Minutes of the Leicester, Leicestershire and Rutland PCT ... - NHS

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LLR PCT Cluster Board meeting
14 June 2012
Minutes of the
Leicester, Leicestershire and Rutland PCT Cluster Board Meeting
held on 10 May 2012 at 12.45pm
at Conference Room 1 and 2, Lakeside House, 4 Smith Way, Grove Park,
Enderby, Leicestershire, LE19 1SS
Present:
Mrs Cathy Ellis
Ms Catherine Griffiths
Ms Gill Brigden
Mr Barry Finan
Mr Paul Hackwood
Ms Ruth Ingman
Mr David Mell
Mr Brian Wilson
Ms Sue Bishop
Dr Aly Rashid
Mrs Liz Rowbotham
Ms Vikki Taylor
Ms Deb Watson
Chair
Chief Executive
Non-Executive Director
Non-Executive Director
Non-Executive Director
Non-Executive Director
Non-Executive Director
Non-Executive Director
Director of Finance and Estates
Medical Director
Director of Quality, Communications and Engagement
Director of Commissioning Development
Director of Public Health and Health Improvement (City)
In Attendance:
Mr Nigel Skea
Ms Sharon Robson
Mrs Daljit K. Bains
Ms Christina Marriott
Ms Angela Bright
Dr Simon Freeman
Mr Jim Bosworth
Mrs Janice Hopkins
Director of Organisational Development and Workforce
Associate Director of Quality
Associate Director of Corporate Governance
Contract lead for the Integrated Equality Service, LPT (for
item CB/12/141 only)
Chief Operating Officer of West Leicestershire CCG (for
item CB/12/142 only)
Managing Director of Leicester City CCG (for items
CB/12/149, CB/12/153 and CB/12/154 only)
Associate Director of Non Acute Contracting & Provider
Performance (item CB/12/155 only)
Corporate Services
CB/12/129
Welcome and Introductions
Mrs Cathy Ellis, Chair welcomed Mrs Sue Mason from Leicester LINk,
2 other members of the public and Cluster Board members to the
Leicester, Leicestershire and Rutland PCT Cluster Board Meeting.
CB/12/130
Questions from the Public
Mrs Ellis noted that this was a board meeting held in public not a public
meeting. Questions would be taken from members of the public on
current board agenda items only at the beginning of the meeting and
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answered either immediately or when the paper was discussed by the
Board.
Mr Zuffar Haq was not able to be present at the meeting but had sent a
question.
1. Mr Haq has received several complaints with regard to 0844 GP
surgery numbers, he asked:-
How many GPs in LLR have 0844 numbers
When were the contracts entered into
How many GP surgeries have switched over and what
numbers have they switched over to
Mr Haq said that patients are being kept on hold when calling
these 0844 numbers and this costs the patient a large amount of
money to make the call when wishing to make an appointment to
see their GP. Mr Haq is concerned that GP access is
compromised and the patients could then attend A&E as a result
of not calling the 0844 number.
Mrs Mason asked if the same information could be provided for
dental service providers.
Dr Rashid to respond.
Action: Dr Rashid.
Mrs Sue Mason - Leicester LINk
1. It is good to see that the 62 Day Cancer Wait problem seems to
have been addressed to some extent; however your own
minutes in January showed an 83% deterioration and February a
79% deterioration.
On these figures an Exception notice was served on UHL on
24th February.
Now we are being told that the figures for January are 86.9%
and February 85.3%. If these Figures were correct surely you
would not have served an Exception Notice on UHL.
a. Please could you tell us exactly what or which are the
correct figures, those you published in your own
minutes that are in the public domain for January and
February or the ones we are now being given to
believe are correct but not published in the public
domain.
There seems to be a very strange discrepancy here.
Dr Freeman said that the difference in the 62 day
wait cancer figures is that the standard is being
met in the month, but not on a cumulative, year to
date basis.
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2. Can I congratulate the 3 Clinical Commissioning Groups for
being in the first tranche accepted by the Government and wish
them success in everything they are trying to do for the patients
of Leicester City, Leicester East and Leicester West.
CB/12/131
Apologies for Absence
Apologies for absence were received from Ms Judith Hill, Director of
Nursing; Dr Peter Marks, Director of Public Health (County); Mr Toby
Sanders, Managing Director, West Leicestershire Clinical
Commissioning Group.
CB/12/132
Declarations of Interest on agenda items
There were no declarations of interest regarding items on this agenda.
CB/12/133
Minutes of the LLR PCT Cluster Board Meeting held on 12 April
2012
The minutes of the LLR PCT Cluster Board meeting held on 12 April
2012 (as attached in Minute Book – Appendix Number CB/05/10/A)
were received and agreed as an accurate record.
CB/12/134 Matters Arising and Actions from the LLR PCT Cluster Board
Meeting held on 12 April 2012
The action matrix was reviewed (as attached in Minute Book –
Appendix Number CB/05/10/B) and the following noted:
CB/11/255
CB/12/117
CB/12/119
Emergency Care Network – progress report and
assurance
Mr Finan asked if anyone from UHL would be joining the
visit to Nottingham. Mrs Rowbotham replied that UHL had
already visited Nottingham; the invitation list has not been
finalised and UHL and the CCG urgent care leads could
attend.
Final Update on Market Harborough Business Case
It was felt more appropriate that Ms Carmel O’Brien
respond to the action regarding the patient experience of
those people that have attended the new endoscopy unit.
Acute Contract Performance Report January/February
2012
In relation to the UHL Cost Improvement Risk
Reconciliation, Mrs Rowbotham said that the most up to
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date information should be in the report. Ms Bishop said
that the information appeared to be several months old.
Mrs Rowbotham said that she would check this.
ACTIONS which were highlighted green were agreed as complete and
will be removed from the matrix.
CB/12/135
Any Other Business
Mrs Rowbotham said that she would like to reconfirm the Board
meeting dates for the rest of the year.
CB/12/136
Chair’s Report
Mrs Cathy Ellis, Chair of Leicester, Leicestershire and Rutland PCT
Cluster updated the Board on significant events since the Board last
met in April 2012.
Mrs Ellis said that for the first time there were no CCG chairs at the
meeting and from now on the context of this would meeting would
reflect the Cluster role of system manager delivering for today and
focussing on transition. Many of the reports that used to come to the
Cluster Board would from next month be in summary form; the work is
being undertaken by the CCGs as they have been given full delegated
responsibility
As a checking process Mrs Ellis suggested that for each Board report
presented today, the Board assessed the future relevance to the
Cluster Board. Mrs Ellis said that she had been very involved in the
equality and diversity agenda; she noted in particular the mentoring
scheme in which she was taking a part. Leicestershire Partnership
NHS Trust and the Leicester, Leicestershire and Rutland PCT Cluster
are making joint stand against discrimination in the workplace on 17
May which is International Day Against Homophobia (IDAHO) towards
lesbian, gay, bisexual and transgender people (LGB&T) and will be
raising a flag.
Mrs Ellis said that she had attended the UHL Board on 26 April 2012,
where they had signed off their annual plan supported by clinical leads.
Mrs Ellis ended by saying that she had attended the Market
Harborough Phase 2 Board meeting and reported that planning work
was well underway.
It was RESOLVED
- to note the verbal update.
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CB/12/137
Non-Executive Directors’ Report
Mr Finan said that he had visited EMAS as part of the East Midlands
Board Development. The Chair and Chief Executive had talked about
their vision for the future, acknowledged that they had lost the PTS
contract but were working on the NHS 111 project.
CB/12/138
Chief Executive’s Corporate Report
Ms Catherine Griffiths, Chief Executive introduced the report outlining
the key activities the Chief Executive and Transition Management
Team (TMT) had been involved in since the Board meeting in April
2012 (as attached in Minute Book – Appendix Number CB/05/10C).
Ms Griffiths informed the Board that Ms Judith Hill had resigned from
her post as Director of Nursing effective from the end of May 2012,
having found a post nearer to her home; and that Mr Malcolm Lowe-
Lauri Chief Executive of UHL was leaving the Trust very soon. Mrs Ellis
thanked Ms Hill for her contribution to the LLR PCT Cluster.
Ms Griffiths said that she was pleased that the 3 LLR CCGs were in the
first wave of authorisation, 3 of only 7 in the Midlands and East SHA
area and 3 of only 32 CCGs nationally; all the CCG board meetings are
now held in public.
Dr Paul Watson has been appointed Regional Director for the Midlands
and East sector of the National Commissioning Board.
Ms Griffiths in particular thanked the finance team for all their hard
work which resulted in them being in a position to submit the final
accounts one day early. Ms Bishop thanked Ms Griffiths on behalf of
the team.
Mr Wilson asked if there are still two GPs who had not completed the
GP appraisal programme and what would happen if they did not. Dr
Rashid said that any GPs in this position would not be able to remain
on the performers list; they would then need to go through revalidation
or they could not be licensed to practice by the GMC.
It was RESOLVED
- to note the contents of the report.
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SYSTEM TRANSITION
CB/12/139
Revised Committee Terms of Reference
Mrs Liz Rowbotham, Director of Quality, Communications and
Engagement presented the Revised Committee Terms of Reference
(as attached in Minute Book – Appendix Number CB/05/10/D).
Mrs Rowbotham said that this item was about PCT governance and as
such it remained a Cluster responsibility.
Mrs Rowbotham said that the terms of reference for the following
committees of the Board have been reviewed and updated by
Committee members:
Remuneration and Terms of Service Committee
Quality and Clinical Governance Committee
Reference Committee
The Cluster Competition and Procurement Committee and Clinical
Commissioning Group Competition and Procurement Committee terms
of reference had been withdrawn and would be represented to the June
meeting
Action: Mrs Rowbotham
The amendments in the main relate to changes in governance
arrangements across the Cluster, the Commissioning Support Services
and the Clinical Commissioning Groups; reflecting the responsibilities
that have been delegated to the emerging new organisations and how
this affects the role and membership of the Cluster Committees.
A regular review of Cluster Committees’ terms of reference provides
assurance to the Board that its committees regularly monitor their
functions and responsibilities to ensure they remain fit for purpose and
continue to operate within the Corporate Governance Framework (i.e.
Standing Orders, Scheme of Delegations and Standing Financial
Instructions) of the LLR PCT Cluster.
Mrs Rowbotham noted that the resignation of Ms Hill would result in
amendments to these terms of reference.
Ms Brigden noted that in the Reference Committee Terms of Reference
the transfer of this element of the role undertaken by Ms Taylor should
be changed to Dr Rashid.
Mrs Ellis asked if the separate reference to NHS LC and NHS LCR
needed to remain; Mrs Bains said that it did as the 2 PCTs were still the
statutory bodies. Mrs Ellis then clarified that it did not need to
distinguish NEDs for each PCT, as all NEDs now represented the
Cluster.
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Mrs Ellis also noted that there should only be two Non-executive
Directors on the Quality and Clinical Governance Committee Terms of
Reference.
There were a number of amendments required to these terms of
reference which Mrs Rowbotham said she would action.
Action: Mrs Rowbotham
It was RESOLVED
- to approve the terms of reference for the:
- Remuneration and Terms of Service Committee
- Quality and Clinical Governance Committee
- Reference Committee,
in line with the discussion above regarding amendments.
CB/12/140
Developing Arm’s Length Arrangements for Commissioning
Support Services in LLR
Ms Vikki Taylor, Director of Commissioning Development, presented a
report on Developing Arm’s Length Arrangements for Commissioning
Support Services in LLR (as attached in Minute Book – Appendix
Number CB/05/10/E).
Ms Taylor said that this paper had come to the Cluster Board as it is
part of the transition role of the PCT Cluster.
Ms Taylor said that there is a national requirement from the Department
of Health for emerging Commissioning Support Services to operate in
shadow form and become arm’s length from their respective PCT
Cluster from 1 April 2012.
The interim Greater East Midlands Commissioning Support
Organisation Steering Group (GEM CSO), of which we are a member,
has agreed a two phased approach to achieving this separation.
Phase one will be for Leicester, Leicestershire and Rutland
Commissioning Support Services (LLR CSS) to act as arm’s
length from LLR PCT Cluster with immediate effect and
Phase two will see LLR CSS operating in shadow form as a
separate/arm’s length organisation until April 2013. Phase two
will commence once the GEM CSO Interim Board is appointed,
expected to be August.
This paper is about Phase 1.
The Cluster Board is requested to support LLR CSS operating in
shadow form and at arm’s length with immediate effect. The LLR CSS
will adhere to the PCT Cluster’s Corporate Governance Framework as
approved by the Cluster Board in March 2012 and April 2012.
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The LLR CSS Operational Management Group (OMG) will be a subcommittee
of the Cluster Board and regular OMG and LLR CSS
Performance Assurance Reports will be presented to the Cluster Board
at agreed intervals.
LLR Cluster Board will retain ultimate responsibility for all the services
operating under LLR CSS. The Cluster Chief Executive remains the
Accountable Officer for the Cluster, including the LLR CSS Operational
Management Group. LLR Cluster Chief Executive and Director of
Finance (or nominated deputies) will remain accountable officers and
sign off the financial accounts, which will incorporate the financial
transactions of LLR CSS, in accordance with current guidance or any
amendments received in due course.
Ms Taylor said that key performance indicators need to be developed
as the basis of the performance management relationship with the
Cluster.
Ms Brigden asked why the Lay Member does not have a vote. Ms
Taylor agreed that it would be more appropriate if they had and that this
amendment would be made.
Ms Brigden also said that the paper needs to reflect the relationship
between this service and local partners. Ms Taylor said that workshops
with Leicestershire County Council had commenced and that she was
working with Ms Watson to look at where there could be joint working
with the City Council.
Mr Mell said that the development of KPIs was important and that a
similar Board to Board process as there currently is with the CCG
Boards should be implemented in order to monitor the process. Mrs
Ellis agreed that a Board to Board process should be considered.
Mr Wilson asked if this was to be an arm’s length committee would the
chair be a Director of the Cluster, Ms Taylor replied that she would be
covering that role. Mr Wilson noted that when the community health
services provider became an arm’s length organisation there was a
separate more formal board. Mrs Bains said that this is an interim
position. Ms Griffiths noted that the transfer of the primary care function
to Dr Rashid had allowed for Ms Taylor to pick this up amongst other
things. This was an interim arrangement and was not the same level of
separation as it had been for community health services.
Ms Bishop said that the costs of the CSO would be collected and
reported on separately.
Mr Finan said he would like to understand the organisational structure.
Ms Griffiths said that there would be professional links to Cluster
directors.
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It was RESOLVED
- to approve LLR CSS operating in shadow/arm’s length
arrangements with immediate effect.
- to approve the establishment of the LLR CSS OMG as a committee
of the Cluster Board.
- to approve the terms of reference for the LLR CSS OMG as at
Appendix 1 subject to the changes above.
CB/12/141
Equality Delivery System
Mrs Cathy Ellis, Chair of LLR PCT Cluster introduced Ms Christina
Marriott, Contract lead for the LLR PCT and LPT Integrated Equality
Service, who presented a report on the Equality Delivery System (as
attached in Minute Book – Appendix Number CB/05/10/F).
The Equality Act 2010 places a ‘Specific Duty’ to publish Equality
Objectives by the 6 April 2012. The Integrated Equality Service (IES)
developed equality objectives last year, based on available evidence
and identified those that were highest priority in a consultation with
both members of staff, members of the public and stakeholders. These
were approved by the Cluster Board and published last year on our
website, giving the Trust compliance with the second Specific Duty.
The Trust is an early adopter of the Equality Delivery System, although
we are not using it to set our equality objectives. Since the Board was
last updated in January 2012, the IES has commenced engagement
both internally and with external stakeholders and an action plan has
been developed.
Ms Marriott noted that the two PCTs as the statutory bodies retain
responsibility for implementation and delivery although this will
increasingly transfer to the CCGs.
Mrs Ellis asked about communication with the stakeholders that had
been present at the meeting in February. Ms Marriott said that she had
been in contact with them and would be again after this meeting. She
also noted that this paper has gone to the 3 CCGs.
Mr Finan asked about the fifth Equality Objective about preventing age
discrimination and asked why it was restricted to secondary care and
did not for example mention primary care. Ms Marriott said that age
discrimination in any area is illegal but the wording in this objective
denotes the most urgent need as voiced by organisations like Age
Concern and the general public. Mr Finan said that he was
uncomfortable with the wording. Mr Skea said that the PCT Cluster
was not saying that it would only tackle some areas of age
discrimination. Ms Griffiths reaffirmed that age discrimination in
secondary care was the current priority and that it had been highlighted
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in many reports, e.g. the Francis Report on the incidents in Mid
Staffordshire Hospital and the Patients Association report.
Mr Finan asked where care homes fitted into this. Ms Marriott said that
these objectives had been set up a year ago; CCGs may want to pick
that up.
Ms Brigden noted that objective no 6 - Promote a ‘fairness for all’
agenda in the interest of equity of patient outcomes and experience
across different equality groups – would probably cover Mr Finan’s
concerns.
It was RESOLVED
- to be assured of the Trust’s compliance with the Equality Act 2010’s
second specific duty by publishing Equality Objectives by 6 April
2012
- to be assured of progress in implementation of the Equality Delivery
System (EDS)
CB/12/142
Update on the Relocation of the Loughborough Walk-in Centre
Mrs Ellis welcomed Ms Angela Bright, Chief Operating Officer of West
Leicestershire CCG who presented the Update on the Relocation of the
Loughborough Walk-in Centre (as attached in Minute Book – Appendix
Number CB/05/10/G).
Ms Bright said that in February 2012 the LLR PCT Cluster Board
approved the relocation of the Loughborough Walk in Centre from its
current site at Pinfold Gate to Loughborough Community Hospital
conditional on:
Completion of the necessary building works within
Loughborough Community Hospital.
Provision of additional car park spaces on the hospital site, a
minimum level of 40 spaces.
Implementation of a phased communication and patient
information campaign in advance of the move.
Demonstration of improved primary care access
The equalities recommendations being actioned
Continued discussions with public transport providers
LLR PCT Cluster Board requested quarterly update reports from West
Leicestershire Clinical Commissioning Group (WLCCG). This paper is
the first of such reports giving an update on progress since February
2012.
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Mrs Ellis thanked Ms Bright and said that the report was an easy format
to follow. Mrs Ellis also noted that 80% of WL CCG practices have
signed up to the extended hours enhanced service and asked how
many were in the Walk-in Centre area. Ms Bright said that all the
practices in the Walk-in Centre area had signed up to the extended
hours enhanced service.
Mrs Ellis also asked about the work being undertaken with the Borough
Council on how best to work collaboratively together towards improving
health outcomes for those with protected characteristics (as defined by
the Equality Act) and those in more deprived areas and how this could
be evidenced. Ms Bright said that the CCG had developed a Marketing
Campaign with the Communications and Engagement Team and the
intention is to undertake a series of follow-ups with specific groups,
community forums and at local events after the consultation has ended.
Ms Bishop said that she had spoken to Toby Sanders in respect of the
capital required for the re-location. It was likely that there would need to
be a business case presented to the Cluster Board before the work
started.
Action: Toby Sanders
Mr Mell said that he should declare an interest in this item as he was
part of the CCG Board that recommended the re-location. He said that
access is very important both in respect of a timely response to
telephone calls to local practices and the balance between booked
appointments and open access, for surgeries local to Loughborough.
He felt that the paper did not address these issues. Ms Bright noted the
section on ‘improved primary care access” identifies the range of work
that has been undertaken across the CCG e.g. North Charnwood
practices have completed an access report which summarised the
range of initiatives practices have undertaken to improve access along
with “top tips” to share across the CCG. Ms Bright said that she still
sensed that the technical ability to get the right balance with urgent and
routine appointments varied from practice to practice but there was a
willingness to address this together with telephone access. She
confirmed that this is a CCG key work stream and that the specific
issues raised by Mr Mell are being taken forward.
Mr Finan noted that the re-location of the Walk-in Centre had been
signed off with conditions which included additional car parking. The
proposal had been for an additional 40 car parking spaces for the Walkin
Centre and up to 100 in total. The planning application is for 178; Mr
Finan asked if this was considered to be value for money. Ms Bright
said that the costs were for the maximum amount possible which would
also allow for any future development of services. Mrs Ellis suggested
that this was picked up in the CCG Board to Board.
Action: Mrs Rowbotham
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Ms Watson asked if there had been any progress on working with
public transport providers. Ms Bright said that work was underway but
that the transport providers do not consider there is a big enough
footfall, however discussions with related organisations were
continuing.
Mrs Ellis confirmed that the Business Case should come to the June
Cluster Board meeting and that an update report should come to the
September Meeting.
Action: Mrs Rowbotham
It was RESOLVED
- to note progress on the walk in centre transition programme.
CB/12/143
Business Continuity Assurance
Ms Deb Watson Director of Public Health and Health Improvement
(City) presented a report on Business Continuity Assurance (as
attached in Minute Book – Appendix Number CB/05/11/H).
Ms Watson said that this paper came to the Cluster Board from a PCT
governance perspective.
Ms Watson said that this paper addressed the assurance requirements
requested by the Cluster Board. All areas within the current structure
have been working on implementing their Business Continuity
arrangements. Each area is at a different stage with their planning and
exercising.
Of the 15 areas/directorates 14 have completed their business impact
analysis; all 15 will have business continuity plans by the beginning of
June 2012; 5 will have completed the table top exercise by the date of
the Board meeting and the remainder will be complete by the end of
June.
The HIS team have a long history of appropriate business continuity
planning. A Business continuity plan for each key system identified as
a HIS responsibility is reviewed by key leads annually.
For general practice – 140 out of 148 business continuity plans have
been received, reviewed and feedback sent. Emails have been sent to
all practices that do not have a plan or need their plans updating.
For Pharmacy - workshops were held in 2010 with practices to run
through the Business Continuity Plan and to provide a background on
business continuity. All plans that have been received have been
reviewed and feedback sent.
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For Dentists - a business continuity plan template and guidance
document have been presented at a workshop and made available to
all dentists via a dental resilience website.
For Optometry - a business continuity template has been made
available to all optometrists.
It was noted that CCGs have to have Business Continuity Plans as part
of their authorisation.
Ms Ingman asked about general practice and their apparent lack of
enthusiasm and how had the team addressed this. Ms Watson said
that the team have offered practical support which in many cases has
been taken up. Ms Ingman asked if the LMC could help in this area. Ms
Watson said they had talked to the LMC and would do so again.
Mr Mell asked what would happen in general practice if there was an
issue and should we not be encouraging the CCG to be more proactive.
Ms Griffiths and Dr Rashid said that this is part of primary care
commissioning and thus a Cluster and local office responsibility not the
CCGs.
Mr Wilson asked that a report come back to the July Cluster Board as
everything should be completed by then.
Action: Tim Davies
Mrs Ellis asked if we were handing HIS over with a good record in this
area; Ms Taylor confirmed that we were. Mr Mell noted that HIS
provides an IT support service to general practice.
It was RESOLVED
- to note the report
CB/12/144
TCS Benefits Realisation
Mrs Cathy Ellis, Chair of LLR PCT Cluster presented a report
previously presented to Leicestershire Partnership Trust Board on TCS
Benefits Realisation (as attached in Minute Book – Appendix Number
CB/05/10/I).
The report notes that a year has now passed since significant
components of the two PCT provided community health services
transferred to Leicestershire Partnership NHS Trust (LPT). As part of
the process a range of potential benefits were identified as being on
offer to LPT and to a range of other partners and stakeholders. It is
recognised that the realisation of benefits associated with TCS will
continue to be delivered in the future.
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Mrs Ellis said that this paper effectively closed down the risks around
the transfer.
Ms Griffiths noted that there was nothing about clinical benefits or
integration.
Ms Bishop said that the work involved in bringing this finally together
should not be underestimated and that this paper is just a first phase
noting in particular the process that had been undertaken.
Mr Mell said that now LPT had done its internal vertical integration it
should focus on working across its boundaries with other organisations
(primary and acute care). There should be moves to bring services
closer to the patient’s home and connect GPs more with community
services. These are issues that have been discussed for a long time.
Mrs Ellis noted that this would be part of the LLR Reconfiguration
Programme.
Ms Brigden said that the relationship development section was very
thin and not focused.
Mrs Ellis suggested that this paper should go on the Board to Board
agenda.
Action: Mrs Rowbotham
Mr Finan said he considered it was a good paper looking at how the
CHS activities had been amalgamated and are on track to grow and
develop. Mrs Ellis agreed that there has been a safe and effective
transfer.
Ms Griffiths confirmed that this is a close down paper and that it will
become part of the LLR reconfiguration work. In many ways it is more
relevant to the CCGs who commission the service.
It was RESOLVED
- To note the contents of the report
QUALITY AND PATIENT SAFETY
CB/12/145
Quality Accounts for UHL and LPT
Mrs Liz Rowbotham, Director of Quality, Communications and
Engagement noted that the Quality Accounts for UHL and LPT were
not yet in a final position to come to the Cluster Board. The Quality
Accounts had been sent out for consultation and there had been
extensive feedback on them. The comments received are being shared
with the two trusts respectively. Once final statements are factually
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correct and have been amended to take note of the comments they will
be brought to the Cluster Board.
Action: Mrs Rowbotham
CB/12/146
Leicester City Health Visitor Implementation Programme
Ms Sharon Robson, Associate Director of Quality, and Assigned Board
Nurse/Quality Lead Leicester City Clinical Commissioning Group
presented the Leicester City Health Visitor Implementation Programme
(as attached in Minute Book – Appendix Number CB/05/10/K).
The key aim of the Health Visitor Implementation Programme - A call to
Action is to improve services and health outcomes, through expanding
and strengthening the Health Visiting workforce, with an extra 4,200
Health Visitors in post nationally by April 2015.
Leicester is a large city and the scale of diversity is unique compared to
other cities in England; children and young people represent 26% of the
total population. Leicester is ranked as the 25th most deprived local
authority in the country according to the Index of Multiple Deprivation
2010, with some areas of the city falling within the most deprived 5% in
all areas of England. In terms of safeguarding children in Leicester, 458
children are the subject of a child protection plan. Of this figure 48% are
under the age of 5.
Currently there are 63.5 whole time equivalent (WTE) Health Visitors in
Leicester City, supported by 6.41 WTE Children’s Nurses and 28.67
WTE Nursery Nurses, a disparity of 86 WTE Health Visitors between
the current number and the target to be reached by 1st April 2015.
Nationally, Health Visiting caseloads of approximately 250 to 350
cases, less in deprived areas with high numbers of complex cases such
as Leicester, are considered to be appropriate to implement the new
model; in Leicester Health Visitors caseloads are currently in excess of
500 cases per WTE Health Visitor.
The vast majority of the workforce expansion required to deliver the
new model of service in Leicester will stem from working in partnership
with De Montfort University (DMU), Leicester, Leicestershire & Rutland
Workforce Development Team and Leicestershire Partnership NHS
Trust (LPT).
LC CCG Governing Body is proposing the following financial
modelling:-
2012/13, LPT to recruit six health visitors using population
growth funding in the LPT contract, taking the total to 69.5WTE.
This leaves a gap of 80 WTE against the longer term target
Following completion of the recruitment above, recruit a further
24 health visitors at a total annual cost of £1.3m, via a contract
variation.
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Recruitment and retention of health visitors in Leicester City has
historically been challenging. LPT have engaged an independent
consultant to review the current health visiting service and to identify
options for addressing current workforce issues.
Mrs Rowbotham said that we are critically placed to drive this forward.
Ms Griffiths suggested that high level exception reports should come
back to Cluster Board periodically.
Mr Hackwood asked what the national programme looked like locally.
Ms Robson said that the report that had come to the last Cluster Board
had identified the numbers and the money, this paper is about the
issues. Mr Hackwood said that the paper did not indicate how this
would happen. Mrs Rowbotham said that LPT is the provider of health
visiting services and they need to identify the way forward and how the
right staff can be maintained.
Mr Hackwood said that there had been a lot of plans but no convincing
picture of how the numbers of staff will be increased. Ms Robson said
that the main issue was not recruitment but retention.
Ms Robson said that premium payments have been tried but that it was
caseload size that was the issue.
Mrs Rowbotham said that this was a contractual issue with LPT which
needs to be raised.
Action: Mrs Rowbotham
Mrs Ellis said that she had asked last time about the age profile of this
group of staff and that this should be also factored in so that future
vacancy levels arising from retirement could be predicted.
Ms Ingman said that it was an interesting paper but asked what the
impact would be in terms of safeguarding children. Ms Robson said that
they were starting to develop plans and referred back to the timescales
in the last Cluster Board paper.
Ms Bishop suggested that this was an agenda item in the LC CCG
Board to Board.
Mr Mell expressed concern regarding the time this was taking. He said
that one provider – LPT, was the provider for health visiting services
across LLR and as such were not constrained by the City/County
boundary and there should be a balancing capability across the two
areas.
Mr Wilson asked what the situation was in the County. Mrs Rowbotham
said that the County were 15 whole time equivalents short to meet the
2015 target.
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LLR PCT Cluster Board meeting
14 June 2012
It was agreed that an update paper should come to the September
Cluster Board noting the position in both City and County.
Action: Mrs Rowbotham
It was RESOLVED
- to note the contents of the report.
CB/12/147
Quality and Patient Safety in Leicestershire Partnership Trust
Mrs Liz Rowbotham, Director of Quality, Communications and
Engagement presented the report on Quality and Patient Safety in
Leicestershire Partnership Trust (as attached in Minute Book –
Appendix Number CB/05/10/L).
Mrs Rowbotham said that this was the second in a series of reports
looking at Quality and Patient Safety (the first one covered UHL). It
describes the outputs of a review of the many reports related to the
quality of care and patient safety in LPT. These reports are received
through a number of routes, both internally and externally, and between
them they formulate our understanding of compliance with essential
quality and safety standards, and performance against targets for
service improvement.
Key areas to note are:
The initial findings and recovery actions put in place by LPT
following unannounced visits to the Gwendolen ward and the
Agness Unit by the CQC had identified improvement and
compliance actions, and that further assurance has been
provided to commissioners following quality visits to these areas
in March 2012
The LPT Quality Report of on-going risks and positive
improvement identified from the monthly CQRG meeting and the
CQUIN performance.
Mrs Ellis said that this was a very helpful overview and noted that this
role would form part of the CCGs portfolio of provider management.
Mrs Rowbotham agreed that the contracting element of it would
transfer to the CCGs but the nurse lead and medical lead in the
National Commissioning Board would have a broad oversight role and
so a high level report would be appropriate to continue to receive at this
meeting.
Mr Wilson asked if LPT had a plan to address the performance levels in
‘stroke’. Ms Robson said that LC CCG had asked for a deep dive. Mrs
Rowbotham said that we needed to see in which areas the difficulties
were. Mrs Ellis suggested this should be an agenda item in the LPT
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LLR PCT Cluster Board meeting
14 June 2012
Board to Board meeting. Ms Griffiths suggested that these issues were
addressed outside of the meeting.
Action: Mrs Rowbotham
It was RESOLVED
- to note the contents of the report.
CB/12/148
Downham Market Inquiry Briefing
Dr Aly Rashid, Medical Director presented a report on the Downham
Market Inquiry Briefing (as attached in Minute Book – Appendix
Number CB/05/10/M).
Dr Rashid said that the East of England SHA commissioned an
external review in June 2011 as a result of issues arising from four
Serious Incidents within a 12 month period. This involved the
suspension of two salaried GPs and the tragic death of a vulnerable
patient.
The report makes a number of recommendations and together with the
findings from the review, provides valuable learning for all
commissioners. The report and recommendations were circulated in
December 2011 and the SHA has sought assurances from PCTs with
regard to systems and processes against the findings and
recommendations of the review.
Further assessment of the PCT position in relation to the
recommendations is required but appropriate safeguards are in place in
relation to the majority of recommendations and learning from the
external review.
Actions required have been identified and are being completed as
identified in the response to the SHA.
Dr Rashid noted that the practice in question was a nurse-led practice
of which there are none in the LLR Cluster. There were four
recommendations pertinent to LLR:-
Recommendation 1 - in relation to locums being offered
appropriate clinical supervision and training. Dr Rashid said that
only one third of LLR practices had locum induction packs. The
Cluster was now offering practices a standard locum induction
pack.
Recommendation 2 - the contracts of all practices that are not on
conventional contracts should be reviewed.
Recommendation 3 - all practices are encouraged to sign up to
the patient participation directed enhanced service. Dr Rashid
said that 119 out of 148 LLR practices had signed up.
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14 June 2012
Recommendation 5 - senior managers should not work for two
organisations which are in a substantive contractual or oversight
relationship.
Mr Wilson said that locums could be an area of weakness and what
leverage did the Cluster or CCGs have regarding issues such as locum
induction packs. Dr Rashid said that all practices should have one and
that for those practices that did not have an induction pack this would
be addressed through the contract process.
It was RESOLVED
- to note the recommendations following the Inquiry and progress in
relation to each area for which the SHA has sought assurances.
CLUSTER LEGACY
CB/12/149
Financial Plan 2012-2013 - update
Ms Sue Bishop, Director of Finance and Estates presented the update
to the Financial Plan 2012-2013 (as attached in Minute Book –
Appendix Number CB/04/12/N).
Ms Bishop said that the two PCTs are still the recognised statutory
bodies although about 75% of the financial plan will be delivered by
CCGs via delegated budgets.
Ms Bishop said that the Cluster had been notified of non-recurrent
adjustments to the 2012/13 revenue resource and cash limits, in
relation to the transfer of funding to MESHA for the National
Specialised Commissioning Team and Cancer Drugs Fund; this has
resulted in a reduction in revenue resource limits of £11.8m. The
impact this will have on the delivery of the 2012/13 LLR Cluster
financial plan will be mitigated through the use of “in year” flexibilities.
The monthly identification of such flexibilities will be routinely reported
to the Board with effect from June 2012.
The financial plans for both PCTs have been constructed at receiving
organisation level. Since submitting the financial plan considerable
revision to the apportionment of budgets between the two CCGs has
occurred within the NHS LCR plan. This change moves many of the
apportionments from a “fair share” basis to an “historical activity” basis.
The financial plans for both PCTs have been uploaded into the financial
ledgers for month 1 reporting. New coding structures and hierarchies
have been created and work is on-going to refine this process.
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LLR PCT Cluster Board meeting
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It had previously been reported that no formal notification of the capital
allocation for the Cluster had been received and this is still the case.
However, proposed capital plans have been produced for both PCTs.
These plans will need to be reviewed once funding is confirmed, but
revenue resources can always be converted in year to capital, if
deemed appropriate, to ensure that work can be completed. Ms Bishop
suggested that the Cluster Board agree today on the capital plan in
order to mitigate any delay should formal notification be approved.
Mrs Ellis asked about prioritising the capital new build items. Mrs
Bishop confirmed that the capital for the Loughborough Walk-in Centre
would either be from the capital allocation or from transformation funds.
Ms Bishop said that more needed to be understood in relation to the
City Intermediate Care reprovision. Ms Bishop asked if there was no
capital allocation would Leicester City still continue with this. Dr
Freeman (who had just joined the meeting) confirmed that they would.
It was RESOLVED
- to note the on-going update of our revenue resource limits and the
monthly monitoring that will start in June to highlight in year
financial flexibilities that may arise during the year to offset the
national “top slice”;
- to note the updated financial plans at receiving organisation level
are now based on an updated apportionment basis for the two
NHSLCR CCGs;
- to approve the detailed revenue budgets by receiving organisation
as identified in Appendices 2 and 3 and;
- to approve the proposed capital plans as identified in Appendix 4
that should start as soon as capital resource is confirmed.
CB/12/150 Board Assurance Framework 2012-2013
Mrs Daljit K. Bains, Associate Director of Corporate Governance
presented an update report on the Board Assurance Framework 2012-
2013 (as attached in Minute Book – Appendix Number CB/05/10/O).
Mrs Bains said that this report contains updates in respect of controls,
assurances on controls, gaps in controls and/or assurances and
update in relation to the actions across the corporate risk register since
the last report to the Board.
Mrs Bains said that there is further work to be undertaken over the
coming months to ensure that the organisations can be held to
account.
Mr Finan noted the new risk 2.16 (CCGs failing to agree and take
ownership of contractual risks and actions identified resulting in lack of
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LLR PCT Cluster Board meeting
14 June 2012
assurance to the SHA regarding the handover of contracts and
delivering the Cluster implementation plan) and said that this needs to
be actioned before authorisation. Ms Taylor agreed and said that as
part of authorisation, CCGs would agree which contracts they ‘owned
and managed’.
Ms Brigden asked about risk 2.15 (approximately 80% of voluntary
sector contracts and Local Authority contracts are not assigned to
CCGs due to lack of identified contract ownership resulting in financial
risk to the Cluster e.g. money being paid out without formal contracts in
place, no assurance regarding activity etc.). Ms Taylor said that
although it is 80% of voluntary sector and Local Authority contracts this
is still a small percentage of the total contract portfolio.
Mr Wilson said that he understood that there was a national directive
that said that 1.5% of the total budget should be within voluntary sector
contracts. Ms Bishop said she would confirm this.
Action: Ms Bishop
Ms Watson said that they were in the process of establishing an
integrated commissioning board between the CCGs and Leicester City
Council.
Mr Hackwood said that we should not force the voluntary sector into
contracts. Ms Taylor said that this is about regularising the current
position.
Mr Mell asked about risk 4.1(inability to manage provider performance
against the updated health goals and identified health inequalities) and
said he was surprised it was still rated as orange. Mrs Bains said that it
would be discussed at the next Performance TMT. Mrs Ellis said that
recent actions meant that everything possible was being done in this
area.
Mrs Rowbotham noted that the Assurance Framework was likely to be
managed in the future by the CCGs.
Mrs Bains noted that the risk NHS 111 was still to be completed but will
go to the next Audit Committee for review.
It was RESOLVED
- to receive the updated Assurance Framework 2012– 2013
CB/12/151 Documents signed under Seal 2011-2012 for NHS Leicester City
and NHS Leicestershire County and Rutland
Mrs Daljit K. Bains, Associate Director of Corporate Governance
presented a report on Documents signed under Seal 2011-2012 for
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LLR PCT Cluster Board meeting
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NHS Leicester City and NHS Leicestershire County and Rutland (as
attached in Minute Book – Appendix Number CB/05/10/P).
Mrs Bains said that in accordance with section 8 of the Corporate
Governance Framework (i.e. Standing Orders, Scheme of delegation
and Standing Financial Instruction) the Associate Director of Corporate
Governance maintains a record of sealing as authorised by the Chief
Executive; and in accordance with section 8 a report detailing the use
of the seal is made to the Board.
The Board is notified that the Common Seal of NHS Leicester City was
applied, using its legal name of Leicester City Primary Care Trust,
during 2011 – 2012 to nine documents in accordance with the Standing
Orders.
The Board is notified that the Common Seal of NHS Leicestershire
County and Rutland was applied, using its legal name of Leicestershire
County and Rutland Primary Care Trust, during 2011 – 2012 to 17
documents in accordance with the Standing Orders:
It was RESOLVED
- To receive the report and note the documents signed under seal in
accordance with Standing Order 8.
CB/12/152 Register of Interests and Register of Gifts and Hospitality 2011-
2012
Mrs Daljit K. Bains, Associate Director of Corporate Governance
presented a report on Register of Interests and Register of Gifts and
Hospitality 2011-2012 (as attached in Minute Book – Appendix Number
CB/05/10/Q).
All Board members and senior employees of the NHS Leicester City
and NHS Leicestershire County and Rutland have a legal obligation to
act in the best interests of the PCTs and have a duty to conduct NHS
business with probity. The Code of Accountability for NHS Boards sets
out a requirement that chairs and all board directors should declare any
conflict of interest that arises in the course of conducting NHS
business.
All members and senior employees of the PCTs are expected to
declare any personal or business interest which may influence, or may
be perceived to influence, their judgement. This includes, as a
minimum, personal, direct and indirect financial interests, and also
includes such interests of close family members.
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As detailed under section 7.2 of the Leicester, Leicestershire and
Rutland PCT Cluster’s Corporate Governance Framework (approved
March 2012), the Chief Executive is responsible for an annual review of
the declarations of interest register.
Furthermore, all Board members, senior employees and staff are also
required to register any gifts or hospitality received in connection with
their role in the PCTs. A register is maintained by the Associate
Director of Corporate Governance and updated on a regular basis.
This report provides assurance to the LLR PCT Cluster Board that
systems and processes are in place to demonstrate compliance with
the PCT Cluster’s Corporate Governance Framework.
It was noted that recent changes in staff would need to be reflected.
It was RESOLVED
- to receive the current Register of Interests and Register of Gifts and
Hospitality as at 31 March 2012 (as detailed in Appendix 1 and 2).
PERFORMANCE ASSURANCE
CB/12/153 Cluster Finance Performance Report 2011/12 – Month 12
Ms Sue Bishop, Director of Finance presented the Month 12 Cluster
Finance Performance Report 2011/12 (as attached in Minute Book –
Appendix Number CB/05/10/R).
Ms Bishop said that subject to external audit both PCTs had achieved
their statutory financial duties for the year to hit the revenue resource,
cash and capital resource limits. The draft annual accounts for both
PCTs were submitted to the Department of Health and auditors a day
ahead of the deadline. The Audit started on 30 April; audited accounts
will be submitted by 11 June 2012. The Board agreed to approve
delegated authority for the Audit Committee to sign off the accounts.
NHS LCR achieved its administrative duty (BPPC) in all categories.
NHS LC achieved the NHS target, but narrowly missed the non NHS
target.
Once again this year significant components of the Cluster’s capital
programmes have been delivered in March. This has put both the
estates teams and the finance team under considerable pressure to
achieve these targets. The delay in finalising figures impacted on the
year end timetable, although did not delay final submission of the draft
accounts. Consideration should be given to how a similar situation can
be avoided in 2012/13.
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The return of nominal roll confirmation forms has improved this month
to 50%, but is still below what is expected.
Budget holder workshops are taking place in May to advise budget
holders regarding the new coding structure, which takes account of
destination organisation requirements.
The resource limits for NHS LC of £562.65m and NHS LCR of
£976.22m are expected to be the final resource limits for each PCT.
These will be confirmed to the Cluster by the Department of Health
during May.
The final use of in-year flexibilities was also noted. In line with the
delegated approval given by the Cluster Board in March 2012 final
adjustments were made to the expenditure proposals right up to 31
March to ensure that residual expenditure was managed in line with the
resources available to each PCT.
Mr Mell asked about the month 12 position regarding UHL. Dr Freeman
said that at month 12 there were still disputes in relation to follow-up
ratios, changes in A&E coding etc; these sums of approximately £3m
will continue to be disputed during 2012-2013. Ms Bishop said that she
had written to the Director of Finance at UHL as part of the usual year
end process of agreeing balances with other bodies. An agreement
was reached on the numbers to be reflected in the accounts, but there
remain contractual differences between the two organisations. Dr
Freeman noted that the disputed sums are being shown as paid in the
UHL financial plan. Mrs Ellis said that she had raised this with the UHL
Chair after the UHL public Board meeting on 26 th April 2012
It was RESOLVED
- to note the finance report for the month ended 31 March 2012.
- to delegate authority to approve the final 2011/12 accounts to the
Audit Committee.
CB/12/154 Acute Contract Performance Report February/March 2012
Dr Simon Freeman, Managing Director of Leicester City CCG
presented the report detailing the performance position for acute
contracts for both NHS Leicester City (NHS LC) and NHS
Leicestershire County and Rutland (NHS LCR) (as attached in Minute
Book – Appendix Number CB/05/10/S).
The reported position at month 12 against the total acute
commissioning budget for NHS Leicester City is just £26k or 0.01%
over budget, and for NHS Leicestershire County & Rutland £2.15m or
0.54% above budget However, within the overall position there is a
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LLR PCT Cluster Board meeting
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significant overspend for NHS LCR at University Hospitals of Leicester
NHS Trust (UHL) of c£5m (month 12 estimated position prior to
contractual challenges), offset in part by under spends on specialised
services and out of county acute contracts of £2.3m. The position for
NHS LC at UHL has changed from being slightly under plan to £0.9m
over plan.
Dr Freeman said that of the combined overspend in the UHL contract,
£3m remains to be resolved.
Close management of UHL’s recovery of a number of targets is still
required, it is also recognised that a lot of hard work has been carried
out by staff in UHL and progress made in improving performance.
Performance targets in a number of areas remain of concern at UHL,
notably:
In respect of the 18 weeks admitted RTT standard, performance
was 82.02% against the target of 90% at February 2012. This is
an expected deterioration from the previous month’s
performance as a result of UHL addressing backlogs of long
waits in several specialties, including General Surgery,
Ophthalmology and Urology.
UHL’s March 2012 position for the admitted RTT is 83.7%.
Commissioners have concerns, however, that there are several
specialties where there is a risk that backlogs will increase again
in 2012/13, therefore close scrutiny of the backlogs will continue
and contract remedies will be pursued should this be the case.
With regard to the 62 day standard for cancer treatment, UHL’s
cumulative performance for April 2011 to February 2012 shows
83.0% against the 85% target. The February 2012 monthly
position is reported as 85.3%, with trajectories agreed for March
2012 as 85.3%.
Despite the improvement in quarter 4, the year-end cumulative
position of 85% will not be achieved. Commissioners also have
on-going concerns regarding performance in Urology and Lower
GI tumour sites, which is considerably below national
benchmarks. Mrs Ellis asked if we can ask the Trust to focus on
this. Dr Freeman said that he would raise a contractual question.
Mr Mell queried why UHL are not looking at the root cause of the
performance in Urology and Lower GI. Dr Freeman said that with
regard to Lower GI it is a capacity issue. Mrs Rowbotham said
that it is related to the cumulative effect of issues such as referral
forms not marked urgent.
Mr Wilson asked if the voluntary sector could offer anything to
deal with the lack of capacity. Dr Freeman said that it was
difficult to split the care pathways.
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Dr Freeman explained to Mrs Mason from Leicester LINk that
the difference in the 62 day wait cancer figures is that the
standard is being met in the month, but not on a cumulative, year
to date basis.
With regards to the A&E maximum wait of 4 hours, as at 31
March 2012 the year to date position was 92.22% of patients
being seen within 4 hours against the target of 95%. Despite the
revised remedial action plan, commissioners have raised a
second exception notice although the financial penalties will not
be applied. Dr Dave Briggs is leading on this.
Mr Hackwood asked what would happen if there was no reply to
the second exception notice. Dr Freeman said that this could
result in a fine or a direct letter to the UHL Chair, copied to Mrs
Ellis.
As at February 2012, 89.5% of patients whose operations were
cancelled for non-clinical reasons were offered another date
within 28 days against a target of 95%. As at February 2012,
1.7% of operations were cancelled by the provider for nonclinical
reasons, against a target of 0.8%, with a cumulative
performance of 1.4%. UHL acknowledges that reducing the
level of cancelled operations is critical to the delivery of RTT and
cancer waiting times.
In terms of the quality indicators in the UHL contract, a contract query
was issued to UHL on 13 April 2012 for Fractured Neck of Femur
requesting a remedial action plan, trajectory for recovery and risk
assessment by 27 April 2012.
During March 2012 UHL has two unjustified Same Sex
Accommodation Breaches, affecting 13 patients. Both breaches
occurred in an acute medical unit at the LRI. UHL has assured
commissioners that the breach time was minimal and the privacy and
dignity of patients was maintained during the breaches.
The Care Quality Commissioner (CQC) carried out two unannounced
visits to UHL during March 2012. One visit focussed on the acute
medical units (AMUs) at the LRI and one on the termination of
pregnancy services. The CQC has raised a number of concerns that
will be discussed at the April 2012 Clinical Quality Review Group and
will be escalated to the Contract Performance Meeting as necessary.
With regard to the age extension for breast screening to February
2012, UHL does not expect to commence the age extension to breast
cancer screening until June 2012. Further discussions have taken
place with UHL, ultimately resulting in a contract query issued on 7
March 2012 seeking confirmation of plans and milestones to
commence age extension. Commissioners have concerns that the
Remedial Action Plan received against the contract query does not
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LLR PCT Cluster Board meeting
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give adequate assurance that the Trust are committed to rolling out
age extension from June 2012, and are therefore proceeding to the
next stage of contract management – the “Joint Failure to Agree
Notice” which will be issued to the Board of Directors of both parties. It
was noted that the commissioning of this service from 2013-2014 will
move to the commissioning board with all the other screening
programmes.
Mr Wilson asked why there is such deterioration in stroke as noted in
the Quality Schedule Risk table. Dr Freeman said that he had had a
number of conversations with the lead clinician; there was still some
debate regarding the necessity of a stroke brain scan within 1 hour in
all instances. The Trust has been asked to respond in more detail on
this. Dr Freeman said that the swallowing indicator is a long standing
recording issue.
Mrs Ellis said that this report for the Cluster Board will be very different
in the future; she envisaged that it would have less detail and would
report issues by exception. The CCG Board would be examining the
contract details as part of their delegated authority.
It was RESOLVED
- to receive the report.
CB/12/155 Non-Acute Contract Performance Report February 2012
Mr Jim Bosworth, Associate Director of Non Acute Contracting &
Provider Performance presented a report on the performance of NHS
Leicestershire County and Rutland’s and NHS Leicester City’s
contracts for non-acute services (as attached in Minute Book –
Appendix Number CB/05/10/T).
The paper noted the following priorities:-
1. Commissioning activity in respect of LPT over the last month
has been focused on the following priorities:
Completing contract negotiations for 2012/13 – The
contract was agreed within the national timeframe and
cash envelope and commissioning objectives.
Service Development and Improvement Plans – The
detail of these programs is being developed through the
Clinical Sub groups.
Transformation bids – Where agreed implementation
plans are being developed in conjunction with clinical
subgroups and SDIPs.
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LLR PCT Cluster Board meeting
14 June 2012
2. Derbyshire CHS – It is understood the contract has now been
agreed.
3. EMAS – Emergency ambulance service quality standards
remain challenging, with contractual measures being deployed
and additional winter capacity being commissioned
4. Community Equipment – There is agreement between partners
the Information Sharing and Partnership agreements can now
be signed. There is an outstanding issue regarding the provider
contract which is being negotiated. Detailed work with other
providers is progressing to manage NHS costs.
5. Continuing Health Care – A significant underspend of circa £2m
is related to the relative reduction of the year on year increase in
cost; however the underlying pressure remains significant.
Mrs Ellis said that in future reports the Cluster Board would be
expecting less detail, more of an exception report. The more detailed
contract monitoring would be the responsibility of the CCGs.
Mr Finan asked about the compliance with controlled drugs regulation
for community nursing and noted that there would be a re-audit in 6
months. He suggested that this should be 3 months. Mr Bosworth
agreed that this was too long and that the re-audit would be brought
forward.
It was RESOLVED
- to receive the report.
CB/12/156 Performance Assurance Report as at February/March 2012
Mrs Liz Rowbotham, Director of Quality, Communications and
Engagement presented the report providing an overview of
performance for LLR (as attached in Minute Book – Appendix Number
CB/05/10/U).
Mrs Rowbotham said that the PCT Cluster had had a formal
performance review with the SHA. The review concentrated on the
current performance of the Emergency Department in UHL and its
associated actions. Some time was also spent on RTT, cancer waits
and the financial position. No formal actions were required.
There are scheduled Board to Board meetings with LPT and with the 3
CCGs during May. There will be an additional Board to Board with UHL
in June.
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Run Rate Report for Q4 2011/2012 - although the cumulative
performance for the year end is not achievable for the majority of the
indicators, the run rate for Q4 as at March 2012 is showing
achievement for:
MRSA bacteraemias
Cancer 62 Day Waits (provisional)
CPA 7 Day Follow Up (to February 2012)
NHS Health Checks (Leicester City)
The following indicators still remain at risk of achieving the run rate for
Q4:
RTT 18 Weeks: UHL are working to remove long waiters and the
impact is a reduction in admitted and non-admitted patient
performance, with the intention to ensure specialty level
performance is achieved by April 2012 onwards. Weekly reports
are now also being submitted to the SHA which are showing a
significant reduction in long waiters, however this backlog is not
reducing as quickly as anticipated.
A&E Four Hour Wait: Performance has continued to deteriorate,
with the Q4 run rate not being achieved. Following the issue of a
First Exception Notice, a revised remedial plan has been received
and again has been rejected on the basis that it does not meet the
requirements set out in the First Exception Notice. A Second
Exception Notice is to be served to the Trust.
Cancer 62 Day Wait: Cumulative performance will not be achieved
during 2011/12, and a First Exception Notice under clause 32 of the
contract was issued to UHL in February and the provider responded
within the 14 day deadline. A revised trajectory was received, and
as at February 2012 the 85% target was exceeded. Provisional
data for March are also predicting achievement.
UHL have responded to a follow-up to the First Exception Notice,
which had asked for further assurance on how Lower GI and
Urology performance issues were to be addressed and sustained.
The Trust considers that meeting the contract standard of 85%
aggregate performance is adequate. Commissioners are now
considering what options are available to secure improved
performance in the Lower GI and Urology tumour sites.
NHS Health Checks: Cumulative performance has not been
achieved for 2011/12. However, Leicester City CCG has achieved
the run rate for Q4 and will also achieve the targets for Q1 2012/13
if the levels of performance seen in Q4 are sustained. The county
CCGs, while showing a significant increase in performance from
their previous quarterly positions, did not achieve the Q4 run rates.
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There is a deteriorating in month performance for stoke and CPA
follow-up.
The benchmarked report for all providers in the Western District of the
SHA ranks UHL overall as 19 out of 24 providers for the high risk
indicators (patient experience, A&E 4 hour wait, infection control, 18
weeks RTT and 62 day cancer waits), which is an improvement on last
month’s position of 21.
There is a marked improvement in the performance of Chose and Book
and learning disability health checks.
It was RESOLVED
- to note the at risk indicators and actions in place.
CB/12/157 Primary Care Framework April 2012
Ms Vikki Taylor, Director of Commissioning Development presented a
report on the Primary Care Framework April 2012 in Minute Book –
Appendix Number CB/05/10/V).
Ms Taylor noted that Primary Care would remain the responsibility of
the Cluster.
Ms Taylor said that this report is work in progress.
Ms Taylor confirmed that there was significant amount of triangulation
with CCGs including planned visits and review of complaints. The
report outlines additional areas where there is cause for concern; these
issues are followed up by the fitness to practice team.
Dr Rashid noted the under performance in the dental service; as most
practitioners offer a private and NHS service he asked if the private
work being prioritised over the NHS work. Ms Taylor said this is a
discussion item at the practice reviews if warranted by the data. Ms
Taylor noted the difficulty of insisting that they deliver the agreed level
of service. Mrs Ellis asked if there is over performance are the
contracts re-negotiated upwards to take account of higher volumes; Ms
Taylor confirmed that they were.
Mr Wilson asked about the underperformance of dental activity and
noted that the rate of fluoride varnishing was well below the SHA
average; he asked if there were plans to increase this. Mr Wilson also
noted that there was no dental sedation in the County. He asked if this
was this part of the under spend.
Ms Taylor said that the contract team were looking at how they could
address the under spend. With regard to varnishing, this is being
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discussed with all practices at their annual dental reviews. There is
funding for 30 practice nurses who could undertake this procedure.
Mr Wilson noted the 30 GP practices that were a cause for concern and
asked how this compared to the rest of the country. Dr Rashid said that
this proportion was not unusual; LLR is not an outlier; he also said that
very few of these were serious. Mr Wilson said that the information
given was just a number with no detail as to the problem. Ms Griffiths
said that this was an embryonic report which will develop to include
more information.
Mr Finan asked how the Cluster measures performance of GPs in
quality aspects as happens in secondary care. Ms Taylor said that each
practice has KPIs that they are monitored against e.g. health checks,
access, immunisation. On a quarterly basis the practices submit a self
assessment indicating their performance against the KPIs. These self
assessments are reviewed alongside other information and this will
determine which practices are visited. Dr Rashid said that measuring
quality in primary care was not easy.
Mr Mell asked why it was not possible to rank GPs in the same way as
NHS Trust providers.
Ms Bishop referred to the dental allocation and said that it was not
appropriate to plan to spend the surplus yet as the 2012/13 budgets
had not yet been signed off.
Ms Watson noted the information that the CCGs have. Ms Taylor said
that the team are building strong relationships with the CCGs. Dr
Rashid said that he planned that the contracting team would go out with
the CCGs on their practice visits.
It was RESOLVED
- to note the report.
CB/12/158
Out of Hours Contract, Governance and Performance Report
Ms Vikki Taylor, Director of Commissioning Development presented a
report on Out of Hours Contract, Governance and Performance (as
attached in Minute Book – Appendix Number CB/05/10/W).
Ms Taylor said that since the 1 April 2011 GPs in LLR have opted back
in to provide medical services in the out of hours period. LLR is the
only place in England where GPs have opted back in. The GPs opted
to subcontract their OOHs responsibilities to Central Notts Clinical
Services (CNCS); this arrangement is via a contract between CNCS
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and the LMC who are acting as the authorised agent of the “GP
providers” in their capacity as LMC members.
The LMC has signed the APMS contract with CNCS on behalf of the
individual GPs and has a responsibility to performance manage the
contract in place with CNCS on behalf of the GPs.
The SHA have requested that the PCT undertake quarterly monitoring
visits of the OOHs service. Due to our commissioning arrangements
these visits are led by the LMC with PCT attendance, an SHA
representative may join the meetings.
After collecting information on the number of unfilled shifts in OOH
providers from PCTs across the region the SHA has written asking the
PCT how it will be tackling the issue. The issue has been placed on the
Corporate Risk Register. The PCT are closely monitoring the service
given the gaps (Q3 106 GP shifts were not filled and 65 GP shifts were
covered by a nurse). CNCS have been asked to put forward a plan to
address, approximately 25 GP posts were appointed to in Q4, a further
30 posts out to advert in April. The PCT will assess the impact of these
recruitments.
Mr Wilson said that he found the report difficult to support; the National
Quality Requirements (NQR) for face to face clinical assessments and
consultations are not meeting the standard which could have serious
consequences. Ms Griffiths said that the Cluster Board needed
assurance that there is a remedial action plan to address these issues.
Ms Taylor said that she was working with the LMC to monitor the NQR.
Mr Wilson noted that there were a lot of shifts that were not manned.
Ms Taylor said that she and Dr Rashid had undertaken a site visit and
found that about 70 shifts out of 2,900 had not been manned. Dr
Rashid said they were assured that shifts were not being manned by
tired doctors.
Ms Griffiths said that there were performance issues and noted the plan
to have an external review of the contractual arrangements.
Mrs Rowbotham said that the Quality Group had been strengthened;
the LMC attend as they formally manage the contract. CNCS have not
currently been invited.
It was noted that although the GPs are the accountable people, the
Cluster commissions the service.
Mrs Ellis asked that there is an update report regarding the
management of the contract and the non-compliance with some of the
NQR.
Action: Dr Rashid
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It was RESOLVED
- to note with concern the non-compliance with the contract.
CB/12/159
The Leicester City Assist Practice Contractual Review of the new
APMS Contract
Ms Vikki Taylor, Director of Commissioning Development presented a
report on The Leicester City Assist Practice Contractual Review of the
new APMS Contract (as attached in Minute Book – Appendix Number
CB/05/10/X).
Ms Taylor said that this was a primary care contract which would
devolve to the National Commissioning Board in April 2013 and would
therefore remain as part of the Cluster core business.
This is a separate primary care contract report for although it is a small
contract it is high risk.
This contract is specifically for those many individuals, some of whom
reside in Leicester, who are going through the asylum application
process which takes many years to complete and the length of stay
within Leicester can vary from weeks to many years.
Asylum Seekers are entitled to primary care during their asylum
application. Primary care for failed asylum seekers is provided at the
discretion of GP practices, but all are eligible to ‘immediately
necessary’ treatment. The needs of the asylum seekers are complex
and varied.
The Leicester City Assist Service was developed in 2009 to provide
primary medical care to the estimated 3,000 asylum seekers living
within Leicester City, although many patients do travel from across
East Midlands to access services.
Until April 2011 the service was provided as a PCT Cluster Managed
Service and following an open procurement process, Assura
Leicestershire LLP was appointed as the new provider. They
commenced services under a five year Alternative Personal Medical
Services (APMS) Agreement on 2nd October 2011.
The first contractual review took place in February 2012. Ms Taylor
said that because of the level of Board concern regarding this service
there was extensive Cluster representation on the panel. The site was
visited and there were significant improvements in the willingness of
the provider and in their collaborative approach.
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There are some areas for improvement:-
GP hours
The role and responsibilities of the advanced nurse practitioner
The role of the art therapist
Mr Hackwood noted that the environment is not fit for purpose and
asked if anything could be done. Ms Taylor said that there is nothing
that can be done at present either in a new build or a conversion; the
PCT has identified alternative premises for the provision of minor
surgery and they are working with the practice for future provision.
Mrs Ellis encouraged Ms Taylor to consider other under-utilised
buildings in the City.
Dr Rashid asked about the doctor presence for only 2 days a week. Ms
Taylor said that there is the advanced nurse practitioner for the other
days. The service was never funded for a fulltime doctor. Ms Bishop
said that the service has been set up as a nurse-led service model. Ms
Taylor said the preferred model of Assura is the doctor/nurse model.
She also said that Dr Elizabeth Siddons (Assistant Medical Director) is
comfortable with the assurance provided.
Mr Skea noted the update regarding the Art Therapist and agreed to
pick this up with Ms Taylor outside of the meeting.
It was RESOLVED
- to note the report.
MINUTES/REPORTS FROM COMMITTEES
CB/12/160
Report from the Quality and Clinical Governance Committee
Mr David Mell, Non-executive Director and Chair of the Quality and
Clinical Governance Committee presented the report from the April
meeting of the Quality and Clinical Governance Committee and the
minutes of the meeting of 28 th March 2012 (as attached in Minute Book
– Appendix Number CB/05/10/Y).
Mr Mell noted the 2 issues that had been escalated to the Cluster
Board:-
Need for clarity from LPT re input into the MARAC process: Ms
O’Brien and Ms Robson would raise this via the quality contract;
Need for review of clinical input into the UHL quality contract
process: Ms Trevithick would agree the most effective process
for CCG clinical input to the quality contractual process.
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It was RESOLVED
- to note the report
CB/12/161 Minutes of the Leicester City Clinical Commissioning Group
Board held on 13 March 2012
Mrs Cathy Ellis, Chair of the LLR PCT Cluster presented the minutes of
the meeting held on 14 February 2012 (as attached in Minute Book –
Appendix Number CB/05/10/Z).
It was RESOLVED
- to receive the minutes.
CB/12/162 Minutes of the East Leicestershire and Rutland Clinical
Commissioning Group Board held on 13 March 2012
Mrs Cathy Ellis, Chair of the LLR PCT Cluster presented the minutes of
the meeting held on 13 March 2012 (as attached in Minute Book –
Appendix Number CB/05/10/AA).
It was RESOLVED
- to receive the minutes.
CB/12/163
Minutes of the West Leicestershire Clinical Commissioning Group
Board held on 13 March 2012
Mrs Cathy Ellis, Chair of the LLR PCT Cluster presented the minutes of
the meeting held on 13 March 2012 (as attached in Minute Book –
Appendix Number CB/05/10/BB).
It was RESOLVED
- to receive the minutes.
CB/12/164
Minutes of the East Midlands Specialised Commissioning Group
Board held on 27 January 2012
Ms Vikki Taylor, Director of Commissioning Development presented
the minutes of the meeting held on 27 January 2012 (as attached in
Minute Book – Appendix Number CB/05/10/CC).
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It was RESOLVED
- to receive the minutes.
CB/12/165
Any Other Business
Future Board Meetings
Mrs Rowbotham confirmed the dates of Cluster Board Meetings for the
remainder of 2012/2013.
22 May 2012 - a one agenda item Board to discuss and
approve the transfer of the Health Informatics Service to
Leicestershire Partnership Trust
14 June 2012
The July meeting has been re-scheduled and will be held on
Wednesday 25 th July 2012.
There will be no meeting in August.
It is intended that Cluster Board Meetings should then be held bi-
monthly:-
13 September 2012
8 November 2012
10 January 2013
14 March 2013.
Board members are asked to keep the following dates in their dairies in
case there is a need for them:-
11 October 2012
13 December 2012
14 February 2013.
Date of Next Meeting
The date of the next Board meeting will be Thursday 14 June 2012 at
Conference Room 1 and 2, Lakeside House, 4 Smith Way, Grove
Park, Enderby, Leicestershire, LE19 1SS.
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