MEETING OF THE FYLDE AND WYRE CLINICAL COMMISSIONING GROUP GOVERNING BODY HELD ON TUESDAY 17 JULY 2018 AT 1.00PM BOARDROOM, NHS OFFICES, DERBY ROAD, WESHAM Present: Ms M Dowling, Chair Dr T Naughton, Clinical Chief Officer Dr P Benett, GP and Elected Clinical Member Dr V G Chandrasekar, GP and Elected Clinical Member Dr K Greenwood, GP and Elected Clinical Member Dr A Janjua, GP and Elected Clinical Member Dr T Marland, GP and Elected Clinical Member Dr J Panesar, GP and Elected Clinical Member Mr K Toole, Lay Member, (PPE) Dr I Stewart, Secondary Care Doctor Mr A Harrison, Chief Finance Officer Mr P Tinson, Chief Operating Officer Ms C Lewis, Acting Executive for Governance, Patient Safety and Risk In Attendance: Mrs A Marquis-Carr, Head of Safeguarding Mrs P Bowling, Corporate Affairs/Governing Body Secretary 61/18 Apologies for Absence Mrs J Aldridge, Dr F Guest, Dr T Johnson and Paul Olive. 62/18 Welcome and opening remarks The Chair opened the meeting and thanked members of the public for their attendance. The Chair advised that this was a meeting held in public and not a public meeting and any questions arising from the meeting papers or subsequent discussion would be invited later in the agenda. Questions were also welcomed in writing or via the CCG s website. The Chair referred to the current spell of hot weather and the messages being published by Public Health England. There had been an increase in the number of homeless people being admitted to hospital with sunburn and Clifton Hospital Dermatology Department had been providing advice and support locally. McMillan Skin Care Co-ordinators had also been attending school sports days and local beaches promoting sun awareness and skin safety. 63/18 Any other matters of urgent business There were no other matters of urgent business. 64/18 Declarations of interest There were no declarations of interest relating to items on the agenda. 65/18 Minutes of the previous meeting of the Governing Body held on 22 May 2018 The minutes of the meeting of the Governing Body held on Tuesday 22 May 2018 were agreed as a correct record. 66/18 Matters Arising and Action Points The action sheet was reviewed and all actions were reported to be complete. Comments were noted as follows:
P Tinson advised that with regard to Lancashire Teaching Hospitals (LTH) performance, areas of concern were similar to those of Blackpool Teaching Hospitals, namely A&E, Referral to Treatment Times and Cancer. Improvement plans to address areas of underperformance agreed between Greater Preston CCG and LTH were available on request. In response to the question raised at the last meeting as to whether never events/coroners reports required a separate risk assessment, C Lewis advised that the risk register would be updated at the next review to encapsulate this. 67/18 Chair s Report The Chair presented her report and provided an update on developments across the Lancashire and South Cumbria Integrated Care System (ICS), the Fylde Coast Integrated Care Partnership (ICP) and changes with regard to CCG Leadership. Dr Tony Naughton, Clinical Chief Officer, and Dr Tom Johnson, Governing Body Clinical Member, were due to retire by the end of August and Jennifer Aldridge, Chief Nursing Officer, was due to retire at the end of October. The Chair paid tribute to Dr Johnson for his hard work on behalf of the CCG. Dr Johnson was one of the founder members of the CCG and had made a significant contribution to make the CCG the effective organisation it was today. On behalf of the Governing Body, the Chair extended best wishes to Tom and his family. The Chair also asked that thanks be recorded to Dr Tony Naughton who had done a fantastic job as Clinical Chief Officer and Accountable Officer for the CCG. The agenda for today s meeting was one of many which demonstrated the huge progress made by the CCG under Tony s leadership and vision. Tony will be hugely missed but he has put in place a very effective team that will carry forward what he has started. The CCG s 2017/18 Annual General Meeting took place on 5 July 2018. This was the third joint AGM event with Blackpool Teaching Hospitals and Blackpool CCG and was well attended. The Governing Body noted the content of the report. 68/18 Report of the Clinical Chief Officer Dr Naughton presented the report and highlighted the following key issues. Since the preparation of the report, the CCG s annual assessment for 2017/18 had been published and the results were available online on www.nhs.uk/mynhs. The CCG had been rated as good. The CCG s Annual Report and Accounts had been published and were available on the CCG website. A summary version was also available which had received the Crystal Mark from the Plain English Campaign. The Whyndyke Garden Village Healthy New Town had moved into the next planning stage following the signing of an agreement between all parties. Members of the Governing Body were invited to take part in the Fitter Fylde Coast Guinness World Record attempt on Saturday 21 July at Lytham Festival. The Governing Body noted the content of the report. 69/18 Report from the Council of Members Dr Greenwood presented the summary of key issues extracted from the Council of Members meeting minutes of 8 May and 12 June 2018. Dr Greenwood added that the members continued to engage with the work of the CCG and were committed to partnership working across the Fylde Coast. The Governing Body noted the content of the minutes of the Council of Members meetings held on 8 May and 12 June 2018. 2
70/18 Consultant Connect Dr Tom Marland, Clinical Member for planned care and urgent and emergency care, presented an update on Consultant Connect, a structured telephone advice and guidance service which provides a platform for GPs to dial a single number, choose a specialty and then have an immediate call with a consultant. The system is used in over 50 CCGs and 40 Trusts across the country and commenced in FWCCG on 5 February 2018 across 4 specialities: Gynaecology, Paediatrics, Rheumatology and Diabetic Podiatry. The CCG is also having discussions with Blackpool Teaching Hospitals NHS Foundation Trust (BTHFT) about implementation of the Morecambe Bay email advice and guidance service. The presentation provided information on: system benefits including potential savings for referral avoidance; data on the utilisation and outcomes of calls by speciality; and feedback from both GPs and consultants. Some of the challenges faced included no telephone call pick up, targeting higher impact specialities, GPs not recording the outcomes and communications and engagement with secondary care clinicians. Actions being taken to address these challenges and the next steps were also provided. A question was asked as to at what point during the consultation was the advice sought and if the patient was present, and how/when the outcome was fed back to the patient. Dr Marland confirmed that it was generally a mixture depending upon the circumstances, however, this information was not currently collected. As a user of the service, Dr Greenwood, said she had found the service useful but that the system for recording the outcome could be improved. It was noted that there were other opportunities for GPs to seek secondary care guidance before referring a patient, such as a telephone line to A&E and the e-referral request for guidance in the Rheumatology Department. In response to questions from P Tinson about the use of resources and improving elective waiting times, Dr Marland said that the self-care agenda was being considered in the planned care specialities. The Chair thanked Dr Marland for his informative presentation and commented that whilst good use was being made of the service work must continue to improve take up and resolve any difficulties and suggested that this be discussed further at the Fylde Coast Integrated Care Partnership. It was agreed that the Governing Body would receive an update report in January 2019. Action: Governing Body Secretary for reporting schedule 71/18 2030 Vision for Health and Care P Tinson presented the report, the structure of which had been revised to reflect the changing commissioning landscape as activities were increasingly being undertaken at either a neighbourhood, Fylde Coast or Lancashire and South Cumbria level. Attention was drawn to the neighbourhood development section of the report which provided details of the excellent work taking place. K Toole commented on the importance of the names of each of the neighbourhoods being clear in identifying the specific neighbourhood to which it referred. It was reported that the Lancashire Health and Wellbeing Board had supported a move to Total Neighbourhoods. Two Fylde and Wyre neighbourhoods had volunteered to work with the Council to pilot this programme around devolving services into neighbourhoods. The Chair made reference to the CCG s statutory duty to publish an annual commissioning plan. P Tinson confirmed that a summary plan was available on the CCG s website and represented the position at a point in time. This would be refreshed in light of the deliverables to be signed off by the Fylde Coast Integrated Care Partnership Steering Group. 3
The Chair drew attention to the National Audit Office report on Developing New Care Models through the NHS Vanguard which contained a lot of useful information which would be circulated to Governing Body members. The local Vanguard evaluation was in draft form and a session was due to be held in September at which the outcomes of the evaluation would be presented. The Governing Body approved the direction of travel of initiatives that were underway. 72/18 Performance Dashboard P Tinson presented a summary of current performance for the period up to April 2018 (month 1) and explained that whilst the CCG remained statutorily accountable for delivery of performance standards in 2018-19 there also needed to be a clear line of sight to the Fylde Coast position as the CCG was also accountable as a partner with the Fylde Coast ICP and the Lancashire and South Cumbria ICS. The Governing Body had been engaged in redesigning the format of the report to reflect the changing environmental context. It was noted that due to issues with a new software system implemented by the CSU this report did not include contractual information. P Tinson drew attention to the following areas of concern: cancer 2 week waits; A&E 4 hour waits; 18-week referral to treatment and NWAS targets. The report also included an indication of the confidence in the CCG s ability to achieve the target in 2018-19; to issues, risks and actions; and an indication of whether further escalation was required. It was noted that the draft Winter Plan had been submitted to NHSE and NHSI and feedback was awaited. C Lewis presented the quality section of the report and drew attention to 3 new clostridium difficile cases relating to Fylde and Wyre residents and to two exception reports, ie serious incidents and mixed sex accommodation. Due to pressures in A&E there had continued to be some 12-hour breaches and the Quality Improvement, Governance and Engagement Committee was due to receive a detailed report on this at its next meeting. With regard to reporting on Mortality it was noted that in future a single joint report was being prepared for both Blackpool and Fylde and Wyre CCG Governing Bodies and Blackpool Teaching Hospitals Quality Committee. Members welcomed the new format of the report. A request was made for the written report to include more timely information, recognising that a verbal update was given where possible. P Tinson responded that information on performance in urgent and emergency care was received by the CCG on a daily basis and in future the report would be supplemented with the most recent information available. Action: P Tinson Reference was also made to discussions taking place across the Fylde Coast in an attempt to reach a conclusion on an emergency care improvement plan to deliver trajectories in urgent and emergency care. It was expected that this plan would be submitted to the ICP Steering Group in September for approval. Dr Benett asked if the Governing Body was reassured that the solutions in the plan were whole system and transformational. In response it was suggested that the plans were maybe not as transformational as the CCG would like, however, the plan was stronger and more robust than what had previously been in place. There were many aspects to the plan, however, other opportunities in primary and community care had been identified and needed to be reflected. The Governing Body noted the content of the report and endorsed the actions taking place to improve performance. 4
73/18 Communications and Engagement Strategy 2018/19 C Lewis updated the Governing Body on activity undertaken to deliver the Communications and Engagement Strategy in the six months from January to June 2018. The report emphasised the impact that Patient and Public Engagement has had on the CCG s direction and strategy. Dr Naughton spoke of the excellent communication and engagement in Fylde and Wyre CCG and hoped that as the CCG moved to a single executive management team with Blackpool CCG, this proactive engagement would continue. The Governing Body noted the progress made as outlined in the report and approved the future planned activity. 74/18 Financial Update A Harrison advised that the CCG had met its key financial duties at Month 2 (May 2018). Reserves totalling 8.7m had been set up and an analysis was provided along with key risks for 2018/19. Assumptions had been made regarding the contract information due to the data issues outlined earlier in the meeting. The Governing Body noted and approved the Month 2 performance. 75/18 Governing Body Assurance Framework C Lewis presented an update on the CCG s Operational Risk Register and Governing Body Assurance Framework. There were currently 23 risks held on the full Corporate Risk Register and 6 high rated risks. No risks had been closed during the period 21 February to 26 April 2018 and no new risks had been added to the Register since 29 December 2017. The Governing Body noted the content of the report and agreed that it was a true reflection of the CCG s current risks. 76/18 Financial Control, Planning and Governance self-assessment A Harrison presented the report and outlined the background and purpose of the CCG Financial Control, Planning and Governance self-assessment. The Governing Body was asked to endorse the proposed draft self-assessment for approval by the CCG s Accountable Officer or Audit Committee Chair prior to submission to NHS England. Members considered the content of the document and, following clarification of the entry on line 19 and confirmation that the CCG s Lay Member for Governance was in post for the first quarter of the year, the Governing Body recommended the self-assessment for approval. The Governing Body endorsed the proposed self-assessment for approval by the CCG s Accountable Officer or Audit Committee Chair prior to submission to NHS England. 77/18 Annual Report of the Finance and Performance Committee 2017/18 The Governing Body received the Annual Report of the Finance and Performance Committee 2017/18 in accordance with the Terms of Reference of the Committee. It was suggested that in future the record of attendance included as an Appendix include the names of the members of the committee only and not the attendees. The Governing Body approved the Annual Report of the Finance and Performance Committee 2017/18. 78/18 QUESTIONS FROM THE PUBLIC 5
There were no questions from the members of the public present, however, on behalf of the PPG Group for Great Eccleston Health Centre, Alan Slater wished Dr Naughton all the best for the future. 79/18 Minutes of meeting to be received: (a) Quality Improvement, Governance and Engagement Committee (QIG & EC) - 24/4/18 (b) Finance and Performance Committee 24/4/18 and 29/5/18 (c) Clinical Commissioning Committee 1/5/18 and 5/6/18 (d) Audit Committee 24/5/18 (e) Lancashire Health and Wellbeing Board (LH&WB) (draft) 20/3/18 (f) Healthier Lancashire and South Cumbria Joint Committee of CCGs (draft) 7/6/18 It was agreed that as the Quality Improvement, Governance and Engagement Committee had moved to bi-monthly meetings, the Governing Body was agreeable to receiving draft minutes. The Governing Body reviewed and noted the contents of the minutes. 80/18 Date and time of next meeting: Tuesday 18 September 2018 1.00pm To be confirmed. 6