Attendee: Organisation: Present:

ACTION NOTES Title of Meeting: Date of Meeting: Venue: Lower Lea Valley Locality Meeting Wednesday 6 th January 2016, 1-3.00pm Stockwell Lodge Attendee: Organisation: Present: Catherine Church PM The Maples Sacha Millin Stanhope Surgery Dr Pauline Taylor GP Cuffley & Goffs Oak Adnan Choudhury PM Abbey Road Claire Arno PM High Street Dr Bill Neville GP Abbey Road Dr Ed Bosonnet (Chair) GP Warden Lodge Dr D R Sahni GP High Street Dr K Misra GP High Street Heather Stephenson Locality Manager HCT Emma Ross PN The Maples Helen Edmondson AD Localities CCG Helen Moth PM Warden Lodge John Skitt PPG Stockwell Lodge Julie Street Carers Co-ordinator Ruksana Parkar Locality Manager CCG apologies Dr Alison Jackson (chair) GP The Maples Dr Mo Hossain GP Stanhope Dr Navina Sullivan GP Stockwell Lodge Faisal Ijaz PM Cromwell & Wormley apologies Mihir Varia Pharm Adviser ENHCCG apologies Sherine Sallion PM Stockwell Lodge Teresa Bird PM Cuffley & Goffs Oak Teresa Maczugowska Finance Manager CCG Dr N Malde GP Cromwell and Wormley Ann Freeman PPG The Maples Nichole Stanley PN Warden Lodge Jane Caba HCT - Health Visiting Kim Bilsby HCT- Childrens Health Visitor Aiga Puli PM Stanhope Way apologies 1. Apologies & Introductions 2 Apologies were noted. No new conflicts of interest declared since the completion of the register. Action Notes of meeting held on 16 th December 2015 Action point 9 should Clarity not CQC. Subject to this amendment the notes were agreed as accurate record. 2.1 2.2 Family Health Project: outlined that there were spaces on the programmes and that practices needed to send through more referrals or ask the admin team in practices to book places. Action: increase referrals to Family Health Project. 2.3 Winter Schemes: agreed to provide a response, by 8 th January to HM regarding whether the 1 per patient for 2015/16 could be used to extend winter resilience 1 Page

2.4 schemes up to and including Easter. Premises: Task and finish group meeting agreed for 1pm on 4 th February 2016 at the Maples. Clarity: Agreed that practices pay their fees for 2016 but that Federation to explore purchasing bulk registration for the next year. Action: Federation to explore purchasing bulk registration for the next year. HM 3. Winter Resilience HM reported that she had had confirmation from the CCG that the payment had been made to the federation and that when this had been received she would send payment to practices. The scheme so far had provided an additional 600 face to face appointments and 500 telephone appointments. fed back that they would not have coped without the additional capacity. Action: to provide a response to HM regarding whether the 1 per patient for 2015/16 could be used to extend winter resilience schemes up to and including Easter. 4. 4.1 Provider Updates Hotline Anna Cason reported that there had been a small reduction in referrals from LLV. Queries mainly related to Barnet and Chase Farm booking information, difficulties with Choose and Book and Trust approach that IFR policy should be applied by the GP rather than consultant. Other issues related to policy for BMI, female sterilisation. Issues at PAH related to not getting a response to queries and the lack of response has been escalated via the contract route. The CCG will require, as part of the new contract that the Trust respond in a defined period time. Anna Cason encouraged practices to use the hotline more and agreed to circulate the quarterly report if required. Action: Circulate the quarterly hotline report if required. 4.2 HCT KB reported that a new Health Visitor had joined the team. The move from registered to resident for the Essex border was going well and due to be completed by the end of March 2016. HS reported that a new matron had been recruited to the HomeFirst team and this meant the team was a full complement. Advert for Asst Psychologist had attracted 96 applicants and the senior psychology post was currently out for advert. Practice fed back that the new way of referring to Rapid Response was working well. 5. CCG Bulletin emphasised that the new End of Life templates were available and encouraged practices to start to use them. Action: End of Life Template usage. Any issues were to be sent back to. Action: to send Stockwell Lodge copy of EMIS template so SS could compare with the template on their system. Action: to put Feedback on the EoL template to be added as a future agenda item. 2 Page

6. Commissioning Plans Action: This item was deferred until the February meeting. 7. CCG Finance Report Month 6 TM provided an overview of the finance report that had been circulated. The main points were: Locality small overspend of 28k, an improvement on month 5 when the overspend was 62k. Overspend relates to non tariff care, e.g. critical care and unbundled tariff. There is a prescribing overspend and the acute overspend is offset by an underspend in non acute. Across the CCG CHC continues to be overspent and analysis is being undertaken to understand the increase in placements and related costs. 8. Locality Information Pack It was agreed that a member of the Business Intelligence team would be asked to attend the February meeting to present the key features of the LIP and provide an overview of the areas on which the practices should be concentrating. Action: the Business Intelligence team would be asked to attend the February meeting to present the key features of the LIP 9. Map of Medicine asked practices to review the letter that had recently come from the CCG asking for the identification of super users to support the roll out of Map of Medicine. The letter clearly sets out the requirements and identifies that there is remuneration attached to the roles. Action: It was agreed that practices would provide an update on their position at the next meeting. 10. 10.1 10.2 10.3 10.4 Any Other Business Dementia Patients ACP NS shared the advice she had received from the palliative care nurse that patients with dementia could not have an ACP. Action: agreed to discuss with Prag Moodley, CCG mental health lead to clarify the position. Dementia Transfer of Care confirmed that practices should be submitting the claim for the transfer of care when they have completed the review. added that when the practice receives a transfer the patient should be added to HomeFirst case management. Practice Update outlined the aim of undertaking practice updates and four practices agreed to prepare and present to the next meeting. who agreed are: Cromwell and Wormley; Stanhope, Stockwell Lodge and High Street. Action: Cromwell and Wormley; Stanhope, Stockwell Lodge and High Street to provide practice update at the February Meeting Practice Nurse ER reported that nurse forum is being held on 27 th January 2016 at 12.30-2pm. ER will email practices with details, practices to ensure practice nurses are reading emails. ER 3 Page

10.5 10.6 10.7 Covent House Refuge agreed to share a specification for an enhanced service for a homelessness centre with CC. Generic Email reminded practices to complete the request for confirmation of the generic email for the practice. HPFT asked for feedback from practices on services at HPFT that needed to be improved, the issues raised were: Responsiveness and criteria of crisis services (Stockwell and Stanhope) CAMHS and Step2 service rarely accepts a patient. Venues where is it provided from (Watford and Stevenage) are too far from LLV 11. Date and Time of Next meeting Wednesday 10 th February 2016 Table of Actions Actions Responsible Lead 1. Amend minutes 2. increase referrals to Family Health Project. 3. Federation to explore purchasing bulk registration for Clarity for future years. 4. to provide a response to HM regarding whether the 1 per patient for 2015/16 could be used to extend winter resilience schemes up to and including Easter. HM 5. Circulate the quarterly hotline report if required. 6. to use new End of Life templates, any issues were to be sent back to. to send Stockwell Lodge copy of EMIS EoL template so SS could compare with the template on their system. Feedback on the EoL templates to be added as a future agenda item. 7. Commissioning Plans item to be deferred until February meeting 8. Member of the Business Intelligence team to attend the February meeting to present the key features of the LIP and provide an overview of the areas on which the practices should be concentrating. 9. to provide an update on their position with regard to Map of Medicine at the next meeting. 10. Dementia Patients ACP agreed to discuss with Prag Moodley, CCG mental health lead to clarify the position. 11. Cromwell and Wormley; Stanhope, Stockwell Lodge and High Street to provide practice update at the February Meeting 12. agreed to share a specification for an enhanced service for a homelessness centre with CC. Relevant practices 4 Page

ACTION NOTES Title of Meeting: Date of Meeting: Venue: Lower Lea Valley Locality Meeting Wednesday 10 th February 2016, 1-3.00pm Stockwell Lodge Attendee: Organisation: Present: Catherine Church PM The Maples Sacha Millin Stanhope Surgery Dr Pauline Taylor GP Cuffley & Goffs Oak Adnan Choudhury PM Abbey Road Claire Arno PM High Street Dr Bill Neville GP Abbey Road Dr Ed Bosonnet (Chair) GP Warden Lodge Dr D R Sahni GP High Street Apologies Dr K Misra GP High Street Dr S Parkar GP High Street Heather Stephenson Locality Manager HCT Emma Ross PN The Maples Helen Edmondson AD Localities CCG Apologies Helen Moth PM Warden Lodge John Skitt PPG Stockwell Lodge Val Presland PPG Apologies Julie Street Carers Co-ordinator Apologies Ruksana Parkar Locality Manager CCG Dr Alison Jackson (chair) GP The Maples Dr Mo Hossain GP Stanhope Dr Navina Sullivan GP Stockwell Lodge Dr M Dobrowolski Faisal Ijaz PM Cromwell & Wormley Mihir Varia Pharm Adviser ENHCCG Sherine Sallion PM Stockwell Lodge Teresa Bird PM Cuffley & Goffs Oak Teresa Maczugowska Finance Manager CCG Dr N Malde GP Cromwell and Wormley Ann Freeman PPG The Maples Nichole Stanley PN Warden Lodge Jane Cabon HCT - Health Visiting Kim Bilsby HCT- Childrens Health Visitor Aiga Puli PM Stanhope Way 1. Apologies & Introductions Apologies were noted. welcomed the new Education & Workforce Lead Vishal Kapil and PAH Representatives MD & JM. No new conflicts of interest declared 2 Action Notes of meeting held on 6 th January 2016 the notes were agreed as accurate and true record of proceedings Updates on the following actions: Family Health Project 2 sessions were cancelled due to only one family being booked in. Need to educate families in how to manage minor illnesses to reduce A&E 1 Page

rate. Stockwell Lodge requires leaflets. Action: JS happy to email electronic copy of Family Health Project Leaflet. CC shared a useful questionnaire that her practice has developed. Action: CC to share a copy of the questionnaire that her practice has developed Further sessions to be booked in March and April. Dementia Patients ACP confirmed that she spoke to Prag and he confirmed you can do ACP for dementia patients. 3 PAH Engagement Issues MD & JM attended from PAH. The following was discussed: Phlebotomy Natural flow is to Barnet and Chase Farm nothing for Harlow. Its difficult to getting the test done locally. MD very keen to work with the primary care services There is changes in patient flow and changes in chase farm. There is a need to understand which practices are affected by these changes. MD confirmed issues are due to system changes and they are still catching up. Possible solution is Lea Valley Health (Federation) to open a phlebotomy service working along with PAH. MD agreed. MD & JM Action: CC as a federation lead to explore with the federation and MD in how to open a suitable local phlebotomy service. Reported longer waiting times for orthopaedics. MD would welcome elective work. MD confirmed issues with capacity and significant pressure on emergency admissions. Looking into developing in existing premises or options of moving. MD happy to put something in place were patients are turnaround back to community services but this would require a collaborative approach Action: Final Commissioning Plans to be shared with MD after April. Providing a facility outside Cheshunt Hospital has been a challenge due to broken relationship EB said physiotherapy service needs to be revised to link in with the current Hertfordshire services. X-ray facilities at Cheshunt community are an issue. Quality of X-ray is poor. Action: to report Quality of X-ray at Cheshunt Community to contracts team 4 CCG LIP Report MK sent his apologies. However TM kindly stepped in to do an update on the locality finances. Please find attached report: M8 Finance Report 2 Page

5 ECG Leg Ulcer Methotrexate Clinic Community Hospital shared with the locality that she s not sure if the ECG Leg Ulcer Methotrexate Clinic is needed. As a locality we need to understand the flows to these clinics Question whether this could be carried out in house. Highest referrals are for Leg ulcers followed by ECG s. 10 different providers operating from Cheshunt community hospital Wound care and stitches removal were identified as high referrals. were stunned. It was agreed this is not good value for money. HS to provide practices with data and costing of their activity. The costing and activity will determine whether it is effective to carry on with the service or take the decision as a locality to de-commission it. Action: HS to provide practices with data and costing of their activity from Cheshunt Community Hospital. Action: to report their referral activity to Cheshunt Community Hospital at the next locality meeting in April 6 End of Life Template Usage Update No one had any negative report. Locality reported it was useful. 7 Map of Medicine said everyone should have identified a super user at every practice Everyone confirmed training is in place All 8 Workforce Planning. VK spoke about the GP fellowship scheme The workforce education project started in October VK confirmed he looks after recruitment crisis for GPs. Nurse tutors have been implemented to help with recruitment crisis for nursing. There are 7 GP fellowship posts this will be based on 6 to 7 clinical sessions paid by the practice and it will be full time. Part-time option is available. Employer would be the host practice. VK speaking to local hospitals to retain training for GP fellowship and this will be in the department where the interest lies. They will require mentorship and supervision but they are just like any other GPs. The aim is for them to get to know the local area and practices well and hoping the stay in the area. There is 100 posts in the whole of Hertfordshire. are requested to come forward and express interest by the end of next week (19 th February 2016). Warden Lodge, Cromwell and Stanhope has expressed interest. Other interests to email to or directly to VK. Interviews will be carried out on the 26 th February Discussion broke out to not limit the post to 7. VK confirmed this should not be a problem if we have other eligible candidates. Action: VK to double check if the GP fellowship scheme is open to more than 7 posts if suitable candidates are available. Action: to add workforce as part of the premises agenda for Target Event in March 3 Page

Action: to send an invite to VK to the Target Event. 9 Primary Care Nurse Training Spirometry confirmed Spirometry Training needs to be updated every 3 years All nurses not trained are going on the training course. See attached training flyer for details Training update (January 2016).pdf ER brought up the pharma companies use to come and do educational events for free. The locality agreed that speaker should be bought in and billed to the locality management budget to. 10 Patient Commissioning Group (PCG) JS confirmed that its not PPG (Patient Participation Group) but should be PCG. Last PCG took place on the 11 th January 2016 Type 2 diabetes group is up and running Variation in packaging for meds and size of tables is still an issue for vulnerable patients. Action: JS to forward CCG response on meds packaging to MV added that Chris the clinical pharmacist should be involved in these discussions. Transforming Care Road show events took place19th and 22 nd January. JS shared the Swiftqueue link to who sent it around to all the practices. This online system helps to books blood test at your convenience. Chase Farm provides appointments and sometimes you could book it on the same day. This online system helps diminish long waits. https://www.swiftqueue.com/select-login.php JS promised to send the link for the CQC Consultation document, shaping the Future. The consultation period lasts until 14th March: www.cqc.org.uk/2016strategyconsultation Action: JS promised to send the link for the CQC Consultation document, shaping the Future. The consultation period lasts until 14th March 11. Any Other Business Declaration of interest was circulated to all GP that attend locality meeting. Confusion on the falls liaison service was discussed. Action: to liaise with Fiona and clarify what s happening with the falls liaison service. University of Hertfordshire is doing an evaluation on the home 1 st service and how we could further improve it. Calls will be coming out to practices and practices are asked to cooperate. 11. Date and Time of Next meeting Wednesday 24 th February 2016 Integrated Care Planning Meeting. 4 Page

Table of Actions Actions 1. Federation to explore purchasing bulk registration for Clarity for future years. 2. to provide a response to HM regarding whether the 1 per patient for 2015/16 could be used to extend winter resilience schemes up to and including Easter. 3. to send Stockwell Lodge copy of EMIS EoL template so SS could compare with the template on their system. 4. Member of the Business Intelligence team to attend the February meeting to present the key features of the LIP and provide an overview of the areas on which the practices should be concentrating. 5. Cromwell and Wormley; Stanhope, Stockwell Lodge and High Street to provide practice update at the February Meeting Responsible Lead HM MK Relevant practices 6. agreed to share a specification for an enhanced service for a homelessness centre with CC. 7. JS happy to email electronic copy of Family Health Project Leaflet JS 8. CC to share a copy of the questionnaire that her practice has developed CC 9. CC as a federation lead to explore with the federation and MD in how to open a suitable local phlebotomy service. CC 10 Final Commissioning Plans to be shared with MD after April 11 to report Quality of X-ray at Cheshunt Community to contracts team 12 HS to provide practices with data and costing of their activity from Cheshunt Community Hospital. 13 to report their referral activity to Cheshunt Community Hospital at the next locality meeting in April 14 VK to double check if the GP fellowship scheme is open to more than 7 posts if suitable candidates are available 15 to add workforce as part of the premises agenda for Target Event in March HS All VK 16 to send an invite to VK to the Target Event. 17 JS to forward CCG response on meds packaging to MV JS 18 JS promised to send the link for the CQC Consultation document Shaping the Future. The consultation period lasts until 14th March 19 to liaise with Fiona and clarify what s happening with the falls liaison service JS 5 Page