Chair: Nigel Gray Minutes: Nicola Smith LNCCG Governance, Performance & Risk Committee Thursday 12 May 2016, 10:00-12:00 Boardroom Leafield House, Leeds Minutes Members Initials Role Present Apologies Nigel Gray NG Chief Officer Martin Wright MW Chief Financial Officer Dr Manjit Purewal (from item 327) MP Clinical Director Graham Prestwich GPr Lay Member PPI Dr Nick Ibbotson NI GP Non-executive Director Dr Simon Robinson SR GP Non-executive Director Clare Linley CL Director of Nursing Rob Goodyear RG Deputy Director of Commissioning In Attendance Initials Role Apologies Joanna Howard JH Head of Governance (City wide) Stephen Gregg SG Head of Governance and Corporate Services Russell Hart-Davies RHD Head of Quality (City wide) Nicola Smith NS PA to Executives Simon Harris SH Business Intelligence Manager Jane Mischenko (item 323 only) Farmida Ishaq (item 328 only) Commissioning Lead: Children & Maternity Services FI HR Manager Gina Davy (item 327 GD Deputy Director of Commissioning (new only) Models of Care) Item No. AGENDA ITEM Action 321/2016 Welcome and apologies The Chair welcomed the members to the Committee. Apologies were noted as above. 322/2016 Declarations of Interest GPr made a new declaration of interest, which had previously been passed to the governance team. Page 1 of 5
323/2016 Update around CAMHS/TAMHS issues presented a paper which was submitted to NHS England. highlighted the following areas; A new eating disorders service, Single point access (SPA) - significant work has been undertaken as part of the Single Point of Access development to gather a comprehensive understanding of the offer across the City. MindMate - plans to develop MindMate further and maximise the opportunities digital technologies offer. CQUIN delivered CAMHS consultation clinic waits now at 12 weeks (maximum). Recovery plan in place to deliver 12 week waits for autism assessment by December 2016. First data reports being received from clusters this month. Good progress in delivery of first year of Local Transformation Plan. Specialist CAHMS tier 3 have an outreach service. Transforming care policy. Transitions to adult MH services. Perinatal developing pathways for anti-natal depression. GPr was pleased to hear progress is being made with CAHMS waiting times, but continued to express concern about children waiting for an appointment for 12 weeks. said that the 12 week wait was for routine services. The focus was on consultation clinics as these met the needs of 50-60% of patients. Some children s mental health can be managed through school services and GP practices. Patients requiring very urgent attention can be seen within 4 hours at A&E, or can access an urgent referral in 2 days. said they have put more resources into clusters. This is the first year of a five year plan, and we expect to see further improvements. In response to a question from NG about TAMHS funding, said that the pilots would need to be reviewed in conjunction with the CCG in September/October. In response to questions from GPr and CL, said that outcome measures were being developed across the system. NI commented that the referral point is difficult for GPs, presentation of patients is very varied and said that GPs could benefit from some guidance around SPA. NG asked to create concise guidance around SPA and also look to include at a future Target session. Action to produce guidance for GPs around SPA. GPr asked if could attend a PAG meeting. suggested Liz Neil would be suitable to do this. Action to pass Liz Neil contact details to GPr, regarding attending a future PAG meeting. 324/2016 Draft Minutes from 22 March 2016 The minutes were accepted as an accurate record. 325/2016 Actions and Matters Arising from 22 March 2016 The action log was addressed and updated accordingly. 295/2016 GPR terms of reference Page 2 of 5
SG advised that Audit Committee had expressed concern about inconsistent attendance at GPR committee. MW emphasised that, as one of the CCG s statutory committees, attendance should be a priority for all members. 309/2016 GP Patient survey SH presented a paper detailing the results of the GP survey experience of making an appointment. The most recent data shows that the maximum rating the CCG has achieved over the past 5 reporting periods is 80%. Additional effort is therefore required from the CCG and practices to help improve the July 16 reported performance by 3 percentage points. It was noted that there was a lot a fluctuation in percentages between practices. GPr was concerned that large numbers of patients were having problems in getting an appointment. NG asked SH, what key actions are being taken to assure GPR that these issues are being addressed? SH said that a task and finish group has been formed to address access issues and review progress. It was discussed that LWCCG have increased their GP practices access times, and NG asked whether this has this helped? CL said that the same level of understanding was needed about performance against all Quality Premium schemes. Action SH to discuss at task and finish group and report back to GPR on progress on actions taken to improve survey results, including whether LWCCG has improved performance since increasing GP access times. SH 326/2016 Performance Report RG presented the performance report. LNCCG will fail the YAS and A&E targets; failure will cost 25% of potential Quality Premium earnings, amounting to 500k. LNCCG will also fail C-diff and IAPT targets. 2,200 operations were cancelled during the Junior doctors strikes, which will have effect on backlog of operations. A new general practice performance dashboard is being created. GD is working on this with Embed, working across the City to ensure consistency. RHD advised that there were delays in the production of the dashboard. GPr commented that we need a joined up approach to performance issues. SG advised that to ensure that primary care performance and quality issues were not looked at in isolation, they would be reported to GPR and Q&S. Any significant issues would then be escalated to the Board or Primary Care Commissioning Committee, as appropriate. CL noted that the performance report cover sheet only requested GPR Committee to note the contents, and said that GPR needed more assurance about what we are doing to address issues. RG said that actions were covered in the 1 year operational plan, and would make the appropriate links. Action - RG to link the performance report to key actions, including those set out in the 1 year operational plan, to make it clear how we are making progress with addressing performance issues. Page 3 of 5
Noted the contents of the performance report, but requested clarification on the actions being taken to address under-performance. 327/2016 Board Assurance Framework update Note MP and GD joined the meeting. It was agreed at the last meeting to conduct an in-depth review of all risks at the next meeting, especially those risks that are operating above the risk appetite. JH reported that three risks are still operating above the agreed level of risk appetite. However a number of actions have been identified to mitigate these risks which should reduce the risk score once complete. Risk 2 Tackling inequalities (Owners: RG/GD) risk score is 9, appetite is 8. Reducing health inequalities was a key aim of the CCG s mission. GD advised that the CCG was doing everything in its control locally to address inequalities. However, core contracts were not yet being re-drawn to target areas of most need. The risk appetite was discussed and it was concluded that completing all the actions is unlikely to reduce the risk below the risk appetite. NG said there should be greater links between the gaps in assurance and the actions being taken and also more on what was being done across the City. It was agreed to keep the risk appetite and score. Risk 4 Provider quality standards (Owner: MP) - risk score 12, appetite is 8. There was a discussion around the risk covering multiple providers and whether it should be a Citywide risk. MP said that joining up Q&S Committees with Leeds South and East would help with this. Action - JH to review the wording of risk 4, and consider whether we break it down into providers; to be reviewed at Q&A Committee next week and also at the Board workshop in June. Risk 8 Capacity and skills (Owners: RG/GD) risk score 12, appetite 9. Further conversations are needed around this risk, in particular the gaps identified. Some wording to be added as to what work is being done around organisational development plan. Action NG, GD and RG to review risk 8 before it is presented to the Board Accepted the current Board Assurance Framework, subject to the amendments agreed at the meeting Requested that the BAF be reviewed at the Board workshop in June. Corporate Risk Register There are currently 55 operational risks on Datix. Two risks are red and 17 are high amber risks. The remaining 36 risks score under 12 and are managed locally within teams. There are currently 17 high scoring amber risks on the operational risk register Changes since the last meeting are; Risk 504 - Increasing CAMHS Waiting Times for all but urgent referrals, plus 7 new risks have been added Page 4 of 5
There was a general discussion around risk 466 YAS performance targets, in that the current score of 20 seemed too high. It was agreed that the wording was appropriate, but the risk score is too high. Action JH to review with Sue Robins with a view to reduce the score of risk 466. Risk 541 it was agreed that system resilience should be included in the description. Action - JH to add system resilience within the description of risk 541. GPr commented that BCF should be reviewed. MW said that there was previously a lot of risk around non-recurrent schemes which have now finished. MW to ask Matt Ward to provide an update on BCF. Action MW/RG to liaise with Matt Ward to produce an update on BCF. Accepted the current corporate and higher amber risks; and Noted the information relating to the operational risks on Datix. 328/2016 Trade Union Recognition and Time Off Policy FI advised that the policy had now been re-worded in section 8.2 to state that, should there be a shortage of trade union representatives, then any Leeds CCG s could be contacted to try and ascertain trade union support. It was agreed that the policy should be amended to state that the CCG would support staff to secure appropriate trade union representation. Agreed the Trade Union Recognition and Time Off Policy, subject to minor amendments. 329/2016 Any Other Business GPR Committee Membership MW suggested that GD should be included in the membership of GPR Committee. Action: Add GD to the membership of GPR committee NS GPr reported that he had raised with Tim Sanders an issue in relation to equality and diversity recording in primary care 330/2016 Review of meeting The meeting had over-run, and there was no time for this item. Date of next meeting: 10.30-12.30, Thursday 14 July 2016 Venue: Boardroom, Leafield House Page 5 of 5