The board agreed the outcomes need to be tighten up - NP 12 Primary Care Operations / Quality Group As discussed above. 13 Confederation Quarterly Report The board reviewed the Confederations current position and progress was noted. The board was advised the Confederation is in a good position and is near to getting registered with CQC. Items for Information 14 BAF It was agreed the BAF is a transformational risk and therefore should be taken to the Primary Care Transformation Group. ACTION: BAF to be revised RP. 15 Date of the next meeting To be arranged. Hillingdon CCG, Primary Care Board Part 1, Page 7