Commissioning Strategy Committee 17 TH SEPTEMBER 2013 Aylesbury Medical Centre Members: Amr Zeineldine (AZ) Andrew Bland (AB) Roger Durston (RD) Simon Fradd (SF) Alison Furey (AF) Malcolm Hines (MH) Patrick Holden (PH) Tamsin Hooton (TH) Sian Howell (SH) Alvin Kinch (AK) Robert Park (RP) Tushar Sharma (TS) Kieran Swann (KS) In attendance: Linda Drake (LD) Jacquie Foster (JF) Vicky Bradding (VB) Rosemary Watts (RW) Kate Moriarty-Baker (KMB) Ali Young (AY) Jean Young (JY) Kathy McAdam Freud (KMcA) Sarah McClinton (SMcC) Kate Radcliffe Chris McCree (CMcC) Chris Bassa Apologies: Adam Bradford (ABr) Diane French (DF) Richard Gibbs (RG) Jonty Heaversedge (JH) Gwen Kennedy (GK) Nancy Kuchemann (NK) & Chair Chief Officer Consultant in Public Health Chief Financial Officer Director of Service Redesign HealthWatch Southwark Lay Member Head of Planning & Performance Practice Nurse Commissioning Lead Head of Governance & OD Corporate Secretary Head of Membership & Engagement Head of Continuing care & Safeguarding Head of Pathway Redesign Head of Primary Care Development LMC representative Director of Adult Social Care CSU Communications SLAM Public Health Trainee Lay Member Lay Member Director of Client Group Commissioning 1. DECLARATION OF INTERESTS No changes to the current Register of Interests were reported. 1
2. MINUTES & MATTERS ARISING The minutes of the meeting held on 20 th August were agreed to be a correct record with the following amendment: 4.3 Primary & community Care strategy (PCCS) 6 th Para- last sentence: She thought variation in district nurses and community matrons and premises were important to the document. It was also noted that Alison Furey is the member of the Commissioning Strategy committee representing Public Health not in attendance for Ruth Wallis ACTION TRACKER Children s Integrated Care Project - AD is a member of the Programme Board and further clinical representation would be welcome. TH suggested that this may be a suitable role for a clinical associate linked to a clinical lead. Interest to be obtained when prospective interests in membership of the Governing Body membership for next year are invited. Clinical representation on the Project group- interest to be obtained from future clinical associates ACTION TH Locality reports Date of next Council of Members meeting to be highlighted at next locality meetings NHS Call to Action RW requested the flyers brought to the meeting are distributed All other actions have been completed 3 AGENDA ITEMS a. Minutes & reports from Locality groups Borough & Walworth TH outlined the items discussed. She requested that members feedback comments on the ENT pathway back to Nick Harris by the end of next week b. Business Case primary care Contract for Nursing Homes KMB presented the paper which has been re-worked in the light of considerable discussions. She summarised the four options for providing this service detailed in the paper. Option 1 provides for a multi-disciplinary approach for the CCG s most vulnerable population across Lambeth & Southwark. She pointed out the consideration that empty beds would need to be funded. Option 2 extends the service to residential care. There are two sub options within this: 2a extending the service to include care Homes with nursing and residential care and 2b as 2a but with a reduced bed rate for residential care Option 3 Roll out of Home ward/enhanced Rapid response. This option was developed following ABr s points re admission avoidance and illustrates an additional service to be provided alongside one of the above options. 2
Option 4 provides for services to be provided by an alternative organisation. KMB highlighted the need tom consider timescales for implementation and also the procurement process. Option 1 could be in implemented very quickly and the contracts need not be restricted to one GP practice. Options 2a & 2b are new models and she suggested that this model should be tested out. AZ reminded the CSC that all GPs present have interest in this item and this was noted. The role of the CSG is to provide comments on the preferred option for consideration by the Conflict of Interest panel next week who will be looking at value for money and quality of patient care. KMB stated that option 1 could be provided through separate contracts with GPs for provision of services to the four homes with nursing beds or by one provider. There would be a maximum of four contracts. In answer to a question from SF, KMcB stated that some of the 10 homes in Southwark have both nursing & residential beds. Discussion ensued. AF highlighted the unmet need in residential care and the need to provide consistency. KMB agreed there is unmet need in the provision of primary care support services to residential care but she highlighted the need to consider the other support available. SH stated that she welcomed this proposal. Services have ben historically provided piece meal and she pointed out that the scale of service delivery is important. TH stated that if the recommendation is to include residential homes at present there is a need to make further provision. KMcA stated that residential homes have been supported by GSTT nurses. The difference in hospital admission/a&e attendance rates from residential homes is particularly marked and option 2 provides more integration and good value compared with the number of A&E attendances. SF also pointed out that if more service is provided to clients in residential homes then less will arrive in nursing beds. SMcC stated that the local authority is looking to reduce the number of residents in residential homes. In answer to a question from AB, KMcB stated that she would recommend Option 1 because of the speed in which it could be implemented. The other options are different ways of working and need to be tested out and AB pointed out that any changes to future arrangements were not precluded. MH stated that there must be a robust rationale in setting the bed rate. The CSC agreed that the preferred option is 2 but agreed that Option 1 is rolled out now with a speedy follow through and testing to implement Option 2. This should be referred to the Conflict of Interest Panel, ACTION AB AB stated that this service will also be part of the discussion on Commissioning Intentions for 2014/5TH suggested that the home care support team be asked to support residential homes in the interim period. 3.3 Care Home Quality Improvement Strategy SMcC outlined the strategy. She stated that it responds to the recommendations from the Francis Review and is shaped by the priorities in My Home Life. The strategy provides an over arching approach which will be shaped as things develop. She asked for comments from CSC members. KMcA welcomed the focus of delivery on compassionate integrated care. However, she enquired how compassionate care can be measured and highlighted the need to link all the work being carried out to achieve this. AK stated that Healthwatch Southwark has been 3
involved in the development of the strategy. She suggested that the case studies be strengthened. The need to concentrate on the workforce was highlighted and SMcC confirmed that this has been recognised and a number of initiatives are in place. PH suggested that there should be a GP representative with experience of supporting care homes on the steering group overseeing the delivery of the strategy. ACTION AB AF suggested input from the Wellbeing group. LD stated that the more people going into homes, the more opportunity is provided for comment. It would also be useful to develop more involvement with young people. The CSC approved the Care Home Quality Improvement Strategy. SMcC thanked everyone for their comments. 3.4 Mental Health Family Strategy CMcC stated that joint service protocols were developed following two serious case reviews, but it was felt that more work on family mental health was required. This strategy addresses early intervention to promote family mental health and prevention of difficulties. CMcC requested input from the CSC and discussion ensued. AZ suggested that localities could also provide input. SH outlined a recent patient experience and highlighted the risk of spreading services across lots of agencies culminating in confusion for patients. She suggested that CMcC has discussions with the Safeguarding Team who focus on neglect. KMcA highlighted the need for under five support. There is a family and children s intervention policy but difficulties are not being picked up early enough. AZ highlighted that the fear to challenge is very real and it is important to make all information easily available to staff. TH pointed out the need to ensure that any actions are carried through. LD enquired about facilities for self referral, but CMcC stated that the service is not advertised as such. LD stated that it is important to get primary care involvement. Self referral is essential as sometimes practices may not have the necessary expertise. A single point of referral is also essential so that people don t get lost in the system and details must be included in the strategy. CMcC thanked the CSC for their comments and ideas and will approach localities for further discussion. RW also suggested posting details on the GP intranet. ACTION RW 3.5.1 Clinical Membership of the Governing Body AB reported that the invitation to apply for future chair has been sent out today. Appointment will be through local and national assessment. He requested anyone wishing to be considered or expressing an interest notify JF by the end of the week. In answer to a question from PH, AB confirmed that application requirements do stipulate previous clinical lead experience. Further details are available from JF AB outlined the proposal for changes in the clinical membership of the CCG. He emphasised that there is no financial driver initiating this proposal which will maximise the value and input by clinicians in the CCG s Commissioning Work. proposals suggest there is a reduction from nine to six clinician members plus a clinical chair whilst enhancing the amount of clinical leadership roles. The proposal cannot make changes in the clinical 4
leadership required legally retention of the clinical chair, requirement for a nurse and secondary care physician external to the area. It is extremely difficult to attract out of area secondary care physician and this is a problem encountered by other local CCGs. AB stated that voting arrangements would be unchanged and adequate clinical membership would be retained to achieve a voting majority. Clinical representation is ensured from each part of the borough. AB stated that the proposal is a discussion document and he invited comments. LD welcomed continuation of clinical membership. Working parties are a practical way of getting people involved and it is important to get the balance right. AZ highlighted the current deficiency of associate workers and he advocated that fresher associates are appointed to build up for succession. KMcA stated that it is difficult to be clear about the impact of the reduction of clinical leads into commissioning decisions. Balance is important and she stated that clarity is required between ad hoc and permanent clinical associate role and these may require re-naming. SH welcomed the proposal especially the increase in clinical associates and suitable candidates must be encouraged to apply. She also agreed that balance is very important. She highlighted the need for dedicated admin support at CCG headquarters and suggested that this is an opportunity to resource this need as well. TH highlighted the difficulties in attracting clinical associates. In answer to a question from PH, AB confirmed that the clinical associates and working party membership are funded by an underspend on clinical associates. PH stated that he dis not able to support the reduction of clinical lead membership from nine to seven because of the reduction of influence. He stated that decisions do not tend to require block voting and he was anxious to avoid fragmentation. AB pointed out that interest in clinical leadership roles is not high. LD pointed out that this may change in the future. SF stated that he was concerned re the process and it is important for the proposal is discussed with practices. MH stated that a presentation will be prepared with a supporting report for the Council of members meeting and SF requested that this is sent out in good time. KMcA suggested that the reasons behind the proposal are included. SH suggested that the finalised proposal is first presented through localities before the Council of Members meeting. AB thanked the CSC for a very useful discussion. The proposal will be presented to the Council of Members meeting on 9 th October. ACTION AB 3.5 Integration Transformation Fund MH reported that the paper is for information only at this point in time and refers to the establishment of the shared budget for Health & Social care services to enable the delivery of community services from one budget. Discussions have commenced with the local authority and he highlighted the importance of achieving the right balance. The process is being overseen by the Health & Well Being Board 5
AB highlighted that no new money is being made available. Although the social care budget is protected by the local authority at the moment, other local authority budgets have suffered cuts and it is important that the HWB ensure that the money is not being used to support those services that have been cut. SH queried the timescale for the implementation of seven day working can be implemented. TH stated that this will involve considerable transfer and effective plans need to be agreed by year end. The CSC noted the report. AZ requested that the joint SMT advise the Governing Board on progress. AB stated that the local authority will nee to identify the governance processes. ACTION AB/MH 3.6 Draft Commissioning Intentions 2014/5 &2015/6 TH stated that the report reflects the input received. She requested CSC view on whether further engagement is required and whether the commissioning intentions are sufficient. She added that a genuine commitment is required to reduce healthcare expenditure. AB pointed out that it may not be possible to meet all of the intentions and it is important to have an alternative option available. Areas that are not being commissioned need to be clearly identified. JY stated that requirements for change and reluctance to change need to be addressed. There is a need to focus on the workforce. KS stated that the QIPP delivery programme may need to be extended to include feasibility. Support is required for the delivery of costs and this could be an area of work undertaken by an associate. AZ stated that the commissioning Intentions must be shared with member practices first It was agreed that a workshop be organised in October to discuss the Commissioning Intentions further. ACTION AB 4. Any other business PH reported that the H&SC Information Centre will start extracting patient identifiable data from practices and practices cannot refuse to provide this. Patients will need to opt out if they don not want their information submitted and he suggested that the CCG provide a communication for patients. JF stated that information governance support advice has been obtained from the CSU and this issue has been raised at the CCG Information Governance Steering Group. RW will post information on the website. ACTION RW AB circulated a copy of the CCG prospectus which is a requirement for all CCGs. The prospectus had been recommended by the Engagement & Patient Experience Committee and he invited ideas on ways of publicising it and detailed the costs involved. The SMT had felt that possible distribution to every household in the first year was required but this could lead to criticism because of the costs involved. The CSC felt that visibility in key places throughout Southwark is the best option and requested that the most effective way of dissemination without delivery to every household is explored. The CSC also requested that the front cover is changed to Your Local NHS ACTION RW 5. Date of next meeting Tuesday 15 th October 6
Commissioning Strategy Committee 17 th September 2013 ACTION TRACKER ITEM ACTION BY COMPLETION/ REPORT BACK Action Tracker Children s Integrated Care Project Clinical representation on the Project group- interest to be obtained from future clinical associates TH Locality Reports Feedback on ENT pathway for Nick Harris required by 27 th September All Not required Primary Care Contract for Care Homes Recommendation to implement Option 1 in the first instance while exploring implementation of option 2 [the preferred option] to be considered by the Conflict of Interest panel on 24 th September 2013 AB Care Home Quality Improvement Strategy GP representative with experience of supporting care homes to join the working group AB/PH Mental Health Family Strategy Project to be to be linked in to GP locality meetings. Also posted on the GP intranet RW Clinical membership on the Governing Body All current Southwark CCG Clinical Leads and Clinical Associates to be contacted regarding their interest in going through a national assessment centre for future CCG Chairs Final proposal for changes to clinical membership on the Governing Body to be discussed with localities and then Council of Members JF AB End September October Transformation Funds Joint CCG and Local Authority SMT to update Governing Body on the delivery of integrated services. AB/MH 7
Governance process to be identified Draft Commissioning Intentions Governing Body workshop/seminar to be arranged for October TH October Any other business - extraction of Patient Identifiable Data by HSIC Information to be produced for patients by NHS England Information to be posted on the GP intranet when available RW Any other business - CCG Prospectus Front cover title to be changed Most effective dissemination to be explored without delivering to every household. RW October 8