NORFOLK & WAVENEY LOCAL OPTICAL COMMITTEE MEETING MINUTES 10 MAY 2017 The regular meeting of the 23TNorfolk & Waveney Local Optical Committee held at Dereham Town Football Club, Aldiss Park, Dereham, Norfolk was called to order by Mrs. Deborah Daplyn, (Chair) at 19:35 on 08 March 2017 PRESENT: Deborah Daplyn, Niall O Brien, Ed Adkins, Roger Lee, Ian Sinha,, Kate Fenn, Julien Nelson, Linda Vernon-Wood,& Peter Hutchinson (Administrator) VISITORS: Ann Touray, North Norfolk CCG Commissioner, Head of Pathway Design; Dr. Linda Hunter, GP and Governing Body Member of North Norfolk CCG. APOLOGIES FOR ABESENCE: Dan Rosser, Elizabeth Bunn ABSENT WITHOUT APOLOGY Tim Burgis, DECLARATIONS OF INTEREST: None APPROVAL OF MINUTES: The Minutes from the Committee Meeting held on 8 th March 2017 were approved and signed. 1) Deborah Daplyn welcomed Ann Touray and Dr. Linda Hunter and invited them to address the meeting. Ann Touray began the presentation by explaining the commissioning cycle for clinical services and the complexities of the system that are necessary to ensure service quality and value for money. North Norfolk CCG shares much of the CCG management with South Norfolk CCG and works closely with Central Norfolk GGG as the main commissioners for NNUH. The rules for commissioning services, in the majority of cases, require them to be acquired by competitive tendering. There are situations however, when a specialist service is only available from a single provider or, the total cost of a contract over its lifetime is small, that do not justify the complex process and cost of tendering. The very complex commissioning process has arisen from a need for the final decision to be based on quality and value for money such that it is not exposed to challenges from unsuccessful bidders during the 10 day Alcatel Period. Dr. Linda Hunter took over to explain the structure and work of the recently formed group charged with developing Sustainability and Transformation Plans (STP) for Norfolk & Waveney. There are forty four of these groups nationally that will be responsible for reviewing health and social care services throughout their localities. The Norfolk & Waveney STP is comprised of representatives from all of the CCGs, the three Acute Hospital
Trusts, the Mental Health Trust and Local Councils providing Social Services, with the aim of reviewing all aspects of NHS spending, while focusing on better integration for NHS with social care and other local authority services. The STP will look at new ways of providing services to improve quality and control costs, as well as addressing inequalities, by creating an overarching local plan for future implementation. All this is to be delivered without any additional funding; bearing in mind there is currently about 70m funding gap. The STP has produced a basic plan aimed at prevention; demand management (i.e. providing the correct service in the right place with the aim of reducing the number of patients attending hospitals); Chief care reform which aims to improve services by Hospital Trusts working together collaboratively; Mental Health improving Services; System Enablers, includes staff management, rationalisation of communication between the providers. STPs have no budget of their own but are able to bid for Transformational Funds to enable some of the proposed changes. Dr. Hunter commented that there is a high probability that the CCGs will merge creating a grouping which has the appearance of the PCTs and Local health Authorities of the past! Ann Touray spoke on the present commissioning of ophthalmic services, commenting that the Paediatric Eyecare Service we have been negotiating cannot be commissioned by NNUH as it comes under the control of NHS England but it is anticipated that a telephone conference in the next few days will resolve some of the outstanding issues to move this service forward. MECS is very likely to go out to tender soon with a possibility this will be combined with Direct Referral, hopefully to all three Hospital Trusts. Ian Sinha asked why MECS is not treated the same as Audiology services with contracts being awarded via Any Qualified Provider (AQP) routes rather than tendering. Mrs. Touray said that the National Framework documents better lend MECS to tendering rather than AQP due to the size of the contract and the diversity of providers. Retirement of Martin Sweeney Deborah Daplyn announced she had received a letter of resignation from Martin Sweeney stating he was no longer a member of AOP Council and felt it was no longer appropriate for him to serve on the committee. He said he has passed on details of the N&WLOC to the new council member for Eastern England. The Committee thanks Martin for his valuable contribution and wishes him well in his future endeavours. Matters Arising from the Minutes of 8 th March 2017 a) NHS.net e-mail addresses Dan Rosser sent a report indicating NNUH is concerned about the loss of information from GPs with direct referral. We had proposed referrals are routed through GP practices so that information on patient medication and concurrent medical conditions can be added before being sent to NNUH. The LMC is unhappy with direct referrals sent this way due to the increase in administrative load. He and Ann Touray are due to have further discussions with LMC to resolve this impasse. b) MECS Training The MECS Practical Assessment was held on 23 April 2017 when 30 optometrists attended with 20 passing on the day. Those who failed will have a telephone examination with WOPEC on information sent to them by the assessor. The aim of this training is to form a group of practitioners ready to be signed up for MECS as soon
as he contract is signed; Deborah Daplyn asked if another training session/assessment should be arranged in light of the news that MECS is very likely to be commissioned in the near future. Over 60 optometrists asked for WOPEC codes to complete the online training so it was concluded that another assessment needs to be arranged. It was agreed to ask WOPEC for another session in September. Linda Vernon-Wood said the net fees receipts after discounts but before costs have been met, from the last assessment are 2,250 which will largely cover the costs. She went on to say that LOC funds are sufficient to subsidise this and future assessments. c) Post-Cataract Assessment Dan Rosser has four candidates for assessment next week. He is willing to continue to offer practical assessments for groups of four when they have completed the on-line training. i) Ann Touray is unhappy with the current Post-Cataract Examination contract due to the manner in which it was rolled over at the last review. She has expressed a wish to unify all ophthalmic contracts as part of current negotiations. d) Glaucoma Assessment a several of optometrists have expressed a desire to qualify for this service so Deborah Daplyn will liaise with Dan Rosser to arrange another session. 2) Community Services a) Paediatric Scheme - Ed Akins reported NNUH is too large a Hospital Trust to commission a Paediatric Service although James Paget and Queen Elizabeth Hospitals can because they are smaller. A telephone conference has been arranged with a special commissioning unit from NHS England, Ann Touray of North Norfolk CCG, Ed Adkins and Niall O Brien to discuss this further with a view to commissioning as soon as possible. b) Post Cataract Assessment Yarmouth & Waveney CCG have not been able to communicate with the James Paget Trust and the ophthalmologist there is unwilling to go back on the need for dilation. Deborah Daplyn declined to accept the offer of 5.00 and has informed the commissioner that LOC will refuse to provide the service unless dilation is removed from the contract requirements. c) Ocular Hypertension 5 year Scheme Cycle - Dan Rosser has yet to look at the five year cycle requirements and will report back. 3) LOCSU New Model Constitution has been adapted to the needs of Norfolk & Waveney LOC and is now ready for approval at the AGM. Peter Hutchinson said an amendment is necessary to the signatories for PENW for the Memorandum of Understanding between N&WLOC and PENW relating to the formation of the company. He has been informed that Julien Nelson is not a director as currently stated on the document. It was agreed that Niall O Brien s name will be inserted instead. 4) AGM Preparation Peter Hutchinson reported he had prepared all the documents needed for the AGM and the election of six committee members. All the documents will be uploaded to the website immediately following the meeting with the exception of the voting forms which will have to wait until the deadline for election nominations and AGM motions has passed on 6 th June. The six committee
members standing for re-election were reminded they have to complete nomination forms. He stated an additional item has been added to the agenda; Nomination of two scrutineers to assist the Returning Officer in the event of there being an election vote. It was decided that Tim Burgis, Roger Lee, and Kate Fenn will stand as Contractors and Deborah Daplyn, Linda Vernon-Wood and Ed Adkins will stand as Performers. A further vacancy for a performer has arisen due the Martin Sweeney s resignation which will be added to the agenda list. The Chairman, Secretary and Treasurer were reminded that their reports must reach Peter Hutchinson no later than 31st May in order that they can be uploaded to the website. 5) Financial Report Linda Vernon-Wood presented the current Financial Report but said there has been little activity since the stat of the financial year. The 2016 accounts have been given to Ed Adkins to pass on to Michelle Cade for scrutiny prior to them being presented to the AGM. Michelle is to be asked to appoint another scrutineer. Linda Vernon-Wood reported she has received the first Levy Report from Capita for May 2017 however the report includes Cambridgeshire and Peterborough but not the figures for Waveney. Now she has a contact in Capita she will email back asking for the report to be corrected and then follow this with a request for reports covering the last twelve months. 6) Web Manager Report a) Ed Adkins stated 148 members are now signed up on the website. There has been no further activity on reviving Facebook on behalf of both LOA and LOC. b) Website Metrics - Peter Hutchinson referred to the recent report circulated commenting that overall usage was fairly consistent with previous months. A new page Jobs & Sales has been added, attracting 54 hits for a single job advertisement. It was recommended that this new facility should be advertised in the Newsletter to encourage more use. c) Newsletter Ed Adkins was asked i) to include a notice to remind all contractors with PENW they have an obligation to notify the company of any changes in personnel and ask all performer optometrists, involved in providing Community Services, to notify PENW by emailing Julien Nelson if they change jobs or leave the area. ii) To remind Optometrists to address the new QIO now that we have been informed that all contract will be of the Short Form type. 7) PENW Ian Sinha reported a) Julien Nelson has analysed glaucoma activity involving repeat visual field tests. There were 950 activities in the year of which 790 were deflected i.e. did not need referral to HES at 120 each a saving of over 60,000. The survey revealed 54% of the field tests were carried out by four practices out of 59 participating. These were not the largest practices in the sample leading to the conclusion that there is possibly some misinterpretation of the Standard Common Pathway. PENW will review its responsibility in ensuring compliance by contractors and maybe reissue guidance on the correct process at the same time as considering how to police outliers. There has not been a recent financial report but a decision to make a repayment of 1500 to the LOC Loan in May 2017 will go ahead as planned with a view to
repaying the balance of 1500 in December 2107 or as soon as funds are available. b) Yarmouth & Waveney CCG want to have the NHS Standard Contract that was rolled over in March 2017 formalised to run until March 2018. c) Julien Nelson reported an incident where a patient was referred to hospital for raised IOP but was told the hospital had no capacity to see them and referred her back to the optometrist. It transpired that Optomanager software has no facility for re-entering patient data once the patient has been referred to HES. A work around has been agreed with the practice where the patient is re-entered on the system using a new ID with a reference on the original record to the original ID. Julien Nelson will email Dan Rosser to make him aware of this case. Further action by PENW and N&WLOC has been deferred to see if this event happens more frequently as the hospitals get busier. Deborah Daplyn agreed to contact the patient and practice to get more details on the case. 8) Correspondence None 9) Any Other Business a) Meeting dates: the November meeting clashes with the NOC again and will need to be changed to 15 th November. It was agreed this meeting will be moved back a week for future years. b) NOC delegates: NOC is a one day conference this year which means the LOC will be able to fund more delegates. It was concluded that Deborah Daplyn, Julien Nelson and Kate Fenn will attend. c) Linda Vernon-Wood informed the meeting that West Norfolk Cataract Referral Centre notified practitioners at very short notice that it was no longer issuing patients with an explanatory booklet about the service since the same information was available from the College of Optometry booklet on the subject. Practices are now expected to obtain a supply of this literature from the College. No other practices in West Norfolk have commented. It was noted that the practitioner has a duty to inform the patient anyway. 10) Date of Next Committee meeting 12 th July 2017 Meeting closed at 21:35 hrs.