Croydon Clinical Commissioning Group Clinical Leadership Meeting Minutes

Attachment 16 Appendix 1 Date: 13 July 2012 Time: 13 30 15 30 Location: Room 11.4, Leon House Present: Dev Malhotra, GP Board Member Bobby Abbot, GP Dipti Gandhi, Clinical Leader Brian Okumu, GP Clinical Leader Rajeev Sagar, GP Clinical Leader Farhhan Sami, GP Clinical Leader Mike Sexton, Chief Finance Officer Paula Swann, Borough Managing Director and Designate Accountable Officer (Croydon Borough Team) Croydon Clinical Commissioning Group Clinical Leadership Meeting Minutes In Attendance: Sara Corben, Deputy Director Public Health Team James Slater, Croydon Borough Team Emma Gillgrass, Consortium Lead, Croydon Borough Team Fouzia Harrington, Croydon Borough Team Observer: Yogesh Patel, GP Upper Norwood Practice 1. Apologies Action 1.1 Dev Malhotra welcomed the Group. Apologies were noted from Anthony Brzezicki, Agnelo Fernandes, Karthiga Gengatharan and Dipti Gandhi. 2. Declaration Of Interests 2.1 There were no new declarations of interest. 3. Minutes of meeting held on 12 June 2012 3.1 Minutes of the meeting held on 12 June 2012, were approved as a true and accurate reflection of discussions held, pending noting that Bobby Abbot had attended the meeting in June. 4. Matters Arising 4.1 CLG27 The Group noted that Paula Swann s work on GP Engagement had been circulated. The Group noted that there was a need to ensure that Networks expressed their training and developmental needs. It was suggested that a slot in each network meeting, could be identified to cover aspects of commissioning. 4.2 4.3 The Group noted that Networks and QIPP Operational Board had discussed provision of services to patients from other practices not offering some services. The Group agreed that a distinction was required around GPs commissioning and provider roles. The Group noted that practices would be required to sign up to the constitution. Paula Swann suggested that there was a need for the Page 1

Vision to be reviewed and re-launched. 4.4 CLG30 A summary report on the Intermediate Gynae Services was presented to the Group. The Group noted the following issues: the cost of a direct access TV scan via secondary care is more expensive than the intermediate service which include scan, consultant review and management plan; Referrals from Norbury Medical Practice to the intermediate service include referrals for scans that other practices may send as direct access. 4.5 The Group was concerned that be patients were being referred to the service that could have been seen in house thereby giving rise to a conflict of interest. Paula Swann suggested that a full clinical audit and peer review be carried out with comparable data for all practices looked at including number of patients seen in house / intermediate care / secondary care / direct access scans. The Group noted that there was a need for conflict of interests to be robustly managed in all services 4.6 Session to be held on Vision and Constitution Peer Review to be carried out by Board Direct Access Diagnostics The Group noted that guidance on Direct Access Diagnostics had been circulated. All direct access diagnostics should be referred to Croydon University Hospital. FH DM Cost comparison InHealth / CUH For Network agendas To confirm process for MRI referrals 5. Standing Items 5.1 Report from Chair/ Managing Director 5.1.1 The Group noted that Peter Brambleby, previous Director of Public Health had spoken to the press regarding his concerns over the financial issues at NHS Croydon. 5.1.2 5.1.3 Paula Swann advised that a report had been published by NHS London following a letter blowing the whistle issues such as bullying at Croydon University Hospital. The Group noted that following a recent visit at Croydon University Hospital, the CQC had noted a lack of monitoring equipment in the Maternity Unit. The CQC had also noted that Theatres were not following the WHO checklist but had an internal list, which was not Page 2 of 9

5.1.4 5.1.5 consistently followed. The WHO list has now been implemented. The Group also noted that an A&E action plan had been put in place to address performance issues within the A&E. The Group noted that a GP in New Addington, was subject to a supervision order. The Group was concerned that there might be other GPs in the borough under such orders that the Borough Team were not aware of. CQC report to be shared with the Group Paula Swann to follow up with Dow Smith PS 5.2 CCG Development Authorisation 5.2.1 The Group noted that there was a need to submit evidence against 6 domains. There were 19 key documents required plus additional evidence to support the key lines of enquiry. The Group noted that Croydon CCG was submitting it s authorisation application in the 4 th wave, therefore evidences needed to be submitted by 1 November 2012. After the submission of evidences, a site visit and panel session with the Board was planned. 5.2.2 5.2.3 5.2.4 5.2.5 5.2.6 5.2.7 The Group noted that the CCG was working with KPMG to take forward the work required ahead of submission. A number of sessions to cover key areas would be run. The Group noted that KPMG would also work on developing the Board as a unit as well as individual Board members. KPMG was hoping to present their plans at the CCG Board meeting scheduled for 24 July 2012. Clinical Leadership Group members were invited to attend the 24 th July Board meeting. The Group noted that there was a possibility that Croydon Clinical Commissioning Group did not receive full authorisation, however, it was anticipated that authorisation with conditions around finance, delegation be received. Recruitment The Group noted that the vacancies for the Nurse, Consultant and Lay members needed to be in place prior to the site visit. A recruitment plan from KPMG was expected by week commencing 16 July 2012 The Group also noted that a Programme Manager was expected to be recruited to support the authorisation process. The Group noted that CCGs across London had agreed to go out for advert for Head of Commissioning and Head of Quality roles at the same time. It was anticipated that jobs would be advertised week starting 16 July 2012 and recruited to by mid-august. Page 3 of 9

5.2.8 5.2.9 5.2.10 5.2.11 5.2.12 KPMG coaching The Group noted that there had been low uptake on coaching being offered to members. Members reported that this was due to the difficulties in organising sessions around practice commitments. Members commented that sessions had been cancelled and on one occasion the coach did not turn up. The Group noted that the previous deadline of taking up coaching by July had been lifted and these could now run over a period of time. Dev Malhotra suggested that the sessions covered practical areas of Commissioning rather than only on personal development. 2/head The Group noted that for the current financial year the CCG had approximately 700k plus approximately 400k that had not been drawn down last year. It was proposed that this would fund the Board costs and other development. The Group noted the proposals from the Management Team following their discussions: 500k for the Board 250k for primary care support / QIPP delivery / recovery 250k for a programme manager, Organisational Development Commissioning Support Services The Group noted that Croydon CCG intended to buy in all its commissioning support from the Commissioning Support Services or Joint Commissioning Unit. The Group noted that service specifications and structures were being developed. It is understood that the Joint Commissioning Unit would be co-located with the Local Authority, and within 18 months would work towards full integration. Engagement sessions with all staff were planned for next week. Emma Gillgrass to circulate the KPMG presentation on authorisation plan following the July CCG Board meeting Fouzia Harrington to liaise with Will Perks re: Coaching feedback FH 5.3 Feedback and Update from Portfolios 5.3.1 Farhhan Sami advised the group that following the CQC report for Safeguarding Children, Croydon had passed adequately. He advised that an action plan was now in place. The Group noted that there was not a named GP in place and there was need to recruit to this role. 5.3.2 5.3.3 Farhhan Sami advised that there was a meeting on Immunisations was planned for 19 July 2012 to look on how to improve flu vaccine uptake in pregnancy. There was a suggestion that midwives could administer this. Farhhan Sami advised that there were recommendations suggested that all under 5 s be on a vitamin D supplement. Discussions on how Page 4 of 9

5.3.4 5.3.5 5.3.6 5.3.7 5.3.8 5.3.9 5.3.10 5.3.11 these would work locally were needed. Brian Okumu commented that the Safeguarding team had been seeking reassurance around where their function and roles would sit in the new structures. James Slater suggested that there was a need for a CLG lead for safeguarding children. It was agreed that this would fit within Farhhan Sami s role. Bobby Abbot reported that he had had an introductory meeting with Steve Morton regarding the Health and Well Being Board and an introductory meeting with the Prescribing Team was being set up. He advised that standardised agendas for Network meetings had been developed. He advised that the continued to provide Clinical Leadership for Mental Health. Rajeev Sagar advised that 36 practices had expressed an interest in the risk stratification tool. 21 practices were proceeding and 16 were still signing up to the data sharing agreement. He advised that the best way to carry out training was being looked at. He added that a LES was being considered to encourage practices to use the system. He added that he had also been attending QIPP Operational Board meetings. Dev Malhotra advised that within Mental Health a PID was being developed to support discharge and a LES was being developed to support practices in taking back patients from the low intensity team. He added that a Croydon University Hospital CQUIN around alcohol and A&E attendances had been developed and 3 alcohol nurses had been recruited. Dev Malhotra advised that the Older Adults team were looking at how patients with mild dementia could be kept at home. He advised that within CAMHS money had been redeployed from tier 4 to tier 3 services. There had been issues due to reduced staffing. James Slater advised that South London and the Maudsley, the Local Authority and the Borough Team were attending the Overview and Scrutiny Committee on Tuesday 17 July 2012 regarding mental health finances. The Group noted that as part of the Joint Strategic Needs Assessment, a deep dive into Mental Health was being undertaken, specifically around Depression and Early Intervention in Psychosis. The Group noted that an update on BSBV was provided at the open meeting. A pre-consultation business case was currently being developed. 6. Feedback and Development of Cluster Commissioning Meetings Page 5 of 9

6.1 6.2 6.3 6.4 6.5 Farhhan Sami advised that a first network meeting was held with all but one practice attending, and most practices sending 2 representatives. Some of the issues raised at the meeting were A single point of contact to feedback issues, and a process for feeding back within agreed timescales. It was agreed that practices could contact their network lead or the Borough Team More direction to be included within the practice level data report and guidance on areas that required focusing Referrals appeared to have bounced back from the Purley Resource Centre. A GP had sought clarification for this from John Haseler There was concern on Ophthalmology waiting times and the service provided by Croydon University Hospital James Slater advised that Moorfields was providing support to Croydon University Hospital and discussions were underway about the future of the service Brian Okumu advised that his first network meeting was due in a couple of weeks time. Bobby Abbot advised that his first network meeting was due shortly. Rajeev Sagar advised that he had met both clusters separately and they had agreed to merge. Some of the issues raised at the meeting were: a forum for communication e.g. website where practices could leave comments, updated information could be posted How financial issues could be prevented in the future. Paula Swann suggested that a newsletter, addressing these concerns be sent out to practices. The Newsletter could cover actions that had been taken, governance arrangements and future plans to address these concerns More direction was asked through the Practice level data It was agreed that the link persons for the network would be Rajeev Sagar and Emma Gillgrass. Clarification on MCATs referral was sought 6.1 Delivery: Quality and Performance 6.1.1 Commissioning Overview and Key Priorities 6.1.2 James Slater provided an update for the Group. He advised that Diane Carter was now the ACU Contract Lead for the Borough Team. He added that the ACU were providing monthly reports as well as assisting in monthly Clinical Quality Review meetings with Croydon University Hospital. 6.1.3 The Group noted that at present the Clinical Quality Review meetings with CUH were chaired by Peter Boffa with a view of Tony Brzezicki taking over. It was also noted that Bobby Abbot would be attending these meetings. Page 6 of 9

6.1.4 6.1.5 6.1.6 6.1.7 6.1.8 6.1.9 6.1.10 The Group noted that there was a need for Clinical Leaders to discuss how they could contribute to these meetings. It was suggested that minutes of meetings and draft agenda be shared with them for input. James Slater reported that following the introduction of NHS 111 and the opening of the Urgent Care Centre a drop in A&E performance had been noted. James Slater advised that discussions were underway with Croydon Community Health Services regarding rebasing of their contract. He added that Q1 activity had been reviewed and work was being done for a new baseline to be established. James Slater informed the Group that a draft business case for developing Integrated Care had been approved and a final confirmation of a grant of 900k was awaited. The group noted that a bid for 100k around Children and LTC had been put forward. The Group noted that the Strategic Sponsorship Group made up of Chief Executives from various organisations to take forward transformation of services and Integrated Care had been renamed as Transformation Board. James Slater advised that last year NHS Croydon had come close to entering mediation with South London and the Maudsley NHS Trust, however for the current financial year a financial risk sharing agreement had been made. He added that South London and the Maudsley NHS Trust were expected to submit a business case for triage ward. The Group noted that the business case was overdue. James Slater advised members that his team would be in touch shortly for clinical guidance on a number of strategy areas. He added that the Operating plan had been revised and an integrated plan with the Local Authority was being developed. The joint plan was due by end of September. 6.2 GP Engagement in QIPP 6.2.1 The Group noted that a presentation was given at the Open meeting around this area. The group noted that there was a need for clear messages from each work stream to be cascaded to the Networks. 6.2.2 6.2.3 Mike Sexton suggested that the projects were discussed on a rolling basis at QIPP Operational Board. However a dedicated time was also required to allow for issues to be escalated. The Group noted that there was a need for feedback from Network meetings to be passed to the appropriate lead. Page 7 of 9

7. Practice Level Information Report 7.1 The Group noted that following discussion at Network meetings and the Open Meeting a meeting was needed with Practice Managers to discuss the format and content of the Practice Level Information Reports. The reports needed to contain direction as which areas required more focus. This would require practices approval and cooperation with implementation of appropriate actions 7.2 Mike Sexton reported that he would be working towards producing practice level budgets to help practices identify areas to focus on. Meeting with Practice Managers to discuss data reports 7.1 Governance 7.1.1 Register of Interest 7.1.2 The Group noted the updated Register of Interest. Members agreed that any new interests would be declared. It was also agreed that in line with guidance the Register of Interest would be brought back to the Clinical Leadership Group for review 7.1.3 7.1.4 The group queried the body validating the register and assessing the conflicts. Rajeev Sagar and Bobby Abbot declared their interests in CReSS as Triagers. Identify what dates mean on the register Register to be updated with above declarations To understand what other Boroughs have done with regards to validating their registers Register to be brought back quarterly FH VR 7.1.2 Risk Register 7.1.3 The Group noted that the Risk Register captured organisational risks. Individual projects have risk registers held within the Project Management Office. 7.1.4 7.1.5 The summary presented to the Group set out key risks, mitigations and action plans. They noted that the Risk Register needed to be an active document, with CCG objectives aligned to risks It was agreed the whole register should be brought back quarterly with issues brought as required. A draft Board Assurance Framework aligning objectives and risks to be brought to the CCG Board meeting scheduled for 21 August. FH Page 8 of 9

Risk Register to be brought to the Clinical Leadership Group on a quarterly basis VR 8. Any Other Business 8.1 Safeguarding The Group noted that there was a need to identify the safeguarding adults lead. 8.2 Finance Mike Sexton advised that there was a need for Finance to be a standing item on the agenda. A Finance report would be taken to the Clinical Commissioning Board meeting scheduled for 24 July 2012, with 2 months worth of acute data now available. He added that over performance on acute services had been noted and the Acute Commissioning Unit was analysing the causes. Data regarding Croydon University Hospital s outpatient data appeared favourable and work was needed to assess whether this would have an impact on the Recovery Plans. The Group noted that costs associated with non elective admissions and high cost drugs were higher than planned, however there were some under performance in non-acute services which was not expected to continue through the year. 8.3 MCATS Private Providers Bobby Abbot advised that he had been approached by a private physiotherapy provider who interested in providing physiotherapy services under the Any Qualified Provider commissioning approach. The group noted that a Provider could only apply to deliver a service which had been approved by the Clinical Commissioning Group and there was a requirement for the formal procurement process to be followed. The Group noted that there were no plans to procure for the physiotherapy services and the requester would be advised of the same. Rajeev Sagar suggested an educational session on procurement so that members would be aware of the process. Finance to be a standing item on the agenda Educational session on Procurement to be run for Clinical Leaders. VR JS 9. Date of Next Meeting 9.1 14 August1.00 3.00 11.4, Leon House Page 9 of 9