Joint Borderline & Peterborough LCGs Board Meeting Friday 4

Joint Borderline & Peterborough LCGs Board Meeting
Friday 4th October 2013, 2:00 pm - 4:00 pm
Sorrento Room, The Fleet, Fleet Way,
High Street, Fletton, Peterborough, PE2 8DL
MINUTES
Attendees:
Dr Richard Withers (RW)
Dr Oliver Stovin (OS)
Dr Cosmas Nnochiri (CN)
Belinda Fraser (BF)
Karen McNally (KM)
Mary Bryce (MB)
Michael Bacon (MB)
Chair
Referral Lead
PDMA Lead
Nurse Representative
Practice Manager Representation
Healthwatch Representative
Patient Participation Group Lead)
In Attendance:
Tina Almond (TA)
Chris Humphris (CH)
(for agenda item 1.1)
Karen Hayton (KH)
(for agenda item 1.2)
Dr Stuti Mukherjee (SM)
(for agenda item 1.2)
Jill Eastment (JE)
(for agenda item 1.2)
Dr Andrew Anderson (AA)
(for agenda item 1.3)
Simon Brown (SB)
(for agenda item 1.3)
Marie Kinch (MK)
(for agenda item 1.3)
Peter Wightman (PW)
(for agenda item 1.4)
Vi Thomas (VT)
Borderline Administration Support Officer
Assistant Director Commissioning &
Contracting
Contracts Manager, Catch/Cam Health LCGs
GP Lead for Cancer, Catch/Cam Health LCGs
Public Health Information, Cambridgeshire
County Council
Community Services Lead
Strategic Project Support, Cambridgeshire and
Peterborough CCG
Deputy Director of Quality, Safety & Patient
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(for agenda item 1.6)
Experience, CCG
Apologies for Borderline LCG Board:
Dr Mark Attah (MA)
Dr Andrew Anderson (AA)
Dr Gary Howsam (GH)
Kyle Cliff (KC)
Cathy Mitchell (CM)
Caroline Houlton (CH)
Margaret Osibowale (MO)
Simon Pitts (SP)
Alan Sadler (AS)
Co-opted Member
Community Services Lead
Vice Chair
Assistant Director of Commissioning & Contracts
LCG Lead, Borderline & Peterborough LCGs
Lead Pharmacist
Finance System Lead, Borderline & Peterborough
LCGs
Programme Manager, Borderline & Peterborough
LCGs
Business Manager, Borderline & Peterborough
LCGs
Action
The running order of the agenda was changed to accommodate staff who had
been delayed. Running order; Item 1.6, 1.2, 1.3, 1.1, 1.4, 1.5, 1.7, 1.8, 1.9, 1.10
and 1.11
1.
1.1
Agenda Item 1 JOINT MEETING:
BORDERLINE AND PETERBOROUGH LCG BUSINESS
Children’s Procurement Update
• Plus request for update on the CAMHS re-commissioning
exercise – (following the OPPB meeting held 25/09/13)
Chris Humphris, Assistant Director Commissioning & Contracting attended
the meeting to provide an update on CCS options for Children’s services for
the future.
The paper shared with the LCG Boards went to the Governing Body last
week.
The Governing Body had been asked to;
•
•
•
agree to the two stage process for commissioning services for
children and young people as outlined in this paper
note the proposed scope of services to be considered and the
planned timetable
note that key decisions about how services will be secured for the
future will come to the February 2014 Governing Body meeting
Noted the Governing Body had approved the recommendations.
It was noted the future commissioning of children’s health services was an
important area for the CCG and members were asked to endorse the
continuation of the work as outlined in the paper in order to be able to bring
proposals to the Governing Body for decision in February 2014.
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CH indicated CCS can choose the timeframe to commission future services
ready for April 2015.
Services will need to continue until then with
contractual rigour.
CCS recognises the commissioning plans for the Cambridgeshire &
Peterborough area. CM advised there were plans in progress to create a
Joint Commissioning Unit with Peterborough City Council and other outlying
providers. CMET had approved the joint commissioning unit to progress.
A draft Section 75 document was in development. This will be shared with
the Joint Commissioning Forum and the LCG Boards in November. Further
work will be required to develop a vision and service spec.
Action: Draft Section 75 document to be shared with the Joint
Commissioning Forum and the LCG Boards in November 2013.
CM
The LCG Boards noted and are aware of the work programme for the Joint
Commissioning Unit and are assured it fits with local needs.
1.2
Cancer Dashboard (Presentation)
Karen Hayton, Contracts Manager, Catch/Cam Health LCGs, Dr Stuti
Mukherjee, GP Lead for Cancer, Catch/Cam Health LCGs and Jill
Eastment, Public Health Information, Cambridgeshire County Council
attended the meeting to give a presentation on Cancer Dashboard.
Presentation attached for information.
Agenda Item 1.2 General Practice Profiles for Cancer Pet Borderline
KH informed the LCG Boards the National General Practice Profiles had
been designed to assist GPs, Clinical Commissioning Groups (CCGs),
Local Authorities and others to ensure provision of commissioning effective
and appropriate healthcare services for the local population.
Noted the profiles had been produced by the National Cancer Intelligence
Network (NCIN) and provided information about key indicators relating to
cancer services for GP practices in England. The profiles provided
comparative information for benchmarking and review variations at a
general practice level. KH informed the LCG Boards these were intended
to help primary care think about clinical practice and service delivery in
cancer and, in particular, early detection and diagnosis.
Updated profiles had been produced for every GP practice earlier in the
year using data from 2011/12, but the volume of data and the number of
different measures included could be quite overwhelming. Noted KH/SM
and JE had undertaken a piece of work in the Cambridge Health System
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around distilling the information in the NCIN profiles to make it more
digestible for LCGs/individual practices.
Recommendations
It was encouraged that all practices review their cancer referral pathways
and consider carrying out a local audit. Noted one of the Cam Health
practices had carried out an audit and the methodology for this could be
shared on request.
It was recommended one aspect for high referring practices to look at
would be whether any patients referred under the two week wait could have
been referred routinely rather than under the two week wait. It may be
necessary to review the use of referral proformas to ensure it is clear which
patient referrals are intended for the two week wait pathway and which are
routine.
With regard to low referring practices, it was suggested it may be worth
reviewing cancers diagnosed through ‘Emergency’ and ‘Other’
presentations to see if anything different could have been done to diagnose
the patient through a managed pathway. An audit of unexpected deaths
may also be of value. Practices may want to consider selective use of
Qcancer.org, which is a risk stratification tool to help GPs identify patients
at risk of cancer.
LCGs may want to review the design of local referral proformas to ensure it
is clear which referrals are intended for the two week wait pathway and
which are routine.
Noted this had been discussed locally with
Addenbrookes and a plan to understand further work in this area is being
progressed. Noted some proformas did not require a GP to choose the
referral route until the referral criteria was completed. This could be helpful
as the process of completing referral criteria may alter the GPs view of
whether the referral needs to be under the two week wait system or not.
Where patients were referred under the two week wait, GPs are
encouraged to issue the two week wait patient leaflet, which explains why
the referral is being made under the two week wait and will prompt the
patient to make themselves available to attend any appointments in that
timeframe. Acute trusts find that many patients wait longer than two weeks
because they choose not to prioritise their appointment.
Discussion around data/graphs took place;
Scatter graph of C&P CCG two week wait (GP urgent) cancer referrals
2011/12:
Some concern that the graph seems to indicate very low numbers of
cancers when GPs are aware of higher incidences.
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BP queried whether the drivers that drive up high referrals had been
investigated.
KH responded it was quite difficult as the team looked at the wider data and
practices looked at their own data at practice level.
It was commented that areas of low deprivation may not get involved with
cancer screening processes. How is the co-relation of deprivation plotted?
Dr Stuti Mukherjee, Karen Hayton to share report more widely and circulate
to practices/individual GPs.
The LCG Boards thanked Dr Stuti Mukherjee, Karen Hayton and Jill
Eastment for the presentation on the Cancer Dashboard. Tabled report to
be sent round electronically to Board members.
Action: TJ/TA to request electronic copy of report to circulate to
Board members. (Report attached)
Cancer Practice
LCG Graphs GP
Profiles paper for LCGs.doc
Profiles for Cancer Pet Borderline.pptx
1.3
Herts Urgent Care (111 provider Q&A) to be confirmed
• 111 CG responsibilities for ensuring DoS is up to date
Dr Andrew Anderson, Marie Kinch and Simon Brown attended the meeting
to provide an update on 111.
Work continues on the local Directory of Services (DoS). Go live date for
Cambridge is scheduled 12/11/13. Plans are progressing for Peterborough
go live 03/12/13.
The Directory of Services will be CCG owned and will require regular input
from localities to make sure information is up to date.
A GP DOS is being developed using the national GP template.
There are plans in place with a GP practice in Sawston to manage the
frequent callers to the 111 service (people who call 3 times or more in a 4
day period). The caller will be referred back to their own GP practice.
AA advised that detail and special notes have been shared with GP
practices.
The LCG Boards queried how OOH services will be accessed if required.
Dr Anderson advised that there is a health professional phone line that will
be available.
CH asked for confirmation if the community pharmacy DoS had been
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TA/TJ
developed using the national template. This was confirmed.
AA suggested it will be part of future planning that each GP practice review
its own DoS profile.
No action required currently at GP Practices. Phone messages should not
be changed until notified.
The LCG Boards thanked Dr Andrew, Simon Brown and Marie Kinch for the
update on the 111 service.
1.4
GP Primary Care Offer
Peter Wightman, Strategic Project Support, Cambridgeshire and
Peterborough CCG, attended the meeting to generate a discussion to
identify opportunities and ideas for the scope of the Primary Care Offer.
It was noted there was a clear conflict of interest for CCG members. The
scheme needs to ensure that its decision making and performance
management arrangements are robust and open to scrutiny.
The purpose of the scheme was to use commissioning resources to support
practices to fulfil the CCG’s primary care vision and thereby improve quality
and outcomes for patients and reduce system costs. The aim was to
implement a scheme from 1 April 2014.
This paper aims to stimulate LCG ideas during 1 October – 21 October so a
more detailed proposal can be developed for discussion in early November.
This will then allow for a proposal to be considered by the Governing body
in December 2013.
Ideally PW would like a GP lead for each domain in developing the Primary
care offer.
A suggestion was made, if there is time, to send a questionnaire to all GPs
for input and ideas.
The LCG Boards discussed the paper and the following comments were
recorded;
• should unplanned care be listed within the domains?
• positive the process is moving forward, but not optimistic that it will
work
• awareness of statement regarding overfunded practices and
concerns regarding which practices may receive less monies
• the LCG Boards acknowledged differences between C&P Primary
care establishments and the primary care offer will need to take into
account local pressures and issues
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•
concern regarding LES payments – need clarity on what is working
and what is not
PW advised work is in progress with regard to LES agreements to identify if
these are fit for purpose.
1.5
Recommendation
The Borderline and Peterborough LCGs are asked to contribute specific
proposals and consider how they wish to be involved in the development of
the proposal (through chairs or a named GP lead).
Action: Each LCG Chair to consider name of lead and deputy to be
involved in the GP Primary Care Offer process.
RW/MC
The LCG Boards thanked PW for attending the Joint Board meeting to
discuss the GP Primary Care Offer. PW concluded updates will be
provided in the future as the Primary Care Offer develops. TJ/TA To add to
forward plan.
Action: TJ/TA to add GP Primary Care Offer to forward plan for future
updates to the Joint LCG Boards.
TJ/TA
Hospital Alcohol Liaison Project (HALP)
CM informed the LCG Boards the HALP report had been submitted to the
last Borderline & Peterborough Transformation Board on 6th September
2013.
As part of the update to the Borderline & Peterborough
Transformation Board, Rod Grant had reminded the Board the HALP
Project was currently funded up to 31st March 2014 at which point the
service would cease operating if further funding was not available. The
Borderline & Peterborough Transformation had suggested the report be
brought to the next meeting of the LCG Boards to discuss whether the
Project should be funded post 31st March 2014. Noted the Borderline &
Peterborough Transformation Board had supported the proposal.
The LCG Boards were asked to agree to fund the service for 2014/15 at a
cost of £105k. This would also require a letter to be written to South Lincs
CCG to request a contribution to the running costs for 2014/15.
The LCG Boards agreed to fund the HALP service post 31st March 2014
and agreed a letter should be written to South Lincs CCG to request a
contribution to the running costs for 2014/15.
Action: CM to draft a letter to South Lincs CCG to request a
contribution to the running costs for 2014/15 for the Hospital Alcohol
and Liaison Project (HALP).
1.6
Quality Report – September 2013
Vi Thomas, Deputy Director of Quality, Safety & Patient Experience, CCG,
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CM
attended the meeting to enable the LCG Boards to discuss the Quality
Report and any issues or exceptions arisen from the Quarter (June-August
data).
VT informed the LCG Boards the Quality team had pulled out the providers
relevant to the LCGs, which had been part of the bigger report which went
to the Patient Quality & Safety Committee. Noted concerns had
materialised with CQC for CCS. Additional visits had been planned to
resolve these issues and this was incorporated in the Remedial Action Plan
(RAP).
VT highlighted the following from the report;
District nursing – contract query issued and positive steps were being
taken.
Safeguarding (provider detail) – concern expressed with regard some
providers not getting staff to regularly attend the safeguarding training. This
is being reviewed.
PSHFT – there is concern with regard to Infection Control (CDiff). Numbers
were below the threshold, but still a cause for concern. Peer review visits
are planned to address this.
Safeguarding PSHFT – issued with a contract query. RAP in place.
Steady progress being made to resolve issues.
Care Homes – there are areas within care homes where there are
concerns. Care Home Exception Report is in place to monitor quality with
regard to standard of care.
The LCG Boards discussed the report and the following comments were
captured;
HM questioned the review dates. VT responded the next report will have
an update of reviews undertaken, unless reviews were delayed for any
reason.
RW strongly highlighted the need to be aware that CDiff was part of the
Quality Premium at a cost of around £1/2 million and there was a big risk if
this was not hit across all providers.
Question was asked around where the team focussed their attention
matrix/soft intelligence.
VT informed the LCG Boards soft intelligence was launched in February for
GPs to flag concerns with regard to providers being available for PRG
Groups, but that the email address had not been utilised very well. Noted
visits to Practice Managers Forum to promote the Soft Intelligence phone
line.
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OS informed VT the soft intelligence phone line had caused concern on at
least two occasions and had recently been cascaded into full blown
complains which had caused anxiety with the process. OS to send
information through to VT so she is able to look into the process which had
been followed and see why this happened. (to take place outside the
meeting).
Action: OS to share Soft Intelligence detail, outside the meeting, to VT
to enable investigation into the process utilised.
OS/VT
HM/AS requested detail with regard to Soft Intelligence be shared more
widely amongst GPs and not just the Practice Managers. VT advised the
Patient Reference Groups will be receiving information about the process.
Request for posters/leaflets to promote the Soft Intelligence system be
supplied at a clinical governance event for GPs/practices to take away with
them.
The LCG Boards thanked VT for attending the meeting to give an update
on the Quality Exception Report for September 2013.
1.7
Early Supported Discharge (ESD)
CM advised Early Supported Discharge (ESD) was a CCG wide priority and
that CAM Health and CATCH LCGs had led on this work.
Noted all LCGs were required to give input and views on the Business
Case and paper by the end of October via CMET. The Borderline and
Peterborough Boards had provided a view which CM will feed in the CCG
meeting.
CM to share outcomes from the CMET group at the November Joint Board
meeting.
Action: CM to share outcomes from CMET at November Joint Board.
TA/TJ to agenda Early Supported Discharge Outcomes for November CM/TA/TJ
2013.
1.8
Contingency Planning Team (MONITOR)
CM informed the LCG Boards a public document was now available and
links have been shared with the papers.
The recommendation was that the PSHFT Acute Trust was clinically viable
but the hospital was financially unstable. CPT have a proposal for recovery
over a 12-18 month period.
The Borderline and Peterborough LCG Boards were asked to note the
content and recommendations made by the Contingency planning Team.
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There was a request for a Peterborough Region Steering Group (PRSG) to
be established and will comprise of Local Clinical Commissioning Group
representatives. The LCGs need to identify a Clinical Lead to become a
member of the Steering Group. It was agreed that Richard Withers and
Mike Caskey would act as our LCG reps on the PRSG
The Borderline and Peterborough LCGs need to engage with the
Peterborough Region Steering Group (PRSG) to ensure that the views of
the local commissioners are considered as the hospital moves forward to
implement the recommendations on the report. The chair of the PRSG will
be an independent member from CPT.
It was commented that this was a key requirement but was not part of the
CCG aims and objectives. Concern that this work will become a large
piece of additional work for the commissioning team and the LCG Boards
expressed concern with being able to offer the additional capacity required.
CM confirmed that the current management team at PSHFT will remain in
place.
Noted if the PRSG does not achieve its goals then CPT will bring in a team
to manage the commissioning aspect.
Add standing item to joint agenda: feedback from the Peterborough Region
Steering Group.
Action: TJ/TA to add Feedback from the Peterborough Region
Steering Group as a standing item on the Joint LCG Agenda.
1.9
Medium Term Financial Plan/Living within our Means (LWOM)
Presentation attached for information.
The Medium Term
Financial Plan_B+P 04 10 13.pptx
Key points of the medium term financial plan for the LCGs to note:
Requirement that a MTF Plan is produced and submitted to the Area Team:
CM advised that Borderline & Peterborough LCGs have fed in details of
Commissioning Intentions, QIPP and all work programmes into the
Financial Plan which has been submitted to the Area Team.
Both Borderline & Peterborough LCG’s have between now and the end of
November to ensure the Financial Plan is complete and meets the needs of
both Borderline & Peterborough LCGs. This will drive forward the work to
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TJ/TA
refresh the Business Plan and help to develop the 3 year LCG’s Business
Plan.
Commissioning Intentions and Living within our Means Action Plans must
be captured within the Financial Plan and the Business Plan. Plus both
Borderline and Peterborough LCG’s need to share detail of Commissioning
Intentions and Living within our Means with GP practices for awareness
and to support delivery.
CM asked for the LCG Boards to ensure the medium term financial plan
(105 pages) is reviewed either in full by nominee of the Board or separated
into sections for several members to review. LCG Boards agreed CM and
MO to break down report (version 2 data) by sections for individual
members to scrutinise.
Action: CM and MO to break down Medium Term Financial Plan
(version 2 data) by sections for individual members to scrutinise.
CM/MO
Concern on the detail of the savings on table 4 and 5 is based on incorrect
referral data coding. CM advised she had made the CCG aware of this
and had requested a refresh of the information.
Request for clarity on the purpose of the Borderline & Peterborough LCG
input?
The LCG Boards will be required to deliver the plans and will be monitored
against the local actions in the MTF plan, the business intelligence team for
the CCG will be supporting each of the 8 LCGs.
1.10
Commissioning Intentions 2014/15
The Joint Board noted the attached letters and it was proposed a response
was drafted to the Commissioning Intentions Letter received from PSHFT.
Action: KC to draft a response to the Commissioning Intentions letter
received from PSHFT.
1.11
KC
QP Initiatives – Area Team Dialogue
MC informed the LCG Boards that QP Initiatives had been discussed at the
recent Governing Body meeting and NM and AV are to write to the Area
Team to express their concern and lack of input to the programme.
S Pitts will prepare a 1 page guide with detail of the Pathways to be SP
included e.g. Sapphire Nurses, Ophthalmology, The Firm etc to be shared
with Practices.
Action: SP to prepare a 1 page guide with detail of Pathways to be
included e.g. Sapphire Nurses, Ophthalmology, The Firm to be shared
with practice.
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SP
Peterborough LCG had not submitted all plans to the Area Team.
noted but not clarified if any penalties would be incurred.
It was
It was noted that Borderline LCG will be working with 2 Area Teams on this
matter, each with differing requirements.
Date & Time of Next Meeting
Friday 1st November 2013, 2.00 – 4.00 pm, Sorrento Room, The Fleet,
Fleet Way, Fletton, Peterborough, PE2 8DL.
Due to the apologies received, no separate LCG Board meeting took place
for Borderline LCG.
There being no further business, the meeting closed at 4.00 pm.
Contact Details
Name: Tina Almond
Email: tina.almond@cambridgeshireandpeterboroughccg.nhs.uk
Telephone 01733 704452
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