Clinical Attendance Members in attendance Ian Goodman, Chair, Hillingdon CCG (Chairing the meeting) Amol Kelshiker, Chair, Harrow CCG Fiona Butler, Chair, West London CCG Ethie Kong, Chair, Brent CCG Rob Larkman, Chief Officer, Brent, Harrow, Hillingdon (BHH) CCGs Daniel Elkeles, Chief Officer, Central London, West London, Hammersmith & Fulham, Hounslow and Ealing (CWHHE) CCGs Jonathan Wise, Chief Financial Officer, BHH CCGs Clare Parker, Chief Financial Officer, CWHHE CCGs Nicola Burbidge, Chair, Hounslow CCG Raj Chandok, Ealing CCG Susan McGoldrick, Vice Chair, Hammersmith & Fulham CCG Ruth O Hare, Chair, Central London CCG IG AK FB EK RL DE JW CP NB RC SMc ROH Non Members in attendance Bernard Quinn Director Delivery & Performance, Brent, Harrow, Hillingdon (BHH) CCGs Shona Fearn, Programme Manager, Brent, Harrow and Hillingdon CCGs Kieran Seale, Governance Manager, Central London, West London, Hammersmith & Fulham, Hounslow and Ealing CCGs Members of the public. Apologies Apologies were received from Tim Spicer, Chair, Hammersmith and Fulham CCG. Page 1 of 5
Clinical Minutes Welcome and apologies Ian Goodman welcomed all those present to the meeting. He explained that it was a meeting of the Chairs of the eight CCGs in North West London Central London, West London, Hammersmith & Fulham, Hounslow, Ealing, Brent, Harrow and Hillingdon. He said that the paper being discussed had been considered by the Governing Bodies of seven of the eight Clinical (CCGs) in North West London (Hillingdon will be considering it on 27 th March). The Governing Bodies had mandated the Chairs to meet and agree the way forward on the issues set out in the paper. Declarations of Interest Rob Larkman (Accountable Officer, Brent, Harrow and Hillingdon CCGs) introduced the paper entitled North West London CCGs the future of collaborative working. He said that it covered three main areas, which would be considered in turn. He said that the ideas in this paper built on the successful collaborative work that has taken place across the eight CCGs in North West London. Commissioning support services Rob Larkman said that the contract for services provided by the Commissioning Support Unit (CSU) expires on 30 th September 2014. Consideration has been given as to how to go forward after the end of the contract. Both sets of CCGs had commissioned reviews as to how to proceed and a business case setting out the preferred options is now being developed to create a consistent approach across the eight CCGs. He said that the Chairs were now being asked to confirm that the work for the development of the Business Case for the preferred option should be pursued. He noted that NHS England had put an assurance process in place to ensure that best practice is observed throughout the business case process. Page 2 of 5
Clinical Ruth O Hare stressed the importance to each Governing Body of commissioning services that best support the needs of local practices. Amol Kelshiker agreed that greater local sensitivity was needed than at present. Nicola Burbidge noted that both sets of CCGs had come to the same conclusion that a more responsive service was needed. Ethie Kong said that a year into the life of the CCGs was a good time to reflect on this sort of issue. The meeting agreed to: a) Note the work in progress to review the options for the future commissioning support services for the eight North West London CCGs: b) Take forward a full business case to be completed by the end of April; c) Note that NHS England are undertaking an assurance process of the business case development and will provide their assessment to the Governing Bodies prior to the end of April; d) Agree to assign resources to ensure that the full business case can be completed by the end of April. Primary care co-commissioning Rob Larkman explained that the commissioning of Primary Care was not currently carried out by CCGs. This task is undertaken by NHS England. Talks have been underway in recent months about exploring the sharing of Primary Care commissioning between NHS England and the CCGs. This would focus on areas such as the co-ordination of planning and strategic thinking with the aim of delivering improved services. He said that the meeting was being asked to support exploring with NHSE further what co-commissioning might mean. Ruth O Hare said that GPs were aware of the potential risk of conflict of interest involved in this issue. She said that a number of measures had been put in place to combat this, including strong Lay representation on committees where conflicts might exist. Nicola Burbidge said that the proposals built on work that had been undertaken with NHS England and that she supported it. Daniel Elkeles stressed the importance of Out of Hospital strategies and said that a divided commissioning system hinders their implementation. He said that this proposal would facilitate that work. Amol Kelshiker supported the proposals but said that it was important to distinguish between this proposal and CCGs being given responsibility for contract management. Ruth O Hare added that the word explore in the proposal was key a final decision is yet to be made. Raj Chandok said that these proposals would allow CCGs to contribute to shaping services and to put greater emphasis on prevention and early intervention. Page 3 of 5
Clinical e) To endorse the direction of travel for primary care transformation in North West London, and therefore the rationale for exploring a new co-commissioning arrangement with NHS England; f) That the CCGs agree what information they will require to enable them to make a formal decision at a future board meeting on whether the CCGs and NHS England should embark on a new co-commissioning arrangement. Financial strategy Rob Larkman said that there was a five year financial strategy in support of Shaping a Healthier Future. This recognises the disparity of funding across North West London and that each CCG has an important role to play in delivering the strategy. He said that there were three parts to the strategy: investing in the transition costs of change; putting all CCGs on a level playing field; and creating an investment fund across North West London to be used to improve services. The exact figures for 2014/15 have been agreed and further work will be carried out to set the figures for 2015/16 and subsequent years, subject to agreement by NHS England. Daniel Elkeles added that the principles behind these proposals are very important as the implementation of Shaping a Healthier Future is a common endeavour that requires the pooling of resources. Ian Goodman noted that the financial strategy redresses the financial imbalances that exist. The Department of Health have started to tackle this issue, but more remains to be done. Ethie Kong added that equity of care across North West London is a key objective. g) To approve the framework, principles and strategy; the figures for 2014-15 and to recognise that further work will be needed on the figures for 2015/16 onwards with the aim of completing the 2015/16 figures by the end of April 2014, subject to discussion with NHS England; h) That a finance committee is set up as part of the Collaboration Board to oversee the implementation and delivery of this strategy. This committee will be tasked with monitoring/reviewing progress in implementing the strategy and updating it each year to make recommendations on the required contribution to each Governing Body for the following year s strategy. Page 4 of 5
Clinical Governance Rob Larkman said that with these additional responsibilities agreed, it was important to ensure that robust governance arrangements are put in place. The main mechanism for this would be the Collaboration Board, which involves the eight CCGs working together. Daniel Elkeles emphasised that this arrangement consisted of eight sovereign CCGs working together to discharge wider responsibilities. Ruth O Hare said that each CCG Governing Body had scrutinised the proposed arrangements and agreed that more joining up is needed. i) That the terms of reference for the NW London CCG Collaboration Board be revised to enable it to take on the additional functions agreed in the meeting. The revised Terms of Reference will be brought to a future meeting of the Governing Bodies for approval; j) To support the recommendation that the directors working across the eight North West London CCGs would be accountable to the Collaboration Board and line managed by the Accountable Officer for CWHHE CCGs or the Accountable Officer for BHH CCGs; k) That Governing Bodies should consider whether to have one or two members each on the Collaboration Board; l) That a programme of Organisational Development for the members of the Collaboration Board be designed. Page 5 of 5