CWHHE CLINICAL COMMISSIONING GROUP COLLABORATIVE

PAPER 14a CWHHE CLINICAL COMMISSIONING GROUP COLLABORATIVE Performance Committee Thursday 13 th March 2014 5.4, 15 Marylebone Road Members in attendance Trevor Woolley (TW) Nicola Burbidge (NB) Daniel Elkeles (DE) Alan Hakim (AH) Jonathan Munday (JM) John Riordan (JR) Tim Spicer (TS) Ben Westmancott (BW) Philip Young (PY) Lay Member, Hounslow CCG, Chair Chair, Hounslow CCG Chief Officer, CWHHE, Item 8 only Secondary Care Consultant, CWHH CCGs Central London CCG Secondary Care Consultant, Ealing CCG Chair, Hammersmith & Fulham CCG Director of Compliance, CWHHE Lay Member for Audit & Governance CWHHE Non Members in attendance Matthew Bazeley (MB) Managing Director, Central London CCG Neetika Mahan (NM) Business Manager, Ealing CCG (by phone) Elizabeth Ogunoye (EO) Associate Director of Performance Management, CSU Elizabeth Rahim (ER) Interim Account Director Mental Health, CSU Kieran Seale (KS) Governance Manager CWHHE, Minutes Elizabeth Youard (EY) Community Services Programme Director, CWHHE Minutes Business Items 1. Welcome/Apologies 1.1. Apologies were received from James Eaton, Alastair Gilchrist and Clare Parker. 2. Declaration of Interests 2.1. No interests in addition to those previously identified were declared at the beginning of the meeting. 3. Minutes of Meeting 13 th February 2014 3.1. The minutes were agreed as an accurate record of the meeting. Action Page 1 of 3

4. Matters Arising 4.1. 4.3 13 th February 2014 111 activity data: Elizabeth Ogunoye has sent the information to James Eaton who is reviewing it. He will report back to the next meeting. 4.2. 5.3 13 th February 2014 18 week target letters from providers: it was noted that although a reply had been received from Ealing Hospital, the letter didn t answer the question that had been asked. More information has been requested. Further information has also been requested from Chelsea & Westminster and West Middlesex. Elizabeth Ogunoye will circulate further responses when they are received. 5. Performance Report 5.1. Elizabeth Ogunoye presented the report. She said that there had been a slight improvement since January in A&E performance and that targets are now being met. For 18 weeks Ealing Hospital is not meeting the target and has submitted an action plan. West Middlesex also have issues on the 18 weeks target and there are on-going issues at Imperial. A contact query has been issued to Imperial and an action plan produced, on which feedback has been given. 5.2. Elizabeth Ogunoye also reported that Ealing is not meeting the 62 day target. She said that a contract query was issued on 11 th March and a meeting regarding the remedial action plan had been set for 25 th March. A revised action plan for West Middlesex had been sent to the Care Quality Commission. Information on performance at the Royal Marsden Hospital has been requested from South London CSU. 5.3. With regards to Healthcare Acquired Infections, a report on Imperial has been sent to the Director of Patient Safety & Quality. It was noted that there have been 19 incidents of MRSA across the five CCGs. It was agreed that the Quality & Patient Safety committee should be asked to look into this issue. 5.4. The report was noted. 6. Deep Dive : Improving Access to Psychological Therapies 6.1. Elizabeth Rahim, the Account Director for Mental Health presented the report. She said that there are two main providers, West London Mental Health Trust and Central & North West London Foundation Trust. She said that exception reports are provided on performance and action plans requested if an issue persists. Both Trusts have been asked to present to Clinical Quality Groups on issues that have arisen recently. 6.2. With regards to Improving Access to Psychological Therapies she said that this sat outside of the standard contract, but that targets are included within the contracting regime. Central London CCG have hit the targets both for access to services and the recovery rate. Individual CCG targets are set though the annual Operating Plan process. It was agreed that thought should be given to additional metrics that might more accurately reflect performance than those set nationally. 6.3. The report was noted. 6.4. Community Services within the CWHHE CCGs JE EO KS ER Page 2 of 3

6.5. Elizabeth Youard, Community Services Programme Director, presented a paper on Community Services. Jonathan Munday declared an interest in being part of a bid in central London affecting community services. 6.6. For Central London Community Healthcare (CLCH), she said that an external investigation had been carried out on performance reporting. PA consulting completed the review in February. It highlighted a number of areas for improvement to performance reporting and actions for CLCH to take. Key recommendations included upgrading and integration of technology. The recommendations were accepted in full by CLCH and a remedial action plan has now been produced. It is hoped that improvements will begin to be seen in Q2 of 2014/15 and cumulatively throughout the year. The committee welcomed progress to date but agreed that implementation is key and should be monitored closely. 6.7. The discussion turned to the strategic way forward for community services. The steps being taken are firstly to take stock of the current providers across the three CCGs and to use the opportunities provided by the 2014/15 contracting round. Consideration will also be given through the work around the Better Care Fund and the development of Whole Systems. An approach tailored to each provider will be developed. Conversations are also being held with CCG Cahir and GP leads. The possibility of unbundling services was discussed. It was noted that this would have cost implications and would involve a significant amount of work. 6.8. The report was noted. 7. Any Other Business 7.1. Daniel Elkeles tabled a briefing note on the commissioning of the Emergency and Urgent Ambulance Service. It included a proposal to invest in technology to allow the introduction of intelligence conveyancing. As not all CCGs were agreed on the benefits of this proposal it was proposed that funding would be agreed for six months so that the benefits could be evaluated. The paper also set out targets for London Ambulance services. The committee agreed that the proposals should be supported. 8. Dates of next meetings Date and time of future meetings: Thursday 10 th April, 10am Thursday 8 th May, 10am Thursday 12 th June, 10am Thursday 10 th July, 10am Thursday 11 th September, 10am Thursday 9 th October, 10am Thursday 13 th November, 10am Thursday 11 th December, 10am. CWHHE is a collaboration of Clinical Commissioning Groups: Central London, West London, Hammersmith & Fulham, Hounslow & Ealing Page 3 of 3

PAPER 14b CWHHE CLINICAL COMMISSIONING GROUP COLLABORATIVE Investment Committee Thursday 27 th March 2014 Room 5.4, 15 Marylebone Road Members in attendance Philip Young (PY) Lay Member for Audit & Governance CWHHE CCGs, Chair Nicola Burbidge (NB) Chair, Hounslow CCG Fiona Butler (FB) Chair, West London CCG Raj Chandok (RC) Vice Chair, Ealing CCG Daniel Elkeles (DE) Chief Officer, CWHHE CCGs, Items 1-5 Ruth O Hare (ROH) Chair, Central London CCG Clare Parker (CP) Chief Finance Officer, CWHHE CCGs Tim Spicer (TS) Chair, Hammersmith & Fulham CCG Ben Westmancott (BW) Director of Compliance, CWHHE CCGs Trevor Woolley (TW) Lay member, Hounslow CCG (by phone) Non Members in attendance Matthew Bazeley (MB) Katie Beach (KB) Janet Cree (JC) Clare Graley (CG) Carolyn Regan (CR) Tessa Sandall (TS) Kieran Seale (KS) Managing Director, Central London CCG Senior Locality and Commissioning Manager, West London CCG Deputy Managing Director, Hounslow CCG GP Clinical Lead, Hammersmith & Fulham CCG Managing Director, West London CCG Deputy Managing Director, Hammersmith & Fulham CCG Governance Manager CWHHE CCGs, Minutes Minutes Business Items Action 1. Welcome/Apologies 1.1. Apologies were received from Alan Hakim, Philippa Jones and John Riordan. 1.2. Philip Young said that he had been reflecting on the membership of the committee in the light of the work that it has been doing at recent meetings. He proposed that the Terms of Reference be reviewed with a view to having a larger proportion of Lay members and for this to be reflected in the quorum. This was agreed. 2. Declaration of Interests 2.1. The GPs present noted that as providers of GP services they had a conflict of interest with regards to the re-commissioning of Out of Hospital services. Page 1 of 5

PAPER 14b 3. Minutes of Meeting 13 th February 2014 3.1. The minutes were approved as an accurate record of the meeting. 4. Matters Arising 4.1. 7.2 6 th March 2014 - Community Diabetes service redesign (Hounslow): Alan Hakim has found a diabetic consultant from North East London to participate in the evaluation. As no GP practices in Hounslow are bidding, there will be also be GPs on the panel. 5. Update on re-commissioning of enhanced services 5.1. Tessa Sandall gave an update. She said that a great deal of progress has now been made and all but three of the specifications had been circulated for comment. 5.2. Philip Young thanked Tessa and the team for their hard work. He raised the issue of how much it was possible to develop common plans across the five CCGs and suggested beginning the work earlier in the year to make that possible. Ruth O Hare said that the best approach would be to develop common principles and then adapt the detail individually in each CCG. Daniel Elkeles noted that a very significant amount of progress had been made during the last year. He agreed that the approach should be to have general principles that are adapted locally by each CCG. 6. Local Incentive Scheme 14/15 (Central London) 6.1. Matthew Bazeley presented the locality scheme for 2014/15 for Central London CCG. He said that the core elements were locality working, quality and productivity initiatives, information management & technology and prescribing. The total cost of the scheme in central London is 4.42 per weighted patient. 6.2. Nicola Burbidge asked about the ability to obtain good quality data across the five CCGs to support the implementation of the schemes. Ben Westmancott will raise this with the Strategic IT lead (Farid Fouladinejad) and report back to the committee. 6.3. Philip Young asked if SystmOne money was included in the original roll-out and if so, whether there was double-counting. Matthew Bazeley agreed to check this. 6.4. Daniel Elkeles asked if the rates being paid for emergency admissions were correct. Matthew Bazeley will check this and ensure that the level of payments incentives the delivery of the desired outcomes. 6.5. The Central London paper was approved subject to the comments made in the meeting. It was agreed that Philip Young and Clare Parker would sign off the final wording taking account of these changes. 6.6. Comparing the schemes across the five CCGs, Trevor Woolley noted that only Hammersmith & Fulham had quantified the savings to be made. He said that it would be better if a consistent approach was taken across the five CCGs. The committee agreed the importance of learning lessons from this year to be fed into next year in general and of the desirability of schemes consistently identifying what value was delivered for each pound invested, in particular. BW MB MB Page 2 of 5

6.7. Trevor Woolley commented that only Hounslow and Ealing had practice eligibility standards. The other CCGs explained the approach that they took to this issue and it was noted that the approaches reflected similar aspirations but differences in style between CCGs. It was agreed that the approaches should be reviewed to see which works best. This approach can then be used across the CCGs next year. 7. Local Incentive Scheme 14/15 (West London) 7.1. Katie Beach presented the West London Local Incentive Scheme. She said that it was similar to the approach that was taken in central London. Payments are divided between 30% for following process and 70% for delivering outcomes. The total cost is 5.43 per weighted patient. 7.2. Philip Young asked about the reliability of data. Katie Beach said that the CCG was reasonably confident that sufficient data would be available. 7.3. Nicola Burbidge asked why the same was being paid to practices of different sizes in the Commissioning Learning Set plan. It was explained that this was because the amount of work that needs to be done was similar irrespective of practice size and also to support small practices. Nicola Burbidge said that the issue of transitional funding for practices should be given more consideration in 2015/16. 8. Local Incentive Scheme 14/15 (Hammersmith & Fulham) 8.1. Clare Graley presented the Hammersmith & Fulham Local Incentive Scheme. She said that this was the fourth year of network plans in Hammersmith & Fulham and that the scheme had been developed following consultation with practices. She said that the scheme had been designed on the basis that each pound invested would bring three in savings. The areas covered are: network development and improved data quality; reduction in referral variation; reduction non-elective admission variation; quality improvements; and prescribing. The total cost is 5.96 per weighted patient. 8.2. The scheme for Hammersmith & Fulham CCG was agreed. 9. Local Incentive Scheme 14/15 (Hounslow) 9.1. Janet Cree presented the proposal for Hounslow CCG, which she said builds on the work done in previous years. The key elements are: admission reductions, prescribing, General Practice Outcomes Standards, GP Validations/Clinical Audit, and protected time to support improvement in quality. The total cost comes to 4.58 per weighted patient. 9.2. The scheme for Hounslow CCG was agreed. 10. Local Incentive Scheme 14/15 (Ealing) + Modernisation Fund 10.1. Raj Chandok presented the paper relating to the Local Incentive Scheme. The Scheme covers working in networks, planned care reduction, reduction in nonelective admissions, improvement in the quality of patient care, improvement in the quality of prescribing and delivery of QIPP. The total cost is 5 per patient. 10.2. The scheme was agreed. 10.3. Looking across the five Local Incentive Schemes it was agreed that consideration should be given to the consistency of non-elective indicators and the approach SystmOne. It was agreed that Philip Young and Clare Parker will sign off any resultant changes to the schemes. PAPER 14b Page 3 of 5

10.4. Modernisation Fund Ealing have operated a modernisation fund since 1990. NHS England have agreed to the withdrawal of the scheme during 2014/15, but practices will be guaranteed income for one year (2014/15) to allow them time to adjust. The total cost is 416,000 across 42 practices. 10.5. Raj Chandok declared an interest that his practice received 8,400 during 2013/14 from the modernisation fund. 10.6. Philip Young noted that this was an idiosyncrasy with Ealing practices. He said that given that the scheme would finish at the end of March 2015 and the money then be recycled into appropriate primary care provision, it should be approved for this year. The proposal was agreed. 11. Primary Care Access - Weekend opening & Enhanced Access (West London) 11.1. Introducing the paper, Carolyn Regan said that this proposal was for an extension of the existing enhanced access and weekend opening scheme until the new CWHHE Extended Primary Care Access service is launched, at which time both services will be decommissioned. 11.2. The committee agreed that this temporary proposal should be agreed and the approach to be taken agreed across the five CCGs for the future. 12. GP Network Organisational Development proposal (West London) 12.1. It was noted that the proposal for West London was very similar to that which the committee had previously approved in Hammersmith & Fulham. The committee agreed the paper. 13. Enhanced Service Income Guarantee 13.1. Tessa Sandall presented the paper which outlined a proposal to guarantee the income to practices from enhanced services during 2014/15 at 2013/14 levels unless the service has been decommissioned. She said that the total cost would be between 8m and 10m. All practices would be written to in order to explain the process being followed. 13.2. Trevor Woolley asked for clarity on what the CCGs were getting in exchange for this income guarantee. Clare Parker said that there would be requirements such as participation in networks linked to the funding. 13.3. Philip Young stressed the importance of having a good appeals process in place to deal with any disputes. This was agreed. 13.4. The committee gave its support to the approach being taken to this work. 14. Any Other Business 14.1. It was noted that additional meetings had been added to the schedule, so that the upcoming dates are now: 10 th April; 1 st May; 15 th May; 12 th June. PAPER 14b Page 4 of 5

PAPER 14b 14.2. It was also noted that it is important to be clear what action the committee is taking. Decision-making power rests with CCGs so that in most cases the committee will be making recommendations back to the CCG Governing Body for them to act on, rather than the committee actually making the decision. An exception to this would be if the Governing Body had specifically delegated power to the Investment committee. 15. Dates and times of next meeting 10 th April 2014, 11.30am 1 st May 2014, 10am 15 th May 2014, 9.30am 12 th June 2014, 11.30am 3 rd July 2014, 10.30am 11 th September 2014, 11.30am 2 nd October 2014, 10.30am 13 th November 2014, 11.30am 4 th December 2014, 10.30am CWHHE is a collaboration of Clinical Commissioning Groups: Central London, West London, Hammersmith & Fulham, Hounslow & Ealing Page 5 of 5

PAPER 14c CWHHE CLINICAL COMMISSIONING GROUP COLLABORATIVE Investment Committee Thursday 10 th April 2014 Room 5.4, 15 Marylebone Road Members in attendance Philip Young (PY) Nicola Burbidge (NB) Daniel Elkeles (DE) Alan Hakim (AH) Clare Parker (CP) Mohini Parmar (MP) John Riordan Ben Westmancott (BW) Trevor Woolley (TW) Lay Member for Audit & Governance CWHHE CCGs, Chair Chair, Hounslow CCG Chief Officer, CWHHE CCGs Secondary Care Consultant, CWHH CCGs Chief Finance Officer, CWHHE CCGs Chair, Ealing CCG Secondary Care Consultant, Ealing CCG Director of Compliance, CWHHE CCGs Lay member, Hounslow CCG Non Members in attendance Matthew Bazeley (MB) Kiran Chauhan Clare Graley (CG) Sue Jeffers (SJ) Kathryn Magson (KM) Carolyn Regan (CR) Tessa Sandall (TS) Kieran Seale (KS) Managing Director, Central London CCG, Item 5 on Deputy Managing Director, Central London CCG GP Clinical Lead, Hammersmith & Fulham CCG Managing Director, Hounslow CCG Managing Director, Ealing CCG Managing Director, West London CCG Deputy Managing Director, Hammersmith & Fulham CCG Governance Manager CWHHE CCGs, Minutes Minutes Business Items Action 1. Welcome/Apologies 1.1. Apologies were received from Matthew Bazeley, Fiona Butler and Tim Spicer. 2. Declaration of Interests 2.1. No interests in addition to those previously identified were declared at the beginning of the meeting. 3. Minutes of Meeting 27 th March 2014 3.1. It was noted that Alan Hakim and Kathryn Magson had attended the meeting by phone. With this change, the minutes were approved as an accurate record of the meeting. Page 1 of 3

PAPER 14c 4. Matters Arising 4.1. 6.3 27 th March 2014 - Local Incentive Scheme 14/15 (Central London): Matthew Bazeley had confirmed with Philip Young that there was no double counting in the costs for SystmOne. 4.2. 6.4 27 th March 2014 - Local Incentive Scheme 14/15 (Central London): Matthew Bazeley had also confirmed with Philip Young that the rates being paid for emergency admissions were correct. Daniel Elkeles said that it would be important to check that the proposed Local Incentive Schemes do not overlap with what is being provided nationally. Tessa Sandall said that she is looking into this. 5. Additional Primary Care Capacity Weekend Opening (Hounslow) 5.1. The papers on weekend opening in Hounslow and Hammersmith & Fulham were considered together. 5.2. Alan Hakim asked about the relationship between the proposals and winter funding (as the proposals had originally been developed in that context). He said that all the winter schemes were currently being reviewed with a view to deciding priorities for next year. Daniel Elkeles said that although the proposals had originally been developed in the context of winter funding, weekend opening hours are part of the wider strategy of improving the accessibility of primary care and therefore the two issues are no longer linked. This was agreed, but it was noted that evaluation of the benefits of such schemes using a common methodology across the five CCGs was desirable. 5.3. Philip Young asked about standardisation of the proposed levels of payment across CCGs. It was noted that the payments were generally of the same level, although Hounslow had proposed an uplift on Sunday payments for work on Bank Holiday Mondays. The committee did not see how such an uplift could be justified and asked the Hounslow Governing Body to reconsider this part of the proposal. 5.4. Following discussion, the proposition in the Hounslow paper that there was evidence to indicate that longer GP opening in winter had reduced A and E admissions was withdrawn. 5.5. It was noted that the two papers differed in the length of time it was proposed the contract should last. It was agreed that the intention was for the approach set out in the papers to continue until a specification can be agreed across the five CCGs as part of the work to re-commission enhanced services. It was agreed that this would be made clear in both cases. 5.6. With these changes the papers were agreed. It was agreed that there should be a review in September 2014 to distil the lessons learnt from these schemes. 5.7. Trevor Woolley noted that while the Hammersmith & Fulham proposal was accompanied by a business case, the Hounslow proposal was not. This raised the question of what precisely the Committee was being asked to approve, and hence the paperwork which was needed to support its decision making. Philip Young said that the purpose of the committee was either to consider items referred to it by the Governing Body and provide guidance so that the Governing Body can make a final decision, or to make specific decisions that had been expressly delegated to them by the Governing Body. It was agreed that Philip Young, Clare Parker, Trevor Woolley and Alan Hakim should reconsider the committee's terms of reference in the light of the experience of its operation over the previous year, and suggest any changes for the Committee's approval, along with guidance for the preparation of papers for submission to the Committee. TS SJ SJ/ TS PY Page 2 of 3

PAPER 14c 6. Extending Weekend Opening (Hammersmith & Fulham) 6.1. See discussion on item above. 7. Any Other Business 7.1. Community Ophthalmology (Central London) - a paper on the procurement of Community Ophthalmology by Central London CCG was tabled. It was agreed that further time was needed to consider this paper in detail, but the question of when papers relating to procurements need to be brought to the Investment committee was discussed. Clare Parker noted that the process had been considered in some detail a year ago and that a diagram mapping out the process had been produced. It was agreed that this should be revisited, revised as necessary, and brought back to the committee. Clare Parker will discuss the document with Philip Young, Alan Hakim and Trevor Woolley before it is brought back to the committee. CP 8. Dates and times of next meeting 1 st May 2014, 10am 15 th May 2014, 9.30am 12 th June 2014, 11.30am 3 rd July 2014, 10.30am 11 th September 2014, 11.30am 2 nd October 2014, 10.30am 13 th November 2014, 11.30am 4 th December 2014, 10.30am CWHHE is a collaboration of Clinical Commissioning Groups: Central London, West London, Hammersmith & Fulham, Hounslow & Ealing Page 3 of 3

PAPER 14D CWHHE CLINICAL COMMISSIONING GROUP COLLABORATIVE Information Strategy and Information Governance Committee Thursday 6 th February 2014 15 Marylebone Road Members in attendance Alastair Gilchrist Arjun Dhillon (phoned In) Ben Westmancott Farid Fouladinejad (phoned in) Matthew Bazeley Michael Morton Tim Spicer Daniel Elkeles Richard Baxter Ruth O Hare Robert McLaren Tony Willis Jonathan Webster Lay member, West London CCG, Chair Ealing CCG Director of Compliance and Deputy SIRO, CWHHE CCGs IT Strategic Lead, CWHHE CCGs Managing Director, Central London CCG Lay member, Central London CCG Chair, Hammersmith & Fulham CCG Chief Officer CWHHE GP IT Lead, Hounslow CCG Chair, Central London CCG GP IT lead, Ealing CCG GP IT lead, Hammersmith and Fulham CCG Caldicott Guardian, CWHHE CCGs Non Members in attendance Sanjay Gautuma Shivam Natarajan Joanna Daffurn Amy Sanchis Tandeep Fairman (phoned in) Jonathan McInerny Minutes Business Items Caldicott Guardian and IT lead, Imperial College (items 6 and 7) NWL CSU Governance Officer, CWHHE CCGs Governance Assistant, CWHHE CCGs, Minutes Head of Quality, Hounslow CCG Locality Coordinator, West London CCG Action 1. Welcome/Apologies 1.1. Apologies were received from Fiona Butler. CWHHE is a collaboration between the Central London, West London, Hammersmith & Fulham, Hounslow and Ealing Clinical Commissioning Groups Page 1 of 4

2. Declaration of interests 2.1. No interests were declared. 3. Minutes of the last meeting 5 th December 2013 3.1. The minutes of the last meeting were approved as an accurate record of the meeting. 4. Matters Arising 4.1. The committee reviewed the matters arising report and noted that all actions had been completed. 5. Committee Governance 5.1. Terms of Reference The committee reviewed the terms of reference and requested that a patient representative is included in the committee membership. The committee recommended that the terms of reference are presented to the CCG governing bodies for approval. The committee also noted the number and range of other IS or IG groups across the collaborative and asked for a document to be produced which lists each with a summary of its primary contact and governance which could be maintained and updated on an ongoing basis. 5.2. IG Policies to be monitored The list of Information Governance policies to be monitored was noted by the committee. AG requested that these be added to the ToR (above) for information 6. Imperial 6.1. E-mail Encryption Sanjay Gautuma gave an update on recent changes at Imperial College Healthcare NHS Trust. Imperial recently implemented Watchguard (Voltage Securemail) to prevent data leakage by email and to provide a mechanism to securely transmit sensitive information to partners as well as to their patients and other third parties. There is an increasing demand for patients to utilise email as the primary form of communication and this needs to be done securely. 6.2. The committee requested that Imperial use nhs.net to nhs.net email for all communication from the Trust to GPs and Watchguard is used when communicating with patients. It was agreed that this would be safer and more convenient to GPs, concerns were raised that some GPs use non nhs.net accounts and this needs to be addressed. It was agreed that a working group would be set up to develop a proposal that is suitable for all parties. 6.3. Cerner Implementation The committee discussed CWHHE CCGs IT strategy and the importance of ensuring provider strategies are aligned. The CCGs want a shared care record and it was questioned to what extent interoperability would provide a satisfactory answer. There was a growing demand for patients to be given access to their care records on hand-held devices and a safe and convenient way to do this was required. It was agreed that this will be discussed further in the working group. 7. SystmOne Update JD BW BW BW CWHHE is a collaboration between the Central London, West London, Hammersmith & Fulham, Hounslow and Ealing Clinical Commissioning Groups Page 2 of 4

7.1. Farid Fouladinejad provided an update on SystmOne implementation across CWHHE CCGs. The number of GP practices that have signed up continues to increase. The committee requested additional qualitative metrics to measure the success of SystmOne implementation such as a short survey for GPs to complete which would be reviewed by the committee of their experiences in moving to SystmOne and suggestions about what more needs to be done to embed the system with the practice. This should be requested 2 weeks after practice roll-out. 7.2. Farid Fouladinejad agreed to share the CWHHE CCGs issue log for SystmOne at a forthcoming meeting so that common issues can be reviewed. 7.3. It was noted that Ealing GP practices have much lower levels of GPs signed up to SystmOne than the other CCGs. The committee agreed that a development plan is needed. 7.4. A benefits realisation framework is being prepared to ensure that we get the most out of using a common system across the collaborative. 8. CQUIN metric 8.1. A single patient record is the most significant area of this CQUIN this year. Shivam Natarajan and Farid Fouladinejad will present a more detailed update at the next meeting. The committee reinforced that this CQUIN is very important and patients should be able to see their full record and not just a summary. Providers are aware of the CCGs strategic direction and must ensure that their system meets our requirements. There were different opinions as to whether the CQUIN investment should be used to incentivise providers to make sure patients can see their summary record or whether this should be a requirement within the standard contract payment. 8.2. The committee suggested that the system provider is invited to the next meeting to demonstrate what data a patient could see on their equipment (including hand-held devices) and to discuss the provider strategy for patients accessing their own information. 9. CCG Data Strategies 9.1. NHS England is creating a data strategy template that all CCGs will be required to complete by September 2014 and are asking for input from CCGs to create this template. The committee agreed that one strategy will be completed across the five CCGs and the development of this document would be led by Farid Fouledinejad. 10. CCG Information Governance Update 10.1. The committee received an update on the progress of Information Governance training to help ensure the necessary safeguards for, and appropriate use of, patient and personal information. It was noted that we require GP s to be Level 2 compliant with version 11 of the Information Governance Toolkit by 31 March 2014. Network co-ordinators and IG leads are continuing to support practices to achieve this. The committee noted that the CWHHE Quality and Safety Committee will continue to monitor GP IG compliance from a quality perspective. It was agreed that Chairs and Managing Directors will need to actively promote IG compliance among their member practices to ensure a full understanding of the reasons and rationale as well as the practices and policies they are required to adopt. FF FF FF FF SN/FF FF FF MB/ RO H/ JMcI/ TS/RB /AD CWHHE is a collaboration between the Central London, West London, Hammersmith & Fulham, Hounslow and Ealing Clinical Commissioning Groups Page 3 of 4

10.2. The low uptake of IG training among staff was noted with concern. A major effort in February and March to encourage staff to complete training is planned and the committee was asked to endorse this effort. It was noted that staff need to update their record if they were still registered under the PCT. 10.3. The committee noted the update and the good progress that was being made to improve IG compliance within the CCGs. 11. Work Plan Discussion 11.1. This was postponed to the next meeting due to lack of time. 12. Minutes of Other IT Groups 12.1. The work of other IT committees was noted. 13. Any Other Business 13.1. The committee were informed that the CSU has commissioned a piece of work to look at IT and information. This work is necessary to review the ICP IT platform. 13.2. It was noted that the IT lead for the Central London CCG, Sam Rogers, was leaving. The committee noted his hard work and contributions during the migration to a single system. A replacement would be identified. 14. Date and time of future Meetings 14.1. Future meetings will be held as follows: - 3 rd April 2014 10.30am 12.00pm 15 MBR - 15 th May 2014, 11.00am 12.30pm, 15 MBR - 17 th July 2014, 10.30am 12.00pm, 15 MBR - 16 th October 2014, 10.30am 12.00pm, 15 MBR - 5 th February 2015, 12.00pm 1.00pm, 15 MBR CWHHE is a collaboration between the Central London, West London, Hammersmith & Fulham, Hounslow and Ealing Clinical Commissioning Groups Page 4 of 4

PAPER 14e CWHHE CLINICAL COMMISSIONING GROUP COLLABORATIVE Quality & Patient Safety Committee Thursday 20 th March 2014 15 Marylebone Road Members in attendance Alan Hakim (AH) Daniel Elkeles (DE) John Riordan (JR) Jonathan Webster (JW) Michael Morton (MMo) Mohini Parmar (MP) Neville Purssell (NP) Nicola Burbidge (NB) Philip Portwood (PP) Tim Spicer (TS) Trish Longdon (TL) Secondary Care Consultant, CWHH CCGs Chief Officer, CWHHE CCGs Secondary Care Consultant, Ealing CCG Director of Patient Safety and Quality, CWHHE CCGs Lay Member, Central London CCG Chair, Ealing CCG GP, Central London CCG Chair, Hounslow CCG Lay Member, Ealing CCG Chair, Hammersmith and Fulham CCG Lay Member, Hammersmith & Fulham CCG (Chair) Non Members in attendance Joanna Daffurn (JD) Keith Stone (KS) Lizzie Wallman (LW) Mary Mullix (MM) Nada Schiavone (NS) Stephanie Grant (SG) Tandeep Fairman (TF) Governance Officer, CWHHE CCGs, minutes Clinical lead Quality and Safety, CSU Deputy Director of Quality & Patient Safety CWHHE CCGs Deputy Director of Nursing, Quality and Safety, CWHHE CCGs Commissioning Support Unit, CSU Commissioning Development Manager, CSU Head of Quality and Governance, Hounslow CCG Minutes Business Items Action 1. Welcome/Apologies 1.1. Apologies were received from Simon Tucker, Rachel Garner, Fiona Butler, Alison Baker and Ben Westmancott. 2. Declaration of interests CWHHE is a collaboration between the Central London, West London, Hammersmith & Fulham, Hounslow and Ealing Clinical Commissioning Groups Page 1 of 5

2.1. There were no declarations of interest. 3. Minutes of Meeting 20 th February 2014 3.1 The minutes were approved as an accurate record of the meeting. 4. Matters Arising 4.1 WLCCG Exception Report ChelWest and the use of Coordinate My Care Rachel Garner raised the CCGs concerns regarding ChelWest not using coordinate my care at the ChelWest CQG and further assurances were provided. 4.2 Pressure Ulcer Themes Mary Mullix reported that a number of reporting tools are being used across provider organisations and protocols and guidelines are being reviewed. The committee were informed that work is being conducted across NWL that includes Providers, Local Authorities and care homes. The Committee received assurances that the work being carried out was sufficient and requested further assurances once the issues had been addressed and the evidence to support this. Mary Mullix agreed to present the action plan at the May meeting. 4.3 HFCCG Exception Report ChelWest SI Reporting Mary Mullix informed the committee that she has reviewed the minutes of the Trust s Board meeting over the last year but was unable to review what has been discussed in the private section of the meeting. This will be addressed under agenda item 10. 4.4 Board Assurance Framework West Middlesex and ChelWest Hospital Partnership: A decision is still waiting to be made and an update will be provided at the next meeting. 4.5 CLCCG Exception Report Increasing pressures in ENT, Urology, ophthalmology and oral surgery at ICHT resulting in deteriorating performance: On the basis of increasing backlogs the CSU has approached ICHT to establish whether additional specialties were at risk of future performance issues in addition to Urology and General Surgery. The Trust has confirmed that T&O and ENT are at risk of not meeting specialty performance from M10. Ophthalmology and Oral Surgery backlog has increased marginally in M10 by 2 and 8 patients respectively and remain within tolerance of national standards. ICHT has provided a Remedial Action Plan that will require further work to provide assurance that the Trust has appropriate systems in place to meet specialty standards. The performance team and contract lead are meeting with Imperial Chief Operating Officer to discuss the revised action plan and to receive assurances. The committee expressed concern about these failings, and NP confirmed that he had had patient appointments cancelled in ophthalmology. The Committee sought assurance from ICHT that they have the capacity and plans to reduce waits in these areas quickly. Nada Schiavone agreed to feedback these concerns to the performance team and will provide an update at the next meeting. 4.6 WLCCG Exception Report ChelWest not meeting speciality standards: Nada Schiavone provided an update to the Committee and is attending a meeting next week to discuss the issues, remedial action plan and to gain assurances. An update will be provided at the next meeting. MM DE NS NS CWHHE is a collaboration between the Central London, West London, Hammersmith & Fulham, Hounslow and Ealing Clinical Commissioning Groups Page 2 of 5

4.7 NHS 111 Update: The CCG 111 leads met to discuss the future contract arrangements the discussions of which have been summarised in a letter to the CCG Chief Officers. The Committee requested that this letter is also sent to Chairs and their PAs for discussion at clinical boards and/or executive team meetings. 4.8 NHS 111 Update: Stephanie Grant presented a 111 assurance paper in response to the CCG queries at the previous meeting. Stephanie Grant confirmed that the directory of services has been updated to include all practices that are open on the weekend. A detailed call analysis has been carried out to review the process. It was agreed that a further analysis will be carried out to look at all call logs and see what service is returned, how many callers were directed to a GP and the UCC compared to what the DoS list stated. A report will be drafted for the next Committee meeting. 4.8.1 The Committee discussed UCC notifications and queried why ChelWest, Hammersmith and Fulham Centre for Health, St Charles and St Mary UCCs do not have DoS endpoints set up to enable them to receive notifications. Stephanie Grant agreed to follow up to see if there has been any progress in setting these up. 4.8.2 The CCGs have requested CCG level reporting of 111 performance. This is available but there is currently not a staff resource for this activity. The Committee requested that a proposal for additional designated analysis resource is submitted to the Committee including the additional costs per CCG. 5. Exception Report Central London CCG 5.1 How information from the performance and quality reports should be shared with GPs and how they should use the information This will be discussed at the next meeting. 6. Exception Report - West London CCG 6.1 No exceptions to report. 7. Exception Report Hammersmith and Fulham CCG 7.1 No exceptions to report. SG SG SG SG NP 8. Exception Report Hounslow CCG 8.1 No exceptions to report. 9. Exception Report Ealing CCG 9.1 18 weeks assurance ECCG raised concern that the content of the letter sent to EHT regarding the governance arrangements in place to ensure accurate reporting on 18 week referral to treatment (RTT) waiting list and RTT performance reporting was insufficient and that 3 specialities are failing to achieve target with significant issues in T&O. The Committee agreed that due to the issues highlighted this is to be included as an item on next month s agenda. 10. Chelsea and Westminster SI Reporting KM CWHHE is a collaboration between the Central London, West London, Hammersmith & Fulham, Hounslow and Ealing Clinical Commissioning Groups Page 3 of 5

10.1 Elizabeth McManus was introduced to the Committee and provided background to her role as Executive Director of Nursing and Quality for ChelWest. Elizabeth McManus explained that the issues are not just about SI reporting but reflect relationships, Trust behaviours and transparency on how events are responded to. Elizabeth McManus said that ChelWest have a thorough SI process which is why delays occur, but agreed that the process needs to be revised to meet the Collaborative s concerns. Trish Longdon commented that ChelWest may indeed be dealing with these issues well, but that in the absence of transparency and open, timely reporting, the CCGs could not be assured this was the case. It was confirmed that active steps are being taken to address the issues including training and quality improvement to assist staff in reporting efficiently. ChelWest have updated their processes and the cultural changes are in place to ensure that all learning is embedded within the organisation. 10.2 The organisational structure and governance arrangements within ChelWest were explained to the Committee. Trish Longdon explained these longstanding concerns raised by the CCGs had been escalated due to the lack of response, reporting and information being received from the Trust. It was suggested that Trish Longdon, Chair of the committee, attend ChelWest Board to explain the CCGs concerns so that the process can be used as a learning experience. Elizabeth McManus confirmed that she will ensure Trish Longdon is invited to a future Board meeting. 11. Primary Care Complaints Report 11.1 Alison McMilan, Head of GP Complaints for NHSE, explained to the Committee that the CSU run the complaints service for NHSE with 10 area teams and 28 staff. A report on CWHHE CCG complaints was presented and the Committee was informed that the current system can only produce a limited, pre-determined data set. The national system is currently under review and in future will include details on whether the complaint is being upheld, learning outcomes etc. The data only covers complaints to NHSE and not complaints to the individual practice. Alison McMilan explained that the 2009 legislation outlines a 2 stage complaints process and states that a person can make a complaint to the practice or NHSE and not to both. If it is not resolved at this level then it is escalated to the Ombudsman. The Committee was informed that case workers work to an area and are able to highlight and raise any patterns of complaints. 11.2 The Committee raised concerns that the NHS complaints process is far too complicated and that people are not aware of the process. Alison McMilan confirmed that a pilot of a simpler complaints process is currently underway and that leaflets will be sent to all GP practices for their patients. 12. Serious Incident Report 12.1 Nada Schiavone presented the report to the committee and provided a summary of the never events reported in February. The Committee raised their concerns in regard to ChelWest maternity unit closing for 10 hours due to capacity issues. The Committee requested details on how the decision was made and who it was communicated to, how many women were diverted etc. 13. Any Other Business 13.1 There was no other business TL NS CWHHE is a collaboration between the Central London, West London, Hammersmith & Fulham, Hounslow and Ealing Clinical Commissioning Groups Page 4 of 5

15. Dates of next meetings 24 th April 2014, 10.00am 29 th May 2014, 10.00am 26 th June 2014, 10.00am 31 st July 2014, 10.00am 25 th September 2014, 10.00am CWHHE is a collaboration between the Central London, West London, Hammersmith & Fulham, Hounslow and Ealing Clinical Commissioning Groups Page 5 of 5