GB 16/030
MINUTES
Nottingham North & East Clinical Commissioning Group Governing Body Meeting Held 15 March 2016 at Gedling Civic Centre
Present
Janet Champion (JC) Deputy Chair – Lay Member PPI Terry Allen (TA) Lay Member – Financial Management & Audit Dr Mohammed Al-Uzri (MA) Secondary Care Consultant Dr Sue Bailey (SB) GP Representative Jonathan Bemrose (JB) Chief Finance Officer Nichola Bramhall (NB) Registered Nurse, Director of Nursing & Quality Dr James Hopkinson (JH) Assistant Clinical Chair Paul McKay (PM) Service Director, Nottinghamshire County Council Dr Paramjit Panesar (PP) Assistant Clinical Chair Stephen Storr (SS) Patient and Public Representative, Observer Sam Walters (SW) Chief Officer
In Attendance
Hazel Buchanan (HB) Director of Operations Maxine Bunn (MB) Director of Contracting Andy Hall (AH) Director of Outcomes and Information Sharon Pickett (SP) Deputy Chief Officer Nikki Pownall (NP) Programme Director, Urgent Care,(agenda item 16/033)
Agenda Actions Items GB 16/027 Welcome & Apologies
Janet Champion (JC) welcomed Dr Sue Bailey (SB) who has been co-opted to the Governing Body as GP representative. Hazel Buchanan (HB) confirmed that JC is Chair due to Dr Paul Oliver’s resignation as Clinical Lead.
GB 16/028 Declarations of Interest
As a co-opted member, SB listed declarations of interest as salaried GP at Calverton Practice. HB confirmed that this does not impact on any items on the agenda.
GB 16/029 Questions from the Public relating to the Agenda
No questions from the public were raised prior to the
meeting.
GB 16/030 Minutes of the Last Meeting
The minutes of the meeting held on 19 January 2016 were accepted as an accurate record.
GB 16/031 Matters arising and actions from the meeting held on 19 January 2016
16/007 – Paul McKay (PM) confirmed that David Pearson, Director of Adult Social Care, Health and Public Protection has written to all CCGs. PM confirmed that there are challenges for both health and social care in relation to continuing healthcare however, since the consultation considerable work has been carried out and the number of cases behind schedule has reduced by half.
16/013 – Nichola Bramhall (NB) and PM have met to discuss how CCGs can work closely with Nottinghamshire County Council on Personal Health Budgets. NB confirmed that the CCG post has been recruited to.
16/016 - East Midlands CCGs Affiliated Commissioning – Sharon Pickett (SP) was confirmed as the CCG representative. A GP representative will be identified when recruitment to the Governing Body is complete.
GB 16/039 Patient Story
NB introduced the patient story and welcomed the patient who shared the story. NB highlighted that the story had been brought to the Governing Body as it referenced a positive experience. The story is in relation to the Fetal Care Unit at Nottingham University Hospitals NHS Trust and in particular staff Alec McEwan and Anne Rooke. NB emphasised that if involvement and compassion are demonstrated even really difficult and tragic situations can be a positive experience of care. The story demonstrates ease of access and self-referral into the service which gave an element of control and confidence to the patient. The patient confirmed that the Trust is reviewing how the compassionate care demonstrated in the Fetal Care Unit can be rolled out to the whole of the maternity unity. The patient emphasised that there are foundations to learn from rather than re-inventing in other areas of the Trust.
NB confirmed that Nottingham University Hospitals NHS Trust have responded well to the recommendations from the patient story in January.
Dr Parm Panesar (PP) emphasised that the positives were around fundamentals including shared decision-making,
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communication and consultation skills and our response should focus on these points and how to embed.
JC thanked the patient for her contribution.
The Governing Body:
Acknowledged the patient story.
GB 16/033 Urgent Care Vanguard Update
JC welcomed Nikki Pownall (NP) who presented an update on the urgent care vanguard. NP confirmed that the original bid covered three models of care that covered the front door of the Emergency Department, clinical navigation within medicine, 24/7 crisis support for mental health access to the Emergency Department. An evaluation has been commissioned for the front door model. A piece of work has also been commissioned to understand whether Nottingham University Hospital NHS Trust have the right capacity in the right place by looking at a system flow model. NP confirmed that there is a risk that the level of funding will be reduced. NP highlighted some of the successes to date and emphasised that these had been as a result of the Nottingham bid being clinically and patient driven. There is now a much more managed and safer environment for patients in AMRU. Clinical navigation has resulted in a considerable reduction in GP admissions of over 1,000 per month and in AMRU attendances. Navigation to community services is in place. Work has started on integrated care ready to implement in 2017. NP confirmed that Nottingham is one of the centres that has a mental health practitioner attached to 111.
PP highlighted that the care navigator is very well received in primary care and has re-introduced dialogue on complex patients. NP confirmed that plans are to mainstream it through the integrated front door. In response to a query raised by PM, NP confirmed that modelling is being carried out to help progress with transfer of care across health and social care.
The Governing Body:
Acknowledged the progress in urgent care and supported ongoing plans.
GB 16/032 Chief Officer Report
Sam Walters (SW) introduced the report and highlighted the following points:
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SW confirmed that discussions have progressed in relation to the footprint. The footprint will include all of Nottinghamshire except for Bassetlaw. Governance is being pulled together using the Collaborative Congress with a steering group. The sustainability and transformation plan (STP) will be made up of Greater Nottingham Health and Care Partners and Mid-Notts plans and what is being worked on together ie acute services reconfiguration. NHS Rushcliffe CCG is the co-ordinating CCG and there will be named individual. A decision has been made to have an external person in order to provide additional capacity and this is out to advert on NHS jobs.
SW highlighted that the national tariff proposals have been published and the CCG have to have 1% of budget uncommitted. Jonathan Bemrose (JB) confirmed that this resource can not be committed and there has been some detail on how it should be deployed.
CCGs have a new improvement and assessment framework. NHS Clinical Commissioners have responded back to the consultation on behalf of CCGs and the focus of the framework is on three aims. The themes are around the right cultures and behaviours to implement transformation.
PLANNING GB 16/034 Contract Negotiation Update
Maxine Bunn (MB) provided an update on the contract negotiations and confirmed that contracts should be signed by the end of March with notification by the 18 March if there is going to be a side contract. The negotiations are hindered by the fact that final tariff is not published and the final contract is still out for consultation. MB confirmed that there is still quite a big gap in the negotiations and offers have been put in for an envelope and payment by results contract. An envelope would help facilitate transformation and help Nottingham University Hospitals NHS Trust to get costs out of the system. Payment by results provides the wrong incentives. SW confirmed that the difference in mediation leading to arbitration is very different this year compared to last year. JB emphasised that those involved in the negotiations at Nottingham University Hospitals NHS Trust are not focused on the wider picture and transformation and are massively focused on the numbers only. SW highlighted that Nottingham University Hospitals NHS Trust are not seeing this as an opportunity to take activity and costs out. In response to a query raised by Terry Allen (TA), MB confirmed that Derbyshire are looking at an envelope.
The Governing Body:
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Acknowledged progress with negotiations.
GB 16/035 Planning Submissions 2016/17 Operational Plan Activity Plan Finance Plan & Opening Budgets
Sharon Pickett (SP) introduced the operational plan for comment and approval. SP confirmed that NHS England have reviewed and provided feedback. NB thanked SP for pulling together, including co-ordinating across south Nottinghamshire, and TA highlighted that is a super document.
Andy Hall (AH) presented the activity plan and confirmed that it is in two parts covering the activity that need to contract for and performance against NHS Constitution standards. The contracts will add up to the value of the plan. Expectations from NHS England are included in the plan. SW highlighted that NHS England are concerned whether CCGs are buying enough activity and the plans must show an expected level of growth.
JB confirmed that there are further iterations of the finance plans to submit with constructive challenge around activity. JB highlighted that despite increase in allocation there are places for the growth to go. JB recommended the Governing Body approve the opening budget with the recognition that the final submission is impacted by the agreement of contracts. TA outlined support for the finance plans and confirmed that there have been length discussions in the Finance and Information Group. The challenge is £8m QIPP.
NB highlighted concerns in relation to the increasing costs of packages of care for Continuing Healthcare. JB emphasised the need to ensure that the CCG is doing everything it can to ensure that getting best value through new contract for Continuing Healthcare. PM outlined the opportunities to look at an integrated Continuing Healthcare budget.
The Governing Body:
Approved the plan and delegated authority to Sharon Pickett for any subsequent minor changes ready for final submission.
Approved the opening budgets.
FINANCE AND PERFORMANCE GB 16/036 Finance Update Finance Position
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Activity Report Month 10
JB confirmed that reported agreed position for year end with Nottingham University Hospitals NHS Trust, Circle and Health Partnerships and that the CCG will deliver against duties for 2015/16. JB highlighted that QIPP pressures remain and there is concern on the scale of the challenge. JB confirmed that the year end surplus will be £1.8m. TA highlighted that the activity report had been reviewed in the Finance and Information Group and apart from outpatient follow ups the CCG have been relatively consistent on plan.
The Governing Body:
Acknowledged the year end position and activity.
GB 16/037 Performance Report – March 2016
Andy Hall (AH) presented the performance report. AH highlighted urgent care performance and cancer. Accident & Emergency figures are below 90% for the whole of the year, and continues to be poor performance. AH confirmed that there are a series of escalation discussions taking place locally and regionally. AH highlighted that cancer performance is improving. There is still some work to be done for breast two week wait but this has been impacted by increasing demand and pressures that continue to be received due to closures of sites in Lincolnshire. There are some remaining issues around patient choice and high proportion of patients declining appointments. Nottingham University Hospitals NHS Trust are working on stratifying those that are potentially a cancer and those that are not to improve performance on two week wait. AH confirmed that the backlog for 62d wait is coming down but this is impacting on overall performance. Issues remain re late tertiary. Discussions are being held against the remedial action plan. The CCG is showing marginally above threshold for diagnostics. Ambulance services are getting worst and regional discussions are taking place. The junior doctors strike has impacted on cancelled operations.
PP highlighted that Sherwood Forest Hospitals NHS Foundation Trust are also struggling with 62d target and action plans for both organisations relate to getting through the backlog. PP questioned whether there a risk on the need to spread clinical capacity. AH confirmed that there is a risk however there is also the opportunity to through improvements in clinical pathways resulting in fewer delays.
PP raised the question as to whether the CCG should and could be doing more in relation to East Midlands Ambulance Service NHS Trust, taking into consideration the challenges within the Trust itself. AH is attending performance
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discussions with NHS Mansfield and Ashfield CCG and supporting NHS Hardwick CCG. All contract levers have been applied and issues have been escalated through the Trust Development Authority and NHS England. SW confirmed that consideration is being given to the contract at East Midlands Congress. A risk summit has been undertaken.
In response to a question raised by SB on the urgent care centre, SW confirmed that this is being accessed as expected and future communications are planned to promote further.
The Governing Body
Acknowledged performance and actions being taken by Commissioners.
GB 16/038 Better Care Fund
JB provided an update on the Better Care Fund. JB confirmed that fund covers Nottinghamshire, excluding Nottingham City. JB presented three documents detailing the schemes and confirmed that they meet the national requirements and conditions. JB confirmed that there has been external scrutiny. TA highlighted that significant assurance has been received on al reviews which is not the case elsewhere in the country. JB asked for delegated authority to JB and SW to approve any minor changes prior to final submission.
The Governing Body
Approved the schemes and submission with minor changes following comments from Governing Bodies.
QUALITY
GB 16/040 Quarter 3 Quality Report
NB presented the quarter three quality report and highlighted areas to be escalated to the Governing Body. These include health care associated infections and Nottingham University Hospitals NHS Trust were over the limit for C Diff at the end of quarter three and the current position is 91 cases against a year end of 91. This is an improved position. Whilst will end the year over trajectory at the start of the year the Trust were at 60%. Work has been carried out on environmental cleanliness which has had a positive impact. The CCG are on target to meet the trajectory. Nottingham University Hospitals NHS Trust have had six cases of MRSA against a target zero. Only one has been clinically avoidable. There is a revised
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trajectory for retrospective Continuing Healthcare. NB confirmed that there is a case by case contract with Arden Gem Commissioning Support Unit. NB is confident that the CCG cases will be concluded by the end of March.
GB 16/041 Personal Health Budgets - Local Offer
NB provided an update and confirmed that the offer is within and outside of Continuing Healthcare. Plans are to start small with the view to expand over time. In response to a query raised by JB, PM confirmed that resource has been freed up where personal assistants have been recruited as opposed to using agencies. PM highlighted that personal health budgets are not a means of saving money and more work is required from social workers to allow for creativity and flexibility in support planning.
The Governing Body:
Acknowledged the local offer.
GB 16/042 a) South CCGs Quality and Risk Committee Meeting- highlight report – 3 February 2016 b) South CCGs Quality and Risk Committee Meeting – 29 Oct 2015
NB confirmed that work is being carried out on scoping deprivation of liberty safeguards and can now apply to NB homecare packages. NB will bring a paper to the Governing Body.
The Governing Body:
Acknowledged the outcomes of the Committee meetings.
GOVERNANCE GB 16/043 Primary Care Commissioning Committee
TA provided an overview of the Committee meeting and confirmed that a paper had been presented on the Colwick branch closure.
The Governing Body:
Acknowledged the outcomes of the Committee meeting.
GB 16/044 Audit and Governance Committee 27 January 2016
TA provided an overview of the Committee meeting and confirmed delivery against plan for the year. JB confirmed that the external auditors have carried out an initial review and have not identified any issues. TA confirmed that a meeting was held with the Committee and Finance to review month nine figures and submissions. TA highlighted that
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the Committee considered the register of declarations of interest made.
The Governing Body:
Acknowledged the outcomes of the Committee meeting.
GB 16/045 Governing Body Assurance Framework
HB presented the updated assurance framework and highlighted the assurance and controls and risk ratings for each strategic risk. The Governing Body requested that risk 8 is reviewed in May as rating is dependent on the outcome HB of the contract negotiations. To be reviewed in May meeting. The Governing Body asked that new models of care remain red as not achieving some of core standards.
The Governing Body:
Approved the assurance framework.
GB 16/046 Integrated Risk Management Framework
HB presented the framework highlighting the amendments. HB highlighted the risk appetite as working towards “mature” and asked the Governing Body for confirmation that this was still accurate.
The Governing Body:
Approved the framework and the risk appetite.
GB 16/047 Information Governance Update
HB presented an update on information governance, including the completion of the toolkit. HB requested delegated authority to approve the IG toolkit. HB highlighted that the CCG is a strong position in relation to practices, processes and knowledge on information governance.
The Governing Body:
Acknowledged the good work on information governance and approved delegated authority.
DOCUMENTS GB 16/048 Minutes
a) Nottinghamshire Safeguarding Children’s Board Minutes 21 September 2015 b) Nottinghamshire Safeguarding Adults Board 8 October 2015 c) IGMT Committee & Highlight report
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d) Clinical Cabinet 16 February 2016 e) Finance & Information Group 9 February 2016 f) People’s Council Minutes 26 January 2016
The Governing Body:
Acknowledged the minutes.
GB 16/049 Reports
a) Connected Nottinghamshire Newsletter Feb 2016 b) HWB Summary January & February 2016 c) Research – County CCGs 3rd Quarter
The Governing Body:
Acknowledged the reports.
CLOSING ITEMS GB 16/050 Have the Public Questions Been Answered
No questions were raised.
GB 16/051 Any other business
SW circulated a letter on a Call to Action on the prevention challenge in the East Midlands. A key element is the appointment of a Governing Body level prevention champion. SW would like to support. The Governing Body HB supported with a decision on the champion when new GPs recruited.
An urgent Governing Body meeting took place but confirmation has not been made in public with respect to Dr Paul Oliver resigning as Clinical Lead. Janet Champion is interim Chair. Interviews are scheduled for the end of April.
SW confirmed that Dr Mohammed Al-Uzri (MA) has resigned and will remain on the Governing Body until a replacement is found. MA highlighted that is was not an easy decision and has enjoyed being part of the team and involved in the journey since authorisation and the CCG becoming a statutory organisation.
Date, Time and Venue of Next Meeting
Tuesday: 19 May 2015, Gedling Civic Centre, Arnold.
SIGNED: ……………………………….…………… (Chair)
DATE: ………………………………………………………..
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