Minutes Nottingham North & East Clinical Commissioning Group Clinical Cabinet Meeting Held 16 th November 2016 at the Civic Centre, Arnot Hill Park, Arnold, Nottinghamshire, NG5 6LU Present Dr James Hopkinson (JH) Clinical Chair (Chair) Dr Umar Ahmad (UA) GP Representative, Plains View Surgery Dr Sarah Bamford (SB) GP Representative, Newthorpe Medical Centre Jonathan Bemrose (JB) Chief Finance Officer Jeff Burgoyne (JBu) Patient and Public Representative Dr Ian Campbell (IC) GP Representative, Park House Medical Centre Dr Gerry Gallagher (GG) GP Representative, Daybrook Medical Practice Dr David Hannah (DH) GP Representative, Torkard Hill Medical Centre Dr Smita Jobling (SJ) GP Representative, Highcroft Surgery Dr Manas Karpha (MK) GP Representative, West Oak Surgery Dr Azim Khan (AK) GP Representative, Unity Surgery Dr Elaine Maddock (EM) GP Representative, Stenhouse Medical Centre Dr Akila Malik (AM) GP Representative, Westdale Lane Surgery Dr Suman Mohindra (SM) GP Representative, Om Surgery Dr Amelia Ndirika (AN) GP Representative, Whyburn Medical Practice Dr Paramjit Panesar (PP) Assistant Clinical Chair Sharon Pickett (SP) Deputy Chief Officer Dr Jacques Ransford (JR) GP Representative, Giltbrook Surgery Kathryn Sanderson (KS) Patient and Public Representative Dr Arun Shetty (AS) GP Representative, Apple Tree Practice Dr Ben Teasdale (BT) Secondary Care Consultant Dr John Tomlinson (JT) Consultant in Public Health, Nottinghamshire County Council Sam Walters (SW) Chief Officer In Attendance Hazel Buchanan (HB) Director of Operations Marie Crowley (MC) Primary Care Mental Health Implementation Manager, Newark and Sherwood CCG (For Agenda Item 16/130) Dr Matt Jelpke (MJ) St Georges Medical Practice (For Presentation on Unwarranted Clinical Variation only) Natalie Shouler (NS) Service Improvement Manager Gareth Jones (GJ) Assurance Lead Officer (Note Taker) Stewart Newman (SN) Director of Commissioning (For Agenda Items 16/132 and 16/133) Sergio Pappalettera (SPa) Contract and Information Manager Vickie Walker (VW) Senior Service Improvement Manager Apologies Paul McKay (PK) Colleen Mulvany (CM) GP Representative GP Representative Service Director, Nottinghamshire County Council Practice Nurse Representative Jubilee Practice Oakenhall Medical Centre Page 1 of 7
GP Representative Trentside Medical Practice GP Representative Peacock Medical Practice Practice Manager Representative Actions Managing Unwarranted Clinical Variation Presentation Dr Matt Jelpke (MJ) provided a presentation on managing unwarranted clinical variation and presented the findings from the showcase event regarding the Rushcliffe Vanguard Project and noted the following: This was an opportunity to look at how referrals were managed including prescribing and first outpatient elective GP initiated referrals. Each practice within Rushcliffe has identified specialities in which referrals can be peer reviewed. A peer review pilot took place on any areas identified as a high referral area with a view to meeting the QIPP arrangements for 2017 / 18. It has been suggested that this approach could be used for all South Nottinghamshire practices. Outcomes are managed on a savings basis with consideration given to the impact on patient care. The review on the impact of patient care had not taken place but feedback suggested that 1 in 5 Rushcliffe residents attend an outpatient appointment every year and there is scope to reduce improve this figure. There are no blockages in making appropriate referrals but a better way in managing referrals is encouraged. Practices have been given a lot of training and operational meetings that have built on good working relationships for the peer reviews to take place. Clinical Commissioning Groups (CCG) provides the rules on how the referral criteria must be set and the parameters in which the providers must achieve. A financial incentive is then given at the end of the year if the CCG meet their QIPP targets. It was noted that there are not enough Clinical Specialists to be able to provide a second triage that has an expertise in a particular area. A Clinical Assessment Service is available within Rushcliffe CCG which provides an opportunity to delay the referral while a second review takes place. CC 16/123 MJ left the meeting at 13:25. Welcome and Apologies James Hopkinson (JH) welcomed all to the meeting. Apologies were noted as above. Page 2 of 7
CC 16/124 Declaration of Interest JH reminded committee members of their obligation to declare any interest they may have on any issues arising at committee meetings which might conflict with the business of NNE Clinical Commissioning Group. Declarations of the Clinical Cabinet were listed in the CCG s Register of Interests. JH noted that the Register was available either via the secretary to the Clinical Cabinet or the CCG website at the following link: http://www.nottinghamnortheastccg.nhs.uk/contactus/freedom-of-information/conflicts-of-interest/ No additional conflicts of interest were declared above those already recorded on the CCG register of interests CC 16/125 Minutes of the meeting held on 21 st September 2016 CC 16/126 CC 16/127 Minutes agreed as an accurate record. Matters arising and actions from the meeting held on 21 st September 2016 No matters arising. All actions from previous meeting completed. Chief Officer and Chair s Report Sam Walters (SW) discussed the Chief Officer and Chair s Report and highlighted the following points: Sherwood Forest Hospitals NHS Foundation Trust (SFH) and Nottingham University Hospitals NHS Trust (NUH) will no longer be pursuing the formal merger and will continue to operate as standalone organisations. The NHS Operational Planning and Contractual Guidance 2017 2019 describes how operational planning and contracting for 2017 2019 needs to change to support delivery of the Sustainability and Transformation Plans (STP) over the next two years. The CCG is required to produce a two year narrative operational plan to accompany activity and finance plans, all of which are to be submitted to NHS England for agreement. Draft plans to be submitted by 24 th November 2016 with finals plans submitted by 23 rd December 2016. NNE is part of the second cohort for the NHS RightCare programme and for this year s planning activity the CCG and the health system will be expected to review, understand and address unwarranted variation by the end of 2017/18. The CCG had its assurance meeting for the second quarter on the 21 st October with performance rated on the 6 clinical priorities as follows; Cancer needs improvement, Dementia top performing, Diabetes Page 3 of 7
needs improvement, Learning Disabilities needs improvement, Maternity performing well and Mental Health needs improvement. NHS England has published its Armed Forces and their Families Commissioning Intentions 2017 / 18 to 2018 / 19, providing information to commissioners of healthcare services about the changes and planned developments. Public Health England has launched its Stay Well This Winter campaign. The CCG stakeholder survey will take from 16 th January 2017 to 24 th February 2017. Along with our CCG and Healthcare Colleagues, two awards have been won; the Healthcare Supply Association Awards 2016 and the PrescQipp Gold Award. CC 16/128 The Clinical Cabinet acknowledged the Chief Officers report. Finance Update Jonathan Bemrose (JB) discussed the activity report and highlighted NNE is already overspent with 5 months remaining in this financial year. All risk and contingency reserves already utilised. JB noted the following key points: In previous years, by redistributing the resources and using reserves, the CCG have managed to recover some of the deficit but this cannot be achieved this year and therefore the CCG has had to declare its financial position. If no changes are made and we continue to work as we currently are, the savings required for next year will be 12.40m. Internal financial turnaround has been declared, along with all South CCG s, to which Andy Hall is overseeing a financial recovery team. This will be used to performance manage the CCG to identify gaps, what thresholds require changing and what we need to change to hit targets. It was expressed that practices are not being asked not to refer, but to think twice before referring on. Jeff Burgoyne (JBu) raised that the Peoples Council recommended that prescribing of Paracetamol and other medications could be stopped. JBu said that patients want to be involved in helping to provide ideas to meet the financial targets. JBu expressed his concern over the suspension of the People s Council. Hazel Buchanan (HB) advised that we have a statutory duty to inform and involve patients in all that we do to which we have developed a strengthened people s council. This includes Patient and Public Involvement (PPI) representation at Governing Body and Clinical Cabinet and Page 4 of 7
PPI Quality Innovations Productivity and Prevention (QIPP) Group meeting every two months to look at items suggested on the QIPP plan. There is also a new PPI Committee made up of 5 patient representatives, CCG Executive Team and Governing Body Members. Every suggestion made at Clinical Cabinet is as a result of the suggestions of Patient and Public Involvement. A wealth of networks are available to include patients. CC 16/129 The Clinical Cabinet acknowledged the finance update. Over the Counter Medicines and difficult decisions Lucia Calland () provided a presentation on over the counter medicines and noted the following key points: Pharmacy First, funded by NHS England provide free medications for patients but more work is required to raise awareness. Advertisements on websites, posters/banners and leaflets to be developed for practices. to liaise with Antonia Smith. Clearer guidelines, a list of the common medicines and where to access them cheaper or are available from Pharmacy First to be included in the leaflet to patients. to discuss with Sam Travis. For 2015/16 the spend is 659,652 with anticipated savings of 70,000. Spend per practices ranges from 7,165/ year to 72,374/year. Grey Drugs should not be prescribed as there is limited clinical evidence to support the effectiveness. to provide a list of grey drugs. to provide a breakdown of costs for 2015 / 2016 into each medicine spend. CC 16/130 The clinical cabinet acknowledged the update. Parity of Esteem Marie Crowley (MC) presented the report which outlines NNE s position for patients with severe mental illness and their outcomes. Parity of Esteem sets the agenda for the CCGs to ensure that with a severe Mental Illness life expectancy matches that of the wider community. The recent report recommends actions for a system wide approach in tackling the Parity Agenda with a key aim in ensuring that the psychological outcomes of their physical health is cared for regardless of where the patients pathway takes them in the healthcare system. CC 16/131 The Clinical Cabinet acknowledged the report. National Diabetes Prevention Programme Dr Elaine Maddock (EM) provided an update on the National Page 5 of 7
Diabetes Prevention Programme to include the referral activity to date for all NNE practices. The CCG requests that all practices discuss their current referral activity within their practice in order to support future referrals. Practices are requested to review existing activity levels with their practice to support future referrals. All referrals must be submitted in bulks of 10 where possible and patients booked directly onto the programme. The programme takes place at two venues including Arnold and Hucknall but additional venues will be coming soon. Each session on the programme takes 1.5hrs and has 4 core sessions that must be attended in the first 6 weeks, followed by 8 maintenance sessions that can be taken in the patient s own time with one final review session to complete the programme. The provider is given a financial incentive by NHS England for the whole 13 courses providing they keep the patient on the course. Natalie Shouler (NS) highlighted that the referral forms is electronic and is populated by SystmOne. Due to a recent NHS.net mail error, any referrals sent on Monday 14 th or Tuesday 15 th November must be resent or contact NS with the number of referrals sent so this can be followed up. CC 16/132 The Clinical Cabinet acknowledged the update. Functional Seizures Stewart Newman (SN) provided an update on the Functional Seizures Service that was piloted in 2014/15. SN highlighted the report that reviewed the first 9 months of service. Following a review of an evaluation report the service was commissioned by the 4 South CCG s with recurrent funding as part of the NUH contract. The service is not part of the local pricing review but will be funded as a local price. CC 16/133 CC 16/134 The Clinical Cabinet acknowledged the update. Decommissioning Policy This item was deferred to the next meeting. Reports a) NNE Performance Report b) Better Care Fund Update The Clinical Cabinet acknowledged the Performance Report and Better Care Fund update. No comments were made. Page 6 of 7
CC 16/135 Minutes a) Health and Wellbeing Summary September 2016 b) Health and Wellbeing Summary October 2016 c) Service Improvement Group Minutes from 17 th August 2016 CC 16/136 The Clinical Cabinet acknowledged the minutes. No comments were made. Any Other Business Blood Test Results Concerns raised that blood test results are still being received from A&E via pathlinks. Resilience Funding Resilience funding of 42,000 is now available. Currently looking at a plan that gets the best value for the funding across the CCG. As part of the system, there is a performance management assurance processes that is aligned that will include a memorandum from each practice with KPI s. It is requested that practices write to the CCG to say how they wish to use this funding. Date, Time and Venue of Next Meeting 20 th December 2016-13:30 16:30 Reception Room, Civic Centre, Arnot Hill Park, Nottingham, NG5 6LU SIGNED:. (Chair) DATE:.. Page 7 of 7