NHS TRAFFORD CLINICAL COMMISSIONING GROUP GOVERNING BODY 16 th December 2014

Agenda Item No: 22 Part 1 X Part 2 NHS TRAFFORD CLINICAL COMMISSIONING GROUP GOVERNING BODY 16 th December 2014 Title of Report Purpose of the Report Minutes of the Public Reference and Advisory Panel held on the 9 th October 2014 and the draft minutes of the meeting held on 6 th November 2014 For information Actions Requested Decision Discussion Information X Strategic Objectives Supported by the Report 1. Consistently achieving local and national quality standards. 2. Delivering an increasing proportion of services from primary care and community services from primary care and community services in an integrated way. 3. Reduce the gap in health outcomes between the most and least deprived communities in Trafford. 4. To be a financial sustainable economy. Recommendations Discussion history prior to the Governing Body Financial Implications Risk Implications Equality Impact Assessment Communications Issues Public Engagement Summary Prepared by Responsible Director The NHS Trafford Clinical Commissioning Group Governing Body is asked to note the minutes of the Public Reference and Advisory Panel held on the 9 th October and the draft minutes of the meeting held on 6 th November 2014 (subject to ratification at next committee meeting) N/A N/A N/A N/A N/A N/A Jenna Lancaster, Governance Support Officer Paul Hulme, Associate Director of Corporate Services and OD

Minutes of the NHS Trafford Clinical Commissioning Group Public Reference & Advisory Panel Held on Thursday 9 th October 2014, 10.30am, At Crossgate House, Sale PRESENT: Dr Priscilla Nkwenti Chair Ann Day Chris Jacob Ann-Marie Jones Brian Wilkins IN ATTENDANCE: Tracy Clarke Communications & Engagement Specialist Rachel Mills Policy Officer (Minutes) Jason Swift Head of Primary Care Interface (for item 14/36) Dr Paula Whittaker Public Health Consultant, Trafford Council (for item 14/37) Imran Khan Service Transformation Project Manager (for item 14/37) Lauren Collins Communications and Engagement Specialist: PR and Media (for item 14/40) PRAP 14/31 APOLOGIES FOR ABSENCE Apologies for absence were received from Patricia Lees, George Devlin, John Howe, Lesley Thornton, Khan Moghal, Lesley Spencer and Gill Leng. It was recorded that Gill Leng had provided her resignation from the Public Reference and Advisory Panel (PRAP) due to other work commitments. The Chair expressed thanks for her interest in joining the PRAP and reported that further recruitment would be undertaken to fill the three remaining vacant positions. PRAP 14/32 DECLARATIONS OF MEMBERS INTEREST CONCERNING AGENDA ITEMS There were no declarations of interest made in line with Section 8 of the Clinical Commissioning Group s (CCG) Constitution. PRAP 14/33 MINUTES FROM THE PREVIOUS MEETING HELD ON 2 ND SEPTEMBER 2014 INCLUDING THE ACTION LOG The minutes of the previous meeting held on the 2 nd September 2014 were agreed as an accurate record, subject to the following amendments being made: 1. Coversheet Strategic objectives supported by the report

Trafford Clinical Commissioning Group Agenda Item No. 4 Objective 2 should read Delivering an increasing proportion of services from primary care and community services in an integrated way. 2. PRAP 14/21 Title should read Minutes of the previous meeting held on the 7 th August 2014. 3. 14/26 - Frail and Older People PID Refresh Paragraph one, fifth sentence should read The reason the project is focusing on 75 plus is because there are 3 times more patients at age 75 plus in Trafford presenting with complex needs. 4. 14/26 - Frail and Older People PID Refresh Paragraph three, third sentence should read The Chair added that the data needs to be brought back here, in order to aid further discussion. 5. 14/28 Any Other Business Paragraph five, third sentence should read Other evidence would be that Trafford General Hospital s Electrocardiogram (ECG) figures would be reduced. ACTION: The Public Reference and Advisory Panel (PRAP) approved the minutes of the previous meeting held on 2 nd September 2014, subject to the above amendments being made and the revised version of minutes being circulated to the PRAP. PRAP 14/34 MATTERS ARISING PRAP 14/08 Tracy Clarke, Communications and Engagement Specialist will email the proposed changes to the PRAP Vision/Charter document to members, asking for approval/comments. The final version of the document will be ratified at the PRAP meeting on 6 th November 2014. PRAP 14/23 PCCC has been added to the PRAP workplan. Patient experience feedback will be reported to the Quality and Performance Committee in relation to any quality and performance issues. The work around patient stories will be led by the Customer Care and Experience Team, and if they plan to develop patient stories further they will involve PRAP where required. Matter of Experience newsletters have been circulated to members and stakeholders for information. Further clarification is needed in regards to how and where outcomes from patient stories will be reported. Updates from Project Leads It was agreed that any information/updates requested from Project Leads should be presented to the PRAP on a six month basis. Tracy Clarke to Page 2 of 11 October 2014 Public Reference & Advisory Panel Minutes Date of Destruction: 31 October 2044 Created By: Rachel Mills, NHS Trafford CCG

Trafford Clinical Commissioning Group Agenda Item No. 4 liaise with Project Leads to schedule into the PRAP workplan when updates would be required at the PRAP. ACTION: The Public Reference and Advisory Panel noted the actions arising from the action log. PRAP 14/35 REVIEW OF WORKPLAN Tracy Clarke, Communications and Engagement Specialist reported that the PRAP were involved in the NHS Trafford CCG Annual General Meeting (AGM) on the 30 th September 2014, which will be added to the 2014/15 PRAP workplan. There was also the intention that the PRAP will have greater involvement in the development of the Patient Care Co-ordination Centre (PCCC), which would be discussed later in the agenda. The Chair suggested that performance and progress updates need to be added to the 2015/14 workplan under the Performance section. Mrs Clarke advised that under the Culture and Values section of the workplan, a review of the CCG s Strategic Objectives needs to be scheduled to be discussed at PRAP in March 2015. Further to this suggestion and in line with annual committee reviews, the Chair advised that an annual appraisal of the PRAP needs to be scheduled into the workplan. The Chair suggested that public stories would need to be included under the Public Engagement section. Mrs Clarke advised that patient stories were no longer required to be reported in this forum and she would liaise with the Associate Director of Corporate Services and OD to consider where patient experience outcomes would be reported. In regards to the PRAP s participation at the CCG s AGM, members reflected that the PRAP s introduction and presentation was well received. However, due to time constraints the timing of the PRAP presentation was limited as the AGM was required to finish at 2:30pm. On the other hand, feedback was received that the AGM was well attended and attendees were impressed with the CCG s level of openness and transparency when discussing strategic objectives, its current position and the challenges ahead. Members commented that the CCG has a positive reputation for proactively engaging with stakeholders and members of the public, sharing ideas and information. Mrs Clarke advised that the PRAP s comments would be fed back to the CCG. ACTION: The Public Reference and Advisory Panel (PRAP) noted the 2014/15 workplan and suggested the following additions: Performance and progress updates need to be added to the 2015/14 workplan under the Performance section. Page 3 of 11 October 2014 Public Reference & Advisory Panel Minutes Date of Destruction: 31 October 2044 Created By: Rachel Mills, NHS Trafford CCG

Trafford Clinical Commissioning Group Agenda Item No. 4 Under the Culture and Values section of the workplan, a review of the CCG s Strategic Objectives needs to be scheduled to be discussed at PRAP in March 2015. Tracy Clarke to liaise with the Associate Director of Corporate Services and OD to consider where patient experience outcomes would be reported. PRAP 14/36 PRIMARY CARE STRATEGY Jason Swift, Head of Primary Care Interface presented the Primary Care Strategy, which outlined how primary care services would be developed and improved in Trafford. The strategy described Trafford s demographics, the current primary care challenges faced in Trafford and how the primary care services need to be developed and adapted to meet patients needs. The key aims of the strategy include encouraging GP practices to work and operate on a locality scale. Working in locality models would bring GP practices together to work in collaboration. Smaller GP practices tend to experience difficulty in complying with governance and Care Quality Commission (CQC) requirements, as well as reaching quality and performance standards. Mr Swift referred to page 9 of the strategy which included a map of Trafford borough and its 4 localities. The strategy explains how investment would be directed into localities to allow GP practices to work in collaboration and offer a wider portfolio of services per locality rather than as individual practices. Working in locality models would help to reduce health inequalities across Trafford and would allow more patients to be treated in primary care settings rather than being referred to hospitals. The Primary Care Strategy outlined how a more developed and improved model of health care would be provided in Trafford, with GP practices in the centre of the model receiving support from community care and social care. Enablers would be put in place, such as a standard IT platform to all patient records to be shared and accessed by other Trafford GP practices. A comment was made around the potential for patients to be concerned about their health records being shared. Mr Swift explained that the Information Governance Team would be involved in the implementation of the strategy and ensuring that patients are engaged with and consent is obtained before records are shared. A question was asked about which practices would have access to shared records and whether this would extend to other Greater Manchester practices outside of Trafford. Mr Swift assured members that in compliance with the Data Protection Act 1998, an assessment would be undertaken to consider whether there would be a requirement for patient records to be accessed by other Locality Hubs in Trafford. A query was raised about the patient registration process if Locality Hubs become established. Mr Swift explained that non-registered patients would still be required to register with a GP practice. In future, patients may be required to register at a Super Hub in each Locality. All the Super Hubs would operate Page 4 of 11 October 2014 Public Reference & Advisory Panel Minutes Date of Destruction: 31 October 2044 Created By: Rachel Mills, NHS Trafford CCG

Trafford Clinical Commissioning Group Agenda Item No. 4 under the same performance metrics and quality standards, in order to provide a standardised level of care and reduce variations. Members enquired whether all GP practices would agree to use the same IT system across Trafford. Mr Swift reported that the CCG has been working with GP practices on a GP IT project which will consider the needs of the GPs and encourage all GP practices to agree to have a single IT system. 65% of GP practices in Trafford have signed up to using the single IT platform. The CCG aspires to have 30 out of 35 GP practices signed up to the EMIS web platform by the end of 2014/15. The CCG continues to engage with the remaining practices yet to sign up. As part of Primary Care Co-commissioning, the CCG will hold responsibility for Alternative Provider Medical Services contracts (APMS), which would result in one GP practices having to sign up to use the single IT platform. Concern was expressed about patients not knowing whether their GP practice would be signed up to the single IT platform and whether this would disadvantage patients in any way. Mr Swift noted the concern and agreed that this may impact where patients decide to register with a GP or whether they would switch to a different GP practice. A further concern was highlighted that patients moving to alternative GP practices may result in the weakening of smaller GP practices and less services being provided locally. Mr Swift advised that any GP practice that is weakened or at threat of closure would merge with larger neighbouring practices and any remaining patients would be dispersed to other neighbouring practices. Mr Swift explained that the Primary Care Strategy would allow investment to be directed into GP practices across Trafford to support their development. Assurance was provided to members that all of the Trafford GP practices have been engaged with in the development of the Primary Care Strategy. There may be elements of the vision that all GP practices haven t yet signed up to, but overall, all practices have all signed up to the strategy and its vision. A comment was made in regards to the GP practices in West Trafford and the potential geographical and transport issues that may arise for patients in this area. Mr Swift assured members that these issues would be addressed and a secondary Locality Hub would be established in West Trafford to manage the geographical issues. A question was asked whether the vulnerabilities within the strategy, such as IT and geography, would be risk assessed and whether mitigating actions will be carried out to overcome any challenges/obstacles. Mr Swift advised that a Primary Care Operational Plan would be developed following on from the Primary Care Strategy, outlining what actions would be required. A query was raised about GP practices located on the Trafford borders that may have Manchester patients registered with them. In day-to-day operational terms, Mr Swift advised that in border practices may operate in a different way to other Trafford practices; however, Trafford performance metrics and quality requirements would be standardised across the borough. Page 5 of 11 October 2014 Public Reference & Advisory Panel Minutes Date of Destruction: 31 October 2044 Created By: Rachel Mills, NHS Trafford CCG

Trafford Clinical Commissioning Group Agenda Item No. 4 A query was raised in regards to page 6 of the Primary Care Strategy and the statement regarding 57.5% of Trafford s adult population were achieving 150 minutes of physical activity per week. It was reported that the Public Health Team at Trafford Council provided this data for the strategy. A further comment was made in regards to the table on page 10 of the strategy and it was noted that Sale Locality should read Central Locality. In response to a query regarding GP premises, Mr Swift advised that an Estates Strategy Group has been established and were in the process of developing a Primary Care Estates Strategy, which would be brought to a future PRAP meeting for review. A concern was expressed about the table on page 10 of the strategy regarding the 2017/18 timescales set for developing integrated locality care in North Trafford, particularly as North Trafford experiences higher levels of deprivation compared to the other localities in Trafford. Mr Swift explained that the date reflects the timescales for completion of the Shrewsbury Street development; however, assurance was provided that there would be continuous work and investment directed into North Trafford over a four year time period. It was noted that page 22 of the strategy should read that Trafford s Health and Wellbeing Strategy has been developed in partnership with Age UK and not Age Concern. It was also suggested that a Primary Care Co- Commissioning information session for PRAP would be helpful in future. The Public Reference and Advisory Panel supported the vision and direction of travel outlined in the Primary Care Strategy and agreed to forward any further questions to Mr Swift (jason.swift@nhs.net) in regards to the strategy. PRAP 14/37 FALLS STRATEGY Imran Khan, Service Transformation Project Manager presented the Falls Strategy, which focuses on falls prevention and improvement of bone health in Trafford. This strategy forms part of the Frail and Older People Programme that has been developed as part of Trafford s Better Care Fund. The strategy was developed as Trafford did not have a Falls Strategy in place and there was a requirement to redesign Falls Services in order to meet the needs of Trafford patients. Dr Paula Whittaker, Public Health Consultant reported that this strategy was work in progress and welcomed any comments from members. Dr Whittaker highlighted the following areas in the strategy: - Trafford has an ageing population. Factors such as bone health, age, gender, health and lifestyle have become important to consider when investigating the causes, location and effects of falls. Page 6 of 11 October 2014 Public Reference & Advisory Panel Minutes Date of Destruction: 31 October 2044 Created By: Rachel Mills, NHS Trafford CCG

Trafford Clinical Commissioning Group Agenda Item No. 4 The death rate from falls for the 65+ year olds in Trafford is significantly higher than the England and the North West average rates, due to Greater Manchester having a growing population. Falls have no link to deprivation. There was a strategic need to develop a Falls Strategy in line with the Public Health Outcome Framework (PHOF) and it was identified as an area for improvement under the Better Care Fund. The strategy considered who was at risk of falling, the reason why falls occur and what the community and social requirements involved. The vision outlined in the strategy was to reduce the rate of falls and lower the PHOF RAG-rating from red to amber, and to increase the use of the Falls Risk Assessment Tool (FRAT). FRAT is a nationally developed tool which would help improve prevention and care delivery in the community, review telecare services and care aids/equipment for patients, integrate first responder services and Trafford community services, increase the profile of bone health in primary and intermediate care services. The Frail and Elderly Programme Board and Trafford Council Adult Social Care Business Delivery Programme Board have been established, made up of representation from the CCG, Trafford Council, Third Sector organisations and local providers. Strategic performance will be monitored in line with the PHOF, Better Care Fund and Integrated Community Equipment Services (ICES). The Strategy would be implemented in April 2015 and reviewed in 2017. The Falls Strategy is currently out for consultation and members were welcomed to submit any comments or questions to the Public Health Speciality Registrar, Helen Gollins (helen.gollins@trafford.gov.uk) by Friday 17 th October 2014. A question was asked about how the strategy would prevent falls in practical terms and how would the strategy improve bone health. Dr Whittaker advised that steering groups have been established to redesign scheduled care pathways, focussing on patient enablement and independence, and developing health improvement and prevention workstreams that will be evidence based. The steering groups would also consider how to engage with and inform patients, how to change culture/behaviours of patients to prevent falls and improve bone health, and how services need to adapt to meet patient needs In response to a query about bone density scanning, Dr Whittaker advised that bone density scanning would be only be carried out in line with National Institute for Clinical Excellence guidance (NICE). The Chair enquired whether there would be any campaign/educational/selfawareness materials available that can be shared with the public and patient groups. Dr Whittaker reported that there were no leaflets/educational material available as yet; however, this would become available in preparation for the implementation of the strategy in April 2015. Page 7 of 11 October 2014 Public Reference & Advisory Panel Minutes Date of Destruction: 31 October 2044 Created By: Rachel Mills, NHS Trafford CCG

Trafford Clinical Commissioning Group Agenda Item No. 4 Members asked about engagement with the public and voluntary groups, and whether prevention advice could be directed at at risk groups sooner. Dr Whittaker advised that engaging with public groups would allow the steering groups to assess and research the needs of different patient groups. Research has indicated that Trafford has a slightly older/elderly population compared to other boroughs in Greater Manchester and these population groups tend to stay at home longer and were therefore, more active in the community. Mr Khan commented that other factors such as housing and access were also being reviewed as a high rate of falls occur at home. A query was raised in regards to page 13 of the strategy relating to higher rates of falls in North and West Trafford than in the South. Mr Khan reported that there are more wards in South Trafford, which might have an impact on the rate of falls compared to other localities in Trafford. A question was asked in regards to levels of reporting for falls. Dr Whittaker advised that studies have been carried out to review rates of reporting as older/elderly patients tend to be reluctant at reporting falls, due to concern that they may be considered as unable to cope alone or live independently in their homes. The Public Reference and Advisory Panel supported the Preventing Falls and Improving Bone Health in Trafford Strategy for 2015-18, and welcomed any further information in regards to falls prevention and bone health promotion to be shared with members for information in future. PRAP 14/38 FUTURE MEETING DATES The Chair presented a list of proposed dates for upcoming PRAP meetings for consideration. Although the paper suggested the continuation of monthly meetings, the Chair asked members to consider whether meetings should be held on a monthly or bi-monthly basis, in light of members other commitments or time constraints. The Chair also asked members to consider whether virtual/online meetings (i.e. meeting virtually by email or via a web based forum) would be helpful. It was recognised that some members may have other time constraints or work commitments that bi-monthly meetings would help alleviate, and virtual meetings via email could be effective by circulating information and asking for comments/decisions by a certain deadline. However, concern was expressed that a two month gap may have a detrimental impact on PRAP s momentum and progress. It was suggested that virtual meetings could be trialed after November s PRAP meeting and held bi-monthly in between meeting at the CCG. It was also suggested that development sessions could be arranged in between bimonthly meetings at the CCG to focus on the development needs of the PRAP Page 8 of 11 October 2014 Public Reference & Advisory Panel Minutes Date of Destruction: 31 October 2044 Created By: Rachel Mills, NHS Trafford CCG

Trafford Clinical Commissioning Group Agenda Item No. 4 and having information workshops on topics such as Primary Care Co- Commissioning as requested in agenda item 14/36. Another concern was raised about holding meetings bi-monthly as members who were unable to attend meetings at the CCG would have to wait another four months until the next face-to-face meeting. Members commented that a virtual forum would be helpful to keep discussions active and relevant to ensure that momentum is not lost. It was also suggested that the timings of future PRAP meetings could be canvassed to ascertain what times are more convenient for members. ACTION: The Public Reference and Advisory Panel agreed that further dates and times of future meetings should be canvassed to ascertain when would be more convenient for members to attend. It was suggested that Tracy Clarke sends a list of potential dates/times to members for them to vote on their preferred options. PRAP 14/39 PCCC PROGRAMME BOARD REPRESENTATION BY PRAP Tracy Clarke informed the PRAP that the Patient Care Co-ordination Centre (PCCC) Implementation Board has been established and the Board has requested to have PRAP representation. Mrs Clarke reported that the PCCC procurement process continues and is currently in the process of procuring an IT provider. Expressions of interest have been received from Ann-Marie Jones and Brian Wilkins to represent the PRAP at the PCCC Implementation Programme Board. The draft Terms of Reference have been shared with the PRAP, however the upcoming dates of the Board are yet to be made available. The Chair thanked members for their interest and it was recommended that Ann-Marie Jones would represent the PRAP at the PCCC Implementation Board and Brian Wilkins would act as deputy if Ann-Marie was unable to attend. Mrs Clarke confirmed that she would inform the CCG Procurement Team of the PRAP s representation and will circulate the upcoming dates of the Board as soon as they become available. The Public Reference and Advisory Panel (PRAP) agreed that Ann-Marie Jones would represent the PRAP at the PCCC Implementation Board and Brian Wilkins would act as deputy if Ann-Marie was unable to attend. PRAP 14/40 PRAP ONLINE Lauren Collins presented the PRAP with options and ideas for members to interact online and potentially hold virtual meetings. Ms Collins suggested that PRAP members could meet virtually in-between meetings via a private Page 9 of 11 October 2014 Public Reference & Advisory Panel Minutes Date of Destruction: 31 October 2044 Created By: Rachel Mills, NHS Trafford CCG

Trafford Clinical Commissioning Group Agenda Item No. 4 password-protected forum where discussion and decision-making could take place. The forum could also act as a central library where previous PRAP papers, presentations or other information documents could be stored and accessed by PRAP members and Tracy Clarke. There was further discussion about the potential for members to arrange virtual meetings and hold discussions through instant messaging via the private forum. A query was raised about the possibility of member receiving alerts when other members have logged onto the forum or whether social media applications such as Yammer could be used. Ms Collins noted members feedback and advised that she would look into all suggestions made and whether they could be achieved. The Public Reference and Advisory Panel noted the options available for allowing members to meet/interact virtually and welcomed feedback from Lauren Collins in regards to what online options could be achieved. PRAP 14/41 ANY OTHER BUSINESS i) Healthier Together Consultation Tracy Clarke advised members that the Greater Manchester Healthier Together Consultation had been extended to 24 th October 2014. Consultation documents are available on request. The Public Reference and Advisory Panel noted the update. PRAP 14/42 DATE AND TIME OF NEXT FORMAL MEETING It was noted that the next meeting would take place on Thursday 6 th November 2014, 10.30am in the Partington Suite at Crossgate House. PRAP 14/43 POST MEETING REFLECTION The Public Reference and Advisory Panel (PRAP) commented that the meeting progressed well and it was agreed that the group were gaining more momentum and understanding. There was a general consensus that it would have been more advantageous if more members could have attended the meeting. Members commented that the meeting and agenda items were well organised, and members greatly appreciated the agenda Leads attending to support their items and provide informative presentations. In regards to the lunch provided for members, it was requested that vegetarian options are kept separate from the meat options. This was noted for the next meeting. Page 10 of 11 October 2014 Public Reference & Advisory Panel Minutes Date of Destruction: 31 October 2044 Created By: Rachel Mills, NHS Trafford CCG

Trafford Clinical Commissioning Group Agenda Item No. 4 The Chair thanked members for their contributions and assured members that the CCG Governing Body are listening to the views of the PRAP and noting the issues being raised. Page 11 of 11 October 2014 Public Reference & Advisory Panel Minutes Date of Destruction: 31 October 2044 Created By: Rachel Mills, NHS Trafford CCG

DRAFT Minutes of the NHS Trafford Clinical Commissioning Group Public Reference & Advisory Panel Held on Thursday 6 th November, 2014 At Crossgate House, Sale Meeting commenced: 10.35 am Meeting ended: 02.10 pm PRESENT: Ann Day In the Chair George Devlin John Howe Patricia Lees Nasrullah Khan Moghal Lesley Spencer Lesley Thornton Brian Wilkins Representing the Trafford Population (West) Neighbourhood Participation Group Representative (West) Representing the Trafford Population (South) Third Sector Representative - Voice of BME, Trafford Neighbourhood Participation Group Representative (South) Third Sector Representative - Counselling and Family Centre Healthwatch Representative IN ATTENDANCE: Tracy Clarke Jenna Lancaster Andrew Howard Communications and Engagement Specialist Governance Support Officer (minutes) Commissioning Manager, Trafford Council (for item14/48) Frances Romagnoli Business & Project Manager (for item 14/51) Julie Crossley Associate Director of Commissioning (for item 14/53) PRAP 14/44 APOLOGIES FOR ABSENCE Apologies for absence were submitted from Shabir Abdul, Chris Jacob, Ann- Marie Jones and Pricilla NkWenti. PRAP 14/45 DECLARATIONS OF MEMBERS INTEREST CONCERNING AGENDA ITEMS Lesley Thornton expressed an interest with regards to agenda item 14/48, the review of Trafford tier 3 specialist child and adolescent mental health services (CAMHs). As the report did not include any specific detail with regards to charities, the Chair asked Lesley to raise any specific interests should they arise during the presentation of the item.

Trafford Clinical Commissioning Group With regards to the completion of declaration of interest forms, the Chair stated that a number of completed forms were still outstanding and requested that all members of the panel complete and returned the form as soon as possible to the Governance Support Officer. 1) The declaration of interest be noted. 2) All members of PRAP to complete and return a declaration of interest form to the Governance Support Officer at the earliest opportunity. PRAP 14/46 MINUTES FROM THE PREVIOUS MEETING HELD ON 9 th OCTOBER 2014 INCLUDING THE ACTION LOG The minutes of the previous meeting held on the 9 th agreed as an accurate record. October, 2014 were The Communications and Engagement Specialist informed members of the panel that she had not received a short profile from all members. A discussion ensued and members stated that as a minimum, members should provide a profile including who they represent. The Communications and Engagement Specialist agreed to send one final reminder to members and following the deadline, should profiles not be received, members names and designation would be added to the intranet. With regards to the Local Commissioned Services Group, it was noted that three members of PRAP would potentially attend the group, two members within their role from Healthwatch and one member as a PRAP representative. It was queried whether a member of PRAP could attend as a representative for both groups and report back as appropriate. It was noted that this would create extra capacity amongst group members to represented PRAP at additional appropriate groups. It was suggested that Brian Wilkins would attend the group on behalf of PRAP and Healthwatch and Lesley Thornton would deputise when Brian was unable to attend. The Governance Support Officer stated that she would check this with the governance team and report back to members. The Chair also commented that as Chair of Healthwatch Trafford, she would need to check with the Board of HWT that this arrangement was acceptable to them. Lesley Spencer informed the Panel that she was unable to attend the last meeting of the Individual Funding Request Panel due to being on holiday. Lesley raised that attendance at the previous meeting was useful, however, did not receive a copy of the agenda prior to the meeting taking place. The Governance Support Officer stated that she would ensure that Lesley was on the distribution list for future meetings. Page 2 of 12 November 2014 Public Reference & Advisory Panel Minutes Date of Destruction:30 November 2044 Created By: Jenna Lancaster, NHS Trafford CCG

Trafford Clinical Commissioning Group 1) The Public Reference and Advisory Panel (PRAP) approved the minutes of the previous meeting held on 9 th October, 2014. 2) Members to complete and return a short profile to the Communications and Engagement Specialist. 3) The Governance Support Officer to seek advice from the Governance Team with regards to Local Commissioned Services Group representation and report back to the group accordingly. 4) The Governance Support Officer to ensure that Lesley Spencer was on the distribution list for agendas, for future meetings of the Individual Funding Request Panel. PRAP 14/47 REVIEW OF WORKPLAN 2014/15 The Communications and Engagement Specialist presented the workplan and informed the panel that the format had been revised to include further information with regards to future agenda items including the purpose of the item and the lead officer. The plan also included a section to list future items where a date hadn t been agreed, to ensure that items were tracked and monitored. Members of the panel welcomed the new format. The Governance Support Officer informed members that since the circulation of the agenda, Early Support Discharge had been added to the agenda for the meeting scheduled to take place on 6 th January. The workplan would be updated and circulated to all members. With regards to the meeting of PRAP scheduled to take place on 6 th January, 2015, the Governance Support Officer informed members that she would circulate the agenda on Tuesday 23 rd December, to accommodate the Christmas period. Concerns were raised with regards to the possibility of report writers submitting papers late which would impact on the circulation of the agenda. The Governance Support Officer stated that she would inform all report writers of the earlier deadline to reduce the risk of late submissions. A discussion ensued with regards to the number of items on each agenda and whether this should be limited, to allow sufficient time to ensure each item was given the right level of consideration and discussion that it would require. A member suggested that the workplan should clearly indicate when a report is an update from a report that had been presented previously to the group which would not take as long to discuss. The Governance Support Officer indicated that the meetings of PRAP were scheduled to take place in alignment with the Clinical Commissioning and Finance Committee and Quality and Performance Committee and therefore, items must be discussed at PRAP at certain dates, potentially resulting in instances when more than four items would be presented. However, it was stressed that this would only happen in exceptional circumstances. Page 3 of 12 November 2014 Public Reference & Advisory Panel Minutes Date of Destruction:30 November 2044 Created By: Jenna Lancaster, NHS Trafford CCG

Trafford Clinical Commissioning Group The Communications and Engagement Specialist suggested that virtual online reporting could be an option to communicate with members of PRAP outside of meetings for urgent items or when an item was for information only. 1) The Public Reference and Advisory Panel noted the work plan. 2) A copy of the updated work programme to be circulated to all members. 3) The agenda for the meeting of PRAP being held on 6 th January, 2015 be circulated on Tuesday 23 rd December, 2014. 4) The workplan to include when an item was an update from a previous report. PRAP 14/48 REVIEW OF TRAFFORD TIER 3 SPECIALIST CHILD AND ADOLESCENT MENTAL HEALTH SERVICES (CAMHS) Andy Howard, Commissioning Manager, Trafford Council attended the meeting to present an update with regards to the review of the Trafford tier 3 Specialist Child and Adolescent Mental Health Services (CAMHS). The Chair asked members of the panel to introduce themselves. The Commissioning Manager provided an overview of the current service that was provided by Pennine Care Trust. A recent tendering process had been carried out to test the market and Pennine Care Trust was awarded the contract based upon their expertise and experience of providing the service within Greater Manchester. The NHS Trafford CCG 5 year strategic plan 2014-2019 included a number of priorities with regards to mental health interventions and CAMHS had a responsibility to meet these priorities. Currently, mental health services could be accessed via a number of routes and combined with an increase in referrals, there was a need to review the current service. The Commissioning Manager indicated that the current service was good but there was a need to utilise resources more effectively, continue dialogue and improve communication. He reported that there was an intention to move to a future state whereby children and young people along with their parents/carers would have an improved experience of local CAMHS on an on-going basis. It was reported that a similar review of CAMHS in Bury had been carried out and they was currently looking to implement a revised model. The Commissioning Manager stated that he would link into the work carried out by Bury, to seek out any best practice to adapt to the Trafford Model. A member questioned what good practice had been identified from Bury to date. It was reported that a lot of work had been put into the review at Bury and therefore Page 4 of 12 November 2014 Public Reference & Advisory Panel Minutes Date of Destruction:30 November 2044 Created By: Jenna Lancaster, NHS Trafford CCG

Trafford Clinical Commissioning Group the Commissioning Manager stated that he would want to adapt a similar level of commitment and hard work in carrying out the review in Trafford. In addition, the engagement that was carried out by Bury was excellent and therefore, good practice would be sought. It was reported that the scope for the review was in the process of being designed and therefore no terms of reference had yet been established. It was envisaged that the review would be carried out over the forthcoming months and a report including recommendations would be produced by April, 2015. With regards to the key intended outcomes, a member questioned whether (i) there would be flexibility to add additional outcomes and, (ii) how had the intended items been agreed/reached. The Commissioning Manager informed members that the key intended outcomes had been created as a result of a number of information gathering methods. For example, patient experience, via the youth cabinet, youth annual conference, health professionals and intelligence from the CCGs Integrated Commissioning Unit for Children, Families and Well-Being. Members were informed that the purpose of the update to this panel was to seek advice with regards to appropriate public engagement in the project, which could lead to the key intended outcomes being amended/expanded. In addition, a member made reference to the key intended outcomes and stated that more information was required in relation to the background of the outcomes and how they had been reached. As a result, people would more likely be inclined to engage in the process. A member made reference to the objective of improving the service that was currently provided but stated that people would want to know to what level the service would and could be improved. A member referred to the Improving Access to Psychological Therapies (IAPT) service and questioned whether there would be an increase in usage of the service. The Commissioning Manager stated that there would be an increase and this was included in the NHS Trafford CCG 5 year strategic plan 2014 2019. In relation to public engagement, members suggested a number of routes that could be taken to engage with key groups regarding the review. This included the youth cabinet and linking into weekly communications to schools, via school nursing services, social media, support groups and voluntary and community providers. A member referred to the importance of engaging with young people with mental health issues who felt that they received no support from CAMHS and didn t know where help could be accessed. Despite a provision being in place, it could be more accessible. In addition, a member expressed concern that people who were off the radar needed to be considered who may require the services. The Communications and Engagement Specialist stated that a wide range of people need to be consulted with, utilising different methods and approaches. She suggested meeting with the Commissioning Manager to discuss this further. Page 5 of 12 November 2014 Public Reference & Advisory Panel Minutes Date of Destruction:30 November 2044 Created By: Jenna Lancaster, NHS Trafford CCG

Trafford Clinical Commissioning Group The Communications and Engagement Specialist referred to a video that had been produced by the Trafford Youth Cabinet who intended to present the video to Trafford CCG s Clinical Directors. A member queried the tendering process and questioned when the service would go to tender again, as the review could identify that the service currently being provided was not fit for purpose. The Commissioning Manager reported that initially a three year contract had been agreed with Pennine Care Trust which had now been extended for a further two years. A member referred to drug and alcohol addiction amongst young people and asked if this would be incorporated into the review. The Commissioning Manager stated that drug and alcohol services were delivered by Trafford Council who work closely with CAMHS as and when required and therefore, would depend on individual cases. With regards to the service offered by CAMHS (0-18 years) and the Greater Manchester West Mental Health NHS Foundation Trust (18+ years), a Member questioned whether the age of a patient was determined by their date of birth or mental health age, to determine which service would support them. The Commissioning Manager stated that an individual s case was unique and a service would be provided based on their need. He reported that CAMHS would not automatically discharge a patient once they reached 18 years of age and that close working relationships had been created between CAMHS and the Greater Manchester West Mental Health NHS Foundation Trust to ensure that each patient was given the correct level of support and service. The Commissioning Manager informed members that the review was not focused on cost savings but would ensure that the service was providing value for money. It was reported that Trafford Council had proposed a reduction in the CAMHS budget which would potentially impact on the service that was provided to looked after children. Members expressed concern with regards to the potential budget reduction and the possible impact on the CCG in the long term. Members requested that a copy of the terms of reference, project plan and engagement and consultation plan be sent to them once they had been created. Members could then provide advice/suggestions of any stakeholders that had not been included in and advise on the consultation questions. Members expressed a keen interest in the outcomes of the review. The Commissioning Manager exited the meeting. 1) The Public Reference and Advisory Panel noted the contents of the report. 2) The Public Reference and Advisory Panel supported the progression of the review. Page 6 of 12 November 2014 Public Reference & Advisory Panel Minutes Date of Destruction:30 November 2044 Created By: Jenna Lancaster, NHS Trafford CCG

Trafford Clinical Commissioning Group 3) The advice provided by the Public Reference and Advisory Panel with regards to public engagement be noted. 4) The Commissioning Manager and Communications and Engagement Specialist to meet to discuss appropriate engagement methods. 5) A copy of the terms of reference, project plan and engagement and consultation plan be sent to the Public Reference and Advisory Panel once it had been created. PRAP 14/49 PRAP VISION/CHARTER The Communications and Engagement Specialist presented the PRAP Vision and Culture Charter and asked members for any comments/feedback. A member suggested that the charter should be re-iterated at the start of each meeting. It was therefore suggested and agreed that a copy of the charter would be displayed on an A3 poster at all meetings of PRAP. A member stated that the charter required regular review as PRAP continued to develop and grow. The Communications and Engagement Specialist informed members that the charter would be published on the staff intranet. 1) The Public Reference and Advisory Panel approved the charter. 2) A copy of the charter to be displayed at all future meetings of PRAP. 3) A copy of the charter to be published on the staff intranet. PRAP 14/50 NHS ENGLAND 5 YEAR FORWARD VIEW The Chair presented the NHS England Five Year Forward View, for member s information. A member stated that it would be helpful if further information could be provided with regards to the relevance of the document and the associated implications for the Trafford CCG. 1) Further information with regards to the NHS England 5 Year Forward View and the associated implications for the Trafford CCG be provided at the next meeting of PRAP taking place on 6 th January, 2015. Page 7 of 12 November 2014 Public Reference & Advisory Panel Minutes Date of Destruction:30 November 2044 Created By: Jenna Lancaster, NHS Trafford CCG

Trafford Clinical Commissioning Group PRAP 14/51 EXTENDED HOURS ACCESS SPECIFICATION Frances Romagnoli, Business & Project Manager attended the meeting to discuss the proposal for a pilot scheme to increase access to primary care in Trafford. It was reported that the aim of the scheme was to improve access to primary care, although was not a mandatory sign up for practices. Currently, core opening times for GP practices was 8.00am 6.30pm. In Trafford, 63% of practices were operating more than the core hours under the Extended Hours Directed Enhances Services (DES). The Business and Project Manager reported that a model was currently being established that would encompass two phases. The first phase would focus on GP practices opening Monday Friday from 8.00am until 8.00pm. The second phase would incorporate weekend opening hours. An engagement exercise would be carried out with patients to determine preferred options of access, which would feed into the model. It had been recognised that there was an aspiration for seven day access but there was a need to understand what good access meant as this would vary amongst area and people and therefore, a good level of understanding was required amongst localities. Engagement would be carried out via the use of an electronic survey and the Communications and Engagement Specialist assured members that the consultation would be delivered wider than the internet with community groups. Members asked that access and continuity were included as key themes within the consultation. A member expressed concern with regards to the associated costs of extending GP practice opening hours, GP retention, staffing and resources. Concern was also voiced in relation to the possibility of clinicians treating patients from other practices and access to private medical records. In addition, a member stated that the quality of services delivered could be compromised due to extended hours A member referred to the out of hours service and questioned why extended hours were required when a service was already in place. The Business and Project Manager stated that current Extended Hours DES could be improved upon. The drive to provide seven day access was a nationally agreed target. Due to an upgrade of IT systems in GP practices, a member expressed concern that GP surgeries were closing whilst the update was being implemented. It was discussed that the upgrade would allow patients to book appointments online which was welcomed across the group. The Business & Project Manager exited the meeting. Page 8 of 12 November 2014 Public Reference & Advisory Panel Minutes Date of Destruction:30 November 2044 Created By: Jenna Lancaster, NHS Trafford CCG

Trafford Clinical Commissioning Group 1) The Public Reference and Advisory Panel noted the information. 2) That issues raised by the Public Reference and Advisory Panel be considered and fed into the consultation process. 3) That a report be presented back to a future meeting of the Public Reference and Advisory Panel, once the model had been established. PRAP 14/52 FUTURE MEETING DATES The Communications and Engagement Specialist circulated a copy of the results from a recent survey she had carried out amongst PRAP members. She reported that five members of PRAP had responded to the survey. A discussion ensued with regards to the timings of meetings and one member commented that late morning start times were inconvenient as the meeting would often continue into the afternoon. Adversely, members commented that if meeting were to start too early, traffic and travel times would impact on their availability. It was agreed that future meetings of PRAP would commence at 10am with an expected finish time of 1.00pm. A member referred to the recruitment process of PRAP members and stated that all members of the panel should expect meetings to be arranged to take place during the day. The work plan was discussed and it was agreed that monthly meetings would remain although a discussion would take place at each meeting regarding the forthcoming agenda items and during instances when no items were due to be reported, it could be decided if the meeting could be cancelled. Consequently, as no items were included on the work plan for the meeting of PRAP scheduled to take place in December, it was agreed unanimously that the meeting would be cancelled. A member raised that the PRAP was still running without a Vice Chair. The Governance Support Officer stated that she would report this back to the governance team and provide an update at the next meeting. With regards to the buffet that is provided at PRAP, members raised that too much food was ordered. The Communications and Engagement Specialist informed members that the buffet was ordered based on expected attendance numbers and members did not always submit their apologies, resulting in extra food. Members were therefore reminded to submit their apologies to future meetings of PRAP when they were not available to attend. It was agreed that the cheapest buffet option would be ordered for all future meetings of PRAP. Page 9 of 12 November 2014 Public Reference & Advisory Panel Minutes Date of Destruction:30 November 2044 Created By: Jenna Lancaster, NHS Trafford CCG