WOLVERHAMPTON CCG Governing Body Meeting ` Agenda item:12 TITLE OF REPORT: REPORT PRESENTED BY: Commissioning Committee Summary Dr Kamran Ahmed Title of Report: Update from the Commissioning Committee reporting period 31 March 2014. Purpose of Report: To provide an update of the Commissioning Committee to the Governing Body of Wolverhampton Clinical Commissioning Group (CCG). Author(s): Owner: Filepath: Key Points: Recommendation to the Board. Action Required: Clinical view: View of patients, carers or the public and the extent of their involvement. Dr Kamran Ahmed Dr Kamran Ahmed W:\Commissioning\Sharon\Comissioning Committee Board\Meetings\Meeting 2014\March 2014 For Information and Assurance Key points highlighted in the report. The Governing Body of Wolverhampton CCG considers the contents of this report. Decision X Assurance The meeting is attended by CCG board members and DDG leads providing clinical and managerial input. Meeting open to the Public and attended by appointed Lay representatives. WCCG Governing Body Meeting Page 1 of 6
Resource Implications and Financial consequences: Relevance to Board Assurance Framework (BAF): Risk / Legal implications: Implications on Quality and Safety: Equality Impact Assessment: Implications on Information Governance Relevance to National / Local Policy: Contained within the report and detailed in formal minutes. Select which Domain(s) the report is relevant to: Domain 1: A clinical and multi-professional focus, with quality central to the organisation. Domain2: Good engagement with patients and the public, listening to what they say and truly reflecting their wishes. Domain 3: A clear and credible plan over the mediumterm to deliver great outcomes within budget, which has been determined in partnership locally, and reflects the priorities of the health and wellbeing board. Domain 4: Proper constitutional and governance arrangements, and the capacity and capability to deliver all their duties and responsibilities. Domain 5: Collaborative arrangements with other CCG s, local authorities and NHS England, appropriate commissioning support and good partnership relationships with their providers Domain 6: Great leaders who individually and collectively can make a real difference. OUTLINED IN REPORT OUTLINED IN REPORT N/A N/A WCCG Board Assurance Framework 1. PURPOSE OF THE REPORT To provide an update from the Commissioning Committee to the Governing Body of Wolverhampton City Clinical Commissioning Group (CCG). WCCG Governing Body Meeting Page 2 of 6
2. Overview of Committee Discussions 2.1 Emergency Care & Urgent Care Centre UPDATE RY provided a Verbal update on the current status of the Emergency Care & Urgent Care Centre Project. Over the past two weeks RWT have made a draft copy of the Full Business Case available. CCG executive members and Urgent Care DDG leads have met frequently to discuss the content of the FBC and how it aligns to the CCG Urgent Care Strategy. The CCG has clarified it position and prioritise:- 1) Primary Care / GP led triage at the front door Evidence suggest this will ensure appropriate signposting of patients to the Urgent Care centre and in the long term will aid in educating patients about the use of urgent care. 2) Primary Care led centre ensuring the service is led by practitioners experienced in working in Primary Care and GP led. 3) The Urgent Care Centre must undergo open procurement once up and running in line with legislation and advice from CSU. CCG Urgent Care team and Executive Team continue to work with RWT to realise the CCG s Urgent Care Strategy 2.2 Medicines Optimisation (MO) Update The DDG presented a report on the work that has been completed to date The MO team have worked closely with GP s on the Primary Care Investment Scheme and the introduction of Electronic Prescriptions (EPS2). MO continues to work closely with other DDGs to plan priority projects. Overall prescribing budget remains on target to under-spend. Key Schemes GP Prescribing Budget Savings on target to achieve 400k Secondary Care High Cost Drugs Target - 350k. Month 10 Achieved 630K! MO is represented on the recently setup Pharmacies Local Professionals Network (LPN). New QIPP Plans for 2014/15 include: WCCG Governing Body Meeting Page 3 of 6
Working with RWT and GP practices to increase the proportion of dressings procured via the NHS supply chain to minimise waste. Utilise benefits provided by the manufacturers commercial discount scheme to use certolizimab in secondary care with licensed indications for psoriatic arthritis and ankylosing spondylitis. Nationally identified medicines optimisation savings. Respiratory care plans (COPD/asthma) with savings from optimising choice of inhaler. 2.3 Use of Biologics in Rheumatology outside of Current NICE Guidance a) Rituximab b) Tocilizumab These business cases were presented to the Commissioning Committee. There were some concerns with regards the finances and the contractual detail in the business cases. Action: Medicines Optimisation DDG to meet with Finance and Contracting leads to ratify the detail and bring business case to future committee. 2.4 Oral Nutritional Supplementation Around 28% of admissions to acute hospitals and up to 42% of people admitted to care homes have or are at risk of malnutrition when evaluated using criteria based on the Malnutrition Universal Screening Tool ( MUST ) (Russell & Elia, 2008, 2009). Work done by Registered Dieticians as part of the 2012/14 QIPP project suggests effective nutritional screening and management is patchy, and that 60% of ONS in Care Homes could be stopped or reduced by taking a Food First approach to nutritional management. It is estimated that the service could provide an annual cost avoidance of 280,000. The nutrition management guidelines and formulary were launched in the Summer of 2012, and since then there has been a consistent downward trend in the use of ONS, falling from a spend of 86K/month at its highest to 61.5K in December 2013 It is proposed to commission a service to help control prescribing of Oral Nutritional Supplements and prevent malnutrition. The service will: Facilitate a comprehensive malnutrition screening service in Wolverhampton to work with all GP practices and care homes. WCCG Governing Body Meeting Page 4 of 6
Promote the use of Wolverhampton guidelines and screening materials together with training. Detect malnutrition as identified by Malnutrition Universal Screening Tool (MUST) and treat effectively. Promote a Food First approach to management of malnutrition and ensure oral nutritional supplements (ONS) are prescribed appropriately according to ACBS indications e.g. disease related malnutrition for new and existing patients. To continue no minimise oral nutrition supplement waste. To offer further support to primary care health professionals to implement cost effective management of malnourished patients on their caseloads. Continue to develop relationships between Nutrition and Dietetics department RWT, Care Homes and general practices in Wolverhampton to promote hospital admission avoidance. Action: This report is presented to commissioning committee for assurance as the QIPP scheme has been added to the contract for 2014/15. Ensure Quality Team aware of scheme and tie into care home work Ensure mechanism for identifying Care Homes were poor nutrition is a persistent problem. 2.5 Anticoagulation Programme of Works Analysis of existing services for anticoagulation (predominantly for AF) was presented and recommendations with cost benefit analysis and project plans for service redesign. Of the 263,038 people registered in Wolverhampton, the latest QIPP report estimates that 2% (5261) may have AF (Atrial Fibrillation). QOF data for 2012/13 states that only 3839 have a diagnosis of AF and only 2067(estimated) of those are receiving an OAC (Oral Anticoagulant). NICE guidelines recommend that 85% of patients diagnosed with AF should receive an OAC. INR monitoring in Wolverhampton is predominantly conducted via the community clinics held throughout the city accounting for 2825 patients and paid for under a block contract costing 812kpa or 267 per patient. It was recommended that a programme manager be appointed to drive through the programme of works. Engagement, support and visibility will be key issues, it is therefore suggested that the INRstar project be commenced ASAP as there are no cost implications with providing access to all GP s throughout the locality and this will have a substantial impact on engagement and future project measurement. Dedicated resource will realise the detailed benefits faster and easily offset any costs incurred. WCCG Governing Body Meeting Page 5 of 6
Action: The full report was tabled at the Committee and due to the complexity of the information presented and the potential impact on resource / finance decision was taken for finance and contracting colleagues to review the suggestions and decide on plan of action. 2.6 Contract & Procurement Report Month 10 report was presented. Key Points:- Q3 A&E target failed (94.58% v s 95%) Referral To Treatment for General Surgery & Trauma & Orthopaedics remains a problem with the trust continuing to breach 18week target. A Recovery Plan has been put in place. RWT failed for a second month percentage of patients waiting no more than 62 days from urgent GP referral to definitive treatment for cancer RWT have reported issues with tertiary referrals from another local provider and Workforce issues in urology causing delays. RWT - 3.8m Over performance at month 10 (FOT 4.5m = 3.3% contract) Black country partnership No issues Block Contract Dudley FOT 1.6m over performance Vascular / elective inpatients & outpatients. Walsall - 0.5m Over performance Elective inpatients and day cases. Nuffield - 0.59m Over performance 29% contract. Data sharing issues prevent full analysis of this data. Action: Note report 3. CURRENT SITUATION Contained within section 2 of the report 4. KEY RISKS AND IMPLICATIONS Contained within section 2 of the report 5. RECOMMENDATIONS Receive and discuss this report. Note the action being taken. Name Dr Kamran Ahmed Job Title Governing Body Lead - Commissioning & Contracting Date: 28 March 2014 WCCG Governing Body Meeting Page 6 of 6