CCG Council of Members

CCG Council of Members Minutes of the Third Meeting of the CCG Council of Members 29 January 2014 at Millwall F.C. Present: Practice Representatives (South Southwark) Dr M. Chawdhery 3-Zero-6 Medical Centre Dr Tanja Gordinsky Elm Lodge Surgery Dr Shivali Talsania Sternhall Lane Surgery Dr Sid Persadh Lister Primary Care Centre Dr Rebecca Scorer Forest Hill Road Group Practice Dr Karen Goodfellow Lister-Hurley Surgery Dr Iqbal Lordship Lane Dr Jane Cliffe The Gardens Deputy Representatives (South Southwark) Dr.Anita Baker Acorn Surgery Nick Christou Hambleden Clinic Saud Doha The Lordship Lane Surgery David Pink St Giles Surgery (Drs Virji & Begley) Sonia Hall Concordia Parkside Telisha Milton Concordia Melbourne Grove Dr Kishor Vasant St Giles (Patel, Roseman & Vasant) Dr Catriona Brodie Camberwell Green Stephanie Smith Sternhall Lane Practice Representatives (Bermondsey and Rotherhithe) Dr JN Bhatt Park Medical Centre Dr D Zigmond St James Surgery Dr Catherine Otty Albion Street Dr Stefan Lipinski Bermondsey & Lansdowne Dr Sharjeel Hassan Silverlock Medical Centre Dr Pam Marrinan Surrey Docks Health Centre Deputy Representatives (Bermondsey and Rotherhithe) Dr Salahuddin Khan Grange Road Practice Lin Clarke Bermondsey & Lansdowne Medical Mission Naresh Subramanian Silverlock Dr Emily Gibbs The New Mill Street Surgery Dr Tim Humphrey Albion Street Practice Representatives (Borough and Walworth) Dr. D. Abraham East Street Surgery Dr Kenny Chan Aylesbury Partnership Dr K Misra Borough Medical Centre Dr. Ramesh Sharma Borough Medical Centre Dr. Richard Proctor Sir John Kirk Close Surgery (Chair) Dr. Misra Borough Medical Centre Dr Abu Nijaila Old Kent Road Surgery Dr. A. Babalola Villa Street 1

Dr. RHK Sinha Maddock Way Deputy Representatives (Borough and Walworth) Laura Nagi Trafalgar Surgery Alison Pisani Aylesbury Partnership (Deputy Chair) Dr Sharleet Mahal Blackfriars Medical Centre Ali Shariff Manor Place Catherine Arden Princess Street Group Practice Venetia Herzmark Sir John Kirk Close Dr. Rani Sinha Maddock Way NHS Southwark CCG Governing Body members and CCG Staff Dr Sian Howell (SH) Clinical Lead, SCCG Dr Simon Fradd (SF) Clinical Lead, SCCG Dr Roger Durston(RD) Clinical Lead, SCCG Dr Nancy Kuchemann (NK) Clinical Lead, SCCG Dr Jonty Heaversedge (JH) Clinical lead, SCCG Dr. Patrick Holden (PH) Clinical Lead, SCCG Dr Adam Bradford (AB) Clinical Lead, SCCG Andrew Bland (AB) Chief Officer, SCCG Malcolm Hines (MH) Chief Financial Officer, SCCG Tamsin Hooton (TH) Director of Service Redesign, SCCG Gwen Kennedy (GK) Director of Client Group Commissioning, SCCG Jean Young (JY) Head of Primary & Community Care Development Kieran Swann (KS) Head of Planning & Performance, SCCG Rosemary Watts Head of Membership and Engagement, SCCG Daniel Blagdon Membership & Engagement Manager SCCG Vicky Bradding Corporate Secretary (Minutes) Kate Moriarty-Baker (KMB) Head of Continuing Care & Safeguarding, SCCG Rabia Alexander (RA) Head of MH Commissioning, SCCG Jacquie Foster (JF) Head of Governance and OD, SCCG In attendance: Dr Robin Rastogi Bermondsey & Lansdowne Dr Louise Tebboth Bermondsey & Lansdowne Dr Nwakuru Nwaogwugwu Sternhall Lane Apologies: Dr S. Chudha Dr Amr Zeineldine (AZ) Linda Drake Dr Sarma Dr Olufemi Osonuga Ali Young Dr Elizabeth Begely Blackfriars Medical centre Chair, SCCG Practice Nurse Member, SCCG East Dulwich Medical Centre Manor Place Surgery Head of Pathway Commissioning St Giles Surgery 2

Agenda Item Welcome & Introductions ACTION 1 Dr. Richard Proctor (RP) Chair welcomed everyone to the fourth meeting of the Council of Members (CoM). He outlined the format of the meeting and explained the voting procedures Minutes of the previous meeting (19 October 2013 ) 2 Corrections The minutes of the previous meeting held on 19 th October 2013 were agreed to be a correct record with the following changes: Under Matters Arising: RP reported that Alison Pisani, Nurse Practitioner (delete Practice Nurse) at Aylesbury Partnership, has been elected as CoM Deputy Chair RP stated that all actions from the last meeting are included in the agenda items and will be discussed at the meeting. 3 Clinical Involvement in the Leadership of Commissioning RP reminded members of the rationale supporting the proposals to increase clinical involvement in the leadership of CCG commissioning. He stated that no clear consensus had been reached and therefore a vote on the proposals is required. These originated from the Governing Body [GB] after a review of the current arrangements and provide for an increase in clinical involvement while still maintaining the governance function. RP outlined the three proposals: 1. Proposal one broadens the definition of GB Clinical Lead to any clinician working for a Southwark practice whilst ensuring that there are a minimum of four GPs of which one would be the chair 2. Proposal 2 increases the number of ways for clinicians to be involved in leadership by increasing the number and type of clinical associate positions available and varying the level of time commitment they require 3. Proposal 3 reduces the number of clinical leads on the GB by two (from 9 to 7) whilst ensuring that clinicians still represent an overall voting majority. Proposals 2 and 3 are linked financially as the money released if proposal 3 is adopted would fund proposal 2 to increase the number of ways for clinicians to be involved in leadership by increasing the number and type of clinical associate positions available and varying the level of time commitment they require RP outlined the current composition of the GB. If the number of clinical leads is reduced he emphasised that there would still be a majority of clinicians on the GB. He also stated that the clinical associate role allows a great deal of flexibility. Engagement on the proposals has taken place with practices and the concerns expressed by some practices to the proposals are recognised. However, RP stated that it is important to move forward now as four of the current clinical leads terms of office come to an end and a selection/ election process will be launched on 21 February 2014.. Voting on the options for change took place with the following results: 3

No change to the current arrangements 52% Agree all 3 proposed changes as a package 21% Enact a partial change by retaining the number of elected voting clinical leads (9 in total) on the GB but broaden the definition of clinician to mean any clinician working for a Southwark practice 27% The Council of Members, therefore, approved that there should be no change to the current arrangements for clinical leadership in commissioning and the selection/election process will be launched on 21 st February. RP also encouraged members to put themselves forward for these positions. RP pointed out that there will be further opportunities to consider change as selection/election processes will take place more or less every year. Updates on CCG Position Current Financial Situation MH presented the CCG financial position for month 9 2013/14. There is now more certainty about the 2013/14 year end position. He outlined the CCG programme budget summary and highlighted the increasing pressure on acute contracts. MH outlined the budget summary and drew members attention to the predicted overspend of 8m on Guy s & St. Thomas (GSTT) and King s (KCH) acute activity. All other areas are within budget. Running costs are within budget and further savings are predicted. 4 MH stated that this year s budget was set on last year s year end position. An overspend of 7.5m is predicted. This is a continuing trend with year on year activity growing more than population. MH reported that he is working with acute trusts through the Commissioning Support Unit to agree the year end position. The arrangements for GSTT are in place and he did not anticipate that the KCH overspend will be more than 7.5m. MH also highlighted the overspend on Client Groups. He drew attention to the risks facing the CCG and particularly highlighted the issues that have arisen regarding Walk in Centres (WIC). CCGs are still waiting further guidance about re-charging for attendance at the WIC for non- Southwark residents and this presents a potential risk of over 1m. A significant savings programme is in place and MH reported that the CCG is on track to achieve the 1% surplus, although it must be recognised that the situation will become more challenging as we move forward. MH drew members attention to the required savings target of 7.3m. He stated that this will be steep to achieve but he remains confident that this will be achieved within 100k of target. RP thanked MH for his report and invited questions. David Zigmond stated that there are many obvious areas such as the QOF and Chronic Kidney Disease Stage 3 testing where there is tremendous wastage and where savings can be made. He enquired whether members have any leverage on these areas. JH replied that the CCG has no influence over QOF but it is important 4

that conversations continue and these issues are highlighted. RP stated that consultation on QOF is currently taking place, but not by the CCG.. Further to the five areas identified by the COM to track Catherine Arden, Princess Street, requested that district nursing and access to community matrons is included as a priority area to track. JY stated that Southwark provider services are being paid to provide community matrons and requested that member practices should notify the CCG (JY) of any problems in this area. 5 Emergency care pressures AB stated that the 95% performance standard for A&E waits is a NHS Constitution l standard and he is held to account that this target is delivered. He also added that there is the responsibility to improve the situation for Southwark residents. Urgent care is a good barometer of hospital performance and how the health systems are working and there is concern nationally about the length of waits in A&E departments. Most Southwark residents attend King s College (KCH) or Guy s and St. Thomas (GST) hospitals. At present GSTT are consistently exceeding national targets and are in the top five performing Trusts in London. This performance has continued into January and, therefore, approximately half of Southwark residents are receiving that level of care. However, KCH A&E has failed to meet the 95% performance standard for the past three months. Daily updates are received and performance is regularly monitored at a high level each week. The slight improvement at the beginning of January has not been sustained. He outlined the knock on impact of urgent care pressures on other patients regarding achievement of Referral To Treatment(RTT) and Mixed Sex Accommodation(MSA) targets and also the increased pressures on diagnostics. AB reported that KCH is seeking to address the problem and has given the highest priority as outlined in his presentation. He also outlined the actions being undertaken by the CCG and clinical leadership. Details of actions that can be taken by members to improve the position on A&E waits are also outlined in the presentation.. Discussion ensued. Dr. Vassant stated that he works at A&E at KCH and there are no yellow men leaflets on display there. The staff at A&E were also unaware of the campaign. AB replied that the campaign is definitely live and information should be available in practices. RP stated that information should definitely available in KCH A&E and suggested that there should be further discussion with A&E department TH also confirmed that KCH A&E have the information and will follow this up SH emphasised that there are lessons to be learnt regarding consistent messaging so that patients receive the same message from everyone. She felt that it is important to have collective agreement on the level of care in which setting and how this should be delivered. As commissioners, the CoM must be clear about ensuring consistent patient pathways. ACTION TH Laura Nagi stated that in her practice all patients are called in to be seen after their attendance at A&E to discuss their attendance and educate them about alternatives for for the future. However, they still continue to use A&E and she queried what else could/should be done. SH stated that this is again about consistent messaging and approach. The messages to be delivered need to be decided collectively between the CCG, member practices and secondary care. In response to a question about whose role this is SH clarified that as clinical lead for primary and community care she would have a lead role in taking this forward but the messages need to be collectively decided across the 5

system. ACTION : SH Understanding the Challenge AB highlighted the engagement undertaken to develop the CCG headline Commissioning Intentions for the year. He stated that this has been the first time that it is has been possible to develop commissioning intentions knowing the CCG s allocation for this year. The period between now and March will be used to decide which of these intentions can be taken forward. He highlighted that the CCG GB must also consider how to achieve the savings schemes required ensuring that the CCG can make available investment resources without risking a balanced budget. MH outlined the financial allocations and position for 2014-15 onwards. He highlighted the pledge that the NHS should be awarded over and above the rate of inflation. In spite of this everyone had received a flat rate increase for the past four to five years. However, different levels of increase have now been awarded with Southwark CCG receiving an increase of 3.5% in 2014-15 and a further 2.7% in 2015-16. However, it is likely that the CCG will only receive an annual increase of less than 2% a year beyond this time. MH also highlighted the pressure of population growth which will be increased when development schemes underway are completed. All these factors have been built in to establish our financial position. MH stated that budgets will be tight going forward. Further programmes are likely to require additional funding and a balanced position will only be achieved by everyone working together. 6 AB added that everyone involved with healthcare will be contracting over this period and he highlighted that the cuts in primary care and local authority funding will have significant implications. AB drew members attention to integrated care and emphasised that it is important for this to be addressed before it becomes too expensive. There is a great deal of interdependency between the system and strong financial reasons for issues to be thoroughly addressed. The QIPP must also be part of the whole process. AB emphasised that there are no quick wins and while all this is taking place the retention of quality is paramount. Extended Access to Primary Care and The Challenge Fund TH presented an update on emerging commissioning intentions for extended primary care access, following the review of the Lister Walk In Centre and King s Primary Care Service. The CCG was working up a proposal for commissioning 8-8 seven days a week extended access from neighbourhood groups in future, to be funded as an extended service in addition to the core contract. She also stated that the proposed model was relevant to the Prime Minister s Challenge Fund, and that there was interest in submitting a bid from Southwark practices in conjunction with SELDOC. She asked two questions, one relating to the CoM as commissioners, in terms of their support for the emerging commissioning intentions, and the other directed at members as providers, in terms of their commitment to submit a bid to the Challenge Fund. She requested confirmation from the CoM that a bid should be submitted and enquired whether there were any members willing to lead on or help draft the bid. Round Table discussion took place. Feedback from each table confirmed support for submitting a Southwark bid. 6

Feedback Group supports bid application with the right model Clear guidance about the level of funding and services being reviewed is essential Clarity is required about the links into the Out of Hours Service. Location of extended access is an important issue Model must be right to capture the right people Support the bid application Triage based model is important Help in writing the bid would be appreciated Group positive and enthusiastic about the bid Discussion about the number of sites across the borough Clarity about the finances essential More clarity about urgent care model including unplanned care Good IT access essential with access to patient records Patients could be seen virtually Link into 111 essential SH group positive but some anxiety. Consensus is to support the application Important to move thinking beyond own practices RP concluded from the group discussions that the membership supported a bid, with support from the CCG and SELDOC TH thanked members for their comments and support for an application. She highlighted that the bid would be about commissioning more access to primary care services and provide interplay between core and extended access. Robust booking and triage arrangements are essential. IT services are critical. The capability is in place and shared access to EMIS is nearly possible. The Challenge Bid is the first hurdle and she requested nominations for a work group to take this forward. 7 Questions and Answers of the Governing Body No other questions Any other Business 8 9 10 RP reported that four members of the GB are stepping down and the election process for new members will commence at the Oval on 27 th March RP thanked all practice representatives and attendees for attending the meeting and for their participation. The meeting closed at 9.15pm Date of Next meeting 27 March 2014 at 7pm (6.30 for refreshments) in the John Major Room at the Kia Oval Cricket Ground 7