Clinical Planning and Delivery Committee

Clinical Planning and Delivery Committee Date Minutes 19 December 2014 12.00pm 2.00pm Committee Room 1 - Surrey Heath House, Knoll Road, Camberley, Surrey GU15 3HD Chair Dr John Fraser (JF) Interim Medical Director (Upper Gordon Road) Members Present In attendance Apologies Nicola Airey (NA) Dr Rachel Darroch (RD) Dr Fiona Buxton (FB) Dr Andy Brooks Alison Huggett Kevin Solomons (KS) Julie Curtis Samantha Harrison Carina Joanes Carol Bewley Diane McCormack Michele Harrison Nicky Townsend (NT) Adrian Davis (AD) Rob Morgan (RM) Dr Peter Cureton Dr Emma Whitehouse Director of Planning & Delivery Clinical Lead Unplanned Care Clinical Lead - Mental Health Chief Officer Director of Quality & Nursing Head of Medicines Management Programme Director Primary Care PA Support (minute taker) Lead Commissioning Pharmacist Head of Finance Head of Children with complex & specialist needs Children s Clinical Lead GP, Medicines Management Lead GP, Planned Care Lead Chief Finance Officer GP, Clinical Lead Clinical Lead Cancer & EOLC Lead FOI NOTICE Freedom of Information: Those present at the Governing Body meeting should be aware that their name will be listed in the minutes of this meeting, which may be released to members of the public on request under Freedom of Information. Page 1 of 10

COMMITTEE BUSINESS 1. Welcome and Introductions JF welcomed all to the meeting and introductions were conveyed. This was NOTED by the committee. 2. Minutes of Meeting held on 21 November 2014 to be agreed Amendment to spelling required on page 2 item 3. Amendment made. This was NOTED by the committee. The minutes were AGREED by the committee. The committee provided updates on the actions as recorded on the action tracker. 3. Declaration of Interests Karen Hampton completed and signed Declaration of Interests. This was NOTED by the committee. 4. Focus on Planning Joint Commissioning Strategy: Speech and Language Therapy for Children & Young people in Surrey Michele Harrison introduced the committee to the Joint Commissioning Strategy: Speech and Language Therapy for children and young people. Michele highlighted that the Stakeholder and service user feedback highlighted challenges within the speech and language therapy (SLT) service which included: lengthy waiting times, lack of early identification and intervention; need for workforce development, transition between early years and school. The Surrey Heath Health & Wellbeing Board identified improving speech and therapy as a key focus. The committee were asked to endorse the commissioning principles and responsibilities outlined in the Strategy, e.g. CCG commissioning should be focussed on the early year s population, working with Surrey County Council (SCC), as well as children with specific health issues. - SCC will be responsible for commissioning an enhanced level of speech and language therapy for school-age children. - Education settings will be responsible for meeting the universal, targeted speech, language and communications needs of children and young people. The committee APPROVED the endorsement principles of the Strategy. Page 2 of 10

The committee were also asked to agree for SCC (with G & W CCG support) to lead a public consultation on the principles and impact. Michele highlighted that post-consultation the paper will go to each CCG Governing Body for final agreement on any revisions to current commissioning plans. The committee AGREED for SCC to lead a public consultation. The expectation is that this will be cost neutral to the CCG but will require diversion of investment for SCC. This was NOTED by the committee. CAMHS procurement options Nicola Airey introduced the CAMHS procurement paper to the committee and asked the committee to CONSIDER the attached papers from Guildford and Waverley CCG on the proposed re procurement of CAMHS services currently delivered by Surrey and Borders Partnership NHS Foundation Trust. The CCG have been asked to agree to the following options: Option 1: Agree recommendations for service improvement approx. 2m cost risk across Surrey: 1A Go to procurement with additional maximum financial envelop and impact on providers outlined; 1B Negotiate increased scope to secure changes with incumbent provider (SABP). Option 2: retain current service scope and financial envelope 2A Cease procurement and retain CAMH services as is 2B Tender with current scope (no service changes). Whilst working through the options Nicola asked the CPD to focus on the following 4 questions: 1. Will clinical improvements be best provided working with existing provider or should the CCG go out to procurement? (Options 1B and 2A would be working with the existing provider) 2. Should SH CCG invest additional resources in CAMH services? (Options 1A and 1B) 3. If additional investment chosen what is our priority order (page numbers refer to attached document): a) Raising the age of CAMHS from 18 to 25 (page 12); b) A countywide behavioural pathway in line with NICE guidance (page 15); c) Counselling/IAPT provision for young people (page 21) and d) Equitability of Learning disabilities service (page 23) Page 3 of 10

4. If the CPD recommends additional investment where could savings be realised to fund this investment (NB will need to be in addition to the 3.5m QIPP for 15/16) Surrey Surrey Heath 1 Raising age to 25 250,000 19,875 County wide behavioural pathway 1,400,000 111,300 Counselling IAPTS 225,000 17,888 Learning disability service 150,00 11,925 TOTAL 2,025,000 160,988 IAPTS Counselling The CPD also noted that the CCG has already identified developing a young person s IAPTS service as a potential gap in current services. There may be other options to developing this service outside the CAMHS procurement but there will be some economies of scale doing this across Surrey through this process. Following discussions the following recommendations were made by the committee. 1. Due to the narrow range of alternative providers and the costs/risks of pricing increasing the CCG would prefer to work to improve the quality and scope of services with the existing provider. This was in line with SHCCG s view prior to the commencement of the procurement. It was recognised that all CCGs views would need to be taken into account. 2. The CCG would support some additional funding into the CAMHS service and saw the behavioural pathway and IAPTS services as the key area for investment. The CCG fed back to Diane that they would not want to cease the existing Youth Counselling service but provide additional capacity through the procurement. 3. It was thought that SCC should be approached to fund 50% of the behavioural pathway funding therefore the total level of additional funding from the CCG would be 60k for behavioural pathway and 18k for IAPTS. 4. The committee thought the transition period between children and adults and learning disability quality improvements should be achieved through working with existing contracts and providers Page 4 of 10

Next steps: CCG decisions going to Collaborative Strategy Review in January. 5. Integrated Alcohol Service Pilot Nicola Airey introduced to the committee an Integrated Alcohol Service Pilot for approval. Nicola has been working with NEHF who have developed the outline pilot proposal. The proposal is for 6 months with a total cost of 88,000. The cost to SHCCG would be 8,400. The proposal is supported by FPH and SADAS who would be the service providers. The pilot could be up and running in 3 months. It is recommended that the CPDC supports the pilot with the following strengthening of the plans prior to commencement. - Agreed baseline of current levels of alcohol admissions and A & E attendances - Consideration to be given as to whether GP attendances should form part of the baseline and success metrics - Success criteria should be identified prior to commencement - It is made clear to providers that commissioners do not have resources to invest in these services unless in year savings can be demonstrated by the pilot. The importance of having clear metrics was discussed and John Fraser offered to sign these off before the commencement of the pilot. Action: John Fraser to check metrics for pilot The committee APPROVED the outline proposal. 6. End of life care plan strategy The committee agreed to the EOLC Strategy with Emma Whitehouse s amendments. 7. Formulary Carina Joanes presented to the committee two potential changes to the management of medicines between the hospital and community. Both were pieces of work taking place in conjunction with NEHF and the Berkshire CCGs and their prescribing leads. The committee was being asked to agree to plans being developed further prior to coming back to the committee for approval. - The concept of a Joint Frimley System Formulary between acute and community services - A revision to the geographical scope, Terms of reference and membership of the PCN (prescribing Clinical Network) Page 5 of 10

Joint Formulary The benefits and risks requiring mitigation of having a Joint Formulary were discussed. The Plan will comply with NICE medicines practice guidelines on developing and updating local formularies. The formulary would allow local optimisation of medicine and devices, especially useful in ensuring familiarity with a smaller selection of medicines. Moving to local optimisation around the new Frimley Health acute provider may result in differences between our local system and the rest of Surrey. The aim would be to mitigate this by continued membership of the Surrey Prescribing Network as well as a local Frimley Health network. It was agreed that it was important to maintain as Surrey wide process for high cost drugs and drug requests that went through the IFR process. These would therefore be excluded from the Frimley Health Formulary. Frimley Health Prescribing Network Frimley was already establishing a joint Prescribing Network meeting across their two sites. It was key that CCGs had a formal place around the table. This is currently the case for Wexham but not for Frimley Hospital. Carina stressed the important of getting the TOR for this group right in order to support decisions around the joint formulary. Carina stated it would be useful to be able to contribute to the funding of a one-off implementation bursary to ensure we have an external body recommending joint terms of reference (to comply with MPG1). This was NOTED by the committee. Carina highlighted potential risks of not being part of the development process of the PN and formulary. These included: losing an opportunity to drive robust ToR to comply with NICE MPG1, which give the CCG a formal voice hospital clinicians will not be able to manage different formularies for different CCGs at the bedside hospital implementation electronic prescribing which is setting the pace (April 2015) Dr John Fraser expressed his support for the move to a joint formulary and new PC. Dr Andy Brooks stated he liked the current Surrey PAD and use of Script Switch and asked how this would be affected. Kevin Solomons pointed out that with the new formulary system would still have script switch and an equivalent to the Surrey PAD. It was recognised that any changes would have implications for all Surrey CCGs that referred to Frimley Health and a plan for sharing progress with the other CCGs would need to be developed. The committee AGREED for Carina to cautiously move forward with the plan in mandate but must provide checkpoints throughout with the opportunity to check and veto. Action: Carina to move forward representing Surrey Heath CCG and provide regular updates. Page 6 of 10

8. Practice Engagement Alison Huggett agreed to shared outline plans for the next and future protected learning time events to the clinicians on the group. Action: Alison to circulate practice engagement comms with clinical leads for feedback. AOB None Next Meeting: Friday 16 January 2014, 12-2pm CR1 Minutes signed and agreed: Chair: Date Print Name: Page 7 of 10

ACTION TRACKER - Active Meeting Sept 14 Agenda item No Action Who Meeting Update Completed 26/9/14 5 36 EOLC Metrics Make suggestions for review at CPDC 26/9/14 5 38 Cancer Strategy Circulate final draft Cancer Strategy 26/9/14 5 39 Cancer direct access to diagnostics Liaise with Adrian Davis Planned care lead 26/9/14 5 40 EOLC drug charts Engage with prescribing leads and bring back recommendation to CPDC 26/9/14 6 41 Young person s IAPTS Develop outline business case 26/9/14 7 43 Falls gone Live 9 th Dec Discuss interface between falls project and CQUIN 26/9/14 7 45 Revised ICT metrics to show link with benefits Need to agree on what high level Metrics CPDC to be cited on. Jonathan and Michele H-J to engage with Julie Curtis. 21/11/14 4 60 Planning Financial benefits NS to forward national QIPP tracker to attendees. 21/11/14 4 61 Planning Financial benefits meeting to be set up with Jonathan hull (FPH) before Christmas to consider joint working around orthopaedics. 21/11/14 4.2 62 Medicines Management Strategy KS to consider CCG aims and strategies and pull out what will align with CCG objectives. Emma W Dec 2014 Carry forward to Feb meeting. In progress Emma W Dec 2014 Move to Jan meeting In progress Emma W On going Pathway to be completed. Update at next meeting in Dec. Nicky T Dec 2014 NT to work with community teams. Update Feb Christy T Dec 2014 Carry forward. On hold awaiting decision from CAMHS Rachel & Emma Holden Dec 2014 Need to work on communications plan SH & RD. Present at Jan stakeholder event. In progress In progress On hold In Progress Nicola S Dec 2014 Update Jan meeting. In Progress Nicola Smith Sam Harvey Kevin Solomons Dec 2014 Roll Over to Jan In Progress Dec 2014 Roll Over to Jan In Progress Dec 2014 Roll Over to Jan In Progress Page 9 of 10

Evidence to come through Programme Board 21/11/14 4.2 63 Medicines Management Strategy NS to forward KS list of projects. To come back to CPD in January. Nicola Smith 21/11/14 5 66 Performance & Delivery Christy Tilney 21/11/14 5 68 Extended GP hours JC to update on data sharing at practices at January meeting. 19/12/14 5 70 Integrated Alcohol Services Pilot John Fraser to censor check metrics 19/12/14 7 71 Formulary Carina to move forward with Formulary plan with regular updates 19/12/14 8 72 Practice Engagement Alison to send agenda of next meeting Julie Curtis Jan 2015 Roll Over to Jan In Progress Dec 2014 Jan 2015 Before next month CT working on capacity / message re self-referral / group sessions. SHCCG referrals low. Leaflets out in practice re selfreferral. In Progress In Progress JF On-going Review before Feb meeting In Progress CJ In Progress AH Jan 2015 In Progress Page 10 of 10