Commissioning Strategy Committee 20 August Aylesbury Medical Centre

Transcription

1 Commissioning Strategy Committee 20 August 2013 Aylesbury Medical Centre Members: Amr Zeineldine (AZ) Andrew Bland (AB) Malcolm Hines (MH) Patrick Holden (PH) Tamsin Hooton (TH) Jonty Heaversedge (JH) Alvin Kinch (AK) Robert Park (RP) Kieran Swann (KS) In attendance: Linda Drake (LD) Jacquie Foster (JF) Vicky Bradding (VB) Rosemary Watts (RW) Jean Young (JY) Alison Furey (AF) Kathy McAdam Freud (KMcA) Alex Laidler (AL) Daniel Blagdon Diane French Richard Gibbs Tushar Sharma (TS) Nancy Kuchemann (NK) & Chair Chief Officer Chief Financial Officer Director of Service Redesign HealthWatch Southwark Lay Member Head of Planning & Performance Practice Nurse Commissioning Lead Head of Governance & OD Corporate Secretary Head of Membership & Engagement Head of Primary Care Development Consultant in Public Health LMC representative Southwark Social Care Membership & Engagement Manager Lay Member Lay Member Apologies: Simon Fradd (SF) Adam Bradford (ABr) Roger Durston (RD) Sian Howell (SH) Gwen Kennedy (GK) Ruth Wallis (RW) Rebecca Scott (RS) Director of Client Group Commissioning Director of Public Health, Lambeth and Southwark Programme Director, Dulwich 1. DECLARATION OF INTERESTS No changes to the current Register of Interests were reported. 2. MINUTES & MATTERS ARISING

2 The minutes of the previous meting were agreed to be a correct record with the following amendments: 4.1 Children s Integrated Care Project 8 th Para 2 nd sentence. AZ stated that the concept seems more like an addition to the Southwark & Lambeth Integrated Care project [delete South London] TH reported that Ingrid Walsh has been in contact and more information is being made available. It is important that the CCG links with the project are in place and it was suggested that Ami David be approached to represent the CCG on this group. AZ reminded the group that Ingrid Walsh was to be invited back to the CSC later in the Autumn. 4.6 Rollout of Homeward 5 th Para- first sentence - KMcA emphasised the need to be clear on clinical governance responsibilities. TH reported that NHS Lambeth CCG is considering funding this project at its next meeting. The SCCG Governing Body will receive the committee s recommendation to proceed at their meeting on 12 September KMcA stated that the LMC is working jointly with Lambeth and Southwark to develop the operational policy. Operational details of the Homeward programme will be reported back through the SCCG Integrated Governance & Performance committee. 3. ACTION SHEET A number of actions were carried forward; these and new actions are listed at the end of the minutes. 4. AGENDA ITEMS 4.1 Minutes & reports from locality groups Borough & Walworth/Bermondsey & Rotherhithe - JH reported that there was a presentation on new services that have been developed. The issues raised were related primarily to the location of these new services. PH enquired whether the CCG would consider submission of bids for different models of service from the same provider. TH replied that all bids are considered on merit and providers can also submit bids in collaboration. South Southwark LD reported that the links between the development of the primary and community care strategy and development of health services in Dulwich had not been clearly noted by many attenders at the meeting. It illustrated that more work is required in communicating the developing strategy. AB suggested that locality meeting agendas could be reviewed to better incorporate major commissioning items, local issues and key areas where members can get involved. JH stated that there may be a need to consider other effective mechanisms to talk these issues through as the volume and capacity of items was quite substantial. LD raised a

3 concern that participants at locality meetings are not necessarily representing their practices views, nor feeding back information. KMcA asked if the CCG could press for Council of Members representatives to be those attending locality meetings to improve this. RW stated that the Chair of the Council of Members was very aware of the situation and will be visiting locality meetings to discuss. Localities should be the transforming medium and an electronic response to information received should be part of the process. JH highlighted that small practices have difficulty attending all meetings but AZ emphasised that the onus is on member GPs attending locality meetings to keep themselves informed and up to date. RW stated that the new GP intranet being developed will be very useful. Any views on improving engagement with GP practices would be most welcome. 4.2 BUSINESS CASE FOR PRIMARY CARE SERVICES TO HOMES WITH NURSING AZ stated that any CSC member who had a conflict of interest with regard to this item could offer their experiences to the discussion but may not participate in the decision making process. A Conflict of Interest panel will be held after this meeting to endorse the procurement proposals. AB reiterated that it is very important that that interests be recorded. TS declared that his practice provides services to a nursing home and the CSC noted he could not participate in decisions. TH introduced the paper in order that the CSC could give feedback on the business case. She stated that the business case has been developed in response to quality concerns and the lack of a clear commissioning approach to care homes in Southwark. A model of service is set out in the business case and she highlighted the associated costs of it which are not commissioned at present. It is also recommended that other services in residential homes are de-commissioned. TH stated that the proposals have been shared with the LMC and a meeting is being arranged to obtain views. KMcA stated that insufficient time for views to be obtained had been provided and the timescale of the contract (12 months) was unrealistic to attract bidders. She expressed concern about the proposal because of the increasing acuity of clients and felt that residential homes do require considerable clinical input. Another important area to be addressed is the level of nursing services. JH and KMcA stated that the comments they had submitted earlier on this had not been addressed in full and felt the KPIs proposed were process rather than evidence. He had requested the opportunity cost impact be provided versus using a more integrated approach. He was concerned about the basis of the information used and would like to have seen more information on admission avoidance. TH noted that speed of paperwork reflected the pace of development and the length of contract being offered reflected what could be done without going through a much longer OEJU procurement.. Changes can be made to the service specification details but it is important that the CSC approvals the overall direction and general shape of the service. Regarding support to residential care homes, she agreed that the quality of nursing care is critical to support the Admission Avoidance Scheme, and she would welcome involvement in developing the service specification.

4 DF emphasised the need to be clear about the numbers of clients and beds for whom this service is commissioned as felt the paper was slightly confusing. She noted as important that GP services are not de-stabilised, and that there is equity in provision. She highlighted the need for clear distinction between residential and nursing homes as the treatment protocol in many residential homes was to call an ambulance. Out of Hours services are key in deferring patients being transferred to from A&E. TH replied that limited data is available relating to residential care. She agreed that data on avoidable admissions in/out of hours is important but unfortunately this is not available at present. TH agreed that more work is required re residential home data. She highlighted concern that winter is approaching and without adequate support for nursing homes, the CCG is exposed to financial risks. RP highlighted a concern about the risk scores and lack of mitigating actions in the paper. KMcA emphasised that nursing support is key and the model chosen must reflect this. JH stated that he would support a model led by GPs with expertise in this area. AB requested a CSC view on whether the Business Case presented should be progressed to the COI panel while work is carried out on obtaining data for residential homes and nursing input. JH stated that he would like comparison of how else the service can be provided. AK requested that the risks to patients should also be reviewed. DF highlighted the pressure to get something in place before the winter. TH emphasised the need to be clear what the CCG can influence as care homes are within Local Authority responsibility. There are national standards by which the homes are given contracts and the CSG must understand any limitations. It was agreed that the Business Case would be reworked in the light of CSC discussions to include more comparison of alternative models before a recommendation is made to the Conflict of Interest panel 4.3. PRIMARY & COMMUNITY CARE STRATEGY TH summarised the development of the strategy and requested feedback on the draft document. She, particularly sought views regarding how to shape it to give a clear view of the strategic principles, objectives and key actions required for the next 5 years. She added that the draft strategy would be presented to the Governing Body meeting in September 2013 and would have evolved following feedback from received. AZ noted the national perspective and stated that a number of other primary & community care strategies are similar. The main issues are access, integration and the shift of work into primary care. TH said that these are covered within the SCCG strategy; the organisation would need to change how services are commissioned including pursuing locality provision and networks of care to achieve this. Discussion ensued. RG enquired what will be included in enhanced services and if not explicit in the PCC where they would be defined and if will be possible to include anything in the future. He was keen to achieve a high degree of clinical involvement in such decisions, without exposure to conflicts of interest. TH replied that adding granularity to that level of detail was not anticipated.

5 NK stated that Southwark GPs are very motivated but there is a need to learn from successes and build from there. She suggested learning from the Southwark and Lambeth Integrated Care project, for example. RP stated that the development of health services in the Dulwich area provides a good opportunity to link implementing the primary & community care strategy across Southwark. The two processes have worked in parallel and fed into one another; there is a need to demonstrate the reason for the two strands rather than one. He is aware of the need to engage local practices so that the strategy is developed with their input rather than imposed. AB stated that he had been involved in work on a Primary & Community Care strategy across South East London and agreed that the right level of detail has been included. He acknowledged variations at this point but Southwark CCG needs to set the direction of travel. TH agreed with RPs comments and suggested a section on engagement be included. JH propos a presentation be held for members in September. KMcA expressed concern about sufficient capacity in primary care. She stated that primary care is overloaded and community matrons are an important part of the picture, as are premises. AZ agreed that the Dulwich project has provided a blue print that can be replicated. AB stated that whilst Dulwich project has provided opportunities, the premises situation across Southwark is less clear. NHS Property Services will not consider business case applications without an agreed strategy in place. MH updated that discussions are being taken forward across South East London to develop a premises strategy. AB stated that premises principles can be included in the PCC strategy without detailing actual requirements. DF asked if this was an opportunity to look at wider well-being implications, beyond health. TH responded that the scope of the project was community health services. The group agreed the strategy was pitched at the right level and focused on how the CCG supports primary care to delivery what the strategy requires. Placeholders would be added for nationally anticipated documents including a national primary care strategy, a GP Call for Action. It was agreed that the primary & community care strategy would be redrafted incorporating the CSC comments and that an open meeting about the strategy be held for practices in early September. 4.4 DULWICH CONSULTATION RECOMMENDATIONS UPDATE MH outlined the discussion at the public feedback event held on 8 th August. He updated that RS/MH have redrafted the paper in response to feedback and stated that the full recommendations will be presented to the CCG Governing Body on 12 th September. AB requested that next steps are clearly laid out for the Governing Body meeting on 12 th September. The CSG noted the report. 4.5 DEMENTIA

6 TS introduced a paper which outlined the options for developing the Memory Service, following the discussion at the previous meeting. He suggested that Option 1-2x fulltime community practitioners to carry out the 6-12 month reviews for clients stable on dementia medication is the more prudent choice and provides better value for money. JH highlighted variation in use of the Memory Service and stated that educating GPs regarding the service chosen is key to ensure the service is properly used. TS stated that a PLT has been arranged for September to focus on Mental Health which would cover this topic, and Directly Enhanced Service payment is in place. KMcA stated that she felt that Option 2 3xfulltime band 6 with review responsibility remaining with SLMS is more favourable. She had significant concerns regarding the implications of identifying patients for )ption 1 and the additional work required. The CSC noted KMcA concerns but collectively recommended the in principle decision that Option 1 be progressed. 4.6 CCG APPROACH TO CO-PRODUCTION DB introduced the report which brings together various pieces of work and highlighted that co-production has been adopted in Lambeth & Newcastle CCGs. He suggested that the CCG could learn from the local authority on where the approach can be best used. Discussion ensued. Members of the CSC agreed that if this was adopted it must not be lip service. DF highlighted that co-production was time-consuming and must be noted against the pace of decisions required. She requested that members be informed when particular pieces of work are being considered. LD welcomed the paper and noted the paragraph stating all co-production participants were on an equal footing. TH highlighted the level of commitment co-production would require and suggested there should be limitations as some service developments cannot be planned with the timeframe this would require. AB agreed and suggested that as CCG resources were already stretched, co-production be trialled for one or two new developments where a calendar can be agreed, to enable wider input. AL suggested that a map of co-production and engagement activities be produced together with guidance for leaders of the projects. JH noted that the report was presented to EPEC where members were very positive and supported the change. EPEC has asked the paper be discussed by the CSC. This represented a new move which the CSC welcomed. He noted the paper was an indication of an approach rather than a policy, and suggested it would further evolve and can be built upon from previous projects such as Dulwich. He also suggested that individual parts of a project may be suitable for co-production. The CSC agreed that a co-production approach would be trialled for discrete areas and potential projects and topics would be identified to initiate working in this way. 4.7 TSA UPDATE

7 AB reported that acquisition and mergers relating to the TSA recommendations will be discussed at the NHS England s Finance & Investment Committee in the first week of September. 5. ANY OTHER BUSINESS 5.1 NHS CALL TO ACTION KS outlined the report. He suggested that a public event be held in October 2013 to review engagement work carried out to date. It was agreed that a public event be set up for October to promote patient engagement in CCG strategies. 5.2 CCG SUCCESSION PLANNING AB introduced a paper to initiate discussion on the makeup of the Southwark CCG Governing Body. The proposals enhanced the core leadership whilst retaining a majority of clinicians for voting purposes. The definition of clinician was also expanded to include others beyond GPs. AB suggested that this be discussed at a Governing Body workshop before being presented to the Council of Members meeting in October. AZ pointed out that clinical leaders are accountable for CCG business and must not be limited to advisory roles. He agreed that the proposals should be shared with members. LD suggested that the one member per practice rule is revisited if the pool of clinical leadership is to be broadened. JH stated that the membership must not be divided into professional leader versus GP but must ensure influence. PH noted that practices recognise the locality model and that needed to be reflected in the paper. It was agreed that the proposal be re-drafted before presentation to the Council of Members in October. 6. DATE OF NEXT MEETING 17 th September.