Quality and Clinical Governance Committee Date Friday 19 th August : 1400 1600 hours Conference Room 2 Surrey Heath House, Knoll Road, Camberley, Surrey Chair Alison Huggett (AH) Director of Quality and Nursing (SHCCG) Members Present In attendance Apologies Minutes Karen Hampton (KH) Gareth Jones (GJ) Linda Cunningham (LC) Ann Cooper (AC) Dr Andy Brooks(AB) Dr Gail Milligan (GM) Dr John Fraser (JF) Kevin Solomons (KS) Sue Fosh (SF) None Julie Comer (JC) Helen Blunden (HB) Ann Cooper (AC) Karen Hampton (KH) Head of Quality (SHCCG) Lay Member, PPE, (SHCCG) Deputy Designated Nurse for Safeguarding Children Governance & Corporate Manager (SHCCG) Chief Officer (SHCCG) GP Lead for Quality Medical Director (SHCCG) Head of Medicines Management (SDSSG) Quality & Engagement Support Officer (SHCCG) Quality & Patient Experience Manager (SHCCG) Deputy Designated Nurse for Safeguarding Vulnerable Adults (SDCCG) Governance & Corporate Manager (SHCCG) Head of Quality (SHCCG) 1. Welcome, Introductions and Apologies AH welcomed everyone to the meeting and advised that if everybody was in agreement, SF would like to electronically record the meeting for purposes of accuracy. The voice recording will be deleted once the Minutes have been approved. Everybody present agreed to the recording. AH advised that the meeting would be the last meeting for Gareth Jones, Julie Comer and Sue Fosh and thanked them for their contribution to the meetings. The committee wished them well for the future. 2. Declarations of Interest No declarations of interest were received. 3. Minutes of the last Quality & Clinical Governance Committee The Minutes from the previous meeting held on 23 June, were agreed as an accurate record with the following minor changes: Under infection Control section 7.1 CDiff update the minutes should read in the first bullet point: To seek advice from the microbiologist when a patient requires antibiotics Pg 6: Safeguarding exception: to add the date (September ) of when the host CCG will change. Page 1 of 10
Reword the section 11.2 relating to domestic violence: Over the past few years, there have been 2 domestic homicides in Surrey Heath. AH informed the committee of a pilot that has been undertaken in East Surrey CCG area where investment in GP Practice training and software to collate referrals/cases had been successful in promoting referrals and ensuring those requiring support had access to it. The statistics indicate that 1:4 females and 1:6 males are subject to domestic abuse which often is manifested in the victim visiting their GP more frequently and being more susceptible to long term conditions. AH is developing a business case proposing implementation of the service (IRIS) for GP Practice support and training across Surrey Heath. HB highlighted that SABP has a Domestic Violence Policy and currently one is being developed by the safeguarding teams for adoption across all Surrey CCGs. Clinical Risk register on page 9 risk C5 (robust patient safety and quality structures) is now being reported as C5a CCG internal structures and C5b provider structures. ACTIONS: AH to amend minutes to reflect the changes agreed. Matters Arising - Not on the Agenda: There were no issues arising which were not listed on the agenda. 4. Patient Story JF shared with the committee some examples of significant events that occur in primary care. There is still a need to encourage primary care to report incidents to enable learning. The culture to share learning across GP Practices is not common place. However, with the introduction of CQC in primary care this may change. JF suggested that the CCG should consider collecting primary care incidents and the learning. KH explained that this is encouraged through the CCG quality issues email but is not currently used. JF stated that the Medical Defence Union circulate an annual report to the GPs which shares the learning of reported incidents. KS described the process on how medicine incidents are reported through to CCG. This is time restricted as the incidents are only visible on the system for 30 days. KS explained that each practice has a folder which is accessible by the medicines management team. It was suggested that GM look at some of the incidents with KS. Page 2 of 10
KH presented the first quarterly SI and learning newsletter which included information on the learning and service changes following incidents relating to diabetes, falls, mental health, and community pressure ulcers. The committee approved the layout of the newsletter and agreed it should be circulated within the CCG and General Practice. Actions KH to review if CQC collect data on significant events and what learning from general practice through the NRLS AH/KH to work with GM on further supporting the culture to share across practices. JF to share MDU report with KH. KH to circulate the newsletter. 5. Quality Exception Reports KH presented the Quality Exception Report for the month of June. Frimley Park 4 hour A&E performance had slightly improved to 94% from the previous month. The Trust had reported a 12 hour trolley breach which is currently under investigation and will be managed through the Serious Incident reporting process. AH explained that there had been a piece of work analysing the increase in activity in A&E and the challenges to performance. The CCG has been working with Frimley and neighbouring CCG s to address the issue. The paper will be going to the Clinical Planning and Delivery Committee for discussion. JF described his experience in A&E on a clinical visit and there is a culture to admit in order not to breach. Investigations are automatic as the patients arrive but need another way to deal with inappropriate attendances. The number of CCG CDiff cases is at 8 (year target of 19) this is 2 cases up on this time last year but the pattern of cases is not the same as last year. Each case is reviewed by the GP and Medicines management to identify the learning and any lapses of care. The Surrey CCG s have completed audits on handovers between South East Coast Ambulance (SECAMb) and acute providers. One of the issues that has been identified is the time it takes to complete the paperwork on handover compared to South Central Ambulance Services who use electronic devices. The audits will be taken and discussed at the Trust CQRMs. North West Surrey CCG as Lead commissioners is working with SECAMb on the Recovery plan. The outcome of the CQC investigation is still to be announced. Work continues to improve the cancer targets at Royal Surrey County Hospital (RSCH) KH is coordinating a piece of work on behalf of the Surrey CCG s, cancer alliance and the trust cancer mangers around the process for breach re allocation. This will be presented at the cancer alliance meeting in. The CQC inspection report on Surrey and Borders Partnership (SABP) has been published. The outcome of the inspection was requires improvement. There Page 3 of 10
were elements of good practice in mental health areas for improvement were around learning difficulties and social care homes. The Trust is taking it in positive way. The improvement plan will be monitored through CQRM. CQC inspections have been completed on six out of eight general practices Congratulations to JF and AB on their CQC results. There were no risks to review on the quality risk highlight report KH to review the trolley breaches at FPH under the SI process 6. Independent and Out of Hours report annual report KH explained that Clare Park Hospital (Spire) has downgraded its High Dependency Unit (HDU) to an enhanced recovery unit; they have a contract with Frimley for the transfer of patients to the HDU if required. CQC have been informed of the change. Clare Park will also be opening an endoscopy unit in November. 7. Serious Incidents Reporting and Learning Annual Report KH told the committee that the internally CCG process for monitoring and reviewing serious incidents had been strengthened. This included a notification to the practice of the patient that the incident related to. Practices will also be involved in the investigation were necessary and have the ability to review and comment along with the CCG clinical leads on the investigation report prior to closure with the provider. This was working well. The first edition of the learning from incidents was ready to be circulated. JC has worked with GM to ensure that the content and layout appealed to general practice. The newsletter was discussed under agenda item 4 Frimley Health has had an increase in the number of never events reported during 2015/16. These are being addressed through the Trust s on going work around the WHO checklist and the National Safety Standards for Invasive Procedures. KH to circulate newsletter to Practices. 8. NHS Safety Thermometer Annual Report The report was presented. It was identified that the data was limited. KH explained that the data capture was completed on one day of the month with the aim of themes being reviewed for improvement as the data built. AH told the group that the Patient Safety department at NHSE will now be part of NHS Improvement. 9. Sign up to Safety CCG plan Page 4 of 10
This item was deferred to the meeting when the Patient Safety collaborative will be attending and it will be the focus of the meeting. More organisations have now signed up to national Sign up to Safety pledges including neighbouring CCG s. Frimley Health has been awarded additional money to support the Trust plan. KH to add to the agenda 10. Provider Annual Patient Experience report KH provided an overview of the paper which outlined the themes across complaints, PALs, and patient experience within our providers. Key points: There was a high level of satisfaction across all providers with positive comments and ratings on NHS choices. Frimley Health has seen a reduction in the number of complaints being referred to the ombudsmen. Patient experience at Virgin Care is not currently being broken down into CCG level. This is being addressed and local measures are being put in place. GJ said that health watch collect patient experience data on a Surrey wide basis but as yet this is not broken down by CCG area. 11. Central Alerting System (CAS) The CAS Policy was presented and agreed by the committee. The committee will receive an annual report on compliance or by exception where required. KH to send policy to AC for adding to the CCG policy folder. KH to add CAS annual report to the workplan. 12. Safeguarding 12.1 MASH The Launch of the Multi Agency Safeguarding Hub (MASH) will be launched on the 5th. AH asked what the communication will be to CCG s and Primary Care regarding the MASH. LC to enquire. The MASH will be for adult and children referrals. 12.2 Adult Surrey Heath has one care home that is under a large scale safeguarding enquiry led by Surrey County Council. KH attends these meeting on behalf of the CCG. This will be monitored through OLT. 12.3 Children Page 5 of 10
LC presented the report highlighting the key elements; From September children safeguarding will be integrated with adult safeguarding and will be hosted by Guildford and Waverley CCG. There will be a Looked after Children Ofsted inspection of Surrey County Council in September. The focus will be on the timeliness & quality of Health Assessments and care leavers access to health histories. It was also acknowledged that 43% of Surrey looked after children are placed out of county with most unaccompanied asylum seeking children entering Surrey placed out of county. This matter is being addressed through the Corporate Parenting Board and Unaccompanied Asylum Seeking Children project Group. A paper will be taken to execs proposing how the extra funding from NHSE will be best spent collectively across Surrey to increase named GP sessions for safeguarding Children. The proposal has been agreed by the Surrey CCG Directors of Quality and Nursing. LC to enquire about communications of launch of MASH 13 Governance The risk register was discussed. There was no change in the scoring since last presented. C6b (safeguarding arrangements for adults) remains red however this will be reviewed following the integration of the adult and children teams. 14 Medicines Management KS went through the PCN recommendations. Liothyronine is a high cost drug and covers a small group of patients it has been recommended that endocrinologists are to see the patient before the GP in order to prescribe. Other CCGs have accepted this recommendation. JF stated that a more robust process behind the use of this drug would be helpful. JF and AB questioned whether we actually use this drug. KS will review the use of the drug. KS to discuss with prescribing leads at Frimley to discuss if this drug should not be routinely prescribed. There has been a change of status due to NICE guidance. Sacubitril/ Valsartan now have a cost impact and requires more robust decision making before can be used. Further work to be done by medicine management The PCN has approved a COPD guideline, the development led by a Surrey Heath Pharmacist, Noreen Devanney Ciclosporin Eye drops NICE Technical Appraisal (TA). Funding of this treatment has been mandated. As a result of this product now being licensed, the traffic light status has changed from RED (Unlicensed) to blue (or amber without shared care in the Frimley Health Formulary).The availability of a licensed product may reduce the number of patient followup appointments. The cost is approx 106K per annum for Surrey Heath. Page 6 of 10
AB expressed concern of financial risk. JF stated that a robust framework is needed to prescribe this. KS raised that he had seen a safety alert regarding the treatment of acute kidney patients. There are education and training requirements on the drug element relating to the alert. KH stated that AKI was a CQUIN last year and Frimley Health had incorporated this within their safety campaign. KS to review safety alert and update KH. Update next meeting. GJ asked about the costs of Drs prescribing items that can be purchased over the counter. KS explained that nationally GP s can prescribe a certain number of medication at one time (CCG was 8 items) and that if there is a clinical need the GP is obliged to prescribe. KS to discuss with Frimley the use of Liothyronine and feed back to the committee. KS to look at framework for Circlosporin eye drops 15 Quality items for the Governing Body Report AH advised that the Governing Body quality report is to be submitted next week. Key highlights from this meeting will be included : Friday 21 CR2 2-4pm Dates : Friday 16 CR2 2-4pm Minutes Agreed and Signed : Chair: Date: Print Name: Page 7 of 10
Action Number Agenda item Action Who Action owner Deadline Date to be completed Update & follow up Status Date completed 23/06/ /01 Minutes of previous meeting KS to provide clarification re Page 8, Section 13 Going forward 16/17 There is a high level audit work going ahead and working with practices as patient numbers are high. AH would like to find out details of the audit. Keeping this action open AH/KS August meeting 23/06/ /12 10. Safeguarding HB and LC to provide copies of grading of risks and copy of risk register HB & LC To be carried over to next meeting 19/08/ /16 4. Patient Story KH to review if CQC collect data on significant events and what learning from general practice through the NRLS KH to update on progress KH 19/08/ /16 4. Patient Story AH/KH to work with GM on further supporting the culture to share across practices. AH/KH - update back in 6 months time AH/KH April 2017 meeting Page 8 of 10
19/08/ /17 4. Patient Story JF to share MDU report with KH. JF KH to be contacted for an update 19/08/ /19 5. Quality Exception Reports KH to review the trolley breaches at FPH under the SI process (this will be at the November SI panel meeting) KH 19/08/ /24 14 Medicines Management KS to discuss with Frimley the use of Liothyronine and feed back to the committee Discussed at meeting carried over to the next meeting KS meeting 19/08/ /25 14 Medicines Management KS to look at framework for Circlosporin eye drops To consult with Medicines Management team KS Page 9 of 10
19/08/ /25 14 Medicines Management KS to review AKI safety alert and update KH. Update next meeting To consult with Medicines Management team KS Page 10 of 10