minutes - north somerset ccg · pdf fileaction 33 – embedded in map of medicines (mom)...

Item 19a – Governing Body, 4 July 2017

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Clinical Commissioning Leadership Group Held on

23rd March 2017 Castlewood, G.09/G.10

Minutes Present: Mary Backhouse, Chair (MB) (Chief Clinical Officer, NS CCG)

Jacqui Chidgey-Clark (JCC) (Director of Nursing & Quality, NS CCG) Jeanette George (JG) (Chief Operating Officer, NS CCG) Julie Kell (JK) (Associate Director of Transformation) Kevin Haggerty (KH) (Clinical Lead - Urgent Care) Mike Jenkins (MJ) (Clinical Lead – Mental Health) Mike Vaughton (MV) (Chief Finance Officer, NS CCG) Miriam Ainsworth (MA) (Clinical Lead) Nina Tilton (NT) (Primary Care Development Manager) Rachael Kenyon (RK) (Clinical Lead – Planned Care) Sheila Smith (SS) (Director of People & Communities) Tony Ryan (TR) (Clinical Lead)

Apologies: Debbie Campbell (DC) (Head of Medicines Management, NS CCG)

Georgie Bigg (GB) (Chair of Healthwatch) Gill Ryan (GR) (Deliver Director) Jenny Norman (JN) (Head of Planning & Business Support) Jeremy Maynard (JM) (Clinical Lead – Primary Care Quality) Natalie Field (NF) (Interim Director of Public Health)

In Attendance: Angela Stinchcombe (AS) (Interim Deputy Head of Medicines Management, NS CCG) – Item 9 only

Robyn Smith, Minute Taker (RS) (PA to Senior Officers, NS CCG) Dr Ruth Greer (RG)

Item No Action

Item 1 Welcome MB welcomed all to the meeting.

Item 2 Apologies Apologies noted as above.

Item 3 Declarations of Interest MB and JG reviewed the agenda prior to the meeting and identified 2 items where GPs are potentially conflicted. Item 9 – GPs on the group or their practices may benefit financially from this prescribing scheme and therefore have a direct conflict of interest. MB will hand over the Chair to JG. GPs can comment but will not take part in decision making. Item 10 – Poses a potential conflict of interest for GPs in Weston and Worle. At this stage it is



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unclear whether GPs will benefit from the programme. It was agreed that a potential conflict in the future should be noted.

Item 4 Good News Stories MB informed CCLG that University Hospitals Bristol Trust (UHB) has been rated as ‘outstanding’ by the Care Quality Commission (CQC). MB commented there has been progress on Section 136 work. Six CCGs have been working together with local police forces and acute providers to ensure there is a place of safety for people with mental health illness. MB congratulated the medicines management team who have had 6 posters accepted for a national prescribing congress; and Daniel Stephens (Medicines Optimisation Pharmacist) has been nominated for a Clinical Pharmacy Congress Award.

Item 5 Chairs Reflection MB confirmed Julia Ross is starting earlier than originally planned; her first working day will be Tuesday 2nd May. The advert for the Clinical Chair has gone out, so the process for appointing has started. MB also confirmed that Laura Nicholas will be starting as the permanent Director for the Sustainability and Transformation Plan (STP) next month.

Item 6 Minutes of meeting held on 24th November 2016 The minutes were approved as an accurate record of the meeting.

Item 7 Action Log Action 18 – Complete. Action closed. Action 26 – Moved on, out for consultation. Action closed. Action 29 – Complete. Action closed. Action 31 – Complete. Action closed. Action 32 - JCC confirmed the new AO will chair the Board when she starts. Action closed. Action 33 – Embedded in Map of Medicines (MoM) pathway. Action closed. Action 34 – DC to follow up. Action remains open. Action 35 – Complete. Action closed. Action 36 – MV to add risk to the register. Action remains open. Action 37 – Complete. Action closed. Action 38 – Complete. Action closed.



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Item 8 Integrated Performance Report Quality JCC presented the BNSSG Quality report for March 2017 (January 2017 data). JCC referred to page 15 which provides the BNSSG provider Care Quality Commission (CQC) ratings and advised that these will change over the coming months when official reports come out. JCC highlighted some key updates for the acute providers: University Hospitals Bristol (UHB):

Fundamentals of care – the Trust were commended on the continued good performance relating to the fundamentals of care, particularly in the Emergency Department (ED).

Workforce – the Trust has made improvements against workforce Key Performance Indicators (KPIs).

The CQC has published its report following the inspection. The Trust received an overall rating of ‘outstanding’. JCC advised the Trust did get ‘requires improvements’ ratings in some areas.

Paediatric cardiac report will be going to the next joint Bristol and South Gloucestershire Health Overall and Scrutiny Panel (HOSP) for discussion.

Fractured neck of femur (#NOF) performance remains below the 90% threshold. An update on the action plan arising from the British Orthopaedic Association Review has been received and the Trust has been asked to share the actions with the group assigned to look at #NOF across BNSSG.

Weston Area Health Trust (WAHT):

The contract meetings have been changed to the 3rd Thursday of the month; this will take effect from 1st April.

4 hour ED performance continues to worsen each month since May 2016. JCC advised every Trust has been given a trajectory to deliver 90% and currently WAHT will be at approximately 87% by the end of March.

Outpatient pending list – the Trust have be written to formally regarding this. JCC advised the current outpatient list is thought to be approximately around 3382, however the Trust do not know the numbers. At least 50% greater than last year and therefore has gone straight in to a remedial action plan. The Trust has been asked to confirm an absolute figure by the end of March.

62 day cancer standards has met trajectory.

The Trust’s dementia improvement action plan was accepted following the Contract Performance Notice (CPN) issued in December 2016. The plan will be monitored by the Quality Sub Group.

Pressure ulcers on SHINE documents on presentation of ED patients body map are completed. Will now know if patients come in with pressure ulcers.

Safeguarding children training at level 3 has been reported previously. The Trust do not have a list of staff who require level 3 training and it was reported at 79.1% against a compliance level of 90%.

Miriam Ainsworth and Julie Kell left the meeting. MV updated the CCLG on the discussions which took place at the last contract meeting with WAHT. RK expressed a concern that the 2 letters being sent to the Trust from the CCGs is not enough. MB responded to say that the letters are no means in isolation; they are part of



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discussions with regulators, Boards and with the WAHT Chief Executive. JCC updated the CCLG on the discussions which have taken place at the Clinical Oversight Group. KH commented that is it about understanding what the problem is in Weston Hospital, is it capacity or is it capability. MV commented that CCLG need to be comfortable and confident with what the CCG executive team are doing, and that the CCLG endorse the approach the CCG are taking to address the concerns. SS suggested it is important to record that NHS England (NHSE) and NHS Improvement (NHSI) have been clear with the CCG that it is a whole system issue, and a clear view that it cannot be resolved solely by North Somerset. MB confirmed that CCLG have heard the concerns and discussed the issues and recognises the steps the CCG executive team have taken regarding current positions, including the letters to the Trust. JG also highlighted the heightened concern from the CCLG for patient safety and quality of services. JCC advised CCLG that there is a concern around Serious Incident (SI) reporting, and this needs to be looked at and thought about further in terms of how the CCG deal with the concern. Miriam Ainsworth and Julie Kell re-joined the meeting. Performance MV presented the Performance report for month 10, noting that the key issues were covered through the Quality report discussion. Finance MV presented the Finance report for month 11, which will be the last report received by CCLG before the draft accounts. Letter received from Paul Baumann (Chief Finance Officer, NHSE) to confirm his expectation that the CCG will release the headroom to the ‘bottom line’. This means the outturn deficit in-year will improve by £2.7m to £11.7m. MV updated CCLG on the contract positions for the acute trusts, the figures are based on the January contract position. He highlighted major variances on acute spend with UHB and Weston. The overspend with UHB is expected to be around £1m and is driven by non-elective activity and medical devices expenditure. The reported underspend at Weston at the end of February is over £2m, and largely reflects under-performance against the elective activity plan. Prescribing costs continue below budget with a lower than expected activity in both the volume and cost of prescriptions. Have been forecasting underspend of approximately £300k in the full year however this will increase if current trends continue. The significant overspend in child placements is attributable to both an increase in the number of children requiring placements and a small number of very high cost placements. In terms of the financial plan, there is further iteration due be submitted next week. The ambition is to submit a financial plan that is compliant of the CCG control total. There is a lot



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of work to be done on ambitious savings programmes. The Clinical Commissioning Leadership Group:

Discussed the CCG’s latest performance delivery as at February 2017 for Quality, Finance and Performance standards.

Reviews mitigating actions for those areas of exception.

Reviewed the current risks to the financial position.

Item 9 Prescribing Participation Scheme 2017/18 JG chaired the meeting for this item. MV noted this scheme has been shared previously with Membership for comment. Prescribing is a critical part of CCG business, and is an area that has been set an ambitious savings target. Prescribing is an NHSE focus. Repeat prescribing management, as it becomes more successful, should free up the time of prescribing clerks and create capacity in primary care. AS presented the prescribing participation scheme for 2017/18. The Repeat Prescribing Hub forms the main focus, and this will help to get the pilot up and running. The Prescribing Participation Scheme will consist of 3 parts, and part 3 focuses on quality and safety, which includes looking at appropriate prescribing in urinary tract infections (UTIs) and ensuring achievement of all 3 national targets for type 2 diabetes. There has been a lot of work done around care homes and the Repeat Prescribing Hub will hopefully help as they will focus on repeat dispensing; and a lot of care home prescriptions fall in to this category. The funding for the Prescribing Participation Scheme is up to a maximum of £315k; and £150k of this will get the Repeat Prescribing Hub up and running. AS advised the target is a 2% in reduction in item growth, which is approximately £400k of savings. AS informed CCLG that there are 2 potential sites available to set up the Repeat Prescribing Hub, and those practices who have put themselves forward are already part of a small cluster of approximately 3 practices and the practices are in the building that will be used. Following a successful trial it is planned to create 4 cluster based hubs (Clevedon and Portishead, Rural, Weston and Worle). JCC referred to the paper which talks about the CCG investing in prescribing clerks and asked if this cost comes out of the £350k of funding. MV responded to say this will be a programme cost. MB referred to part 3 of the scheme and asked to be assured that the CCG are not double paying for type 2 diabetes. MB also asked, if things are being reviewed in care homes, could the checks include asking if there is a current Treatment Escalation Plan (TEP) in place. Action: AS to define the stretch target for type 2 diabetes over and above national requirements funded elsewhere. Also to add TEP forms in to the checks, AS to link in with Ruth Gazzane regarding this. TR asked who will set up the Repeat Prescribing Hubs as logistically it is a huge task. MV

AS



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responded to say the CCG will be as inclusive as possible, and will provide leadership for the set up. MB asked if communication to patients has been considered to provide assurance. AS responded to say patient letters have been prepared and are ready, along with posters. AS did comment that patients may need to agree to go through a Repeat Prescribing Hub, and AS advised that this is the only area which has not yet been looked at, but will be considered as part of the pilot. The Clinical Commissioning Leadership Group:

Discussed the proposal and approved the prescribing scheme for 2017/18 subject to the above comments being taken into consideration.

Item 10 Primary Care Local Enhanced Service JG chaired the meeting for this item. NT presented the local enhanced services recommissioning paper which asks the CCLG to approve an extension of 3 of the local enhanced services for a period of 12 months. Each of the 3 services propose extending for another year subject to a 3 month notice period due to other areas of work progressing and the possibility that these services will need to be altered over the coming year. In terms of the diabetes insulin initiation service, NT advised that a modest saving can be demonstrated by this work being done in primary care. The service benefits patients by receiving treatments in the community, reducing the need for patient referral to secondary care. NT commented that it is difficult to do any robust assessment of the minor injuries and nursing home local enhanced services. JK commented that diabetes fits in with the turnaround and asked what Bristol and South Gloucestershire CCG are doing. NT responded to say that their intention is to also extend in the short term, their current contract notice period is 6 months, which they will be reducing to 3 months, so that the CCGs can decommission those services as a whole system. Action: NT to clarify the terms are consistent with Bristol and South Gloucestershire CCG. JCC informed CCLG that the 3 services are being looked at either through the STP or the turnaround control centres. 2 out of the 3 services are progressing to the next stage, and it is likely that these will go back to BNSSG Shadow Joint Commissioning Board (SJCB) and Governing Body within the next month. Therefore JCC proposed that an extension of 3 months is more appropriate. NT asked what message she can give to practices. JK responded to say she has a communications plan which may be able to help NT with a consistent message to practices. Action: JK to share the communications plan she referred to with NT. MV highlighted that there is not enough evidence in the paper to warrant an extension or for the Chief Finance Officer to recommend the schemes. Therefore MV recommended a 3 month extension from the 1st April 2017 with a provision for ongoing assessment and review throughout that period. The CCLG approved this recommendation.

NT

JK



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Action: RS to add primary care local enhanced services to the CCLG agenda for April as a verbal update from NT and MV. The Clinical Commissioning Leadership Group:

Approved the issuing of new 3 month contracts for the Diabetes Insulin Initiation, Minor Injuries and Nursing Home Local Enhanced Services.

RS

Item 11

Discussion Document for Consideration – Collective Clinical Leadership MB informed the CCLG that Ginny Snaith has been supporting the 3 CCGs and has developed the paper. During the meeting MB received a proposed set of standard questions for Clinical Leaders when they review this paper and circulated the list to CCLG members during the meeting. JCC asked the group if they agreed with the definition of Clinical Leadership on page 1 of the document, and asked if her role is viewed as a manager’s role, a clinical role or both. The paper only talks about GPs and practice managers. MB suggested the focus is too narrow, and the North Somerset CCG recognises that the Lead Nurse and Medicines Management Pharmacists are clinicians and are recognised as a clinical voice. MA commented that if the paper is intended to be directed towards GPs then it needs to be narrower and be explicitly about GPs. SS commented that she has no particular views on the paper as a starting point, however suggested that it should be debated at a BNSSG mixed meeting and only then will the CCGs get to where there are commonalities. RK queried the locality arrangements in Bristol and how many Clinical Leaders there are. MB responded to say that Bristol has 3 separate localities which have regular meetings, however it is rare for Bristol to hold a meeting with all practices; Bristol have a very different structure and way of resourcing. MB highlighted that this is about how, on the ground level, ensure people are thinking about leadership, as well as training, and thinking about leadership development. Giving people opportunities to do specific pieces of work and get involved in short projects. JG noted feedback from the group and in considering what the future model might look like, it is also important to ensure there is a strong local voice in this, and JG suggested it does not feel like that is strong enough. The Clinical Commissioning Leadership Group:

Commented on the Collective Clinical Leadership in BNSSG discussion paper.

Item 12 Weston Area Health Trust – CQC/ED Update JCC provided a verbal update on Weston ED. There was a consideration that Weston ED needs to close overnight from the 3rd April 2017; however this is no longer going ahead. JCC informed CCLG that an interim model will be in place from June 2017. The intention is to close ED overnight and Rob Stafford (UHB Clinical Lead) will be taking on a role at Weston. Modelling of what the impact of closing ED overnight may mean does not take into account



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population perception. There is a meeting scheduled for this afternoon, led by Kate Hannam (Director of Operations, NBT), and have asked all acute providers to come back with what they think they will need if and when the closure of Weston ED happens. In terms of community services, we have asked what additional services they could offer. JCC commented that a concern was raised at the BNSSG Shadow Joint Commissioning Board (SJCB) that collectively the CCGs have not formally written to the Trust about the closure of ED overnight. Therefore a letter has been drafted and is expected to go out later today. KH asked what the Trust is doing in terms of a future model. MB advised that the ED Task Group have been given the responsibility.

Item 13 Corporate Risk Register JG presented the corporate risk register and highlighted one new risk in regards to the land at Millcross in Clevedon. JG referred to the previous conversation had about the possible closure of Weston ED overnight, and commented that this would affect how Weston respond to emergencies and major incidents. JG has had initial conversations with Mike Long, EPRR manager for WAHT, and discussed the impact it would have on Weston’s ability to respond to an emergency. This is not being progressed at the moment as Weston ED is remaining open overnight, however JG will liaise with NHSE if it becomes a risk, at which point it will be added to the risk register. The Clinical Commissioning Leadership Group:

Commented on and agreed the corporate risk register as at March 2017.

Item 14 Committee Self-Assessment The Clinical Commissioning Leadership Group reviewed the committee self-assessment and discussed each question as a group. Action: RS and JG to update the CCLG committee self-assessment with comments made today and note actions required.

RS/JG

Item 15 Committee Annual Report MB presented the committee annual report and welcomed any comments. The Clinical Commissioning Leadership Group:

Approved the draft CCLG committee annual report.

Item 16 Approval of Clinical Commissioning Leadership Group Terms of Reference (ToR) JG presented the updates to the CCLG ToR and advised the group that Emma Greenslade (Interim Corporate Manager) has done a review of all committee ToR in light of the constitutional changes which will come in to affect when Julia Ross is in post. JG highlighted the 2 key recommendations proposed, the first being, upon appointment the Clinical Chair will become the Chair of CCLG. Secondly, it is felt that the BNSSG Chief Officer



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(Julia Ross) should not necessarily be required to join the meeting and to put in place mechanisms so she has feedback but it is not essential that they are part of the group. JCC commented that she felt that the BNSSG Chief Officer should be a member of the group but not essential to quoracy that the meeting can happen without her if she is unable to attend. JCC referred to the membership and highlighted that there is no longer a Deputy Head of Quality and this title needs to change to Head of Medicines Management and Primary Care Lead. JCC also commented that the Interim Head of Quality and Patient Safety should be added as a member. Also noted the Delivery Director is normally a member. SS queried the practice manager representative. JG advised this post is still vacant and the CCG have not been able to appoint. JCC asked if it specifically needs to be a practice manger. JG responded to say that this is prescribed in the constitution. JG referred to the Vice Chair of the committee and has checked the constitution which states a Vice Chair should be selected by the committee, and does need to be a member who is a non GP. MB proposed that JG be elected as Vice Chair; which CCLG agreed. JG summarised the suggested changes to the ToR:

Add BNSSG Chief Officer to the membership.

CCLG quoracy not to be dependent on the BNSSG Chief Officer’s attendance.

Add Interim Head of Quality and Patient Safety to membership.

Change Deputy Director of Quality to Head of Medicines Management and Primary Care Lead.

Remove Head of Planning and Business Support as a member.

Add Delivery Director as a member. The Clinical Commissioning Leadership Group:

Received and approved the proposed changes to the ToR for the Clinical Commissioning Leadership Group subject to the changes discussed today.

Item 17 Primary Care Working Group Minutes: 26 January 2017 The CCLG received and noted the minutes.

Item 18 Medicines Management Advisory Group Minutes: 19 January 2017 The CCLG received and noted the minutes.

Item 19 NICE & Clinical Pathways Assurance Group (CPAG) Minutes: 9 March 2017 The CCLG received and noted the minutes.

Item 20 AOB SS informed CCLG that he Local Authority (LA) have been award additional money and the North Somerset share is £3.7m. The money comes with some requirements in regards to how it is spent.

Item 19b – Governing Body, 4 July 2017


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27th April 2017 Room 2, Clevedon Town Council, 44 Old Street, Clevedon, BS21 6BU

Minutes Present: Mary Backhouse, Chair (MB) (Chief Clinical Officer, NS CCG)

Debbie Campbell (DC) (Head of Medicines Management, NS CCG) Jacqui Chidgey-Clark (JCC) (Director of Nursing & Quality, NS CCG) Jeanette George (JG) (Chief Operating Officer, NS CCG) Kevin Haggerty (KH) (Clinical Lead - Urgent Care) Mike Vaughton (MV) (Chief Finance Officer, NS CCG) Miriam Ainsworth (MA) (Clinical Lead – Community services) Rachael Kenyon (RK) (Clinical Lead – Planned Care) Tony Ryan (TR) (Clinical Lead – Children’s and Maternity) Georgie Bigg (GB) (Chair of Healthwatch North Somerset) Jenny Norman (JN) (Head of Planning & Business Support) Mike Jenkins (MJ) (Clinical Lead – Mental Health) Sheila Smith (SS) (Director of People & Communities) Julie Kell (JK) (Associate Director of Transformation)

Apologies: Gill Ryan (GR) (Delivery Director, NS CCG) Jeremy Maynard (JM) (Clinical Lead –Quality) Natalie Field (NF) (Director of Public Health) In Attendance: Sonia Galley, Minute Taker (SG) (PA to Senior Officers, NS CCG)

Item No Action

1 Welcome MB welcomed all to the meeting. MB extended a welcome back to GB who replied with a thank you to everyone for the flowers and card. MB also welcomed back SG.

2 Apologies Apologies noted as above.

3 Declarations of Interest Item 6 – Update on the 2017/18 and 2018/19 BNSSG Operational Plan GP members may be conflicted where plans may directly impact on services provided in primary care. However, it was agreed that because this was a high level paper GP members should take part in discussion and decision making but declare their interest as GP providers. No other declarations of interest were noted.

4 Good News Stories JG celebrated the appointment of MB to the Clinical Chair post, and that Julia Ross will be the new joint Accountable Officer (AO) for the 3 CCGs from Tuesday.



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MA also commented that JK should be congratulated for her work with the Turnaround Group, which has been very challenging.

5 Chair’s Reflection MB stated that this was her last meeting in her role as the Chief Clinical Officer and confirmed that she will continue as Chair of this committee in her new role as the Clinical Chair. MB commented that the day to day work with the Turnaround process is progressing at pace, with proposals being developed and then tested them before development of detailed plans. Laura Nichols is the new Sustainability and Transformation Plan (STP) Director. There is a new approach to STP Governance. An independent chair of the STP has been appointed and will start on Tuesday. The detailed announcement is to come. Next steps have been published for the Five Year Forward View (FYFV). All members have seen this, but it is important to note that it is very practical, with specific focus on mental health and urgent care. Julia Ross visited BNSSG CCGs on Tuesday and met with Officers and senior managers. A series of meetings was held around HR, Quality, Weston and Finance. Julia has confirmed that she will have a single executive team. Senior managers will still meet in North Somerset CCG for the time being. For the Clinical Leaders it will be business as usual. Local working as part of BNSSG is still ongoing. MB confirmed that Julia values clinical leadership of the CCGs. MJ asked if there will be a SMT over the 3 CCGs. MB replied that the Accountable Officer (AO) will meet on a weekly basis with Clinical Chairs and the Executive Team. JCC informed members regarding the Quality Team that this will now be a single team across BNSSG with QAG meeting in Common. The effectiveness of this is being reassessed and in the future there may be a single QAG across the 3 CCGs. There is an away day planned to sort out the future working of the group, which will recognise hotspots. MA and JM are part of QAG. JG reiterated from Julia’s message that she wants to be clear that we are 3 organisations but working as 1, “the local is important”.

6 Minutes of meeting held on 23rd March 2017 MJ asked for the comment to be removed on page 7 item 11. He did not mean that JCC was not a clinical leader. Action 49: remove MJ comments on Page 7 Item 11 regarding JCC Subject to this action, the minutes were approved as an accurate record of the meeting.

SG

7 Action Log Action 34: The audit was shared. Item closed.



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Action 39: Item closed. Action 40: JM is presenting to the GP Forum in June for the best models. Item closed. Action 41: Item closed. Action 42: Item closed. Action 44: DC will find out if this has been completed this. Item remains open. Action 45: This has been written into the forward plan. DC queried ‘terms’. MB commented that the Operational Plan has 1 goal, to ensure enhanced services are consistent across BNSSG. Item remains open. Action 46: item closed. Action 47: Item closed. Action 48: This will go the Governing Body. MB and JG are to do an action plan. Item remains open.

8 Integrated Performance Report Quality: JCC presented the BNSSG Quality report for April 2017 (February 2017 data). UHBristol: Received an Outstanding rating from CQC, which has benefitted the staff morale. UHB has carried out some very good work to meet the Accessible Information Standard (AIS). This has included staff training and changes to alerts in Medway patient administration system. There are no Key Risks to report since February 2017. The Bristol and South Gloucestershire Overview and Scrutiny Committees received the Verita report in February 2017. It was agreed to close the plan. Performance has improved to 61.9% this month for fractured neck of femur. This is still below the threshold of 90%. WAHT: There has been zero MRSA over 900 days, this is good news. Wards were closed in March due to Norovirus, but there have been no further closures since then. A contract performance notice was issued where assurances had not been received. They were given 5 working days to present an action plan. The action plan has now been received. The standard of electronic discharge letters did not comply with their contractual requirements in respect of discharge templates. CQC have carried out follow up visits and a warning notice is in place for hospital flow. The action plan has been received by the CCG. There is a new Director of Operations in place and a new Interim ED manager MB asked that if the issue on discharge summaries was not sorted out by next month, what the action plan is. JCC replied the new director will get staff moved who are not following procedures. JCC reported that the SHMI report was published this morning, it remains 115 The 4Hour Performance has improved for the first time in 18 months. It is up 12% and is now in the low 80s, but because the activity is lower, it is struggling to maintain this. MJ asked what the average number of patients was that went through the A&E per day.



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JCC replied it was 135. This increased suddenly in April to 158 average per day. JCC informed members that outpatient pending follow up list remains a concern. At the previous contract meeting with WAHT they informed that the numbers had increased to 4500 patients from 2500 previously. This is now decreasing, but another pending list has come to light. This has now been drawn together into one action plan, the actual number is 2368 JCC has informed WAHT that there are to be no pending lists going forward. This was agreed by the trust. The trust are keen to move to Patient Initiated Follow-Up GB advised that patients would need signposting to help them to know how to do this. This would need carrying out in a formal way. MB added that this is normal practice nationwide. RK warned that there would be a cohort of patients that this would not be appropriate for. MB also added that patients should get a copy of their out-patient letters. JCC told members that UHB and NBT had previously said that they had no issues with outpatient recording. However NBT now have serious issues with outpatient recording, this is being manged through the contractual route. The 62 Day Cancer standard continues to fluctuate. JCC reported that Serious Incidents (SIs) continue to be monitored fortnightly by the CCG and the Quality Sub Group. March showed progress. Complaints Response Rates are at 66%. NBT: An Emergency General Surgery Review of Acute Trusts in the South West has taken place and NBT was found to be the second highest performing Trust. There is a backlog of Endoscopy surveillance cases. NBT had been failing the six week diagnostic target and had a significant Endoscopy surveillance recall backlog. They are now back on track to meet the improvement trajectory outlined in their RAP and the backlog should be cleared by the end of March 2018 All affected patients have been reviewed and those requiring treatment have received it. The number of complaints went down to 26 in February 2017. TR - NBT discharge letters are currently ok. RK disagreed and said that there are still patients who do not have a discharge letter. NSCP: NSCP are doing well. MB queried the CQC report of Good overall, but showed requiring improvement in safety. The CQC had a pharmacist on the inspection team who was questioning the controlled drugs at Clevedon Hospital when it is closed. 09:50 DC joined the meeting. JK noted that there is a new issue with CAMHS and Children’s Services and asked what it was. CAMS – 2 members of staff off long term sick so there is a delay in the service provision. JCC warned that this might affect the CCG Ofsted, but was unavoidable. AWP Locally: There are no major issues. SIs and learning issues have reoccurred. There is also the question



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of how to manage AWP with the STP. JCC still thinks that there is a lot of discussion at QAG about WAHT and not enough about NBT and UHB. Performance: MV presented the Performance report for month 11; some of the issues are reflected within the quality report and have been discussed already. The summary performance report describes areas of poor performance and the performance dashboard details the month 11 position across all key areas. MV referred to the executive summary which highlights the key issues of performance in terms of challenges. A&E 4 hour standard continued to be failed by all 3 trusts in February and remains an area of concern and challenge. MV referred colleagues to areas of strong performance including waiting times (RTT) at Weston, diagnostic waits and some cancer performance. In addition the ambulance provider has achieved compliance with the category 1 performance target for North Somerset. MB queried the UHB situation reporting 4hour. The Children’s Hospital has been taken out of the calculation and MB wanted to know why this had changed. JCC replied that the trust has corrected its data collection. Clare Thompson is working with UHB on this. The GP at the front door service is suspended, causing problems. Also North Somerset patients have poor performance when going to UHB and there is a need to check that they are receiving good care. JG mentioned that on ambulance handover WAHT improved between January and February. JCC explained that WAHT have put up curtains in corridors, but the patients are still on trolleys. One third of the curtains have now been taken down and all will be down by the end of the month. They did not want to make it the ‘norm’ to have curtains in the corridors. MV added that A&E attendance is down against plan which is not the same picture for across the country. Therefore this does not truly reflect the pressure on the department. This strongly indicates it is not the case then that growing demand on A&E services at Weston is responsible for poor performance against the 4 hour target. MB commented that the public are aware of the closure of Clevedon hospital and have some have therefore taken it as also closure of the MIU which is incorrect. JCC confirmed that advertising/Twitter notice will be taking has been undertaken to inform patients that the MIU remains open for business. Finance: MV presented the Finance report for month 12 of the 2016-17 financial year. He advised that the draft accounts were submitted before the national deadline and reported an in year deficit of £11.7m against the planned in year deficit of £4.3m after the CCG had applied the 0.5% headroom reserved under national planning rules. He also reported that the CCG has met its duty to manage expenditure within the notified cash limit.



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In terms of programme spend areas he reported a net underspend on acute contracts which reflects underperformance at WHAT and NBT and an overspend at UHB. The Weston contract has underspent against the elective plan and the NBT position includes substantial contract fines and penalties. Prescribing has delivered against a challenging savings plan and in fact the CCG spent less cash on primary care prescribing than the previous year. MV commented on cost pressure, the biggest single impact being £1.7m overspend on Funding Nursing Care (FNC) related to the unfunded increase in national FNC rates in year. The shortfall against the planned position largely reflects under performance against the QIPP plan which included a significant element of unidentified savings at the planning stage. In summary MV advised the reported position is consistent with financial reporting throughout the year including our assessment of risks and that delivered savings of £8.5m equate to over 3% of our budget. This is a good position although clearly falls short of the initial plan and the CCG will progress savings delivery in support of the turnaround programme and STP. RK commented that this is a good news story. MB added that QIPP savings are there and this is good. JK informed that the savings have come from intense work on CHC, mental health and complex children’s cases. The Clinical Commissioning Leadership Group:

Discussed the Clinical Commissioning Group’s latest performance delivery as at March 2017 for Quality, Finance and Performance standards.

Reviewed mitigating actions for those areas of exception.

9 BNSSG Operational Plan 2017/18 JG presented the paper on the BNSSG Operational Plan 2017/18. JG noted that there has been a real difference in the way the plan has developed this year, with a single plan for BNSSG and a Turnaround process being developed collaboratively. There have been challenges because it is a new way of working, but the CCGs are now working together more effectively. There is more ownership across BNSSG. Also there is more focus on provider organisations and more transparency across BNSSG. JCC reported that from a quality point of view there is a more robust Equality Impact Assessment (EIA) and Quality Impact Assessment (QIA) process being managed through the Turnaround Programme. GB asked which areas would it be helpful for HealthWatch to be focused on in relation to patient pathways. It is important that HW and the CCG focus on the same areas for the public to understand and to be supported in understanding the messages. JN explained that the approach to the engagement with patients and the public is being developed by the Control Centres and the process is being mapped out for each of the pathways affected.



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There may be no need to go out for full consultation on many of the proposals if not are not significant changes as changes can be co-produced with patients and the public. GB asked where HealthWatch will fit into this. JN replied through the Control Centres. Within their plans Control Centres are currently mapping out key stakeholders they will need to engage with. JG continued that she has also had a conversation at Shadow Joint Commissioning Board about HealthWatch to ensure that individual Control Centres discuss with HealthWatch on how best to align work programmes and suggested that this should be a BNSSG wide approach. Ben Bennett will bring this together and agree with the three BNSSG HealthWatches to formulate how to come together. SS commented that there is a need for a wider conversation with partners and to recognise this and noted that more detailed plans can be discussed in the Closed Session of this meeting. GB confirmed that HealthWatch needs to be aware of the CCG focus. MV advised members that the reason the CCG is in Turnaround is because we are in deficit and the Operational Plan focusses on the finance plan and savings. There is a proposed £65m savings. MV reported: The CFO described the progress against the 2017-18 plan including substantial work by the control centres to identify and scope savings, a total of £66m savings has been scoped so far. Further work is required to assess for delivery risk and equality and quality impact. The turnaround process will move to implementation however a further round of savings planning is also required. No further questions were asked. JG confirmed that there is no need for public and patient engagement for these proposals at this stage. The Clinical Commissioning Leadership Group: • Approved the progress made on the outline financial plan and the implementation of individual projects. • Committed to supporting the delivery of the BNSSG savings plan of £65.9 million in 2017-18. • Committed to the implementation of the proposals outlined in Table 2 which can be moved into immediate implementation.

10 Primary Care Local Enhanced Services Update No update was available.



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11

Update on Enacting CCG Constitutional Change JG reported that the constitutional changes to move to a single Chief Officer for BNSSG CCGs and have a Clinical Chair have been approved by NHSE and they will be enacted on 1st May 2017. Job descriptions are also included in the paper as appendices. Kathy Headdon’s amended job description reflects her role as a Lay Member of the CCG with specific responsibility for PPI. It has been agreed by the two Lay members that Kath Headdon should take on the role of Vice Chair. JG – The 3 organisations will remain, but the way of working will be as one for BNSSG. There will need to be further changes in the constitution as different ways of working are proposed. For instance, to reflect an increasing move to committees in common, Julia Ross needs time to reflect on how she will want to run the organisations. The Clinical Commissioning Leadership Group: • Noted the approval of changes to the North Somerset CCG constitution by NHS England and received the final document • Noted the changes to the following roles in the light of these constitutional changes: o Single Chief Officer for BNSSG CCGs (Non Clinical) o Clinical Chair (Appendix 3) o Lay Member (PPI) as Vice Chair

JG

12 BNSSG Turnaround Steering Group Minutes: a) 22 February 2017 b) 8 March 2017 The CCLG received and noted the minutes.

13 A&E Delivery Board for BNSSG Minutes: a) 27 February 2017 b) 27 March 2017 The CCLG received and noted the minutes.

14 Joint Commissioning Committee Minutes: 29 September 2016 The CCLG received and noted the minutes.

15 BNSSG Strategic Informatics Group Minutes: a) 2 November 2016 b) 11 January 2017 c) 8 February 2017 The CCLG received and noted the minutes.



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16

North Somerset Cancer working Group Minutes: 14 December 2016 The CCLG received and noted the minutes.

17 Medicines Management Advisory Group Minutes: 16 Match 2017 The CCLG received and noted the minutes.

18 Clinical Pathways Assurance Group Minutes: 13 April 2017 The CCLG received and noted the minutes.

19 BNSSG Joint Formulary Minutes: 17 January 2017 The CCLG received and noted the minutes.

20 Weston Primary Care Transformation Programme Board Minutes: 6 April 2017 The CCLG received and noted the minutes.

21 Final Clinical Commissioning Leadership Group Terms of Reference (ToR) JG reported that these have been completed.

22 Final Clinical Commissioning Leadership Group Committee Self-Assessment JG reported that these have been completed.

23

Any Other Business: JCC reported that the SHMI results had dropped by 0.74 to 115.08 up to September 2016. No other business was discussed.

Item 19c – Governing Body, 4 July 2017


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25th May 2017 Room 2, Clevedon Town Council, 44 Old Street, Clevedon, BS21 6BU

Minutes Present: Mary Backhouse, Chair (MB) (Clinical Chair, NS CCG) Julia Ross, (JR) (Chief Executive Officer BNSSG)

Debbie Campbell (DC) (Head of Medicines Management, NS CCG) Jacqui Chidgey-Clark (JCC) (Director of Nursing & Quality, NS CCG) Jeanette George (JG) (Chief Operating Officer, NS CCG) Miriam Ainsworth (MA) (Clinical Lead – Community services) Rachael Kenyon (RK) (Clinical Lead – Planned Care) Tony Ryan (TR) (Clinical Lead – Children’s and Maternity) Georgie Bigg (GB) (Chair of Healthwatch North Somerset) Jenny Norman (JN) (Head of Planning & Business Support) Mike Jenkins (MJ) (Clinical Lead – Mental Health) Julie Kell (JK) (Associate Director of Transformation) Caroline Laing (CL) (Head of Quality North Somerset CCG)

In Attendance: Lee Colwill (LK) (Commissioning Manager- Joint Commissioning and Partnership) for item 9 Niall Mitchell (NM) (Head of Individual Funding) for item 10 Cara Slane (CS) (GP/ST3 Towerhouse Surgery)

Apologies: Gill Ryan (GR) (Delivery Director, NS CCG) Jeremy Maynard (JM) (Clinical Lead –Quality)

Mike Vaughton (MV) (Chief Finance Officer, NS CCG) Natalie Field (NF) (Director of Public Health) Kevin Haggerty (KH) (Clinical Lead - Urgent Care) Sheila Smith (SS) (Director of People & Communities) In Attendance: Bev Villis, Minute Taker (BV). It was noted that the meeting was not quorate. Neither the Chief Finance Officer nor Deputy Finance Officer were present.

Item No Action

1 Welcome: MB welcomed all to the meeting, including Julia Ross and Cara Slane.

2 Apologies: Apologies noted as above.

3 Declarations of Interest: None were received.



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4 Good News Stories: Julie Kell (JK) recognised the 3 community providers’ and the Local Medical Committee’s positive attitudes for taking the initiative to meet and work through the challenges together. Debbie Campbell (DC) informed the meeting that the Medicine Management team have presented four pieces of work that had been carried out in GP Practices at a national conference and this had been well received. The Safety Dashboard that has been put into place in GP practices was also well received. The prescribing end of year position was much better than had been expected and has saved the £800k QIPP target set. Plus an additional £1m. Mary Backhouse (MB) informed the meeting that yesterday information had been received about the Transformation Diabetes successful bid. MB celebrated the post-natal mental health bid and confirmed that Alison Moon and the team will reflect on previous successful bids and look at the approach to future bids to ensure bids are submitted in the best possible light. JK commented for Sheila Smith (SS) - A ‘single voice’ bid was submitted last Friday regarding the Better Care Fund (BCF). It is hoped that the appeal will be that BNSSG are unique in what they are trying to achieve. Georgie Bigg (GB) identified it can be difficult to engage with the younger community and a new I.T technician has been appointed to Healthwatch with a view to branching out from the more traditional public engagement events to social media and other I.T tools to attempt to engage all groups. Jacqui Chidgey Clark (JCC) informed the meeting that as part of the Enhanced Care Model, they have been invited to put in a BNSSG submission. It will be based on the Vanguard work, and will be able to fast-track the benchmarking tools in the Control Centres. JCC continued saying that it has been recognised that there are a lot of care homes in North Somerset and the split of beds is 75% in care homes against 25% in hospital. A good plan is required to ensure the best care is given for those people and to improve quality and efficiency. It is important that the tool is embedded early to get ahead of the curve. JK has arranged a meeting scheduled for 5th June, with a pre-meet, to map out Market Management to secure care home market. JCC noted the difficulty was around DToC in the acute beds and not around DToC of Mental Health beds. Julia Ross (JR) confirmed that the focus is DToC on Weston and the stranded patients metric. JCC noted a great improvement in the figures for Weston hospital. JK will provide an updated brief- JCC will provide updated slides. 09:10 Tony Ryan joined the meeting. MB stated that Weston Emergency Department (ED) figures have shown a significant improvement in performance over the last few weeks. The appointment of a new Director of Operations and an experienced interim manager in the Emergency Department is contributing toward the improvement in performance. It was also noted that the remaining temporary curtains in Weston ED are being removed from the corridors.



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5 Chair’s Reflection: MB confirmed that a change of title since the last meeting and is now the Clinical Chair. MB welcomed the appointment of Julia Ross (JR), the BNSSG Chief Executive Officer. She recognised there is uncertainty for CCG staff with the changes in staff. JR will be holding a series of drop-in sessions for staff to talk through any concerns. HR processes are already in place for a single Executive Team to be appointed. Organisational development will be key in supporting us through this period of change. The national focus on the urgent care system and ensuring better ED performance in all our local hospitals was welcome. It is good to see the improved performance at Weston’s ED. The North Somerset sustainability work is moving forwards including a wider community focus.

6 Minutes of meeting held on 27th April 2017: 09:20 JR and JCC left the room at 9.20. JCC returned to the room and the minutes were agreed as a true record.

7 Action Log: Action 44: Closed Action 45: Closed Action 48: Closed. – It was noted that Committee Structure requires streamlining. Items noted should be fed in through self-assessment with the recognition of the importance of local meetings. This will be revisited again in a few months by Jeanette George (JG) and MB. Action 49: Closed

8 Integrated Performance Report: Quality: JCC outlined her new role as Turnaround Executive Director and the arrangements to cover her Director of Nursing responsibilities. The Weston Nurse lead role will be Anne Morris, and Caroline Laing (CL) will deputise for Quality. Gill Ryan and Anne Morris will attend future meetings as necessary. JG highlighted that it is important to note CL can provide quorum in JCC’s absence. CL presented the Quality Report: UHBristol Overdue Follow Ups - still awaiting assurance that no harm has been suffered by patients in relation to overdue follow up appointments. This is in response to the Contract Penalty Notice. Paediatric Cardiac Action Plan - To be completed by June 2017. Coroner Inquest- A response will be shared when available. Performance for Fractured Neck of Femur best practice tariff – A long term solution will sit within MSK workstreams. WAHT There have been several senior management changes and the new staff are embedding themselves into the organisation. Still awaiting the Deputy Director of Nursing to start, and there is an interim Quality Manager in place.



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CQC- warning notice project plan is in place and addressing flow, reviewing A&E as a single point of access, corridor safety and access overnight to Specialists. A clear improvement has been noted on OPEL Status and ED standard. The full CQC report is awaited. Child Death Overview Panel (CDOP) – there is a delay in answering questions and discrepancies within the Trust and with Clinical Leads about where critically sick children are managed. This has been escalated to QPSG and will be completed next week at the SI Panel and June QPSG. Sue Masters is working with them. The focus is on making the Emergency Department the safe place for paediatric resuscitation. The Dr Foster Summary Hospital-level Mortality Indicator (SHMI) – This is not worsening, A new Medical Director is in post who is undertaking a review before presenting a new action plan. Remains under a Contract Performance Notice (CPN). VTE compliance has not been achieved during the last year and the CCG remain unassured on the VTE collection data at the Trust. There is a Contract Performance Notice (CPN) in place. The new Medical Director will present a new action plan in July at the Quality & Performance Sub Group (QPSG) meeting. The 62 Day Cancer Standard has not been met. A Remedial Action Plan (RAP) is in place and the new trajectory for 2017/18 should be achieved from July. Outpatient Pending List - lots of work has been carried out. The CCG feel more assured now there is a Remedial Action Plan (RAP) in place. There is also a Standing Operating Policy in place alongside Clinical evaluation of cases. Reviews are starting to be undertaken to validate and reduce the number of patients and there will not be any further additions made to the list. Staff training and appraisals – the Trust to present this at the QPSG meeting in June. JK asked if long term sickness in the CAHMS Team had been investigated. CL confirmed it had been raised in QPSG and actioned.

NBT MRSA – there have been 7 cases of MRSA and a RAP is in place. Never Events RAP – there have been 5 Never Events within the year to date. A CPN issued in November 2016 is in place for direction. NSCP Pressure Ulcers – there has been an increase in the number of pressure ulcers and work is being carried out to identify any themes. School Nursing Establishment – this remains fractured due to long-term sickness absence and compassionate leave, but is being supported through the wider Management Team. MB asked if the Community Paediatric Team staffing issues were still ongoing. Action 50: JK to check with Mark Hemmings and will feedback if there is a quality issue.

AWP North Somerset Locality Mandatory training has been an issue in reaching compliance. There has been an improvement and more training sessions have been made available. This has been highlighted at the wider Trust meetings and has been filtered down.

JK



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Physical Emergency Response Training at the Long Fox unit is now compliant. Cardiac Arrest Support to Juniper Ward - a letter from the Director of Nursing assures the CCG that a new policy is in place. The occurrence of a cardiac arrest 2 weeks ago highlighted that staff responded as per the policy and this was reassuring. Falls- Long Fox Unit and WAHT will work together and share the learning.

SWAST Purple (previously known as red) performance continues to be a challenge. A rota consultation is currently happening, looking at the staff mix for cover purposes.

BRISDOC The draft report for the CQC inspection in March has been received and feedback on the draft has been invited.

09:30 Debbie Campbell (DC) left the room.

North Somerset CCG There have been 46 cases of C Diff in the year against an 87 trajectory (includes Community and the Trust). This is a vast improvement on last year. Of the 36 Community cases, 26 were unavoidable and 10 are still to be looked at. The outcome of the learning will be shared once received from the HCAI Team. MB asked if Bristol and South Gloucestershire CCGs had similar trends and what were the contributing factors? CL stated that they had reductions but these were not quite as large. Long term antibiotic prescribing for recurrent UTI’s was identified as a theme and Medicines Management are reviewing the guidelines. Twenty six cases were unavoidable because the correct antibiotics were prescribed. Going forward the CCG will look at the E Coli cases.

09:35 Lee Colwill (LC) entered the room.

Performance and Finance: The Performance and Finance report was not discussed due to Michael Vaughton (MV) absent from the meeting.

9 BNSSG CHC Commissioning Policy: This paper is a BNSSG version to seek approval from the CCLG. Previously referred to as a choice and equity policy but looking to standardise and merge the 3 documents into one. 2 Key points : First: Implementation of Enhanced Care, to formalise the approach to care homes that request additional 1:1 or 2:1 support for individuals that need CHC. Requests are already scrutinised, but on a more informal basis. Limits will now be set and ask care homes to justify why this is in place through set forms/templates and to present consistent evidence across the area to support this. Second: To strengthen the decision making process around complex cases that may be of a higher cost to the CCG and are looking at implementing a 2 tier approach. The lower tier



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allows the CHC lead and the Team Manager to make a decision on the merits of whether a case is exceptional or not, with an escalation up to a higher level to review the decision if it is appealed or challenged by the family. This will provide real confidence within the teams to have the challenging discussions with people but know that there is a set process to follow that brings in the right level of decision making should it be required. JK wanted to highlight that LC will not be taking a clinical role but a commissioning view. The CCLG reviewed the BNSSG Commissioning Policy for Continuing Healthcare and approved amendments subject to the Chair’s action reference agreeing a decision with MV as Chief Finance Officer. Action 51: Chair’s action reference agreeing a decision with MV as Chief Finance Officer. The CCLG noted that this policy will replace the existing North Somerset CCG CHC Commissioning Policy. 09:45 LC left the room. 09:45 Mike Jenkins (MJ) and Niall Mitchell (NM) entered the room.

MB/MV

10 INNF Policy Updates: NM presented this paper. Policies for Review: Breast Reconstruction – Post Cancer Policy. GB questioned if emotional support was available to patients as it is not stated within the policy, and if not, asked how this may lead to other/possible mental health problems and in turn having cost implications for the CCG. NM stated that patients were supported emotionally and GPs have the knowledge of what help/support is available to patients and families.

Action 52: NM will try to get links to advice and support published on the website.

There is concern about the potential number of Individual Funded Review (IFR) cases. A new approach is being developed regarding the future structure of IFR and this will come to the CCLG.

The CCLG approved this policy subject to the Chair’s action reference agreeing a decision with MV as Chief Finance Officer. Action 53: Chair’s action reference agreeing a decision with MV as Chief Finance Officer. Low Back Pain Policy. No highlights made from MSK/NSCP regarding the effects on activity. Comms Team will communicate information to the GP Practices regarding contract variances. NBT agreed as the main provider. The CCLG approved this policy subject to the Chair’s action reference agreeing a decision with MV as Chief Finance Officer. Action 54: Chair’s action reference agreeing a decision with MV as Chief Finance Officer. Updated Policies for Review :

NM

MB/MV MB/MV



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Penile Conditions - Surgical Opinion and Treatment Policy including Circumcision in all male patients under the age of 18 years

Penile Conditions - Surgical Opinion and Treatment Policy including Circumcision in all male patients over the age of 18 years

Percutaneous Tibial Nerve stimulation for Urinary Incontinence

Rectopexy / Starr

Chiropractor

Varicose Veins The CCLG approved these policies subject to the Chair’s action reference agreeing a decision with MV as Chief Finance Officer. Action 55: Chair’s action reference agreeing a decision with MV as Chief Finance Officer.

MB/MV

11

Emergency Contraception PGD Update: The CCLG approved this policy subject to the Chair’s action reference agreeing a decision with MV as Chief Finance Officer. Action 56: Chair’s action reference agreeing a decision with MV as Chief Finance Officer. 10:00 NM left the room.

MB/MV

12 Annual Review of Committee Terms of Reference: It was noted that as Head of Planning and Business Support, Jenny Norman should be added to the Terms of Reference. The CCLG approved this policy subject to the Chair’s action reference agreeing a decision with MV as Chief Finance Officer. Action 57: Chair’s action reference agreeing a decision with MV as Chief Finance Officer.

MB/MV

13 Risk Register: The CCLG agreed this, subject to the addition of a risk in relation to the delivery of savings as identified in the Turnaround process; also a risk on unidentified savings. It was noted there will be a move to a BNSSG approach to Corporate Risk Registers and work is ongoing on a BNSSG Risk Management Strategy.

The CCLG approved this policy subject to the Chair’s action reference agreeing a decision with MV as Chief Finance Officer. Action 58: Chair’s action reference agreeing a decision with MV as Chief Finance Officer.

MB/MV

14 BNSSG Turnaround Steering Group Minutes: a) 22nd March 2017 b) 5th April 2017 c) 19th April 2017 d) 3rd May 2017 The CCLG received and noted the minutes.



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15 BNSSG Clinical Policy Review Group: 29th March 2017 The CCLG received and noted the minutes.

16 Clinical Pathways Advisory Group: 11th May 2017 The CCLG received and noted the minutes.

17 GP Forum: 8th February 2017 The CCLG received and noted the minutes.

18 A&E Delivery Board for BNSSG Minutes: 24th April 2017 The CCLG received and noted the minutes.

19 Joint Commissioning Committee: 30th March 2017 The CCLG received and noted the minutes.

20 BNSSG Strategic Informatics Group Minutes: a) 8th March 2017 Minutes b) 8th March 2017 Key messages c) 8th March 2017 NHSmail 2 Programme Update d) 5th April 2017 The CCLG received and noted the minutes.

21

Any Other Business: UK Threat Level Escalation. JG briefed the CCLG on the change in threat level from severe (an attack is highly likely to critical (an attack is expected imminently). All CCGs have reviewed their Incident Response Plan and ensured staff are aware of their role in this should an incident occur in BNSSG. The three CCGs would operate as one and set up a single Incident Control Centre should this be required. JG advised that she had agreed to act as Bristol CCG’s Accountable Emergency Officer (AEO) as well as North Somerset’s. Dave Jarret is AEO for South Glos and will work closely with JG to ensure that there is an AEO available to support EPRR at all times. The CCGs also have a 24/7 On-Call Director available with tactical support. The meeting closed at 10:30.

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