Meeting of NHS Bristol CCG Finance, Performance and Planning Committee Minutes of the meeting held on Tuesday 22 nd March 2016 in the CCG Conference Room, South Plaza Minutes Present: Patsy Hudson Lay member for Governance (Chair) Tara Mistry Lay member for PPI Nicola Dunn Chief Financial Officer Alison Moon Transformation and Quality Director Uli Freudenstein North and West Locality Representative Sarah Carr Corporate Secretary Rachel Anthwal Delivery Director (CSU) Emma Gara Head of Performance and Information Jon Hayhurst Head of Medicines Management Jo White Primary Care (for item 11) Carol Slater Head of Localities (for item 11) Matt Barz Management Accountant (for item 11) Lucy Powell Note taker 1 Apologies Apologies were received from Martin Jones, Jill Shepherd, Judith Brown, Steve Davies, Ewan Cameron and Justine Rawlings. 2 Declarations of Interest Uli Freudenstein declared an interest in item 11. There were no GPs or Practice Managers present for item 11. 3 Minutes of previous meeting, matters arising and action log There were several amendments to the minutes as outlined below: Action Action Minutes Page 1 of 7
Rachel Anthwal s job title was changed to Delivery Director The word not was removed from the 5 th paragraph down on page 3. The word partly was added to the 7 th paragraph on page 3. With these amendments, the minutes were agreed as a correct record. The committee discussed the action log. 15/12 7(1) Nicola Dunn updated the committee on the status of the Mental Health Out of Area placement schemes. The updates outlined on the action log are still ongoing. It was agreed to add Mental Health to the agenda as a standing item as this is an area of risk to the financial position. 15/02 4(2) The AWP Contract Performance Notice and Recovery Action Plan information was tabled and it was agreed that this would be emailed to members with the minutes and action log. This action was closed. 15/02 5(1) The meeting regarding the Rightcare benchmarking process has occurred and the group have looked through the data and prepared this for Steering Group review. Emma Gara noted that this process has been included within the Operational Plan and will be evidenced by the individual Steering Group minutes. It was agreed to close the action as this process has been picked up through a Rightcare group that are meeting each month. LP 4 Integrated Quality, Performance and Finance Report Finance Nicola Dunn noted that there was a decision of recommendation to the Governing Body to be taken by the FPP Committee whilst quorate. Nicola Dunn asked, that due to the current situation with the underachieved QIPP target, that the CCG spend at 2015/16 budget level plus inflation. Once the 2016/17 budget has been agreed with the Trusts, the spend would increase. The committee agreed that this option should be presented to the Governing Body. At this point, Alison Moon left the meeting. The financial position was updated, noting that the surplus of 5.7m was compliant with the 1% as stated in the business rules. There are 1.1m cost pressures which are absorbed through non recurrent means. The areas of risk to the position were outlined in annex 1.6 which included the acute contracts. It was noted that Action Minutes Page 2 of 7
there had been a lock in meeting with NBT to finalise the outturn position. Performance Rachel Anthwal updated the committee on the current performance issues. It was noted that the sections regarding NBT had been omitted or updated for the latest available figures; this was due to ongoing problems with the Lorenzo implementation. This meant that the CCG totals were indicative only as they omitted NBT figures. The performance key messages had been updated to include all current Bristol CCG Contracts. Contract Performance Notices and Recovery Action Plans are in place for UHB and NBT, following the worst month for achievement of targets in January for 2015/16. Only 3 out of 9 cancer standards were achieved. However, at present, 5 out of the 9 cancer standards should be achieved at year end. However, the junior doctor strikes scheduled for March may be a possible barrier for achievement. UHB achieved the 18 week RTT (Referral to Treatment Time) national standard in January 2016. AT NBT, the RTT national standard was achieved at 88.77% against the target for January 2016 of 86.5%. The switch to Lorenzo has impacted data quality with more incomplete pathways reported than expected. The committee discussed the trolley waits for both NBT and UHB and Sarah Carr asked whether it could be clarified how many of the waiting patients were Bristol patients. RA Quality Alison Moon confirmed that Quality issues had been discussed in the Quality and Governance Committee and there was nothing to report to the FPP Committee. 5 Item removed 6 Financial Planning Nicola Dunn updated the committee on the Bristol CCG financial position highlighting the challenges and mitigations. The Rightcare approach was explained noting that the CCG has begun the process with key people having met and pack information being disseminated to the Steering Groups. Opportunity has been identified within the urgent care system and Action Minutes Page 3 of 7
this is the CCG focus. The committee discussed the cost containment strategy and the key areas of potential savings were outlined. 7 Operational Plan Emma Gara gave an update to the current progress on developing the operational plan. The Committee were asked to review the objectives set out within the draft prior to Governing Body sign off. It was noted that the plan focusses on the Bristol CCG objectives but also notes the partners that the CCG will work with to achieve its aims. The next submission date is the 11 th April 2016. Post meeting note The submission date has been changed to the 18 th April 2016. 8 Draft Governance Statement Sarah Carr updated the committee on the progress of the Governance Statement, noting that the content of the statement is prescribed. This has been reviewed by the Quality and Governance Committee and the Audit Committee. Sarah Carr asked that the committee review the draft and send her any comments by the end of the week. 9 Corporate Risk Register and Assurance Framework Sarah Carr noted that the financial risks would be closed due to the end of year position being finalised. The new areas of financial risk for 2016/17 will be identified by Sarah Carr and the finance team. 10 Business Cases Expansion of the Community Heart Failure service The committee agreed that the business case needed further scrutiny and clarification. It was agreed to delegate the approval of this business case via email. It was agreed to raise this with the PMO team. Post Meeting note: Decision to confirm investments in: Extra Care Housing ( 97k investment) PMO/FPP Committee Action Minutes Page 4 of 7
11 AOB HG Wells Diabetes Integrated Model of Care ( 225k investment) Dementia flexi beds ( 99k investment) carry forward from previous year. It is important to note that these investments form part of the QIPP delivery programme. Tara Mistry gave her apologies to the April FPP Committee. 12 Primary Care Service Review 2016/17 This item excluded Uli Freudenstein due to conflict of interest. The other GP and practice manager members sent their apologies. Jo White gave the background to the paper and explained that the Governing Body had delegated the decision for reviewing and commissioning primary care services to the FPP committee by way of a chairs action. This is to ensure conflicts of interest are managed appropriately. The decision will be taken to the March Governing Body for information. Carol Slater presented the BPCAg paper to the committee. It was explained that primary care was experiencing unprecedented pressure and the focus of the BPCAg has been scrutinised with a view for the work undertaken to impact upon admission avoidance, length of stay and other pressure points for the health system. The updated specification was presented to the committee which outlined the activity which will be maintained within the BPCAg and the new areas of focus. These included focus on Mental Health, frail, and complex patients as well as NHS England priorities such as informatics systems and practice sustainability. Alison Moon asked whether the locality plans were weighted by process or outcomes. Carol Slater explained that the new activity aimed to be more outcomes focused and measurable, whilst not losing the transformative approach. It was also asked whether it was too late to link the BPCAg specifications with the Quality Premium indicators, it was noted that GP practices had not been specifically incentivised to do this within the specification but the BPCAg aligns with the CCG objectives in the Operational plan and the Quality Premium achievements would be included within this. Action Minutes Page 5 of 7
Jo White presented the Primary Care Services Review paper and explained that the services being commissioned were not part of the GMS and PMS contracts which are held by NHS England, therefore the CCG commissions these services on the NHS standard contract. Each of the primary care services is reviewed annually with the relevant commissioning lead and steering group using a template to encourage consideration of the desired clinical outcomes, value for money, impact on other services, equality of service provision and impact on patient outcomes, amongst other things. Other considerations could also be made, for example how a service fits with the scope of Better Care Bristol. To ensure proper management of any Conflict of Interest there was a guide incorporated in the template to support GPs considering services they might provide, or have an interest in providing. Jo White outlined the proposed service changes and explained the services to the Committee as in appendix 1.. It was noted that the additional funding relating to the DVT service had been agreed previously by the FPP Committee. The investment for the supplementary services was agreed by FPP in its November 2015 meeting using the premium funding identified as part of the NHS England PMS review process. The FPP Committee agreed the following recommendations: 12.1 The primary care services are re-commissioned for one year from April 2016 from list based GP providers on the NHS standard contract 12.2 The Bristol Primary Care Agreement specification changes are agreed for implementation in 2016-17 as part of the three year contract 12.3 The supplementary services specification is commissioned from GP practices from April 2016 It was agreed to remove the last recommendation as streamlining the administration burden should be part of the improved outcomes and review into streamlining the contract process. 13 Key Messages The CCG expects to end the year with a 5.7m surplus Contract Performance Notices and Recovery Action Plans are in place at UHB and NBT. Action Minutes Page 6 of 7
Both UHB and NBT achieved the RTT national standard in January 2016. The Rightcare approach is being embedded into the CCG planning process with a monthly group being set up to evaluate the information provided in the packs. The operational plan is due to be submitted on the 18 th April. The decision on the expansion of the community heart failure service business case was agreed to be delegated as an email decision outside of the meeting. 14 Date of Next Meetings Tuesday 19 th April 12.00pm Tuesday 17 th May 12.00pm Tuesday 21 st June 12.00pm Administrator Lucy Powell: 0117 900 3417 Action Minutes Page 7 of 7