Date: Tuesday 19 th September 2017 Time: 13:30 hours Location: Parkwall Hall, The Batch, Warmley South Gloucestershire Clinical Commissioning Group Minutes of Clinical Operational Executive Meeting Attendees: In Attendance: Apologies: Dr Jon Hayes (JH), Clinical Chair, South Gloucestershire CCG (Chair) Dr Norman Douglas (ND), Primary Care Lead, South Gloucestershire CCG David Jarrett (DJ), Director of Operations, South Gloucestershire CCG Steve Rea (SR), Commissioning Delivery Manager, South Gloucestershire CCG Dr Peter Bagshaw (PB), Mental Health, Dementia, Learning Difficulties and Adult Safeguarding Lead, South Gloucestershire CCG Dr Kate Mansfield (KM), Children and Maternity Lead, Named Doctor for Safeguarding Children and Board Member, South Gloucestershire CCG Dr Jon Evans (JE), Long-Term Conditions Lead, South Gloucestershire CCG Ben Bennett (BB), Director of Strategic Projects, South Gloucestershire CCG Lindsay Gee (LG), Head of Commissioning Children, Young People and Maternity, South Gloucestershire CCG Jon Shaw (JS), Head of Commissioning Partnership and Performance, South Gloucestershire Council Thom Manning, Head of Information & Performance South Gloucestershire Dr Peter Young (PY), Planned Care Lead, South Gloucestershire CCG Chris Flook (CF), Deputy Director of Finance, South Gloucestershire CCG Samantha Benney [note taker], PA, South Gloucestershire CCG Julia Ross (JR), BNSSG Chief Executive Melanie Green (MG), Director of Primary Care and Medicines Optimisation, South Gloucestershire CCG Dr Andrew Appleton (AA), IT Lead and Board Member, South Gloucestershire CCG Kate Archibald (KA), Commissioning Manager Partnerships and Integration, South Gloucestershire CCG Dr Joanne Hartland (JHar), Research and Development Manager, Avon Primary Care Research Collaborative David Moss (DM), Delivery Director, South Gloucestershire CCG Dr Nick Kennedy, Secondary Care Doctor, South Gloucestershire CCG Gemma Artz (GA), Head of Community Commissioning, South Gloucestershire CCG Sarah Weld (SW), Consultant in Public Health, South Gloucestershire CCG Dr Ann Sephton (AS), Deputy Clinical Chair and Urgent Care Lead, South Mark Pietroni, Director of Public Health, South Gloucestershire Council Janet Biard (JB), CCG Board Member Dr Alison Wint (AW), Clinical Lead for Cancer, South Gloucestershire CCG Sara Blackmore (SB), Consultant in Public Health, South Gloucestershire Council Anne Morris (AM), Director of Nursing and Quality, South Gloucestershire CCG Louise Rickitt (LR), Head of Strategy & Service Redesign, South Gloucestershire CCG Dr Phil Simons (PS), Clinical Evidence Fellow, South Gloucestershire CCG 1
1 Welcome and Apologies 2 Declarations of Interests 2a) To consider any changes to attendee interests since the last meeting None 2b) To consider any conflicts of interest arising from this agenda None Minutes of previous meeting/matters arising There were no minutes from the last meeting, new action log to be created. Matters arising not on the agenda SB 3 Chair s Update JH thanked all Practices for the support received in regards to the merger and the benefit of communication beforehand was noted. The merger was formally supported at each of the CCGs individual membership meetings and knowing that there is confidence and support going forward was reassuring. It was felt important to maintain everything good about South Gloucestershire across the BNSSG footprint. KM noted her agreement that moving forward a larger locality would be better for getting things off the ground rather than smaller groups. BB and PB raised that population would need to be looked at and compared against the areas covered by other organisations e.g. South Gloucestershire Council. ND raised that the membership also needed to be made fully aware of the total deficit. 4 Update on financial position CF provided an update on the BNSSG wide financial position at month 5. It was noted that the annual control total is 7.8million, at present the CCGs are 4 million above the year to date target with an overspend of 7.3 million. The CCGs currently forecast achieving the control total however there is a 32.4m risk of the planned savings target not being met and only partly being mitigated by the release of contingency and headroom reserves. A meeting with NHS England will take place in September to agree the likely financial outturn position and forecast deficit at the end of the year. CF explained that the BNSSG CCGs still report financial data to NHS England as separate entities however this is aggregated by NHS England when considering BNSSG financial performance against the control total. JE noted that it is helpful to understand the savings in each CCG area to decide whether to upscale certain initiatives e.g. respiratory in the South Gloucestershire area. DJ queried whether there were any key variances that the Executive Committee needed to be aware of. CF explained that delivery of savings was difficult to predict accurately due to the number of projects however there is a robust method of risk assessing each initiative to forecast a likely outturn position. The Executive Committee noted the report. 2
5 Update on System Financial Recovery Plan SR provided the Executive Committee with an update on the System Financial Recovery Plan. Month 5 YTD reports 11.5m saved against a YTD plan of 24m. Key savings are delivered from the following: CHC and EOL CHC Commissioning Approach, Meds Management Optimising Primary Care Prescribing, Planned Care RTT Backlog, Primary and Community Care growth, Urgent Care Critical Care. The highlight report gave a 17/18 forecast outturn saving of 48.4m across the nine control centres. The PMO has developed a RAG rating criteria for each Control Centre to risk assess the Control Centre forecast savings position and a summary paper has been provided to the Exec Team. The risk assessed 17/18 forecast savings is 37m. PB questioned the new process and governance going forward giving an example of the possible review of the effectiveness of the Dementia Advisors service. DJ explained that any issues would be fed through the Clinical Operational Executive for DJ/JH to escalate to the Commissioning Executive. It was noted that Paul Frisby has spoken to Penny Harris with regard to Dementia Advisors and will provide an update to DJ/JH. The Executive Committee noted the report. 6 BNSSG Transition/Merger JH reiterated that each CCG s membership meeting had formally supported the proposed merger of Bristol, North Somerset and South Gloucestershire CCGs from 1 st April 2018. From now until 1 st April 2018 some committee s will be meeting In-Common, including the Governing Body and Finance Board meetings. Louise Rickitt is leading the work on the new CCG NHS Constitution. John Shaw raised a concern regarding the decision not to take the BCF Board forward as it was felt it was very much needed. BB to look into the decision was taken not to submit/delay submission. BB It was noted that NBT are on the radar for their A&E performance. 7 Clinical Leads Update Planned Care The Support tool used in South Gloucestershire will be used across BNSSG. The Control Centre will be looking at REMEDY, the website is still Bristol based and so this is going to be changed. Tier 3 and 4 weight management, pilot for tier 3 trying to get a review, pilot for tier 4 now under surgical. Children, Young People and Maternity (Lindsay Gee, on behalf of Kate Mansfield) CAMHS Transformation funds business case will be considered in the Commissioning Executive. CAMHS new service model ithrive being launched in October. Community service remains under significant pressure 3
Enuresis clinic service model to be reviewed in partnership with Sirona. Service will close to new referrals to allow the backlog to be addressed and for the service review to be completed. Communications to referrers are being prepared and will be circulated in due course. PIFU scheme (Planned Care) BRHC have developed their own systems to ensure safeguarding concerns are addressed Norman Douglas All clusters are working together and all have developed a resistance plan. Integrated care is highly valued. Estates development for Thornbury Hospital is under Capita review, an options paper has been drafted with a preferred option of a health centre in Thornbury made up of three practices. However, the practices are concerned about residing in a building they don t own and would not want to increase in size. There is no funding or business case in place at present. Primary Care leads all meet regularly. Training funding has gone to practices and NHS England has asked for proof this has been used appropriately. Ben Bennett 3RS Continuing to review the proposals taking account of emerging BNSSG requirement for community services Consideration is being given to the 3Rs beds in the context of system wide capacity requirements In parallel Sirona are progressing design and planning issues and further developing their proposals for extra care housing with reference to the Homes & Community Agency grant previously applied for A four way meeting is planned with NBT, Sirona, SGC and CCG to review progress and unblock any issues where required Intention is to resolve all outstanding issues by the end of the financial year Separately but linked to this, BB has been asked to support Ann Sephton with the draft OBC for the BNSSG Stroke services. Some elements of the overall proposals may be able to be brought forward e.g. prevention and Rehab. Consideration will need to be given to identifying a clinical lead to succeed Ann Peter Bagshaw PB described frustrations with NBT in regards to accepting and processing CT scans, this has been escalated. AWP have downgraded their management structure due to the organisation going BNSSG wide, therefore there is now no local management in place. PCLS model is going through redesign, PB felt that this should go to Primary Care and Richard Lyle has been emailed informally. PB has been meeting regularly with the University of Chester re IAPT, it is clear which model is the preferred option however Bristol use a different model. BB to escalate as next Clinical Forum. DDRs have gone up to national levels 4
8 South Gloucestershire CCG AGM Planning South Gloucestershire CCG will be holding their AGM on the 27 th September from 13.30 at Cleve Rugby Club. All Clinical Leads, CCG Staff and the CCG Membership are invited to attend. 9 9.1 Papers for Decision Ageing Better Plan for South Gloucestershire This item was not discussed. 10 Any other Business GP IT - TM advised that GPIT is being considered BNSSG wide for 2017-2018 and CCGs are pooling the respective budgets. A programme to refresh the replacement of monitors in clinical workspaces and front desks in surgeries would take place next year, upsizing the standard monitor size to 23". Funding for WIFI in GP Practices has been devolved to CCGs. However, the funding is relatively small with a likelihood that most practices will only be equipped with one access point/router and focus will be in patient waiting areas in practices that currently have no existing wifi. South Plaza A communication has gone out and it was noted that all staff have concerns. An Accommodation Working Group will be set up. There will be a small local office based in South Gloucestershire and Badminton Road has been offered as an option. Staff are encouraged to speak to their Joint Committee Consultative staff representatives if they have any concerns. Joint Primary Care Commissioning Committee A South Gloucestershire representative is needed. Please let Norman Douglas or Mel Green know if you are interested. The meeting closed at 16:11 Next meeting 17th October 5