Agenda item 9 GOVERNING BODY MEETING – TUESDAY 11 NOVEMBER 2014 MINUTES TO BE RECEIVED Title of Meeting Council of Members Date of Meeting 16 September 2014 Status (ratified/draft) Ratified CCG Representatives Dr T Johnson (Chair) One representative of each GP Practice Mr I Stoddart, Chief Finance Officer Summary of key issues discussed: Justine Howe, Senior Commissioning Manager, presented an update on the Better Care Fund and Operational Resilience Planning. Dr Kath Greenwood, Mental Health Lead GP, presented an update on dementia and in particular projects that were ongoing within the CCG to support dementia diagnosis. Peter Kelly, Head of IM&T, presented an update on Digital Health from a local and Lancashire-wide perspective. The Chair announced the outcome of the invitation for expressions of interest in the two vacant GP clinical lead positions on the Governing Body. The Council of Members approved the appointment of Dr Jacky Panesar, GP at Ash Tree House in Kirkham, and Dr Felicity Guest, GP at The Thornton Practice. The Clinical Chief Officer provided information regarding the Diabetes primary care service, the Higher Quality Local Improvement Service and the RSPE Enhanced Service. A discussion took place regarding the outcome of the 360-degree stakeholder survey, and in particular, how the CCG could improve its communications with GP Practices. Tracy Riddick, Senior Integrated Governance Manager, briefing members regarding the forthcoming CQC process for inspections of primary care. Dr Smyth updated members and clarified the arrangements regarding the referral pathway and accountability and responsibility of patients referred to the out of hours IV antibiotic therapy service. Members were notified of the CCG’s forthcoming quality assurance review of the stroke pathway and were encouraged to complete a short online survey. Issues requiring action: Details: All actions are identified within the minutes. By whom: Timescale: Recommendation The Governing Body is asked to review and note the contents of the minutes. Dr Tom Johnson Chair – Council of Members 1 Fylde and Wyre Clinical Commissioning Group Council of Members Tuesday 16 September 2014 – 7pm - Grasmere Room, Wesham Present: Dr T Johnson – GP Elected Clinical Lead and Chair of the Council of Members Dr K Greenwood – Queensway Surgery and GP Elected Clinical Lead (Vice Chair) Dr T Naughton – Clinical Chief Officer Dr Kwun – Waverley Practice Dr V G Chandrasekar – Beechwood Surgery and GP Elected Clinical Lead Dr Butler-Reid – Ansdell Medical Centre Dr P Benett – Clifton Medical Practice and GP Elected Clinical Lead Dr I Kirkham – Lockwood Avenue Surgery Dr H Grenier – The Mount View Practice Dr S Hardwick – Kirkham Health Centre Dr R Smyth – Broadway Medical Centre Dr R Thorpe – The Old Links Surgery Dr M Zaryckyi – Park Medical Centre Dr Ali – Dr Ali’s Practice Dr M Cook – Carleton Surgery Dr Ramesh – Belle Vue Surgery Dr J Panesar – Ash Tree House Dr S Ellwood – Fernbank Surgery Dr P O’Sullivan – The Thornton Practice Dr Sobha – The Village Practice Dr J Chesworth - Over Wyre Medical Centre Dr Samad – Poplar House Surgery Dr N Lowe - Holland House Mr I Stoddart – Chief Finance Officer In Attendance: Mrs T Riddick – Senior Integrated Governance Manager - Primary Care Mrs S Camplin – Head of Commissioning (for agenda item 110/14) Mr M Britton – Communications Manager Mr P Kelly – Head of IM&T Mrs J Howe – Senior Commissioning Manager (for agenda item 109/14) Mrs P Bowling – Governing Body Secretary Apologies for absence: Dr A Janjua – Waverley Surgery Dr J Reid – Ansdell Medical Centre Mr P Tinson - Chief Operating Officer Mrs J Aldridge - Chief Nursing Officer 106/14 Any other items of urgent business There were no other matters of urgent business. 107/14 Declarations of Interest There were no declarations of interest relating to items on the agenda. 108/14 Proteus Digital Health This item was deferred. 109/14 Better Care Fund and Operational Resilience Planning Better Care Fund Update Justine Howe set out the background to the establishment of the Better Care Fund (BCF) and highlighted recent changes in the guidance, including a change to the performance related metric. Total emergency admissions replaced the original metric of avoidable emergency admissions and the funding corresponding to any reduction formed the element of the pay for performance fund. The Better Care Fund plan was a Lancashire-wide plan and was subject to approval by the Lancashire Health and Wellbeing Board prior to submission to NHS England on 19/9/14. Operational Resilience Planning Justine Howe advised that the CCG had received just over £1m in June this year to plan for resilience over the winter months. A joint plan had been produced across the Fylde Coast in conjunction with Blackpool CCG and Blackpool Hospitals Trust and submitted to NHS England. Progress on implementation of the plan would be monitored via NHS England. Early receipt of the resource would enable the CCG to put schemes in place early to make a difference to the provision of services. Some concern was expressed regarding Community Matron resource in the St Annes area due to retirement and Justine Howe agreed to ask Nicola Walmsley to raise this at the contract review meeting. Action: J Howe Members were advised of a change in the guidance in terms of reporting against the A&E targets in that activity at the Walk-in Centre in Blackpool was now included. 110/14 Dementia Dr Greenwood delivered a presentation on dementia and confirmed that the target for dementia diagnosis in Fylde and Wyre was 67% of the expected prevalence rate. At present the CCG was not achieving this target. The presentation covered the following:      Why is dementia diagnosis important Results of the dementia survey Dementia projects – Cantab mobile and retrospective dementia diagnosis Patient story What else practices can do Dr Greenwood explained that Cantab mobile had been commissioned as a 12-month pilot in Fylde and Wyre using non-recurrent resource. All interested practices had been issued with equipment to undertake the assessment and training was almost complete. It was noted that some practices had raised issues around patient confidentiality, however, Dr Greenwood was able to give reassurance on this. It was noted that there was a Dementia Adviser post in Fylde and also in Wyre. A discussion took place around whether there was an evidence base for screening for dementia and reference was made to the NICE guidance on dementia. Iain Stoddart referred to the guidance from NHS England which is available on the following link: http://www.england.nhs.uk/2014/09/10/dementia-guide/. Members also requested further information regarding the prevalence rate. Action: S Camplin Reference was made to a possible impact on radiology due to increase in referrals for scans. Members commented that the waiting time for the Memory Assessment Service had reduced and it was confirmed that the CCG had invested in capacity. The Chair thanked Dr Greenwood and Sarah Camplin for their presentation and encouraged practices to improve their performance in this area in order to ensure that patients and their carers got the necessary support and access relevant services. Big White Wall Dr Greenwood provided an update on the Big White Wall. Since its launch in April 2014, 124 people in Fylde and Wyre had used the service. Most people were using the support network and 8 prescriptions had been issued by GPs for the live therapy, one of which had been taken up to date. Positive feedback had been received from service users. GPs were asked to continue to support and promote the use of this service. S Camplin agreed to arrange for each GP’s log-in details to be re-circulated. Action: S Camplin 111/14 Digital Health – update Peter Kelly presented an update on Digital Health from a local and Lancashire-wide perspective. The presentation covered the following areas:         National drivers Local drivers Fylde and Wyre CCG’s IM&T vision Strategic benefits Current position across all the CCGs in Lancashire GPIT contract changes to be in place by March 2015 Programme portfolios Lancashire’s Digital Health Ecosystem overview Suggestions/ideas were welcomed from members on priorities linking these to the CCG’s 8 priority service areas. An issue was raised regarding e-correspondence and that this did not work effectively at all providers. Peter Kelly agreed to follow this up. Action: P Kelly 112/14 Minutes of the last meeting held on Tuesday 15 July 2014 The minutes of the last meeting were approved as a correct record, subject to the addition of the following under ‘apologies for absence’: Dr T Naughton, Dr M Cook and Mrs J Aldridge’. 113/14 Matters arising Item 97/14 – Iain Stoddart advised that the Remuneration Committee had not met since the last Council of Members meeting. Their next meeting was in October at which time the matters raised by the Council of Members would be considered. 114/14 Chairs Update 1. Changes to the Constitution The Chair advised that the next opportunity to make any changes to the CCG Constitution was 1 November 2014. Changes had to be submitted to NHS England for approval and would be presented to the Council of Members for agreement at the next meeting. 2. Appointment of Elected Clinical Leads on the Governing Body Members were advised that two expressions of interest in becoming an elected clinical member on the CCG Governing Body had been received from: Dr Jacky Panesar at Ash Tree House Dr Felicity Guest at The Thornton Practice. It was confirmed that as there were two vacancies and two applications, there was no requirement to hold an election. The Clinical Chief Officer and Council of Members Chair had met with the two candidates to assess their eligibility for the role and recommended Dr Panesar and Dr Guest to the Council of Members for appointment for a term of office of two years. It was noted that Dr Paul O’Sullivan was currently the representative on the Council of Members for the Thornton Practice and would stand down as the representative, should Dr Guest be appointed. Dr Naughton advised that Dr Guest would be taking on the clinical lead role for medicines management and that Dr Panesar’s clinical led area was to be confirmed. RESOLVED: 1. That Dr Panesar and Dr Guest are appointed as elected clinical leads on the Governing Body for a term of office of two years. 2. That thanks be recorded to Dr Paul O’Sullivan, Practice Representative, for his input and support to the Clinical Commissioning Group. 3. Practice Bulletin Members were reminded that the weekly Practice Bulletin contained important information from the CCG and asked members to encourage their colleagues to read it. 115/14 Clinical Chief Officer’s Update 1. Diabetes primary care service A draft service specification for the diabetes primary care service (previously LES) had been sent out to practices via the Practice Bulletin and comments were sought from practices. Practices were encouraged to review the documentation and send comments to Pete Smith on [email protected]. 2. Higher Quality Local Improvement 16 out of 21 practices had signed up to the Local Improvement Service. Practices that had not signed up had been contacted about their future intentions. Since its launch there had been a 30% increase in the number of care plans and there were now over 6000 care plans in place across the Fylde Coast. 3. 360 degree survey The 360-degree stakeholder survey took place in March/April 2014 and the CCG did well compared to the national average across all indicators. However, detailed analysis of the results had indicated some areas where the CCG could improve. These were outlined as follows: - Not all practices felt that arrangements for member experience were very effective. - Not all practices were receiving information about decision making. - 33% of practices did not feel involved in the CCG’s decision making process. - 72% of practices had confidence in the CCG’s ability to commission high quality service - 72% of practices agreed leadership is delivering quality improvements. Dr Naughton discussed the findings with members and encouraged feedback on any further comments/suggestions that could help the CCG to improve its communications. Dr Naughton said that in future, within his regular report to members, he would include reference to any key CCG decisions and of action taken on any suggestions. In addition a timely summary of Council of Members’ decisions would be circulated to all practices via the Practice Bulletin. 4. Neighbourhood event The next neighbourhood event was due to be held on Wednesday 24 September 2014. 5. Winter campaigns The CCG had been given resource of approximately £10k to reinforce national campaigns locally. 6. RSPE Enhanced Service The CCG was committed to the same level of funding. A support pack will be issued and will be discussed at the next Practice Managers Forum. Practices were asked to ensure that the forms were returned to the same email address from which the email originated ie [email protected]. 7. National recognition of New Models of Care The CCG had been chosen from the North of England to bid for some European Union funding to trial new long-term conditions management approaches. In addition, the CCG would be informed on 8 October if its bid to become a ‘care innovation site’ to accelerate the implementation of the new models of care plans, had been successful. Dr Naughton expressed his gratitude to all those involved with this. 116/14 CQC process for inspections Tracy Riddick advised that the CQC had announced a new process for inspections during October 2014. Practices within each CCG would be inspected as a block. The CQC inspecting team would include a CQC inspector, a GP Adviser and a Practice Nurse or Practice Manager and would cover a number of areas including safety, effectiveness, well led and responsive. During the visit the inspection team will speak to staff, patients, carers and relatives and will present a verbal report at the end of the visit followed by a formal report at a later date published on the website. It was expected that two weeks’ notice would be provided and that promotional material would be provided in advance. All GP practices in England are to be visited by April 2016. 117/14 Community IV antibiotic therapy Dr Smyth updated members regarding the referral pathway and arrangements for accountability and responsibility of patients referred to the out of hours IV therapy. The service is run from the micro-biology department at Victoria Hospital. About 50% of patients are in-patients with the acute trust and are referred into the service by their consultant who retains clinical responsibility whilst the patient is receiving the out of hours IV therapy until the process ends and the patient is no longer an inpatient. With regard to patients referred into the service by GPs, once accepted, the accountable clinician is the consultant microbiologist until formally discharged. Referrals can be done in a number of ways, including at the medical triage directly, at the PCAU directly and to the consultant microbiology team. Members were asked to share this information with their colleagues. 118/14 Any Other Business 1. GP survey Tracy Riddick reported that Fylde and Wyre CCG and Blackpool CCG were working collaboratively as part of the quality review programme, commencing a review of the stroke pathway in October 2014 at Blackpool Teaching Hospitals NHS Foundation Trust and in the community. In support of this a GP survey was being arranged and would be sent out to practices on 17/9/14. Members were encouraged to respond to this short online survey by 26/9/14. 2. Worforce Data Capture tool Thanks were expressed to all for getting involved in the workforce data capture tool. 20 out of 21 practices had already begun submitting data. 3. Practice Nurse Forum A Practice Nurse Forum was being held on Wednesday 17 September from 4pm to 7pm at Singleton Lodge. Representatives from 16 practices had registered to attend. 4. Friends and Family Test Confirmation was sought as to the CCG’s role in the Friends and Family Test which Practices were obliged to offer to patients by the end of December. T Riddick confirmed that she was attending a launch event on this organised by the Area Team on 8 October 2014. 119/14 Date and time of next meeting Tuesday 21 October at 7.00pm. Venue to be confirmed.