CCG Minutes - NHS Cumbria

Interim CCG Executive21 June 2012MINUTES OF THE MEETING OF THE INTERIM CCG EXECUTIVEHELD ON 21 JUNE 2012 AT 08:30amIN THE CONFERENCE ROOM AT HACKTHORPE HALLPRESENT:IN ATTENDANCE:Dr Hugh Reeve – Chair, GP Lead South LakesDr Simon Dessert – GP AllerdaleDr Geoff Jolliffe – GP Lead FurnessDr Rachel Preston – GP Lead EdenDr Neela Shabde – Medical DirectorDr Peter Weaving – GP Lead CarlisleAnthony Gardner – Director of Planning, CCGNigel Maguire - MD, CCGJohn Roebuck – Interim Finance Director, CCGAmy Clements – Communications Specialist, NHS CumbriaJen Lawson – Authorisation Support Manager, CCGJoanne Percival – Minutes, CCGCaroline Rea – Deputy Director, CCGCharles Welbourn – Deputy Director of Finance, NHS Cumbria82/12 AGENDA ITEM 1 - APOLOGIES FOR ABSENCEACTIONApologies of absence were received from:Dr Fayyaz ChaudhriMark GrahamDr Alistair MacKenzieDr David Rogers83/12 AGENDA ITEM 2 - MINUTES OF THE PREVIOUS MEETINGThe minutes of the previous meeting held on 17 th May 2012 were approvedwith the exception of one amendment - 70/12 Long Term Conditions.MATTERS ARISING52/12 CONSULTANT TO CONSULTANT REFERRAL’S IN NORTHCUMBRIADr Fayyaz Chaudhri had distributed the final model, which has now beenapproved by North Cumbria Clinical Leads Group with a view to- 1 -

Interim CCG Executive21 June 2012implementation commencing in July 2012.59/12 PUBLIC HEALTH CORE OFFERThe group have now met and a ‘work plan’ is currently being drafted.75/12 LOCALITY PLANSImplementation plans are being drafted for discussion at the next meeting.84/12AGENDA ITEM 3 - DECLARATIONS OF INTERESTNo declarations of interest were declared.85/12AGENDA ITEM 4 - CHAIRS BRIEFDr Hugh Reeve updated the group on recent key events:GOVERNING BODYRecruitment to the governing body is now underway, three lay membershave now been appointed subject to confirmation.Recruitment to the Doctor and Nurse representative posts will beconcluded in the next few weeks.Dr Geoff Jolliffe (South) and Dr Peter Weaving (North) were nominated asCCG Executive GP Representative’s on the Governing Body. Formaldecision to be confirmed on July 5 th .It’s anticipated that induction for the group will be early July.CCG SENIOR POSTSRecruitment to the CCG senior team is ongoing, applications are in andinterviews will be held in late June.111 PROCUREMENT PROCESSIs underway. Dr Hugh Reeve, Dr Fayyaz Chaudhri and Dr David Rogersare all involved in the process. Nationally a proposed implementation dateof 1 st April 2013 has been suggested, but this will be subject to finalassessment and approval of bidders.MEETING WITH NOTRHUMBRIA AHEALTHCAREDr Hugh Reeve and Nigel Maguire met with Jim Mackey and colleaguesfrom Northumbria Healthcare regarding the Acquisition in the North of thecounty.MEETING WITH STEPHEN SINGLETONDr Hugh Reeve and Nigel Maguire met with Stephen Singleton on the 20 thJune. They shared updates on developments both locality and nationally.Current issues in the North and South of the county were discussed. It wasalso confirmed that the National Commissioning Board have decided on- 2 -

Interim CCG Executive21 June 2012the siting of local area teams and Cumbria will sit with the North East.Stephen Singleton will be attending the CCG Executive meeting in July.GRAFTON GROUPAre intending to hold a full day workshop on ‘Alliance Contracting’. ChrisHam will be in attendance and it’s hoped that we’ll be able to send twogroups of attendee’s to cover the North and South of the county. Hugh willshare dates when announced. The workshop will prove useful when weengage more in the future with Northumbria Healthcare, who are keen toexplore different avenues of contracting.86/12AGENDA ITEM 5 - MANAGING DIRECTOR’S BRIEFIncorporated in Dr Hugh Reeve’s report.87/12AGENDA ITEM 6 – CLINICAL STRATEGY PROGRAME BOARDSUPDATESNorth CumbriaGood progress is being made and the detail of various programmes isbeing worked through.South CumbriaNigel Maguire updated the group. Lancs North CCG have recentlyappointed their Management Lead, Andrew Bennett and have good clinicalengagement, who together with representatives from Cumbria CCG, will beworking with senior colleagues from UHMBFT on a ‘Joint GovernanceBoard’. Dr Hugh Reeve will chair the group for the 1 st 6 months and thenhand over to Dr Alex Gaw from North Lancs CCG. A programme office hasbeen set up and a sub group, to be chaired by Peter Clarke, will encouragepublic engagement. The JCB have already met and had a productivemeeting. In the future a clinical strategy will be drafted, with 5 mainworkstreams; Planned, Unplanned, Maternity, Children and Infrastructure.Reviews of some workstreams will take place in the near future and willinvolve engagement with the general public. The interim managementteam at UHMBFT are fully engaged in the process and very committed tochange. It is hoped that services in the north and south will be aligned in amore strategic manner.88/12AGENDA ITEM 7 – SAFEGUARDINGDr Neela Shabde updated the group regarding the CQC report which hadbeen published on Wednesday 20 June. The report had raised similarrecommendations and actions to the recent Ofsted report. A county wideintegrated action plan is being compiled and Nicola Jackson has beenappointed to co-ordinate NHS Cumbria’s role within the group. A JointImprovement Board is also being set up, which senior directors will beattending. Dr Neela Shadbe and Moira Angel are driving theseprogrammes forward on behalf of the CCG and NHS Cumbria.- 3 -

Interim CCG Executive21 June 201289/12AGENDA ITEM 8 – QUALITYCaroline Rea gave a verbal update of key issues:UHMBFT – CQUIN scheme negotiations have been concluded and linkwith clinical teams and improvement areas. Stretch targets will be agreedin June.NCUHT – Mortality rates (as per Dr Foster report) will be discussed at nextweek’s meeting, along with issues regarding strategic leadership andpatient feedback.Internal quality evidence systems identified problem’s which have beenaddressed and shows that processes put in place recently are working.Communication between ourselves and our provider’s needs to becontinually improved.Issues have been raised with both trusts regarding urology and oncologyservices, along with RTT rates. Issues have also been noted with regardsto turnaround time for some biopsies, which is also being addressed.CPFT – a new format to the meetings has been agreed, this will includesenior clinical members. Separate meetings will be held for children andadult services. Dr Jim Hacking provides clinical input into mental healthmatters. It is hoped that an additional GP lead can be identified to provideinput on community services.90/12AGENDA ITEM 9 – CONSTITUTIONAnthony Gardner gave an update on the ‘condensed’ draft of theConstitution which had been circulated.Feedback from the earlier meetings and the elected GP session indicatedthat the Constitution using the NCB template was not as clear as it neededto be on a range of issues, such as: the responsibilities of localities, theCCG executive and the Governing Body; how these elements fittedtogether; clarity on the rights and responsibilities of member practices andthe benefits or added value to the practices of being in the CCG; and therole of the LMC. In light of the feedback, a more digestible version of theConstitution has been produced. This was circulated to localities andfeedback provided at the informal CCG earlier in June from those localitieswho were able to attend the session. Importantly, this digestible versionseeks to assure member practices that we are not starting from scratch asthey may be in other CCGs; that this is formalising what we are doing atthe moment and addressing additional formal requirements such as theneed for a Governing Body. So this is evolution not revolution andrepresents a codification of ‘common law’.The NCB have recently clarified their stance on constitutional agreementand the authorisation process. The expectation is that we have aconstitution for submission of evidence on 2nd July. But it is not mandatory- 4 -

Interim CCG Executive21 June 2012that we use the NCB template: but we have to demonstrate that we haveaddressed all of the issues set out in the template. Similarly, it is notmandatory to have all practices signed up to the constitution when wesubmit evidence on the 2nd July: however, we must show the journey weare on and sign up from practices as evidence of engagement andagreement before the panel visit in September is still important. This helpsto ensure we have appropriate time to engage with member practices andthe LMC to develop an effective document with local ownership.It is suggested that we use the digestible version (or future iterations) forengagement and sign up, with practices and the LMC. We should still aimto have the full template document as part of the governance suite ofdocuments; but only to the extent that it reflects the digestible version.At the informal session in June, there was recognition that for some, it ishard to feel entirely comfortable with the constitution without some of thetechnical detail which will come later through the detailed standing orders,financial regulations and other supporting documents (eg delegated budgetsplit corporate/localities). To help with this, some worked examples will beconstructed which can show how decision making scenarios would play outthrough the arrangements specified in the constitution.Some issues will need clarifying in due course ie voting system, role andresponsibilities and members rights to make amendments. A system tofacilitate such issues will be introduced. Liaison will be required via thegoverning body and ‘council of members’.Localities are the driving force of the organisation and we need to promote,educate and engage both practices and the public.Additional narrative around the role of the National Commissioning Boardwill be added and inter-practice agreements need to be formalised.The CCG approved the document for use, with some minor narrativeupdates. The definite version will be issued at the end of June. Localitieswill then be asked to share the document via locality executive meetings,member groups and practice visits. It was also noted that the document willbe updated over the coming months with a view to gaining formalagreement by the ‘council of members’ in the autumn. Anthony Gardner tocollate any comments for future consideration.- 5 -

Interim CCG Executive21 June 201291/12 AGENDA ITEM 10 – PERFORMANCE & FINANCE REPORTSi) 11/12 & 12/13 INTEGRATED PERFORMANCE AND FINANCEREPORTJohn Roebuck summarised the report previously circulated which included:NHS North of England 2012/13 Performance ReviewHad recently taken place and included discussion relating to strategicissues associated with our main acute providers. The outcome of themeeting had been positive with regards to the action taken to addressissues including RTT, A&E Targets, Mixed Sex Accommodation andStroke.The latest NHS NoE report shows a slightly better overall position than inrecent months. The report now includes health checks but doesn’t reflectthe trust status in relation to health visitor targets (which should be green -although some issues remain). RTT and Mixed Sex Accommodation stillremain concern areas, which are being addressed via contract meetings.An improved performance is expected in the second quarter.Subsequent to the NHS NofE review, an additional issue relating to longwaiters has been identified. A plan to address this will be agreed with ouracute performers.Action taken with local acute providersLetters have been sent to Chief Executives of our acute providershighlighting the need to improve performance in a sustainable manner.This has been followed up at contract meetings, whereby a standing itemsets out the penalties associated with poor performances (includingfinancial penalties, contract query notices and remedial action plans).Non acute performanceCommunity service contracts need to be continually monitored to ensurefront end services are working effectively to support flow of patients to andfrom secondary care. Clear and consistent operating arrangements acrosslocalities are required to support this. Localities need to revisit action plans(set last year) to ensure operational delivery. Peter Rooney and RachelFleming are working with CPFT colleagues to determine better outcomesin the future.A group comprising of staff from the CCG, Partnership and Social Servicewill shortly be visiting a trust in Yorkshire to see have they’ve usedsoftware to support processes and enhance service delivery.Finance 11/12 final positionExternal auditors have confirmed that the PCT achieved its financialtargets and met its statutory duties. Detailed information for each area ofmajor expenditure is available and will be shared with Locality executives.- 6 -

Interim CCG Executive21 June 2012This will help inform member practices and highlight issues / concerns thatcould impact the current position.Finance 12/13 current positionInitial information from acute providers indicates that month 1 activity is inline with agreed contracts. Elective activity is up but is offset by reducedlevels of emergency care activity. Week 10 data reflects this. It isanticipated that the closing position for Quarter 1 will be available at theJuly meeting. Data relating to prescribing spending will also be available atthe July meeting.The CCG Executive noted the report.ii)MEDIUM TERM FINANCIAL STARTEGYCharles Welbourn gave a brief overview of the report previously circulatedwhich outlined the CCG financial strategy for the next 3 years and hasbeen based on the ISOP plan for 2012 – 2015 including the CCG’scommissioning intentions and reflects budgets devolved to the CCGthrough the accountability agreement for 2012/13. The financialarchitecture at the current time remains considerably uncertain and theapproach has therefore incorporated a number of assumptions which willneed reviewing and formalising in due time. It is anticipated that a financialstocktake in August will allow further detail to be added. Further iterationsof the plan will be issued when available.The paper details:• Overall planning approach• Specific planning assumptions and approach to risk includingrecurring costs and non-recurring funding• Key resource changes, summary of the financial plan and 3 yearlocality analysisThe CCG executive approved the financial strategy as a working documentand acknowledged the assumptions which it is based upon.iii)CHARITABLE FUNDSCharles Welbourn summarised the paper previously distributed.The NHS Cumbria Charitable Fund is an independent charity (registeredwith the Charity Commission) and the Board of Cumbria Teaching PCTacts as the corporate trustee under statute.Given the planned demise of the PCT on 31 March 2013 then appropriatefuture trustee arrangements need to be established. The PCT’s CharitableFund Committee has identified that, following the proposed transfer ofassets, around 85% of the fund will relate to services provided by andoperated in premises owned by Cumbria Partnership FT (CPFT), and theremaining funds for services provided by CPFT. Therefore, the Committee- 7 -

Interim CCG Executive21 June 2012has identified that, assuming the proposed asset transfer progresses, thelogical successor as Trustee would be CPFT. Therefore, the Committeehas provided approval in principle, subject to a number of caveats, fordiscussions to commence to transfer the funds to the CPFT charitablefund. Fundamental to this approach is to ensure that funds are to beapplied in line with the donor’s wishes.Therefore, as a result of this approach then it is proposed NOT to establisha charitable fund for the CCG as the governance arrangements for theNHS Cumbria Charitable Fund in future would provide a vehicle toeffectively manage any CCG funds appropriately in a cost effective way.However, should the position change then the feasibility of establishing aCCG fund will be considered.The CCG Executive noted the report.ITEM 11 – PALLIATIVE CARE BUSINESS CASE92/12Ray Beale-Pratt joined the meeting and outlined the paper previouslycirculated.The business case seeks support for the creation of 4 specialist palliativecare beds within the Copeland Unit. The service is costed at £388k and beoperated by the CPFT, funded partly by reduced PbR payments to NCUHTand partly by additional monies which the CCG / Locality will need toprovide. Estimated split of reduced PbR / new funding is approximately50/50, dependant on admission pathways and casemix.Historically, provision of palliative care in the west of the county has beenfragmented, across a number of providers, which had led to a lack ofcohesion. The business case provides a short term solution, to this longterm issue, and will allow an opportunity for a more community orientatedmodel to be delivered through community facilities and specialist nursesworking within the Copeland Unit. The locality will have responsibility offunding in years 2 and 3, however initially funding may be required untilsavings are known and released for re-investment. It is anticipated that theservice will be fully functional by October 2012.Charles Welbourn confirmed that funds to support the business case in theshort term are available.The CCG Executive approved the business case, on the basis that in thelong term, palliative care funding would be reviewed county wide, which inturn would address evident in-equalities across the localities.93/12 AGENDA ITEM 12 – AUTHORISATION PROGRAMME UPDATEAnthony Gardner updated the group regarding a recent meeting with JanLedward from NHS NoE, who had been supportive of our progress to date.Dr Peter Weaving updated the group on key developments including:- 8 -

Interim CCG Executive21 June 2012Confirmation of panel day has been received. The date proposed, 4 thSeptember, is a Tuesday. Jen Lawson is liaising with organisers to changethis, in order that GP’s can be included on the panel. It had also beenhoped that a ‘mock’ panel day would be organised but this is unlikely,however a preparation session will be taking place, when the group willhave the opportunity to work through the detail.360 Survey results will be sent to NHS NoE next week. We’ll get a factualsummary of the report.Dr Peter Weaving and Caroline Rea have both applied to be AuthorisationAssessor’s. This would enable a better understanding of the process.Progress is ongoing with regards to key documents and work areasincluding OD plan, Draft Health and Wellbeing Strategy, Comms andEngagement Plan, key financial documents, governance tools and the CSSprogramme (documentation, outcomes and work programme).Slippage area’s have been identified:• Transition plan for safeguarding – is being worked through but notcomplete at this stage, due to changing national guidance. Abriefing document is being prepared, which will be followed by ahalf day workshop. Dr Neela Shabde is working with VernonWatson to ensure delivery.• Review of key documents is under way, but technical problemshave been experienced. It is hoped that feedback on all documentswill completed week commencing 25 June.• Membership engagement – core actions have been agreed butfurther liaison with localities is needed regarding consistency.Submission of evidence for Wave 1 CCG’s is due on the 2 July. Work isongoing to ensure collation of evidence and signposting of documents, ineach of the 6 domain’s, is ready.94/12 AGENDA ITEM 13 – CSS PROGRAMME UPDATECaroline Rea updated the group on paper previously distributed whichsummarises progress to date with regards to CCG requirements and theformation of Cumbria and Lancashire Support Services (CLaSS). The draftSpecification document was also distributed.Three significant pieces of work will be developed in the coming months toensure the CCG has an effective working relationship with its CSS partnerfrom April 2013:• Development of CCG requirements and the CSS proposition formeeting those requirements, resulting in an Agreed SLA• Transition to the new CSS organisation (systems, services andstaff) to ensure continuity during transition- 9 -

• Building confidence in the CCG and CSS as partners through earlyachievement of some early outcomes.Interim CCG Executive21 June 2012Commissioning Support Services (CSS) are intended to provide CCG’swith a wide range of products and services that are designed to meetspecific business needs of each client CCG, covering at scale transactionalservices, as well as areas of highly specialised support. CSS’s will behosted by the National Commissioning Board until April 2016, when theyare expected to become independent bodies. Cumbria CCG and CCG’sfrom across Lancashire are working together to develop a joint CSS(CLaSS).A co-design for delivery is essential to ensure:• Organisational design and structures of both CSS and CCG knittogether ensuring commissioning work in undertaken in the mostefficient and effective manner• The balance between locality presence and centralisedtransactional support is optimised• DH authorisation criteria for both CCG and CSS is met andevidence• Short-term support requirements of the CCG’s in the period leadingupto April 2012 are metThe specification document details the requirements of Cumbria CCG asthe client and CLaSS as a provider, and will be used to inform thedevelopment of a Service Level Agreement in the future. The specificationhas been set out in three areas:• A Strategic Partnership• Dedicated staff working in and with the CCG• Commissioning support servicesCLaSS has been developed and has already gained Department of HealthBusiness Development Gateway 2 status and will be assessed again inSeptember. The project team is developing business systems andprocesses that are needed to enable it’s status as an authorisedorganisation from April 2013. It’s aim is be the provider of choice for locallydelivered, high quality innovative, customer focussed support services andhas been working closely with the 9 CCG’s in the Cumbria and Lancashirearea, whom will form it’s client base in the future. CLaSS are also workingcollaboratively with neighbouring CCG’s to agree systems for the futurethat can be built upon.NCB local offices will also be using CSS services for support. Cumbria willbe sited with the North East, which will have implications as geographicallythe NCB and CSS’s team will be operating in different geographicallocations which has been identified as a risk.Relationships and contracts will be continually reviewed and initially 12- 10 -

Interim CCG Executive21 June 2012month SLA’s will be drawn up. This will allow all parties to gain confidencewith each other and assess effectiveness. To assist development,performance management and monitoring will be done, on an ongoingbasis. 6 specific outcomes will be identified by the CCG as high priority.Costing options have been provided by CLaSS, in line with servicespecification outlined by the CCG. Aggregate costs across the CCG’s willalso be identified. Terms and conditions have been developed, anddiscussions regarding agreement of an initial 12 month contract are takingplace.A steering group, including staff from Cumbria CCG and NHS Cumbria hasbeen formed and will oversee the work programme. Staff engagementhas commenced and roadshows, informing wider staff teams of progress todate, have taken place.95/12 AGENDA ITEM 14 – MINUTES OF LOCALITY MEETINGSWere received from:Allerdale 26/4Copeland 26/4Eden 8/5‘Locality Executives’ will be formalised as per the constitution.96/12 AGENDA ITEM 15 – ANY OTHER BUSINESSNo further items were noted.97/12 DATE, TIME AND LOCATION OF NEXT MEETING19 July 2012 – 8.30am Shap Wells Hotel, Shap16 Aug 2012 – 8.30am Conference Room, Hackthorpe Hall- 11 -