Council of Members Minutes of the ninth meeting of NHS Southwark Clinical Commissioning Group s Council of Members 20 May 2015 Present: Practice Representatives (South Southwark) Dr M. Chawdhery (MC) 3-Zero-6 Medical Centre Dr Jane Cliffe (JC) The Gardens Dr Elizabeth Begley (EB) St Giles Surgery (Virji & Begley) Dr Lauren Parry (LP) Queen s Road Surgery Dr Jonathon Love (JL) Concordia Melbourne Grove Dr Rebecca Scorer (RS) Forest Hill Road Group Practice Dr Tanja Gordinsky (TG) Elm Lodge Surgery Dr Kishor Vasant (KV) St Giles Surgery (Roseman & Vasant) Deputy Representatives (South Southwark) Dr Jonathan McAllister (JM) Camberwell Green Surgery Nick Christou (NC) Hambleden Clinic Dr Steven Hunte (SH) St Giles Surgery (Roseman & Vasant) Miofa Ngoke (MN) Concordia Melbourne Grove Practice Representatives (Bermondsey and Rotherhithe) Dr Stefan Lipinski (SL) Bermondsey & Lansdowne Dr Salahuddin Khan (SK) Grange Road Practice Dr Pam Marrinan (PM) Surrey Docks Health Centre Dr David Zigmond (DZ) St James Surgery Dr Alan Campion (SC) New Mill Street Surgery Deputy Representatives (Bermondsey and Rotherhithe) Danielle Caswell (DC) Silverlock Surgery Dr Tim Humphrey (TH) Albion Street Surgery Practice Representatives (Borough and Walworth) Dr Ka Kin Chan (KC) Aylesbury Medical Centre Dr Gaby Weale (GW) Villa Street Medical Practice Dr Misra (KM) Borough Medical Centre (Dr Misra) Dr Sharma (RS) Borough Medical Centre (Dr Sharma) Dr Richard Proctor (RP) Sir John Kirk Close Surgery (Chair) 1
Dr Abu Nijaila (AN) Dr Olufemi Osonuga (OO) Old Kent Road Surgery Manor Place Surgery Deputy Representatives (Borough and Walworth) Alison Pisani (AP) Aylesbury Partnership (Deputy Chair) Catherine Arden (CA) Princess Street Tilly Wright (TW) Villa Street Medical Practice NHS Southwark CCG Governing Body members and CCG Staff Dr Jonty Heaversedge (JH) Clinical Lead and SCCG Chair Dr Yvonneke Roe (YR) Clinical Lead SCCG Dr Nancy Küchemann (NK) Clinical Lead, SCCG Dr Sian Howell (SHo) Clinical Lead, SCCG Malcolm Hines (MH) Chief Financial Officer, SCCG Gwen Kennedy (GK) Director of Client Group Commissioning, SCCG Rosemary Watts (RW) Head of Membership & Engagement, SCCG Kate Moriarty-Baker (KMB) Head of Continuing Care & Safeguarding, SCCG Jean Young (JY) Head of Primary & Community Care Devt, SCCG David Smith (DS) Head of Transformation Integration, SCCG Nigel Smith (NS) Head of Pathway Commissioning, SCCG Kieran Swann (KS) Head of Planning and Assurance, SCCG Rabia Alexander (RA) Head of Mental Health Commissioning, SCCG In Attendance Dr Rob Davidson (RD) Albion Street Dr Kathy McAdam-Freud (KMF) LMC Apologies: Dr Noel Baxter (NB) Dr Jacques Mizan (JM) Andrew Bland (AB) Linda Drake (LD) Dr S. Chudha (SC) Clinical Lead, SCCG Clinical Lead, SCCG Chief Officer, SCCG Clinical Lead, SCCG Blackfriars Medical Centre 2
Agenda Item Action 1 Welcome and Introductions Dr Richard Proctor (RP) Chair welcomed everyone to the ninth meeting of the Council of Members (CoM). 2 3 4 Minutes of previous meeting The minutes of the previous meeting held in March 2015 were agreed to be a correct record. RP confirmed that the CCG risk register will be published on the CCG website in June 2015. Matters Arising There were no matters arising for discussion. Dr Chan (Aylesbury Partnership) asked about the assurances given by King s College NHS Foundation Trust that patients on the trust s waiting list will be continue to be reviewed by responsible clinicians and that quality of care would not be affected. This questioned followed JH s recent email about the temporary suspension of the trust s RTT reporting. Dr Chan also asked whether the reporting pause is for all patients on waiting lists, including two-week-wait referrals. RP agreed that we would come back to this question before the end of the meeting. Integrated Care: Vision for the Future JH introduced a presentation on the CCG s ambitions to transform care in Southwark and the work we are planning to lead in order to deliver the integration of local services. Practice representatives at the meeting were asked to feed in their views about what integration means to them. JH s presentation summarised the national context for integration as described in the NHS Forward View. He highlighted the way that integration is described in this document as breaking down barriers between: secondary and primary care; between health and social care; and between physical and mental health care and wellbeing. JH described the two models for integration set out in the Forward View the multispecialty community provider (MCP) and the integrated primary and acute care system (PACS). He described these models as being primarily organised either as a community-based horizontally integrated organisations the MCP; or as being more of a vertically integrated model, where a current secondary care provider assumes some responsibilities for community and primary care services - PACS. JH said that locally we were looking at the MCP model. David Smith (DS) continued the presentation and described the course for integration 3 MH
being developed locally. He described the work initiated already, including GP federations as the lynchpin of a multi-speciality community integrated system in the borough. DS described the ambition to establish local care networks (LCNs) in Southwark and Lambeth, founded on fully developed GP federations. DS described the importance of focussing on prevention; listening to what patients say and want; the necessity to improve access to primary care services; as fundamental parts to an effectively integrated LCN. DS described the CCG s proposed change to the way its commissions services. He described this as moving from using contracts with an activity basis to adopting a new approach which uses patient and population outcomes as the basis of payment. DS stated that a changed focus on outcomes was a key driver of better care and would incentivise organisations to collaborate on managing patients across care pathways. He also flagged the potential benefits of contracting in a way that drives innovation. JH concluded the presentation by giving an example of how our current systems of contracting and financial incentives do not always support prevention. He described an approach to renal dialysis that would incentive secondary care providers to have an interest in prevention. He went on to describe how the proposed approach to transforming commissioning and the structure of local provision could be realised in Southwark and how it would address the local challenges of improving outcomes and mitigating the financial and organisational pressures in the system. Dr. Davidson (Albion St Practice) asked what a segment of the population was. JH said this was something we are currently looking at and suggested it would be a group of patients where there was a commonality of outcomes. Dr Zigmund (St James Surgery) raised a point about the proposed structure of integration and whether this was something that could be planned for rather than something that developed in more of an organic way. JH said that part of the proposed approach would support providers to identify solutions and improvements in collaboration with commissioners rescinding their involvement in determining the structure of commissioned services and redesign of pathways. The outcomes-focussed system is structured to incentive collaboration and innovation. Dr Vasant (St. Giles) raised a concern about the potential cost of this change and asked whether the approach to be taken was one of trial-and-error or something more comprehensive. JH said that what this new approach would do is to enable providers to take risks and innovate and that was a different way of commissioning and doing things. Dr Vasant stated his view that this approach was driven primarily by reducing costs and was primarily politically determined and top-down. JH accepted the need for a new approach being something that drives value in the NHS and this would mean resourcing being transferred and used in different parts of the system where value can be enhanced. 4
Dr Abu Nijaila (Old Kent Road) asked whether taking risk to support innovation would mean that patients do not receive equitable outcomes under outcomes-based commissioning. JH responding by talking through the positive potential of looking at outcomes and getting these right for certain types of patients. Dr Love (Melbourne Grove) asked a question about who would be accountable in the new alliances of providers responding to an outcomes-based contract. JH acknowledged the challenges in identifying accountabilities and said this is one thing we are working through. He ventured to suggest that at some point in the future GP federations as list holders would assume some responsibility for their patients outcomes. Dr Love asked about the buy-in in secondary care and JH suggested that this has been good at the top level and was being developed further with a wider range of clinicians at providers. Nick Christou (Hambledon) asked why the MCP model had been preferred to the PACS vertically-integrated approach. JH welcomed this challenge and suggested that this was important to for members as commissioners to make their views and preferences known. JH said that the MCP approach had been favoured by the work we have taken forward with local partners as part of the Southwark and Lambeth Integrated Care (SLIC) programme. 5
Constitutional Changes Relating to Our Healthier South East London Programme: Proposal for Establishing the SEL Committee in Common MH described the work the CCG is involved with as part of the Our Healthier South East London programme of service change. He suggested that as this work progresses the CCG will need to take decisions about proposals and business cases that arise as part of this programme, following publication of a strategy for south east London. MH explained the proposal for the CoM to support the establishment of a committee in common between CCGs in south east London and partners to enable us to take join decisions. He referenced the detail of the proposed changes that had been included in CoM papers. MH described the responsibilities and structure of the proposed committee. This included details of members of the committee and the content of the Terms of Reference. 5 Dr Humphrey (Albion St) asked how the CCG would ensure engagement with the membership ahead of decisions being made at the proposed committee. MH said that decisions would go through the CCG s governance structure. RP highlighted that the proposal does not change the usual process for decision making in the CCG. Dr Humphrey asked why the CCG had three members on the committee. MH said that this number was to ensure the CCG was represented by a cross-section of its board. These members would collectively convey an agreed position that the CCG s governing body supported. Dr Lepinski (Bermondsey and Landsdowne) asked whether practice representatives are fully equipped to contribute to decision-making in some of the big matters that the committee would likely consider. MH said the CCG would continue to work to support practices to understand issues and be informed enough to provide wise counsel. JH noted that a role of the CoM was also to register its satisfaction that the CCG had undertaken the right steps itself in order to make a fully considered and evidenced based decision on any matter of its business. The Council of Members accepted the Governing Body recommendation to approve the changes to the CCG s Constitution and voted as follows: In favour 20, Against 1, Abstentions - 3. 6
Update on CCG Financial Position MH went through the presentation on the CCG s financial position, reporting that the CCG met its surplus requirement in the previous financial year 2014/15. He highlighted the positive outturn from the CCG contracts with local acute providers. 6 MH took the Council of Members through the opening budgets for the CCG in 2015/16 and flagged an increase of 13m in the CCG s budget, which will fund developments in mental health services, primary care access and the Better Care Fund. Dr Osonuga (Manor Place) asked about the reduction in re-ablement expenditure and MH said that this money was now incorporated into the Better Care Fund. Dr Osonuga also asked if there was any risk that CCG funds could be used in other financially challenged parts of south east London. MH stated that there were clear HM Treasury rules governing this and decisions required local agreement. 7 Programme Boards Update CCG clinical leads gave an update on progress in each of their programme boards. Dr Sian Howell presented a slide on primary care, and commented on the work that has been completed to support the development of GP federations; the opportunities offered by co-commissioning; and how we need to work with practices to improve outcomes. Dr Nancy Küchemann reminded members what the mental health and parity of esteem board is looking at doing. She described work the board has undertaken to support better access to care for people with psychosis including prevention and outcomes. NK also talked about the work being completed on improving the diagnosis and management of dementia. She described the board s role in the Adult Mental Health Transformation programme. Dr Yvonneke Roe talked about the impact of brief interventions. She noted the work the board is completing with partner organisations to address obesity, smoking and alcohol use. She encouraged members to embrace every contact counts and described some of the proposed developments in obesity services, which would incorporate psychological support for patients. Dr Noel Baxter and Dr Jacques Mizan sent their apologies for this meeting. JH summarised the slides and highlighted recent issues discussed at the Clinical Quality Review Group of King s College NHS Foundation Trust including work undertaken on patient experience; ophthalmology never events; the financial challenge faced by the trust; the risks to quality of delivering efficiencies; and the quality assurance and clinical governance arrangements at King s outsourced providers. JH/ NB JH addressed the earlier question raised by Dr Chan (Aylesbury Partnership) and described the rationale for King s suspension of reporting referral to treatment (RTT) 7
pathway performance as a part of a validation exercise and reducing their backlog. He noted the weekly and monthly reporting that would happen locally to provide commissioners with a view on how this work was proceeding. JH made clear that this arrangement would not affect the CCG s performance management of King s during the reporting suspension. JH agreed to provide a fuller report on King s use of Choose and Book to the Council of Members. This would be shared via Noel Baxter as CCG quality lead with responsibility for King s. Rosemary Watts described the recent work of the CCG s engagement board and noted progress to develop digital platforms and work completed on engaging people on the CCG obesity strategy. 8 Question and Answer session of the CCG Governing Body There were no questions for the Governing Body. 9 Any Other Business There were no items raised. 8
Appendix 1 Integrated Care: Vision for the Future - Interactive polling comments The q n a session on MCPs was a sign of the council of members working well Despite the semi-nebulous concept of MCPs, it is definitely forward thinking Barriers- IT can be a barrier or a tool to integrate Holistic Services need to be joined up to deliver holistic and patient centred care Sharing, therefore easier! Recognising different peoples' skills and using them effectively Sharing workloads Organisations working the same way, thus saving money and time. Working together in 21st century! Joined up for patients Easier communication All joined up Hard-work Joining together Delivering services together for the best outcome for patients Clearer pathway for patients. Joining together better for patients Smoother transitions Sharing information!!! Working together for a more efficient service Joined up working Connected Working together & not duplicating Is it free? Technology is great 9