Agenda item 14 CCG Operational Leadership Team 18 July 2013, 8.30 11.30am Board Room, Trust HQ, St Martin s Hospital In Attendance: Simon Douglass (Chair) (SD) Hester McLain (For Item 10) Tracey Cox (Chair) (TC) Margaret Fairbairn (For Items 4 & 5) Ian Orpen (IO) Joel Hirst (For Item 11) Ruth Grabham (RG) Simon Allen (B&NES Council) (For Item 9) Dawn Clarke (DC) Jane Shayler (B&NES Council) (For Item 9) Helen Harris (HH) Shanil Mantri (SM) Jim Hampton (JH) Julie-Anne Wales Mike Greaney (MG) for Sarah James Evelyn Allen (Minute taker) (EA) 1 Apologies Liz Hersch and Sarah James. ACTIONS 2 Minutes of Meeting Held on 27/06/13 The following amendments were noted: Page 2, Item 3 NHS Change Day Pledges RG s pledge to be amended to RG confirmed she was trying to arrange to go out with a Dementia Support Worker. Page 5, Item 6 Risk Management Tool SM advised of a spelling error in paragraph 4 Sollice to be amended to Sollis. With these corrections made, it was agreed that the Minutes be approved as a correct record. EA 3 Actions from Previous Meetings These were reviewed (see updated list for Meeting on 29/8/13). 4 Designated Doctor for Safeguarding Children increase in sessions Margaret Fairbairn (MF) joined the Meeting and presented this Paper on behalf of Catherine Phillips (Children s Health Commissioning Manager). 1
MF advised that the recommendation was to fund additional time for the role of Designated Doctor for Safeguarding Children. This role, which currently sits with Community Paediatricians as part of the Sirona Community Services contract, is currently specified for one session per week which, following service review and new statutory guidance, was believed to be insufficient to fulfil the role. The recommendation from Children s Health was for this role to be increased to three sessions per week. It was noted that an additional two sessions per week of consultant time would be at an annual recurring cost of 39,806 and that the total annual cost for three sessions would then be 59,709. MF went on to explain that a particular level of expertise was required for this role and therefore it would not be appropriate to recruit a less experienced doctor to this role. Following discussion all were in favour of supporting, in principle, the recommendation for two extra sessions. It was, however, felt that additional clarity was required on the costings involved. MF agreed to take this away and also for cost comparisons with other areas to be made. It was agreed that this could then be presented to SD and DC for final signoff and not brought back to the OLT. MF SD/DC 5 Revised IFR Policy - Grommets MF presented this Paper on behalf of Catherine Phillips of Children s Health and explained that the current IFR Policy for grommet insertion is now out of date and does not reflect the current NICE guidance. The proposal detailed in the Paper would bring the CCG s policy for Otitis Media with Effusion (OME or glue ear ) in line with NICE guidance in terms of the period of watchful waiting. It was noted that the proposal also introduces a new policy on Acute Otitis Media (AOM) when grommet insertion may prove helpful. MF added that Children s Health Commissioners did not feel that this course of action would lead to an increase in the number of referrals for grommet insertion, but will reduce the wait for treatment. During discussion it was noted that confirmation of the new criteria for ENT consultants would be taken to the Clinical Commissioning Reference Group and also that these referrals will be audited. SD The proposal, which only refers to points 1-5 of the Surgical Referral for 2
Myringotomy and/or Insertion of Grommets (July 2013), was supported by all at the Meeting. Point 6 of this Policy will remain as Exceptional Funding. SM agreed to add this to the Map of Medicine. It was also agreed to share this decision with Wiltshire CCG. SM DC 6 Finance and QIPP Report MG presented these Papers which provide an update of the financial position. MG advised that the CCG was on plan year-to-date to hit the required target of a 2m surplus. MG added that overall it is anticipated that QIPP schemes will deliver in full although substitute schemes may be required. MG explained that work was also going on with the Area Team regarding allocation issues, identified post B&NES PCT, in order to ensure that all money due to the CCG was recouped. SD thanked MG for the helpful information supplied and it was noted that confirmation of the next 2 years CCG allocations would be available in October 2013 and will assist with financial planning going forward. TC tabled BaNES QIPP Bi-monthly reports for: Planned Care Unplanned Care and Long Term Conditions High Impact Alcohol Programme with the RUH Continuing Health Care and Funded Nursing Care Children s Health Commissioning Learning Disabilities Medicines Management Data Challenges TC explained that these new reports, which show progress at project level, provide a quick sense check on how each area is progressing and is designed to strengthen oversight of each QIPP initiative. All found these reports helpful and SD asked clinical leads to give feedback directly to Senior Commissioning Managers following August 2013 s reports when SCMs will have received more guidance on completion. Clinical Leads 7 Partnership Risk Register apologised that the incorrect version of this Paper had been issued 3
for this Meeting and a revised version will be sent following the Meeting. added that there were 54 risks in total on the Register, four of which are yet to be reviewed in detail. It was noted that the Corporate (High) Risks, scoring 15 or above, were detailed within Appendix 1 and are reported in the public domain. TC queried the commentary within Risk 21 Discharge Summaries - being out of date which DC will confirm. It was agreed that further training may be required for all staff who are involved in contributing to the Risk Register to help in defining the risks more clearly and smart actions. IO raised a concern about the timeliness of RUH out-patient letters, particularly for ophthalmology and stroke patients. It was agreed to take this to a GP forum in order to gather feedback and evidence from GPs. SM agreed to prepare a Google form and send a link to GPs for them to complete detailing when the clinic was held, the letter written and letter received by the GP. Following this exercise SD agreed to take the evidence gathered to the Commissioning Reference Group. It was also agreed to add this to the Risk Register. SD asked for the Risk Register to be a standing item at the weekly Monday morning CCG Catch-up Meeting. DC IO SM SD 8 Briefing on Towards Commissioning Excellence a Strategy for Commissioning Support Services TC presented this Paper which provides a briefing on NHS England s future plans for the development of commissioning support services and how CCGs will be required to begin developing a plan to procure future service arrangements from the Autumn of 2013. TC asked the Meeting to note this information and to consider how this work will be resourced. TC highlighted the main issues for the CCG which were; the capacity to carry this out in the Autumn of 2013 and the strategic approach to take. Other issues noted include the CCG s relationship with the Local Authority. Following discussion it was agreed that firstly, input was required from Senior Commissioning Managers via a Team Discussion Forum which will be arranged. Following this an additional Board Seminar session will be arranged to explore this further. TC & 4
9 RUH Transforming Emergency Care Business Case (This Agenda Item was brought forward to 9.00am when Simon Allen and Jane Shayler were able to attend) SD welcomed SA and JS to the Meeting and presented this Paper in Hester McLain s absence. It was noted that the Paper, which details the RUH s bid for use of CCG retained non elective threshold monies (the BaNES CCG value is 660k, non- recurrently in 2013/14) to deliver improved outcomes for urgent care, takes into account feedback from the national clinical Emergency Care Intensive Support Team (ECIST) and the King s Fund Emergency Care Checklist. SD advised the Business Case had also been shared with both the Area Team and Local Authority. SD added that there had some discussions with the RUH around KPIs and the need to evidence how this should be an Invest to Save initiative, but that further discussions with the RUH were required. SM expressed some disappointment that the Business Case did not include Primary Care or community care. TC explained that whilst this business case was very acute focused, the CCG was making changes and investing in community schemes this year, including the virtual ward. Discussion took place around the CQUIN scheme already in place and it was recognised that this Plan should free up other capacity in the system. All agreed to support the following recommendation to the CCG Board: Investment of 660k BaNES marginal rate non-elective threshold monies to the RUH in 2013/14 Continuing investment of the marginal rate, if the marginal rate is still applied in the tariff rules, into 2014/15.* The Urgent Care Board oversees delivery and development of the KPIs for this transformation project and works to ensure community support is in place. * The Meeting agreed to capture the following additional wording in relation to this recommendation to the Board. Continued investment into 2014/15 would need to be specifically in relation to this bid and subject to progress on delivery of the KPIs in the business case." This was in recognition of the lead in time for delivering transformation. 5
10 Commissioning of Vasectomy Services It was noted that Jim Hampton declared an interest in the current vasectomy service in B&NES and so did not take part in this discussion. Hester McLain (HM) joined the Meeting to give a verbal update on the vasectomy service which is currently provided by CASH as part of their services. The value of the current block contract was noted to be 42k. As the Council are going to re-tender the CASH service, they have asked the CCG to re-tender the vasectomy service. The Meeting confirmed they were all in agreement for the vasectomy service to be taken out of the CASH contract and for this to be re-tendered under AQP, where a requirement to work to the same protocol and cost would be made. HM agreed to pass this to the CSU to action. HM 11 QoF QP Proposals for 2013/14 JH joined the meeting at 11.15am to present this Paper which sets out the following clinical themes for the Quality Outcomes Framework Quality and Productivity Indicators (QoF QP) for 2013/14:- Outpatient Referrals: Urology Data review plus pathways for; heart failure, back pain and endoscope. Emergency Admissions Follow pathways for; heart failure, community IV and COPD. It was noted that these themes link to the following CCG objectives: Responding to the challenges of an aging population Improving quality and patient safety Improving access and consistency of care It was also noted that the cost of implementing the scheme (potentially 415k) falls to the Area Team through its direct commissioning of GP services, but that any savings derived from managing the system better will fall to the CCG. JH went on to detail the following timelines, which all agreed were achievable, from overview and briefing to the OLT at this Meeting to GP Practice payment qualification at the end of March 2014. 6
Following discussion when JH agreed to add; Alcohol and Substance Misuse, LD and Safeguarding to the list of clinical themes, the Meeting agreed to the proposed process and It was also agreed to take this to the GP Forum and cluster meetings in the Autumn of 2013. 12 Corporate Work Programme presented this report and drew the Meeting s attention to the three Red status issues. It was agreed to bring this report back to the OLT bimonthly, unless there are exceptions, when it will be brought to the next OLT. IO/ CLUSTER LEADS 13 Outline Planning Timetable presented this Paper which sets out the proposed arrangements for ensuring the CCG meets the requirement to develop appropriate plans for 2014/15. The OLT were asked to: a) Approve the refreshed Strategic Objectives and service priorities for 2014/15 and recommend these to the Board. b) Approve the Outline Planning Timetable and the process for development of the CCG s Plans for 2014/15. c) Note the contribution required from all members of the commissioning team and CSU in support of the process. d) Approve the arrangements for engaging with patients and members of the public, understanding that a detailed plan will be brought to the August 2013 meeting. e) Approve the intention to engage with Clusters to seek early support for key priorities and outline plans prior to final approval by the Council of Members, understanding the detailed plans will be brought in August 2013. f) Approve the Terms of Reference for the QIPP Programme Board. e explained that the End State Vision for acute/tertiary care; primary, community and social care services was initially considered at the Board Seminar held on 20/6/13. This has also been discussed at a Joint Commissioning Team Meeting and the CSU has been asked to supply a list of benchmarking outputs and potential QIPP priorities for next year by 31/7/13. It was noted that following the OLT Meeting on 29/8/13, that it is planned to 7
establish a QIPP Programme Board to progress the initial schemes identified and to oversee the delivery of this year s programme. This will include representation from the CSU. Discussion took place around the possibility of pooling time and resources, as it was acknowledged that there is a great deal of work to be done by Senior Commissioning Managers during August. TC advised that she is expecting the CSU to be looking at potential options to bring back to the CCG. It was noted that the next step is for the CSU to arrange a meeting involving Clinical Leads and Senior Commissioning Managers and a GP Council of Members Meeting was identified as an appropriate forum for GP involvement. Date of Next Meeting: 29 th August 2013 8.30-11.30am Board Room, St Martin s Hospital 8