October and 3 rd November 2015 meetings.

NHS BOLTON CLINICAL COMMISSIONING GROUP Public Board Meeting AGENDA ITEM NO: 16(i) Date of Meeting: 27 th November 2015 TITLE OF REPORT: AUTHOR: PRESENTED BY: GM Association of CCGs Minutes from 20 th October and 3 rd November 2015 meetings. GM Association of CCGs Su Long, Chief Officer PURPOSE OF PAPER: (Linking to Strategic Objectives) RECOMMENDATION TO THE BOARD: (Please be clear if decision required, or for noting) To update the Board on the discussions held at the meetings on 20 th October and 3 rd November 2015. The Board is asked to note the Minutes. COMMITTEES/GROUPS PREVIOUSLY CONSULTED: GM Association of CCGs. VIEW OF THE PATIENTS, CARERS OR THE PUBLIC, AND THE EXTENT OF THEIR INVOLVEMENT: Patient views are not specifically sought as part of this report. EQUALITY IMPACT ASSESSMENT (EIA) COMPLETED & OUTCOME OF ASSESSMENT: EIA and an assessment is not considered necessary for the report. 1

GM ASSOCIATION OF CCGs: Association Governing Group (AGG) Tuesday 20 th October 2015 09:15am 11:00am MANCHESTER TOWN HALL, CONFERENCE HALL Attendance: Trish Anderson (TA) NHS Wigan Borough CCG Wirin Bhatiani (WB) NHS Bolton CCG Ed Dyson (ED) NHS Central Manchester CCG Hannah Dobrowolska (HD) NHS Salford CCG Behalf Anthony Hassall Denis Gizzi (DG) NHS Oldham CCG Nigel Guest (NG) NHS Trafford CCG Caroline Kurzeja (CK) NHS South Manchester CCG Gina Lawrence (GL) NHS Trafford CCG Su Long (SL) NHS Bolton CCG Lesley Mort (LM) NHS Heywood, Middleton & Rochdale CCG Gaynor Mullins (GMu) NHS Stockport CCG Stuart North (SN) NHS Bury CCG Bill Tamkin (BT) NHS South Manchester CCG Simon Wootton (SW) NHS North Manchester CCG Apologies: Steve Allinson (SA) NHS Tameside & Glossop CCG Tim Dalton (TD) NHS Wigan Borough CCG Alan Dow (AD) NHS Tameside & Glossop CCG Chris Duffy (CD) NHS Heywood, Middleton & Rochdale CCG Michael Eeckelaers (ME) NHS Central Manchester CCG Ranjit Gill (RG) NHS Stockport CCG Anthony Hassall (AH) NHS Salford CG Kiran Patel (KP) NHS Bury CCG Karen Proctor (KPr) NHS Salford CCG (HoC Chair) Hamish Stedman (HS) NHS Salford CCG (Chair) Annette Walker (AW) NHS Bolton CCG (CFO Chair) Martin Whiting (MW) NHS North Manchester CCG Ian Wilkinson (IW) NHS Oldham CCG In Attendance: Rob Bellingham (RB) NHSE - GM & Lancs Sub Region Team Andrea Dayson (ADa) GM Association of CCGs Stephanie Pearson (SP) GM Association of CCGs (Note Taker) Melissa Surgey (MS) GM Association of CCGs Helen Hosker (HH) NHS Central Manchester CCG 1.WELCOME & APOLOGIES FOR ABSENCE Noted. Page 1 of 6

2. MINUTES OF THE LAST MEETING (06.10.15) & REVIEW OF THE ACTION LOG The minutes were accepted as an accurate reflection of the meeting. Action Log: Agenda Item No. ACTION LOG 3.1 HS to send supportive letter on behalf of AGG agreeing to the principles of the governance structure but noting that further work is required on the detail 3.2 SW would be asked to lead the link between the GM housing providers and the PSR work programme 6.1 Members to commence local engagement with members/stakeholders 6.2 GM/AW to liaise on the financial aspects of delivering Primary Care 7 Day Access Primary Care 7 Day Access for discussion at the next CFO meeting GM to continue to report through CO meetings 7. Extension of 20 October and 3 November AGG meetings 7.2 AD to seek nominations for the GM Devolution CO interview panel by email COMMENTS Completed AD to confirm if SW will be the rep. Completed Discussed at CFOs working progress. Completed Still awaiting confirmation of the date. AD to approach SW to lead the link between the GM housing providers and the PSR work programme AD to seek nominations for the GM Devolution CO interview panel by email 3. COMMUNITY PHARMACY PROVISION FOR OOH EMERGENCY REPEAT PRESCRIPTIONS Helen Hosker (GP, Central Manchester CCG) attended the meeting to provide an update on the community pharmacy provision for OOH emergency repeat prescriptions. A paper was circulated prior to the meeting. The below was discussed: Kate Kinsey (NHSE) and her team have agreed to project manage the pilot. 50k has been identified to support the pilot. Pilot will run for 3-6 months. Noted that one area may not be large enough to provide appropriate data and that is needs to be aligned to the proposals for self-care under devolution. HH to provide a further update when the pilot has started (December) and then schedule for three months after (March) to look at the evaluation and then develop a model that can be rolled out wider subject to learning. Page 2 of 6

AGREED: AGG agreed to support the Pilot based at Salford. SP to schedule community pharmacy provision for OOH emergency repeat prescriptions on the forward plan for December and March. 4. LD FAST TRACK CK informed AGG of the approval for the GM fast track funding and provided a brief outline of the work programme and the key risks to delivery. A summary report was circulated prior to the meeting and the below was discussed: GM has been named as an LD Fast Track site by Simon Stevens as we use more hospital beds for people with LD per 1000 of population. Focus on moving patients towards care closer to home and the closure of Calderstones. This will also include Winterbourne reforms. LD Board established with representatives from the LA - CK and Theresa Grant co-chair. 3m funding agreed from the national fast track fund the money will sit with Trafford CCG as NHSE do not as yet recognise the devolution architecture. 1m still in transition for the closure of Calderstones; currently GM has 85 inpatients. Should also focus on building resilient commissioning - very challenging area. To create 4 hubs to share best practice across GM - Salford, Bury, T&G and Oldham strong areas to focus the development of the Hubs. Workshop plans to present GM as the place to market providers. Families can be resistant to changes to placements - need to ensure this is considered and we engage with families and carers. Only move service users back when the processes and facilities are right for that individual Need to embrace new devolved ways of working we won't succeed if we continue to work in silos. Need to work with HoCs to identify the right individuals. Confirmed that Mike Tate is the CFO lead and is working up the plans in detail. Might need to be picked up by Specialised Commissioning Board. Mixed definitions of pooling are not helpful. If this is a formal joint budget there needs to be a written proposal to take it forward to the JCB. Need to engage other parties e.g. Fire, police, prison service. Noted that clinical oversight is needed. Feedback will come through Cos; need to standardise what we are doing across GM CK highlighted the below main risks: o Bed closures at Calderstone potential of staff losing their jobs. o Funding not sufficient to do the job o NHSE to understand the dowry must follow the patients. AGG agreed that they are supportive of the paper and await further updates Page 3 of 6

5. SPECIALISED COMMISSIONING GL provided a progress update on Specialist Commissioning and the Cancer Vanguard bid. A briefing paper on specialist Commissioning was circulated prior to the meeting. The below was noted and discussed: SPECIALISED COMMISSIONING: Interim governance established for the specialised advisory group Bundles and buckets had been agreed and mapped out CEOs at the Cancer Board argued that they are not recognised in terms of evidence. Workshop is taking place on Friday with all the acute providers which GL will feedback at the next AGG. Concern noted re the devolution of this budget this should remain in shadow form for at least 12 months due to the huge financial risks. RB thinks 850m of specialised commissioning monies is in scope as 6bn devolved system - SL thinks project plan at governance group highlighted specialised commissioning would not be fully devolved by April 2016. Need to have conversation about risks and any caveats to taking it on. Conversation needed to look at pooling budget and risk share. SLA with the North West team is being developed to understand the work going forward. GL will feedback at a later date. Everyone agreed that any conversations taking place with the devolution team around spec comm need to include NG or GL as a number of conversation appear to be conducted through other individuals. GL to write a letter to Ian Williamson highlighting our current position. CANCER VANGUARD BID: Trafford have been heavily involved in developing vanguard bid. Cancer survival rates very good in GM - Clinical networks are very strong. Need to commission end to end pathways this needs a single commissioning lead and single provider who would sub contract to other providers - very complex and politically sensitive model. Being adopted into devolution system - work was already underway. Completely aligned to specialised commissioning. Applied for vanguard status as GM but NHSE only wanted one national vanguard so linked with UCLH and Royal Marsden as one pot of money. Very high profile and historic agreement. GM volunteered to put GL in contact with their vanguard lead for support and shared learning. Need to agree how localities that are not vanguards develop new pathways. Difficult to commission Primary Care aspect of cancer separately -need to look at whole pathway. Variation in uptake of screening - lead provider would be responsible for these KPIs. Development of a kite mark of quality for all cancer services (including screening and primary care) SP to circulate the slides. GL to write a letter to Ian Williamson highlighting our current position regarding clear leadership through Trafford CCG. Page 4 of 6

SP to circulate the Cancer Vanguard Slides 6. SRO WORKFORCE LM to bring back more detail on the programme in December. MOU with HEE progressing. Strategic Workforce Committee is leading on the work - LM linking with Carolyn Wilkins on leadership and OD. Aware that we need a programme plan and project support. Yvonne Rogers is leading on this and her secondment has been extended to December. Need to get an understanding on unpaid and third sector workforce. Some noise in the system from wider workforce about impact of devolution - trade unions request for information. LM requested that if any AGG items have links to workforce she is made aware so she can pull it all together. Succession planning for when LM leaves - this will be a gap for workforce for both AGG and devolution. SP to put SRO Workforce on the AGG forward for December. 7. FORWARD PLANNING FUTURE AGENDA ITEMS TA advised that the below agenda items are currently on the AGG forward plan. Any areas missing please inform AD. Estates Primary Care 7 Day Access Devolution SRO workforce MH programme Update Emergency & Urgent Care Network MOU/ToR Ambulance Commissioning Proposal Devolution Strategic Plan GM Shared Services Quarterly update CCG Assurance Model Noted that the all the GM strategic plan content needs to be ready by 3rd December for strategic plan. Review aligned to AGG meetings. 8. GMMMG OPTIMISING MEDICINES FOR GM SW presented a paper on GMMMG Optimising Medicines for GM which looked at how to make GM the safest, most effective place to receive medicine. The paper looks at two main areas: o A. Opportunities to transform health and social care medicines optimisation across GM o B. Medicines optimisation work stream enabling package Page 5 of 6

The paper has been previously seen by the AGG in July 2015, the below was noted and discussed: Programme A - support from HoCs and CFOs. Programme B o The aim is to develop an ODN type system. o Need support from the providers. o HoCs supportive o CFO agreed that there should be a medicine funds but need to agree how this is done. Claire Wilson is working with NHSE on this. CFOs have requested a baseline audit. HD to share community pharmacist business case. Kirsty Baxter at HEE has done a lot of work around community pharmacists and links to physician associate work. Don't use our allocation for cancer drugs needs to be reviewed. Are we keeping track of all the bids coming across the table so we can prioritise these? Agreed support for clinical standards board. SW to circulate the GM pharmacy stocktake completed by Clare Vaughan for information. AGG agreed recommendations SW to circulate the GM pharmacy stocktake completed by Clare Vaughan for information. 9. AOB 9.1 DATA MAPPING AND DIGITAL MATURITY EXERCISE: Paper to go to COs. COs to make decision on the footprint by March. Agreed to proceed on a GM footprint rather than individual CCGs. GM volunteer required to be the representative. Jonathan from Wigan is interested in becoming the representative TA to take back and discuss. TA to discuss GM representative within Wigan CCG NEXT MEETING DATE: Tuesday 3 rd November 2015 TIME: 8.30-12.30 VENUE: AJ Bell Stadium- Fans Bar Page 6 of 6

GM ASSOCIATION OF CCGs: Association Governing Group (AGG) DATE 3 rd November 2015 TIME 08.30-12.30 AJ Bell Stadium, 1 Stadium Way, Barton-upon-Irwell, Salford, M307EY Attendance: Steve Allinson (SA) NHS Tameside & Glossop CCG Trish Anderson (TA) NHS Wigan Borough CCG Wirin Bhatiani (WB) NHS Bolton CCG Tim Dalton (TD) NHS Wigan Borough CCG Alan Dow (AD) NHS Tameside & Glossop CCG Chris Duffy (CD) NHS Heywood, Middleton & Rochdale CCG Michael Eeckelaers (ME) NHS Central Manchester CCG Denis Gizzi (DG) NHS Oldham CCG Nigel Guest (NG) NHS Trafford CCG Anthony Hassall (AH) NHS Salford CG Su Long (SL) NHS Bolton CCG Lesley Mort (LM) NHS Heywood, Middleton & Rochdale CCG Gaynor Mullins (GMu) NHS Stockport CCG Kiran Patel (KP) NHS Bury CCG Hamish Stedman (HS) NHS Salford CCG (Chair) Bill Tamkin (BT) NHS South Manchester CCG Simon Wootton (SW) NHS North Manchester CCG Apologies: Martin Whiting (MW) NHS North Manchester CCG Ian Wilkinson (IW) NHS Oldham CCG Karen Proctor Ed Dyson Stuart North (KPr) (ED) (SN) NHS Salford CCG NHS Central Manchester CCG NHS Bury CCG In Attendance: Alison Bali (ABa) GM Association of CCGs (Minutes) Rob Bellingham (RB) NHSE - GM & Lancs Sub Region Team Andrea Dayson (ADa) GM Association of CCGs Melissa Surgey (MS) GM Association of CCGs Annette Walker (AW) NHS Bolton CCG (CFO Chair) Kath Wynne- Jones (KWJ) NHS Oldham CCG (HOC Chair) Janet Ratcliffe (JR) SCN Sarah Rickard Jonathan Kerry 1.WELCOME & APOLOGIES FOR ABSENCE (SR) (JK) Stroke ODN NHS Wigan Borough CCG Noted. 2. DECLARATION OF INTEREST No declarations of interest declared other than acknowledgement that GPs present when there is reference to the GP contract. Page 1 of 7

3. MINUTES OF THE LAST MEETING (20.10.15) & REVIEW OF THE ACTION LOG (A) Minutes agreed as an accurate record of the meeting. Action Log: Agenda ACTION LOG Item No. 2. AD to approach SW to lead the link between the GM housing providers and the PSR work programme AD to seek nominations for the GM Devolution CO interview panel by email 3. AGG agreed to support the Pilot based at Salford. SP to schedule community pharmacy provision for OOH emergency repeat prescriptions on the forward plan for December and March. 5. GL to write a letter to Ian Williamson highlighting our current position regarding clear leadership through Trafford CCG. PROGRESS Complete Awaiting confirmation of date Complete Complete In progress SP to circulate the Cancer Vanguard Slides Complete 6. SP to put SRO Workforce on the AGG forward for December. 8. AGG agreed recommendations Complete Complete SW to circulate the GM pharmacy stocktake completed by Clare Vaughan for information. Complete 9. TA to discuss GM representative within Wigan CCG Agreed this will be Jonathan Kerry 3a. PTS PROCUREMENT Agreed that this would be a level B decision at AGG 4. DEVOLUTION UPDATES:- 4.1 ASSURANCE SYSTEM FOR CCGs Proposal is based on the discussions at the last away day in October NHSE will present a short paper to the November Devolution Programme Board regarding their involvement and assurance in the newly formed devolved GM system. In essence they will only intervene if GM as a conurbation is a cause for concern OR if one organisation is consistently underperforming. AGG need to consider options and agree how we manage ourselves as a system and provide Page 2 of 7

assurance to NHSE. Options could include an OFSTED style framework, however some of the proposed domains for this are larger than individual localities We should not develop another laborious mechanism that replaces the one we already have or requires duplication. New process could include more forward planning to mitigate risk requiring robust reporting processes into AGG and devolution architecture. Assurance processes does not necessarily result in delivery of targets - we should create an assurance system which encourages behaviours and processes to deliver improved outcomes Potential to create an executive group which comprises of all localities who are accountable for performance. CQC are moving towards holding place based systems to account this could work for AGG in line with locality plans. Issue will be that some providers sit across multiple "places" - it will be a complex process to define footprints upon which accountability will work There will still need to be one individual who we are accountable to - most likely the GM Chief Officer SL will continue to develop this proposal. AGREED: The AGG supported SL to develop the proposal further To arrange a focussed AGG OD session to develop the assurance model - AD 4.2 PRIMARY CARE TRANSFORMATION INITIATIVE Tracey Vell has been asked to support the transformation initiative - brings a different perspective to work and new dynamic. Transformation initiative is exploring the appetite for primary care providers to work more collaboratively similar to MCP model. Idea will be discussed informally at Primary Care Summit on 4th November, more work needed to link into local primary care plans. Primary care is integral to the transformation initiative areas - primary care and acute hospital care have parity of esteem. Opportunity for GM to influence the national contract content in 2017. The work that GM and RB are leading is focusing on development of new approaches to primary care this is not intended to undermine individual localities. The language used is important to make this message very clear Must ensure we uphold the Primary Care Medical Standards - is there appetite for investment in rolling these out on a wider footprint Could be a powerful mechanism to bring all GPs into new ways of working - although conscious there is more detail needed. The Summit should focus on the clinical perspective - this model could enable enriched primary care services. Should consider if this proposal will a) mitigate risk and b) be commercially viable RB and GM will feedback to Summit and work up proposals further before a formal launch - AGG will agree timing of this in advance Page 3 of 7

RB to circulate original transformation initiative EOI 4.3 PRIMARY CARE 7 DAY ACCESS CFOs were tasked by AGG with doing due diligence on 7 day access funding. AW provided a verbal update a paper will be provided at the next AGG. Assured 15/16 part year funding but this will be confirmed at the next AGG. CFOs are now looking at assuring the whole of primary care budgets - need to agree with NHSE process for devolving this funding back to CCGs. CFOs will formally make recommendation at AGG on 17th November so funding can be released into the system. 7m available to GM CCGs to deliver 7 day access in 15/16 year (for those without PMCF) 9.4m from this year's allocation that will be available for 16/17 year - CFOs want to ensure all CCGs get their fair share, may need to consider risk share Discussions with Ian Currell at NHSE highlights 12m available for enabling 7 day access. Agreed to delegate authority to AW as CFO chair to authorise letter from Ian Williamson to Ian Currell to release 7m funding. Action: MS to add 7 day access funding to 17th November AGG agenda AW to authorise a letter from IW to release the funding when CFOs have provided due diligence. 4.4 LOCALITY PLANS 9/10 localities have submitted updated locality plans, executive summary and updated financial modelling. Finance and activity figures for bridging the gap do not add up - detail not known for latter years of the five year plans. Sign off is through the Health and Wellbeing Boards - dates scheduled over next month Difficulty with provider sign up to the plans - no consensus on whether plans are commissioning plans or whole place plans. Financial templates were submitted on 31st October and are being analysed by PwC. Stocktake of the GM wide work streams taking place - SROs concerned about how the GM work will align with the locality plans and avoid double counting. Workshop on 5th November to triangulate all the work and explore GM wide metrics. SROs have received a slide pack with a stocktake of all 10 localities. TA to arrange for circulation of stocktake slide pack to CFOs 4.5 DIGITAL ROAD MAP Page 4 of 7

Jonathan Kerry from Wigan CCG joined the group for this item - lead on roadmap work on behalf of GM. Makes sense to do roadmap work on a GM footprint due to devolution work. GM level work is about nurturing and progressing work already in place locally and scaling up. Not all localities are starting at the same place - task group are mapping out starting points and individual visions. Ultimately visions are very similar so this work will be about sharing learning and supporting one another The digital roadmap work group sits under the GM IM&T group and are linked into the AGG infrastructure. The template submitted to NHSE is not a full list of all stakeholders - will also include primary care providers, third sector, care homes and hospices, NWAS Estates and IM&T will be core enablers for the transformation initiatives AGREED: Quarterly updates are requested 5. WET AMD Advised that this should be discussed in part 2 of individual CCG boards due to commercial sensitivity. AGG requested that a narrative is prepared by SW for CCG boards 6. STROKE PATHWAY Janet Ratcliffe and Sarah Rickard from the SCN joined the meeting for this item Full implementation of stroke centralisation from April 2015 Data in the report is only the first quarter (April - July 2015) Tony Rudd (Stroke National Clinical Director) conducted site visits at Bolton and East Cheshire due to concerns about compliance data issues with Bolton. Model based on 90% of all patients going to the hyper acute stroke units, current data shows only 77%- ODN looking at why this is, could be due to late presentation Team level data does not show whole patient journey Fairfield Hospital is the best performing stroke unit in the country; Salford Royal is the largest (and 3rd best performing hyper acute unit) ODN is going to do a piece of work around data entry to improve reliability of figures Centralisation is improving the quality of stroke care, this will be further confirmed upon completion of ODN review in January 2016 SSNAP data doesn't tell the whole story - ODN review will also look at patient experience across whole pathway. AGG would like more data on outcomes at a population level rather than by provider Steve Dixon currently represents the CCGs on the stroke ODN board - 2 spaces on the ODN board and 3 spaces on clinical group capacity issue need to consider how this is progressed. Still issues with ESD and HoCs are putting in place standards to improve service improvements. Page 5 of 7

Would like to see data on mortality rates and levels of disability post-stroke. Overall this is a good news story, and should be publicised. Data can be taken by commissioners to their providers to challenge them on their stroke unit quality and outcomes Planning a commissioner event in the New Year to demonstrate how to use SSNAP data Next set of data will be ready at the end of the month and the ODN will be share this with CCGs. 7. REVIEW OF SCREENING & IMMUNISATION Agreed that there was not enough context to make a decision on this and would like public health advice AD to approach Wendy Meredith to review this and make a recommendation. 8. AGG EXECUTIVE GROUP AD has circulated a role profile for membership of this group and asked for expressions of interest by 6th November Noted that it continues to be challenging to balance local and GM commitments. Still no clarity or agreement on whether we should fund these posts and if so how? We still have not agreed future funding arrangements for strengthening wider AGG support e.g. Secretariat, chair. Need to strike a balance between consistent representation and strong leadership and wider involvement of existing SROs. Whoever takes on these roles need to work together cohesively as a group. Agreed that we cannot make a long term decision on this immediately and needs further focus. An election may be an option to select these when all EoI gathered as it is assumed that AGG will select those that they wish to represent them at a GM level. Agreed to select reps and review April 2016. 9. AOB 9.1 DELIVERING EFFECTIVE PRIMARY CARE ENGAGEMENT Some AGG members would like to input into this. GM would welcome clinical reps to support the engagement work further. 9.2 COMMITTEE IN COMMON Some discussion regarding the future of this beyond Healthier Together and how this links to potential AGG joint committee arrangements and devolution architecture. Further discussion required through the AGG executive group when elected. NEXT MEETING Page 6 of 7

DATE: Tuesday 17 th November 2015 TIME: 13.30-17.30 VENUE: Town Hall- Reception Room Page 7 of 7