Shared support services

Item 1 (Document 1.1) NWL collaboration board 23 October 2014 Members in attendance: Shared support services Minutes of meeting North West London collaboration of clinical commissioning groups Room 5.4, 15 Marylebone Road, London NW1 5JD Members Secretary NWL CCGs chairs: Nicola Burbidge, Hounslow CCG Fiona Butler, West London CCG Ian Goodman, Hillingdon CCG Amol Kelshiker, Harrow CCG Ethie Kong, Brent CCG Ruth O Hare, Central London CCG Mohini Parmar, Ealing CCG Tim Spicer, Hammersmith & Fulham CCG Collaboration governance manager, NWL CCGs: Emma Taylor Chief accountable officers: Daniel Elkeles (CWHHE) Rob Larkman (BHH) (SRO for transition) Minutes Chief finance officers: Clare Parker (CWHHE) Jonathan Wise (BHH) Business manager to director of contracts and performance: Director of contracts and performance Andrew Burgess (Interim, NWL CCGs) Alison Smith Apologies received Director of strategy and transformation Director of informatics Thirza Sawtell (NWL CCGs) Alastair Gilchrist (NWL CCGs) Lay members Trevor Begg (BHH) Trish Longdon (TBC) Chief operating officers/ Managing Directors Matthew Bazeley, Central CCG Ceri Jacob, Hillingdon CCG Sue Jeffers, Hounslow CCG Philippa Jones, Hammersmith & Fulham CCG Kathryn Magson, Ealing CCG Sarah Mansuralli, Brent CCG Louise Proctor, West CCG Javina Sehgal, Harrow CCG Ruth O Hare, chair, Central London CCG Kathryn Magson, MD, Ealing CCG Amol Kelshiker, Harrow CCG Ian Goodman, Hillingdon CCG Bernard Quinn, Transition director (NWL CCGs) In attendance: David Melville, Business development (deputising for Maggie Gibbs, HR Dir) Tom Stevenson, Director of communications and engagement (NWL CCGs) Welcome and apologies Members were welcomed to the meeting, which was the first of its kind, established in order to discuss the shared management and delivery of NWL CCGs shared support services. Apologies were noted as shown above. Item 1: Collaboration governance: Shared support services: vision and purpose (inc. terms of reference) The board discussed the purpose of the new meeting that is being introduced to ensure that the CCGs share a transparent mechanism to oversee the support services, which from 1 October 2014 have been inhoused across the CCGs. It is also taking on the work of the NWL-wide group known as the Commissioning Delivery Group that has been responsible for managing the annual contracting process. The shared support services meeting is part of the NWL CCGs collaboration board. The collaboration 1

board has met since the CCGs were first authorised as a committee in common. Under the updated NHS Act 2006 it has been formally recognised as a joint committee reporting to the CCGs. This is in order that in limited areas agreed by the CCGs it can take joint decisions, which themselves are subject to unanimous agreement. In the majority of its work areas it does not take any decisions but rather continues to make recommendations to our governing bodies. These limited areas of joint decision making are to deliver and manage shared support services, to negotiate joint procurement agreements with shared suppliers and to agree NWL-wide policy positions in response to Individual Funding Requests received in NWL. The meeting is operational in nature and plans to meet monthly to ensure that the various services are being delivered equitably and to the agreed standards and objectives. It is the meeting which will give a strategic steer to the NWL CCGs jointly appointed service line leads to agree strategic priorities and performance requirements for communications, human resources, contracting and business intelligence and IT. Commissioning intentions and final contracts continue to be locally determined and signed off by the CCGs, with some CCGs acting as the lead CCG for contracting with large providers, as has been the case since the CCGs were first authorised. It was confirmed that all CCG chairs are members of all meeting modes of the collaboration board. ACTION: It was agreed that the collaboration board s terms of reference for this meeting mode should reflect that the recommendations of the NWL CCGs Policy Development Group (PDG) should now be formally approved at the shared support services meeting, since this is the meeting authorised by the CCGs as the decision-making mode of the collaboration board. It was agreed that this would be preferable and a more inclusive method of responding to the recommendations than using only chairs actions (as was set out in the PDG terms of reference, as approved in July 2014 by the CCGs prior to the collaboration board s revision). The CCGs recent constitutional changes, approved during October 2014 by CCGs members, expressly provide for the CCGs to collaborate in order to achieve equitable funding policies across NWL, taking direct account of the individual funding requests that are received across NWL as a whole. The CCGs agreed to review the collaboration board s complete terms of reference in April 2015, after six months of operation in its new format. This exercise will be conducted as part of a wider evaluation of collaboration governance arrangements, at which time agreement with CCGs governing bodies will be sought on the degree to which supporting documentation should be revised. Item 2: Transition update It was intended that the detailed report would be taken to CCGs next governing body meetings in November, together with a risk management dashboard. (A) Human Resources A key HR priority for the CCGs is to reduce the number of interim staff (104) covering key posts. This was being achieved through an active recruitment process through the internal and external advertising of vacant substantive posts. A successful all-staff Launch Event had been held by NWL CCGs on 9 October 2014 to recognise the coming together of former CSU staff into the CCGs own local management structures and to set the tone for new ways of working. Longer term, organisational development 2

priorities are to tap into and articulate CCGs common vision and values, especially pertinent for staff working across all eight CCGs. With regard to the consultation process for the 240 staff affected by change, this had concluded in September with only six redundancies. Letters had been issued to all affected staff confirming the final outcome. A pragmatic phased approach was being taken to the related office moves. (B) Communications and engagement Key priorities for communications and engagement are to recruit to outstanding vacancies and to ensure central resourcing helps to facilitate CCGs communications on the local implementation of strategy and transformation programmes. Interviews for three communications roles took place the week of 10-14 November and offers have been made for all three roles. The FOI officer role was advertised but no suitable candidates were shortlisted; the role is now going to a second round of recruitment. Communications objectives are being set relative to CCGs priorities to ensure that pro-active and consistent communications are delivered across the eight CCGs, which reinforce organisational development and engagement. It was recognised by the collaboration board at the October meeting that the central communications resource will be relatively light, even when fully recruited to. Working together with local CCG communications and engagement staff will be essential to identify opportunities and avoid duplication. (C) Contracting and performance New structures are now fully operational and there are 19 vacancies in provider management that have already progressed to advert with a closing date of 27 October 2014. Full and final sign-off is being obtained over the coming fortnight for the small number of unsigned contracts for 2014/15 and review meetings will be held to examine meetings scheduled for the next week to look at performance for the first quarter and correctly apply contractual terms. The first meeting of the procurement steering group will be held on 6 November 2014 to finalise Key Performance Indicators to ensure that the procurement provider service is being managed effectively and that any emerging issues affecting any of the CCGs are resolved in a timely way. A task and finish group has been formed to help standardise the approach to contracts. This includes the creation of a single comprehensive contract database. Risks and issues relating to smaller contracts are being addressed. (D) Business intelligence and informatics The Hitachi programme has been re-energised and seven work streams have been developed to support a tool that our business analysts can use to run ad hoc reports. One work stream has focused on identifying CCG leads to provide input into the main requirements for the platform. A customer engagement programme has been held with staff drop-in sessions. In addition, an education and training module is being planned to be rolled out in December to ensure that CCGs are well equipped to access the data warehouse. ACTION: The IT infrastructure is to be rolled out to support GPs, incorporating member practices in Brent and Harrow. The net effect of the enhanced infrastructure will be service improvements and greater business continuity. Hillingdon, which runs to a different system, has elected to remain outside of this for a time yet. The informatics work stream is looking at systems interoperability with a view to taking worked up proposals to governing bodies in due course. 3

Item 3: Performance management of shared support services The final monthly performance report from the CSU (month 5) was circulated for information and discussion, together with a summary paper on how reporting could be developed now that the shared support services are being managed in-house. The board considered favourably the suggestion to re-shape the KPIs against CCGs strategic objectives to enable dashboard-based reporting. This approach could be supplemented with what the priorities are for each service-line, plus deliverables in this financial year and beyond, to support performance monitoring. A related issue is to ensure that the approach to Red Amber Green (RAG) performance rating fully reflects the views of the CCGs. ACTION: The board requested the development of an approach to performance monitoring that is service-line orientated and connects with wider performance across the system. Dynamic KPI reporting, both qualitative and quantitative, will give an idea of progress made against CCGs evolving work plans and primary strategic objectives. The new framework needs to be aspirational and closely aligned with strategic objectives to provide a cohesive view of overall performance, whilst still recognising complexity and certain constant measures. Item 4: Annual contracting process The board discussed a detailed timetable for the 2015/16 contracting process that was circulated. Six monthly contract notification letters have been issued and contract mandate forms are due to reach conclusion ready for approval by CCGs managing directors / chief operating officers by the first week in November. Provider responses to counting and coding notifications are under evaluation. The quality work stream underway is focusing on how to incorporate patient involvement into each of the contracting teams, building on what has worked well in the past. The first offers to providers will be delivered by 19 December 2014, based on 2014/15 prices. After this, national tariff data received will be incorporated into the models for 2015/16 to be put out by 19 January 2015. Metrics will be informed by performance against current contracts. Target templates are being developed for Better Care Fund plans to pull out key deliverables for 2015/16, due to be presented to the steering group in mid-november. The clinical leads for each CCG are producing a long-list of CQUINs to be reviewed on 5 November, to be reviewed by the quality work stream. ACTION: At the November meeting: 1) discuss the planned mix of block contracts and payment by results. 2) discuss the alignment of CCGs approach to large provider contracting to ensure that the metrics adopted foster equitable outcomes for the respective health populations. Item 5: Recommendations of the Policy Development Group in response to Individual Funding Requests Recommendations of NWL CCGs Policy Development Group are brought to the collaboration board for discussion and decision. The three policies discussed were on knee replacement (planned procedures with a threshold), biologic agents in rheumatoid arthritis, and biologic agents in psoriatic arthritis in relation to the decision-making framework that has been developed. Knee replacement policy The PDG recommended that the BMI threshold, which does not feature in NICE guidance CG177 and which is an outlier with regard to other policies, should be removed from the policy for knee replacement. The proposed revised policy was discussed by the collaboration board on 28 August 2014, when further information was sought as to the affordability implications. The board accepted the evidence set out in the 4

paper and considered the range of factors outlined in the decision-making framework, which included patient experience and CCGs local affordability for 2014/15. The board fully recognised the need to work towards achieving consistency and equitable outcomes across different policies with regard to eligibility criteria and thresholds. Outcome: After discussion, rather than make the policy effective for 2014/15, it was agreed to look at this as part of the 2015/16 annual planning round, where full consideration will be given to the opportunity cost of funding this proposal. Rheumatoid arthritis It was noted that a number of IFRs are being received from patients not meeting NICE guidelines on account of their contra-indications for Anti-TNF agents, who as a result have no immediate alternative treatment options, and for whom the vast majority of requests are subsequently approved via NWL s IFR panel. The strength of the clinical evidence underpinning the proposal was recognised as strong. Specifically in the case of rheumatoid arthritis, it is recommended that a choice of treatment for biologic agents for rheumatoid arthritis patients with contra-indications be provided. For patients with contraindications to Anti-TNF agents, this will include introducing Rituximab as a first, second and third-line choice for monotherapy and as an alternative first and second line choice in combination therapy with methotrexate. This is an established clinical practice. It was noted that the reason Rituximab is not currently licensed for this indication is due to lack for incentives for pharmaceutical companies to pursue this, rather than due to a lack of evidence of its efficacy, or due to safety issues. Outcome: The collaboration board approved the proposed revised policy. Psoriatic arthritis The proposed revised policy recommended providing the use and choice of second line biologic treatments for psoriatic arthritis patients with primary or secondary failure, loss of efficacy or adverse events to first line treatment. The board recognised that strong evidence support the switch of biologics to second line anti-tnf, which included joint guidance from the British Society for Rheumatology and British Health Professionals in Rheumatology. Outcome: The collaboration board approved the proposed revised policy Item 6: AOB and future agenda items A greater part of the next meeting will be dedicated to discussing the annual contracting round. ACTION: For future policy development recommendations, it was agreed to develop a prioritisation framework, so that proposals are considered in the context of the wider priorities identified by NWL CCGs. This will be taken to the collaboration board in the next couple of months. These items will also be taken at the start of the meeting. 5