BIRKENHEAD AND WALLASEY PRIMARY CARE TRUST

THE 20th MEETING OF BIRKENHEAD AND WALLASEY PRIMARY CARE TRUST 1.00pm, THURSDAY 29 JANUARY 2004 COMMITTEE ROOM, ST CATHERINE S HOSPITAL MINUTES PRESENT Mr M Brereton Dr A Mantgani Mr J Corkill Ms K Doran Mr P Eaglesfield Mr R Jones Mrs M Downs (In the Chair) Mrs C Maddaford Dr S Mukherjee Ms L Quarrell Mr P Russell Ms J Harvey IN ATTENDANCE Mrs L Danher, Birkenhead and Wallasey PCT Mr P Reed, Director WHIS Mrs C Keating, Birkenhead and Wallasey PCT Mr R Favager, Birkenhead & Wallasey PCT MEMBERS OF THE PUBLIC No members of the public attended. PRESENTATION CHILD PROTECTION REVIEW Following on from the presentation at the November Board Meeting on the Green Paper Every Child Matters, two Designated Nurses, Ms Jill Pinnington & Ms Helen Stewart gave a review of Child Protection highlighting the implications for the PCT of the national framework for safeguarding and promoting the welfare of children. Ms Jill Pinnington gave details of the roles of the named doctors and nurses. Concerns were raised by the Medical Directors of the lack of child protection training for GP registrars. Mrs Muriel Downs, Chairman, agreed to raise this matter as PCT representative on the Deanery. Concern was also raised about the impact of the Child Concern Model on Health Visitors as there is a shortage of Health Visitors, particularly in deprived areas. Although this is a national problem, the PCT is currently training a number of Health Visitors as well as District Nurses to try to address this issue. The need for additional specialist resource on child protection was highlighted. Ms Kathy Doran, Chief Executive, confirmed that these Page 1of 10

issues would be followed up in the Operational Plan which would be discussed at the informal Board Meeting in February 2004. It was agreed that the Designated Nurses would submit a Progress Report to the Board in due course. 109/04 110/04 111/04 112/04 APOLOGIES FOR ABSENCE Apologies for absence were received from Lord Michael Chan, Mrs Rose Dixon and Mr John South. CHAIRMAN S ANNOUNCEMENTS Mrs Muriel Downs, Chairman, announced a change in the agenda in that draft minutes from statutory Committees would now be submitted to the Board to enable members to get the latest reports. Any amendments to these minutes would be brought to subsequent Board meetings. MINUTES OF THE PREVIOUS MEETING It was RESOLVED that the minutes of the previous meeting of Birkenhead and Wallasey Primary Care Trust held on Thursday 27 November 2003, be agreed as a correct record. MATTERS ARISING FROM MINUTES Mr Peter Eaglesfield, Non-Executive Director, requested an update on the transfer of St Catherine s & Victoria Central Hospital Sites to BKW PCT (Item 106/03 refers). Ms Kathy Doran, Chief Executive, confirmed that discussions on the key issues and their financial implications are on-going with Bebington & West Wirral PCT and Cheshire & Wirral Partnership Trust to ensure that the transfer can take place in April 2004. Mr Doug Baker, Assistant Director Estates, was involved with the consultation on facilities management. Mr Richard Jones, Director of Human Resources, confirmed that the final response rate for the Staff Attitude Survey (Item 100/03 refers) was 61.3%, higher than the target response rate of 60% set by the Commission for Health Improvement (CHI). 113/04 CHAIRMAN S REPORT The Chairman tabled a report detailing events and functions she had attended during December 2003 and January 2004. Page 2of 10

Core Aim 1: Be a model employer; provide a safe and supportive 114/04 working environment where staff are valued and supported; promote personal development through teaching and learning opportunities for all. Human Resources Issues Mr Richard Jones, Director of Human Resources & Operational Management, presented a report on the HR issues facing Provider Acute and Mental Health NHS Trusts, citing three major challenges: Agenda for Change, Working Time Directive and the Consultant Contract. The Board received and noted the report. Items for Noting The Board received and noted the draft minutes of a meeting of the Human Resources Committee held on 26 November 2003. Core Aim 2: Deliver the NHS Plan in relation to Birkenhead & 115/04 Wallasey GMS Contract Update Ms Kathy Doran, Chief Executive, on behalf of Mr John South, Director of Primary Care, gave an update on GMS Contracts. Since the informal Board meeting in December, guidance had been received from the Department of Health including details of draft contracts. These are now being worked through by the GMS Implementation Group and the PMS groups. Central to the new contracts is the development of local enhanced services which will be included in the draft Operational Plan. A set of guidelines had also been received for new PMS Contracts and Wallasey & Birkenhead groups were working together on these to ensure that quality measures were implemented across the PCT. The Board noted the action to date regarding the implementation of the new GMS Contract. (ii) Field Site Dental Project and Service Level Agreement (SLA ) Ms Kathy Doran, Chief Executive, on behalf of Mr John South, Director of Primary Care, presented the report to members and welcomed that comments from the Informal Board meeting on the emphasis on benefits to patients had been acted upon. Ms Doran informed members that a 5% activity increase had been agreed within the SLA. Mr Peter Russell, Non-Executive Director, welcomed the purposes clearly set out on the front cover but enquired as to the mechanisms in place to ensure their delivery. Ms Kathy Doran confirmed that monitoring would be taking place within the Steering Group and by the Page 3of 10

Dental Commissioning team which is to be set up to focus on the dental health needs of the population. Notification had been received from the Modernisation Agency that the software support for computerised practices would be funded. The Chief Executive also informed members that Mr John South is working nationally with the Department of Health on Dental Contracts due to be implemented nationally in 2005. The Board welcomed this radical service redesign which should improve quality of care for all. They also recommended that the SLA should be used as a template for other agreements. Ms Kathy Doran agreed to pass on the thanks of the Board to all concerned with this project. It was RESOLVED to approve the Service Level Agreement for the delivery of Primary Care Dental Services. Items for Noting (ii) (iii) The Board received and noted the minutes of a meeting of the Professional Executive Committee (PEC) held on 13 November 2003 and the draft minutes of a PEC meeting held on 15 January 2004. The Board received and noted the minutes of meetings of Wallasey Local Health Directorate (LHD) held on 15 October and 19 November 2003 and the draft minutes of a Wallasey LHD meeting held on 14 January 2004. The Board received and noted the minutes of a meeting of Birkenhead Local Health Directorate held on 6 November 2003 and summary notes of a Birkenhead LHD meeting held on? December 2003. Core Aim 3: Operate systems which monitor and promote high 116/04 clinical quality and meet national standards Risk Management Mrs Cathy Maddaford, Director of Nursing & Quality presented the following reports to the Board as part of the Risk Management Procedures in support of the Clinical Negligence Schemes for Trusts Assessment (CNST): a) Incident Reporting Procedure b) Root Cause Analysis Procedure c) Infection Control Annual Report d) Risk Management Process As the first annual report, the Infection Control Report offers a baseline to the Board and is, therefore, key to demonstrating future progress. The next report to be presented to the Board will cover the period from Page 4of 10

January 2003 to April 2004 to bring the reporting procedure in line with April to April reporting. Ms Jane Harvey, Director of Public Health, informed members that Dr Katy Kidd, Medical Director, had agreed to be the Director of Infection Control. Mrs Cathy Maddaford, Director of Nursing & Quality, gave a short presentation on the Risk Management Process, showing the structures that are in place to ensure connectivity. The Board RESOLVED to approve the Risk Management Procedures and Reports. (ii) Continuing Health Care Update Mrs Cathy Maddaford, Director of Nursing & Quality, updated members on issues within Continuing Health Care (CHC). The new eligibility criteria are now in place with the Multi Agency CHC Operational Group identifying more detailed operational issues. The need for a Care Manager had been identified to handle complicated cases. As part of audit requirements, the monthly Community Care panel has established a robust framework for the recording of documentation leading to a decision. Training of key people is currently being undertaken with the SHA and this will be cascaded down. The logistics of doing so to large numbers locally are under consideration. An independent audit of how the eligibility criteria are being implemented is to be carried out within Cheshire & Merseyside with planned site visits both at strategic and operational levels. Mrs Cathy Maddaford informed members that a Restitution panel had been set up by the SHA and that she and Mr John South, Director of Primary Care were members of said panel. This panel would only review the decisions on those patients who had been turned down for CHC Restitution. (iii) Quarterly Report on Complaints The Board welcomed the trend of the numbers of compliments outweighing the numbers of complaints. It was agreed that Team Brief should be used to stimulate all departments to forward comments and that the launch of the PALs Service would be an opportunity to raise the profile of the Hotline. The Board noted the Quarterly Complaints Information. Items for Noting. The Board received and noted the draft minutes of a meeting of Page 5of 10

the Corporate & Clinical Governance Committee held on 19 January 2004. Mr Peter Eaglesfield referred to the high quality of the reports presented to the Committee and suggested details should be circulated more widely. Ms Jane Harvey confirmed that opportunities for publishing details were being explored. Core Aim 4: Tackle ill health and its wider determinants through 117/04 partnership working with any individual or organisation which add value to the delivery of our core purpose; promote health improving behaviour and fully engage in the protection of the population s health. Public Health Update Ms Jane Harvey, Director of Public Health, presented the update on the issues currently facing Public Health and informed members that key items would be discussed in more detail at the Informal Board Meeting in February 2004. Ms Jane Harvey announced the appointment of Ms Sue Drew as Deputy Director Public Health. Mrs Muriel Downs, Chairman, offered her congratulations on behalf of the Board. Items for Noting The Board received and noted the Minutes of a Meeting of the Modernisation Executive Committee held on 27 October 2003, the draft minutes of a meeting of the Modernisation Executive Committee of 25 November 2003 and of an Extraordinary Meeting of 15 December 2003. Ms Kathy Doran, Chief Executive, informed members that the Extraordinary Meeting had been called to discuss the continued funding for the Citizens Advice Bureau and Beechwood schemes. Support for these schemes had been given in principle by both the Modernisation Executive and the NRF Policy Group. Discussions were taking place with both schemes in order to update their respective SLAs. Formal approval for continued funding is anticipated through the LSP (Local Strategic Partnership) in March. Core Aim 5: Encourage a culture which promotes innovation, 118/04 service improvement, audit and research and development Service Redesign Funding Report Ms Kathy Doran, Chief Executive, presented a report on the funding issues for Service Redesign. At the Board Meeting in September 2003, it had been agreed that the programme would be funded by a mixture of capacity funding and deferred repayment of brokerage which the PCT had discussed with the SHA. However, since that time, and due to changes in capital to revenue brokerage arrangements, the SHA could not guarantee to defer repayment. As a result, the PCT with Page 6of 10

colleagues in Bebington and West Wirral has reviewed the programme put to the September Board and is proposing a tightening up of the criteria for funding future schemes. The Service Redesign Group recommends that no further schemes are implemented in the short term unless the scheme is self-financing, funding is available from another source, eg. Modernisation monies, or the scheme is being developed in response to another policy initiative, eg. GMS contracts. Work on service redesign will continue so that, should funding become available, schemes will be able to be implemented. This will allow for schemes to be thoroughly tested before final implementation. In addition, the PCTs propose to ask the SHA whether its position on the proposed deferred repayment of brokerage can be reconsidered in light of developing understanding of the local and national financial position for 2004/05. The Board RESOLVED to accept and approve the recommendations from the Service Redesign Group. (ii) Service Redesign Update Dr Shyamal Mukherjee and Dr Abhi Mantgani, Medical Directors, gave an update on key issues within Service Redesign. Mr Peter Eaglesfield, Non-Executive Director, raised concerns about the waiting lists within Urology Acute Trust Services. Dr Mantgani confirmed that discussions were taking place to resolve this. Mr Joe Corkill, Non-Executive Director, queried how changes were communicated to patients. Members were informed that this was considered in the context of each scheme. Ms Pam Broadhead, Intermediate Services Manager, is responsible for co-ordinating implementation of the process from media coverage to notices and targeted leaflets in practices. Core Aim 6: Deliver accessible services which actively seek and 119/04 reflect the aspirations and our patients, the public, carers and our staff and contractors. Core Aim 7: Develop efficient communication and information processes supported by modern technology. National Programme for IT (NPFIT) Mr Patrick Reed, Director Wirral Health Informatics Service (WHIS), presented a report on current progress to deliver the national programme for NPFIT, outlining the position to date on implementing the Wirral Electronic Health Record (EHR). The national strategy for NPFIT is to deliver a national programme for IT in the NHS. As part of this process a Local Service Provider (LSP) Page 7of 10

has been appointed to work with the Wirral Health Economy to deliver the agenda although the full specification on offer is not as yet clarified. Funding for the Local Delivery Agreement (LDA) is anticipated to be around 4m per year for the Wirral Health Economy. The SHA would be contacting the PCT to ensure sign up to the LDA by March 2004. They had asked that the Board agree delegated powers to the Chief Executive to allow this to happen. Given the lack of clarity re the specification, Ms Kathy Doran, Chief Executive, proposed that it would be appropriate to use delegated powers when sufficient detail had been given of the potential benefit to Wirral patients and health professionals. Mr Patrick Reed agreed to report back to the March Board to give further clarification of the service. Mr Patrick Reed explained the scope of the Wirral Electronic Health Record (EHR) project and gave details of the proposed publicity campaign to inform the public of the fact that their details were to be shared and of the confidentiality safeguards built into the service. Members of the public would be able to opt out of the system. But if they did not opt out consent would be taken as implied. This approach had been developed following national guidance and legal advice. First contact for the public would be through the PALS Officers who have had briefing and training to support this. The Board RESOLVED to agree delegated powers of approval to Ms Kathy Doran, Chief Executive, for the PCT s Local Delivery Agreement and confirmed their support for the EHR subject to the consultation with the public as described in the report. (ii) Communications and PPI Update The Board received and noted a Communications and Patient & Public Involvement (PPI) update. The update included draft minutes of the Communications & PPI Strategy Group Meeting held on 3 December 2003 and a PALs Report. Ms Kathy Doran, Chief Executive, informed members that first appointments had been made to the Birkenhead and Wallasey Patient Forum. A meeting would be organised with Board members in due course. Core Aim 8: Ensure value for money and good financial 120/04 management Finance Report for the Month Ended 31 December 2003 Mr Mike Brereton, Director of Finance, reported that the financial position shows an overspend of 1,445,497 with a forecast overspend at 31 March 2004 of 3m. The slight improvement from the figure given Page 8of 10

at the end of October 2003 is due to primary care prescribing savings and both the LHDs and the Medicines Management Team should be congratulated for their role in this. Plans remain in place to deliver a balanced position for the end of the financial year. For the first nine months of the financial year the PCT has achieved 88% on the number of invoices paid within target and 97% on the value of invoices paid. This is an encouraging improving trend. Mrs Muriel Downs, Chairman, asked whether there would be available cash to fund Continuing Care payments before the year end. Mr Mike Brereton confirmed that the current cash position allows for these payments to be made. The Board noted both the financial position at 31 December 2003 and the forecast outturn position for the end of the financial year. It also noted the work being undertaken by the Finance and Performance Improvement Committee in developing a recovery plan for the current financial year and a further recovery plan to assist the whole local economy reach recurring balance over the next three financial years. Items for noting The Board received and noted the Minutes of a Meeting of the Finance and Performance Improvement Committee held on 21 November & 12 December 2003. 121/04 ANY OTHER BUSINESS Wirral Local Health Community Meeting Ms Kathy Doran, Chief Executive, tabled the letter from the Strategic Health Authority on the Wirral Local Health Community Meeting held on 15 December 2003. She noted the presentation given by Ms Maggie Johnson on the change in service provision for DVTs which is having a major impact on work in hospital. Ms Doran also brought members attention to the Mid Year Financial Review which requires the Financial Recovery Plan to be signed off by the Board in January/February to allow the SHA to approve the Community Recovery Plan in early March. 122/04 123/04 PRIVATE BUSINESS Private Business was discussed. DATE AND TIME OF NEXT MEETING The next Board Meeting (informal) of Birkenhead and Wallasey Primary Care Trust will be on Thursday 26 February 2004 commencing at 1.00pm. The meeting closed at 4.10pm. Page 9of 10

Signed:. Muriel Downs, Chairman Date: Page 10of 10