GOVERNING BOARD

Date of Meeting 20 January 2019 Agenda Item No

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Title

Minutes of Other Meetings

Purpose of Paper

To accept the following:

Minutes of the Health and Wellbeing Board meeting held on 28 November 2018.

Minutes of the Clinical Strategy Committee meetings held on 2 January 2019

Minutes of the Primary Care Commissioning Committee held on 19 September 2018

Recommendations/ Actions requested

Accept

Engagement Activities – Clinical, Stakeholder and Public/Patient

N/A

Item previously considered at

N/A

Potential Conflicts of Interests for Board Members

N/A

Author

Various

Sponsoring member

Dr Elizabeth Fellows, Chair of Governing Board

Date of Paper

8 March 2019

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HEALTH AND WELLBEING BOARD MINUTES OF THE MEETING of the Health and Wellbeing Board held on Wednesday, 28 November 2018 at 10.00 am in Conference Room A, Civic Offices, Portsmouth.

Present

Councillor Matthew Winnington (in the Chair) Dr Linda Collie

Councillor Gerald Vernon-Jackson CBE Councillor Rob Wood Innes Richens Dr Jason Horsley Mark Cubbon Sue Harriman Alison Jeffery Siobhain McCurrach Dr Nick Moore Jackie Powell

Non-voting members Councillor Jennie Brent

Officers Present Kelly Nash David Williams

58. Apologies for absence (AI 1) These had been received from Dianne Sherlock and Councillor Luke Stubbs.

59. Declarations of Interest (AI 2) There were no declarations of interest.

60. Previous Minutes - 3 October 2018 and Matters Arising (AI 3) RESOLVED that the minutes of the Health and Wellbeing Board held on 3 October 2018 were approved as a correct record, with no matters arising.

61. Portsmouth Safeguarding Children's Board - Annual Report 2017/18 (AI 4)

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Dr Richard John, the PSCB Independent Chair, presented the annual report (his first in this role). Dr John picked out the key points and went through how the priorities had been delivered (as set out on pages7-9):

Children Experiencing Neglect

Missing, exploited and trafficked children

Children affected by Domestic Abuse

These had been discussed with the Ofsted inspectors (referenced page 12) and it was noted that there is some joint membership of the PSCB and the Health and Wellbeing Board. A large scale programme of Restorative Practice training was being undertaken (with a reduction in numbers attending Safeguarding training, partly due to one trainer leaving who had since been replaced). The data set out on page 13 included:

20,518 contacts to the Multi-agency Safeguarding Hub, for 10,905 children

An increase of 12% on the number of assessments leading to the child being referred to the Children and Family Services

An increase in the number of Looked After Children from 358 to 419

Dr John praised the professionalism of colleagues which resulted in a high standard of joint working. There had been 7 Serious Case Reviews from which there had been reflected learning. Looking ahead there would be broader issues with new safeguarding arrangements to be implemented, and work would continue to identify good practice from elsewhere. Questions and points raised by HWB members included:

The challenges and risks raised by a multi-media climate

The continued rise in the number of Looked After Children had a knock on implications for resourcing

The rise in the number of fixed term exclusions (by 25%) was of concern, although this was mirrored nationally and this could be linked to the growth of academies

It was reported that Portsmouth was part of a Home Office pilot to better identify trafficked children, with the rise in the number of unaccompanied minors arriving in the UK as asylum seekers.

An area that could receive further attention was reintegrating looked after children with their families (Alison Jeffery confirmed that this is being looked at)

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With regard to transparency it was noted that the recent Ofsted inspection of Children's Services had received a "good" rating

Councillor Gerald Vernon-Jackson, as Leader of PCC, thought that due to the significance of the issues contained in the annual report, it should be brought to the attention of all councillors. The report was being submitted to PCC Cabinet on 4th December, and he would like this to go on to full Council for their information. Councillor Winnington, as Chair, had gone on the restorative practice training which he had found inspiring. As the Cabinet Member for Health Wellbeing and Social Care was pleased to see the joined up working with Adults Social Care and Public Health as evidenced, and he thanked Dr John for presenting the PSCB annual report. RESOLVED that the content of the PSCB annual report 2017/18 be noted.

62. Portsmouth Health & Care Operating Model (AI 5) Innes Richens, as Chief Operating Officer CCG, presented the report and outlined the main headline issues, with the review of ways of working between the NHS and the City Council, building on the integration already taking place and planned through the Portsmouth Blueprint and STP regional work (to be discussed in the next agenda item). The report set out the operating model structures, showing a collaborative approach for health and care providers for the city. The report set out in section 7 the proposed Health & Care Operating Model, which were summarised as:

Incorporate defined PCCG functions for children services within the existing Director for Children’s’ Services in PCC, mirroring the integrated role for adults already established within the Chief of Health & Care Portsmouth in PCCG

Integrate defined Public Health and PCCG commissioning functions within a single role or roles (utilising existing roles)

To strengthen support to the Chief of Health & Care Portsmouth in the discharge of their statutory Director of Adult Social Services (DASS) functions - create a dedicated Director of Adults Services role, from an existing post within Adult Social Care, reporting to the Chief of Health & Care Portsmouth. This will ensure sufficient leadership capacity for adult social care transformation in the City and for engagement in other tiers (in particular the local Integrated Care Partnership)

Review existing PCC and PCCG capacity currently reporting to the Chief of Health & Care Portsmouth, Director of Children’s’ Services and Director of Public Health and align roles and portfolios to this integrated Health & Care Portsmouth executive

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It was stressed that the intention was not to bring all the budgets together. It was also acknowledged that the review of the role of the Health & Wellbeing Board was underway and it was possible that a specific sub-group of HWB could focus on Health & Care. Members of HWB welcomed the opportunity to see these proposals and to influence the shape of partnership working, which was successful in the city, rather than wait for the government to implement changes. The charts were useful, but did not show areas where there are overlaps in responsibility. The HWB would be a forum for broader discussions. It was asked where the hospital fits in, as for the public this was the focus of healthcare with the NHS divisions not widely understood? Mark Cubbon responded that the proposals were positive in advocating even closer working between the organisations. He stressed that only one third of patients at Queen Alexandra Hospital were Portsmouth residents and two-thirds from South East Hants. Siobhain McCurrach reported that Healthwatch Portsmouth would offer support in engaging residents to aid their understanding of the changes. The details on the scope of a HWB sub committee were not known at this stage. Councillor Winnington as Chair, thanked Innes Richens for his report and advocated consensus working. The report had been endorsed by the CCG Board. The Health and Wellbeing Board RESOLVED to give support to:

(i) Establishment of a single operating model for Health & Care Portsmouth between PCC and CCG

(ii) Establishment of a committee on behalf of PCC and PCCG for its commissioning of adult and children’s health, social care and public health services

(iii)Integration of PCCG and PCC functions into joint roles: Chief of Health & Care Portsmouth, Director of Children’s’ Services and Director of Public Health

(iv) Review and reconfigure the structures and existing capacity under these roles to ensure capacity is available to deliver Health & Care Portsmouth whilst recognising the need to achieve running cost efficiencies

(v) A review of other enabling functions to assess the benefits of further integration to support delivery of the Health & Care Portsmouth operating model – specifically financial management, business intelligence, communications/ engagement, community sector partnership development

(vi) Direct the respective Accountable/Chief Executive Officers, working within their scheme of delegations and constitutional powers, to review the management and staffing structures currently in place in order to align this capacity with the new

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Health & Care Portsmouth operating model and for this to include cost-share arrangements.

63. Hampshire & Isle of Wight (HIOW) Sustainability Transformation

Partnership (STP) System reform paper (AI 6) Innes Richens (for CCG & PCC) and Sue Harriman (Chief Executive Officer, Solent NHS Trust) presented this report which comprise the "System Reform Statutory Body Pack" presentation and the report's recommendations as set out in the covering summary document. The pack had been produced in August for consideration by all the region's NHS provider boards, CCG Governing Boards and local government cabinets. The aim was to get in principal agreement then there would need to be future approvals on the detailed developments in due course. Sue Harriman reported that the report had been considered by boards around the county and by PCC's Health Overview & Scrutiny Panel the previous week. The NHS 10 year plan was awaited and this was expected in the first week of December. Discussion took place on the role of clusters (detailed on slide 23) and this was further explained by Dr Collie regarding the need for input to decide what type of cluster is best for our area. Mark Cubbon welcomed the development of clusters as a positive step, and felt that there would be further clarity from the planning footprints of the Integrated Care System (ICS). Alison Jeffery is involved in the children's strand, and would press for attention to early intervention and preventative work with families. She was also keen for children's mental health (a Portsmouth CCG priority) to be given protection. Councillor Gerald Vernon-Jackson asked if there were any major areas of concern for the Health and Wellbeing Board? At the CCG Board discussions most concern had been regarding the geographical boundaries and not wishing Hampshire & Isle of Wight level responsibility for all functions and decisions. The need to maintain a strong sub regional emphasis was supported by HWB members, with the close relationship to the local hospital. David Williams, as PCC Chief Executive, advised a close watch on the progress of the STP to guard against subsidiarity and to ensure that decisions are only drawn up a level when necessary. Dr Horsley advised engaging in the development of the SPT to help steer its course. There was need for clarity (especially with the awaited NHS 10 year plan) of how budgets will be allocated and further distributed. Regarding the accessibility of the proposals for public involvement and understanding, Healthwatch Portsmouth would be working on translating the messages and would work with the STP Communications team to encourage engagement in the process. Councillor Winnington asked what was being learned from elsewhere in the country? Sue Harriman reported that there had been pilots of integrated

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systems and the STP Executive Group worked with partners nationally and internationally. Sue Harriman had visited Berkshire West to see different models (which varied with demographics) and David Williams reported that links had been made with Dorset (where they have a different structure) and good practice had been seen in Salford. Councillor Winnington reported that he and Dr Collie as joint chairs were liaising with the Southampton and Hampshire HWB Chairs to discuss the budgetary issues. In considering the separate, summarised recommendations, it was agreed that a joint submission by the Portsmouth Health and Wellbeing Board rather than separately from Portsmouth City Council, to represent Portsmouth Health and Care which was supported by Dr Collie. RESOLVED

(1) that the recommendations as set out in the covering report be supported

(2) that contact be made with Caroline Dineage MP

(3) that a joint response be sent for Health and Care in Portsmouth.

64. Date of next meeting (AI 7) The date of the next meeting was noted as 13th February 2019 at 10am.

- - -

At the conclusion of the meeting an informal meeting took place with Dr Horsley to create an action plan to tackle Childhood Obesity. The meeting concluded at 11.27 am.

Councillor Matthew Winnington and Dr Linda Collie Chair

Minutes of a Meeting of the Clinical Strategy Committee held on Wednesday 2nd January 2019 at 1.00pm - 3.00pm in the Committee Room, CCG Headquarters,

1 Guildhall Square, Portsmouth PO1 2GJ

Summary of Actions

item: Action: Action for: Due:

5 LTCs Hub Business Case Further information is required for outcomes/measures. Workforce and funding sources also require clarification.

M Compton/S Davies Jan 2019

5 A meeting with Solent colleagues to be arranged for as soon as possible to resolve any finance issues.

M Compton/S Davies/M Spandley

Jan 2019

5 The Appendices to the Business Case to be circulated to committee members for information.

L Foster Jan 2019

8 SHIP 8 CCGs Priority Statement 43 – Circumcision. Members requested clarification that the criteria/conditions stated were in addition or replacements to those already considered for prior approval.

Dr N Moore/ K Hovenden

Jan 2019

Present: Dr Nick Moore (GP) - Clinical Executive Member (Chair) Simon Cooper - Deputy Director of Medicines Optimisation Michael Drake - Director of Planning & Performance Margaret Geary - Lay Member Justina Jeffs - Head of Governance Graham Love - Lay Member Dr Jonathan Price (GP) - Clinical Commissioning Lead Innes Richens - Chief of Health and Care Portsmouth Suzannah Rosenberg - Director of Quality & Commissioning Dave Scarborough - Practice Manager Representative Michelle Spandley - Chief Finance Officer Dr Kevin Vernon (GP) - Clinical Commissioning Lead In attendance: Linda Foster - Executive Assistant (Minutes) Mark Compton - Deputy Director Transformation (Rep. Jo York & item 5) Sue Davies - Senior Programme Manager, Solent NHS Trust (for item 5) Rosie Penlington - Commissioning Project Manager (for item 6) Kerry Pearson - Senior Commissioning Manager (for item 6) 1. Apologies and Welcome

Dr Nick Moore welcomed everyone to the meeting. Apologies were received from: Dr Linda Collie, Dr Elizabeth Fellows, Jo York, Dr Tahwinder Upile, Jane Cole, Terri Russell, Katie Hovenden and Dr David Chilvers.

2. Register and Declarations of Interest

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The Register of Interests was noted. A potential Conflict of Interest was noted for Agenda Item 5 – Long Term Conditions Hub Business Case for all GPs and GP practice employed colleagues. There are two GP practice populations participating in the pilot; East Shore Practice and Portsdown Group Practice. It was noted that Dr Linda Collie and Dr Elizabeth Fellows, CCG Clinical Executives, are GP partners at the East Shore Practice, neither were present at the meeting.

3. Minutes of Previous Meeting The minutes of the Clinical Commissioning Committee held on Wednesday 5th December 2018 were approved as an accurate record. The summary of actions from the Clinical Commissioning Committee held on Wednesday 5th December were discussed and reviewed as follows:

Item Action Who By Progress/update

3 Matters Arising 5.9.2018

Spinal Business Care Update. A verbal update to be brought to January CSC.

J York/ M Compton

Jan 2019 As below: action complete.

3 Matters Arising 3.10.18

Early Help – Children & Young People’s Mental Health (U Matter Service) A review of CAMHS to be brought to the CCG April 2019

S McDowell April 2019 Noted.

10 K Hovenden to feedback the CCG clinical input and comments to the SHIP 8 CCGs Priorities Committee

K Hovenden Jan 2019 Action complete.

10 SHIP 8 CCGs Priorities Committee Policy statements. New referral/IFR Forms to be circulated to GPs and circulated via the CCG Update

K Hovenden Jan 2019 Action complete.

14 Enabling Estates Transformation. Members requested further clarification of the meaning of a ‘letter of comfort’ as stated in the Local Estates Forum Minutes.

M Spandley Jan 2109 Discussed – no further action.

b) Matters Arising Mark Compton provided a verbal update on the Spinal Business Case.

The UHSFT Wessex Spinal Centre has been in operation since 1st November 2018 and is receiving all new routine referrals via the Solent NHS MSK Triage Service. There was a backlog of consultant to consultant patients transferred from PHT, who were not part of the original business case. Arrangements have now been agreed, including finance, for this cohort of patients. The MSK Triage team have reviewed the backlog in order to identify causational factors and ensure the needs of these patients are addressed. The Clinical Strategy Committee noted the update.

4. Planning Update

Michael Drake presented the planning update.

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The NHS Long Term Plan was received from NHS England on 21st December 2018. The Operating Plan Guidance indicated key areas at STP/ICS level, including: contract consultation guidance, investment in Primary Care Transformation and Mental Health, “RightCare” etc, which were all as expected. The CCG allocations and activity growth targets are due to be received in January. The 10 year Plan is currently on hold and expected soon. Post meeting note: The 10 Year Plan was received on 7th January 2019. NHSE have requested the CCG’s submission of the activity template and efficiency savings template at STP level by the 14th January 2019. The pre-populated templates were received today (2nd January) for completion on behalf of the 3 CCGs. It was noted that the CCG and PHT hold regular ECRM meetings and are working together to ensure their approach is aligned with regards to the submission. Michael Drake advised there are some areas of risk which may impact on the documents required for submission on 12th February of the first Operating Plan. He added that more engagement and traction is needed around the detail of the benefits realisation work in order to articulate the efficiency savings. The Final Operating Plan submission date is 4th April. System Plans will need to be submitted in addition to individual Organisation plans. The submission dates for these being 19th February and 11th April. Michelle Spandley confirmed that this included the 20% reduction in running costs requirement. The allocations information has not yet been received. The Clinical Strategy Committee noted the content of the Planning Update.

5. Long Term Conditions Hub Business Case for approval. Mark Compton and Sue Davies presented the Business Case to run a pilot of a Long Term Conditions (LTC) Hub Mark Compton provided an overview of the concept of the pilot. Recognising current levels of variation in the management of LTCs, the increasing numbers of patients being newly diagnosed and increased costs associated with this. The pilot will bring together in one place (Hub), healthcare professionals from primary care, community and secondary care to focus on better management and outcomes for newly diagnosed patients. This cohort of patients with more complex needs will be supported in the self-management of a healthier lifestyle, influencing behaviour in order to reduce costs over their lifetime. The Business Case is a pilot initially with two GP practices; East Shore and Portsdown Group Practices which constitutes approximately 25% of the practice population in Portsmouth. The focus will be for patients newly diagnosed with Type II Diabetes and patients with Asthma, Chronic Respiratory Disease and Chronic Obstructive Pulmonary Disease (COPD). The pilot also seeks to co-locate the community Heart Failure Services. Sue Davies explained the estates plan in the long-term is for the Hub to be located in on the St Mary’s site; however there is not enough space there at present, therefore the proposal is for the Somerstown Hub to be used for the pilot period.

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The business case includes commissioned estates work to identify space at the St Mary’s site. Sue Davies informed members the that additional costs of the pilot were identified in the business case which included staff costs for staff being rotated into the Hub, (transformation) and additional estates costs. It was noted that the business case was considered at the MCP Programme Board and the costs were brought down by approx. £30,000 to a total of £260,000 for 19/20. The total cost for 18/19 and 19/20 is £609,000. The costs also include two new services one of which includes Feno Testing, (for patients with Asthma) and for patients with breathing pattern disorders. It is likely that costs will increase over the next few years in the management of respiratory conditions and therefore it is hoped that the new services will off-set some of these costs. Dave Scarborough asked several questions around any potential risks to the two practices involved in the pilot; financially, capacity to ‘free up’ specialist staff resources and how the practices would manage if the practice’s priorities change. He also queried whether there will be a legal arrangement in place. Mark Compton advised of a National MCP (Draft) Partnership Agreement template which will be used for the pilot; a commitment in writing. It was noted that despite any practice issues, practices would be expected to donate staff to the Hub. Sue Davies informed that East Shore Practice required one more member of staff to be fully trained up in respiratory, adding that there is time to do this before the pilot begins. There will be additional funding for new demands to ensure that practices are still able to deliver their services. Dr Jonathon Price noted that there was no dietician input in the pilot for the Hub. Mark Compton responded that it is the intention to draw in more professionals in time, but that Health & Wellbeing is the priority currently. Adding that the team have been engaged with the dieticians from PHT; however, there are limited aspirations for the pilot phase.

Sue Davies met with Gosport CCG regarding their pilot Diabetes project, which is a similar project but on a smaller scale. It was agreed that learning can be made through working/linking together. The Committee discussed as this is an evidence based service, the potential to consider undertaking local research by using a CQUIN. Further information is required for the outcomes/measures comparisons between pilot practices and non-pilot practices to identify potential savings for the pilot. Workforce and of funding sources also require clarification.

Action: M Compton

Sue Davies said that by investment in this pilot will bring long term benefits to patients and the potential to make savings on medications and prevent readmissions of LTC patients into hospital. Mark Compton confirmed that the MCP Board are looking to fund the pilot within their budget.

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Michelle Spandley said that a robust review of the financial plans was needed to understand and check value for money and any impact on other areas, however was quite content with the business case. A meeting with Solent colleagues to be arranged for as soon as possible to resolve any issues.

Action: M Compton/L Foster

The Appendices to the Business Case to be circulated to committee members for information.

Action: L Foster The Clinical Strategy Committee approved the implementation to proceed with the Long Term Conditions Hub Business Case, subject to clarifications around the finances.

6. Mental Health Rehabilitation Redesign. Oakdene Rehab Remodelling Briefing Paper for pipeline approval. Rosie Penlington informed members on the planned remodelling of the Portsmouth rehabilitation pathways. Clinicians across the pathway were involved in a remodelling workshop held last November (2018). Solent NHS Trust 4year savings plan includes changes to the inpatient provision currently provided at the Oakdene Unit at St James Hospital by disinvesting and utilising the funds to further develop rehab provision in the community. Commissioners undertook a review of the Oakdene Unit. It was noted that the unit provides an overflow/step-down function for the acute wards. Mark Compton asked if the proposed impact was known for the overflow beds for the acute wards. It was noted that the review had not looked at physical health rehab (from PHT), just the mental health wards, and the rehab admissions which are managed by Solent. Michelle Spandley asked if there would be any impact on Out of Area patients, and how this fits with the ECR budgets. Rosie Penlington responded that rehab in the community is better for the patient, but that it might be possible to use step-down beds for some ESR placements. Michelle Spandley stated that it was important to look at the whole picture so as not to increase ECR use and close beds if they are needed. Rosie Penlington also confirmed that peer support is integral to the new model. A formal public consultation will be carried out by Solent NHS Trust and the results will be known March/April 2019. Portsmouth Health Overview and Scrutiny Panel. (HOSP) will also be informed and involved in the consultation process. The Clinical Strategy Committee agreed pipeline approval of the Oakdene Rehab Remodelling project.

7. Portsmouth Wellbeing House Update

Suzannah Rosenberg provided an update on progress and refinements made to the original concept; the combined interdependencies with The HIVE and social prescribing. It is hoped the project will go live in June 2019.

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It was noted that the Crisis service will be opened up to self-referrals for the first time in Portsmouth, but there is a need to manage patient expectations. The provision changes to a Universal Service at Wellbeing House will support the service in secondary care. Discussions with Talking Changes have been very helpful and the interventions at Wellbeing House will be the same as at the Pompey Centre. Suzannah Rosenberg informed that the Beneficial Foundation Service has been wound up, and the vacant building would be an excellent resource for Wellbeing House. A small amount of internal building work will be required. Following a meeting with the (now ex) CEO of the Beneficial Foundation, it was agreed that a proposal would be made to Trustees for Solent Mind to take over the property. A meeting will be held on 15th January between Suzannah Rosenberg (CCG), Matthew Hall (Solent NHS Trust), the CEO of Solent Mind and the CEO of the Beneficial Centre to discuss the property. Suzannah Rosenberg informed members that work is on-going as to how the benefits of the service can be captured. This includes learning from current projects such as Care Navigators, Talking Changes and MSK pathway. Marketing strategy funds of £11,000 have been allocated from January to April 2019. A marketing specialist from Solent is helping with the soft launch to open up the first channel to open up the service through Primary Care. Also via Survey Monkey, the City Wide PPG mailing lists and help from Healthwatch Portsmouth to test out the concept. Table 2 on page 4 showed the indicative costs for the first year. The Committee discussed the costs and funding for various aspects of the service provision. Staffing levels include: 15 hours input from the Citizens Advice Bureau. Two or three people working from the Wellbeing Service, one or two people from Solent Mind. Funds of £90,000 will be utilised for additional staff as required. Suzannah Rosenberg informed there would be no lone working, but numbers are not yet known, therefore capacity & demand modelling will be needed. The opening hours will be: 12 – 8 Monday to Friday and 12 – 2 pm on Saturdays. Dr Nick Moore enquired whether Wellbeing House would be using SystmOne to record data. It was noted that only Solent Mind currently use this data system for secondary care. Commissioners will need to consider what is required for all. Dr Kevin Vernon asked if Portsmouth University were involved in the Wellbeing Project. Suzannah Rosenberg said the University are seen as a partner in the project. A meeting will be held later this week to discuss in more detail for their students. Business cards will be introduced to GP practices, patients will be offered these to self-refer to Wellbeing House. Dr Kevin Vernon suggested that information for GPs and Health professionals be loaded onto ARDENS (on the psychology page) for signposting patients. Members

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were informed that it is hoped that in the future calls to NHS 111 disposition, will also be able to advise patients and link into the Portsmouth Hub. Michelle Spandley asked if the set up costs were only for this year, and this was confirmed. The branding will come under Health and Care Portsmouth. A full business case will be presented to the CCG after the first six months of operation for consideration of any future revenue and funding. The Clinical Strategy Committee noted the Wellbeing House update and funding was approved as below:

£17,800 for CAB funding for 19/20

£11,000 for marketing – January to April 2019

£50,000 for ICT and minor works

8. SHIP 8 CCGs Priorities Committee Policy Recommendations

The Clinical Strategy Committee reviewed the Policy Statements as below:

• Priority Statement 43 – Circumcision. Members requested clarification that the criteria/conditions stated were in addition or replacements to those already considered for prior approval. Dr Nick Moore to confirm with Katie Hovenden. If they are in addition, CSC approve.

Action: Dr N Moore • Priority Statement 44 – Revision of knee replacement – approved • Priority Statement 40 – management of haemorrhoids – amendments to this

policy at following feedback at the November SHIP meeting - approved The Clinical Strategy Committee accepted the above Priorities Statements

9. Minutes of Other Meetings for noting: • Minutes of the SHIP 8 CCGs Priorities Committee Meeting held on 20.9.2018 • Minutes of the Local Estates Forum Meeting held on 17.9.2018

The Clinical Strategy Committee noted and accepted the above Minutes.

10. Any Other Business Dr Nick Moore reminded the Committee members that this meeting is the last of the Clinical Strategy Committee Meetings. These will be replaced by The Clinical Advisory Group, which will be an informal discussion group of clinicians reviewing clinical and commissioning issues and projects. This will be an opportunity for member practice GPs and Healthcare professionals to join the group on an ad-hoc basis, or as interested in items on the Agenda. Commissioning Managers will also be invited to attend. Agenda items will be circulated in advance via the Weekly Update and by email to the core members. Agenda items - Clinical Advisory Group Meeting Wednesday 6th February 2019:

CQUIN 2019/2020 Update on chronic pain management - Dr J Price/Dr K Vernon SHIP Prioritisation – Katie Hovenden

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Clinical Strategy Committee – Attendance Log

Member Name April 18

May 18

June 18

July 18

Aug 18

Sept 18

Oct 18

Nov 2018

Dec 18

Jan 19

Feb19

Mar 19

Dr Linda Collie A A A A

Jane Cole A n/a A A

Simon Cooper A n/a A

Michael Drake n/a

Alison Edgington A A

Dr Annie Eggins (Chair)

A A

Dr Elizabeth Fellows A A A A A A A

Margaret Geary n/a

Dr Jason Horsley A A A

Justina Jeffs

Dr Jonathan Lake A A

Graham Love A n/a

Dr Nick Moore A A Chair Chair

Dr Jonathan Price

Innes Richens A n/a A

Terri Russell A A n/a A

Suzannah Rosenberg A A n/a

Dave Scarborough A n/a

Michelle Spandley A A A n/a A

Dr Tahwinder Upile A A A A A A A A

Dr Kevin Vernon

Jo York A A A n/a A

In attendance

Claire Currie n/a

Lin Foster (Minutes) A A n/a

Debbie Bishop n/a

Lisa Stray (Minutes) n/a

Katie Hovenden A A

Mark Compton n/a

Rebecca Spandley

A = Apologies = Present

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APPROVED

Minutes of the Primary Care Commissioning Committee meeting held on Wednesday 19 September 2018 at 1.00pm – 2.45pm in Conference Room A, 2nd Floor, Civic Offices,

Portsmouth

Summary of Actions

Agenda Item

Action Who By

4. Risks Risk Register is brought to the Committee at regular intervals. Post meeting note: Key high level risks will be taken to Public meetings and can be summarised on a Front Sheet. A full Risk Register will be taken to a PCCC Part II once a year.

TR

November

8. Merger Review Bring Primary Care Workforce Development Strategy to a future meeting

TR

January

Present: Margaret Geary - Lay Member (Chair) Andy Silvester - Lay Member Dr Annie Eggins - Clinical Executive (GP) Dr Julie Cullen - Registered Nurse Dr Linda Collie - Clinical Leader/Clinical Executive (GP) Dr Jason Horsley - Director of Public Health, Portsmouth City Council Dr Jonathan Lake - Clinical Executive (GP) Innes Richens - Chief of Health & Care Portsmouth Jackie Powell - Lay Member Jo York - Director (New Models of Care) Suzannah Rosenberg - Director of Quality and Commissioning Terri Russell - Deputy Director of Primary Care Michelle Spandley - Chief Finance Officer In Attendance Justina Jeffs - Head of Governance Lisa Stray - Business Assistant Apologies: Mark Compton - Deputy Director of Transformation Roger Batterbury - Healthwatch Portsmouth Vice-Chair 1. Apologies and Welcome

Margaret Geary welcomed members to the meeting, noted the apologies as above and reminded those present of the following:

The meeting is not a public meeting and therefore no participation from members of the audience would be allowed during the formal business of the Committee.

The CCG undertakes Primary Care Co-commissioning under delegated powers from NHS England

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In order to support the management of any conflicts of interests, the Chair is a lay member of the CCG.

The Chair will determine action to be taken where members declare a conflict in line with the CCG’s policies.

The Clinical Executive lead for Primary Care, Dr Linda Collie, will be allowed to participate in discussions for such items unless they are directly about her practice.

2. Declarations/Conflicts of Interest

Dr Linda Collie as GP working in practice and as a member of the Portsmouth Primary Care Alliance, declared a conflict of interest for Agenda items 5, 6, 8 and 10. Margaret Geary, as the Chair, agreed that the conflicted member could participate in the discussion but not in any decision-making. Justina Jeffs informed the Committee that updates had been received against the Register of Interests, and these changes have been included.

3. Minutes of Previous Meeting

The minutes of the Primary Care Commissioning Committee meeting held on Wednesday 16 May 2018 were approved as an accurate record, subject to the following change: Page 4, Agenda Item 7: delete ‘6.00am – 8.00am.’ and replace with ‘6.00am – 8.00pm.’ An update on actions from the previous meeting was provided as follows:

Agenda Item

Action Progress

4. Risks Provide an overarching risk register at regular intervals.

As required

5. Personal Medical Services (PMS) contract variations

University Surgery - Provide student health needs assessment update for the September meeting.

General – All concerns regarding practice sustainability will be included on the Primary Care Operational Group Risk Register.

Committee members to ratify Chair’s Action PMS practice change for a GP retirement at Portsdown Group Practice.

On agenda

Completed

4. Risks

Margaret Geary reported no new risks escalated from the Primary Care Operational Group. Committee Members requested that the overarching risk register is brought to the Committee at regular intervals.

Action: Terri Russell

5. Chair’s Action - Personal Medical Services (PMS) contract variations Dr Linda Collie working in practice in the city, and practice representatives of the Committee working within Primary Care declared a direct conflict of interest with information contained within this paper. Margaret Geary, as the Chair, agreed that Dr Collie could participate in the discussion but not in any decision-making.

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In keeping with the Terms of Reference, Terri Russell reported on the Chair’s Action as agreed by members at the May 2018 meeting. Committee members ratified the Chair’s Action PMS practice change for a GP retirement at Portsdown Group Practice, although members felt that the GP to patient ratio in Portsmouth seemed high. Dr Jason Horsley commented that it would be good practice to compare published statistics with other University towns.

The Primary Care Commissioning Committee approved the contract variation for Portsdown Group Practice.

6. Personal Medical Services (PMS) Reinvestment - Workforce

Dr Linda Collie and Dr Annie Eggins as GPs working within Portsmouth City and Dr Linda Collie as primary care lead declared a direct conflict of interest with information contained within this paper. Margaret Geary, as the Chair, agreed that both of these members could participate in the discussion but not in any decision-making. Terri Russell spoke to a paper that set out proposals for a GP Practice workforce development scheme that utilises recurrent PMS reinvestment monies. The scheme was developed by the CCG’s Primary Care Operational Group with Local Medical Committee representation and was presented to the Committee to consider. The Committee had previously agreed the principles for PMS reinvestment but asked to see the detail of this proposed scheme the proposals scheme.

Proposal

Terri Russell explained that subject to bids being agreed by the CCG, practices are able to access £1.65 per head of population for 2018-19, based on April 2018 raw list size. Where such bids are for new or enhanced roles, this would be recurring funding. For training and associated backfill bids, this would be a single, one-off payment and the practice would need to consider how to utilise their funding the following year.

Committee members raised the following:

Dr Julie Cullen questioned whether the CCG should purchase training across a range of practices to ensure uniformity and make use of economies of scale. Terri Russell stated that training has been provided in this way previously for Receptionists and Healthcare Assistants however practice needs vary depending on their plans.

Dr Julie Cullen questioned if we were heading towards a situation where the CCG is funding GP practice staff. Terri Russell highlighted that this funding is being made available to encourage Primary Care transformation, which includes the need to develop staff and adopt new roles.

Following a query by Dr Jason Horsley, Terri Russell confirmed that each practice is aware of access to, and use of this funding.

Terri Russell confirmed that assurance regarding the use of funds will be built into the CCG quality and assurance programme. Recurrent funds will cease if/when the post-holder leaves the practice and the practice will need to put forward a new proposal.

Jo York asked if there was an evaluation on how successful these roles have been. Terri Russell confirmed that evaluation through Care Navigation and work flow redirection is built into the programmes.

Dr Jason Horsley queried whether the CCG should specifically direct funding to some practices rather than others. Terri Russell highlighted that there was equal opportunity for all practices to utilise this funding in a way that meets their needs and that is one of the principles for the PMS reinvestment programme.

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Michelle Spandley asked if practices could use the funding for clinical roles that may duplicate some of the at scale work that is developing, for example, Long Term Conditions hubs. Terri Russell confirmed that the CCG would provide practices with an example list of the roles that would be supported and would consider on a case by case basis any requests that fall outside of that scope.

Margaret Geary and Jackie Powell commented on the importance of monitoring.

The Primary Care Commissioning Committee approved the content of the scheme.

7. Integrated Primary Care Service Dr Linda Collie and Dr Annie Eggins, working in practices in the city, and practice representatives of the Committee working within Primary Care whose practices are members of Portsmouth Primary Care Alliance, the service provider of the Integrated Primary Care Service, declared a direct conflict of interest with information contained within this paper. Margaret Geary, as the Chair, agreed that the conflicted members could participate in the discussion but not in any decision-making. Jo York spoke to a paper that provided an update on the progress regarding the newly commissioned Integrated Primary Care Service following a contract award to the Portsmouth Primary Care Alliance on 29 June 2018. The service was working well since it started at the end of June 2018.

Committee members were asked to note the contents of the report. No actions or decisions were required at this stage. The following key points were discussed:

Post Service Go-Live Update

Service Developments

Integrated Urgent Care

Integration of Overnight Services

Emergency Department (ED) Clinical Screening

Urgent Treatment Centres

Workforce Diversification

The Primary Care Commissioning Committee noted the contents of the report.

8. Merger Review Dr Linda Collie and Dr Annie Eggins as GPs working in practice in the city, and practice representatives of the Committee working within Primary Care declared a direct conflict of interest with information contained within this paper as outcomes of practice mergers may have a direct impact on their practices. Margaret Geary, as the Chair, agreed that the conflicted members could participate in the discussion but not in any decision-making.

Terri Russell spoke to a paper that reported on the findings of a review of local GP practice mergers, undertaken jointly by NHS Portsmouth Clinical Commissioning Group (CCG) and Healthwatch Portsmouth (HWP). Committee members were asked to note and discuss the content of the report, and to provide recommendations and direction as appropriate. The following key points were discussed:

Background and content

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The Portsmouth Blueprint sets out plans for creating a different primary care service for the city, retaining the GP as the basis for the service but with a wider workforce, which sees individual GP practices working together or merging to provide services collectively for the city. Since April 2013, the overall number of practices in the city has reduced from 27 to 16 in five years.

Stakeholder engagement A review was undertaken by CCG and HWP with a selection of GP practices in the city. As a result of the review, they also engaged with stakeholders e.g. patients, GPs, nurses and other practice staff.

Findings Both HWP and the CCG will share a summary of feedback with individual practices. Committee members considered the list of Recommendations for the following: o Communications o Sustainability o Benefits realisation o Access o Site closures o ‘Performance’ of practices o Findings/learning from elsewhere

Conclusion and next steps Terri Russell concluded that the report will act as a discussion point for the CCG, HWP, GP practices and other stakeholders to identify and share what has worked well, where improvements may be necessary; and how mergers can best accommodate the needs of patients, practices and the wider health economy.

Committee members raised the following:

Dr Jason Horsley commented that there has been an issue with workforce since 2013. Terri Russell replied that we need to ensure we have the right people in the right roles.

Dr Julie Cullen asked if there had been a change to GP whole time equivalent working and if the CCG were aware of the number of GP partners in each practice and if the number of salaried GPs was increasing. Terri Russell informed members that number of GP partners in the city is decreasing due, in some part, to retirements and that the number of salaried GPs was increasing. Terri Russell will be bringing the workforce development strategy to a future Meeting (plan to complete the strategy in December) .

Action: T Russell

The Primary Care Commissioning Committee received and noted the report.

9. University Student Health Needs Assessment

Claire Currie, Consultant in Public Health, Portsmouth City Council, presented a report that provided an overview of the student needs assessment in Portsmouth. The approach of the needs assessment included involvement from stakeholders and a survey of undergraduate students, of which 81 responses were analysed. Committee members were asked to note the contents of the report, and to consider the recommendations made.

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The report sought to assess the health needs of the students that included:

Sexual Health

Mental Health and wellbeing

Healthy lifestyles

Primary healthcare

Urgent and emergency care Dr Jason Horsley suggested tailoring a new working group to discuss this way forward.

The Primary Care Commissioning Committee noted the report and considered the recommendations made.

10. Special Allocation Scheme

Dr Linda Collie and Dr Annie Eggins, working in practices in the city, and practice representatives of the Committee working within Primary Care declared a conflict of interest with information contained within this paper as they may have patients who in the future may need to use this service. Margaret Geary, as the Chair, agreed that the conflicted members could participate in the discussion but not in any decision-making.

Terri Russell presented a proposals paper for provision of a Special Allocation Scheme (SAS) as the current provider has served notice on the contract.

Proposal

Terri Russell reported that NHS Portsmouth CCG, Fareham & Gosport and South Eastern Hampshire CCGs propose to work together to jointly commission one SAS across the three geographical areas. This would allow the proposed provider to work across a larger patch and enable them to optimise delivery of services. The funding for the scheme has been reviewed and tariffs aligned across all three CCGs. For Portsmouth, there will be little or no adjustment to the current financial envelope, circa £15k. Terri Russell reported that Partnering Health Limited (PHL) will provide this service at a primary base at Guildhall Walk or via a telephone service.

The Primary Care Commissioning Committee accepted the position for future provision of the service and agreed the proposals.

11. Integrated Care Partnership Consultation

Jo York took members through the national consultation that had been launched by NHS England on the proposed Integrated Care Partnership contract, which related to the Portsmouth Clinical Committee Group’s pursuit of a Multi-speciality Community Provider (MCP) model of care.

Committee members were requested to note the content of the report and consider any specific feedback or points of clarity to be included within a formal response. Jo York highlighted that if the CCG would like to issue a formal response to the consultation; this needed to be submitted before the closing date on the 26 October 2018. The outcome of the national consultation will help determine the appropriate course of action to implement the MCP model of care and Portsmouth Blueprint.

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The Primary Care Commissioning Committee agreed to provide a formal response to the consultation, and to align with other responses.

12. Minutes of Other Meetings

The minutes of the following meetings were presented for acceptance by the Committee:

Minutes of the Primary Care Operational Group meeting held 23 April, 29 May and 26 June 2018.

Minutes of the Multi-speciality Community Provider (MCP) Working Group meeting held 9 May and 29 August 2019.

The Primary Care Commissioning Committee accepted the minutes.

13. Any Other Business No further business to discuss.

14. Date of Next Meeting The next Primary Care Commissioning Committee meeting to be held in public will take place on 21 November 2018 at 1.00pm – 2.45pm in Conference Room A, 2nd Floor, Civic Offices.

Member Name May 2018

Jul 2018

Sept 2018

Nov 2018

Jan 2019

Mar 2019

Dr Linda Collie

Mark Compton A Dr Julie Cullen A Dr Annie Eggins Patrick Fowler Jo Gooch Dr Jason Horsley Justina Jeffs Dr Jonathan Lake Sabbatical Jackie Powell Innes Richens A Terri Russell Suzannah Rosenberg Tracy Sanders Andy Silvester A Jo York Michelle Spandley Lisa Stray Margaret Geary Roger Batterbury A

- Present

A – Apologies