Paper 22.0(e) PRESENT Debbie Frost Regina Shakespeare Valerie Harrison Ahmer Farooqi Michelle Newman Barry Subel Jonathan Lubin John Bentley Swati Dholakia Karl Marlowe Hugh McGarel-Groves Maria O Dwyer Vivienne Stimpson Matt Powls Elizabeth James NHS Barnet Clinical Commissioning Group Clinical Cabinet Meeting Thursday 22 October 2015, 08.45a.m. to 10.30a.m. Room G7, Building 2, North London Business Park (DF) (RS) (VH) (AF) (MN) (BS) (JL) (JB) (SD) (KM) (HM-G) (MO D) (VS) (MP) (EJ) Barnet CCG Chair (West Locality) Chief Operating Officer (Interim) Lay Member Governing Body GP GB Member (North Locality) GP GB Member (West Locality) GP GB Member (South Locality) GP GB Member (North Locality) GP GB Member (South Locality) GP and Governing Body Member (West Locality) Secondary Care Board Member Chief Finance Officer Director of Integrated Commissioning Director of Quality and Governance Director of Planning and Performance (Interim) Director of Clinical Commissioning (Interim) IN ATTENDANCE Alan Gavurin Beverley Wilding Brenda Thomas APOLOGIES Bernadette Conroy Helen Donovan Charlotte Benjamin Clare Stephens (AG) (BW) (BT) (BC) (HD) (CB) (CS) FMH Project Manager (minute 188 only) Head of Primary Care Commissioning (minute 191 only) Corporate Secretary (Interim) (minutes) Lay Member Governing Body Registered Nurse Governing Body Member GP GB Member (South Locality) GP GB Member (North Locality) 182/15 Introductions and Apologies for Absence 182.1 DF welcomed everyone present at the meeting. Apologies for absence were noted as above. 183/15 Declarations of Interest 183.1 DF declared that one of her partners in Millway Medical Practice is the Chair of Barndoc Healthcare Ltd. 184/15 184.1 185/15 185.1 Minutes of the previous meetings The minutes of the meetings on 8 October 2015 were accepted as a true reflection of the meeting, subject to minute 174.4, which should read The Clinical Cabinet suggested MO D attempt to negotiate a month s extension or the shortest possible time with the current provider. Minutes and Action log The Clinical Cabinet discussed DF s action (172.3) on taking forward engagement with GPs. It was agreed to draw up a comprehensive work plan to take this forward, which would include providing update at locality meetings and to work out GPs needs on co-commissioning and other areas, by stimulating a dialogue. The communications and engagement team would lead on this. Members should feedback comments to VH for incorporation into the plan. 185.2 Action 54 Ref 089/15. The PoLCE Policy would be brought back to Clinical Cabinet in November 2015 to review how the implementation had gone. This action was recorded as OPEN. VH/JB/VS Clinical Cabinet - 22 October 2015 1
185.3 Action 64 Ref 123/15. At its meeting on 18 June 2015, the Cabinet agreed that the Chair should discuss with the Chair of the Health and Wellbeing Board (HWBB) the inclusion of patient stories. DF reported that the Chair of HWBB had agreed that patient stories should be told at HWBB, with a focus on social care. This action was recorded as CLOSED. 185.4 185.5 185.6 185.7 185.8 185.9 185.10 185.11 185.12 185.13 186/15 186.1 Action 72 Ref 143/15. At its meeting on 23 July, the Cabinet agreed that VS should provide an update on Patient Stories in six months time and an annual review paper should be presented in a year s time. This item is on the Clinical cabinet agenda for 21 January 2016. This action was recorded as OPEN. Action 77 Ref 160/15. At its meeting on 20 August, the Cabinet asked MP to take the 2015/16 Barnet Immunisation Action Plan to the Governing Body meeting on 24 September 2015. This item would be taken to the Governing Body on 26 November 2015. This action was recorded as CLOSED Action 80 Ref 168/15. At its meeting on 8 October, the Cabinet asked BT to pull together a central register of leave, which should be accessed centrally, with a named individual to manage it. This action was recorded as OPEN. Action 83 Ref 170/15. At its meeting on 8 October, the Cabinet asked MP to clarify details with Public Health on funding for screening and the actions they are taking on cancer prevention. This action was recorded as OPEN. Action 84 Ref 170/15. At its meeting on 8 October, the Cabinet asked CS to present the cancer paper with rigorous proposals highlighting the key issues and actions to be taken in six months. This action was recorded as OPEN. Action 85 Ref 170/15. At its meeting on 8 October, the Cabinet asked MO D to circulate more information on the model for adult and children s IAPT services. This action was recorded as OPEN. Action 86 Ref 171/15. At its meeting on 8 October, the Cabinet asked VS to have a patient story that reflects mental health challenge. This action was recorded as OPEN. Action 87 Ref 173/15. At its meeting on 8 October, the Cabinet asked MP to display in calendar format the key milestones for the CCG noting pressure points and having an understanding of start and end dates, responsible person, final submission dates and Governing Body dates. This action was recorded as OPEN. Action 90 Ref 176/15. At its meeting on 8 October, the Cabinet asked SD to bring back a paper on District Nursing, with a firmer plan, highlighting costs, in addition to an update on progress and dialogue with the membership. This action was recorded as OPEN. The following actions were noted as CLOSED: Action 74 Ref 145/15, Action 75 Ref 147/15, Action 81 Ref 169/15, Action 82 Ref 170/15, Action 89 Ref 174/15, Action 91 Ref 180/15 - RS was asked to follow up whether the response to RFL s letter sent by Rob Larkman was copied to Monitor and NHS England. Proposed procurement of an integrated NHS 111/ Out of Hours service across NCL and outcomes of engagement activities BS presented the proposed procurement of an integrated NHS 111/ Out of Hours service across NCL and outcomes of engagement activities. The Clinical Cabinet was asked to note the update on the final version of the North Central London (NCL) integrated NHS 111 and OOH service specification Clinical Cabinet - 22 October 2015 2 RS
186.2 186.3 187/15 187.1 187.2 which had been developed with input from a wide range of stakeholders including clinical oversight across NCL and Barnet CCG s Urgent Care Clinical Lead. There had been delays to NHS England s release of the revised commissioning standards for integrated urgent care which was due 30 September; this was now expected to be published 15 October 2015. The final service specification was therefore subject to further consideration and amendments pending the release of the commissioning standards and would be presented to the Primary Care Procurement Committee on 29 October 2015 and then to the November Governing Body meeting part 2 for ratification (excluding any conflicted GB members, that is, those GPs with shares in Barndoc Healthcare Ltd.). JL sought reassurance that admission avoidance for the elderly frail had been factored in and asked what targets had been set and whether there were KPIs to ensure the current level of admission is reduced. BS responded that a section on the elderly frail had been included and further work would be carried out. JB was of the opinion that elderly frail should have a separate section. Responding to JB s question on where the hub would be based, EJ noted this was being set out. There would be provision in all CCGs for patients to be seen across the NCL Boroughs and ensure patients proximity to services. EJ confirmed that the service would be periodically reviewed at the Primary Care Procurement Committee (PCPC). The specification would be adapted to reflect the national requirement feeding in over the next few months. The Clinical Cabinet agreed for EJ to share with Clinical Cabinet members the non-sensitive areas of the service specifications. The Clinical Cabinet NOTED the update on the final version of the NCL integrated NHS 111 and OOH service specification. North Central London CCGs Strategic Planning Collaboration RS gave a presentation on NCL CCGs Strategic Planning Collaboration. The slide deck presented had been agreed by the Collaboration Board and was in use by each of the NCL CCGs. No decision was required at this point. The Collaboration Board had secured an interim Programme Director, Janet Soo Chung; an interim Finance Lead, Rob Whiteford of Enfield CCG who has been released part time to ensure the financial strategy is further developed (Jonathan Wise would join the team from January 2016); and Caz Sayer, Chair of Camden CCG was keeping a watching brief on the Clinical Lead portfolio (pending a substantive appointment). The four programme areas prioritised are: Acute Services Redesign initial focus on urgent and emergency care; Mental Health initial focus on In- patient care; Pathways initial focus on primary care transformation; and system wide enablers initial focus on estates. The report detailed the proposed outline scope for these four programmes for collaboration and a proposed governance and delivery model. Detailed proposals on consulting the CCG s membership on any proposals, if required, prior to formal agreement at the November Governing Body meeting, including any necessary governance implications for the CCG s Constitution (and or Schedule of Reservation and Delegation) are being co-ordinated by the Director of Quality and Governance, in concert with fellow CCGs. Given the development of the strategic plan and forthcoming planning guidance which was expected to emphasise the SPG footprint, there was consensus on RS s suggestion that the Collaboration Board s Project Management Office (PMO) team support the planning by acting as single coordinating point for the NCL CCGs. JL asked what the risks of significant conflict between CCGs and providers were, if there was 3-5year strategic plan and asked what the strategies were in order to succeed. In addition, he asked what actions were being taken by NHS England and Monitor to remove obstacles, if these had been identified. Clinical Cabinet - 22 October 2015 3 EJ
RS responded that the interventions by NHS England in health economics that are most challenged are very substantial and it was clear to most people that either a compelling 3-5 year strategic plan is produced for NCL or the collaboration will be considered to have failed. In order to overcome the obstacles, there has to be a whole system understanding about service ambitions, leadership and plans for the provider landscape. DF added that an away day had been planned for the Collaboration Board to discuss the strategic plan. KM commented that the biggest acute problem for the CCG in the health economy is mental health provision, as addressed in the Carnall Farrar report, and suggested that the CCG should drive ahead with the work that had been carried out with University College London Partners (UCLP) in the last two years. He added that setting aside resources for this work was very crucial. VH noted that a lot of the ability to deliver this would depend on local ability and asked at what point the development and range of local capability was being given consideration. RS responded that there had been initial discussions and that the first priority for the interim Programme Director is to produce a resource plan, which would be presented by end November. 187.3 188/15 188.1 188.2 188.3 The Clinical Cabinet NOTED the update on the NCL CCGs Strategic Planning Collaboration. Finchley Memorial Hospital (FMH) Transformation Project AG attended the meeting to provide an update on the FMH Transformation Project and to request approval of the Programme Board s Terms of Reference. Following the Clinical Cabinet s meeting on 23 rd July where the four priority workstreams for the FMH Transformation project were agreed, the FMH Programme Board had been set up and held its first meeting on 15 th October. The agreed governance structure for the FMH project is for the Programme Board to be accountable to Clinical Cabinet for all matters relating to clinical and service input, while accountability for commissioning and procurement issues would be to the Finance, Performance & QIPP (FPQ) Committee and Primary Care Procurement Committee. The Programme Board is in the process of developing a project plan and timeline to be brought to the Governing Body in March 2016. There would be a repeat of the workshop that was held in April 2015 on 5 November 2015, with the aim of securing high level agreement on the service model and vision for each of the priority options. This would then shape the next stage of more detailed analysis for each option workstream. These services are being developed to improve the pathway and would not include additional layers. AG explained that the CCG had expressed interest to CLCH, the provider of inpatient services at FMH, to convert some of the single rooms into multi-bed bays. CLCH had expressed concern that the fact that all beds are in single rooms has a number of adverse consequences. A feasibility has shown how this conversion could be undertaken, how much it would cost and duration. The CCG would confirm whether or not this would be undertaken by mid- November with a requirement to complete the work by the end of March 2016. VH commented that this was a central pivot for strategic change, and should therefore be closely monitored to get the best out of it. She further asked how this work relates to the work of the Estates Group and the need for Local Working Group to fit into the Estates Strategy. VH and EJ were asked to look into this. EJ noted that it was necessary to determine whether reference should be made to the Estates Group in the Programme Board s terms of reference. RS noted the importance of GPs having knowledge of the services and flexibility available to them when managing patients. BS added that acute providers should be made aware of the services provided for patients while JL commented on the need to have a strategy. EJ noted that a detailed plan was being worked through and the procurement Clinical Cabinet - 22 October 2015 4 VH/EJ
requirements are being considered. It would be key to develop services that are more clinically appropriate to patients than admission to acute hospitals. The dates for the Programme Board meetings were being finalised and a further report would be submitted to the Clinical Cabinet following the next Programme Board meeting. The Clinical Cabinet agreed to VH s suggestion of having a representative from MO D s team to be part of the working group. MO D 188.4 189/15 189.1 189.2 189.3 190/15 190.1 The Clinical Cabinet NOTED the update on the FMH Transformation Project and APPROVED the Programme Board s Terms of Reference. Progress update - Future commissioning arrangements for Community ENT, Audiology and Wax removal services AF and EJ presented the progress update on future commissioning arrangements for Community ENT, Audiology and Wax removal services which sets out a summary of the progress of the development of service model and reprocurement for the community ENT, Adult Audiology (AA) and Wax Removal Service to date including draft specifications for the new service. The clinical case for change is to have a one stop shop for patients pathway for ENT, Wax removal and AA. A Business Case would be submitted to the FPQ Committee in November 2015. There was consensus that the documents were very well written. EJ would look into adding a scope for children under ENT, as suggested by SD. DF suggested being specific about weekends and locations where these would be held. She further suggested having a 5-year contract broken down into 3- yearly and 2-yearly, for example, opposed to 3-yearly contracts. EJ would be meeting with the procurement team for advice and this would be discussed. DF further added there was no mention of Procedures of Limited Clinical Effectiveness (PoLCE) in the document and the need for specificity on locations. JL noted that the papers fail to address the physical needs of elderly frail patients in care homes, for example, how they would be conveyed to an external service for ear wax removal. He further noted that elderly frail constantly lose their hearing aids and suggested looking into how this service could be transformed to meet their needs. DF added that no timings had been included on having ear wax removed. MO D suggested giving thought to requesting statutory bodies to team up with voluntary bodies, by subcontracting some of these services to the latter to deliver services for housebound patients, cutting out the need for GPs to refer patients back to hospital, thereby providing value for money and having wider coverage. EJ added that there had been discussion on the form the contract would take to incentivise providers to deliver the service through the one stop shop and to educate patients on more appropriate ways to manage their ear wax. JB suggested exploring the possibility of training appropriate ancillary care staff on ear wax removal, as it was noted that approximately 180k was spent on ear wax in 2014/15 in Barnet. Responding to JB s point on lack of specification on the method of wax removal, whether irrigation or suctioning, DF noted that the Consultant ENT had confirmed that there was no risk in the use of syringe on elderly frail patients and therefore, either method could be used. JB queried the lack of specification on the types of hearing aids and noted the minimum standard specification be stated. He further noted that a question for consideration was what the requirement would be for GP practices to continue syringing should this service be procured. The Clinical Cabinet NOTED the progress update on future commissioning arrangements for Community ENT, Audiology and Wax removal services. Sign off of Joint Health and Wellbeing (HWB) Strategy MP presented for approval the draft refreshed Health and Wellbeing (HWB) Strategy, which reflects plans by Barnet CCG and Barnet Council on how they would support residents to stay healthy and lead active, independent lives Clinical Cabinet - 22 October 2015 5 EJ EJ
over the next four years (2016 2020). The current HWB Strategy had been reviewed in light of the Joint Strategic Needs Assessment (JSNA) 2015-2020 refresh, local strategies (current and draft), national guidance and policy and discussions with Barnet Council, Barnet CCG, Healthwatch and the 5 Partnerships Boards which are made up of service users, carers and voluntary and community sector organisations. The strategy sets out the priorities for Barnet s HWB Board, with the aim of improving health and wellbeing for all Barnet residents. The priorities within the Strategy are based on the evidence provided by the JSNA and reflect feedback from consultation. The final draft would be presented at the HWBB on 12 November 2015 for sign off. Changes that are material would be feedback to the Chair. 190.2 191/15 191.1 191.2 191.3 192/15 192.1 The Clinical Cabinet APPROVED the Joint Health and Wellbeing Strategy 2015-2020. Information Sharing Agreement (ISA) between Barnet GP Practices and Local Named Providers BW attended to present the ISA between Barnet GP Practices and Local Named Providers. MO D explained that the pre-circulated document was as an earlier iteration of the work being carried out by Central London Community Healthcare (CLCH) around data sharing agreement to ensure system-wide EMIS are in synchronisation. A follow up to this was a broader piece of work around GP information sharing, which superseded CLCH work and which was tabled for the Clinical Cabinet to comment and approve to send out to all Barnet GPs. The paper set out the data sharing practice that is expected to be put in place in GP practices. This agreement also directly supports the Barnet CCG s IM&T priority to become paperless. The ISA had been reviewed and amended by London-wide Local Medical Committees (LMC). The same information sharing agreement has been implemented in Haringey and Islington CCGs. An agreement in principle had been obtained from London-wide LMC and BW would discuss with the Director of Primary Care Strategy for London-wide LMC to ensure the right version of the document was being discussed. JL suggested sending a joint letter from LMC and Barnet CCG with the ISA. JB raised concern on the numerous information sharing agreements in place and suggested, if possible, simplifying the Information Governance sharing agreement for primary care in future. Work should be carried out to simplify the overall process. In response to JL s question on whether the reference to Barndoc was sufficient, BW stated that there would be variations to the document as more organisations sign up. AF queried safeguarding data being sensitive information. BW stated that the document states that GPs remain the data controller. EJ suggested future providers to sign up to data sharing agreement, for example, including in the 111 specification that the supplier of the 111/ OoH service must sign the data sharing agreement. The Clinical Cabinet APPROVED the Information Sharing Agreement between Barnet GP Practices and Local Named Providers and AGREED it should be presented to all Barnet GPs for electronic signature. This is expected to be done by end November. The CSU would oversee this process. Clinical Cabinet Rolling Agenda The Clinical Cabinet NOTED the rolling agenda. BW 193/15 193.1 Any Other Business There were no items of other business. 194/15 Date and time of next meeting Thursday 19 November 2015 08.45a.m-10.30a.m Clinical Cabinet - 22 October 2015 6