NHS DORSET CLINICAL COMMISSIONING GROUP GENERAL MEDICAL AND SURGICAL CLINICAL COMMISSIONING PROGRAMME (CCP) 26 JUNE 2014 A General Medical and Surgical CCP Meeting took place on Thursday 26 June 2014 at 2.00pm at Vespasian House, Bridport Road, Dorchester DT1 1TG. Present: Chris McCall (CM) Chair Frances Aviss (FA) Diane Bardsley () Tony Bowering (TB) Hilary Clark (HC) Anna Doherty (AD) Chris Emblen (CE) Vicki Fearne (VF) Basil Fozard (BF) Chris Fuller (CF) David Haines (DH) Richard Holmes (RH) Paul Lear (PL) Susan O Flanagan (SO) Steve Scott (SSc) Sally Shead (SS) Frances Stevens (FS) Hazel Thorp (HT) Richard Wakelam (RW) Angus Wood (AW) GM&S CCP Clinical Chair, NHS Dorset CCG Engagement and Communications Manager, NHS Dorset CCG Senior Programme Lead GM&S CCP, NHS Dorset CCG GP Broadmayne Surgery and CCP link for West cluster localities GP Poole Town Surgery and CCP link for Mid cluster localities Principal Programme Lead GM&S CCP, NHS Dorset CCG Dorset Adult Integrated Respiratory Service GM&S CCP, NHS Dorset CCG Consultant in Public Health, NHS Dorset CCG Medical Director, Royal Bournemouth and Christchurch Hospital NHS Foundation Trust (RBCHFT) Senior Finance Manager, NHS Dorset CCG GP Swanage Medical Centre and CCP link for Mid cluster localities GP Talbot Medical Centre and CCP Link for East cluster localities Medical Director, DCHFT Senior Programme Lead GM&S CCP, NHS Dorset CCG GP Prince of Wales Surgery Senior Quality Manager, NHS Dorset CCG Deputy Director Review Design and Delivery, NHS Dorset CCG Head of GM&S CCP, NHS Dorset CCG Deputy Head of Management Accounts & Financial Reporting, NHS Dorset CCG Deputy Medical Director, Poole Hospital NHS Foundation Trust (PHFT) In Attendance: Kirsty Williams Apologies Riaz Dharamshi Tracy Hill Nikki Rowland PA/Team Administrator General Medical and Surgical Team (minute taker) Consultant Geriatrician, Dorset Healthcare University NHS Foundation Trust Principal Programme Lead GM&S CCP, NHS Dorset CCG Deputy Director of Finance, NHS Dorset CCG 1. Welcome and Introductions CM Welcomed everyone to the meeting. It was noted that Dr Hilary Clark would be the second Mid Cluster representative. Actions 1
2. Declaration of Interests No updates of interests were declared. HC to complete a Declaration of Interest form. 3. Chair s Update An update was given by the chair, the key points covered were: Lipoma Pathway and ultrasounds - Concern has been raised by the radiologists at PHFT regarding the high number of requests for ultrasound examination of benign lipoma lesions. A management pathway has been drafted and is currently being discussed with relevant clinicians within secondary care. Local Enhanced Services GPs have now been issued with contracts that contain service specifications for local enhanced service, such as Minor Surgery. Work is ongoing to look at elements of minor surgery procedures. Faecal Calprotectin There has been some enquires about its current availability as a test for GPs and therefore it has been placed on the prioritisation list for the September Priority Event as it will have financial and pathway implications. Pinnaplasty As part of the cosmetic criteria based protocol Pinnaplasty has been confirmed as an exclusion. ENT - PHFT have been advised that any projects they wish to undertake in ENT will need to be identified through the prioritisation event. 4. Minutes of the meeting held on 19 December 2013 The group agreed the minutes were an accurate record of the meeting. 5. 5.1 Matters Arising Revised Terms of Reference The CCP has increased its GP cluster representation to two members. HC is the second for the Mid Cluster but additional representation is still needed for East and West, HT to chase. The revised Terms of Reference were agreed subject to the following amendment: HT Section 3.2 removal of Appendix A. 6. 6.1 Reports back from Task & Finish Groups Progress Report on Dorset Adult Integrated Respiratory Service CE presented an update on Dorset Adult Integrated Respiratory Service and the following points were noted: Leadership Group has been formed and met 3 times. The group consists of consultants, GP lead, senior nurses and the CCG; All three acute trusts have accepted the service spec and CV issued to all. All three trusts are now actively recruiting into the identified posts with RBCHFT completely reorganising their respiratory department to support the merging of REDS and DAIRS; GPs at cluster and locality level, and the patient reference groups have been briefed; The plans for the respiratory education programme are currently under development with the senior consultants and primary education providers; The GP Lead, Dr Holmes and the Project Manager, Chris Emblen, have been appointed; The project is on schedule to be fully up and running by April 2015. It is currently on schedule to start accepting referrals by August 2014, in at least one of the MDTs. With all up and running in a limited capacity by November 2014; The two major risks are recruitment and a coherent patient record system. 2
7. 7.1 To Note and Approve Tender Waiver Document for Dorset Adult Integrated Respiratory Service AD presented the Tender Waiver Document and reminded the members that the original Contract Waiver document that was approved by the GM&S CCP in 2013 was for a one year period from April 2014-2015. At the GM&S CCP in December 2013 the members had asked that this one year period be extended for a second year. This waiver covers the period April 2015-16. The waiver of tender was approved. 7.2 Dermatology Review A briefing paper on Dermatology Services was presented by. The following recommendations were agreed: GM&S CCP to lead the review but work closely with Cancer and End of Life CCP; Take the review forward, outside of prioritisation process; Establish a Clinical Reference Group and Patient Reference Group to support the project; To produce a worked up Project Initiation Document, Terms of Reference for Clinical and Patient reference groups and a review to take place to map out the current position, time scales, the way forward and option appraisals for the next CCP meeting in August 2014. 7.3 TB Briefing Paper provided a briefing paper on TB and the group came to the following agreements: Work is needed on how Primary Care will be supported; The project is to await publication of the national strategy before developing the service specification and service review; Put forward for the prioritisation event in September. 7.4 Community Headache Service Specification DH presented the service specification for Community Headache which is to cover Chronic Headache. The following points were noted: The service specification has been developed with input from clinicians and patients; It is based on a MDT approached, similar to the chronic pain service; A key element will be ensuring a comprehensive education programme delivered to primary healthcare professionals to ensure NICE guidances are adhered to; The group approved the service specification subject to section 2.2 including some baseline figures. It was agreed that a business case will now be developed to be presented at the next CCP meeting in August 2014. It was recognised that due to current financial constraints the implementation of this service will be dependent on the feasibility of service redesign to release funding. 7.5 Neurology Update The neurology update was noted. 3
7.6 Access To Urgent Advice for Primary Care Clinicians SSc presented a report on the work of the Task and Finish Group. The following key points were agreed: Section 6 Conclusion - the group are fully supportive of points 1, 2, 4 and 6; Work to be done to clarify the current payment structure especially inclusions and exclusions relating to CAB costing s within contracts to link with finance and report at next CCP meeting in August 2014; RBCHFT would like feedback from GPs on how their new ambulatory care developments are working; Domiciliary visiting is seen as crucial and needs recognition CM to feed back to Clinical Service Review, Urgent Care Board and Better Together Programme. CM 7.7 Urgent Ophthalmology Services and Community Ophthalmology Services SO presented the two papers together as they were interlinked. The Ophthalmology briefing paper and the service specification for Community Ophthalmology, Triage, Treatment and Referral Service was agreed. In addition it was agreed: That all current providers will be required to provide services in accordance of the newly approved specification as of April 2015; Localities wishing to pilot services must use the new service specification and funded from locality resources only; Any further expansion of community ophthalmology services will be dependent upon the outcome of the clinical services review; In support of point 10.1 and 10.2 of the briefing paper, DCHFT and RBCHFT agreed to discuss collectively the provision of an out of hours Ophthalmology service for Dorset Residents. BF/PL 8. 8.1 For Discussion Stakeholder Event on Wednesday 3 September 2014 Colleagues have been invited to attend this event with views and proposals from their organisation for the next GM&S CCP year. Anything that was not set high enough to be prioritised for 2014/15 will be put forward again in September. A list of topics suggested since the last stakeholder event has been collated HT to send out with minutes for information. The group noted that the financial position of foundation trusts could impact upon future services and their design. HT 9. For Information and to note The group noted: The response to National TB Strategy; Aspyre Update. 4
9.1 CCP Quality Report Following a discussion around the Quality report, the group agreed on the following: The report had a lot of information included that is not in the remit of the CCP; Future quarterly quality reports for the CCP should include: Exception Report; Combined Quality Report; Financial Risk Report. Headway risk rating will be reduced over the next few months as the new provider starts the service on 1 July 2014 Mobilisation going ahead smoothly. 10. Any Other Business No further business was discussed. 11. Date of the next meeting The next General Medical and Surgical CCP Meeting will be held on 7 August 2014 commencing at 2:00pm at Vespasian House Meeting Rooms 12/13. 5