Notes from meeting Bassetlaw Commissioning Organisation Committee 6 th December 2011, 9am -1pm Collinson Board Room, Retford Hospital Not yet ratified by BCO Committee ATTENDEES Dr Steve Kell (SK) Chair Dr K Fairholme (KF) Dr V Nanthakumar (VN) Dr Mike Ho (MH) Phil Mettam (PM) Chief Operating Officer Penny Spring (PS) Consultant in Public Health Lisa Bromley (LB) Assistant Chief Operating Officer John Bell (JB)-Lay Member Dr Andrew Perkins (AP) Dr Nik Craig (NC) Interim Vice Chair Denise Nightingale (DN) Dr Heshan Ariyasena (HA) Michele Godley (MG) Deputy Director of Finance Mukesh Panchal (MP)- Lay Member APOLOGIES Alan Burbanks(AB) Director of Finance In Attendance: Charlotte Evans (CE) Administrative Assistant Item Apologies and Welcomes ACTIONS DATE Apologies were received for this meeting from Alan Burbanks, Director of Finance. Michele Godley, Deputy Director of Finance is attending in his absence. 11/60 Declaration of Interest There were no declaration of interests to be added to the register. 11/61 Minutes of Last Meeting The minutes of the meeting held on the 8 th November 2011 were agreed as a true and accurate record after the following corrections. Page 4 section C: The Quality and Safety group section should be Audit and Risk. Page 1 of 9
Page 10 Winter Planning Dr Ho expressed concern that last year only part of the car parks were gritted around some healthcare sites. Check with Nicola that the winter plan covers gritting of the car parks around all sites. LB Action log Completed actions can now be removed from the list. 11/48 a EMAS Phil Mettam explained to the committee that he has had a discussion with Simon Clark regarding data showing that there have been periods where ambulances maybe diverted from Bassetlaw to cover other parts of the East Midlands. There are also concerns regarding engagement from EMAS on local strategic developments such as trauma, 111, and stroke. PM will write to the Chief Executive and look at the strategic issues. PM 11/48a 18 week data John Bell has had a discussion with Andy Roberts and he will speak to the relevant director to arrange a meeting. 11/62 Managing Transition a BCO Chair Update Dr Kell informed that BCO won the Acorn Awards for the GP Consortia of the year. Phil Mettam attended the awards ceremony with Dr Kell in Manchester and this is a good recognition for BCO. Dr Kell informed the committee that the CCG Governance document has now been released along with the Operating Framework 2012/13. Westwood b Dr Kell explained to the Committee that Phil Mettam and Annette Laban had a meeting with Dr Rosie Hamlin from Westwood 8 to 8 centre. It is hoped that Westwood will officially join BCO soon. In the meantime it has been agreed to share BCO information and literature with Westwood that the practices get (patient leaflets, BCO newsletters and prescribing and referrals data for Westwood compared to Bassetlaw as a whole). Commissioning Support Unit Phil Mettam explained to the Committee that there is a lot of detail included within the attached papers on the Commissioning Support Unit Page 2 of 9
(CSU) and outlined the main points. PM expressed that the North of England SHA will include a milestone in February where the CSU specification needs to be finalised with the CCG. The prospectus shows the progress made at cluster level and states within this that CSU s not performing well may be offered to the market in 2016. The 4 CCG s with delegated responsibilities will get their commissioning support from the CSU. The Attain report outlines the views and feedback from all CCGs on the development of the CSU and this has been used to produce the Prospectus. The Prospectus needs to be used to move the CCG forwards and Andy Buck would like a GP from each CCG to join in with discussions and help with a service level agreement. PM expressed that for authorisation the CCG will need to have a viable CSU and the process that we go through in the summer will be focused around this. PM explained that we had a discussion with NHS Doncaster to consider extending the existing arrangements for an integrated finance and contract team to other areas to compliment the establishment of a CSU. Andy Buck will be attending the staff briefing at Bassetlaw on the 8 th December and he will touch on some of the staffing issues. The Committee had a discussion based on the proposed CSU in the context of the running cost position and considered whether this will include weighted population. CCG Governance paper c PM presented the paper tabled on CCG Governance guidance and expressed to the Committee that we need to look at the CCG arrangements within the document. PM explained to the Committee that we need to look at strengths and gaps in line with this document. PM informed the Committee that the model constitution will be coming out the end of January to cover functions and governance arrangements. (section 2 page 6 of the paper provided). Committee to provide comments and views on this paper to be taken back to Ginny Snaith and to come back to the meeting in January 2012. Paper to be discussed with GPs at the members meeting on the 14 th December for feedback and discussion. All CE Page 3 of 9
d Governance Arrangements PPE Strategy PS presented the paper on the PPE strategy and asked for any comments and amendments so it can go out for consultation to stakeholders, the public and partners in the community. The Committee approved this paper and agreed for it to go out for consultation. Finalised TOR to the Nottinghamshire group to be circulated. e Preparing for Public Meetings The Committee had a discussion about this and decided to have the first public meeting in January and to put an advertisement in the local papers. The committee agreed that if there were any queries with the proposed agenda for them to e-mail Phil/Lisa or Steve. Advert to go into local press at end December 2011. CE 11/63 Performance a NHS Bassetlaw Executive Summary JB queried why some of the data was missing from the report as trends had not been included. PM explained to the Committee that the format and structure of the report will be changing as the North of England SHA are introducing a quality and performance dashboard and they will require a particular format for all reports feeding into this from January. However, we will also continue to try and provide the information that is required locally. PM discussed with the Committee a letter that he had received from the SYB Cluster and that we are currently ranked positively. The letter received for November looks at quality and safety and references, readmission, FNOF and safeguarding the letter also looked at finance and IM&T but there were no issues noted for Bassetlaw. The following performance issues were considered in more detail: CDIFF & MRSA CDIFF is off-plan, however this is consistent with the rest of Yorkshire and Humber. MRSA is off plan. Discussions are underway with the Cluster regarding related technical definitions. A&E performance continues to be variable. DBHFT are planning Page 4 of 9
to review this and have invited BCO to participate in this review. 18 weeks RTT is under review to look at the numbers of patients waiting with an incomplete pathway. Cancer PM expressed that there was a situation with some waiting times and the North Trent network are looking into this. LB explained that a leaflet has been circulated to practice managers that will help to raise awareness with patients on the importance of keeping urgent appointments to within two weeks. The Committee had a discussion on the mechanism for GPs to bring clinical issues to the service and also where any complaints get fed into. LB expressed that any issues with patients should be discussed at practice managers meetings and if appropriate sent to the quality and safety meeting. Andrew Beardsall to provide details to practices on patients with no diagnosis and details of themes of complaints. 11/64 Managing the Business AB a Chief Operating Officer Briefing PM reported to the Committee that the day of industrial action was broadly successful and no operational or service issues arose. Considering the reduced capacity across the system the day was managed well. Finance b MG explained to the group that overall the financial position remains on plan and the risks are manageable. Prescribing remains on plan to deliver the required savings. The NHS contracts overall are overspending but are manageable however with some concern heading into winter. MG informed the committee that the mid year financial review is nearly complete including a review of reserves and the financial position of the PCT/ CCG is on plan. MG explained that the reports and schedules have been reformatted and the operating costs now show a clear split of the organisation. It shows the CCG has a net underspend of 376,000 but this includes the majority of running costs which are yet to be fully allocated. MG confirmed that there are still some areas that need to be transferred out of the CCG position and some funding held in reserves that will need adding in to the CCG position. MG explained to the Committee that we are still awaiting definitions of future specialised service costs. Where services are currently commissioned via specialist commissioning groups, these elements have been excluded from the CCG costs but contracts have not been split down at this stage where definitions are unclear. MG explained that, in relation to QIPP savings, there is 2m to be achieved reported separately in reserves but 4m has already been MG Page 5 of 9
taken out of the budgets. c MG to confirm to JB what the high level of non-nhs receivables relate to.. Assurance Framework The document on the Assurance Framework has been provided for information and feedback. 11/65 Service and Development a Acute Services Review Maternity PM explained that the Foundation Trust has an action plan to meet standards for maternity services on both sites BDGH and DRI. Paediatrics Work is ongoing with the FT. Commissioners are to develop a service specification for community paediatrics. DN informed the work is ongoing with Doncaster and the Trust to enable BDGH to meet national standards. ATC The service specification has been agreed and DBH have asked for more time to look at the possible integration of other services. Stroke PM explained to the Committee that that all providers have been asked by the SHA to undertake a self-assessment. There are a number of concerns regarding the progress being made with DBHFT. This matter was discussed with a number of stakeholders including the SYB Cluster and the Care Quality Commission. Trauma DN expressed that a lot of work has been done on Trauma more locally and the aim is to get DRI and BDGH working on a hub and spoke model of urgent care /A&E pathways for trauma to ensure BDGH can continue to see clinically appropriate patients in A&E. This is still in discussion at a regional level with the Cluster and SHA. Anaesthetics Outlined DN to the Committee the proposal that had been developed by DBHFT, however there are a number of recruitment concerns and other options are currently being considered. 11/66 Quality and Safety Group PM referenced the care home based around Misterton and Gringley section in the paper. We are working with the County Council to review services. This issue had been discussed at Quality and Safety group It was agreed that the minutes of this group will be included for information in CE Page 6 of 9
the Committee minutes. 11/67 Risk and Audit Group This group has not met yet. 11/68 Nottinghamshire Group SK informed the Committee that they have completed the Learning Disabilities plan as part of Yorkshire and Humber. Chris Kenny is liaising with Nottinghamshire and South Yorkshire on the emergency planning responsibilities. 11/69 Service and Delivery Group LB explained to the Committee that the Service Delivery Group had confirmed support for the successful bidder of the EMPACT led Procurement for Bassetlaw Patient Transport Service as Arriva. 11/70 Risk Register There were no risks to add to the register. 11/71 Evidence for Authorisation Evidence to be used from the papers provided. 11/72 AOB There was no AOB at this meeting. Page 7 of 9
Part 3 11/73 Operating Framework PM undertook a presentation on developing the commissioning plan with the committee. A two page summary of the operating framework was tabled giving an overview of the service issues with some key questions, a timetable and supporting infrastructure for January/February. PM informed that the contract and the commissioning plans need to be signed off by 31 st March 2012. The first draft is required at the January Committee and final draft needs to be ready for the end of February/ early March. All sub groups under the committee need to be involved in developing the plan. Smoking priorities and NHS quitters to be added to the priorities. Action LB Finance MG explained to the group that the allocations are due out later this month and this will help to set plans as a whole. The shadow CCG allocations are to follow. There is no indication on what methodology that will be used and how this will be split. This all has an impact on how we allocate fair share budgets going forward. MG explained that it has been announced that the deflator that is added to tariff will be at 2.5%; the tariff will be reduced by 1.5% and CQUIN will increase from 1.5% to 2.5%. MG expressed that we need to consider the impact of tariff changes around acute and mental health. Social care funding for reablement will need to continue, re-admissions will also need factoring in. Need to look at the pre commitment growth and forecast outturn and a model to come up with bottom line figure that will be the QIPP target. The estimated QIPP figure for 2012-13 is currently 3-4m. Date and time of next meeting The next meeting will be held on the 10 th January 2012 9.00am - 1.00pm, Collinson Board Room, Retford Hospital Page 8 of 9
Page 9 of 9