Governing Body s Committees Minutes (Part One)

Agenda Item: 11 Report Number: GB66-17 (i) Venue: NWS CCG HQ 59 Church St, Weybridge, Surrey, KT13 8DP Date: Monday 22 May 2017 Meeting: North West Surrey CCG Governing Body (Part One) Title of Report Purpose of the report Governing Body s Committees Minutes (Part One) This report is on the agenda for the Governing Body to Note the approved minutes from its Committees and to Receive verbal updates on current business. Reason for presentation to the Governing Body For Information For Discussion For Decision Describe To ensure proper governance processes are followed and the Governing Body receives the Minutes and current updates from its Committees. Prepared and Presented by: Relative Legislation & Source Documents: Freedom of Information: Prepared by the Secretariat. Presented by the Chair of each Governing Body Committee. N/A Restricted Open X This report has previously been presented to the following Committee/Group/s (please state date) Clinical Executive Operational Leadership Team Audit and Risk Committee Quality Committee Contracts and Finance Committee Remuneration and Nominations Committee

The outcome of previous presentation/s or reviews N/A Executive Summary Minutes and updates from the following Governing Body Committees (Part One) are presented for noting: 1: To receive and note: (a) Authorised Minutes of the Governing Body s committees (as listed below) and verbal updates from each Committee Chair or Representative on current business: (i) Clinical Executive: (Dr Jags Rai) o 8 March 0217 (ii) Strategic Finance Committee: (William McKee) o 27 March 2017 (iii) Quality Committee: (Julia Dutchman-Bailey) o 22 February 2017 (iv) Remuneration Committee (William McKee) o Verbal Update o Revised Terms of Reference (Note: Any discussion of sensitive sections to be reserved for Part Two.) Primary Care Commissioning Committee: 2: To receive and note (b) authorised Minutes of the Primary Care Commissioning Committee of 7 April 2017 (Julia Dutchman-Bailey) (c) To review quorum arrangements for the PCCC Committee: Recommendations: To receive and note: (a) the approved Minutes presented by the Committees of the Governing Body, note the verbal update on current business and to receive the revised Terms of Reference for the Remuneration & Nominations Committee.

(b) the approved Minutes presented by the Chair of the NWS CCG s Primary Care Commissioning Committee. (c ) to discuss quorum arrangement for the PCCC Committee.

Present: North West Surrey CCG Draft Minutes of the Clinical Executive Part One Held on : 8 March 2017 commencing at 3.40pm At : NWS CCG, 58 Church St, Weybridge, Surrey, KT13 8DP. Job Title Name Attended / Apology Clinical Executive Chair Dr Jags Rai (JRa) NW Surrey Clinical Chair Dr Charlotte Canniff (CC) Chief Executive Julia Ross (JR) Clinical Chief of Leadership & - - Development Clinical Chief of Quality & Innovation Dr Richard Barnett (RB) A Woking Locality Lead & Clinical Chief of Dr Deborah Shiel (DS) Contracts & Performance Woking Locality Lead Dr Chrissie Clayton (CCl) Woking Locality Lead Dr Alex Henderson (AH) SASSE Locality Lead Dr Diljit Bhatia (DB) SASSE Locality Lead - Thames Medical Locality Lead Dr Asha Pillai (AP) A Thames Medical Locality Lead Dr Layth Delaimy LD) Thames Medical Locality Lead - - Planned Care Programme Lead Dr Beth Coward (BC) Director of Finance Mark Baker (MB) Interim Director of Strategic Sumona Chatterjee (SCh) Commissioning Director of System Redesign Karen Thorburn (KT) Chief Nurse Clare Stone (CSt) Lead Primary Care Pharmacist Sophie Bhandary Programme Lead Dementia & Carers, & Dr Yvonne Collins Mental Health Surrey County Council Deputy Director of Ruth Hutchinson (RH) Public Health Surrey County Council Area Director : Shelley Head (SH) A Adult Social Care NW Surrey In Attendance: Governing Body & Committees Elizabeth Ure (EU) Administrator Interim Governing Body Secretary Paul Mitchell (PM) A Head of Collaborative Programmes and Partnership Sue Robertson (SR) 1 Minutes of the Executive Committee Part One 8 March 2017

No. Item Description Actions 1 Welcome, Apologies & Proxies - Chair The Chair, Dr Jags Rai (JRa) welcomed attendees and declared the Clinical Executive Part One meeting open at 1.15 pm. Apologies were received from: Dr Richard Barnett Dr Asha Pillai Shelley Head 2 Declaration of Conflict of Interest Chair Clinical Executive Members confirmed that : Their entry in the 2016-17 Register of Interests was up to date, accurate and complete. There were no other Declarations of Interest pertinent to the Agenda. Their entry in the 2016-17 Hospitality, Gifts and Sponsorship Register was up-to-date, accurate and complete. Dr Chrissie Clayton (CCl) noted that Goldsworth Medical Practice was not shown on the Register of Interests. Secretariat to correct this. 3 Draft Minutes from the Last Meeting of Clinical Executive Part One held on 8 February 2017, Actions and Matters Arising Minutes: The Part One Minutes from the 8 February 2017 meeting were approved without amendment. Actions: Item 6, Medicines Optimisation Group (MOG) Minutes from 3 January 2017. (i) Sophie Bhandary () advised that the 2017-18 Quality Delivery Scheme included a joint meeting between community pharmacists and GPs to improve inhaler technique advice and communication concerning patients, for example, the overuse of bronchodilators. (ii) advised that the Medicines Management Quality Delivery Scheme 2017-18 was on the agenda for this meeting and included locality feedback. 2 Minutes of the Executive Committee Part One 8 March 2017

4 Action Log Item 91 on the Action Log was noted as completed and closed. 5 Medicines Optimisation Group (MOG) Revised Terms of Reference presented the revised Terms of Reference (ToR) for the Medicines Optimisation Group. advised that the point 3 Role Remit, has an amended point 3.5 which now reads : To approve medicines policies, prescribing guidelines, Patient Group Directions and any other information prepared about medicines and appliances for staff or patients served by NW Surrey CCG. Julia Ross (JR) noted that this would not include responsibility for the Locally Commissioned Services (LCS) practice delivery scheme, which would remain with the Clinical Executive. Clinical Executive approved the amendment to the MOG ToR. 6 Medicines Optimisation Group (MOG) Minutes Clinical Executive requested that the approved MOG minutes for 1 February 2017 be brought to the April Clinical Executive meeting. 7 Prescribing Clinical Network (PCN) Minutes and Policy Statements It was agreed that the PCN confirmed minutes for 1st February 2017 be brought to the April Clinical Executive meeting. Clinical Executive approved policy statement numbers : PCN 238-2017, PCN 239-2017, PCN 242-2017, PCN 243-2017 and PCN 244-2017. Policy statement number PCN 240-2017 Management of Vitamin D deficiency (without bone disease) was not approved and it was requested that this be referred back to the PCN and returned to the Clinical Executive with tighter clarity agreed to bring the pathway to support the policy statement back to Clinical Executive with a supporting pathway, and to circulate the NICE Clinical Knowledge Summaries guidelines for Vitamin D. Action (1) : to provide the pathway to support the policy statement PCN 240-2017 Management of Vitamin D deficiency (without bone disease). Action (2) : to circulate the NICE guidelines for Vitamin D to 3 Minutes of the Executive Committee Part One 8 March 2017

Clinical Executive members. Ruth Hutchinson said she would provide a Surrey County Council link to a webpage about Healthy Start and the criteria and process for supplying vitamins, including Vitamin D. RH suggested that this link could also be added to the NWS CCG s Medicines Management newsletter. Action (1) : RH to provide a web link to Healthy Start to Secretariat for sending onto Clinical Executive members. Action (2) : to ensure the Health Start scheme has been communicated with a web link via the NWS CCG s Medicine Management Matters newsletter. RH 8 Medicines Optimisations Commissioning Intentions and QIPP Plan 2017-18 presented the Medicines Optimisation Commissioning Intentions and QIPP Plan for 2017-18. Clinical Executive discussed the intentions and QIPP plan and noted the following : i) Item 1 (c) Diabetes, p.3. Dr Charlotte Canniff (CC) advised that diabetes management planning was being done across all CCGs, including consideration about prescribing hypoglycaemic agents. JRa inquired about the NHS England (NHSE) Diabetes Prevention Programme and RH agreed to provide information on this to the Clinical Executive. Action : RH to provide information about the NHSE Diabetes Prevention Programme. RH ii) iii) iv) item 2 (a) Payment by Results excluded drugs, p.4. FCO to be removed. item 3 Prescribing Efficiencies, p. 5. The PCN was horizon scanning drug prescribing, as per the chart on p.5. item3 Prescribing Efficiencies, p.6. It was agreed that two further categories be added to the chart on Drug Groups. These categories to be branded drugs and infant feeds (see discussion points later in this item). Action (1) : to add Branded Drugs and Infant Feeds as two extra categories in the chart on page 6. Action (2) : to bring a paper to Clinical Executive on infant feeds v) item 4(a) Community Pharmacy, p.7. Dr Deborah Shiel (DS) inquired if there would be a quality control mechanism around 4 Minutes of the Executive Committee Part One 8 March 2017

advice to patients by community pharmacists. answered that community pharmacists contracts are managed by NHS England. Note : Dr Yvonne Collins joined the meeting at 3.15pm. vi) item 4(c) Medicines Optimisation : Communication and Information Flow, p.7, CC requested that the uptake of Electronic Repeat Dispensing (erd) be amended. Clinical Executive approved the Medicines Optimisation Commissioning Intentions and QIPP Plan for 2017-18 9 Practice Medicines Management Quality Delivery Scheme 2017-18 Prior to discussion about the 2017-18 Practice Medicines Management Quality Delivery Scheme, JR spoke about recognising general practices that have achieved excellent results and JRa suggested that this might be considered in the 2018-19 scheme. Clinical Executive discussed this and it was suggested that the MOG look into the implications of doing this, and other ways to incentivise all general practices. Action : MOG to consider recognising General Practices that have achieved excellent results in the 2018-19 Practice Medicines Management Quality Delivery Scheme. was asked to go to the three Locality meetings and explain the current process for the 2017-18 Practice Medicines Management Quality Delivery Scheme. Action : to attend the three Locality meetings and explain the processes involved in the 2017-18 Practice Medicines Management Quality Delivery Scheme. introduced the 2017-18 Practice Medicines Management Quality Delivery Scheme and provided an overview of the scheme. Clinical Executive discussed the Proposed Scheme for 2017-18 and suggested that in relation to the antibiotic element of the scheme, add a note to clarify that the focus was with adults only, although the dataset cannot distinguish on age. The FAQs supporting information will clarify that the preference for nitrofurantoin is on adults only. to also add an introductory paragraph for item 4. Reporting safety incidences via National Reporting and Learning System (NRLS). General Practices are to submit one safety report per 1000 list size via the National Reporting and Learning System (NRLS). 5 Minutes of the Executive Committee Part One 8 March 2017

Action : to add an introductory paragraph for item 4.Practices to submit one safety report via National Reporting and Learning System (NRLS) to say that General Practices are to submit one safety report per 1000 list size. Dr Diljit Bhatia (DB) inquired about urinary tract infections (UTIs) and Out of Hours (OOH) clinicians, commenting that OOH clinicians do not have access to patient details when visiting care homes. Karen Thorburn (KT) said the Medicines Management team would pick this up with the provider. Action : to investigate if access to patient details can be provided to OOH clinicians prior to prescribing for UTIs. KT thanked and the Medicines Management Team for the work they had put into preparing the Scheme. Clinical Executive approved the Quality Delivery Scheme 2017/18, on the proviso that adjustments as discussed and noted above be included in the Scheme. 10 Surrey Children and Young People s Joint Commissioning Strategy 2017-2022 JRa invited Dr Alex Henderson and Sue Robertson (Head of Collaborative Programmes and Partnership) to present the executive plan for the Surrey Children and Young People s Joint Commissioning Strategy 2017-2022. Clinical Executive received a high-level overview of the executive plan and the agreement of the strategy by organisations and agencies involved was noted. 11 Locality Hubs Annual Report 2016-17 DS, in her role of Chair of the Joint Management Board for Locality Hubs, presented the Locality Hubs Annual Report and provided a brief overview of the development and highlights of the Woking Locality Hub. The CCG was reviewing how the Hub was being used including triaging of suitable outpatients, A&E patients, and patients discharged by ASPHFT. The Hub was presently working with over 75 year old patients with specific chronic conditions and patients with more complex pathways. It was now considering offering access to young people and patients over 60 years old. Having patients come direct to the Hub rather than going to A&E was another focus. Following discussion about the services offered at the Hub, DS said 6 Minutes of the Executive Committee Part One 8 March 2017

she would inquire further about mental health dementia services being provided at the Hub. Action : JW to provide information to Clinical Executive about mental health dementia services being provided by the Woking Hub. JW DS commended the Report, saying the Hub was a good example of the success of the shared data programme. KT advised that interim hubs were in the process of going live and thanked Lisa Compton for leading on this project. KT noted that Lisa Compton was retiring at the end of March 2017. From 1 April 2017 the project would be transferred to a provider led model and a commissioning manager within Jack Wagstaff s team would manage the CCGs development of this service. The Report was noted by the Clinical Executive. 12 Localities Update DS provided a brief update for the Woking Locality and advised that Woking Hub professionals attend the final 15 minutes of each Woking Locality meeting to give an update on the Hub. The Locality also has a small operational group looking at communications and said their work will be shared to other localities. 13 Any Other Business 1. Dr Layth Delaimy (LD) in his role as Clinical Lead for Urgent Care spoke about managing urgent care during the 2017 Easter period and advised that a letter about this, similar to that sent out for the 2016/17 Christmas / New Year period, would be sent to NWS General Practices. 2. CC advised that CC and JR have agreed to bring forward JR s leaving date to the 30 April 2017. CCG staff was in receipt of a letter from CC advising of this changed date. CC said that the process for safe transfer of JRs role for the interim period, and until the Joint Accountable Officer was in place, was in hand. 14 Dates of Next Meetings All meetings of the Clinical Executive will be held at the NWS CCG HQ, 58 Church St, Weybridge, Surrey, KT13 8DP. Wednesday 12 April 2017 Wednesday 10 May 2017 Wednesday 14 June 2017 Wednesday 12 July 2017 Wednesday 9 August 2017 7 Minutes of the Executive Committee Part One 8 March 2017

13 Closure The Chair, Dr Jags Rai, declared the Part One meeting of the Clinical Executive closed at 4.30pm. Decision Log: Agenda Action Lead No 3 Draft Minutes from 8 February 2017 (part one) Approved 4 Action Log Noted 5 Medicines Optimisation Group (MOG) Revised Terms of Reference 6 Medicines Optimisation Group (MOG) Minutes from 1 February 2017 7 Prescribing Clinical Network (PCN) Minutes and Policy Statements: Approved To return to 12 April 2017 meeting (i) PCN Minutes from 1 February 2017 (ii) PCN 240-2017 Policy Statement Vitamin D (iii) PCN 238 PCN 244-2017 Policy Statements 8 (i) Medicines Optimisations Commissioning Intentions (ii) QIPP Plan 2017-18 9 Practice Medicines Management Quality Delivery Scheme 2017-18 10 Surrey Children and Young People s Joint Commissioning Strategy 2017-2022 (i) To return to 12 April 2017 meeting (ii) To return to 12 April 2017 meeting (iii) Approved (i) Approved (ii) Approved Approved (with conditions) Noted 11 Locality Hubs Annual Report 2016-17 Noted 12 Localities Update Noted 13 Any Other Business 1 2 Noted 8 Minutes of the Executive Committee Part One 8 March 2017

North West Surrey CCG Quality Committee Meeting MINUTES Meeting No: 13 of North West Surrey CCG Quality Committee held on Wednesday 22 February 2017 at 14:00-16.00h in the Boardroom, NWS CCG Offices, 58 Church Street Weybridge, Surrey KT13 8DP Attendees Members Independent Secondary Care Doctor (Deputy Chair) Dr Naila Kamal (NK) Registered Nurse (Chair) Julia Dutchman-Bailey Patient Representative Doug Macdonald (DMC) Public Health Consultant, Surrey County Council Ruth Hutchinson (RH) Public Health Consultant, Surrey County Council Lisa Andrews (LA) A Clinical Chief of Quality & System Redesign, NWS CCG Dr Richard Barnett Chief Nurse, NWS CCG Clare Stone (CSt) Primary Care Pharmacist, NWS CCG (deputising for LH) Sophie Bhandary () A Head of Medicines Management, NWS CCG Linda Honey (LH) (maternity leave) A Associate Director of Contracts, NWS CCG Sumona Chatterjee (SC) A In attendance Quality and Safety Team Support Officer, NWS CCG Iwona Reynard-Nowicka (notes) (IRN) Director of Corporate Development &Assurance, NWS Tony Shipley (TS) CCG A Head of Performance and Delivery, NWS CCG Julia Jones (JJ) Head of Corporate Services & Risk, NWS CCG Elaine Stevens (ES) Designated Nurse Safeguarding Children Dr Amanda Boodhoo (AB) A Designated Nurse for Safeguarding Vulnerable Adults in Helen Blunden (HB) Surrey A Quality and Patient Safety Manager, NWS CCG Caroline Simonds (CSi) Quality and Contracts Manager, NWS CCG Jane Lovatt (JL) Governing Body Secretary, NWS CCG Paul Mitchell (PM) Lead GP for Cancer, End of Life Care, Macmillan GP, Dr Chrissie Clayton (CC) NWS CCG Item Details Action 1. Introductions and apologies The Chair welcomed everyone to the meeting. Introductions were made and apologies noted as above. 2. Declaration of Conflict of Interest i. Members confirmed that their entry in the Register of Interests is up- 1 Quality Committee

to-date, accurate and complete ii. No Declarations of Interest pertaining to agenda items were noted. iii. Confirmation was received from all members that their entries in the Register of Hospitality is up-to-date, accurate and complete 3. Minutes of the previous meeting The minutes of the previous meeting held on Wednesday 21 December 2016 were reviewed and agreed as an accurate record of the proceedings, subject to the following: i) Item 3 on safeguarding, to be added: "The chair asked for confirmation about the numbers of UACs (Unaccompanied Asylum Seeking Children) in Surrey and the timeliness of their IHAs (Individual Health Assessment). HB agreed to supply information regarding any delays in the system that NWS CCG needed to be alerted to in a briefing paper." CSi advised this information is provided annually and 6-monthly by the Surrey wide designated safeguarding team. CSi to share previous report with the Chair. ii) Item 5.vi) on page 3 should read: All agreed it is important not to stifle discussion, but at the same time confidential discussions need to be kept separate from what is being published in the public domain. 4. Matters arising and action log review i. The action log was reviewed and updates annotated. DMC provided patient and GP feedback relating to the item on flu vaccination. RH advised us that a flu vaccine campaign is part of the winter wellness campaign, and she will make sure DMC s feedback is relayed to the team dealing with it in readiness for next year s campaign. Please also see item 11 below. ii. The amended ToRs were reviewed. a) CSt advised us that she had approached the lay person in Healthwatch to ascertain if they have the capacity to join this committee, and is awaiting their response. b) It was agreed that the Director of Strategic Commissioning needs to stay in item 2.6. ACTION: IRN to amend. ACTION: Final draft of ToRs to be submitted to Corporate Secretary for review and approval by the Governing Body. iii. Update on Accelerated Planning 2017-2019 no emerging issues were raised. iv. Community provider exit and mobilisation update the Commissioning and Performance Directorate was represented by JJ. It was agreed to share the update outside the meeting. ACTION: An update on the community provider exit and mobilisation to be shared outside the meeting. 5. Quality Committee self-assessment members were asked to fill out the self-assessment forms outside the meeting. ACTION: All to email the self-assessment forms to IRN by 8 th March. 6. Deep dive into Cancer Care services This item was previously on the agenda for Clinical Executive Part II. A IRN IRN / PM SC All 2 Quality Committee

discussion took place. 7. SEND Special Educational Needs and Disability - programme update The Committee received a written update from Amanda Boodhoo (AB), Deputy Director for Safeguarding Surrey-wide. Key points: a) Ofstead and the Care Quality Commission (CQC) carried out a joint inspection of the local Surrey area in October 2016 to ascertain the effectiveness of the implementation of the disability and special needs reforms, as set out in the Children and Families Act 2014. b) The focus of the inspection and the findings are outlined in the paper. 8. Quality Governance update i. Reporting schedule proposal a) JL presented the reporting schedule for 2017. A discussion took place. It was suggested that relevant elements of Public Health reporting should be included in the schedule, and asked RH to propose some dates. The committee accepted the schedule and complimented JL on her efforts. ACTION: RH to provide a summary of timings for Public Health reports to be received and included in the schedule. ii. Safeguarding policy a) The committee agreed changes to the policy, which is now an integrated Adult, Children and Young People policy, in line with the Surrey-wide approach. This document reflects the change in the Surrey-wide service arrangements. 9. Chief Nurse update i. Quality dashboards a) Process - The revised schedule, as per suggestions at the last QC (Quality Committee) meeting in December, was reviewed and agreed. A discussion on CQUINs, SECAmb, mixed sex accommodation and stroke services took place. As per the decision at the last QC meeting in December, the format of the dashboards will remain as they are until September, and then reviewed again. ACTION: The review of dashboards to be included in the October agenda. b) Overview of February 2017 dashboards as detailed in the document embedded below. c) Assurance - QC noted the following: Assured on ASPH Not assured on SECAmb RH IRN ii. iii. iv. Quality surveillance reports - the content was noted. JDB said it is a comprehensive document and it is good evidence of the assurance process. The Patient Experience report was reviewed and approved for submission to the Governing Body. SECAmb update CSt gave an overview of the current 3 Quality Committee

situation. CSt advised the committee of monthly meetings of the Strategic Oversight Group led by NHSI. This is work in progress and further updates will follow. v. Quality Surveillance Group no emerging issues were noted. vi. Risk register - the content of the risk register was reviewed. The quality related risks / issues were noted. CSt advised the committee that a request to hold a SECAmb Risk Summit relating to Medicines Management had been made. Further updates will be provided and the risk entry will reflect these. Further updates on SECAmb Medicines Management risk to be provided as part of the Risk Register updates. vii. Emerging issues update a) Serious Incidents nothing to report. b) Workforce assurance nothing to report. c) Safeguarding nothing to report. d) VCSL community nursing this has been added as a new risk on the risk register see item 9.vi above). e) SECAmb CSt advised the committee that the CCG was assured that the initial risks were mitigated, and that there is no patient risk involved to date. The CCG has offered Medicines Management support. f) RB advised the group that the CQC are visiting care homes, and a number of safeguarding issues were raised. As a result 2 homes are closing down this week, impacting patient flow. RB advised us of a summit on 24 th March. Further updates will be provided. ACTION: Update on the CQC care home visits to be provided in April 2017. viii. Chief Nurse Conference - CSt advised the committee of the forthcoming Chief Nurse Conference which will be held in Birmingham on 14 th and 15 th March. CSt will provide feedback at the next QC meeting in April 2017. ACTION: CSt to provide feedback from the conference at QC meeting in April 2017 / IRN to include in the agenda. 10. Summary of issues for Governing Body It was agreed to raise the following: a) SECAmb update on any regulatory monitoring and any emerging themes and time scales for quality improvement and risks associated with this. b) Community programme exit and mobilization. c) Assurance with regard to the cancer waiting times and actions being taken. d) Reporting planner schedule providing the right level of assurance for the Governing Body. 11. AOB A discussion was held on item 4.i patient and GP feedback / winter wellness programme. ACTION: The committee agreed to relay this information to HS for action. RB CSt / IRN HS 4 Quality Committee

Meeting dates in 2017 Meeting dates in 2018 22 February 2017 28 February 2018 26 April 2017 25 April 2018 28 June 2017 27 June 2018 30 August 2017 22 August 2018 25 October 2017 24 October 2018 20 December 2017` 19 December 2018 Please note all meetings are held between 2-4.00pm in the Boardroom, NWS CCG, 58 Church Street, Weybridge KT13 8DT ** Freedom of Information: Those present at the meeting should be aware that their name will be listed in the agenda and action notes of this meeting, which may be released to members of the public on request under Freedom of Information requirements. 5 Quality Committee