1 EAST AND NORTH HERTFORDSHIRE CLINICAL COMMISSIONING GROUP INTERIM SHADOW BOARD MEETING IN PUBLIC THURSDAY 2 AUGUST 2012, COLLINGWOOD SUITE, GOSLING SPORTS PARK, WGC Present: Apologies: Tony Kostick (Chair ENGPCC) Chair of Stevenage Locality (TK) Rob Graham, Vice Chair of North Herts Locality (RG) Nabeil Shukur, Stort Valley and Villages Locality (NS) Alison Jackson, Joint Vice Chair of Lower Lea Valley Locality (AJ) Mark Andrews, Co-Chair of Upper Lea Valley Locality (MA) John Constable, Joint Vice Chair of Welwyn & Hatfield Locality (JC) Mo Hossain, Chair of Lower Lea Valley (ex South) Locality (MH) Martin Hoffman, Chair of North Herts Locality (MGH) Hari Pathmanathan, Chair of Welwyn & Hatfield Locality (HP) Jeremy Cox, LMC (JC) Michael Taylor, LINKS Representative (MT) Linda Farrant, Non Executive Director, PCT (LF) Lesley Watts, Interim Chief Executive E&N CCG (LW) Jessica Linskill, Interim Nurse Member (JL) Helen Edmondson, Assistant Director, Governance (HE) Noreen Coles, Finance Lead (NC) John Paton (Minutes) (JP) Bill Rial, Governance Adviser (BR), for item 3 Beverley Flowers, Interim M, HIICSS, (BF) for item 4 Phil Crossley, Interim Director of Services (PC) for item 4 Trudi Southam, Interim Customer Accounts Manager (TS) for item 4 Sukeina Kassam, AD Community Commissioning (SA), for items 4-9 Caroline Swindell, HCC Children s Centres Lead, (CS) for item 5 David Law, Chief executive HCT, for item (DL) for item 9 Prag Moodley, Vice Chair, Stevenage Locality (PM) Nicky Williams, Co-Chair of Upper lea Valley Locality (NW) Peter Shilliday, Joint Vice Chair of Welwyn & Hatfield Locality (PS) Deborah Kearns, Stort Valley and Villages Locality (DK) Nicky Poulain, Assistant Director Locality Commissioning, PCT (NP) Grant Neofitou, Information Lead (GN) Raymond Jankowski, Deputy Director of Public Health, PCT (RJ) 1. Minutes of the last Board meeting in Public (7.6.2012) and Business meeting (19/7.2012) and BMIP action tracker The minutes were agreed and the action tracker noted. Action by 2 Matters Arising Secondary Care Consultant Board member TK reported that the CCG had a list of interested consultants and was following the prescribed process to appoint such a Board member. National guidance was that this Board member could not be employed by an acute provider with whom the CCG had a significant contract.
Vascular Surgery consultation CCG response TK reported that he had drafted a response, due by 14/8, saying that until the CCG had been provided with evidence that the proposed arrangements for vascular surgery support to renal and cardiac surgery were clinically safe the CCG could not support the proposed centralisation of services in Hertfordshire and would continue to commission from the current provider. He agreed to circulate his response. T Kostick 3. Constitution development BR noted 20 responses were received & considered. The main issues were: 1. Threshold for convening a Council of Members meeting it was agreed that the basis for the threshold should be a minimum number of Practices and to retain the 20 member Practices threshold 2. Weighting of Locality votes at Governing Body meetings It was agreed that introducing a weighting for Locality voting undermined the equality of Practices and LCGs. It was appreciated that ULV locality strongly believed that weighting was appropriate. The Board members voted with one in favour and remaining votes against changing the current system to introduce the weighting of Locality votes at Governing Body meetings. It was further agreed to review this decision in a year s times and the constitution annually. 3. Governing Body to consist of 1 representative from each Practice it was agreed that such a change would make Governing Body meetings unsustainable and to retain the composition previously agreed 4. Recognise the LMC within the constitution it was agreed that the constitution should include a duty to work with the Local Medical Committee and other Professional Committees as the representative of healthcare contractors and to continue to invite the LMC to attend BMIPs 5. Resolution of disputes between Practices and the CCG it was agreed to adopt the procedures currently followed by the PCT in such a dispute and to reference this within the constitution 6. Locum Doctors representation it was agreed the constitution previously agreed should be retained but to invite Locums to form a Liaison Group to contribute to and inform the work of the Governing Body, possible on a Locality basis, and to review this aspect of the constitution after1 year 7. Assisting and supporting the NCB in relation to the Board s duty to improve the quality of primary medical services it was noted that this was a requirement for CCGs under primary legislation and despite a number of concerns expressed about this; it could not be removed from the constitution. It was agreed to retain the constitutional provision previously agreed. B Rial It was agreed to amend the requirement of recent experience for secondary care clinician to 10 years to be line with the secondary regulations, but the Board noted that it was their preference for the experience to be within 4 years. The meeting thanked BR for his work on the CCG s constitution. 4. Commissioning 4.1 Process for the issuing 2013/14 Commissioning Intentions The Board agreed the process proposed and asked that a Commissioning 2
and Contract Group meeting be held urgently with all Board members invited to explore ambitions and priorities for improving the commissioning process from all major acute providers and to link this at an early stage with CQUIN requirements 4.2 Pulmonary Rehabilitation provision It was noted that that the last meeting had deferred a decision on the proposed expansion pending clarification of what service was currently commissioned and provided and the metrics that would be used to assess the success of the service. HICSS were mapping provision against SLA statements. The Pulmonary Rehabilitation service provision level varied because in the past some Localities had been able to fund extended services. It was noted that the service level commissioned and the service provided and the success metrics needed to be reported to the 16/8 BM after review by the Executive Team, together with the impact on admissions of the existing Pulmonary Rehabilitation service at Welwyn Hatfield L Watts/ B Flowers S Kassam 4.3 Commissioning Community Health Services BF reported that a new Commissioning Manager for the HCT contract had started recently, Sukeina Kassam. NC reported on the apportionment exercise to establish provision and funding for these services across the CCG and a meeting with LCG Community Service leads was due this week to clarify this. 5 Children s Centres CS outlined the nature and organisation of the services provided in these centres. In discussion the following points were made: Some practices had experienced a drop in communication between GPs and HVs following the transfer of their operational base to the local Children s Centre. Some vulnerable and disadvantaged children were being brought to surgeries because parents were not aware of or could not travel to the local Children s Centre, adding to health inequalities Decisions about the operational base for HVs had been made by HCT not the Children s Centres service A referral form for GPs to use to direct patients to their local centre would be helpful HCC was undertaking an evaluation of the effectiveness of the different models of care operating in Children s Centres and their impact on reducing health inequalities and this should be shared with LCGs. It was agreed that there needed to be improved communication between Children s Centres, LCGs and Practices. It was agreed that Childrens Centre briefing would be taken to locality meetings. JL agreed to meet with CS to explore ways forward. 6. Performance report LW commented that the content of these reports was evolving and there was still some overlap with the Quality report which would be resolved in future. Different services had different reporting schedules and this would be reflected in future reports to the BMIP. She noted that a significant concern for the CCG was the relatively high SHMI level at E&NHT and this would be raised with the E&NHT Chief Executive and Medical Director when they attended the 30/8 BM and it was agreed to include the Trust s SHMI report in N Poulain J Linskill J Paton 3
the agenda papers for this meeting. LW briefed members about recent developments at the Clinicenta in relation to the LMC letter to GPs about referring patients there for ophthalmology. 7. Quality Report In discussion the following points were made: There was an allowed limit for 2012/13 of 14 C Diff. cases for ENHT so 2 or 3 cases in one month followed by none in the next month resulted in significant changes in the RAG ratings There had been significant delays in arranging follow up appointment for Rheumatology and Orthopaedics which would be taken up with E&NHT The CCG will consider complaints received by Herts Urgent Care referred to in Appendix 1 in future commissioning. There is an established process for monitoring delivery of CQUINs. Performance monitoring of SIs takes place in quality review meetings and specific SI meetings with providers. L Watts 8. 8.1 Finance report Finance report M2 NC reported that the non recurrent credit derived from the over-estimate of acute and prescribing spend assumed in the annual accounts was shown separately in the report in Appendix 1. Budgets were being re-based to take account of the contracts signed since the budgets were agreed and the likely annual prescribing spend. MGH noted that acute activity was increasing although at this stage trends were not established. LCGs needed to continue to monitor acute activity. 8.2 CCG Baselines Exercise NC reported the changes in PCT allocations for the new commissioning arrangements with some services being commissioned by the NCB, notably HV and School Nursing, and some by HCC. Some parts of the Public Health department providing commissioning advice to CCGs would transfer to HICSS and a mapping exercise to identify these was underway. Members expressed concern that the HV and family nursing services were not to be commissioned by CCGs in the new NHS architecture when the capacity of this service was so central to the delivery of the CCG s strategy. TK reported that he was involved in setting up a CCG Chair s Forum to advise the NCB on commissioning arrangements post 1/4/2013. 9. HCT Quarterly report DL outlined the service and staffing information available from HCT, noting: HCT would provide validated data on a Practice, LCG and CCG basis 4
Communication was needed between HCT core staff and Practices to establish clear standards for what was being commissioned agreeing frequency of reporting and what the desired outcomes should be rather than the current contacts data Service specifications needed to be radically re-worked and tested, perhaps in one LCG to establish what level of outcomes would be provided for the resources available There had been significant changes in the HCT management structure In discussion the following points were made: The CCG needed a statement of spend and staffing by Locality and outcome metrics and core service specifications At the previous quarterly report provision of this information had been agreed and similar information requested in September 2011 If all services operated to a common level of provision and cost per outcome efficiency savings could resource additional services The meeting agreed that clarifying spend and staffing by Locality and outcome metrics and core service specifications for community services was the highest priority for the CCG to allow it to make informed decisions on strategic service investments. LW noted that daily PMO progress meetings would be held within the CCG to resolve outstanding issues L Watts 10. Kings Fund/Nuffield Research project TK commented that the KF wished to focus on how the CCG undertook Performance Management of GP Practices. He had advised the KF that this was not a high priority area for the CCG but that the CCG was interested in principle in participating in research on an area of mutual interest. The Board supported the project in principle. The Board noted HE s declared an interest as Dr Judith Smith, Nuffield Trust was a personal friend. 11. 11.1 11.2 11.3 Safeguarding reports Safeguarding knowledge transfers to CCGs JL outlined the assurances that the CCG would be expected to provide as part of it s authorisation process. A key area was to recruit a Named GP for the area covered by ULV, LLV and SV&V. The relevant localities agreed to secure a GP for the area. The LMC agreed to support this process when necessary. JL confirmed that the CCG would be employing Designated Safeguarding posts, with this CCG probably host managing the Hertfordshire wide service. The NCB would be employing Named Safeguarding posts Safeguarding Adults Annual Report 2011/12 It was noted that inspections had identified good practice in Hertfordshire with the major priority to maintain safe arrangements during organisational change. The Board received and noted this report. Safeguarding Children Annual Report 2011/12 JL commented that a major priority was to increase awareness of all staff on safeguarding issues and the CCG should encourage staff to undertake the Safeguarding e-learning module. A Jackson M Andrews N Shukur 5
The Board agreed to encourage staff and GPs to take the e-learning module and to monitor up-take. The Board needed to receive more regular reports on Safeguarding and it was agreed to arrange a Board Briefing on this. 12. Authorisation LW reported on proposed arrangements for the 19/9 NCB site visit. The Internal Auditors had prepared an evaluation of the CCG s submission and the CCG had secured management consultant support for the Board s Organisation Development. The scheduled 16/8 BM would be replaced by a session on this with a mock site-visit arranged for 23/8 in time to apply the lessons learned at the substantive 19/9 visit. An email confirming these arrangements would be sent to Board members. J Linskill H Edmondson TK reported that interviews for the Accountable Officer/Chief Executive post were to be held this week and interviews for the Chief Finance Officer on 8 th August. 13. 13.1 13.2 13.3 13.4 Any Other Business Telemedicine trial in N Herts Locality The Board agreed that the trial scheme should be worked up as a Business Case with expected outcomes and success criteria clearer and more detail about what action will be taken from the information gathered. HPFT contract letter LW commented that the draft letter needed to be expanded to clarify the terms of the proposed 3 year contract and to include a break clause, with the benefits to the CCG of a 3 year contract should be more clearly specified. Annual Audit Letter Noted BMIP agendas LF commented that apart from the regular Finance, Performance and Quality reports it was not always clear which matters needed to be addressed at a Board Meeting in Public and which were more appropriate for a Business Meeting or a Board workshop. LW agreed that this was an issue that needed further consideration. N Poulain L Watts J Paton 14. Dr Mo Hossain MH reported that he was resigning from his CCG work as from 1/9 and thanked CCG staff and Board colleagues for their support. His LCG would elect a replacement representative. H Edmondson 15. Date of next Interim Shadow Business meeting: 30th August 2012 at 9 am in Collingwood Suite, Gosling Sports Park. Date of next Interim Shadow Board Meeting in Public: 11 th October at 9 am at the Collingwood Suite, Gosling Sports Park 6