DRAFT Notes of the Trafford Clinical Commissioning Group Annual General Meeting (AGM) and Listening Event Held on Tuesday, 26 September 2017, 1.00pm at the Waterside Centre, Sale PRESENT: M Colledge (MC) Chair Dr L Clarke (LC) GP Member R Demaine (RD) Director of Commissioning A Foster (AF) Lay Member for Governance, Audit and Finance Dr N Guest (NG) Medical Officer Dr A Harrison (AH) GP Member Dr M Jarvis (MJ) Clinical Director for Quality and Performance J Liggett (JL) Lay Members for Partnerships and Integration J McGuigan (JM) Chief Finance Officer Dr P Nkwenti (PN) Lay Member for Patient and Public Involvement M Moore (MM) Chief Nurse S Sherrington (SS) Governing Body Nurse Dr C Tower (CT) Council of Members Chair C Ward (CW) Interim Accountable Officer IN ATTENDANCE: S Andres (SA) Dr Y Burke (YB) T Clarke (TC) J Lancaster (JL) V McDonald (VM) R Riddell (RR) M Taylor (MT) L Walker (LW) T Weedall (TW) Management Accountant Assistant GP advisor Communications & Engagement Specialist Governance and Support Services Officer Senior Management Accountant Risk and Planning Manager Associate Director of Corporate Services Governance and Support Services Officer Transformation Project Lead PUBLIC/PARTNERS/STAKEHOLDERS: C Alcock M Armstrong D Atkins C Barber H Barnett K Bay D Benjamin C Booth Y Burke J Cherrett J Collins M Cottam Great Places Housing Group Public VCSE Bruntwood Healthwatch TMBC Healthwatch Pennine Care Bodmin MHC CCG Trafford Leisure Public Member Laing O Rourke 1
M Dawson A Day G Devlin G Dolby D Evans H Fairfield R Fontana S George D Griffin D Hawker R Horton L Huntley S Hurst J Lams C Lewis S Maunder V McCall M McHugh R McJannett J Mildenhall S Musgrave I Niakrasonla J Reilly K Ringrow E Roaf J Rose A Savage J Schofield S Singh R Spearing H Tester S Waheed A Weaver G Williams Just Psychology Public Member PRAP Trafford Housing Trust Africa Caribbean Care Group Healthwatch Trafford Council PRAP Laing O Rourke Trafford Veterans THT Just Psychology Trafford Hospital TMDC HWBB Thrive, Trafford Home Instead Senior Care Alzheimer s Society Public Member THT Manchester United Foundation Parkinson s UK Trafford Hilti Trafford Council Trafford Housing Trust Trafford Council Healthwatch Home Instead Pennine Care Public Member PCFT/TMBC TCC Healthwatch Bruntwood Age UK Trafford 1. INTRODUCTION/WELCOME The Chair welcomed Governing Body members, partners, staff, stakeholders and public members to the Annual General Meeting (AGM) for Trafford CCG. It was reported that the first hour of the AGM would focus on the CCG s statutory requirements for 2016/17 which would cover operational performance, patient and public involvement and the financial review. The second part of the meeting would be the Trafford quality mark and healthy workplace awards and the third section would take the form of a listening event to understand how the CCG could work together with partners and stakeholders to drive forward its future plans for the benefit of Trafford. The Chair made reference to Gina Lawrence and advised Gina was on secondment to the Greater Manchester Health and Social Care Partnership. The Chair expressed 2
his thanks and gratitude to Gina for all of the work she carried out on behalf of the CCG during her role as Accountable Officer. RESOLVED Members noted the information. 2. ANNUAL GENERAL MEETING Introduction The Chair reported that: - Trafford Clinical Commissioning Group (CCG) was a clinically led membership organisation made up of 32 general practices in Trafford. The CCG covered a population of approximately 238,000 and was coterminous with Trafford Metropolitan Borough Council. The CCG s budget was 340.3m for 2016/17. The overall aim of the CCG was to ensure that the Trafford population had the best possible healthcare outcomes by commissioning high quality, equitable and integrated services. The CCG had four strategic aims: - Continually improve engagement with member practices, patients, the public, carers, providers, our staff and other partners to effectively contribute to and influence the work of Trafford CCG. Working with health and social care partners deliver the transformation plan for Trafford including an increasing proportion of services from primary care and community services in an integrated way. Through effective integrated commissioning improve the quality of services and reduce the gap in health outcomes between the most and least deprived communities in Trafford. To be a sustainable economy both in terms of clinical services and finances. The Greater Manchester Strategic Plan was underpinned by 10 Locality Plans, one for each of the Greater Manchester Districts. These plans were a critical aspect of the process as they described the specific work which would take place in each area to make Greater Manchester s vision for transformed health and care a reality. The CCG s Locality Plan; The Trafford Plan to 2020 - taking charge of our health and social care sets out Trafford s collaborative commissioning plans. The CCG had worked throughout 2016/17 in delivery of the NHS 5 Year Forward View to improve outcomes for the patients of Trafford whilst preparing for delivery of Devolution Greater Manchester and further improved outcomes for the patients of Trafford. This has been done by working towards achieving: - - A shift towards early intervention and prevention; - Delivering high quality of services; - Making the best use of resources; - Working effectively collaboratively across Greater Manchester; 3
- Integrating Health and Social Care services. 2016/17 Operational Performance CW acknowledged the hard work carried out by CCG staff in terms carrying out the work of the CCG, CW reported the CCG improvement and assessment framework covered indicators in 4 domains: Better Health Better Care Sustainability, and Leadership. CW advised the key performance indicators were primarily located within the better health and better care domains which included 45 indicators. As of June 2017, Trafford was reported as having 8 indicators in the top quartile, 29 indicators within the inter quartile and 8 indicators within the bottom quartile. An example was given in relation to the top quartile indicators and included (i) people eligible for standard NHS Continuing Healthcare, (ii) cancers diagnosed at early stage, (iii) people with urgent GP referral having first definitive treatment for cancer within 62 days of referral, (iv) one-year survival from all cancers, (v) children and young people s mental health services transformation, (vii) crisis care and liaison mental health services transformation, (viii) neonatal mortality and stillbirths, and (ix) women s experience of maternity services. In terms of the bottom quartile indicators, these related to (i) injuries from falls in people aged 65 and over, (ii) percentage of deaths which take place in hospital, (iii) anti-microbial resistance: appropriate prescribing of broad spectrum antibiotics in primary care, (iv) provision of high quality care - Adult Social Care, (v) out of area placements for acute mental health inpatient care transformation, (vii) delayed transfers of care per 100,000 population (viii) population use of hospital beds following emergency admission, and (ix) primary care workforce. CW added improvements were required in terms of intermediate care. NG outlined the key primary care achievements for 2016/17. It was reported that: - The CCG successfully operated under full delegated arrangements for the commissioning of primary care, In terms of the quality premium, the recording for the following diseases had improved (i) cancer diagnosis, (ii) chronic kidney disease, and (iii) chronic obstructive airways disease, Trafford continued to perform well in terms of flu screening, Productive General Practice national and local support secured for the 8 most vulnerable general practices in Trafford, Urgent Care Centre October 2016 saw the implementation of the new Trafford Urgent Care Centre, which provides a more streamlined service for patients with minor injury and illness, 4
Care Quality Commission the CCG worked to support quality improvement in general practice which resulted in 4 practices seeing their rating improve from a Requires Improvement rating to a Good rating, Limelight Development a flagship new health and social care facility has been developed in North Trafford bringing practices together to deal new models of primary care, Practice Collaborative Working and New Models of Care continued progress has been made with all practices across Trafford to develop collaborative working and prepare for new models of primary care, and Transformation fund bid successful submission of the transformation fund bid to support New Models of Primary Care (NMoPC). In terms of moving forward, CW advised members of the following work streams: Design, plan and begin implementation of the transformation plan including New Models of Primary Care, integration with Trafford MBC, Local Care Organisation, Care Complex and maximising the Trafford Co-ordination Centre, Attain delayed transfers of care targets, Meet waiting time standards in urgent care, cancer, mental health and planned care, Achieve financial plans, Implement the GP Five Year Forward View, Prepare a Trafford wide integrated estate and service plan including Altrincham and Limelight, Enhance engagement with communities, providers, and primary care, and Progress commissioned service changes e.g. end of life, diabetes. Patient and public involvement PN reported on the patient and public involvement work undertaken in the last 12 months and stated patients and the public were at the heart of the CCGs plans. It was reported that the CCG had worked with commissioners, partners and the public to give as many people as possible the opportunity to engage with the CCG about a wide range of issues. This was done via: The public reference and advisory panel, Focus and patient groups, Patient experience and feedback, Partnership working, and Public meetings. PN explained patient stories were now a key component of the CCG s Governing Body meetings and they highlighted patients experiences of the services the CCG had commissioned. Members were provided with details of each of the patient stories that had been presented to the Governing Body including the action taken to improve services as a result of the patient story. PN provided an update in terms of the Public Reference and Advisory Panel (PRAP) and it was reported that: - 5
The PRAP had been recruited to represent the views of the Trafford population and its representative groups. The PRAP consisted of: - 4 x public representatives 4 x 3 rd sector representatives 4 x GP patient participation group reps 1 x Healthwatch representative 1 x Trafford population representative PN explained there were a number of vacancies on the PRAP and welcomed members to find out more about the positions if they were interested. In terms of looking ahead, PN stated partnership communications and engagement was key and 3 rd sector organisations were instrumental in terms of the CCG achieving its aims. PN added it was key for patients and the public to take charge of their own health. Finance update 2016/17 The Chief Finance Officer provided an overview of the finances for 2016/17 in terms of how the 340.m had been spent. It was reported that: - All financial duties had been achieved, The CCG had delivered a surplus of 4.7m, as required by NHS England, The CCG had managed cash within notified cash limit, The CCG had delivered running costs expenditure within target, The CCG had paid 95% of supplier invoices within target, The CCG had delivered savings of 10.6m, and; The CCG had received a clean audit report from the external auditors in terms of value for money and compliance. In terms of the 2016/17 healthcare funding, it was reported that the annual funding per person in Trafford was 1,343 compared to a Greater Manchester average of 1,432 (+ 89 per person) and a North West average of 1,480 (+ 137 per person). In 2016/17, Trafford CCG commissioned:- 31,200 planned operations (+7% change) averaging 966 each. 28,700 emergency operations (+6% change) of 1,901 each. 395,000 (+20% change) outpatient attendances averaging 114 each. 91,000 (+1% change) A&E attendances averaging 110 each. 3,800 (+3% change) critical care days averaging 1,146 each. In term of investments for 2016/17: - Trafford Co-ordination Centre - 2m, 600k extra for improving mental health services: parity of esteem requirements, 6
5.5m invested into the better care fund to improve the integration of health and social care in Trafford, and; 1m invested in primary care. In terms of the CCG looking forward: - Significant savings of 18m in 2017/18 have to be delivered by the CCG, Council and NHS Providers respectively by 2020/21, People are living longer, however there is an inequality gap of life expectancy of 10 years; so services need to be financially sustainable and deliver outcomes, Continued focus on integrated care where most appropriate, Public engagement is essential to sustainability, TCC will care for 3000 risk stratified patients and optimise referrals, and; New primary care models of delivery to improve outcomes and reduce waste. The Chair welcomed questions/comments from members of the public in relation to the business covered as part of the AGM presentation. A question was raised in relation to NMoPC in terms of what this meant and how the model would look. NG explained NMoPC was about revolutionising primary care to include (i) better access, (ii) prevention, (iii) risk stratification via the TCC, (iv) urgent care and access, (v) improved diagnostics and (vi) establishment of multi-disciplinary teams to provide improved care. NG commented there was a need to utilise specialist skills more appropriately and interface was required with 3 rd sector organisations and wider partners. A member of the public made reference to the University Academy 92 which would be based in Trafford from 2019. It had been suggested this University would attract approximately 6500 students by 2028 and it was questioned when the CCG would receive the funding allocation for these students. JM explained funding had been identified for 2017/18 and 2018/19 and was indicative for the following years. JM stated students would register with a GP practice and then the CCG would receive funding. Work would be required between the CCG and TMBC in terms of investing into primary care services. Reference was made to devolution Manchester and the recent Labour conference. It was suggested the Mayor of Manchester was influential in terms of the health and social care agenda. CW commented on the PFI investment and suggested the value of this investment was millions across the country. CW added a lot of work would be carried out in terms of transformation and integration with the aim to have an integrated commissioning function in place by April, 2018. RESOLVED Members noted the information. 7
4. TRAFFORD QUALITY MARK AND HEALTHY WORKPLACE AWARDS Caroline Lewis explained Thrive Trafford provided free support for voluntary, community, faith based organisations and social enterprises based in Trafford. The Trafford Quality Mark (TQM) was an assessment tool to show the organisations were of recognised standard across 9 areas. Caroline introduced Dorothy Evans from the African Caribbean Care Group. Members were advised the group was a charity and provided health and social care services for 34 years across Greater Manchester. Members were advised the services provided were tailored to address the health and wellbeing of Trafford residents and included a wide range of services. Caroline presented Dorothy with the TQM award and Dorothy thanked thrive for all of their support. Caroline introduced Dawn Hawker from the Trafford Veterans. Members were advised the group was open to everybody and provided peer support and activities. It was stated the group helped people when moving into new areas to help reduce social isolation. Caroline presented Dawn with a recognition that the group was working towards the TQM. Members were informed of Trafford Sunrise, a service aimed to promote emotional health and wellbeing for children and young people and to prevent severe mental health. The service involved (i) 6 week group sessions, (ii) support for parents, and (iii) mental health awareness session. Individuals could self-refer or be referred to the service by professionals. Dr Yvonne Burke introduced the Trafford healthy workplace recognition awards and explained the scheme had been launched approximately 1 month ago. The purpose of the scheme was to promote and acknowledge businesses who encouraged and supported staff to be healthy within the workplace. Dr Burke awarded the following businesses with a Trafford healthy workplace award: Bruntwood- initiatives include walking meetings and Bruntwood care days. Hilti Ltd provide a confidential helpline for staff offering support and guidance, children s parties and a global challenge to walk 150km which equated to 3.7 times around the world. Laing O Rourke trained mental health worker within the workplace, a well point kiosk to carry out health checks, education campaigns and building a healthy workforce workshop. Trafford Co-ordination Centre introduced a wellbeing Wednesday, wellbeing website and deliver mediation sessions. Trafford Council introduced feel good Friday and wellbeing Wednesday, organised an ice cream van available to staff within summer and hold an annual awards ceremony. Trafford general hospital hold a health and wellbeing forum for staff, healthy options within the restaurant and staff recognition each month. MC congratulated and expressed his thanks to each organisation. 8
5. CCG LISTENING EVENT The Chair introduced the final part of the event. It was reported that the aim of the session was to learn more about recent Trafford talks health events and priorities for neighbourhoods. In addition, further discussions would be held around the key themes raised to help inform the CCG s 2018/19 commissioning intentions. Councillor John Lamb introduced himself and explained there was a Trafford and partners vision for 2031. A number of key themes underpinned the vision and were ongoing and emerging. Councillor Lamb commented on the following themes: Mersey Valley was a significant attraction and offered a number of opportunities for Trafford, Trafford was a national beacon for sports and leisure with some fantastic assets. It was stated outreach work was carried out but more could be done, University Academy 92 provided opportunities to regenerate the borough including a brand new sports and leisure facility, Building stronger communities via an asset based approach, Welcomed the workplace awards and stated a number of good examples were provided and were positive in terms of prevention, Money had been invested in leisure centre facilities to upgrade the provision. The Chair thanked Councillor Lamb for the update and suggested the Trafford ambition was now turning into a reality. MC delivered a presentation to highlight the issues raised by members of the public during the Trafford talks health events within each neighbourhood. Three table top discussions were held amongst attendees and the following information was captured as part of the flip chart discussions: - HOW DO WE GET TRAFFORD HEALTHIER? Do the public know how to look after themselves? Get messages to schools to ensure early intervention Reframe the way on appealing to the population in order to get the message out there Health EXPOS/Community events Promote ways in which to get healthier, i.e. C25K, Daily Mile, Leisure Centres, target Faith groups Ask the public What matters to me Have a tailored approach i.e. What happens in my street Look at mental health in schools, support to motivate parents and young people Cambridge Campaign Look at the built environment green spaces/safe spaces Play streets Community development 9
IMPROVING ACCESS TO HEALTH SERVICES IN TRAFFORD More appropriate and multi skilled local provision Requirement for sharing of information Is the most appropriate Front Door the GP practice Not enough or too many points of access Innovative approaches e.g. mental health practitioner within Housing Trust proactive identification and navigation One Trafford response part of the solution Role of TCC & DOS to coordinate including the public facing element Having the right information available TCC & Info sharing: 2 way & agile o Shared care record o TCC Dynamic o Signposting, support and coordination to improve access Directory of services more than IT enabled NG suggested a greater awareness was required in terms of what could be done, for example exercise on a neighbourhood level. NG stated various sectors provided care and services and therefore there was a phenomenal amount of opportunities. The Chair supported this view and stated it was about joint working and utilising a vast wealth of knowledge to make a difference, HOW DO WE GET EVERYONE ENGAGED Public Table Tennis in Streford Mall, physical environment, use spaces i.e. gyms Professional signposting, better peer support/groups Train volunteers to ensure awareness VSCE Support quality assurance facilitation Strategic forum does it fit? MoU to have a clear understanding of services know what Awareness/how do we communicate our work to others Something central Private Build on awards Promote good practice National awards Join sectors together Knock on effect Right courses for the young people Public sector More awareness 10
Open Door One Trafford response Trafford partnership Engagement Perfect weekend Prison relationship Mental Health 6. CONCLUSION The Chair thanked stakeholders for attending today s session and welcomed any future input into discussions around the future of Trafford. The Chair thanked CCG staff for organising the event. 11