ITEM: 8.1 South Gloucestershire Clinical Commissioning Group Membership Meeting Date: Time: Location: Tuesday, 7th January 2014 13.30 – 15.30 Bristol and Bath Science Park Minutes Attendees: Dr Jon Hayes (JH), Hanham Health / Clinical Chair (Chair) Dr Martin Lockyer (ML), Almondsbury Surgery Dr Norman Douglas (ND), Bradley Stoke Surgery Sandra Lloyd (SL), Bradley Stoke Surgery Dr Luke Parker (LP), Close Farm Surgery Linda Marshall (LM), Close Farm Surgery Dr Imran Hamid (IH), Concord Medical Centre Dr Ian Paul (IP), Coniston Medical Practice Dr Andrew Appleton (AA), Courtside Practice Dr John Foubister (JF), Dr Burney and Partners Dr Chris Boelling (CB), Emerson’s Green Medical Centre Dr Felicity Fay (FF), Hanham Health Dr Catherine Buckley (CB), Kennedy Way Surgery Dr Neil Kerfoot (NK), Kingswood Health Centre Dr Jon Evans (JE), Leap Valley Surgery Dr Amanda Ramshaw (AR), Northville Family Practice Dr Alison Wint (AW), Pilning Surgery Dr Mary Harrison (MH), St Mary Street Surgery Dr Graham Deakin (GD), Stoke Gifford Medical Practice Dr Ann Sephton (AS), The Oaks Medical Centre Dr Richard Berkeley (RB), The Orchard Medical Centre Dr Sue Frankland (SF), The Park Medical Centre Mike Lodge (ML), The Three Shires Dr Hannah Richmond (HR), The Willow Surgery Dr Mark Thompson (MT), Thornbury Health Centre Dr Kate Mansfield (KM), Wellington Road Family Practice Ann Magham (AM), Wellington Road Family Practice Martin Wilkes (MW), West Walk Surgery Jane Gibbs (JG), Chief Officer, South Gloucestershire CCG Sharon Kingscott (SK), Chief Finance Officer, South Gloucestershire CCG Melanie Green (MG), Head of Medicines Management, South Glos CCG Eszter Kormendi (EK), PA, South Gloucestershire CCG [notes] In attendance: Janet Rowse, Chief Executive, Sirona Care & Health (for Item 5 only) Jenny Theed, Director of Operations, Sirona Care & Health (for Item 5 only) Pauline Chinnick, Matron, Yate MIU (for Item 6 only) Sue Parris, Locality Lead for South Gloucestershire, Yate MIU (for Item 6 only) ACTION 1. 1.1 Welcome and Apologies Jon Hayes welcomed everyone to the membership meeting and thanked everybody for their attendance. Apologies were noted from:  Dr Tharsha Sivayokan (TS), Christchurch Medical Centre  Dr John Seddon (JS), The Three Shires  Dr Rebecca Fowler (RF), West Walk Surgery 2. Declaration of Interests None. 3. Minutes of the Previous Meeting NHS England and LMC facilitated discussion on Primary Care The feedback summary was forwarded to all membership practices and practice managers. JH has not received any feedback yet. ACTION: If anybody wishes to comment please email JH. Report from the November session was circulated to attendees. ACTION: Please send any comments/feedback to JH. The minutes were approved for accuracy. 4. Members’ Briefing Future of Frenchay Hospital The Health Overview and Scrutiny Committee of South Gloucestershire Council challenged the CCG’s proposals for both the interim rehabilitation beds and for the Frenchay Health and Social Care Plans. The proposals have been referred to the Secretary of State for Health for external scrutiny and validation. The CCG is awaiting the Secretary of State’s reply. It is acknowledged that the decision to refer might have been of a political nature. The Secretary of State’s reply is likely to focus on whether the CCG has followed a fair and appropriate process and if he feels the CCG needs to do Page 2 of 8 All All anything further. The CCG continues to be committed to rehabilitation services being located on the Frenchay site eventually (i.e. in 2016). It is worth noting that out of around 200,000 outpatient appointments every year, the 2010 proposals for the Frenchay site envisaged only 5,700 appointments (100 per week approximately). Now that Emerson’s Green Treatment Centre and Cossham Hospital are open, services are offered there which cannot be duplicated on Frenchay. Members of the group asked JH if the group could do anything to help politicians understand the CCG’s proposals. JH said that at this stage there is nothing the group could do other than if GPs hear any negative comments from their patients, they can express their support for the plans. Members were thanked for their support. Funding allocation Funding allocations were announced before Christmas. The CCG has been given a higher level of growth above the baseline level of 2.14% which everyone received, to 3.7% which equates to an increase in funding above the expected value of £3.7m for 2014/15. The CCG also already knows the allocation for 2015/16 with a growth level of 3.33% which again is higher than the baseline level of 1.7% which everyone will receive, which equates to an additional £3.9m. This is great news for the CCG and will enable us to make progress on the significant financial operational challenge we inherited. For 2013/14 the CCG will report a deficit of £3.3 million on top of the £2 million non-recurrent allocation the CCG had to close the funding gap. Pay back terms of the deficit are being negotiated with NHS England. The CCG’s overall budget is £240 million. SK explained that the reason for the CCG receiving an increase to the national uplift is that it is acknowledged that the CCG is underfunded. The higher level of allocation helps to close the inherited funding gap. The funding allocations formula is very complex and it has to take into account all CCGs around the country. Weekend working pilot AS thanked the Membership Group for their positive approach to this pilot which is now underway. Patients are reviewed on Friday to see who is at risk of being admitted to hospital. There is a Prime Minister’s Challenge Fund which invites bids for innovative ways of working within primary care. On behalf of the practices, the CCG is submitting a bid on an innovative 7-day working Page 3 of 8 project. The pilot would fit in with this. The group raised concerns over the fact that not enough patients are being referred to the weekend working pilot. NBT’s MAU and ED departments claim they have not been aware that the service was set up and could be used to help discharges. NBT’s ED and MAU agreed to provide ambulatory care services but when GPs talk to NBT they are not aware that this service exists. ACTION: GPs to let the CCG know via [email protected] when they are told by NBT that they do not provide ambulatory care services. AS confirmed that COG is still in existence. Possible options are being considered as of April 2014. The CCG is working on this with Harmoni. Feedback from Practice Managers’ meeting The Area Team will no longer be sending out flu letters for over 65s. It will be up to practices to decide how they invite their patients to attend for a flu vaccine in order to meet the national requirements. 5. Sirona Care & Health Janet Rowse and Jenny Theed from Sirona Care & Health attended the Membership meeting to introduce the organisation, their model of care and to answer any questions the group may have. Sirona Care & Health is taking over the provision of community health services from NBT in April 2014. Sirona formed out of the provider arms of Bath and North East Somerset PCT and Bath and North East Somerset Council. It is a small organisation of 1700 staff. 450 staff will transfer from NBT. Sirona has a budget of £50 million. Sirona aims to provide tailor-made community health services and aims to grow into a market which they can add value to, e.g. domiciliary care. Their model of care is orchestrated around primary care and will be a bespoke model for South Gloucestershire. Patients are getting more complex and more have long-term conditions. Sirona’s aim is to help stabilise these patients in the community. Their model includes 4 types of patients: Low complex & stable: core work, majority of patients Low complex & unstable: temporary state only Page 4 of 8 GP practices High complex & stable: more complex needs from community nurses’ point of view High complex & unstable: urgent work needed to prevent hospital admissions Early intervention is essential to prevent escalation. Keep more complex patients stable. Sirona will create MDT working with primary care for high complexity patients in the form of a regular, weekly meeting to help patients stay stable in the community. Practices can expect the following from Sirona: Dedicated district nurses Clusters of practices to share resources (cluster aligned staff) Locality and county-wide staff Key to these will be relationship-building to ensure practices know their community staff. Sirona’s contract starts in April but there are ongoing discussions to assess the feasibility of taking over the contract earlier. Sirona is keen to work with practices to ensure their model of care is fit for area and is most effective. South Gloucestershire GP practices have now been divided into clusters by Sirona. Clustering was based on GIS modelling to minimise staff travel time. ACTION: Practices to contact Jenny Theed ([email protected]) if they see any problem with their cluster allocation. Caseload waiting model is in use in BaNES and will be applied in South Gloucestershire too. Caseload allocation is weighted on current weekly caseload. Resource is limited but could be varied across the patch to ensure demand is met. Resource allocation tool is shared with practices. It is re-run every 6 month to ensure it is up-to-date and resources are in the right place. Allocation is based on the demographic of practice population. Sirona wants to ensure transparency between the clusters to facilitate the redistribution of resources in time of need. A clinical manager and director for each cluster will be identified. The use of the risk stratification tool is expected to be rolled out. There will be the equivalent of 4 whole time health visitors for the elderly working across South Gloucestershire. They will be supported by band 3 support staff targeting 80-85 year olds to help with falls, Page 5 of 8 GP practices long-term conditions and dementia. Sirona aims to facilitate discharge and help with avoidance of hospital admissions by identifying at risk patients and allocating a therapist to them. ACTIONS: Jenny Theed will send practices the service specification for practices to see what Sirona will be contracted to do. Jenny Theed to meet with practices towards the end of February to discuss individual needs. JH thanked Janet Rowse and Jenny Theed for attending the meeting. 6. Yate MIU Pauline Chinnick and Sue Parris attended for this item. Yate MIU opened in May 2010. Attendance has been going up steadily. All patients seen at the MIU are within the agreed criteria and patients not meeting the set criteria are redirected to other services, e.g. pharmacy, own GP, out of hours GP, A&E and self-help. It is worth noting that very few patients are sent to Frenchay A&E for X-ray out of hours. The majority of the patients go back to Yate MIU radiology services “in hours”. Yate MIU is open at 8.30am-7.30pm on Monday-Friday and at 10am2pm on weekends and Bank Holidays. It is acknowledged that the opening of the MIU has not resulted in a reduction in A&E attendances by patients of Yate GP practices. The reception triage decides who to see and who to send to alternative places. There is a leaflet they give to patients signposting them to other services. This also includes the complaints process. Practices raised the importance of knowing if any of their patients visiting the MIU is turned away and with what type of issue they presented. Yate MIU has access to urgent care slots within GP practices, however, uptake of these appointments has been fairly low. The closure of Frenchay will also have an effect on Yate MIU. Given that children will be only seen at the Children’s Hospital as of May, more children are expected to go to Yate MIU. Page 6 of 8 JT JT 7. Any other business 7.1 GP Local Enhanced Services For the past year, NHS England has provided the contracting mechanism for delivery of CCG commissioned local enhanced services for primary care. As of April 2014, this will become the responsibility of the CCG. MG informed the group that there are four programmes to be reviewed by the CCG and determine a way forward by 1st April 2014, these are as follows: Anti-coagulation (adaptation of a national NES) Care Homes Near Patient Testing GP Basket The CCG will also have to consider the following areas: Learning Disabilities Urgent Care/Extended hours Suturing Mark Hayman (CSU) is presenting a paper on this at the January Board meeting to agree a way forward and a contracting process. Having obtained procurement advice, the CCG could choose to continue with the current LES’s and review them in the next 12 months. Public Health LES’s are being reviewed too. Quarter 1 and Quarter 2 invoices have now been paid but the process had been slowed down by Local Authority rules and regulations. MG reassured the group that the same process is happening in other CCGs. The CCG will keep practices up-to-date and will make it clear whether payment will be received from the CCG or NHS England. The importance of primary care building good relationship with Public Health and Local Authority was emphasised. Some practices asked what happens to the money which had been allocated to practices in the 2012/13 and 2013/14 LES’s. ACTION: SK to look into this. 7.2 Advice and Guidance Practices are encouraged to use Choose and Book for Advice and Guidance. Currently vascular and CATS are available on Advice and Page 7 of 8 SK Guidance. 7.3 Tests at NBT Practices raised the issue that the results of tests done at NBT are not routinely sent back to the practices. Practices therefore have to send a “GP to chase” letter to obtain these results. ACTION: Practices to send any specific cases to [email protected] to inform the CCG. 7.4 CCG Intranet The CCG is redeveloping its website and is looking at enhancing its Intranet so that it is accessible to all South Gloucestershire GP practices. There is planned to be an option for practices to “attach” their own practice Intranet onto the site. There will be a presentation at the PLT in February on this to share the plan with practices. 7.5 Instant feedback to practices The group spent some time to agree a few action points which members can feed back to practice colleagues. Points for “instant feedback” will be agreed at the end of every meeting and emailed to group members. 8. Date of next meeting 12th March 2014, 1.30-3.30pm, Bristol and Bath Science Park. [Please remember to sign in at the front desk] Page 8 of 8 GPs