FINAL - Joint LCG Board Meeting Minutes 4th July 2014

Borderline & Peterborough LCGs Joint Board Meeting
Friday 4th July 2014, 2:00 pm – 4.00 pm
Sorrento Room, The Fleet, Fleet Way, High Street, Fletton, Peterborough, PE2 8DL
MINUTES
Attendees:
Borderline LCG Board
Belinda Fraser (BF)
Nurse Representative
Dr Cosmas Nnochiri (CN)
Cancer Lead, Borderline LCG
Dr Gary Howsam
Vice Chair, Borderline LCG
Dr Mark Attah
Quality Lead, Borderline LCG
Dr Oliver Stovin (OS)
Referral Lead, Borderline LCG
Michael Bacon
Patient Participation Group Lead
Rebecca Powell (RB)
Practice Manager Representative, Borderline LCG
Peterborough LCG Board
Brian Parsons (BP)
Patient Representative
Dr Michael Caskey
Chair of Peterborough LCG
Dr Rob Bailey
GP Lead Peterborough
Sarah Kennedy (SK)
Practice Manager Representative
Borderline and Peterborough LCG
Alan Sadler (AS)
Business Manager, Borderline & Peterborough LCGs
Cath Mitchell (CM)
Local Chief Officer, Borderline & Peterborough LCGs
Christina Shaw
Assistant Director of Communications, CCG
Louise Jinks (LJ)
Finance Manager, Borderline and Peterborough LCGs
Margaret Osibowale (MO)
Finance System Lead, Borderline & Peterborough LCGs
Simon Pitts (SP)
Programme Manager, Borderline & Peterborough LCGs
In Attendance:
Elaine Overend (EO)
Peterborough Administration Support Officer
Teresa Johnson (TJ)
Peterborough Administration Support Officer
Apologies for Borderline LCG Board:
Rev David Parkes
Deputy Patient Rep
Dr Richard Withers
Chair, Borderline LCG
Mary Bryce (MB)
Healthwatch Representative, Borderline LCG
Apologies for Peterborough LCG Board:
GP Clinical Lead
Dr H Mistry
Healthwatch
Gill Metcalf
GP Clinical Lead
Dr F Bailey
Barbara Cork
Dr P vd Bent
Dr M Laliwala
Apologies Borderline & Peterborough
ACTION
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1.
Agenda Item 1 – Joint LCGs Board Meeting (Borderline & Peterborough)
1.1
Minutes of previous meeting held 6th June
Noted that on Page 3 – wording to be changed to make sense. (6th paragraph)
O Stovin commented that 4 different LES agreements had been inherited with
gross inequality. B&P LCGs are not assured that other LCGs are appropriately
scrutinised on their performance. With regard to the QIPP target we were initially
set a percentage of 4.4% which was roughly in relation to the Hunts Health
system who have the highest QIPP target. There seems to have been no attempt
year on year to encourage LCGs to stop overspending or to set them more
challenging targets.
1.1.2
Action Log from 6th June
Action number 10: District Nursing: (re the amber box) this action is linked to
#19. C Mitchell recommended that BLCG need to nominate a representative to
support Dr van den Bent as a deputy to attend meetings. Action: BLCG to seek AS/Chair
representative.
Action 002: Evolutio: Noted the difficulties and delays that have been discussed
and recorded with the Ophthalmology project.
Action 008: MIIU: CM has received information from S Oakman
Proposals are being discussed with MIIU to alter shift patterns to give later cover
by staff and GPs in the MIIU. Some changes have been implemented.
C
Mitchell was asked to clarify how this will impact with GPs who may be working in
the OOH.
The Board asked if the MIIU service had reduced its GP coverage at weekends.
Anecdotal reports of reduced GP shifts at weekends. C Mitchell to check contract
CM
details with C Humphris of CCS. (Action 015/14)
1.2
111/OOHs Procurement
April 2015 for procurement. This has been discussed at CMET re timescales.
Dr Caskey has agreed to be clinical link for B&P LCGs.
Harper Brown, Director of Commissioning has asked for delay for the
procurement for the 111 and OOH. C Mitchell raised concern on how delay
impacts CCS. C Mitchell advised work with Harper Brown is scheduled on 111
and OOH and will try to work up earlier procurement for our local health economy.
Urgent resolution needed to reduce numbers attending at the ED.
advised programme of work is being discussed at the UCB.
C Mitchell
Dr Howsam asked if plans are for a CCG wide solution or a local solution.
Potentially CCG wide focus, but a local solution is needed urgently.
C Mitchell is working with Peterborough City Council to outline the local health
economy plans.
K Cliff confirmed that under terms of the contract there will be opportunity to work
with relocation of services. Then longer term procurement for MIIU and OOH can
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commence. Dr Caskey asked for the Boards views on future of services.
Dr Stovin suggested check the Kings Fund models on services for cities our size.
Agreed the need to keep OOH services as a good quality local model.
C Mitchell advised that solutions are being explored and constraints are being
mapped.
Dr Caskey reminded that the population of Peterborough expressed preference
for services to remain in the City Centre.
Audit of patients attending MIIU and A&E services will take place week
commencing 7th July, to find out reasons why people attend.
The Board were pleased to hear that positive discussions had taken place at the
earlier B&P Transformation Board with PSHFT about planning and changing
pathways.
(2.25pm R Powell arrived)
1.3
Feedback from QIPP Development session (23 May)
Linked to previous 111/OOHs discussion.
Dr Stovin advised data cleansing has been completed and numbers are validated.
Phlebotomy activity is not easy to identify.
Phlebotomy LES is being discussed with CMET.
CMET have acknowledged that LCGs can procure for phlebotomy services.
Follow up appointments would help to close the gap. E.g. Include PSA testing /
follow up. K Cliff advised report has been completed by external agency “N A
Wilson” which outlines opportunities for CCG to consider.
Board agreed need to close the gap on the issues for phlebotomy. I.e. who takes
the blood and who carries out follow ups. It should be clear who is paid for what.
We should not pay PCH for blood testing.
Dr Stovin confirmed that first to follow-up ratios are reviewed on Dr Foster and the
BI team validate the data. Dr Stovin is aware of coding issues between LCGs
and PCH.
Board discussed and made suggestion of potentially reducing costs and closing
financial gap by cancelling 1 x follow up per patient and option to use this money
to procure phlebotomy.
Noting that Primary Care are not paid to carry out phlebotomy services the Board
would like to see options scoped in more detail. Request for LCG to action.
A Sadler added this linked to a recent project suggested by Paston Health Centre.
Board agreed that further urgent consultation and action was needed to resolve.
1.3.1
Developing Primary Care (CMET Paper)
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C Mitchell highlighted the detail on the paper which is below.
The purpose of this paper is to stimulate a discussion on how the CCG might respond
to the recommendation in NHS England’s planning guidance that “around” £5 per
head should be made available to practices to improve care for older people. The
paper concludes with a recommended way forward
“CCGs will be expected to support practices in transforming the care of patients aged 75
or older and reducing avoidable admissions by providing funding for practice plans to do
so. They will be expected to provide additional funding to commission additional services
which practices, individually or collectively, have identified will further support the
accountable GP in improving quality of care for older people. This funding should be at
around £5 per head of population for each practice, which broadly equates to £50 for
patients aged 75 and over. “
Recommendation: The Strategic CMET were asked to:• Comment on this paper
• Discuss the approach to mitigating risk as set out in 3.5
• Discuss the size of the financial envelope that should be set aside to fund this
work
• Discuss the concept of linking payment to emergency admissions
• Agree to develop a local offer as outlined in section 4
CONCLUSION: Given the need to (a) encourage primary care to innovate and
build capacity in order to care for more people closer to home and (b) re-engage
with member practices and encourage them to work together to innovate, it is
recommended that the CCG develops and then offers a local scheme to practices.
However, the working assumption should be that proposals will not come from
individual practices, but rather from several practices working together (possibly in
systems or LCGs).
This scheme should:• Be focused on caring for older people (in line with the CCGs priority as well as
national guidance)
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Be focused on reducing emergency admissions, as this is likely to improve
care, reduce system cost and is clearly measurable
•
Have a split payment model of 50% on sign off of an acceptable plan and 50%
on achievement of agreed outcomes
•
Be offered at a practice level, but on the understanding that practices will work
together in their LCGs to develop proposals
•
Measure outcomes at an LCG – not practice - level
Subject to the views of CMET, LCGs and clinical leads on this paper, it is
proposed that a draft scheme is developed in partnership with LCGs and in
consultation with the LMC, with a view to making an offer to practices by
September 2014.
Discussion followed with views and comments from the Joint Boards. C Mitchell
advised that CMET view is for LCGs to determine the outcome.
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Need to be advised on how much funding is available for each LCG for
commissioning and for primary care. Maximum amount is £5 (per patient aged
65+) but it is unlikely the full amount will be available.
It was suggested GP practices work together to lead on transformational change
as outlined at the LMC recently.
In the absence of Dr Withers, CM feedback his view as previously discussed. The
funding needs to be used to deliver improved outcomes. CM is tasked with
informing CMET of individual or joint LCG views.
Boards asked for clarification on the criteria for using the funding. As the money
has to be used for older people.
Board’s views included:
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Use primary care time to stream and manage the over 65s in the ED.
Ask practices to feedback their preference on individual or joint funding.
Outcomes and measureables will be easier to manage if GP practices work
jointly cluster to deliver services.
Depends how much extra work is required from practices.
GP practices would like to go for full £5 per head.
Keep funding for individual practices.
Use for transformational joint funding.
C Mitchell will feedback views to CMET.
1.4
ENT Update
Procurement with South Lincs CCG is in progress. Time scale has been delayed
by 4 weeks. Service will be mobilised by end of January 2015. Unable to confirm
number of interested bidders as this stage has not been reached yet.
1.4.1
MSK Improvement Options
Needs board decision
CCG wide project being led by Phil McSweeney.
C Mitchell and Dr Stanton-King attended presentation by Pennine Ltd showing
integrated model with capitated budgets.
Board asked if there were any concerns with CCS, the current provider. None
specified.
C Mitchell shared views from other LCGs. Hunts not entering 2nd phase of
procurement. CAMHEALTH and CATCH will opt for model with Addenbrookes.
B&P procurement will be beneficial. Board’s decisions needed. C Mitchell to CM
progress on email to gain responses. (Action 016/14)
Views expressed:
• O Stovin: need changes as MSK service is expensive. Capitated budgeting
is the way to go. Integrated pathway would be of benefit.
• G Howsam: procurement is a good idea.
• M Caskey: agreed procurement best option.
• R Bailey: MSK services have improved. What is perspective from patients?
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1.5
Agree changes needed for physio services and improved self help resources
are required.
Feedback and reflections from OPACS Bidder Event held 09/06/14
Thanks expressed to both Boards for attending the evening event on 9 June.
Next update will be after September.
Joint Board development session 21st November on mobilisation phase of the
AS
contract will be beneficial. (017/14)
Dr Caskey asked how aware are the B&P GP membership of the plans and
timeframes for this work? Boards agreed to send key message outlining that
potential providers may be contacting GPs. Ask if GP Practices want to be more
involved and have more collaborative working to ensure benefits for all. Action
CM
CM Key message.
Standing Items
1.6
Business Manager Update:
1.6.1 Risk Register:
A Sadler advised there is very little change to the risk register.
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•
Highlight that to the Boards QPS4 highlight this is being tracked and should
continue.
Board asked that risk be noted against number of operations cancelled by
PSHFT. It is noted that this is monitored via the Quality and patient Safety
committee and regulated via the Acute Contract.
Dr Stovin asked what are the quality premium plans for the future. C Mitchell
will source information from CMET. She thinks there was a recent CMET
paper regarding future of QP outlining local and national targets. (action CM
018/14)
1.6.2
Accountability Agreement
C Mitchell and A Sadler advised that Dr Withers has indicated a response will be
sent on behalf of LCG to the Governing Body.
1.6.3
GP recruitment steering group (action log # 25 07/03/14)
For review mid-September.
Suggested need to survey Peterborough practices.
GH agreed that BLCG want to be involved. May want to extend to wider B&P
members. Noted LMC are aware.
Noted there is currently a 15% vacancy rate of GPs in the east of England
Dr Attah is aware of only 3 newly qualified GPs for Peterborough area.
1.6.4
B&P GP Clinical Leads
GP Clinical leads and contracts
Request for Board members to review the list of clinical leads and notify Business
Manager of changes, amendments and gaps.
Action: Include on Joint development Board session for July 18th.
C Mitchell advised that Dr Bishop (Joint Clinical Lead for Paediatrics) has noted
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his intention to retire. B&P Boards agreed need to advertise for support to this AS
role before he retires. Action 019/14
(3.30pm Michael Bacon left the meeting)
1.7
1.7.1
Finance
2013/14 End of year Financial accounts
The Boards are made aware that end of year 2013/14 accounts CCG is £4.8m in
deficit which is better position than forecasted.
CCG wide end of year accounts under/over spend were shared.
Overall B&P Boards agreed the financial position was positive.
1.7.2
(a)
Financial Audit Report
The CCG annual report is inclusive of the annual financial accounts. This paper
covers any highlighted issues noted with respect to the accounts.
Directions
• The accounts have been compiled and prepared in accordance with the CCG
Reporting Guidance issued by NHS England 27/03/14.
• Section 17 of Schedule 1A of the NHS ACT 2006 requires clinical
commissioning groups to prepare annual accounts.
ASSUMPTIONS
• The accounts were prepared on a going concern basis
• All legacy balances have been accounted for by NHS England
• 13/14 DH Allocation resources for running costs and programme budget is
£883.2m
• All known income and expenditure has been accounted for including
reasonable estimates total £888.08m
• The recorded deficit is therefore £4.88m which represents no change from the
figures reported in the draft accounts.
SUMMARY POSITION POST EXTERNAL AUDIT
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The accounts have been audited and an unqualified audit opinion will be
issued. An ISA 260 report accompanies the accounts. (ISA 260 requires the
auditors to communicate to the CCG and audit committee; relevant
matters relating to the audit of the financial statements sufficiently
promptly to enable them to take appropriate action)
With respect to the Use of Resources and the Regularity opinions; there will
be a qualified statement in summary due to the CCG’s failing to meet its
statutory break even financial duty.
The Remuneration Report is qualified in respect of missing information from
the NHS Pensions Agency for GP members of the governing body. Clearer
guidance has been received from the Pension’s Agency for 14/15 and this will
be acted upon and implemented for the current financial year.
Uncorrected Misstatements were not adjusted because:
o The combined and individual effects were immaterial to the financial
statements as a whole
o Most of the misstatements were in relation to Maternity pathway; the
differences in the treatment approach by the CCG and trusts. It has
been agreed that consistency will be secured with reference to the
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•
accounting of maternity pathway and agreement of balances.
Finally, management responses have been made to the audit findings and
deficiencies regarding internal control. These have been agreed and form part
of the 14/15 CCG Objectives.
NEXT STEPS
• The accounts have been presented to CMET and the Governing Body for
adoption.
• Following their adoption and accompanied by signed certificates; External
Audit will provide us with a true and fair audit opinion.
• The accounts have been submitted at noon on Friday the 6th of June.
RECOMMENDATION:
The Board is asked to note the Annual Accounts and the PWC report to the Audit
Committee for 13/14.
1.7.2
(b)
PWC report
M Osibowale tabled the PWC document of the C&PCCG report to the audit
committee for the year ended 31/3/14.
Brief discussion followed. The Board acknowledged the content. Any further
comments or queries should be directed to the Finance Team at the CCG office.
Dr Howsam on behalf of B&P Joint Board thanked Margaret Osibowale for her
contributions to the Board and her work in the CCG. The Board wished M
Osibowale well as she moves on to take up a secondment for a year with NHS
Leicester.
1.8
Acute Contract Update
K Cliff updated the Joint LCG Board with regard to the Acute Contract.
The overview of the report was noted based on month 1 data. Forecast out turn is
£200k worse than anticipated.
Positive message needs to be sent to the GP membership to acknowledge we are
contracted for less activity, so we are doing less with less budgeting and are still
overspent.
Nationally Area Teams are placing strict regulations for RTT waiting lists to be met
and have allocated additional funding for hospitals to use against elective care
back log. CCG has received £610k which is to be used to manage down RTT
lists for July and August.
Noted that contract penalties from CCG to PSHFT for 18 week targets will be
suspended.
A&E is performing 14% above contract levels.
Regular auditing by PSHFT and CCG takes place and to date auditing has been
98-99% compliant.
1.9
Prescribing Update
This will be discussed at individual Boards after this meeting.
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1.9.2
CCG wide prescribing report (prescribing dashboard) has been shared with the
Boards for information.
For Information
1.10 Quality Report – June 2014 received for information.
1.11 Personality Disorder Community Service Consultation
Boards are happy to be guided by Dr Panday. LCG Office (CM to ensure Dr CM
Panday advised)
There being no further business, the Joint LCG meeting closed at 15.55.pm.
Contact Details:
Borderline LCG
Name: Tina Almond
Email: [email protected]
Telephone: 01733 704452
Peterborough LCG
Name: Teresa Johnson
Email: [email protected]
Telephone: 01733 776378
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Boards\2014~15\Minutes\4 - July 2014\DRAFT - Joint LCG Board Meeting Minutes 4th July 2014.docx
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