LEICESTER, LEICESTERSHIRE AND RUTLAND CCGs COMMISSIONING COLLABORATIVE BOARD Minutes of the Public Commissioning Collaborative Board held on Thursday 19 April 2018 at 1:00pm in the Conference Room, 8 th Floor, St John s House, 30 East Street, Leicester, LE1 6NB PRESENT: Dr Richard Palin Mrs Karen English Mr Toby Sanders Ms Sue Lock Professor Mayur Lakhani Dr Chris Trzcinski Professor Azhar Farooqi Dr Avi Prasad Ms Gillian Adams Mr Zuffar Haq Ms Donna Enoux Mrs Michelle Iliffe Ms Tamsin Hooton Mrs Caroline Trevithick Ms Sarah Prema IN ATTENDANCE Ms Lesley Gant Mrs Jayshree Raval Clinical Chair, East Leicestershire and Rutland CCG (Chair) Managing Director, East Leicestershire and Rutland CCG Managing Director, West Leicestershire CCG Managing Director, Leicester City CCG Clinical Chair, West Leicestershire CCG Clinical Chair, West Leicestershire CCG Clinical Chair, Leicester City CCG Co-Chair, Leicester City CCG Independent Lay Member, West Leicestershire CCG Independent Lay Member, Leicester City CCG Chief Finance Officer, East Leicestershire and Rutland CCG Director of Finance, Leicester City CCG Director of Urgent and Emergency Care, West Leicestershire CCG Chief Nurse and Quality Lead West Leicestershire CCG Director of Strategy and Implementation, Leicester City CCG Head of Medicines Optimisation, Leicester City CCG (CCBP/18/28) Commissioning Collaborative Support Officer, East Leicestershire and Rutland CCG (minutes) ITEM DISCUSSION LEAD RESPONSIBLE CCBP/18/18 Welcome and Introduction Dr Richard Palin welcomed members of the Commissioning Collaborative Board (CCB) members to the first joint meeting of CCB in public. CCBP/18/19 There was one member of the public present at the meeting and all members of the CCB introduced themselves for the benefit of the member of the public. Apologies received The following apologies were noted: - Dr Andy Ker, Vice Clinical Chair, East Leicestershire and Rutland CCG - Mr Spencer Gay, Chief Finance Officer, WL CCG Page 1 of 10
CCBP/18/20 CCBP/18/21 Mr Clive Wood, Independent Lay Member, East Leicestershire and Rutland CCG Notification of Any Other Business The Chairman had not received notification of any additional items of business. Declarations of Interest on Agenda Items All GP members declared an interest in items relating to Paper F Medicines Optimisation in Care Homes where a potential conflict may arise due to future interim payments for GPs. No action was required. CCBP/18/22 To receive questions from the Public in relation to items on the agenda only. Dr Palin informed that there were no questions received from the member of the public present on items on the agenda. CCBP/18/23 Commissioning Collaborative Board Terms of Reference (ToRs) (Paper A) Dr Palin presented the paper, highlighting that in November 2017, the Commissioning Collaborative Board (CCB) was reconstituted as a joint committee of the three CCGs to enable and support joint decision making. He noted that individual organisations will retain responsibility for the local application of collaborative plans as well as organisations own operational plans, financial planning and reporting, and taking decisions on the outcomes of consultations. Dr Palin stated that as CCB members will recall it was agreed that the Commissioning Collaborative Board would convene meetings in its new form from January 2018, with its first formal meeting held in public in April 2018. This was to enable appropriate governance arrangements to be established ahead of April. Dr Palin briefly went through the areas covered within the Terms of Reference (ToRs) and that the members were requested to receive them which were approved by the Governing Bodies of the respective CCGs. Mrs Iliffe highlighted a spelling error on page 7 of the ToR under Membership. She stated that Managing Director has been misspelt. Dr Palin informed that this would be amended accordingly. Governance Lead RECEIVE the terms of reference for the joint committee as approved by the Governing Bodies of the respective CCGs. Page 2 of 10
CCBP/18/24 Work Programme for 2018/19 (Paper B) Dr Palin went on to talk through the work programme which was part of the report. He informed that the work programme will assist with planning of the CCB meetings in line with the Terms of Reference (ToRs) going forward. Dr Palin asked the members if they had any comments or views on items that should be added onto the work programme which are currently not on. Some comments were received such as: - Bringing regular updates on QIPP programme to be added on the programme. - Triangulating information filtered down from East Midlands Cancer Alliance and see how the work links in with UHL and how this information could filter down to being part of the programme. - To bring updates on Community services redesign - RECEIVE the work programme compiled for CCB CCBP/18/25 Schedule of meetings 2018/19 (Papers C) Dr Palin presented the schedule of meetings for Commissioning Collaborative Board (CCB) meetings for 2018/19. The following was noted from the CCB members: - Papers to be received a week prior to the meetings. - Most papers coming to CCB should have been to through the respective Governing Bodies or to internal governance forums. - It is recognised that due to the timing of the Governing Bodies and the CCB, papers may not always get to the Governing Bodies and this will need to be reviewed. - To schedule in time to review the papers in regards to governance. It was noted that the chairmanship from May 2018 until August 2018 will sit with West Leicestershire CCG. Mr Sanders and Professor Lakhani to review the agendas from next month. CCBP/18/26 - RECEIVE the schedule of meetings for CCB meetings for 2018/19 To APPROVE the minutes of the Public Commissioning Collaborative Board meeting held on 22 March 2018 (Paper D) The minutes of the Public Commissioning Collaborative Board meeting held in March 2018 were approved as an accurate record of the meeting. Page 3 of 10
APPROVE the minutes of the last meeting. Paper I CCBP/18/27 To RECEIVE the Matters Arising: actions from Commissioning Collaborative Board held on 22 March 2018 (Paper E) There were no matters arising following the meeting held in March 2018. CCBP/18/31 It was RESOLVED: RECEIVE the matters arising, and note the progress to date. Collaborative Working Arrangement update (Verbal) Mrs English provided an update on the collaborative working arrangements. She informed that a first Joint Management Team (JMT) meeting was held on 16 April 2018 where discussions on a joint management process took place in regards to looking at a number of priorities going forward. At the JMT meeting proposals were put forward in relation leads taking on some of the priority areas. At the meeting the leads were requested to review the current working methods across the three CCGs and bring back proposals at the next JMT meeting at the end of April 2018. The proposals to include information on areas where alignment can take place and areas that require wider considerations. Ms Adams queried process reviewing the Corporate Committees set up in each of the three CCGs and if there was an opportunity to have joint committees or other suitable options. Ms Lock highlighted that a discussion took place at JMT on this matter and it was noted that whilst exploring opportunities to bring some of the Corporate Committees together it was equally important to ensure that governance around these committees were not compromised. Mrs English informed that further information will be provided at the next CCB meeting. Managing Directors RECEIVE the matters arising, and note the progress to date. Professor Lakhani left the meeting. Page 4 of 10
CCBP/18/29 NHS 111 Online Service Briefing (Paper G) Ms Hooton presented the briefing which highlighted that the Next Steps in the Five Year Forward View requires all NHS 111 services to have an online service in place by December 2018. Ms Lesley Gant joined the meeting. Ms Hooton informed that NHS England has now asked Clinical Commissioning Groups (CCGs) to offer NHS 111 online service in their areas on an accelerated timeframe from December 2018 to July 2018. It was noted that a single provider is mandated in regards to pathways, which is developed by NHS Digital which has set to go live in the East Midlands for 6 June 2018. Ms Hooton stated that the NHS 111 online service will be rolled out in three phases with each phase adding more functions for users. Ms Hooton added that to enable the service to roll out nationally in the accelerated timeframe, NHS England have asked that all clinical contact is managed through NHS 111 via a call back queue. This would mean that LLR must adopt this system by October 2018. NHS Digital have however indicated that it may be possible to link NHS 111 online to regional CAS services such as the LLR Clinical Navigation Hub (CNH) as early as June 2018. She reported that in LLR Urgent & Emergency Care Group indicated the preference to begin the service with clinical contact managed via NHS 111 and then to evaluate options once there is a useful amount of activity coming through the service. Ms Hooton highlighted that currently there are no plans for a national or regional promotion campaign. The LLR Urgent and Emergency Group have agreed to a soft launch in June 2018 with possible targeted audience being university students. A working group will be established to agree the target audiences and then develop a communications plan. Ms Lock queried if the initial focus would be on students, then does NHS 111 online service have the facilities to accommodate those students whose first language is not English. Ms Hooton informed that she was unable to provide a response however would look into the matter. Ms Hooton Ms Adams informed that it would be useful to look at what information is available at the GP practices for students mainly within the campus areas in regards to the ability to navigate through the system. Professor Farooqi stated that the GP practices do have leaflets which provide information Page 5 of 10
on processes especially those practices near the campuses. Dr Trzcinski informed that there could potentially be an impact on resources as NHS 111 will advise patients to call Ambulance on most occasions if they fall out of the algorithm criteria. Ms Hooton stated that once the initiative is rolled out the data will be evaluated to get a better understanding of the system. Mrs Trevithick suggested linking in with the communications team at the university and co-produce communications going forward. Ms Hooton informed that she will take the suggestion on board and look into it. Ms Prema queried if funding will be required for communications. Ms Hooton stated most of the work will be carried out by staff internally however there will be some minimum requirement of funding for printing of leaflets. Ms Hooton added that Phase 1 in April 2018 will use DoS profiled, which means that users of NHS111 online will only receive information about the most appropriate service to call or visit for their disposition. Dr Johnson queried the purpose for launching the online facility in June 2018 when there is not enough evidence to support the benefits and in addition the possibility of increased activities. Ms Hooton explained that by initiating the roll out of the online service does not evident an increase in activity and secondly the soft launch would assist in gathering evidence to be able to move to phase 2. Dr Palin summarised as below: - To Receive the paper - Roll out of the online service as soft launch - Targeted audience - students at University - No budget for communications required - Ms Hooton to link in with University s communication team to co-produce information. It was RESOLVED: - RECEIVE the paper. CCBP/18/28 Medicines Optimisation in Care Homes (Paper F) Ms Gant presented the paper which reported on the programme focusing on care home residents across all care home settings with the aim to deploy a dedicated pharmacy team that will: Provide care home residents with equity of access to a clinical pharmacist (working towards or already qualified as an independent prescriber) to work as a member of a multidisciplinary team. Page 6 of 10
- Provide care home residents with access to pharmacy technicians that will ensure efficient supply and management of medicines within the care home, supporting staff and residents to achieve better outcomes. Ms Gant informed that the programme is aligned to the Framework for Enhanced Health in Care Homes and the STP/ICS plans for Medicines Optimisation and Care Homes. The programme will deliver nationally by funding for 240 new posts for Pharmacists Pharmacy Technicians for two years. She informed that 100% funding will be provided in year 1 and 50% funded in year 2. In addition there will be bespoke funded training pathway over the 2 year period. Ms Gant informed that the paper requests support and agreement to the following recommendations: - The submission of a joint application for the funds available to the LLR Sustainability and Transformation Partnerships (STP) by the 20 April 2018. - Agree a lead CCG to submit the application on behalf of all three CCGs. - Head of Medicines Optimisation Agree to take the work forward on behalf of the STP medicines optimisation medicines value programme. - 50% funding requirement in Year 2 Professor Farooqi queried if this would be additional QIPP savings. Ms Gant replied that this would provide additional QIPP savings. In response to Ms Prema s query in regards to what the impact would be if an agreement was not provided. Ms Gant explained that there are more benefits in taking this forward as it will assist in: - Improving the quality of care through better medicines use. - Reduce the risk of harm from medicines through medicines optimisation, safer medicines systems and staff training. - Release resources through medicines optimisation and waste reduction. - Reduction in hospital admissions and release of care home nurse time. - Ensure care home pharmacy professionals work as part of a multi-disciplinary team. - Improve care home residents health outcomes. - Increase the appropriated use of technology and data supporting medicines optimisation in care homes Although it was noted that agreeing to the programme would show benefits, at the same time some concerns were also shared around the 50% funding requirement in year 2, given Page 7 of 10
the current financial climate for the three CCGs. Dr Prasad left the meeting. Paper I Some further discussion took place with following queries and comments from the CCB members: - The current pharmacists employed by the CCGs do not have a good working relationship with the GP practices. If CCB is to agree to this programme to be taken forward, the Medicines Management team to review the current working relationship between practices and pharmacists. - How is the split worked out between the CCGs as the report did not provide evidence of the workout. - The programme should be given the go ahead to progress. - This funding should assist the existing pharmacies to carry out a full medicines review on patients prescription which is currently not happening. - Is the information embedded in the framework of enhanced health for Care Homes in regards to identifying patients on high value medications. - Suggested to also review patients living on their own as there could be potential savings. Dr Prasad re-joined the meeting. Dr Palin summarised that he notes the concerns shared by the CCB members in regards to the 50% funding requirement in year 2 given the current financial climate for the three CCGs. He however also feels that there is greater benefit in supporting this programme as: - The programme focuses on care home residents where a dedicated pharmacy team could be deployed. - In addition it is in line with the next steps of the five year forward view. - Allocation of funding to all STPs and Integrated Care Systems (ICS) across England provided to improve medicines management within Care Homes and optimise medicines for their individual residents. The CCB supported the submission of a joint application for the funds available to the LLR STP by the 20 April 2018. - Support the submission of a joint application for the funds available to the LLR STP by the 20 April 2018. CCBP/18/30 Community Services Redesign (Paper H) Mrs English presented the brief paper which summarised the discussions leading up to redesigning of the community services. She stated that following discussions at the CCB in Page 8 of 10
March 2018, it was agreed to undertake a comprehensive review with the aim of redesigning the community services. The redesign is expected to include as a minimum Community Hospital Inpatient Services, Intensive Community Services (ICS) and Community Nursing. Ms Hooton added that the scoping exercise is underway via the HomeFirst programme Board. It was noted that the proposed service redesign has been communicated to the current provider who is Leicestershire Partnership Trust (LPT) and has been formally noted in a contract variation for 2018/19. Mrs English indicated that the review of the services will be completed by September 2018. The redesign team will include GPs, Chief Nursing Officer, Finance Officer, Contracting Lead, Urgent Care Lead and Integrated Locality Teams. The work will be carried out in two phases and monthly progress updates will be presented at CCB. Professor Lakhani re-joined the meeting. Professor Farooqi stated that the scope to include work around the localities in terms of strengthening the relationship between practices and community staff. To also ensure the community teams are engaged with the practices. In addition Ms Lock added that the interface change would not only be with LPT but would also include interfacing with acute services. Mr Sanders stated that at the morning s SLT meeting there was some brief discussion on work around frailty and multimorbidity. His views were to ensure that there is right balance of people in the team taking the work forward. In addition to engage with the practices and the Governing Bodies. Ms Hooton explained that some of the frailty interface work around the community services is taken forward via the Delivery board, however she agreed that there needs to be consistency across the work. Ms Hooton requested clinical input to be part of the scoping exercise. Mrs English to nominate a clinical colleague from the CCGs to work with Ms Hooton. In addition it was agreed that further update to be provided at the next meeting. Ms Hooton Note the progress to date and to accept updates at future meetings. Meeting concluded at 2:25pm Page 9 of 10
Date of Next Meeting Thursday, Leicester City CCG, Conference Room, 8 th Floor, St Johns House, 30 East Street, Leicester, LE1 6NB. West Leicestershire CCG to Chair the meeting from May August 2018 Inclusive. Page 10 of 10