How To Run An Islington Gp Practice

Transcription

1 Islington Clinical Commissioning Group Governing Body Business Meeting Wednesday, 11 November a.m p.m. Resource for London, Conference Hall, 356 Holloway Road, London N7 6PA 1. Introduction 1.1 Apologies for Absence and Declarations of Interest AGENDA PART I Lead Action required Appendices Chair To note Appendix 1.1 In addition to being published with this agenda, the Register of Interests is available on the CCG s website ( or from the Business Support Team, Goswell Road, London EC1V 7LQ 1.2 Chair s Introduction and Opening Remarks Chair To note Oral 1.3 Minutes and Actions of the Meeting held on 9 September 2015 Chair For approval 1.4 Matters Arising Chair -- Oral 1.5 Questions from the Public Chair -- Oral Appendix 1.3 NB: Members of the public will be given the opportunity to ask questions. These must relate to items that are on the agenda for this meeting and should not take longer than three minutes per person. 2. Overview Reports 2.1 Chief Officer s Report Chief Officer For Appendix 2.1 discussion 3. Quality, Performance and Finance 3.1 Integrated Quality, Finance and Performance Report Chief Finance Officer 3.2 Healthy London Partnership Chief Finance Officer 4. Strategy 4.1 Collaborative Work Programme Chief Officer Across North Central London 4.2 London Health and Care Chief Officer Collaboration Agreement 4.3 Health and Employment Programme Director of Quality & Integrated Governance For discussion For approval For discussion For decision For discussion Appendix 3.1 Appendix 3.2 Appendix 4.1 Appendix 4.2 Appendix Governance and Assurance 5.1 Risk Report Director of For Appendix 5.1

2 5.2 Report of the Chair of the Patient & Public Participation Committee 5.3 Report of the Chair of the Quality & Performance Committee 5.4 Report of the Chair of the Strategy & Finance Committee Lead Action required Quality & discussion Integrated Governance Chair, Patient & Public Participation Committee Chair, Quality & Performance Committee Chair, Strategy & Finance Committee For assurance For assurance For assurance 6. Date of Next Meeting 13 January 2016, 10:30 a.m p.m. Appendices Appendix 5.2 Appendix 5.3 Appendix 5.4

3 Table of Contents Document Page Register of Interests Governing Body minutes Governing Body minutes - Part ICCG GB Action Log Chief Officer's Report Integrated Quality, Finance and Performance Report Healthy London Partnership HLP Deliverables Tracker HLP Progress Report Terms of Reference Collaborative Work Programme Across NCL CCG Collaborative Working in NCL London Health and Care Collaboration Agreement Draft Collaboration Agreement Health and Employment Programme Risk Report ICCG Corporate Risk Register V Risk Heat Map to go with V45 of the risk register Report of the Chair of the PPP Committee July PPP minutes FINAL Report of the Chair of the Quality & Performance QP minutes QP minutes Report of the Chair of the Strategy & Finance Committee August S&F Committee minutes Part August S&F Committee minutes Part September S&F Committee minutes 183

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5 APPENDIX 1.1 ISLINGTON CLINICAL COMMISSIONING GROUP REGISTER OF GOVERNING BODY MEMBERS' INTERESTS NAME TITLE NAME OF ORGANISATION AND POSITION HELD/ NATURE DATE NATURE OF ITS BUSINESS OF INTEREST DECLARED Voting Members Mr Mo Akmal Secondary Care Clinician London Spine Unit Ltd, medical private Clinical Director 18/05/2015 practice company. Alison Blair Chief Officer No interests declared 07/10/2015 Afsana Bhuiya Elected GP Representative The Tufnell Surgery GP with partner 09/10/2015 responsibilities London Cancer Macmillan GP improvement 09/10/2015 lead Sorrel Brookes Lay Member Whittington Health Spouse is a Non-Executive 08/10/2015 Director Dr Katie Coleman Elected GP Representative / Vice- City Road Medical Centre, GP practice GP Partner 02/11/2015 Chair (Clinical) (Job Share) in Islington South Islington GP Alliance (SIGPAL), Shareholder - The City 02/11/2015 a company providing primary care and community services to the local population Road Medical Centre purchased shares to support the development of SIGPAL. The shares are held as a joint asset by the practice and not by individual partners. Royal College of GPs Clinical Champion for 02/11/2015 Collaborative Care and Support Planning Lucy de Groot Lay Member /Audit Chair No interests declared 07/10/ of Register of Interests

6 4 of 190 NAME TITLE NAME OF ORGANISATION AND NATURE OF ITS BUSINESS Dr Gillian Greenhough Chair Clerkenwell Medical Practice, which is an Islington GP Practice South Islington GP Alliance (SIGPAL), a company providing primary care and community services to the local population POSITION HELD/ NATURE DATE OF INTEREST DECLARED Salaried Honorary Partner 22/10/2015 The other partners at Clerkenwell Medical Practice are shareholders in South Islington GP Alliance (SIGPAL), but I have no pecuniary interest. 22/10/2015 Ian Huckle Practice Manager Representative (Job Share) Rise Group Practice Practice Manager 09/10/2015 WISH Ltd - A consortium of GP practices providing the doctors for the Urgent Care Centre at Whittington Health. ihub group The Rise Group Practice is a shareholder. Undertaking a small amount of paid work for ihub 09/10/ /10/2015 Jennie Hurley Practice Nurse Representative Pine Street Medical Practice, a GP Employee - practice nurse 22/10/2015 practice in Islington South Islington GP Alliance (SIGPAL), GP Principal at Pine Street 22/10/2015 a company providing primary care and community services to the local population Medical Practice is a shareholder Dr Sabin Khan Salaried/sessional GP River Place Group Practice Salaried GP 10/06/2015 Highbury Medical Services, provider of predominantly private medical services and with no interest in providing services to the NHS. Islington Locum pay goes into the Company. Director / Shareholder 10/06/2015 Ahmet Koray Chief Finance Officer Camden and Islington NHS Foundation Trust Partner is Chief Pharmacist at Camden & Islington NHS Foundation Trust 07/10/ Register of Interests

7 NAME TITLE NAME OF ORGANISATION AND NATURE OF ITS BUSINESS Martin Machray Director of Quality and Integrated NHS England Governance Dr Rathini Ratnavel Co-opted GP Representative South Islington GP Alliance (SIGPAL), a company providing primary care and community services to the local population Various Islington GP practices POSITION HELD/ NATURE DATE OF INTEREST DECLARED From 24 August 2015, parttime secondment to post of 07/10/2015 Director of Nursing (North West London), for which the CCG receives remuneration for his time. Shareholder 02/11/2015 Freelance GP working 02/11/2015 sessionally ihub group Freelance GP working 02/11/2015 sessionally Field James Ltd., a construction Spouse is sole director 02/11/2015 company Dr Stephen Rogers Elected GP Representative The Rise Group Practice GP Partner 28/10/2015 WISH Ltd - A consortium of eight GP practices providing the doctors for the Urgent Care Centre at Whittington Health. The Rise Group Practice is a member/shareholder. 28/10/2015 South Islington GP Alliance (SIGPAL), a company providing primary care and community services to the local population Advisor. 28/10/2015 Northamptonshire Healthcare Clinical Lead for Health 28/10/2015 Foundation Trust Services Research Central and North West London NHS Clinical Advisor to North 28/10/2015 Foundation Trust Central London Research/Clinical research Network University of Leicester Honorary Senior Lecturer 28/10/2015 University of Northampton Visiting Professor 28/10/2015 The Social Care Improvement Group Associate Professional 28/10/ of Register of Interests

8 6 of 190 NAME TITLE NAME OF ORGANISATION AND NATURE OF ITS BUSINESS Dr Josephine Sauvage Elected GP Representative / Vice- Islington Practice, City Road Medical Chair (Clinical) (Job Share) Centre South Islington GP Alliance (SIGPAL), a company providing primary care and community services to the local population Dr Karen Sennett Deborah Snook Non Voting Members Julie Billett Elected GP Representative Practice Manager Representative (Job Share) Joint Director of Public Health for Camden and Islington POSITION HELD/ NATURE DATE OF INTEREST DECLARED GP Partner 21/10/2015 Shareholder - The City Road Medical Centre purchased shares to support the development of SIGPAL. The shares are held as a joint asset by the practice and not by individual partners 21/10/2015 Killick Street Health Centre GP Partner 07/10/2015 South Islington GP Alliance (SIGPAL), a company providing primary care and community services to the local population 07/10/2015 Clerkenwell Medical Practice, a GP practice in Islington. South Islington GP Alliance (SIGPAL), a company providing primary care and community services to the local population. Shareholder - The Killick Street Health Centre purchased shares to support the development of SIGPAL. The shares are held as a joint asset by the practice and not by individual partners. Employee 22/10/2015 Clarkenwell Medical Practice is a shareholder 22/10/2015 Mornington Grove Housing Co- Operative - a Full Mutual Housing Co- Operative where all members are voting members of the Management Committee Member 22/10/2015 No interests declared 21/10/ Register of Interests

9 NAME TITLE NAME OF ORGANISATION AND POSITION HELD/ NATURE DATE NATURE OF ITS BUSINESS OF INTEREST DECLARED Dr Robbie Bunt LMC Observer London-wide Local Medical Director 07/10/2015 Committees (LMCs) London-wide Enterprises, subsidiary of Director 07/10/2015 London-wide LMC providing education / training to GP practices South Islington GP Alliance (SIGPAL), a company providing primary care and community services to the local population Member 07/10/2015 Islington Local Medical Committee Chairman 07/10/2015 River Place Group Practice GP Partner 07/10/2015 Simon Galczynski Local Authority Observer - Director of London Borough of Islington Director of Adult Social 11/06/2015 Adult Social Services Services Paul Sinden Director of Commissioning No interests declared 26/05/2015 Phillip Watson Observer - Healthwatch Manor Gardens Welfare Trust Chief Executive 07/10/2015 Healthwatch Islington Director 07/10/ of Register of Interests

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11 Appendix: 1.3 Minutes Meeting of the Islington Clinical Commissioning Group Governing Body 9 September 2015 Resource for London, 356 Holloway Road, N7 6PA Members Present: Dr Gillian Greenhough Sorrel Brookes Alison Blair Dr Jo Sauvage Dr Katie Coleman Jennie Hurley Dr Sabin Khan Ahmet Koray Dr Rathini Ratnavel Lucy de Groot Dr Stephen Rogers Deborah Snook Dr Afsana Bhuiya Non-Voting Members Present: Julie Billett Simon Galczynski Paul Sinden Emma Whitby In Attendance: Marian Harrington Apologies: Dr Robbie Bunt Martin Machray Dr Karen Sennett Mr Mo Akmal Phillip Watson Minutes: Stephanie Hartley Chair, Islington Clinical Commissioning Group Lay Vice Chair Chief Officer Joint Vice Chair (Clinical) this post is a job share Joint Vice Chair (Clinical) this post is a job share Practice Nurse Representative Salaried / Sessional GP Chief Finance Officer South Locality GP representative Lay Member/Audit Chair North Locality GP Representative Practice Manager Representative - this post is a job share Central Locality GP Representative Joint Director of Public Health for Camden and Islington Service Director of Adult Social Care and Health, London Borough of Islington Director of Commissioning Healthwatch Observer, attending on behalf of Phillip Watson Independent Chair of the Islington Safeguarding Adults Partnership Board (for item 5.2) Local Medical Committee Representative Director of Quality and Integrated Governance / Executive Nurse South Locality GP Representative Secondary Care Clinician Healthwatch Observer Committee Secretary 1 9 of 190

12 1. INTRODUCTION Action 1.1 Apologies for Absence Apologies were received from Mr Mo Akmal, Dr Robbie Bunt, Dr Karen Sennett, Phillip Watson and Martin Machray. Declaration of Interests No new declarations were made. 1.2 Chair s Introduction and Opening Remarks The Chair welcomed all to the meeting and noted that the agenda for the meeting was very large. This was due to a culmination of months of work in a number of programmes of work. It was noted that there were a number of innovative programmes of work taking place over the next five years including Value Based Commissioning and the Integrated Digital Care Record and Person Held Record The Chair noted that the CCG s Annual General Meeting was taking place on Wednesday 16 th September 2015, at Resource for London from 5-7pm. The CCG s Annual Report and Annual Accounts for 2014/15 would be presented alongside a summary of work over the past year, and the public were invited to attend The Chair noted that there was a part two Governing Body meeting receiving the Integrated Digital Care Record & Person Held Record Procurement recommendation report and contract award. The report was going to part two due to the commercially sensitive content of the report. The part 2 minutes would be made public at the 11 November 2015 Governing Body meeting. 1.3 Minutes and Actions of the Meeting held on 1 July The minutes from the Part 1 and Part 2 meetings on 1 July 2015 were APPROVED as a true and accurate record of the meeting The Governing Body reviewed the action log and noted completed and updated actions. 1.4 Matters Arising There were no matters arising. 1.5 Questions from the Public There were no questions from the public. 2. OVERVIEW REPORTS 2.1 Chief Officer s Report 10 of 190 2

13 2.1.1 Alison Blair provided updates on areas of note not otherwise covered on the agenda and highlighted the following: Carnall Farrar had been commissioned to support the collaborative programme of work across North Central London CCGs and consider the common challenges. It was noted that there had been discussion at a Governing Body seminar around the potential to develop work across North Central London. The CCG was looking at premises locally that deliver health and social care in Islington ensuring that they are fit for purpose. It was noted that a draft Estates Strategy would be developed by December 2015 and would be brought to a subsequent Governing Body meeting. Whilst the CCG was not ultimately successful in becoming a Vanguard site, the participating organisations (Islington CCG, Islington Council, Haringey CCG, Haringey Council, Whittington Health and Camden and Islington Foundation Trust) had agreed to work together to pursue the aims and service delivery improvements set out in the expression of interest outside of the vanguard programme. An update on this would be provided at the November 2015 Governing Body meeting. Everyone in Islington is invited to Islington CCG s Annual General Meeting and Open House 2015 on Wednesday 16 September 2015 at 5.00pm at Resource for London. There would be a Part two meeting to consider a report on the Integrated Digital Care Record and Person Held Record procurement recommendation as this report contained sensitive information not yet in the public domain The Governing Body NOTED the Chief Officer s Report. 3. QUALITY, PERFORMANCE AND FINANCE 3.1 Integrated Quality, Finance and Performance Report Ahmet Koray presented the Integrated Quality, Finance and Performance Report at the end of July 2015 and highlighted key points to note: There were pressures across acute contracts regarding performance, with forecast over performance standing at 2.2m against plan in particular around University College London Hospital (UCLH) and Barts Hospital. The UCLH contract remained unsigned and therefore, their position may change. With regard to Barts Hospital, significant acute demand reserves had been utilised, ( 1.4m), to fund the transfer of cardiac and cancer services between Bart s Health and UCLH. Significant overspend was reported at Moorfields and The Royal Free, with a review of coding and charging at Moorfields being undertaken to understand the increase in costs. The Royal Free contract was not yet signed and as a result metrics, penalties and QIPP were still to be agreed. Month five data received suggested a slight improvement in performance, however, the CCG faced significant challenges regarding acute performance. Concerns relating to diagnostic waits at Whittington Health were raised relating to a bookings error for endoscopy services. The Trust assured the CCG that they were working to address the issue and expect this to improve. Whittington Heath were not meeting the four hour A&E target and the Trust had set out actions to address this which were outlined in the report of 190

14 3.1.2 Dr Katie Coleman raised concern around the significant (50%) increase in GP referrals to trauma and orthopaedics and suggested that historically, if there was poor performance in physiotherapy services, GPs would refer into orthopaedics instead. Paul Sinden noted that the CCG would go out to GP Practices, as part of the Clinical Commissioning Locally Commissioned Service, for suggestions around the reasons for the increase in referrals. This information would also feed into the CCG s Commissioning Intentions around Musculo-skeletal services Dr Stephen Rogers noted that the QIPP scheme around referral management was under delivering for the second year and asked about the capacity in the programme to release resource. Paul Sinden noted that the CCG had examined GP first referrals into hospital which had increased. As part of the Locally Commissioning Service for Clinical Commissioning, GP Practices would be asked to look into dermatology and cardiology referrals with no follow up Action 09/09-1: To provide further information in the next Integrated Quality, Finance and Performance report to the Governing Body on the measures and performance for preventing and managing long term conditions. Action 09/09-2: To go out to GP Practices as part of the Clinical Commissioning Locally Commissioned Service, for suggestions around the reasons for the increase in referrals to orthopaedics. AK PS The Governing Body NOTED the Integrated Quality, Finance and Performance Report at the end of July STRATEGY 4.1 Primary Care Update Report Paul Sinden introduced the report which provided an update on co-commissioning of primary care contracts with NHS England and North Central London CCGs and an update on service developments and work in support of delivering the primary care strategy. It was noted that the North Central London Primary Care Joint Committee was working in shadow form and would go live in October of 190 4

15 4.1.2 A number of issues were raised by Governing Body members as follows: Co-commissioning was in the early stage of operation including the North Central London Primary Care Joint Committee. The external audit of Locally Commissioned Services had been undertaken by Internal Audit as part of the Internal Audit Plan. It needed to be clarified what is meant by the term transformation and what the CCGs are doing to transform primary care services across North Central London. The objective of extended access to primary care services was to reduce unnecessary hospital admissions and it was asked how would this be evaluated and measured. More administrative work falls to primary care as elements of secondary care are re-designed at which the Local Medical Committee and providers are looking. In the North Central London Primary Care Joint Committee Terms of Reference, clarify the meaning of design of local incentive schemes as an alternative to the Quality Outcomes Framework. With regard to aligning payment to the financial year for Locally Commissioned Services to GP Practices, it was noted that aligning payments to the financial year would introduce difficulty because of the Quality Outcomes Framework year and this could affect capacity. The Local Authority expressed interest in being involved in cocommissioning, however, their attendance was not yet reflected in the terms of reference for the North Central London Primary Care Joint Committee Paul Sinden and Alison Blair responded by explaining that: The transformation of primary care services was to ensure GPs could manage the increasing workload in primary care due to the change in population in Islington. Primary care providers needed to be supported to respond to change through the transformation of services which would look at the way services needed to change in response to population changes. With regard to the North Central London Primary Care Joint Committee, comments from Governing Body members would be addressed. It was noted that the terms of reference would go to all CCG Governing Bodies in North Central London. It was noted that the Health and Wellbeing Board representative on the Joint Committee represented the Local Authority and discussions were underway with Local Authorities regarding representation. The CCG had struggled to find a payment pattern for Locally Commissioned Services that fit in with the Quality Outcomes Framework and the CCG could look into this. Regarding the drift of work from secondary care to primary care, the CCG could replicate work undertaken by the Local Medical Committee in Barnet and look at this through Board Link Visits. With regard to the evaluation of extended access to primary care services and whether it had reduced unnecessary hospital admissions, baseline data on the use of the Out of Hours service, A&E and ambulatory care admissions would be submitted as the platform for evaluation of 190

16 4.1.4 Action 09/09-3: To pick up the comments raised by Governing Body members on the North Central London Primary Care Joint Committee Terms of Reference. Action 09/09-4: To report back to the Governing Body on the representation of the Local Authority on the North Central London Primary Care Joint Committee. Action 09/09-5: To replicate the work undertaken by the Local Medical Committee in Barnet around the drift of work from secondary care to primary care and look at this through Board Link Visits. AB AB PS The Governing Body: APPROVED the Terms of Reference, Standing Orders, Scheme of Delegation for the North Central London Primary Care Joint Committee; NOTED the report for assurance on progress with delivering the primary care strategy; NOTED that in January 2016 a report on the provision of extended primary care access from 2016/17 onwards would be received. 4.2 Value Based Commissioning for people living with psychosis: Business Case Paul Sinden introduced the report and noted that the Strategy & Finance Committee had recommended the Business Case for approval by the Governing Body. It was noted that the service model was supported by investment in Primary Care to closer align physical and mental health treatment Paul Sinden noted that in April 2015, the Strategy & Finance Committee approved the contract options; the lead provider model with a five year contract and the use of a partial bundle approach (lead provider receives 20% payment based on outcomes for onward distribution to other providers, 80% activity payment paid directly to each provider) moving to a full bundle approach (all payments go to the lead provider for onward distribution to other providers). Payment for the service was based on a hybrid model; 80% based on activity and 20% based on outcomes which would increase in challenge over the five year contract Sorrel Brookes asked if there would be an opportunity to review if the contract model was appropriate and whether there were any concerns. In response, Paul Sinden noted that the value based commissioning for psychosis model would be informed by the learning from the diabetes value based commissioning model. Emma Whitby commented that the lead provider needed to support organisations to signpost children and young people into mental health services. In response, Paul Sinden outlined that one of the entry points into the service was through the primary care mental health service and the CCG and Council were also looking at the transition from children to adult mental health services Following a question around how to make transparent the expectation of the model on GPs, Paul Sinden noted that GP clinical leads had been involved in creating the service model and the CCG needed to consider how to incorporate additional mental health services in primary care to facilitate the model which could be address through a Locally Commissioned Service Action 09/09-6: To feedback comments from discussions with children and young people around access to mental health services through signposting to George Howard. EW 14 of 190 6

17 4.2.6 The Governing Body APPROVED the business case for value based commissioning for people living with psychosis and, in particular, the following: Continued joint work between Camden and Islington CCGs to implement a value based commissioning approach, as described, for people living with psychosis. Proceed with the work required to progress VBC for people living with psychosis in Camden and Islington in line with Option 3: implementation of VBC using a hybrid model and following a staged approach from a partial to a full bundle. The invitation of the single capable provider identified, Camden and Islington NHS Foundation Trust, to begin a provider assurance process to assure commissioners of their capability to be a Lead Provider for this model. The Governing Body NOTED the potential for inclusion of Local Authority Commissioned services within the value based commissioning model which will likely be considered in the next year and will be subject to further discussion and approval via the relevant governance process. 4.3 Integrated Digital Care Record and Person Held Record Full Business Case Paul Sinden introduced the report and noted that in August 2015, the Strategy & Finance Committee had recommended the Full Business Case to the Governing Body for approval. It was reported that capital build costs were covered by national and local funds, with a residual gap of 90k in 2017/18. There was an on-going funding gap of 200k per year for revenue costs with plans to close the gap through broadening the population base to other CCGs and Boroughs thereby spreading the cost base, further realisation of benefits, a targeted approach to roll out to complex service users to maximise early benefits realisation and then recurrent use of the Better Care Fund for any residual gap Paul Sinden outlined the financial summary for the Full Business Case: Costs based on those received through the procurement process for both build and on-going costs; Hosting arrangements had been agreed with Islington Council; Treatment and recovery of VAT is in line with guidance; Build costs supported by 2.6m central funds from NHS England, with the balance of 1.7m found locally. CCG funding in recurrent budgets also contributes to affordability of the business case; Only cash releasing benefits were included in the business case, however, there will also be non-cash releasing benefits such as reducing Do Not Attends (DNAs) and patient transport requirements The main comparisons of the Outline Business Case, approved by the Governing Body in September 2014, and the Full Business Case were summarised in the report. The movements from the Outline Business Case to the Full Business Case accrued from a greater specificity for service requirements achieved through the procurement process, and costs may have increased per year as the Full Business Case was based on a five year contract rather than a ten year contract of 190

18 Emma Whitby noted that through discussions with members of the public, concern had been raised around the data sharing. It was suggested that the CCG emphasise that only relevant data would be shared and it would be managed appropriately with patient consent. Sorrel Brookes raised a concern that the return on investment through benefits would not occur until after the five year contract. The point at when the record would be made was queried and it was confirmed that it would be a cradle to grave record for Islington residents registered at an Islington GP Practice Stephen Rogers noted that the responsibility for quality assurance of the data fell to providers and asked how this was included in project costs and asked about the provision of electronic discharge letters. In response, Paul Sinden outlined that from October 2015, providers were legally mandated to provide electronic discharge summaries. It was noted that the six month letters to providers would include requirements for providers around the Integrated Digital Care Record and Person Held Record. Providers had been asked to undertake work to connect their systems to the Integrated Digital Care Record and Person Held Record and ensure maintenance of the data. It was noted that there would be benefits for providers around reducing Do Not Attends, reducing medicines waste and further benefits for providers would be realised going forward It was noted that areas of focus for continuing assurance from the Governing Body IT Assurance Group included an exit strategy at the end of contract term, development of a contract negotiation strategy, engagement and delivery of equalities act requirements. They would continue to meet through the contract negotiation and then the delivery phase The Governing Body APPROVED the Full Business Case for the Integrated Digital Care Record and Person Held Record which provided business intelligence and interoperability across Islington health and social care services on the basis that: Initial build costs are funded; The residual funding gap, 204k per annum, will be covered by the actions listed below. Work is underway to close this funding gap through the following actions: Broadening the population base, and therefore spreading the cost base, for the procurement, with other CCGs potentially interested in procuring the Integrated Digital Care Record and Person Held Record. Other CCGs could make a contribution to the build costs and on-going revenue costs, with a potential unit price reduction for scale from the provider; Further realisation of benefits in particular from the change in business intelligence the Integrated Digital Care Record and Person Held Record will provide for contract management and service redesign; A targeted approach to roll-out of the Person Held Record to people with complex health and care needs to maximise the pace of benefits realisation and slow the costs of licences (the base case for the Full Business Case is based on a roll-out of the Person Held Record for an average Islington resident); Use of Better Care Funds to support on-going costs Procurement Recommendation Report 16 of 190 8

19 Paul Sinden introduced the report which outlined the process to identify the preferred provider. It was noted that the Strategy and Finance Committee had recommended the procurement recommendation report to the Governing Body for approval. It was noted that an Open OJEU procurement approach was used. This was following the initial use of a contract framework approach in order to meet Department of Health deadlines, however, this had not yielded a strong market response The process for procurement was outlined in the report with the providers anonymised. It was noted that the evaluation criteria was based 75% on function and quality and 25% on finance. The functionality checklist used in the procurement process had been useful to gain further information and define what was included in each supplier s offer The Governing Body: APPROVED sign-off of the Integrated Digital Care Record (IDCR) and Person Held Record (PHR) Procurement Report; and NOTED that approval of contract award to the preferred bidder as the provider for a term of five years will be made in Part II of the Governing Body meeting. A reserve bidder will also be made known in order to ensure a competitive contract negotiation stage Assurance Report The Governing Body NOTED the activities, progress and input made by the Governing Body IT Assurance Group. The intention was to continue to meet over the next phase of the programme to provide assurance to the Governing Body on issues of concern and risk management. 4.4 Commissioning Intentions for 2016/ Paul Sinden introduced the report and noted that the framework the commissioning intentions derived from local priorities, the Five Year Forward View, the Better Health for London report and collaboration priorities for North Central London CCGs. It was noted that the commissioning intentions for 2016/17 would help to address the potential funding gap for the NHS and address constitutional targets The Better Health for London report outlined ten aspirations for London and thirteen areas London CCGs could collaborate on to address health and wellbeing. Paul Sinden identified common goals for collaboration across North Central London: Balance the health and care economy in order to invest in prevention; Better manage acute contracts and adopt new models of care supported by new contract forms; Better integration and break down any barriers between primary and secondary care The two appendices attached to the report outline plans for ongoing engagement with clinicians and members of the public on the CCG s commissioning intention proposals and the procurement pipeline for 2016/ of 190

20 4.4.4 A number of issues were raised by Governing Body members as follows: Need to outline the CCG s Commissioning Intentions for 2015/16, what the CCG achieved and consider learning from last year. How would the CCG measure performance against the ten aspirations for London outlined in the Better Health for London report? Need to request assurance from providers that new contracts are London Living Wage compliant. Suggestion for the CCG to adopt a research and evaluation procedure and a framework to enable research and evaluation. The Better Health for London recommendations outlined the importance of staff wellbeing and this needed to be considered through the commissioning intentions It was noted that there would be discussion at a future Governing Body Seminar on the Commissioning Intentions for 2016/17 and the issues raised by the Governing Body would be addressed. Paul Sinden noted that the CCG needed to consider how to prioritise the Commissioning Intentions when agreed and as the commissioning intentions were distilled, a thread of performance and delivery for 2015/16 and how this feed into intentions for 2016/17 needed to be included The Governing Body NOTED the draft commissioning intentions for 2016/ NHS 111 and GP Out of Hours Procurement Gillian Greenhough introduced the report which was provided for information The Governing Body NOTED the NHS 111 and GP Out of Hours Procurement update. 5 GOVERNANCE AND ASSURANCE 5.1 Child Protection and Safeguarding Annual Report 2014/ Katie Coleman introduced the report and flagged key achievements in year: A successful transition of the Designated Nurse post, with the new Designated Nurse also the Designated Nurse for Children Looked After; There had been a number of Serious Case Reviews where learning had been identified and implemented in order to support improvements; including one Internal Management Review for Islington CCG and its commissioning functions; The IRIS domestic violence project had been rolled out to GP Practices which had improved awareness and reporting of domestic violence Challenges for the CCG were identified around: Ensuring all CCG and provider staff had up to date Child Protection training; The difficulties in understanding issues with child safeguarding in prison healthcare due to NHS England commissioning this service Following a question from Lucy de Groot, it was clarified that Holloway prison no longer had a baby and child unit and safeguarding children arrangements were in place for when a child visited a relative in prison The Governing Body NOTED and RECEIVED ASSURANCE from the Child Protection and Safeguarding Children Annual Report for 2014/ Islington Safeguarding Adults Annual Review 2014/15 18 of

21 5.2.1 Marian Harrington introduced the report and noted that there had been work to ensure that the Islington Safeguarding Adults Partnership Board complied with the Care Act 2014 and legislation. The membership of the Islington Safeguarding Adults Partnership Board had been reviewed and more senior level staff from providers attended and feedback to provider Trust Boards. There had been significant contribution from the CCG in work to improve the quality of care in nursing homes in Islington and following this work. It was noted that the Board had no concerns with the six nursing home in Islington. It was noted that NHS England were undertaking a deep dive into safeguarding in the autumn of Areas of improvement were identified in the annual review around the participation of service users especially those who have been through the safeguarding process, Deprivation of Liberty to ensure appropriate referrals and learning identified from a Serious Case Review around involving all partner organisations at the beginning of the process. It was noted that the Islington Safeguarding Adults Partnership Board would continue to work with the Police around prosecutions following instances of adult abuse and neglect Jennie Hurley asked whether specific data was collected on hate crime for adults with Learning Disabilities. In response, Marian Harrington noted that this data was collected by the Community Safety department of Islington Council. Dr Katie Coleman noted that Islington Council provided comprehensive safeguarding adults training for GPs which was a mandatory requirement from the Care Quality Commission Action 09/09-7: To send the data collected on hate crime for adults with Learning Disabilities by the Community Safety department of Islington Council to Jennie Hurley. MH 5.3 Risk Report Alison Blair introduced this item and drew attention to the proposed changes to the risk register with six new risks being proposed for addition, reflecting the progress of programmes of work at the CCG Dr Katie Coleman commented that the CCG needed to set out the local personal health budget offer for people living with long term conditions and include this in the Joint Health and Wellbeing Strategy. It would be helpful for the Governing Body to understand the direction of travel and any associated risks Action 09/09-8: To confirm the offer for personal health budgets for people living with long term conditions in Islington and consider any associated risks. PS The Governing Body NOTED the risk. 5.4 Report of the Chair of the Audit Committee Lucy de Groot presented the report of the Chair of the Audit Committee which provided a summary of how the Committee discharged its responsibilities at the August 2015 Committee meeting. It was noted that the main change to the Committee terms of reference was around the approval of the Annual Report and Annual Accounts of 190

22 5.4.2 The Governing Body: RECEIVED ASSURANCE that the Committee has been considering all key issues within the scope of its terms of reference; and APPROVED the Audit Committee s revised terms of reference. 5.5 Report of the Chair of the Public & Patient Participation Committee Dr Katie Coleman presented the report of the Chair of the Public and Patient Participation Committee which provided a summary of how the Committee discharged its responsibilities at the July 2015 Committee meeting. It was highlighted that the main change to the Committee terms of reference was around the removal of the Commissioning Support Unit complaints representative as a non-voting member of the Committee. Martin Machray is the lead Director responsible for complaints and would provide an annual report on complaints management to the Committee The Governing Body: RECEIVED ASSURANCE that the Patient & Public Participation Committee has been considering all key issues within the scope of its terms of reference; APPROVED the Patient & Public Participation Committee s revised terms of reference. 5.6 Report of the Chair of the Quality & Performance Committee The Governing Body RECEIVED ASSURANCE that the Committee has been considering all key issues within the scope of its terms of reference. 5.7 Report of the Chair of the Strategy & Finance Committee The Governing Body RECEIVED ASSURANCE that the Strategy & Finance Committee has been considering all key issues within the scope of its terms of reference. 6. Any Other Business 6.1 There was no other business. These minutes are agreed to be a correct record of the Part 1 meeting of the Islington Clinical Commissioning Group Governing Body held on 9 September 2015 Signed:. Date:. Gillian Greenhough, Islington CCG Chair 20 of

23 Appendix: Minutes Part 2 meeting of the Islington Clinical Commissioning Group Governing Body 9 September 2015 Resource for London, 356 Holloway Road London, N7 6PA Members Present: Dr Gillian Greenhough Alison Blair Dr Katie Coleman Dr Jo Sauvage Jennie Hurley Dr Sabin Khan Ahmet Koray Dr Rathini Ratnavel Deborah Snook Lucy de Groot Dr Afsana Bhuiya Dr Stephen Rogers Apologies: Sorrel Brookes Minutes: Stephanie Hartley Chair, Islington Clinical Commissioning Group Chief Officer Joint Vice Chair (Clinical) (this post is a job share) Joint Vice Chair (Clinical) (this post is a job share) Practice Nurse Representative Salaried / Sessional GP Chief Finance Officer South Locality GP representative Practice Manager Representative (this post is a job share) Lay Member/Audit Chair Central Locality GP Representative North Locality GP Representative Lay Vice Chair Committee Secretary 1 21 of 190

24 1. Integrated Digital Care Record & Person Held Record Procurement Recommendation Report Action 1.1 Paul Sinden introduced the report and noted that it was brought to the part two meeting in line with procurement rules due to a cooling off period to allow for challenges from suppliers. Following the cooling off period, the provider could be announced publically. It was noted that following the approval of the Full Business Case and recommended contract award; contract negotiations with the supplier would begin. 1.2 The report recommended the appointment of British Telecommunications Plc (BT) as the provider of the Integrated Digital Care Record and Person Held Record. It was noted that the assessment of BT s functionality was consistent throughout the process for all elements; the Integrated Digital Care Record, the Person Held Record and business intelligence. It was noted that BT was the most expensive supplier, but provided the most complete service offer. 1.3 The reserve provider had demonstrated increased Person Held Record functionality and flexibility of approach. It was noted that the scores for the other two potential providers had reduced during the moderation process due to no existing relationships with EMIS web and no central data repository. 1.4 There was discussion around the robustness of the reserved provider to deliver the project if necessary. It was explained that this was discussed as part of the final consensus meeting and it was felt that the bidder understood the project and the moderation panel had confidence they could deliver if necessary. A question was asked around provisions if the provider failed to deliver to the agreed timescales. It was reported that this was a key part of the contract negotiation phase to be agreed with the supplier, including key performance indicators, financial penalties for nondelivery or delays in delivery and key milestones in the implementation plan. There was also phased payments to reflect this plan. 1.5 Recognition of the pioneer status of the programme was requested by the Governing Body alongside the need to put onus on BT to deliver the project. It was emphasised that this was an innovative project and implementing both the Integrated Digital Care Record and the Person Held Record had previously been undertaken. It was therefore agreed that the Governing Body IT Assurance Group would remain in place through the contract negotiation phase. 1.6 On 27 August 2015 the CCG s Strategy and Finance Committee recommended that the Governing Body sign-off the procurement report and appointment of BT as provider of the Integrated Digital Care Record and Person Held Record for a term of five years. 1.7 Action 09/09-9: To Governing Body members when the provider had been announced publically. PS 1.8 The Governing Body: SIGNED-OFF of the Integrated Digital Care Record (IDCR) and Person Held Record (PHR) Procurement Report; and APPROVED the recommendation to appoint British Telecommunications Plc (BT) as the provider for a term of five years. A reserve bidder will also be made known in order to ensure a competitive contract negotiation stage. 22 of 190 2

25 These minutes are agreed to be a correct record of the Part 2 meeting of the Islington Clinical Commissioning Group Governing Body held on 9 September 2015 Signed:. Date:. Dr Gillian Greenhough, Islington CCG Chair 3 23 of 190

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27 Meeting Date 09/09/ / Integrated Quality, To provide further information in the next Finance and Integrated Quality, Finance and Performance Performance Report report to the Governing Body on the measures and performance for preventing and managing long term conditions. Action No. Minutes Reference Action Description Responsibility Target Date Progress details 09/09/ / Integrated Quality, Finance and Performance Report 09/09/ / Primary Care Update Report 09/09/ / Primary Care Update Report ACTION LOG: Islington Clinical Commissioning Group Governing Body To go out to GP Practices as part of the Clinical Commissioning Locally Commissioned Service, for suggestions around the reasons for the increase in referrals to orthopaedics. To pick up the comments raised by Governing Body members on the North Central London Primary Care Joint Committee Terms of Reference. To report back to the Governing Body on the representation of the Local Authority on the North Central London Primary Care Joint Committee. Ahmet Koray Paul Sinden Alison Blair Alison Blair End of September November Governing Body meeting APPENDIX Long term condition indicators monitored by the CCG are reported on an annual basis and many have a significant time lag. It is proposed that an annual update will be included in the Integrated Quality, Finance and Performance report when the next updated data is available. The second commissioning activity (quarter 3) went out to practices mid-october and asked 5 practices to focus on observed increases in Trauma and Orthopaedic outpatient appointments, 5 practices to focus on observed increases in acute gynaecology service referrals and the remaining 24 practices to focus on PoLCE procedures and treatments carried out in secondary care. The results of quarter 3 will be compiled in January 2016 and reported to the following Planned Care Board. On 5 November 2015 the Planned Care Board is considering options for Clinical Advice and Guidance as further support to our referral management programme. In advance of the next round of Board Link Visits practices will be asked to complete a questionnaire on musculo-skeletal services that will support a review of Trauma and Orthopaedic referrals. Complete Complete - Reference included in Chief Officers report 25 of /09/ / Primary Care Update Report 09/09/ / Value Based Commissioning for people living with psychosis: Business Case 09/09/ / Islington Safeguarding Adults Annual Review 2014/15 To replicate the work undertaken by the Local Medical Committee in Barnet around the drift of work from secondary care to primary care and look at this through Board Link Visits. To feedback comments from discussions with children and young people around access to mental health services through signposting to George Howard. To send the data collected on hate crime for adults with Learning Disabilities by the Community Safety department of Islington Council to Jennie Hurley. Paul Sinden Emma Whitby Marian Harrington Included in 6-month commissioning letters to all providers. Link visit agenda setting meeting on 10 November. Complete. The CCG was advised on 2 October that the Healthwatch report on mental health services for young adults in Islington was available on their website. Jennie Hurley meeting with Jenab Yousef and the LBI Adult Safeguarding lead on 12 November to discuss this.

28 26 of 190 ACTION LOG: Islington Clinical Commissioning Group Governing Body APPENDIX Meeting Date Action No. Minutes Reference Action Description Responsibility Target Date Progress details 09/09/ / Risk Report To confirm the offer for personal health budgets Paul Sinden December Options paper to CCG Executive Management Team on for people living with long term conditions in 7 October Agree to work up proposals by end of Islington and consider any associated risks. December 2015 for implementation in quarter /16.