MINUTES Meeting: North Herts Locality Commissioning Meeting

Date: 13th January 2016

Venue: Centre for Healthy Living

Attendee Organisation Present Dr Matt Jarvis (MJ) Ashwell Surgery Yes Debra Stapleton (DS) Ashwell Surgery Apologies Dr Richard Stanley (RS) The Surgery Yes Michael Sissens (MS) The Baldock Surgery Yes Dr Rob Graham (RG) Birchwood Surgery Yes Zoe Smith (ZS) Birchwood Surgery Yes Dr Keith Greenish (KG) Courtenay House Yes Denise Robson (DR) Courtenay House Yes Dr Adrian Wood (AW) Garden City Surgery Yes Anne Hegarty (AH) Garden City Surgery Apologies Dr Rob Newby (RNe) Knebworth and Marymead Yes Ken Spooner (KS) Knebworth and Marymead Yes Dr Tim Ramsbottom (TR) Nevells Road Surgery Yes Dr Simon Chatfield (SC) Nevells Road Surgery Apologies Gill Wilcox (GW) Nevells Road Surgery Yes Dr Jeremy Cox (JC) Orford Lodge Yes Melanie Johnson (MJ) Orford Lodge Yes Dr Tara Belcher (TB) Portmill Surgery Yes Melanie Felgate (MF) Portmill Surgery Yes Dr Fiona Sinclair (FS) Chair Regal Chambers Yes Dr Victoria Fraser (VF) Regal Chambers Yes Hayley Telford (HT) Regal Chambers Apologies Dr Richard Nevard (RN) Sollershott Yes Sandie Ince (SI) Sollershot Yes Dr Rajpreet Millan (RM) Whitwell Surgery Yes Beverley Sheaver (BS) Whitwell Surgery Yes Natasha Larmie (NL) Locum, Mental Health Lead Apologies Lee Doherty (LD) Manor Pharmacy Yes Sue Russell (SR) Lead Pharmacist, E&N Herts CCG Yes Nichola Goddard (NG) Locality Manager, E&N Herts CCG Yes Helen Edmondson (HE) Associate Director, E&N Herts CCG Yes Yvette Twumasi‐Ankrah (YT) Lay chair, Co‐Commissioning Yes Invited speakers: Suzanne Taylor (ST) Physiotherapy Lead, HCT For item 3 only Gillian Porter (GP) Physiotherapy Service Manager, HCT For item 3 only Yvonne Penfold (YP) HCT Contract Manager For item 3 only Mary Ann Gregory (MG) HCT Locality Manager For item 3 only

1. Welcome and apologies Apologies above were noted. Page 1 of 5

Declarations of Interest There were no new declarations of interest from members.

2. Actions from Previous Meeting The minutes of the previous meeting were accepted as accurate.

Matters arising: Premises data – forecast growth data have been requested from NHSE. Practices will need to submit any PCTF submissions to the locality so that they are incorporated in wider locality planning. premises team. Feedback on CCG bulletin – the CCG has received a wide range comments on the new look bulletin; further comments should be sent to NG. Action: Practices are asked to send feedback on the CCG bulletin to NG. HPFT feedback – it is proposed that providers will be invited to the June Target event. KS requested a copy of the HPFT performance report Action: NG to circulate copy of HPFT performance report that is submitted to the CCG.

‘Hot topics’ for discussion at end of meeting Items proposed for discussion: Contract hotline feedback; LMC conference; GP education; availability of just in case medication.

3. Discussion of HCT Physiotherapy Service Please refer to accompanying PowerPoint presentation and referral data from HCT. Suzanne Taylor gave an update. The service currently received approx. 16 referrals from the locality per day. TR commented that GPs cannot prioritise as urgent on referral form: ST confirmed this is done by physiotherapist on basis of clinical information (chronicity, sleep disturbance, time off work). It was agreed that GPs could upgrade a referral to urgent by phone call to the service.

The average wait (including urgent referrals) is 6.3 weeks. RG commented it feels much higher than this. It was suggested that staff and patients could be moved to other localities to reduce the current waiting times. There was discussion whether activity could be sub‐contracted to private providers, as in other CCGs. HCT is working to reduce DNA rates and is implementing a pilot of online booking. TB noted that physiotherapists have provided useful feedback to the surgery when they have additional concerns. Action: HCT to provide per capita physiotherapy referral data.

Yvonne Penfold confirmed that the pathway in the current contract is being reviewed, and the CCG will shortly begin the contract renewal process. The current contract incorporates 18 week RTT target.

Feedback on HCT Community Team Mary Ann Gregory invited comments from the locality. HomeFirst Rapid Response continues to work really well. It was noted that a patient was recently discharged from the eye clinic without a discharge summary. MG confirmed that support to this patient for eye drops should go to core team, not HomeFirst. There was discussion of the Macmillan nurse service. There will be some internal organisation in the near future but this will not affect the service. Macmillian triage patients to manage capacity and demand but they should not be rejecting referrals due to capacity issues.

4. CCG Information Update: FS provided feedback:

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DNACPR status is appearing on discharge summaries in a way that could be misinterpreted as meaning a DNACPR decision is in place where it is not. Work is underway to change this. Ambulance service staff have been reminded about the acceptable format of DNACPR i.e. does not need to have red border. Practices should report any issues to the contract hotline.

The Letchworth Centre is running a ‘Positive Movement’ programme funded by HCC which combines Yoga with the principles of Alexander Technique. Classes will be held in , , Letchworth, Baldock, Royston and villages. There will be 15 classes each week accommodating 150 people. The programme is open to older people, people with mobility problems, people living with chronic illness. The cost to participants is £2.50 per session.

5. Introduction to care home pharmacist – Eleesha Pentiah EP is part of the care home pharmacy team within the Vanguard programme. Complex care premium homes are being targeted first, along with care homes with high hospital admission rates or homes with CQC issues (e.g. Foxholes). It was noted that two CCP homes in Knebworth (Roebuck and Monread Lodge) aren’t on current list. The care home pharmacists are working with care home managers and GP aligned to care homes to undertake medication reviews with the overall aim of preventing hospital admissions. The pharmacy team are liaising with HPFT about patients on dementia drugs, and are working to overcome difficulties sharing information with community pharmacy.

Common medication issues will be shared with locality through the prescribing forum. There appear to be specific issues around rationalisation of pain relief and dietetics. The pharmacy team is trying to recruit a dietician to the team.

6. PCG Update The next meeting is scheduled for Tuesday 26th January.

7. Leads Update LTC – The LTC group have not met since the last locality meeting. Prescribing – LD gave an update. The last prescribing forum discussed the current KPI. The locality is performing well in 3/5 of KPI. There has been less progress on the generic sildenafil and the Duoresp switch. Practice prescribing leads are aware where savings can be made that are not resource intensive. The next meeting is 28th Jan. LD will be leaving the locality in the next few weeks. The locality expressed their thanks to LD for all of his work in community pharmacy and working as prescribing lead and noted that he had provided excellent input into the prescribing lead role. Action: practices to invite colleagues (not necessarily a partner) to take on prescribing lead role for the locality. Action: Locality to look to appoint a community pharmacist to continue the work to improve working across general practice and community pharmacy Mental Health – The mental health group have not met since the last locality meeting. HomeFirst – The integrated community steering group is being established.

There was discussion of succession planning as RG’s term as Locality Lead will finish in March 2017. The current understanding is that he would not be able to stand at that point as he would have served two terms. Applications will need to be made at the end of 2016. Members were invited to consider applying for lead roles within the locality as means of gaining experience that would allow them to consider moving on to a locality lead role. Other localities have provided the opportunity for members to take on lead roles (e.g. prescribing, LTC) for 3‐4 month duration to help succession planning. GP fellows may wish to take on these roles as part of their GP development portfolio and we need to publicise these roles via GP the local sessional GPs group (that Natasha Larmie chairs)

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and LMC communication routes. Action: NL to raise N Herts GP locality prescribing lead vacancy with the local sessional GPs group

The CCG is currently in a Co‐Commissioning role with NHSE but it is anticipated it will move to a fully delegated function in due course, which will involve taking on lots of functions on behalf of NHSE, including the GMS contract.

8. Update on Winter Resilience This discussion will be deferred until the next locality meeting.

9. Practice Performance – Courtenay House Please refer to PowerPoint presentation by KG. KG reported that COPD data had previously been skewed by one patient. IFR will now be discussed at the practice referral meeting.

There was discussion whether hernia repair should be categorised as a low priority treatment. Guidance on MoM states that they shouldn’t be repaired if asymptomatic, but only if it is interfering with the patient’s occupation or is getting larger.

There was discussion around GP access; KS noted that he had found call log monitoring software to be very helpful managing access issues. There was discussion whether new care home patients with an existing cancer diagnosis were recorded in the Locality data as a new diagnosis.

10. Hot topics discussion  Over 75s checks. The CCG has written to practices to remind them of the 51% target, and that they will need to demonstrate that they have generated capacity and offered checks to avoid some or all of the initial £20 payment being re‐claimed. Some practices are a long way from meeting the target.  GP education – RS has been appointed as locality lead on a new CCG committee looking at recruitment, retention and education for GPs, Practice Nurses and HCA. The committee will be looking at GP fellowships and post‐ST3 structures. RS will report back regularly to the locality and will work closely with the Federation.  Contract hotline – HCT have resolved problems with referrals to community diabetes services. If practices experience problems with the transfer of care referrals for dementia patients please inform the contract hotline so this can be recorded.  Diabetes medication – SR reported supply problems with some Sanofi Pasteur insulin formulations. The supply issue is unlikely to be resolved soon.  Macmillan nurses and GP practices have reported a shortage of a cyclizine and haloperidol. There are also supply issues with diamorphine. The CCG is in discussion with the Department of Health to receive updates. There was discussion whether centralised supplies of just in case medication could be held in institutions such as nursing homes to avoid wastage. There is a legal requirement for POM to be for named patients so this might not be possible. Action: SR to ask CCG to escalate issue of centralised supplies of just in case medication in nursing homes.  LMC – JC reported that an extraordinary conference has been convened that is likely to focus on workforce issues. The agenda will be circulated as soon as it is available and practices were asked to provide feedback so that their views can be represented at the meeting.  AIHVS – HUC has reported that 60% of urgent referrals were re‐triaged as non‐urgent. GPs were reminded that they need to speak to the patient or carer prior to referring and only as urgent if really necessary.  PHE has issued notification that flu is now circulating and Tamiflu can be prescribed. They have issued guidance about managing outbreaks in institutions. Action: GPs to review PHE guidance in the CCG bulletin about managing outbreaks of Page 4 of 5

influenza in institutions.

9. Any other Business

LD has drafted a paper about the community pharmacist delivery service. This is being reviewed by the LPC and will be circulated shortly.

ACTION Person Date Progress Responsible Practices are asked to send feedback on the CCG All practices 09/02/16 Completed bulletin to NG. NG to circulate copy of HPFT performance report that NG 09/02/16 Completed is submitted to the CCG. HCT to provide per capita physiotherapy referral data. HCT 09/02/16 Circulated with meeting papers Practices to invite colleagues (not necessarily a All practices 09/02/16 Advert circulated partner) to take on prescribing lead role for the locality. Locality to advertise for a community pharmacist to LD/SR 09/02/16 Completed. Dan continue the work to improve working across general Rahemtulla practice and community pharmacy appointed NL to raise N Herts GP locality prescribing lead NL 16/03/16 To be circulated vacancy with the local sessional GPs group SR to ask CCG to escalate issue of centralised supplies SR 09/02/16 Response awaited of just in case medication in nursing homes. GPs to review PHE guidance in the CCG bulletin about All practices 09/02/16 Completed managing outbreaks of influenza in institution

Next Meeting Dates Practice Manager Meeting: Wednesday 20th January, 13.00‐14.30 Target Event: Tuesday 9th February (Letchworth Hall Hotel), 14.00‐18.30 Locality Meeting: Wednesday 9th March, 12.30‐14.30

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