Attachment A NHS RICHMOND CLINICAL COMMISSIONG GROUP Quality, Finance and Performance Committee Tuesday 6 May 2014 9:30 – 11:30 Room 7, York House Minutes 4.6 2.7 6.8 3.9 1.10 5.11 Bob Armitage (BA) Chair A A A A A A Liam Bayly (LB) A A SA A A Mary Palmer (MP) A SA A A Charles Humphry (CH) A A SA Sheila Jennings (SJ) A A Angela Jones (AJP) A Graham Lewis (GL) Branco Momic (BM) 2.12 7.1.14 4.2 4.3 2.4 A A A A A A SA A A A A A A A SA A Di A SA A A A A A A A A A A A A A SA SA A A A A SA A SA A A A DNA SA SA A A A A A A A A A A SA A A A SA A A SA A A SA A SA A NR NR A NR NR NR A NR NR DN NR NR Tony Moss (TM) 6.5 A Emma Richmond (ER) A A A A A A A A A A A SA Julie Sobrattee (JS) A A A SA A A A AL A A A A A AL A SA A Jacqui Harvey (JH) In Attendance: Minute Taker: Andrew Murphy Shaistah Qureshi Dagmar Zeuner Commissioning Support Unit Medicines Management Public Health Lynn Allen PA to Chief Officer Action 1. Welcome, apologies for absence and confirmation of quoracy Apologies were received from – Sheila Jennings and Emma Richmond 2. Minutes of meeting held on 1 April 2014 and matters arising The minutes of the meeting held on 1 April 2014 were agreed as an accurate record of the meeting. Matters arising: AM would circulate a graph showing comparative data with neighbouring boroughs on maternity. AM reported that Richmond data had stayed static but all other local borough figures had reduced. JS advised that she would be attending future Maternity Network 1 AM Attachment A meetings. Concern had been expressed again that all data shows maternity growth flat-line however, previously planned modelling had been for an upsurge in maternity figures. The West Middlesex action plan had still not been received although a report on the actions to enable them to meet CQC essential standards had been noted. DW had previously attended the sector side Continuing Healthcare meetings, JH would establish who the contact had been to enquire about meetings and lead executive attendance. Graham Rustom (GR) continued to be the commissioning manager, although continuing healthcare had been delegated to CSU as a function. GR received information from the Continuing Health teams and would report to quarterly QFP meetings. MP advised Polly Sinclair had taken the lead looking at personal healthcare budgets and the implications. A letter had been sent out in February concerning the new MSK referral guidelines. The impact had been felt at Kingston Hospital and had been discussed at the CQR. Guidelines for GPs has advised that access to ultrasound would be restricted and would have to follow MSK referral route rather than direct access. GB GPs would be asked to follow up with those not following the MSK pathway. GL AM/MP ER to speak to Patrick Gibson to ask if GPs were involved in drafting the changes to the MSK guidelines, to be brought back to the next meeting. ER Declaration of Interest in matters covered on the agenda There were no new interests declared. 4. MP AM was asked to prepare a briefing paper (liaising with MP and Karina Knights), to be presented to the CET giving a snap shot on the whole of Richmond referrals. Meetings had been taking place around running cost budgets. KE had met with LB and would bring a paper to next meeting. 3. JH Integrated Quality, Finance and Performance Report Primary Care – Submission of the QP indicator had been submitted to NHSE. The Chief Officer and Chief Finance Officer had agreed to contract waivers for all Locally Commissioned Services (LCS) for this year. Funding for the Local Improvement Scheme (LIS) for Heathcare Assistants (HCA), had not been not approved by NHS E. Governance arrangements for the LCS groups were being revised. MP had taken over the Executive Lead from ER and would focus more on activity. Community Education Provider Networks (CEPN), project was being progressed. Marilyn Plant would be taking the clinical lead, JS the Executive lead with Baljit Johal supporting Marilyn in her role. Annalisa Jarvis had been working with practices on their outline business case to be presented to NHS E. 2 LB/KE Attachment A Medicines Management – The new IFR policy had been signed off. No further update from NHS E had been received on the arrangements for controlled drugs. The Patient Group Directions (PGDs) for childhood vaccines and travel vaccines were now available from NHSE and had been posted on the intranet. Recruitment was now complete within the team, enabling the team to focus on the launch of the 2014/15 incentive scheme. The EPS/SCR team at CSU were no longer available to give support. The Primary Care budget was forecasting under spend with a budget setting meeting having taken place in February. Only one practice had refused help to discuss their prescribing plan with their over spend. An update on the over spend for the specified practice was requested for next time. The committee also asked for information on those practices who were significantly under spent. Given the high profile of asthma prescribing currently in news the pharmacy team had planned to look at and update guidelines, alongside QOF data for asthma to look to any trends in asthma prescribing. A summary had been provided of incentive schemes for Q3 2013/14. 2014/15 incentive schemes had been launched and the summary had shown where projects were red and ensure that the correct use of projects. A summary had been circulated along with the full scheme totalling 40 pages, a practice visit had also been arranged. A formal process for sign-off of the incentive scheme to be picked up as part of the on-going governance work. HRCH - There were no major issues to report with no overall trends in quality incidents. Two slip, trip and falls were being investigated. The tissue viability nurse just resigned and HRCH were in the process of recruiting. A high number of pressure ulcer incidents were still being reported. There had been an increase in drug and medication incidents reported showing better processes and a greater understanding of reporting. A gradual increase in reporting figures had been expected. Podiatry and MSK Physiotherapy had under performed due to AQP activity. Paediatric physiotherapy services had experience difficulty due to staffing issues. Quality Service Indicators – the safety thermometer survey was still not hitting target. Friends and Family had not met its workforce target reaching 44 against a target of 60. Learning Disability – The self assessment framework had been completed and the overall RAG rating had improved. The overall budget for placements was slightly overspent but did not highlight much pressure. A potential cost pressure was highlighted around two patient placements which were currently funded by NHS E and would be, in the future funded by Richmond CCG, with no mechanism for moving funding from NHSE to Richmond. The LA and CCG had jointly bid £110,000 for education and joint working looking at Deprivation of Liberties (DoLs). Acute Trust – 18 weeks performance had dipped across board to 91.3%. Diagnostic were improving 98.6%. Two week standard 3 ER JH/ER Attachment A cancer waits was just below target with majority due to patient choice. The CSU now had in place a dedicated (two day a week)Cancer Commissioning team in place. Two more cases of MRSA had been reported at West Middlesex and one of C-Diff although Richmond CCG were still within trajectory. A fuller report requested with year end data for next month showing reasons for delay other than patient choice. AM would link with JS to produce the quarterly cancer summary. AM confirmed that financial a penalty would be issued to trusts who did not meet their pargets. Mental Health - Richmond Wellbeing service were still performing well, East London FT were on target to deliver IAPT targets. SWL & St. Georges Mental Health Trust had an unannounced visit by the CQC to Tolworth Hospital who was found that action was needed on the “Consent to care and treatment” and shown wanting. All Trusts have concerns over the cost improvement programme and reduction in staff and are currently working with the Trust to agree cost improvements. SWL & St Georges performance rating was green masking some concerns amongst commissioners. CCG will work with practices on Operating Plan Mental Health targets to increase figures on dementia diagnostics. Public Health Public heath had concentrated on three areas in their report, commissioned services, commissioning support, and health protection oversight. Commissioned services – the challenge people is to engage with people who are not interested in public health and to help provide the right services for people. An on-going report will be produced to ensure that commissioning support back to the NHS is right. Oversight is difficult as public health was not a commissioner or provider, a dashboard summarising relevant health protection oversight indications was being developed to ensure that there is no duplication. The committee were asked to advise how the CCG can support improvement in the reporting of LiveWell Richmond and childhood immunisation. The committee agreed that this should be channelled through the new established clinical networks. 5 Update on accounts Draft accounts had been submitted on time and achieved its statutory financial targets for 2013/14. The closing financial position for the CCG had given a surplus of £6.783m, a difference of £70k surplus. LB highlighted the potential risk of continuing healthcare provision for claims during April 2012and March 2013. The accounts would be presented to the Governing Body meeting on the 3 June 2014. 6 14/15 SLA CQUIN for update 4 AM/JS Attachment A AM provided an update on the latest position with contracts: Imperial - UNAGREED 2nd proposal received 07/05, following agreement of full block with NWL CCGs. QIPP agreed at 100% Queen Mary’s Roehampton – UNAGREED 2nd proposal received 09/05.QIPP: £360k stroke scheme reassigned from WMUH to QMR. £117k PFI reduction not accepted due to historic PFI support (£117k). St George's - UNAGREED Final contract values TBA. Activity values agreed. Commissioner split of non-elective threshold adjustment value has not yet been agreed – negotiations are ongoing. Chelsea & Westminster - UNAGREED No proposal received to date. CSU estimate = M6x2 + seasonality + tariff deflator + growth. C&W have stated SWL offers are pending agreement of contract terms with NWL CCGs. Ashford & St Peter's - UNAGREED Awaiting info from Trust re phlebotomy charges included in their 14/15 offer as £16k was paid for outside the SLA in 13/14. Also querying why the Trust did not apply any Tariff deflator and their basis for the starting point for 13/14 i.e. it does not look like M6 Freeze x 2. Bart's & the London - UNAGREED No proposal received. Waiting for Host / Trust to provide further information. 7 HRCH CQUINS for information HRCH CQUINS had been distributed to members to members prior to the meeting for information. Integration of community services CQUIN was also finished with imminent sign-off. CQUINS would come to QFP for sign off after being presented to the CET to give assurance to the board. A timely schedule to be implemented next year within the governance arrangements. 8 CSU Integrated Report Executive Summary All ratings were status green or yellow. Demand on A & E was down compared to this time last year. Kingston diagnostic wait performance continue to affect Richmond CCGs overall performance indicator, although an action plan was in place and performance was steadily improving. A final 2013/14 contract settlement for Queen Mary’s Roehampton had been agreed with St. Georges. 9 Quality, Finance and Performance Committee Terms of Reference 5 Attachment A The Terms of Reference had been distributed for final agreement, and would be included in the governance schedule to review in six months. The secondary care doctor had recently resigned and would remain a member of the committee. The Chair of the CCG plus up to three other GPs would remain on the membership The Head of Medicines Management title would be amended to reflect recent CCG changes, to the title of Chief Pharmacist The Company Secretary would be removed from the membership. One Governing Body GP, one 1 Lay Member and one Executive Director would remain the quorate membership with a minimum of four members attending. The Committee would continue to meet on a monthly meeting, or at least 6 times a year. PWC would be asked to look at the operation of the Sub Group and Health Intelligence Group. 9 Any other business Due to the re-schedule of the June Governing Body meeting the committee would not meet in the June, although the papers would be compiled and circulated. 10 Date of Next Meeting – Tuesday 1 July 2014, Room 7, York House 6 JH