NHS DORSET CLINICAL COMMISSIONING GROUP PRIMARY CARE COMMISSIONING COMMITTEE 6 APRIL 2016 PART ONE PUBLIC MINUTES Part 1 of the Inaugural meeting of the Primary Care Commissioning Committee of NHS Dorset Clinical Commissioning Group was held at 14:00hrs on 6 April 2016 at Vespasian House, Barrack Road, Dorchester, Dorset, DT1 1TG. Present: In attendance: Jacqueline Swift, Chair of the Joint Primary Care Commissioning Committee (JS) Tim Goodson, Chief Officer (TG) Sally Shead, Director of Nursing and Quality (SSh) Paul Vater, Chief Finance Officer (PV) Craig Wakeham (GP), Long Term Conditions, Frailty and End of Life CDG Chair (CW) Mike Wood, Director of Service Delivery (MW) Councillor Jill Haynes, Dorset Health and Wellbeing Board (JH) Chris Hickson, Head of Management Accounts, Financial Planning and Primary Care (CH) (Part) Conrad Lakeman, Governing Body Secretary (CGL) Dr Claire Lehman, Medical Director, Local Medical Committees (CL) Steph Lower, Executive Assistant (SL) Sally Sandcraft, Deputy Director of Review, Design and Delivery (East) (SSa) Emma Shipton, Deputy Director of Engagement and Development (ES) (Part) Stephen Tomkins, Locality Lead for Christchurch (ST) (Part) Nigel Watson, Chief Executive, Local Medical Committees (NW) Chris Williams, Executive Director, Healthwatch Dorset (CW) 1. Apologies Action 1.1 Anu Dhir, Primary Care Lead David Jenkins, Vice Chair, Joint Primary Care Commissioning Committee Andy Rutland, Primary Care Lead 2. Quorum 2.1 It was agreed that the meeting could proceed as there was a quorum of Committee members present. 1
3. Declarations of Interest 3.1 - As Chair of Health Education Wessex (HEW) the Committee Chair declared an interest in item 7.6 Proposals to establish a Primary Care Workforce Centre for Dorset. 4. Minutes - As a Board member of HEW, the Chief Executive of the LMC declared an interest in item 7.6 Proposals to establish a Primary Care Workforce Centre for Dorset. 4.1 The draft minutes of Part 1 of the Joint PCCC meeting held on 3 February 2016 were approved for signature by the Chair as a true record. 5. Matters Arising 5.1 11.1 Local Health Resilience Partnership the Director of Assurance and Delivery (NHS England South (Wessex)) had asked that this item be deferred to a future meeting. CGL 5.2 The Committee noted the Report of the Chair on matters arising from the Part 1 minutes of the previous meeting. 6. Chair s Update 6.1 The Chair introduced her update. 6.2 She was pleased to advise that Dr Anu Dhir was continuing to recover and hoped to return to work in the near future. All passed on their best wishes for his continued recovery. 6.3 It was noted there was no Public Health agenda item due to the non-availability of a Public Health attendee for the meeting. 6.4 The Chair had recently attended an NHS England Conflicts of Interest seminar. New guidance would be published in June. 6.5 The Committee noted the Chair s update. 7.1 Primary Care Commissioning Committee (PCCC) Terms of Reference 7.1.1 The Governing Body Secretary and General Counsel introduced the report on the PCCC Terms of Reference. 7.1.2 The Committee noted the PCCC Terms of Reference. 2
7.2 Full Delegation Working Arrangements 7.2.1 The Deputy Director of Review, Design and Delivery (East) introduced the report on Full Delegation Working Arrangements. 7.2.2 She said due diligence processes were underway with NHS England South (Wessex). 7.2.3 A Collaborative Agreement was being developed that would describe the operational model for the delegation of specific functions and tasks to the CCG, and would set out the roles and responsibilities of both organisations across all the contracting, finance, quality and governance functions. 7.2.4 The CCG Primary Care Team had been restructured to enable a responsive service for practices. A practice helpline had been introduced and went live on 1 April 2016. 7.2.5 A Primary Care Operational Group was now meeting regularly and included representatives from the CCG, the LMC and NHS England South (Wessex). 7.2.6 It was noted that the first meeting of the Primary Care Reference Group would be held shortly. The Group would include GP and Practice Manager representation and would lead on the Primary Care Strategy. There was recognition that membership of the group would need to be multi-disciplinary to reflect general practice. 7.2.7 The Committee noted the report on Full Delegation Working Arrangements. 7.3 The Future Development of Primary Care 7.3.1 The Director of Service Delivery introduced the report on the Future Development of Primary Care 7.3.2 The paper outlined the key principles and processes to develop a Primary Care Strategy. 7.3.3 The Committee was concerned that there remained only a written plan for developing a Strategy but no actual draft Strategy. A priority for the new Interim Head of Primary Care would be to focus on the Strategy development. SSa 7.3.4 The Strategy would need to convey the dynamic complexities of primary and community care. 7.3.5 It was noted that local champions were being created to work across all aspects of the frail and elderly. 3
7.3.6 The Committee was concerned regarding the challenges of moving services out of hospital, with the phlebotomy service given as an example. 7.3.7 This was expected to be covered by the Primary Care Reference Group. The Deputy Director of Review, Design and Delivery (East) said discussions were underway internally to test how to implement new models of care. 7.3.8 There would need to be a clear understanding of what was meant by Primary Care, General Practice and Community Care. The Five Year Forward View was clear regarding investment in out of hospital care and this would link to the Sustainability and Transformation Plan. Dorset would need to be bold to enable transformational change. 7.3.9 The Committee noted that the Integrated Community Services work would inform the Primary Care Strategy and the two would be developed together. 7.3.10 The Committee noted the changes this year in acute contracting with payment by results. 7.3.11 The Committee directed that the first draft Primary Care Strategy be reviewed by the Chief Officer before submission to the PCCC meeting. SSa/TG 7.3.12 The Committee approved the development of a Primary Care Strategy. 7.4 Primary Care Finance Update 7.4.1 The Chief Finance Officer introduced the Primary Care Finance Update. 7.4.2 Since the report had been written, further information had been received from NHS England regarding the Doctors, Dentists Remuneration Board (DDRB) national uplifts. It was noted that the estimated percentages provided in the table at 1.4 were in line with the published figures. 7.4.3 It was noted that general practice prescribing was the largest financial risk for the organisation. 7.4.4 Following concern that the general membership was unclear regarding the various primary care funding streams, the Deputy Director of Review, Design and Delivery (East) was directed to work with finance colleagues to prepare a position statement for practices for clarification. SSa 4
7.4.5 The LMC recognised the additional funds NHS Dorset CCG had put into primary care. C Hickson left the meeting. 7.4.6 The Committee noted the Primary Care Finance Update. 7.5 Update on the Estates Strategy and Transformation Fund bids 7.5.1 The Director of Service Delivery introduced the Update on the Estates Strategy and Transformation Fund bids. 7.5.2 The bid to NHS England for funding to support general practice improvement and development work was still being developed. Outline criteria had been received but full guidance was awaited. There had been a delay to the original submission date and it was now expected to be late April 2016. 7.5.3 The Committee noted that the total investment figure of 55M in the capital investment plan (Figure 3) would have a subsequent revenue impact of approximately 10%. 7.5.4 It was noted that each scheme would be assessed on a needs basis, with practices being encouraged to bid where the needs had been established. 7.5.5 It was noted the work with McKinsey regarding the Integrated Community Services outputs would be concluded shortly. 7.5.6 The Deputy Director of Review, Design and Delivery (East) said there was significant activity underway and improvement schemes were now starting to be mobilised. 7.5.7 Under 2.18, the Committee directed that membership of the Overview Group must include a finance representative. SSa/PV 7.5.8 The Committee:- (a) approved the Update on the Estates Strategy and Transformation Fund bids; (b) approved the creation of a CCG Overview Group and delegated to it authority to determine the recommendations/ bid to NHS England, subject to counter signature by the Accountable Officer. SSa/TG 5
7.6 Proposals to establish a Primary Care Workforce Centre for Dorset 7.6.1 Under item 3 Declarations of Interest, the Committee Chair and Chief Executive of the LMC had both declared an interest in this item. Both withdrew and handed the Chair to the Chief Officer. 7.6.2 The Locality Chair for Christchurch introduced the report on Proposals to establish a Primary Care Workforce Centre for Dorset. 7.6.3 The aim of the proposal was to develop the existing GP Centre in Dorset, increase infrastructure and enhance the collective expertise of the key partners involved. 7.6.4 By August 2016, the plan was to deliver a Dorset Graduate Programme for GPs and to be able to offer a graduate programme for practice nurses the following summer. Mentoring would also be part of the programme. 7.6.5 Rather than being an investment only decision, both the Chief Officer and Chief Finance Officer said it should have been documented in the frontis regarding the option to use the underspent locality budget. 7.5.6 The Committee approved the report and the proposals to establish a Primary Care Centre for Dorset using any underspend from the locality budgets. The Committee Chair and LMC Chief Executive returned and the Chair was handed back. E Shipton and Dr S Tomkins left the meeting. 7.7 Medicines Optimisation Group (MOG) 7.7.1 The Director of Nursing and Quality introduced the report on the Medicines Optimisation Group (MOG). 7.7.2 She said the revised draft Escalation Plan for those practices/prescribers who were not prescribing in an optimal way had been approved by the MOG with input from the LMC. 7.7.3 The Committee directed the Director of Nursing and Quality to make representations for a national push for GPs not to be asked to prescribe stoma products. SSh 7.7.4 MOG had carefully considered the planned medicines audits for 2016-17 and the final audits presented for approval by the Committee were Antibiotics and the PINCER software tool. 6
7.7.5 The Committee suggested that the MOG should undertake a different procedure rather than process audits, as it was felt practices did not learn much through the audits. One area could be to look at containing the costs of medicines. 7.7.6 The Director of Nursing and Quality agreed there was value in undertaking the right audits and was directed to feedback the comments to the MOG. SSh 7.7.7 The Committee approved the recommendations set out in the report on the MOG as follows:- (a) The Escalation Plan; (b) The Savings Plan; (c) The Audit brief; (d) The proposal to make the delivery of the Savings Plan and completion of the audits part of a standalone prescribing improvement plan that practices could sign up to using the 40p per patient incentive as per the previous financial year. 8. Local Medical Committees (LMC) 8.1 The Chief Executive introduced the LMC update. 8.2 There was concern at the sustainability and vulnerability of general practice. 8.3 NHS England in collaboration the CCG and LMC had identified vulnerable practices through the NHS England Vulnerable Practice Scheme. 8.4 The LMC was looking to create a SWOT team to assist those practices who did not qualify for assistance under the national scheme. 8.5 The majority of CCGs across Wessex had offered a basket of services approach to practices. It was noted that Dorset had done well in taking the opportunity to strengthen relations with primary care by augmenting the funding for the basket using additional funding. 8.6 In a number of areas the contract for NHS Healthchecks had been awarded to Boots rather than GP federations and this had not been received well. The LMC would be meeting with Public Health to discuss. 8.7 There would be lessons to be learned by those who submitted unsuccessful bids. 7
8.8 The LMC had recently held an event for younger GPs to ascertain what they wanted for the future and it was noted portfolio roles had been a common theme. 8.9 The Committee noted the LMC update. 9. Any Other Business 9.1 The Director of Nursing and Quality said there had been new guidance regarding a Freedom to Speak Up Guardian. All practices would be required to have a Whistleblowing Policy in place by next year. 10. Date and Time of the Next Meeting 10.1 The next meeting of the Primary Care Commissioning Committee will be held at 2pm on Wednesday 1 June 2016 at Vespasian House. 11. Exclusion of the Public 11.1 Resolved : that representatives of the Press and other members of the public, be excluded from the remainder of this meeting having regard to the confidential nature of the business transacted, publicity of which would be prejudicial to the public interest. 8