North Hampshire Clinical Commissioning Group North Hampshire CCG Governing Body Date of meeting 21 st May 2013 Agenda Item 3 Paper No CGB13/063 Draft Minutes of the Governing Body Meeting (23 rd April 2013) Purpose of paper The Draft Minutes of the meeting of the North Hampshire CCG Governing Body meeting of 23 rd April 2013 are attached for approval by the Board. Aims/objective supported by this paper Public involvement activity taken or planned Equality and Diversity Report Author This paper supports North Hampshire Clinical Commissioning Group to fulfil Standing Orders in accordance with the NHS Code of Accountability. Not applicable This paper does not request decisions that impact on equality and diversity. Nikki Kenny Business Services Manager Governing Body Hugh Freeman Sponsor Date of paper 15 th May 2013 Actions requested/ Recommendation The North Hampshire CCG Governing Body is asked to Agree the minutes of the meeting held on 23 rd April 2013 and commend them for signature by the Chair of the meeting. Discuss any matters arising from the minutes.
Minutes (DRAFT) North Hampshire Clinical Commissioning Group Governing Body (CGB) Minutes of the Inaugural meeting of the North Hampshire CCG Governing Body meeting held on Tuesday 23 rd April at 13.30 hours The Ark Conference Centre, Dinwoodie Drive, Basingstoke, Hampshire, RG24 9NN Present: Dr Hugh Freeman (HF) Chair, North Hampshire CCG Dr Sam Hullah (SHu) Chief Clinical Officer, North Hampshire CCG Lisa Briggs (LB) Chief Operating Officer, North Hampshire CCG Pam Hobbs (PH) Chief Finance Officer, North Hampshire CCG Colin Godfrey (CG) Patient Representative Dr Sallie Bacon (SB) Public Health Consultant Anne Phillips (AP) Head of Communications and Stakeholder Engagement Jan Baptiste-Grant (JG) Chief Nurse Dr Amanda Britton (AB) Vice Chair of the Clinical Cabinet David Rice (DR) Lay Member Audit and Remuneration Derek Tree (DT) Lay Member Integrated Governance and Patient and Public Engagement Sue Pidduck (SP) Director of Adult Services, Hampshire County Council Dr Angus Carnegy (AG) Dr Andrew Cameron (AC) In attendance: Nikki Kenny (NK) GP Elected Member GP Elected Member Business Services Manager Apologies: No apologies for absence 1 Chairman s Introduction 1.1 Dr Hugh Freeman welcomed everyone present to the meeting of the North Hampshire Clinical Commissioning Group Governing Body (CGB). 2. Declarations of Interest (Paper CGB13/049) 2.1 HF asked that each member of the North Hampshire Clinical Commissioning Group Governing Body (CGB) complete and sign a new Declaration of Interest. 3. North Hampshire Provider and Commissioner Responses to Patients First & Foremost: The Government s Response to the Francis Public
Enquiry (March 2013) - PRESENTATION 4. Minutes of the previous meeting held Wednesday 20 th March 2013 (Paper CGB13/051) 4.1 Dr Hugh Freeman asked if there were any amendments to be made to the previous minutes of the 20 th March 2013. 4.2 Item 6.5 The next Stakeholder and Communications Committee will be held in May not April as stated. Item 16.1 Only the Account Department has been transferred to Hampshire County Council and not everyone as reported. 4.3 COMPLETED ACTIONS: RC 8.1 Policies to go on website completed PH request for patient level information - completed 4.4 OUTSTANDING ACTIONS: LB 12.1 Corporate Risk Register. To be carried forward to June s meeting. 4.5 AGREED. The NHGB approved the minutes of the meeting held on 20 th March 2013 as being a correct record and commended them for signature by the Chair. 5. Matters Arising 5.1 There were no matters arising. 6. Development Plan Update (CGB13/052) 6.1 Commencement of CCG: LB reported that the CCG formally came into being at midnight on the 31 st March 2013 going forward with the two conditions we expected to have surrounding the clear and credible plan. The CCG will be given opportunities to remove these conditions during the coming months, once the plan is finalised and agreed by the area team. 6.2 Appointments to the Management Structure: The CCG is almost at full headcount apart from the Quality Manager post. It has been agreed to freeze this post until the work programme around quality and diversity has been clarified and at this point, if necessary, the CCG will look to recruit into this position. LB noted that although it had taken some time to get to full strength the CCG had been able to appoint a very skilful workforce who will be able to support the work of the CCG and more importantly, support
clinicians going forward. 6.3 Organisational Development: The organisational development is now underway and it was good to look at how we function as a high performing Governing Body. Senior Management sessions are due to start on 23rd May, 2013 and the Systems Reform Team started on the 17 th April 2013. LB currently working on OD Plans for Clinical Cabinet members. 6.4 Accommodation: The CCG reported a moving date of 16 th June 2013 last meeting but this date has potentially been brought forward to May 16 th 2013. 6.5 AGREED. The NHGB agreed to accept the CCG Development Plan verbal update. 7. Communications Update (CGB13/053) 7.1 AP brought a new format to the NHGB for discussion. AP wished the Board to consider the suitability and format of the contents and whether or not this was the correct place for the report to be shared, it being the one place where the general public can see the report. 7.2 Communication Report Format: LB said that she was very happy with the format of the report; however the risks should be part of a separate Risk Register which is taken as part of this meeting later. DR queried whether the appendices needed to be included as part of a public document and did not believe them to be a necessary part of a public document. DT agreed that the appendices should not be included. CG asked if all press releases could be included. AP agreed that this was a good idea. AP confirmed that the Commissioning Support Unit (CSU) provided media support and they would be able to provide these details. A general discussion was held regarding the Action Plan. It was agreed that this should be taken outside the meeting. Further discussion to continue after the meeting. 7.3 Membership Events: AC asked if the membership events will evolve as time goes by. HF believed that the membership events would provide networking information sharing and another way of letting a wider GP audience know what the CCG is doing. HF believed you needed both formats. A survey has shown how different people liked different things and it was difficult to find a format which everyone liked,
but broadly speaking from the surveys it was found that people tended to get something positive. However, if the membership wished to provide feedback this would be more than welcome. 7.4 Complaints and Requests for Freedom of Information: LB highlighted a correction to be made in Part 1. Complaints are not being dealt with by the CSU but the CCG directly. The CCG has inherited 111 complaints which are being handled in due process. Together with the requests for Freedom of Information and general enquiries these are now being dealt with in a structured process within the CCG. 7.5 AGREED. The NHGB agreed to accept the Communications update paper. 8. Policies for Ratification (CGB13/054) 8.1 HF introduced this item to the Governing Body. HF said that the other policies under this item had previously been through other committees. HF therefore recommended that the Board agree these policies. HF explained that the CGB s role is one of notification and ratification only as the policies have already been approved. SP enquired whether The Personal Information Leaflet was a policy. LB responded that it was not a policy; it was a requirement to be provided to patients. The Personal Information leaflet would be placed on the website. 8.2 AGREED: The NHGB agreed to accept all the Policies for Ratification. 9. Clinical Cabinet Meeting Report (4 th April 2013) (CGB13/055) 9.1 The report was noted. SH reported that the last Clinical Cabinet took place on the 4 th April 2013 and was happy to take any questions on the minutes. SH wanted to highlight 5 things from the report: Item 10.4: Medicine management. A 1.2M saving for year 2012 2013 had been made and is showing on-going success. Item 10.7: Map of medicine. This is gaining momentum and is working well. Dr Simon Hunt is the lead and Map of Medicine guru and is happy to share the Map of Medicine work done at Southampton which will enable us to roll this out quite quickly. Item 13: Covers PLC (Procedures of Limited Clinical value) and IFR (Individual Funding Requirements). PLC covers 3 groups of people (funded, not normally except where certain conditions are met; not normally funded; IFR is the mechanism whereby clinicians can make representation for
a treatment which is not normally funded. This policy was historically generated from the CSU with minor alterations. This policy has been communicated out to the practices. However, there are a couple of problem areas. These are: 1) Varicose Veins: there is now draft NICE guidance being produced together with a relatively new procedure which HHFT surgeons are keen to trial. The benefit of this is that there is no additional cost to the CCG. 2) IVF funding. SH was unaware that the responsibility for IVF fell to the CCG. However, this week it was agreed that CSU will handle these requests on our behalf in the interim and the matter will be discussed fully on the 9 th May 2013. Item 17: Quality Premium. This is a payment made by NHS England to CCGs who fulfil certain criteria. The primary criterion is to stay within budget but there are 3 chosen areas. After much discussion the markers for quality have been agreed as 1) pulmonary rehabilitation for patients with chronic pulmonary obstructive disease. Therefore there is a need to spread the word to GP colleagues regarding referral to pulmonary rehabilitation; 2) Choose and Book Our area is in the lower end range but it is our belief that we can generate a better response from the practices. 3) 9 care processes for diabetes all this work is undertaken within our locality and we normally do well with this. However, the problem here is the high rate of exception reporting and we need to ensure that there is reporting on patients who are not receiving the 9 care processes. CG enquired that if one of the criteria is not met then is the premium paid pro rata? PH said that the national premium is set at 5 per head and relates to 2013/2014. Item 19: Appointments to Clinical Cabinet. SH noted the tension between the need to continue to keep the experience and momentum generated prior to the establishment of the CCG and the need to go out to advertisement in March. To tackle this it was agreed that the item would be taken to the membership senate next week and to seek their approval and agreement only to go out to recruitment where it is demonstrable that there is significant interest from other people. SH stressed the need to take a balanced view. General Discussion Points: A discussion took place regarding the proposed threshold for treatment of varicose veins. AC asked what the threshold would probably be set at. SH replied that the threshold would probably be set at skin changes but this may let the flood gates open. AC highlighted the fact that Basingstoke and Deane Borough Council has one of the highest rates of supporting troubled families but also has the lowest budget. HF enquired about the contract for the Map of Medicine. SH replied that the notice had been served and the contract was due to run out in July. However
SH had received verbal assurances that the service would continue until September 2013. SB enquired about NICE guidelines. SH replied that NICE was within the remit of Dr Robert Walker s Innovation Education and Research portfolio. 9.2 AGREED: The NHGB agreed to accept the Clinical Cabinet Meeting Minutes of 4 th April 2013 10. Integrated Governance Meeting Report (11 th April 2013) (CGB13/056) 10.1 The Integrated Governance report was noted. 10.2 DT stated that a letter had been received from Susan Hasselman regarding Clinical Quality and any outstanding items on the SHIP Clinical Quality Group will be handled by JG. The ICG has also approved 3 roles to be added to the Clinical Quality Group and the Governing Body is asked to confirm these changes to Terms of Reference. This was agreed. There were no further questions. JG 10.3 AGREED: The NHGB agreed to accept the Integrated Governance Report. 11.0 Quality Report (CGB13/057) 11.1 The Quality Report was noted. 11.2 AGREED The NHGB agreed to accept the Quality Report. 12.0 Finance and Performance (CGB13/058) 12.1 The Finance and Performance report was noted. 12.2 Meeting Revenue Resource Limit - Outturn Position to end of March 2013 Full year budget being 222.364m, with expenditure of 221.382m showing an underspend of 0.982m. The year end surplus 0.982m accords with the CCG year end control total of 0.982m surplus. This position has made use of contingency reserves held across SHIP of 5.890m year to date. The year end control total being the CCG s portion of Hampshire PCT year-end surplus of 6.4m. (0.33% turnover) Significant variances against budget year to year end being;
Year end over performance at University Hospital Southampton being 212k, Frimley Park 328k, Salisbury Healthcare 153k, Royal Surrey 270k, Performance at Hampshire Hospitals is 8.8m over plan before application of the contract cap. When this is applied, over performance reduces to 2.944m. The 2012/13 over performance for HHFT is currently showing 8.8M. relating to: 3.2m Elective 2.4m Non Elective 1.1m non-delivery of QIPP schemes 1.2m for First Appointments over performance mainly relating to Gynaecology and Trauma and Orthopaedics. 1.4m Follow up appointments in Trauma and Orthopaedics and Palliative Medicine. 0.6M for Pathology and direct access Radiology. 0.5M Excess Bed days (Elective & Non-Elective). Overspending continued for Non Contracted activity 340k, Continuing Care 546k, Funded Nursing Care 565k, Assura Health 291k. Other non-nhs expenditure included the cost of nursing for people with learning difficulties re-provided community accommodation of 660k. There were year to date under spends in prescribing of 1.286k and Portsmouth Hospitals 222k. 12.3 AGREED: The NHGB agreed to accept the Finance and Performance Report. 13.0 The Local Authority Report (CGB13/059) 13.1 The Local Authority was noted. 13.2 SP reported that Hampshire County Council (HCC) have two new large county-wide contracts: Meals on Wheels and Telecare. Meals on wheels will provide a 7 day a week meal with much lower cost, providing food and friendship. Telecare, will take on all the sheltered homes and alarm schemes and has engaged a supplier who will be taking on all our providers, to be implemented in August. SP Also reviewing quality with regard to governance and care is a recently appointed Care Governance Service Manager. The intention is that some information will come to the CCG about what the Local Authority are funding and purchasing. Need to link with JG. HF asked SP about weight monitoring and whether there was a weight chart available to monitor for malnutrition. SB and SP are to look at this together. SP to provide JG with Care manager details. 13.3 AGREED: The NHGB agreed to accept the Local Authority Report.
14.0 Public Health Report (CSGB13/060) 14.1 The Public Health report was noted. 14.2 SB confirmed that as of 1 April 2013 Hampshire County Council had assumed responsibility for Public Health and the mandated duties for the Local Authority are to provide public health advice to the CCGs and health protection. However, some services now sit with NHS England. SB confirmed that health protection is part of the CCG role as commissioners. The public health role is to direct CCGs to provide a rapid response to outbreaks and incidents, and our team are aware of the arrangements. Regarding MRSA, post infection review, where it cannot be assigned then it is the responsibility of the Director of Public Health to lead a panel to investigate. The Director of Public Health is in the process of arranging meeting with the Directors of Quality in the region to talk about the way we work together. Business delivery of public health: There are some arrangements that still need to be confirmed of how councils and CCG are going to access data from the NHS commissioning support unit. It came to light this national issue has not yet been resolved. In the meantime there is an interim response locally to cover this period to reduce the impact of lack of support and minimise risk. JSNA: has been delayed to June rather than May due to the withdrawal of the deaths and mortality file by the ONS but we are working around that so that the figures will be available in June. SB confirmed that the MOU for 2013/2014 has been agreed. Further discussion regarding the work plan will be picked up at the next Clinical Cabinet. Measles: JG asked whether we had had any measles in terms of the population here. SB replied that there had not been any measles but was awaiting guidance from Health England about communications they were going to put out locally. SB confirmed that 25% of 10-14 had not received the second MMR and as measles comes in 2 year cycles this is high on the agenda. 14.3 AGREED: The NHGB agreed to accept the Public Health Report. 15.0 Healthwatch Update (CSGB13/061) 15.1 CG stated there was nothing to report apart from the address of Healthwatch Hampshire. The address is: Healthwatch Hampshire, Beaconsfield House,
88 Beaconsfield Road, Andover, Hampshire, SO22 6AT LB accepted the invitation LB to stay on the Board. 15.2 AGREED: The NHGB agreed to accept the Healthwatch Report. 16.0 Any Other Business: 16.1 Enhanced Services: AB questioned SB regarding enhanced services. SB confirmed arrangements had been made. LB confirmed this. 17.0 Date of Next Meeting 17.1 The next meeting of the North Hampshire Clinical Commissioning Group Governing Body will be held on Tuesday 25 th June, 2013 at 13:00 hours at Central 40, Lime Tree Way, Chineham Business Park, Basingstoke, RG24 8GU. 17.2 Dates of Future Meetings: 25 th June 2013 at Central 40, Lime Tree Way, Chineham Business Park, Basingstoke. 16 th July 2013 at Alton Maltings Centre, Maltings Close, Alton, Hants, GU34 1DT (open to the public). 18.0 Meeting closed at 15:55 hours Signed as a true record Name: Dr Hugh Freeman Title: Chair Signature: Date: 23 rd April 2013