LAMBETH LOCAL MEDICAL COMMITTEE (LMC)/BOROUGH STANDING JOINT LIAISON COMMITTEE MEETING (BSJLC)

LAMBETH LOCAL MEDICAL COMMITTEE (LMC)/BOROUGH STANDING JOINT LIAISON COMMITTEE MEETING (BSJLC) PART II To be held at 2.45 pm on Tuesday 26 June 2012 at Room ST01 & 2 ground floor 2-8 Gracefield Gardens, Streatham SW16 2ST 1.0 Apologies 1.1 To receive apologies for absence AGENDA 2.0 Declarations of Members Interest 2.1 Members to declare any conflicts of interest in connection with any items on the agenda in light of subsequent debate 3.0 Minutes and matters arising not listed elsewhere on the agenda: 3.1 To confirm the minutes of the SJLC meeting held on 24 April 2012 (page 2-7) 4.0 Business Support Unit (BSU)/ Lambeth Clinical Commissioning Collaborative (LCCC) 4.1 To receive a BSU finance update (to follow) 4.2 Strategic Plan for 3-5 years (page 8-42) 4.3 LCCC update (to follow) 4.4 CCG Constitution (page 43-59) 5.0 Operational Issues To receive an update on the following: 5.1 PMS Contract Review 5.2 Integrated Care Pilot (ICP) update 5.3 GP Contract Steering Group 6.0 Dates of future meeting: 6.1 BSJLC meeting: (Tuesday 26 June 2012) Tuesday 21 August 2012 Tuesday 23 October 2012 Tuesday 18 December 2012 Cluster meeting (Chairs/V-Chairs only) Tuesday 17 July 2012 Tuesday 2 October 2012 Tuesday 4 December 2012 7.0 Any other business: At least 24 hours notice should be given of matters to be raised under this item. The professional voice of general practice in Lambeth Londonwide LMCs is the brand name of Londonwide Local Medical Committees Limited Registered and office address: Tavistock House North, Tavistock Square, London WC1H 9HX. T. 020 7387 2034/7418 F. 020 7383 7442 E. info@lmc.org.uk www.lmc.org.uk Registered in England No. 6391298. Londonwide Local Medical Committees Limited is registered as a Company Limited by Guarantee Chief Executive: Dr Michelle Drage

LAMBETH LOCAL MEDICAL COMMITTEE (LMC)/ BOROUGH STANDING JOINT LIAISON COMMITTEE MEETING (BSJLC) Part II Held at 2.45 pm on Tuesday 24 April 2012 at Gracefield Gardens, Streatham, SW16 2ST LMC Members: Dr Di Aitken Dr Azhar Ala Dr Arun Gadhok Dr Tyrrell Evans Dr Miriam Ish-Horowicz Dr Nigel Konzon Dr Jenny Law (Chair) Dr Himanshu Patel Dr Emma Rowley-Conwy Dr Neil Vass Dr Duveken Voors Ms Lyn Eustace Londonwide LMC Representatives Ms Julie Freeman Mrs Lesley Williams Mrs Jenny Foley Other Representatives BSU Ms Moira McGrath LCCCB Dr Adrian McLachlan Cluster Mr David Sturgeon Ms Rylla Baker Kings college Hospital NHS Foundation Trust Mr Jim Lusby Guy s and St. Thomas NHS Foundation Trust Ms Angela Dawe ACTION NOTES 1.0 Apologies 1.1 Apologies were received from Dr Lee Winter and Dr Dora Waitt. 2.0 Action notes and maters arising 2.1 The action notes from the previous meeting held on 21 February were noted. 3.0 Community Services 3.1 Integrated care Draft IC LES Dr McLachlan informed the committee that the charity had awarded money to the ICP which would be used to focus on frail and elderly people with LTC. They were looking for 600k to improve conditions and treatment for older people in Lambeth. Dr Law indicated that Southwark LMC had also considered the proposal and there was support from them for this approach, but they did have similar concerns. 2

Dr Konzon raised concerns about the amount of work that would be involved and the extra work GPs and nurses would have to undertake with no additional funding. Other concerns raised were; the evidence for the assessment tools which appeared to looked more like a research project, the number of meetings GPs were expected to attend which seemed to be duplication of work that was already taking place within primary care team meetings. Dr Evans pointed out that there were concerns about how the project would backfill nurses in practices, if nurse were taken out of practices to fill/meet the nursing commitment required for the ICP. Dr Law explained that the general view from the LMC was that some areas of the proposal were over complicated and could be tailored. They also had concerns about ensuring that experienced and appropriate nurses were employed. The timing for the additional dementia assessments was unrealistic. Mr Lusby thanked the LMC Members for their responses and early discussions with KHP. He explained that the holistic assessment was a good example of collaborative work with different groups including SLaM. He accepted the points made about the number of meetings and hoped to be able to have some of those meetings by conference calls or webcam. Dr Konzon asked how beneficial was it to have a meeting with around 20 people to discuss one elderly person s case. He indicated that this was just creating another layer and there were already different groups in primary care that could be used. Ms Dawe explained that they were trying to bring key partners such as representatives from the Local Authority, social workers and mental health teams together. Dr Rowley- Conwy suggested building on existing practice teams. Mr Lusby indicated that KHP was not intending to impose new meetings or be prescriptive and would be happy to use existing teams. Ms McGrath pointed out that based on the information in the system, the PCT were able to identify patients who may be at risk, such as people who were not being diagnosed with dementia particularly from ethnic minority groups. Mr Lusby indicated that a number of these issues were also raised at Southwark LMC and he invited Members to have joint discussions. Ms Dawe indicated that she would be attending a locality meeting with Dr Evans and offered to provide figures for the community workforce at that meeting. Ms Dawe also reported that she was putting in additional resources around safeguarding for adults and would gradually be building up a number of strategies as part of the 3

foundation trust. She also pointed out that the trust would be looking to offer a new programme to provide training across both the acute services and nursing development. Dr Aitken indicated that she had a particular interest in the development and leadership of nurses for the future, but currently existing nurses were shared across practices. Ms McGrath informed the committee that someone had just been appointed to look at nursing across the Cluster as a number of issues had come up at the practice nurses forum. Action: i. It was agreed that LMC members would send their comments to Mrs Williams at the LMC office to collate with comments from Southwark LMC and forward on to Mr Lusby. LMC Members ii. Dr Law agreed to take this forward through the GP Contract Steering Group and report back to the next LMC meeting. Dr Law 3.2 Home Ward and Enhanced rapid response Ms Dawe informed the committee that there were 2 pilots and that the number of referrals were increasing, to date there were 29 referrals. The evaluation would be ready by the summer and the plan was to roll it out in early Autumn. Ms Eustace raised concerns about pharmacists not stocking IV antibiotics and Ms Dawe agreed to follow this issue up and get back to Ms Eustace. Ms Eustace 4.0 Business Support Unit (BSU)/ Lambeth Clinical Commissioning Collaborative (LCCB) 4.1 BSU finance The committee noted the report. 4.2 LCCCB update In addition to the update in the agenda, Dr McLachlan informed the committee that the CCG was waiting for final guidance on the constitution. The appointments to the key roles were expected to take place this year. He reminded the committee that all Board meetings were would be public and that reports from locality meetings would be brought to the Board. Dr Law asked for clarification regarding the task and finish group for the LESs mentioned in the update. Ms McGrath indicated that the task and finish group was an internal group within the BSU. In response to concerns about DMARDs, Ms McGrath explained that this would be sorted out in May however there were no plans to back date payments. 4

Dr Aitken commented on the mental health service that was available for older adults. She pointed out that there was a high population of young people with mental health in Lambeth and asked about services for them. Ms McGrath indicated that the younger population were not part of the planned programme yet, currently they were looking to address early intervention with the Local Authority. The LMC indicated that the LCCCB updates were very useful and suggested that they were circulated to all practices. 5.0 Operational Issues 5.1 PMS Contract Review Mr Sturgeon informed the committee that over the last five months negotiations for the PMS review had been taken place through the PMS group. He indicated that there had been some movement on the commissioning intentions and KPIs. Mr Sturgeon and Ms Hornick had met with practices who wanted to meet with them to discuss the review. Mr Sturgeon indicated that work was now taking place on the contract documentation and through meetings and discussions with practices additional non-core work had been identified. The practices had been asked to provide evidence in order to apply for transitional funding which would only be available this year. Dr Law asked how much the transitional funding would be. Mr Surgeon explained that negotiations were still taking place but it could be between 20-25%. Mr Sturgeon confirmed that the commission intentions and the KPI framework had been agreed with Capsticks and was now ready for signing off. The next stage would be to issue this to practices but he needed to liaise with Dr Law about a deadline for practices to submit their bids for transitional funding. The next PMS meeting was scheduled for 7 May and he hoped to have a decision then. Dr Law confirmed that she had asked at the PMS group for a set of principles for submitting bids and had agreed to do some work on setting the principles by email. Mr Sturgeon indicated that he was happy to agree the principles and set a date for submitting bids by email. He advised that practices that had already submitted bids might wish to resubmit them against the agreed principles/criteria. Ms Freeman pointed out that the allocation of transitional funding would be up to Cluster. Mr Sturgeon suggested that it would not be appropriate for a Lambeth LMC Member to sit on the panel that decided or agreed the principles. It was agreed that a non-lambeth LMC GP would be asked to attend the meeting to discuss allocation of transitional funding. 5

Subsequent to the LMC meeting Dr James Heathcote, Medical Director for Bromley LMC was the LMC representative for the panel. Mr Sturgeon added that he hoped to complete the PMS review as soon as possible Ms Freeman explained that the contracts would be looked at by Lockhart s once Capstick s had cleared them. She added that the framework that had been used for Southwark s PMS review could also be used for a speedy process. 5.2 GP Contract Steering Group This is currently the PMS sub group. See minute 5.1 above. 5.3 Virtual Wards update This was discussed under item 3.2 5.4 Update on 111 Ms McGrath indicated that tenders were due by the following week and that a decision was expected by the end of June. Mr Sturgeon reported that at the last Cluster meeting they had agreed to arrange to meet with representatives from SE LMCs to discuss the effects on opted-in practices. 6.0 Dates for the next meeting: 6.1 The date for the next BSJLC meeting on Tuesday 26 June was noted. 7.0 Any other business 7.1 Payment Issues Dr Rowley-Conwy informed Mr Sturgeon that practices had not yet received any PMS statements. Mr Sturgeon indicated that the exeter system was being used and it may be that the statements can only be views through the system. Mr Sturgeon also reported that practices had indicated that they would prefer to remain with payments being made on 15 th of the month. Action: Mr Sturgeon agreed to check and report back to the LMC about when PMS statements will be available for practices. Mr Sturgeon 7.2 Practice payments Dr Law asked who would be managing practice payments in the future. Mr Sturgeon indicated that Cluster was working on the transition for payments to the NCP. There were 18,000 contracts across the sector. 1800 had identified risks in the following areas; legal, clinical risks where LESs exits without specifications, provider cash flow. Cluster would be contacting those practices to remove these risks so that they can hand over perfect contracts to the NCP by 2013. 6

Mr Sturgeon pointed out that there were risks around PCT premises with no lease arrangements. These premises would be transferred but there were no arrangement in place as yet. Dr Rowley Conwy asked about LIFTCO buildings that were part owned by the PCT and Mr Sturgeon indicated that these would also be transferred. Mr Sturgeon indicated that information would be circulated once final guidance was available. 7.3 Training for liquid base smears Members raised concerns about the training requirements for liquid based smear tests. Action: Mr Sturgeon agreed to confirm Cluster s position for the training requirements and forward to the LMC office who agreed to check against GPC advice and report back to Members. 7

FINAL DRAFT NHS South East London Cluster Better for You Commissioning Strategy Plan 2012/13 2014/15 DETAILED APPENDICES 1 8

Contents Appendix A: Commissioning Strategy Plan Summaries by BoroughError! Bookmark not defined. Appendix B: Cluster Measurement Framework... 6 Appendix C: Financial Case for Change and Delivery of Financial Balance... 9 Appendix D: South East London Communications and Engagement Plan Error! Bookmark not defined. 2 9

Lambeth Mission Our mission is to improve the health and reduce the health inequalities of Lambeth people and to commission the highest quality health services on their behalf. Vision 1. Health improvement is at the heart of all we do. We will increase life expectancy for all and reduce the difference in life expectancy between the most and least deprived in our diverse communities. 2. We will maintain a thriving, financially viable, health economy delivering safe and effective high quality care. 3. We will commission comprehensive integrated care that meets the needs of local people. We will value diversity amongst providers, but will expect excellent outcomes. 4. In delivering this Vision we recognise the need: for a rigorous, population needs based approach to commissioning, supported by public health expertise. to work with Lambeth people and their representatives to commission services that best meet their needs. to work in partnership with colleagues, across geographic, organisational and professional boundaries. This will include primary care practitioners, the London Borough of Lambeth, King's Health Partners and neighbouring health commissioners. to support innovation in workforce development and in the local application of teaching, training and research. to look first to local colleagues for management support Three-Year Health Goals Enable 1000 people with serious mental illness to move on from secondary care by accessing a new asset/recovery based service offer. Measure: 98% users in CPA with HONOS Improve hypertension control of 1000 more people in Lambeth. Measure: 76% of people with hypertension with BP <= 150/90 Help 5000 more people with diabetes bring their blood sugar under control. Measure: 74.5% for HbA1c <8 Halve the proportion of Lambeth residents diagnosed very late with HIV (<200 CD4 cells/mm3). Measure: 26% (2009) to 13% (by 2015) Help over 12,500 more people in Lambeth quit smoking. Measure: 1062 smoking quitters per 100,000 Help 900 more children overcome or avoid obesity; and help over 10000 children maintain a healthy weight. Measure: 22.3% Year 6 obesity prevalence in children Increase the number of frontline staff who have received training in screening and brief intervention for alcohol misuse. Measure: 90% of the identified frontline staff have received training in screening and brief intervention for alcohol misuse (to be confirmed) 3 10

Lambeth Clinical Commissioning Group Authorisation Process Purpose of Paper This paper provides an update on Lambeth developments for Clinical Commissioning Group development. Introduction Lambeth has applied for CCG authorisation in Wave 2. This requires the submission of key documentation as part of the application process by 3 rd September 2012. Progress to date On 31 st January 2012 Lambeth practices were invited to an all practice event. The event was well attended and sought practice views on a number of key issues which have informed developments and the current draft (Appendix I). On 13 th June 2012, Lambeth practices were invited to an informal engagement event to discuss the development of the local constitution. Although attendance was limited the discussion was very informative and focussed on: a) What the constitution is intended to achieve proper constitutional and governance arrangements with capacity and capability to deliver all their duties and responsibilities including financial control, as well as effectively commission all the services for which they are responsible Domain 5 b) Minimum requirements for the constitution Interim arrangements Constitution must include: the name of the CCG the Members of the CCG the geographical area for which the CCG will be responsible the arrangements made for the discharge of the CCG s statutory functions the committees and sub-committees of the CCG the arrangements for ensuring effective participation of each CCG member in the operation of the CCG decision making procedures management of conflicts of interests arrangements for operational transparency the role of committees and the functions they will carry out arrangements for meeting the public sector equality duty 43

c) Concerns/issues for clarification were raised by practice representatives particularly around memberships, responsibilities and liabilities and the allocation of votes. It was recognised that the constitution should be owned by the proposed members and therefore engagement of practices in the further development and addressing the issues was crucial. Agreed next steps 1. Locality leads brief practices on discussions and encourage to engage in the constitution discussions so that they are able to influence how things operate locally and seek views on: a) Roles and responsibilities and the scale of delegation to member practices/localities/governing body (the board) eg it is proposed that the first delegation is for members to the governing body (effectively the Board) for nearly all things to allow effective delivery of the CCG duties. What might be reserved to members - ie clinical board member appointment, constitution. b) How should elections (eg to board) be managed eg one practice= one vote, or one vote per performer on list, or one vote per 1000 registered population at practice c) Are there conditions on practice membership eg in Lambeth boundary? Should there be expectations on members eg code of conduct, active participation in discussions? If so, what would be expected? d) How do members want to be engaged? eg a minimum of two all practice events a year plus regular locality engagement e) How should potential conflicts of interest be managed? f) What should be the role of the LMC? 3. The draft constitution should be published on lcccb website and the link distributed to practices. 4. The way in which the CCG should operate should be discussed and agreed at the all practice event on the 17 th July. 5. A final version of the Lambeth constitution will be submitted as part of authorisation process on 3rd September. Lucy Day Assistant Director Organisational Development 44