South East London Sector A meeting of NHS Bromley CCG Governing Body 25 May 2017 ENCLOSURE 4 SOUTH EAST LONDON 111 AND GP OUT OF HOURS MEMORANDUM OF UNDERSTANDING SUMMARY: The NHS England Commissioning Standards for Integrated Urgent Care (IUC) describe a vision of a single entry point - NHS 111 - to fully integrated urgent care services in which organisations collaborate to deliver high quality clinical assessment, advice and treatment. It is intended that we work to shared standards and processes, with clear accountability and leadership. The six SEL CCGs are jointly procuring a functionally integrated 24/7 urgent care service that will be the front door to the NHS in SEL, and which provides the public with access to both treatment and clinical advice. Central to this will be the development of a Clinical Hub offering patients who require it access to a wide range of clinicians. This service will be in place by September 2018, and the tender documentation includes a draft Alliance Agreement to bring together key stakeholders. However, there is a need for an interim arrangement prior to mobilisation of the new service, currently proposed to be in September 2018. This memorandum of understanding (MOU) is a pre-contractual agreement which sets out agreed principles of how 111 and GP Out of Hours (GPOOH) providers and commissioners in SEL will work together, using our collective best endeavours, to develop services towards an integrated urgent care system as described in NHS England s commissioning standards for Integrated Urgent Care, over 2017 and early 2018. The parties to this agreement are: London Ambulance Service NHS Trust (providing the 111 service for SEL) Bromley Healthcare Community Interest Company (providing GP Out of Hours services to Bromley) Hurley Group (providing GP Out of Hours services to Bexley) Greenbrook Healthcare (providing GP Out of Hours services to Greenwich and Bromley) South East London Doctors Cooperative Limited (providing GP Out of Hours services to Lambeth, Lewisham and Southwark) South East London Clinical Commissioning Groups: Bexley, Bromley, Greenwich, Lambeth, Lewisham and Southwark The MOU will support integrated working between current providers and drive system change towards achieving the requirements against which integration of the system is Clinical Chair: Dr Andrew Parson 1 Chief Officer: Dr Angela Bhan
measured via a quarterly return to NHS England. These requirements are evolving, but currently include ensuring that over 50% of our population is covered by either a single IUC contract, or an overarching agreement linking the contracts for NHS 111 and Out of Hours services. This MOU has at its core the principles listed below: Working cooperatively Open and transparent working between parties Aligning interests with the achievement of the agreed aims and objectives of the integrated urgent care service or project. Acting in a 'best for service/project and patient' ethos It is agreed that the parties to this agreement will actively participate and work collaboratively towards shared standards and process and that there will be clear accountability and oversight of the integrated urgent care services by the SEL Directors of Commissioning (DoCs) and Chief Finance Officers (CFOs) as well as the SEL Accident and Emergency (A&E) Delivery Board. KEY ISSUES: On the 9th January 2017, SEL CCGs published an Invitation to Tender (ITT) for provision of Integrated Urgent Care (IUC) Services in SEL. Despite a robust process, disappointingly this has not resulted in the award of a contract. We have a very good model that is supported by stakeholders, our local CCGs and NHS England, and we should remain true to that model. We also have a very good specification, but there may be some flexibility around the exact wording of parts of the specification that might make delivery of the model a little easier for potential providers. If we can work swiftly and smartly, it is quite possible that this withdrawal results in a delay of less than seven months in procurement and final implementation of a new IUC service (partly because we had such a long mobilisation period built into the original timetable). A message has been placed on the procurement portal asking all twenty four interested providers for feedback as to why they did not choose to bid. Moving forward, a series of market engagement events will be held advertised via contracts finder, in order to attract a larger cohort of providers to better understand the reasons why providers did not bid; to test out any changes to the specification with the market and to test the resulting financial envelope with the market. We will aim to have the amended specification, business case and associated documents ready for approval at the November 2017 CCG Governing Body meetings, go through checkpoint 1 with NHS England in December 2017 and publish our ITT in January 2018. The procurement process will run from January 2018 mid-march 2018, and mobilisation will take place from mid-march 2018 mid September 2018. The new contract will begin in mid- September 2018, well in advance of winter pressures. Clinical Chair: Dr Andrew Parson 2 Chief Officer: Dr Angela Bhan
In the meantime, the London Ambulance Service s contract for the provision of SEL 111 services will be extended to mid-september 2018. There will be no break in service provision, as LAS remains committed to the delivery and further development of this essential service. We will engage with SELDOC to address the impact on their call handling staff, who were due to transfer to the new IUC provider in March 2018. We will continue our programme of developing the 111 service into the IUC model, including the implementation of the Memorandum of Understanding between LAS, SEL GPOOH providers and SEL CCGs. Our current programme of development takes us up until the end of February 2018. Now that we have some extra time to evolve the current service, we will consider if our programme of evolution could be more ambitious. We will work with all stakeholders to agree how services develop over the coming months. The MoU describes a new committee structure designed to support the implementation of the MoU and the subsequent alliance agreement. Due to the changes in the procurement timeline it is necessary to phase in the new committee structure. The SEL 111 Programme Board will remain in place until March 2018, in order to provide a forum for decisions relating to the SEL IUC procurement. The Alliance Leadership Team meeting will become the forum for addressing all issues related to the evolution of the existing service, with immediate effect. Following IUC contract award, the SEL 111 Programme Board will be dissolved and replaced by the SEL 111 & GPOOH Commissioner Forum, which will provide an opportunity for commissioners to identify any shared concerns or issues that have been raised via the individual contract meetings, prior to their attendance at the Alliance Leadership Team meetings. OVERALL RISK ASSESSMENT: The contract with London Ambulance Service (LAS) for provision of the 111 service has already been extended twice. If we continue to extend existing contracts then we leave ourselves open to challenge by another provider. However, the current extension is unlikely to be challenged in light of SEL CCG's attempts to procure an IUC service and our commitment to ongoing market engagement and procurement. Current risk score 4x1 = 4 COMMITTEE INVOLVEMENT: SEL 111 Programme Management Board meetings SEL 111 Clinical Governance Group meetings Evolution of the existing 111 service towards the IUC model workshop held on the 8 th November 2016 MOU stakeholder meeting held on 7 th March 2017 SEL CCG s Directors of Commissioning and Chief Finance Officers meetings SEL A&E Delivery Boards Greenwich Executive Group: 3rd May 2017 Clinical Chair: Dr Andrew Parson 3 Chief Officer: Dr Angela Bhan
Lambeth Governing Body: 3rd May 2017 PUBLIC AND USER INVOLVEMENT: Extensive public engagement was completed as part of the development of the SEL IUC service specification. The SEL 111 Programme Management Board meetings and SEL 111 Clinical Governance Group meetings are attended by patient representatives who are active contributors to these forums. IMPACT ASSESSMENT: The SEL IUC service specification (approved by all six SEL CCGs in November 2016) complies with the health inequality duty. PUBLIC SECTOR EQUALITY DUTY: The SEL IUC service specification requires the provider to meet the public sector equality duty. RECOMMENDATIONS: The Governing Body is asked to:- Approve the SEL 111 & GPOOH memorandum of understanding. ACRONYMS A&E = Accident and Emergency CCGs = Clinical Commissioning Groups CFOs = Chief Finance Officers DoCs = Directors of Commissioning GP = General Practitioner GPOOH = GP Out of Hours IUC = Integrated Urgent Care ITT = Invitation to Tender LAS = London Ambulance Service MOU = Memorandum of Understanding NHS = National Health Service SEL = South East London SELDOC = South East London Doctors Cooperative Limited DIRECTORS CONTACT: Name: Dr Angela Bhan E-Mail: angela.bhan@nhs.net Clinical Chair: Dr Andrew Parson 4 Chief Officer: Dr Angela Bhan
Telephone: 01689 866530 AUTHOR CONTACT: Name: Claire Goodey E-Mail: Claire.goodey1@nhs.net Telephone: 02030499984 GP CLINICAL LEAD: Name: Dr Mark Essop E-Mail: markessop@nhs.net Attachments: (i) SEL 111 & GPOOH MoU Clinical Chair: Dr Andrew Parson 5 Chief Officer: Dr Angela Bhan
South East London 111 and GPOOH Memorandum of Understanding Introduction This memorandum of understanding (MOU) is a pre-contractual agreement which sets out agreed principles of how 111 and GP Out of Hours (GPOOH) providers and commissioners in South East London (SEL) will work together, using best endeavours, to develop services towards an integrated urgent care system as described in NHS England s commissioning standards for Integrated Urgent Care over 2017 and early 2018. The parties to this agreement are: London Ambulance Service NHS Trust (providing the 111 service for SEL) Bromley Healthcare Community Interest Company (providing GP Out of Hours services to Bromley) Hurley Group (providing GP Out of Hours services to Bexley) Greenbrook Healthcare (providing GP Out of Hours services to Greenwich and Bromley) South East London Doctors Cooperative Limited (providing GP Out of Hours services to Lambeth, Lewisham and Southwark) South East London Clinical Commissioning Groups: Bexley, Bromley, Greenwich, Lambeth, Lewisham and Southwark The NHS England Commissioning Standards for Integrated Urgent Care describe a vision of a single entry point - NHS 111 - to fully integrated urgent care services in which organisations collaborate to deliver high quality clinical assessment, advice and treatment to shared standards and processes, with clear accountability and leadership. The six SEL Clinical Commissioning Groups (CCGs) are jointly procuring a functionally integrated 24/7 urgent care service that will be the front door to the NHS in SEL, and which provides the public with access to both treatment and clinical advice. Central to this will be the development of a Clinical Hub offering patients who require it access to a wide range of clinicians. This service will be in place by September 2018, and the tender documentation includes a draft Alliance Agreement to bring together the key stakeholders. However, there is a need for an interim arrangement prior to mobilisation of the new service in September 2018. Goals and objectives The MOU will support integrated working between current providers and drive system change towards achieving the requirements against which integration of the system is measured via a quarterly return to NHS England. These requirements are evolving, but currently include:-
Whether more than 50% of the CCG population is covered by either a single IUC contract, or an overarching agreement linking the contracts for NHS 111 and Out of Hours services. This MOU has at its core the principles listed below: Working cooperatively Open and transparent working between parties Aligning interests with the achievement of the agreed aims and objectives of the integrated urgent care service or project. Acting in a 'best for service/project and patient' ethos It is agreed that the parties to this agreement will actively participate and work collaboratively towards shared standards and process and that there will be clear accountability and oversight of the integrated urgent care services by the SEL Directors of Commissioning (DoCs) and Chief Finance Officers (CFOs) as well as the SEL Accident and Emergency (A&E) Delivery Board. Commencement and operation This MOU is to run from 31 st May 2017 to 30 th September 2018. Governance structure and reporting It is intended that the MOU governance arrangements provide a step towards a contractual Alliance Agreement, as set out in the SEL integrated urgent care service specification. This will aid all of the parties in becoming familiar with the future Alliance structure and ways of working. Alliance Leadership Team Meeting The Alliance Leadership Team meeting will include senior representation from each organisation with delegated decision making responsibility, and will hold overall accountability for progress towards an integrated urgent care system. It will provide a point of escalation for any unresolved risks and issues raised through the task and finish groups and have the authority to approve recommendations made by the task and finish groups. The Alliance Leadership Team meeting will take place monthly. Key to driving system change, this meeting will be accountable to the SEL DoCs/CFOs and the SEL A&E Delivery Board, thereby aligning with and supporting delivery of the sustainability and transformation plan. Generally, operational matters that needed escalation will be addressed at the A&E Delivery Board, while more strategic decisions will be escalated to DoCs/CFOs before going to the CCG Governing Bodies for sign off. It is, however, recognised that both forums cover both operational and strategic matters, but the arrangements outlined above will be followed as a general rule of thumb. The ALT will include representation from each organisation that is party to this MOU and will manage the system change required to achieve an integrated urgent care service. Wider stakeholders will be invited where required to facilitate wider system collaboration, including representatives from care homes, mental health trusts and community trusts. The group will support sharing and learning from providers including end to end patient pathway reviews of calls and reviewing and improving the outcomes of the 111 and GPOOH patient pathways, including reducing the number of inappropriate patient handoffs. Data will be used to Page 2
establish the type of calls that are best dealt with by the 111 clinicians and which calls are better dealt with by a GP within the GPOOH service. This will reduce the numbers of patient interactions across urgent care pathways providing a better patient experience, for example by reducing the number of GPOOH patients given a phone consultation and then subsequently offered, or referred on to, another service such as an emergency treatment centre. This group will work towards integrating 111 and GPOOH pathways into an overall service that provides a good patient experience and outcome. The Alliance Leadership Team will oversee the system and the interface points to deliver the following outputs: Fewer patient handoffs between services/health professionals. A reduction in the number of patients referred to a 111 clinician and then also referred to GPOOH/primary care. A reduction in the number of patients re-triaged by GPOOH Direct booking of GP hub and GPOOH appointments by clinicians within 111 and GPOOH Increased patient choice A reduction in the number of inappropriate 111 referrals to GPOOH A reduction in inappropriate classification of urgent referrals to GPOOH Targeted clinical advice for specified local patient groups relevant to CCG borough profiles for emergency department attenders, etc. to be agreed with the commissioners in order to reduce the number of patients who do not adhere to 111 advice and attend acute services. Improved patient adherence with 111 and GPOOH advice shown by a reduction in emergency department attendances when patients were signposted to an alternative service. Learning from calls closed by GPOOH to understand and provide feedback to the 111 service on learning points to close calls earlier in the pathway for a better patient experience and to increase the number of appropriate self-care dispositions. Local contingency and capacity plans should include mutual aid agreements between 111 and local GPOOH services to support surge management. Where there is commercially sensitive information that cannot be shared between providers this will be collated through the individual commissioner provider contract management meetings, commissioners will have an opportunity to identify any issues that jeopardise the system at the commissioner only forum. Task and Finish Working Groups A number of task and finish working groups will be established with a goal of achieving the NHS England IUC requirements. Below are suggested working groups which will be tasked with developing services to meet the needs of the national vision over the sixteen months covered in this MOU. However, as national requirements and policy evolves it is anticipated that the number and focus of these groups may change. It is agreed that each party to this agreement will use best endeavours to send appropriate representation to the required development working groups and to ensure it does not unreasonably withhold support to any work stream. N.B. The work Page 3
programmes for each work stream will be worked up in detail by the sub-groups, once the MOU has been agreed. Direct booking GP hub and GPOOH appointments Direct booking is a key target for integrated urgent care systems. The national requirements state: Patients receiving a contact primary care disposition in the in hours period are direct booked an appointment. (Target = 5% in 2017, 10% in 2018, 30% in 2019) This working group will support and facilitate the ability for both 111 and GPOOH staff to direct book primary care extended access hub (aka GP hub) appointments to achieve (or exceed) the national targets. The national requirements also state: Patients receiving a contact primary care disposition in the out of hours period are direct booked an appointment. (Target = 70% in 2017, 90% in 2018, 95% in 2019) This working group will oversee the design and implementation of GPOOH direct booking pilots to achieve (or exceed) the national targets. Direct transfer of relevant patient information between parties Clinicians will be supported by the availability of clinical records such as Coordinate My Care Records, Special Patient Notes, Summary Care Records (SCR), Mental Health and Community Crisis plans as well as locally available systems to support the strategy of increasing calls closed with self-care advice to 20% of all triaged calls and reduce inappropriate 999/Emergency Department referrals. This working group will facilitate the availability of relevant patient information to 111 and GPOOH providers and support the aims of the NHS 111 Patient Relationship Manager Record Sharing Programme via a working group. Interoperability Objectives of this working group will include increasing IT system interoperability to support cross-referral between 999 and the Integrated Urgent Care Service, and between the various clinical specialisms that make up the virtual clinical hub. This working group will: Explore the potential for a single Adastra platform shared by 111 and GPOOH providers. Explore timelines for enabling the following functions outside of NHS Pathways: o o o Dispatch an ambulance Book appointments via the Directory of Services Send call summaries (in the form of a referral or a post event message) via the Directory of Services. Where possible, implement these functions within 111 and GPOOH. Page 4
Contract Management and Clinical Governance / Quality Assurance meetings Contract management and quality assurance meetings will continue between commissioners and providers in the normal way; however, where there is an opportunity to share information with the consent of all parties through the Alliance Leadership Team which would benefit the system, this should be supported. Any issues of commercial sensitivity will be addressed at contract meetings and will not be shared with the other parties to the MOU without the consent of the provider concerned. Commissioner Forum This meeting provides an opportunity for commissioners to identify any shared concerns or issues that have been raised via the individual contract meetings. MOU/ Alliance Governance SEL CCG Governing Bodies SEL A&E Delivery Board SEL DoCs/CFOs SEL IUC & GPOOH Alliance Leadership Team Meeting SEL 111/IUC & GPOOH Commissioner Forum Various Task and Finish Groups 111/IUC and GPOOH individual contract management and clinical governance / quality meetings Page 5
All parties to this MOU will communicate with each other and all relevant staff in a clear, direct and timely manner to optimise the ability for each of us, the parties to the MOU, to make effective and timely decisions related to achieving the MOU objectives. We will adhere to the actions and decisions made within the Alliance Leadership Team meeting carried out in accordance with this Agreement. The Alliance Leadership Team is the group responsible for directing and leading the Alliance and must: ensure alignment of all organisations to the IUC vision and objectives; review the performance of the task and finish groups and determine strategies to improve their performance or rectify poor performance in relation to the MOU s objectives; agree policy as required, including values to be adopted and annual and short term performance outcomes/targets; promote and encourage commitment to the MOU Principles and MOU Objectives amongst all MOU Participants; formulate, agree and implement strategies for achieving the MOU Objectives and the management of the MOU; and oversee the implementation of this Agreement and all other Services Contracts. Authorisation - signatories On behalf of London Ambulance Service NHS Trust On behalf of Bromley Healthcare Community Interest Company Page 6
On behalf of Hurley Group On behalf of Greenbrook Healthcare On behalf of South East London Doctors Cooperative Limited On behalf of NHS Bexley CCG On behalf of NHS Bromley CCG On behalf of NHS Greenwich CCG Page 7
On behalf of NHS Lambeth CCG On behalf of NHS Lewisham CCG On behalf of NHS Southwark CCG Page 8
Appendix 1 Schedule of meetings Name of meeting Frequency Task and Finish Groups Monthly, or as required SEL 111/IUC Clinical Governance Group Monthly, on the second Tuesday of the month 13:30-15:00 SEL 111 Programme Management Board Monthly, on the second Tuesday of the month June 2017 March 2018, 15:00-16:00 SEL 111/IUC & GPOOH Commissioner Forum Monthly, on the second Tuesday of the month April 2018 onwards, 15:00-15:30 SEL IUC & GPOOH Alliance Leadership Team meeting Monthly, on the second Tuesday of the month June 2017 March 2018, 16:00-17:30 April 2018 onwards, 15:30-17:30 SEL 111 Contract Management Meeting Monthly, on the third Tuesday of the month 09:30-11:30 Page 9
Appendix 2 Introduction SEL 111/IUC & GPOOH Commissioner Forum Terms of Reference The South East London (SEL) 111/ Integrated Urgent Care (IUC) and GP Out of Hours (GPOOH) Commissioner Forum (hereafter known as the Commissioner Forum) will provide an opportunity for commissioners to identify any shared concerns or issues that have been raised via the individual contract management meetings, prior to their attendance at the SEL IUC & GPOOH Alliance Leadership Team (ALT) meeting. Membership The core membership will be made up as follows: SEL CCGs IUC Senior Responsible Officer (Chair) SEL CCGs IUC Clinical Governance Lead (Deputy Chair) SEL CCGs Urgent Care Clinical Leads SEL CCGs Urgent Care Commissioner Leads SEL CCGs GPOOH Commissioner Leads SEL IUC Contract and Service Redesign Manager Bromley CCG Chief Finance Officer Members may send a deputy in their place, when necessary. Responsibilities of members include: Attending scheduled meetings Having an understanding of their provider s performance and any clinical governance issues Providing support Being a champion for the programme Ensuring the group is informed of local CCG commissioning strategies that impact on IUC and GPOOH service provision and commissioning. Raising risks and issues as appropriate, where IUC and GPOOH commissioning impacts on local urgent care provision and vice versa. Managing IUC integration dependencies with other urgent care providers commissioned by their CCG e.g. urgent care centres, GPOOHs. Reporting to their local boards and other stakeholders covering their organisations, through local governance structures. Managing approval of IUC programme deliverables through their internal governance framework e.g. Alliance Agreement. Page 10
Secretary The SEL IUC Programme Team will provide secretarial support to the Commissioner Forum. The responsibilities of the Commissioner Forum secretary include: Setting dates and times for the meetings. Booking meeting venues. Sending calendar invites to all members and guest attendees. Agreeing the agenda with the Chair. Circulating papers prior to the meetings. Attending the meetings and taking minutes, ensuring these are approved by the Chair. Updating the Commissioner Forum action log. Quorum The Commissioner Forum will be considered quorate when the following are in attendance: Either the Chair or the Deputy Chair A representative from each SEL CCG A representative from the SEL IUC Programme Team Frequency and notice of meetings The meetings will be held monthly. Meeting dates will be set during quarter four of the financial year, for the next financial year. Meetings will be documented and papers will be circulated two working days prior to the meeting. Any urgent matters, between monthly meetings, will be dealt with via teleconferences with action points documented and circulated to group members. Remit and responsibilities of the Commissioner Forum The Commissioner Forum is a networking forum which provides an opportunity for commissioners to identify any shared concerns or issues that have been raised via the individual contracting meetings, prior to their attendance at the SEL IUC & GPOOH ALT meeting. The remit and responsibilities are as follows: Monitor any risks or issues in relation to provider performance against: o o o o o o Alliance Agreement KPIs Alliance Agreement Objectives Individual Provider Contract KPIs (where these impact on the Alliance) Statutory responsibilities (where these impact on the Alliance) Demand and capacity planning Business continuity and disaster recovery arrangements Page 11
o Healthcare Professional Feedback / Complaints / Incidents / Serious Incidents (where these impact on the Alliance) Accountability and reporting arrangements Minutes of the Commissioner Forum meetings will be public documents, except for those relating to any meetings or parts of meetings held in private (e.g. where discussions are declared to be commercially in confidence). As this is a networking forum with no decision making powers, it will not formally account to or report to any other committee. Any issues raised will be addressed either through individual contract management meetings or through the SEL IUC and GPOOH Alliance Leadership Team meeting. Conduct of the Commissioner Forum The Commissioner Forum will conduct its business in accordance with national guidance, and relevant codes of conduct / good governance practice. All Commissioner Forum members will be required to complete a declaration of interests form prior to participating in Commissioner Forum meetings / activities. Conflicts of Interest will be a standing item at each Commissioner Forum meeting and members are to raise / update these at each meeting and complete a new form if their situation changes. The Commissioner Forum will review its own performance, membership and terms of reference on an annual basis. Ratified by: Date: Review due: Page 12
Appendix 3 SEL IUC & GPOOH Alliance Leadership Team Meeting Terms of Reference Introduction The South East London (SEL) Integrated Urgent Care (IUC) and GP Out of Hours (GPOOH) Alliance Leadership Team (hereafter known as the ALT) will oversee the evolution of the 111 service towards the IUC model; the mobilisation of the IUC service (following procurement); benefits realisation and the service s ongoing development. This includes oversight of the integration dependencies, with a particular focus on the links with GPOOH, put in place under an MOU and subsequently formalised through an Alliance Agreement. Membership The core membership will be made up as follows: SEL CCGs IUC Senior Responsible Officer (Chair) SEL CCGs IUC Clinical Governance Lead (Deputy Chair) SEL CCGs Urgent Care Clinical Leads SEL CCGs Urgent Care Commissioner Leads SEL CCGs GPOOH Commissioner Leads SEL IUC Contract and Service Redesign Manager SEL IUC Communications Lead Bromley CCG Chief Finance Officer London Ambulance Service 111 Representative Bromley Healthcare Community Interest Company GPOOH Service Representative Greenbrook GPOOH Service Representative The Hurley Group GPOOH Service Representative SELDOC GPOOH Service Representative SEL CCG s Head of System Resilience NHS England London / Healthy London Partnership representatives Two patient representatives / Healthwatch representatives (one from inner SEL and one from outer SEL) Members may send a deputy in their place, when necessary. Responsibilities of members include: Attending scheduled meetings Bringing the appropriate authority to make decisions Committing organisational resources Providing support Being a champion for the programme Responsibilities of commissioning representatives include: Ensuring the ALT is informed of local CCG commissioning strategies that impact on IUC and GPOOH service provision and commissioning. Page 13
Raising risks and issues as appropriate, where IUC and GPOOH commissioning impacts on local urgent care provision and vice versa. Managing IUC integration dependencies with other urgent care providers commissioned by their CCG e.g. urgent care centres, GPOOHs. Reporting to their local boards and other stakeholders covering their organisations, through local governance structures. Managing approval of IUC programme deliverables through their internal governance framework e.g. Alliance Agreement. Secretary The SEL IUC Programme Team will provide secretarial support to the ALT. The responsibilities of the ALT secretary include: Setting dates and times for the meetings. Booking meeting venues. Sending calendar invites to all members and guest attendees. Agreeing the agenda with the Chair. Circulating papers prior to the meetings. Attending the meetings and taking minutes, ensuring these are approved by the Chair. Updating the Committee action log. Quorum The ALT will be considered quorate when the following are in attendance: Either the Chair or the Deputy Chair A representative from each SEL CCG (to include a minimum of three clinical leads) A representative from the SEL IUC Programme Team A representative from each provider affected by the decisions made in that meeting Frequency and notice of meetings The meetings will be held monthly. Meeting dates will be set during quarter four of the financial year, for the next financial year. Meetings will be documented and papers will be circulated two working days prior to the meeting. Any urgent matters, between monthly meetings, will be dealt with via teleconferences with action points documented and circulated to group members. The Chair has delegated authority to take decisions in teleconference meetings, but these must be ratified at the next full meeting of the ALT. Remit and responsibilities of the ALT The ALT will have oversight of the provision of the SEL IUC and GPOOH services. This includes: Oversight of the evolution of the 111 service towards the IUC model o Agreeing the evolution action plan o Setting up task and finish groups o Monitoring the activities of the task and finish groups o Approving workforce retention and development plans Page 14
o Approving business continuity and disaster recovery plans o Undertaking end-to-end call reviews to assess patient pathways of care Oversight of mobilisation o Oversight of mobilisation progress. o Ensuring that appropriate governance arrangements are in place to monitor the provider. o Advising and assisting in mitigations and management of risks and issues. Oversight of benefits realisation o Oversight of the implementation of the Alliance Agreement o Ensuring that the services perform against the key performance indicators as set out in the Alliance Agreement. o Monitoring the activities of the task and finish groups o Oversight of demand and capacity planning, particularly in relation to Christmas / New Year, Easter, other Bank Holiday periods, periods of industrial action and unexpected sustained changes in demand. o Monitoring costs of the services. o Reviewing and agreeing marketing of the services. o Oversight of significant changes to service delivery e.g. change of premises, change of IT / telephony system. o Monitoring any contract extensions. Oversight of the integration dependencies o Providing advice and guidance to the IUC programme team on strategic or external matters that might affect the programme. o Monitoring progress, local engagement and communications through receiving reports and authorising corrective action to ensure delivery. o Securing commitment from member organisations. The ALT has delegated responsibility from SEL CCGs for: All decisions required to achieve delivery of the procurement. All decisions required to performance manage the IUC and GPOOH providers within the constraints of the alliance agreement. Accountability and reporting arrangements Minutes of the ALT meetings will be public documents, except for those relating to any meetings or parts of meetings held in private (e.g. where discussions are declared to be commercially in confidence). The ALT will be accountable to the SEL DoCs/CFOs and the SEL A&E Delivery Board, thereby aligning with and supporting delivery of the sustainability and transformation plan. Generally, operational matters that needed escalation will be addressed at the A&E Delivery Board, while more strategic decisions will be escalated to DoCs/CFOs before going to the CCG Governing Bodies for sign off. If is, however, recognised that both forums cover both operational and strategic matters, but the arrangements outlined above will be followed as a general rule of thumb. The ALT will report to the SEL DoCs/CFOs and the SEL A&E Delivery Board via the sharing of ALT meeting minutes. Members of the ALT will attend the SEL DoCs/CFOs and the SEL A&E Delivery Board as required when there are issues that need escalating to these forums for resolution. The Chair of the ALT is a member of the SEL Urgent Care Network and will provide the formal link to this group. The SEL CCGs Head of System Resilience will be a member of the ALT and is a member of the SEL System Resilience Group, so will provide the formal link to this group. The SEL CCG Governing Bodies are ultimately responsible for governance of the SEL IUC and GPOOH services; oversight will be achieved through the SEL CCG DoCs/DoFs and the SEL A&E Delivery Board. Page 15
Conduct of the ALT The ALT will conduct its business in accordance with national guidance, and relevant codes of conduct / good governance practice. All ALT members will be required to complete a declaration of interests form prior to participating in ALT meetings / activities. Conflicts of Interest will be a standing item at each ALT meeting and members are to raise / update these at each meeting and complete a new form if their situation changes. The ALT will review its own performance, membership and terms of reference on an annual basis. Any resulting changes to the terms of reference must be approved by the SEL CCG DoCs/DoFs. Ratified by: Date: Review due: Page 16