NHS BOLTON CLINICAL COMMISSIONING GROUP Public Board Meeting AGENDA ITEM NO: 14(ii) Date of Meeting: 23 rd January 2015 TITLE OF REPORT: AUTHOR: PRESENTED BY: GM Association of CCGs Summary from January 2015 meeting GM Association of CCGs Su Long, Chief Officer PURPOSE OF PAPER: (Linking to Strategic Objectives) To update the Board on the discussions held at the meeting on 6 th January 2015. RECOMMENDATION TO THE BOARD: (Please be clear if decision required, or for noting) The Board is asked to note the summary. COMMITTEES/GROUPS PREVIOUSLY CONSULTED: GM Association of CCGs. VIEW OF THE PATIENTS, CARERS OR THE PUBLIC, AND THE EXTENT OF THEIR INVOLVEMENT: Patient views are not specifically sought as part of this report. EQUALITY IMPACT ASSESSMENT (EIA) COMPLETED & OUTCOME OF ASSESSMENT: EIA and an assessment is not considered necessary for the report. 1
GM ASSOCIATION OF CCGs: Association Governing Group (AGG) Summary Date: 06/01/2015 Time: 08:30 12:30 Venue: 5 th Floor Townside Primary Care Centre, Knowsley Street Bury Attendance: Steve Allinson NHS Tameside &Glossop CCG Trish Anderson NHS Wigan Borough CCG Wirin Bhatiani NHS Bolton CCG Alan Campbell NHS Salford CCG Tim Dalton NHS Wigan Borough CCG Andrea Dayson GM Association of CCGs Alan Dow NHS Tameside & Glossop CCG Chris Duffy (Chair) NHS Heywood, Middleton & Rochdale CCG Michael Eeckelaers NHS Central Manchester CCG Ranjit Gill NHS Stockport CCG Denis Gizzi NHS Oldham CCG Nigel Guest NHS Trafford CCG Warren Heppolette Health & Social Care Reform Gina Lawrence NHS Trafford CCG Su Long NHS Bolton CCG Wendy Meredith Bolton Council Public Health Lesley Mort NHS Heywood, Middleton & Rochdale CCG Gaynor Mullins NHS Stockport CCG Stuart North NHS Bury CCG Kiran Patel NHS Bury CCG Karen Proctor NHS Salford CCG (HOCs Chair) Jenny Scott NHS England specialized Commissioning Melissa Surgey GM Association of CCGs Bill Tamkin NHS South Manchester CCG Annette Walker NHS Bolton CCG (HOCs Chair) Leila Williams Service Transformation Ian Williamson NHS Central Manchester CCG Simon Wotton NHS North Manchester CCG Apologies: Rob Bellingham Greater Manchester LAT Hamish Stedman (Chair) NHS Salford CCG Martin Whiting NHS North Manchester CCG Ian Wilkinson NHS Oldham CCG Alan Dow NHS Tameside & Glossop CCG In Attendance: Sandy Bering Sara Roscoe Jonathan Berry NHS Trafford NHS E Primary Care Page 1 of 9
1.WELCOME & APOLOGIES FOR ABSENCE Members were welcomed to the meeting and in particular to Karen Proctor (HoC Chair) and Annette Walker (CFO Chair). 2. MINUTES OF THE LAST MEETING (4.11.14) The minutes of the previous meeting were agreed as an accurate record the action log was updated. Matters Arising: GL provided an update on the One to One Midwifery issues; this service is a current AQP contract. Trafford led a review on behalf of GM as there were noted concerns with the service not complying with the GM specification. CQC did a separate report and felt service was adequate, the report for the AGG highlighted significant issues. There is to be a summit which will bring together users across the country that has raised similar concerns. Julie Higgins is leading on behalf of the Area Teams and has sent questionnaires relating to choice to all CCGs. The GM report has been shared with CQC and we are awaiting a response. Following the summit at end of January it is expected that we may have a have a clearer steer 3. SPECIALISED COMMISSIOING JS provided a verbal update the new arrangements for the North West this includes 2 areas teams instead of 4, Greater Manchester/Lancashire and Cheshire &Mersey. The North of England has 3 bases North West still based in Stockton Heath. Now have National Director, Richard Jevins and a regional director Alison Tonge and regional Clinical Director Alison Rylands. Director of Nursing is Lesley Patel. Emphasis is on a regional basis rather than local still 10 hubs across the country but with different reporting arrangements. Jenny Scott will be leaving to go to the Christie at the end of February; new Associate Director of specialised commissioning will be Andrew Bibby. Contracting Single NHS England contract with different schedules but still awaiting contract and CQUIN guidance. Sign off 11th March for all 41 contracts. QIPP will be a 2.4% target and currently have plans for 30m of the 48m and looking at national procurement and other schemes to meet the rest of the 2.4% target. PbR guidance is out for consultation which closed before Christmas with radical proposals commissioners only pay 50% above baseline activity. Awaiting guidance on contracting and this proposal but have had discussions with providers but need guidance before proceeding. Collaborative commissioning Is the term now being used as opposed to co commissioning. The four services to be transferred Outpatient GPreferred neurology and specialist wheelchairs confirmed but bariatric surgery and dialysis are still being discussed. So for this year these will be included in the specialist contract and a contract variation in year will be raised if agreed to include these services in year. The CFOs through Steve Dixon have been testing out methodology and preparing finance impact for Specialised commissioning on a CCG basis and discussions around these 4 services but will hold off any implementation until confirmation has been received that they should transfer. The general direction of travel is that a significant proportion will over a number of years be transferred to CCGs. Highly specialised services, devolved back to national rather than local Area Teams. Guidance is expected at the end of January. Page 2 of 9
JS has started discussions and met with Ivan Benett, GM GP lead, yesterday to progress the development of collaborative commissioning. This needs to be extended to include more clinical leads and managerial input. Need to consider how we progress this work and involve Lancashire with extended footprint. Over next 2 3 weeks small group needs to start discussions and recommend how we take this forward. Vascular services had hoped on consensus on which of the 3 sites are going to be 2 arterial units this has not been agreed and so now needs to be taken to procurement for GM Cancer IOGs gynaecology has been agreed, hepato biliary agreed, neurology will be finalised in February and upper GI will go to procurement. Thanks extended to Jenny Scott for all of the support given over the years. 4. HEALTHIER TOGETHER DECSION MAKING BUSINESS CASE FINANCIAL AW provided an update on the approval of the Decision Making Business Case and reported that this is still work in progress and that a paper will be submitted from Joanne Newton to next week CFOs meeting. Following this AW will report and update position to the AGG. It was confirmed that one CCG was not supportive in its current state but other CCGs also stated that their Governing Bodies had also requested additonal information for assurance purposes. ACTION: AW to report back to AGG member prior to the next AGG 5. HEALTHIER TOGETHER UPDATE Programme update circulated which provided all information needed in terms of the progress. IW confirmed that no decision of hospital sites will be made until after the election 6. GREATER MANCHESTER CCGs MENTAL HEALTH PROGRAMME UPDATE Sandy Bering presented an update as the GM Mental Health lead for reporting purposes and to ensure due governance. National Mental Health priorities: Improved Quality of Life Outcomes for All and Targeted Groups Military Veterans, LGBT, LT Conditions/MUS, BME, LDD, Autism, Dual Diagnoses, CAMHS and Transitions, Out of Area Placements, Offenders Integration of Physical and Mental Health Reducing Health Inequalities and Better Physical Health (eg smoking, alcohol, exercise, healthy workplaces) Support for Co Morbid Conditions Good End of Life experiences Public Sector Reform Starting Early Upstream Enhancing mental health well being / prevention with MH Friendly Lifestyles/Communities and normalising distress where appropriate Reducing Risk (eg Suicide and Self Harm) and Learning Lessons Work and Jobs Support for Families, Carers and Communities as a whole Page 3 of 9
A local Transforming Care Concordat Service Offer Declaration and Practical Action Plan A Targeted Resettlement Programme to Reduce Use of In Patient Beds in line with Agreed Best Practice Norms and the National LD Commissioning Framework Working Arrangements to Make Sure Effective Access to Early Support is Available with Proactive Early Detection and Emergency Response Systems Operating in Each Locality for When a Crisis Does Occur (thereby Reducing Restrictive Out of Area Placements/Practice and In Patient Admissions) Effective Community LD Teams and Services that Prioritise Staying Well, Recovery and Preventing Future Crises Mental Health Leadership Priorities Across Greater Manchester AGG (2014/15) Joint GM MH Service Contract Management/Development /Support (Lead Commissioner Networks, Commissioner Provider Forums, MH PbR, Calderstones,Military Veterans IAPT) Working with GMP To Deliver the MH Crisis Concordat GM Alcohol Strategy & RADAR LD CQUIN for Acute and Community Health Services to Reduce Premature Deaths & Joint LD Health & Social Care Self Assessment Framework GM Performance & Resilience Issues Improved Access to Psychological Therapies Access/Prevalence/Recovery More Dementia Diagnosis + Post Diagnostic Support + Less Meds RAID and MH/LD Liaison in Place Working with Police to reduce Demand Specialist Services Review (egearly Intervention in Psychosis, Community Eating Disorders) Fewer Restrictive Secure Hospital Placements more local specialist health and social care Effective CPA/care management and resource panels/reviews S117 More Local Autism / LD Support *** Public Sector Reforms Early Intervention and Working Well Future GM MH Focus Priorities Safe, Sound, Supportive IAPT Access/Recovery (? Atlas website accuracy) MH Crisis Care Concordat and Reducing Demand for Expensive, Reactive Services Early Assessment for 1st Episode Psychosis De medicalising Mental Illness / Health issues especially Dementia support Co production with patient leaders/groups to agree management of demands with reduced core capacity Parity of Esteem Addressing Inequalities in Health Physical Health of People with Mental Health and Mental Health of People with Physical Health Problems, Patients with LT Conditions providing IAPT services to In pts on Medical Wards, Embedding MH Liaison services when the Patients Access Primary/Acute Care Services Prevention and Early Intervention Supporting Early Years and Promoting Mental Wellbeing and Emotional Resilience in Children, Suicide prevention, Work, Liaison and Diversion Common approaches to standards and measures THE FORWARDVIEW INTO ACTION: PLANNING FOR 2015/16 Mandate from the government to the NHS is broadly stable, apart from the introduction of new and important access standards for mental health. Page 4 of 9
These form part of our wider ambition to achieve a genuine parity of esteem between mental and physical health by 2020. To support that ambition, we expect each CCG s spending on mental health services in 2015/16 to increase and grow by at least as much as each CCG s allocation increase. Major expansion in 2015/16 in the offer and delivery of personal health budgets to people Mandate to NHS England remains largely unchanged. Commissioners will need to develop revised plans where they are not on track for example on dementia diagnosis or delivery of improving access to psychological therapies (IAPT) service standards. 2015/16 introduction of access and waiting time standards in mental health services for the first time. Part of the 2015/16 contracting round, mental health commissioners will need to develop service development and improvement plans with mental health providers By April 2016, it is expected that more than 50% of people experiencing a first episode of psychosis will receive treatment within two weeks The Crisis Care Concordat includes the provision of mental health support as an integral part of NHS 111 services; 24/7 Crisis Care Home Treatment Teams; and the need to ensure that there is enough capacity to prevent children, young people or vulnerable adults, undergoing mental health assessments in police cells. In deploying the additional funding NHS England is seeking to: Ensure that mental health spend will rise in real terms in every CCG and grow at least in line with each CCG s overall allocation growth Transforming care for people in the justice system & armed forces People in the justice system have disproportionately higher health needs, both mental and physical, than the population as a whole. 2015/16 NHS England roll out new models of liaison and diversion services for people in police custody and the courts. For people in the armed forces, 2015/16 priorities are to improve equitable access, focus on the transition for individuals leaving the armed forces particularly in respect of mental health and musculo skeletal services, and work with partners to improve care for veterans Parity of Esteem The resources you are allocating to mental health to achieve parity of esteem? Identification and support for young people with mental health problems? Plans to reduce the 20 year gap in life expectancy for people with severe mental illness? The planned level of real terms increase in spending on mental health services? RADAR has been reviewed through November CFOs and HOCs outcome of which both approved with the finance processes to be managed through CFOs if ratified by the AGG. The paper provided an update on the extended implementation of the RADAR programme, as one important, innovative and effective way to address the practical significant burden of alcohol complex dependency presentations to acute hospitals in Greater Manchester. Since 2012/13 this programme has enabled a pathway for the rapid transfer of patients from acute hospital beds for inpatient alcohol detoxification. RADAR is a medically managed programme operating a multi disciplinary team approach to detoxification, with 24 hour medical and nursing (Hospital at Night) cover provided. The AGG agreed to this extended funding to support RADAR for a further 12 months to allow for a more detailed review of the evidence and through this time address issues of disparity in access across Greater Manchester in line with the outcomes of the emerging Greater Manchester Alcohol Strategy. The RADAR programme has demonstrated its effectiveness in reducing alcohol related acute admissions, reducing lengths of stay and preventing re admissions Page 5 of 9
AGG was asked to note and confirm continued support for the RADAR programme in the context of the national and local Greater Manchester Alcohol Strategy and wider transformation agendas faced by the health and care systems over the next five to ten years. As such: 1. The Association of Greater Manchester CCG s supports the continuation of investment in the RADAR programme for a further 2 year period in line with the confirmed clinical, social and health economic benefits through reduced hospital admissions from the independent economic evaluation. 2. The Association of Greater Manchester CCG s commit consideration of any other non recurrent funds to further develop this service as part of the wider integration of RAID and other Mental Health Complex Dependency A&E diversion programmes. 3. Greater Manchester CCG s consider financial investments to the RADAR programme in line with option 4 as supported by the GM Heads of Commissioning and Chief Finance Officers Groups, and confirm the agreement through their final Commissioning Intentions and strategic plans. The AGG: Noted the update provided as part of Trafford Lead CCG arrangements for Mental Health RADAR All CCGs agreed to the RADAR proposal in principle but that this needed to be confirmed through CFOs in terms of affordability Bolton have agreed but would want further collaborative work to progress further evidence Did not approve recommendation 2 Approved recommendation 1 for a 1 year period for an update in 9 months Approved recommendation 3 with finances and payment methodology to be approved through CFOs 7. NORTH WEST OXYGEN SERVICES GL provided an update for this service commissioned by Trafford through Lead CCG arrangements. There have been concerns about the company in terms of reporting of KPIs to the value of 6m. NHSE have been involved and solicitors have worked through a process to ensure remuneration. The contract will continue as the quality of the service was not in question this is purely accounting around KPIs. A clinical audit is being undertaken which will be reported back and a framework set up to measure any impact on patients. Indications are that there was no impact on patients but issues highlighted on the interpretation of the contact. Have agreed a collective way forward across North West to try to negotiate further money back without going to court but this will be an individual CCG decision. Question moving forward whether stay with same company or re procure the service there are not a huge range of providers. Company have dismissed staff involved and completely changed how company is managed. ACTION: Feedback of the clinical audit when completed GL 8. PMO UPDATE Melissa Surgey GM ACCGs Progamme Manager presented a paper to update the AGG on progress made in establishing a GM Programme Framework. The AGG are asked to note the work to date and Page 6 of 9
make suggestions for further development if appropriate. The GM Programme Framework was originally commissioned by Mike Burrows in early 2014 with the framework in its existing form developed by PA Consulting. Responsibility for further development and maintenance of the framework was later transferred to the GM Association of CCGs. The Association appointed a Programme Manager in September 2014 to oversee the framework s development and act as a liaison between stakeholders across GM. The GM Programme Framework s purpose is to provide a detailed and up to date overview of all health and social care programmes across the conurbation. Upon its completion, the GM Programme Framework will: Provide a comprehensive and up to date list of all GM health and social care programmes Outline governance arrangements for each programme with regards to responsible officers, project managers and governance forums Detail the intent of each programme including aims and objectives, target delivery dates and anticipated benefits Track the delivery of each programme against core milestones based on the commissioning cycle, possibility of adding further custom milestones depending on a programme s needs Track programme reporting and approval through the Association s governance structure including AGG, COs, HoCs, CFOs and other GM sub groups Feed into a central GM risk register overseen by the Association s Programme Manager Prior to the appointment of a Programme Manager within the GM Association of CCGs, the GM Programme Framework had not been updated or reviewed since May 2014. Given the significant developments within the conurbation over the past year, parts of the framework are being completely reworked to ensure it is fit for purpose. Key developments in the past three months: Working with PA Consulting to refine the framework and hand it over to the Association Developing a framework user guide to support data collection Briefing key stakeholders on the framework and seeking feedback and suggestions for further development (ongoing) Amending the programme list and identifying programmes leads Once the GM Programme Framework goes live, it will be able to inform regular reports to AGG and other Association groups. The framework will contain large volumes of detailed information and therefore it may not be appropriate or practical to share it in its entirety regularly. The information can be cut in a variety of ways depending on stakeholder need. Potential options include: RAG rating e.g. summary of RAG ratings of all programmes; summary of all red rated programmes Ownership e.g. Association led programmes; programmes owned by a particular individual Milestone e.g. all programmes at the contracting stage Risk e.g. all programmes with a risk rating of [x] or above The AGG is asked to: Note the progress to date with regards to the GM Programme Framework Where AGG members are responsible leads for programmes, they are asked to support the Programme Manager in identifying relevant individuals and acquiring missing information for their programmes (a list of programmes and leads will be circulated in early January) Consider which reporting methods may be most appropriate and frequency of reports Review a draft of the GM Programme Framework in February and make recommendations for improvements and further development Page 7 of 9
The AGG Noted the progression of the work and approved next steps Update required for February 9. PROGRESS ON RESOURCING PROACTIVE PRIMARY CARE (GM TRANSFORMATIONAL STANDARDS FOR GENERAL PRACTICE) Sara Roscoe and Jonathan Berry presented a paper that looks at defining a Greater Manchester approach to improving the quality and performance of General Practice alongside a corresponding increase of resource in Primary Care. Following the decision by the Association Governing Group in October 2014 to develop a suite of general practice standards, a series of workshops have taken place to develop a set of sentinel standards for Greater Manchester. The aim of the standards is to reduce unwarranted variation, drive up the quality of general practice and improve health outcomes. AGG asked the GM Primary Care Transformation Team to facilitate this work but decisions would be made by AGG. Subsequent implementation would be at individual CCG level at a suitable time within 2015/16. Following 3 workshops, a set of general practice sentinel standards have been developed and shared with CCGs for them to engage with their member practices. Early feedback from a number of CCGs has identified that appropriate consultation with their members will take time and there are already differences in opinion as to what should/should not be included in the standards. These 9 proposed standards have been disseminated to CCGs, LMCs and Public Health England for further review and feedback. Public Health England has responded with proposed metrics for a number of the GM sentinel standards 9 DRAFT STANDARDS: 1. Primary Care Access (extended hours) 2. Equitable access for vulnerable groups 3. Prescribing 4. Health Improvement early detection 5. Cancer referral 6. Best care / LTCs 7. Mental Health 8. Carers 9. Child Health Following 3 workshops, a set of general practice sentinel standards have been developed and shared with CCGs for them to engage with their member practices. Early feedback from a number of CCGs has identified that appropriate consultation with their members will take time and there are already differences in opinion as to what should/should not be included in the standards. Would be useful to know what all CCGs are doing re: standards this could be coordinated through the group. It is therefore proposed: AGG reaffirms the view that determining GM wide general practice standards remains the direction of travel. These, once resourced appropriately and implemented, will enable a clear statement of ambition to improve health outcomes, reduce unwarranted variation and improve the overall scope and quality of general practice. Page 8 of 9
Feedback on the proposed standards continues to be collated by the Primary Care Transformation team, under the direction of Rob Bellingham, Director of Commissioning as mandated by the AGG and on behalf of all CCGs A general practice Clinical Reference Group (CRG) is established to review evidence for each standardprioritise accordingly. CRG to also be tasked to determine the most effective mechanism for measuring performance and report back to AGG. In light of the move to co commissioning and the importance of this agenda, for the Area Team Primary Care Transformation team to provide progress updates as determined by AGG. Recommendation: AGG is requested to reaffirm the need for GM wide general practice standards to drive improvements in the quality of primary care across Greater Manchester To note the progress in developing the standards as outlined within this paper AGG to review and determine the next steps for these standards based on the next steps. The AGG noted: Reaffirmed the work moving forward; need to ensure feedback Requested a current baseline for benchmarking purposes Bolton agreed to share their approach SL to disseminate Timelines would add influence to the work Level A decision at present until we have combined agreement through CCG membership Review/update requested in the spring 10. CHAIRS / VICE CHAIRS HS has indicated that he is happy to continue in the post of Chair but for members to have the conversation. The AGG may require a different structure moving forward so for the moment to continue as we are. AD argued that the current Job Descriptions does not reflect the time committed so will review the job description of the AGG Chair and Managerial Chair. Need to consider the length of tenure and the possibility of having a rotational chair. However, continuity is crucial as well as considering the funding and structure/job description of the posts. There is a need to understand all CCGs contribution to GM work and also conduct a review of lead CCG commitments with a view to developing criteria and for the CFOs to determine if additonal resource is needed. In addition, as the AGG does make commissioning decisions, the guidance suggests meetings should be held in public and we need to consider how this might be managed. SN stepping down as COOs Chair in April TA will be new Chair and AGG managerial lead/vice Chair. CD Vice Chair role any expression of interest to be submitted to AD The AGG Agreed that the governance discussion be progressed through COOs To be added to the Friday (9.1.14) away day agenda Next meeting: Tuesday 3 February 13.30 17.30 Bury CCG 5 th Floor, Bury Townside Primary Care Centre, Knowsley Street, Bury Page 9 of 9