Executive Committee Monday 4 th March 2013 13:30-15:30 TO24, Warehouse k Present Steve Gilvin(Chair) Dr Hardip Nandra Dr Zuhair Zarifa Jane Lindo Bob Arora Dr Ashwin Shah Dr Prakash Chandra (14:00-15:30) Charles Ohanlon Jane Mehta James Peskett Nigel Armitt Dr Lise Hertel Jas Kaur MINUTES Chief Officer (CCG) Quality & Delivery Programme Board Lead (GP) GP (Chair of NCCG) Deputy Director of Delivery (CCG) QIPP Programme Director (CCG) Integrated Care Programme Board Lead (CCG) CHN Programme Board Lead Associate Director (CCG) Commissioning Support Director (CSU) Deputy Director of Contracting & Quality (CSU) Interim Chief Finance Officer (CCG) Mental Health Programme Board Lead (CCG) Minute taker (CCG) Apologies Dr Barry Sullman Chetan Vyas Sajid Shah Dr Barry Sullman GP, Urgent Care Programme Board Deputy Director of Quality Associate Director (CCG) GP, Urgent Care Programme Board 1. General Business 1.1 Welcome, Introductions and Apologies Steve welcomed everyone to the Executive Committee meeting. James Peskett was introduced as the new Deputy Director of Contracting & Quality in the CSU. Apologies were noted as above. 1.2 Conflict of Interest Declarations None declared 1.3 Minutes of previous meeting (04.02.13), action notes and matters outstanding Minutes were agreed as an accurate record 1
Previous Action Log: Virtual Ward - Care pathways remain a concern Jane Lindo and Ashwin to agree a process to take this work forward, involving clinicians from each area to agree a joint care pathway. Action: Jane L Phlebotomy Two main issues highlighted Operation of the service Transfer of data Jane L to ask cluster team to collate response, and feed back to the next meeting Action: Jane L Integrated Care The following points were noted and highlighted Work in progress on the 3 areas prioritised (Rapid response, MH liaison and Self Care) Mckinseys assisting with developing a Newham plan for next 9 weeks as part of Phase II Aim is to ensure our local plan is agreed by end of April CQUINS Plan nearly complete for submission, meeting planned with Dr Zarifa, Dr Shah CV and SG to finalise NUH CQC report Steve confirmed this has now been sent out to the board members Risk Share with Barts Health It is part of the negotiating strategy to maintain the risk share agreement at the same position for 2013/14 contract 2. Delegation areas: Programme Board reports 2.1 Community Health Newham Jane Lindo gave a briefing on the report and key areas outlined:- Health Advocacy Redesign (Language Services) There have been negotiations with ELFT on the Service options The current proposed option has been modelled on moving 30% of activity to non face to face translation. Learning Disability (LD) Redesign ELFT response to new service specification document received and discussed at CHN PB Clinical workshop took place 1 st March to clarify the work of the team Discussions taking place on new service specification and the preferred option, working jointly with Partnerships Programme Board. District Nurse Pilot Agreement for District Nurse Pilot to go ahead for 6 GP practices - 13 GP practices have shown interest. Early discussions required for 2013/14 contract Specification needs to reflect emphasis on integrated care GPs need to be consulted over changes to the specification 2
Service Alert Forms The Executive Committee discussed use of service alert forms. The following points were made:- Jane L confirmed reminders are regularly sent to practices. A system needs to be devised whereby the amber alert form is automatically sent to the Provider and to the CCG, template to be integrated into EMIS web. CCG then only has the responsibility for monitoring. It was agreed to present a report to the CCG Council for feed-back and how it has worked and to receive comments for improvement. Action: Jane L 2.2 Urgent Care Jane Lindo gave a briefing on the report and the following were noted:- Formal approval will be given on Thursday 7 th March with new changes proposed Agreed to go with restricted PQQ, i.e. limit number of bidders going forward to maximum of 8 Noted timeline for urgent care tender process will be delayed by a week due to the proposed changes for the final sign-off, giving go live date of first week of November 2013. Steve highlighted a discrepancy between ELFT and the CCG as to cost of current service, a significant gap was highlighted which is under negotiation with the Trust. 2.3 Mental Health Jane Lindo took the group through the report, the following points were noted:- Adult inpatient beds occupancy Building on the SLAM report which makes eight recommendations for resolving the high (over 100%) bed occupancy for Newham unit. In response to this issue an inpatient review group has been set up to review the system and look for solutions. ELFT have proposed a pilot for a 15 bedded triage ward. Steve said this is a significant extra sum which has not been factored into the Operating plan budget which would have an impact on the QIPP gap savings. There was a lengthy discussion and emphasis was made on the clinical issues which need to be addressed. It was proposed that this initiative might be more effective than investing in further inpatient beds and would give commissioners the opportunity to understand the whole system in and outside of Hospital care. This was conditional on ensuring that there was agreement to a jointly commissioned audit of admissions and a clear exit plan for this ward to be only for a fixed period of 18 months. 2.4 Prescribing Bob briefed on the report and also highlighted the prescribing QIPP update report as attached. Bob proposed to present a more detailed report on the progress made in the last 2-3 years. Action: Bob Revised end of year forecast outturn reported as an underspend of 0.9m It was further reported: Community Pharmacist remains unpaid for the last 3 months as there appears to be no formal process in place. Steve and Ashwin to discuss after the meeting. Bob to brief Steve on how the previous payments were made. Action: Steve, Bob and Ashwin Prescribing Incentive Reimbursement Scheme clarity was required whether this would continue in 2013-14. Steve and Jane to discuss and report to the April Executive Committee. 3
Action: Steve/Jane A point was made to advise practices on the payment process and submission deadlines 2.5 Integrated Care: Bob highlighted the 3 areas that had been agreed to work on locally during 2013-14. The following points were noted:- Diabetes specification this has been emailed out for electronic sign off McKinseys to provide support for 9 weeks as part of the Phase II work, to focus on detailed mapping of current services provided within the CCG and how they fit into the proposed integrated care model. Concern raised around lack of engagement with the Acute Trust at the integrated care programme board Steve agreed to make a formal request for a representative at the CCG Programme Board through James Ross before escalating to Steve Ryan as Trust MD. 2.6 Quality & Delivery Nigel briefed on the report. The report was noted and no comments were made. 2.7 Partnership Commissioning Charles briefed on the report. The following comments were noted: Health Visiting Health Visiting programme in Newham. This was raised as a concern. No support provided to practices. Charles reassured the executive committee issue around providing support to practices will be dealt via the programme board. However NHS Commissioning Board holds responsibility for the resource issues, awaiting confirmation in writing. 3. Draft Operating Plan 2013/14 Steve introduced the document outlining the process for testing the QIPP plans for 2013-14. A key stage in the process will be the Star Chamber sessions scheduled for later that week. Chad gave details of the report and noted:- CSU proposing a workshop with the initiative leads Final paper to Executive Committee clarifying the governance structure Steve noted that there were issues as to how all of the programme boards were operating including whether the level of support was right. A review of how Programme Boards are operating and how the CCG structure is mapped to the Programme Boards will form part of a future Board development session in April. 4
4. DH Contracts Transitions: Transfer to CCGs(to follow) Steve gave a verbal update:- Formal agenda item proposed for March for CCG Board, setting out details of contracts to be transferred to the CCG Work underway to provide a breakdown of contracts and budgets to be aligned with each programme board. A detailed report to the April Executive meeting. Action: Chad 5. Authorisation of Patient Group Directives (PGDs) Bob gave a briefing on the report. The Executive Committee was asked to note the contents of the report and approve the process for authorisation of PGDs across Newham GP practices. The Executive Committee gave approval for authorisation of PGDs process. 6. AOB. Ashwin queried total funding to LBN and Public Health enhanced services. Allocation reported as 20m. Steve agreed to liaise with Andrew Bulloch to get further information. Acton: Steve 7. Date & Time of next meeting Wednesday 3 rd April 2013 @ 13:30, Warehouse K 5