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NHS Rushcliffe Clinical Commissioning Group Minutes of the Clinical Cabinet Meeting

Thursday 7 Augus 2014 1.30 - 4.00 pm

Clumber Meeting Room, Easthorpe House

All attendees should be aware of NHS Rushcliffe CCG’s participation in the Freedom of Information Act. The minutes and papers from this meeting will be published in the Publication Scheme with all names included, unless notified to the Chair before the meeting commences or included in a pre-agreed confidential section due to the sensitive nature of the debate.

Present

Stephen Shortt (SS) GP, East Leake Medical Centre (Chair)

Jeremy Griffiths (JG) GP, Ludlow Hill Surgery (Deputy Chair) A

Vicky Bailey (VB) Chief Officer

Dr Richard Stratton (RS) GP, Belvoir Health Group

Gavin Derbyshire (GD) GP, Muster’s Medical Practice A

Neil Fraser (NFr) GP, East Leake Medical Centre A

Jonathan Gribbin (JoG) Consultant in Public Health, NHS Nottinghamshire County

Cheryl Crocker (CC) Director of Quality and Patient Safety

Helen Griffiths (HG) Assistant Chief Officer A

Matt Jelpke (MJ) GP, St George’s Medical Practice

Alex Macdonald (AM) GP, Belvoir Health Group A

Ann-Marie Stewart (AMS) GP, East Bridgford Medical Centre

Neil Shroff (NS) GP, Keyworth Medical Practice

Sean Ottey (SO) GP, West Bridgford Health Centre

Nick Foster (NF) GP, Orchard Surgery

Ian McCulloch (IM) GP, Musters Medical Practice A

Lynn Ovenden (LO) GP, Southview Surgery A

Nick Page (NP) GP, Ludlow Hill Surgery

Ram Patel (RP) GP, Radcliffe-on-Trent Health Centre A

Bakula Patel (BP) GP, Compton Acres Medical Centre A

Jag Rai (JR) GP, Ruddington Medical Centre A

Clive Rix (CR) Lay Member, Governing Body

Jonathan Bemrose (JB) Director of Finance A

Andy Warren (AW) Patient Cabinet representative

Linda Kandola (LK) GP, Gamston Medical Centre

In Attendance

Andy Hall (AH) Director of Outcomes and Information

Professor Chris Hawkey (CH) Secondary Care Doctor, NUH A

Sarah Everest (SE) Senior Public Health & Commissioning Manager

Maria Principe (MP) Director of Cluster Development & Performance NHS Nottingham City Clinical Commissioning Group

Naomi Robinson (NP) Primary Care Development & Service Integration Manager

Stephen Andersen (SA) Head of Finance

RCCG/GB/14/164

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Robert Barrass (RB) Practice Manager, Orchard Surgery

Rebecca Larder (RL) Transformation Director

John Kemp (JK) Practice Liaison Officer (minutes)

ACTION

CC/14/119 Apologies and Welcome

SS welcomed everyone to the meeting. Apologies were received from those noted above with an ‘A’ next to their name.

CC/14/120 Declarations of Interest

A standing general declaration of interest was acknowledged in respect of: (i) All participants who have provider contract(s) with the CCG. (ii) All participants with membership of Nottingham Emergency Medical

Services.

CC/14/121 Notes from previous meeting & matters arising

The following corrections were noted: -

It was confirmed that Vicky Bailey had sent apologies for the meeting on the 3 July 2014.

Matters Arising

CC/14/105 Gateway Leads – VB and SS met to discuss the re-orientation of the gateway leads and asked that this item be brought back at the September Clinical Cabinet meeting for discussion.

ACTION Gateway Lead agenda item to be discussed again at September Clinical Cabinet

ALL

CC/14/122 Schedule of Actions from the previous meeting

All actions raised were completed or on-going

CC/14/123 Children and Families Act 2014 – Education Health and Care Plan Pathway

Sarah Everest spoke to her paper which informed Rushcliffe Clinical Commissioning Group of the statutory duties for CCGs in the Children and Families Act 2014, specifically in relation to special education needs and disability and to provide the assurance from the Integrated Commissioning Hub these duties are being met on behalf of CCGs. The Clinical Cabinet NOTED the update

CC/14/124 Urgent Care Centre – draft service specification and procurement

MP spoke to her paper which detailed that the Nottingham Walk in Centre (London

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Road, including Clifton Cornerstone Satellite) and the Nottingham 8-8 service has been decommissioned and will be replaced with a Nottingham Urgent Care & Walk in Centre in April 2015. The procurement is led by NHS Nottingham City CCG, on behalf of the South CCGs and supported by Greater East Midlands CSU (GEMCSU). The Expression of Interest and Pre-Qualification Questionnaire was launched Monday 21 July 2014; the deadline for submissions is 17:00hrs on Friday 29th August 2014. ACTION Comments are to be co-ordinated by Liz Harris, Senior Service Improvement Manager on behalf of NHS Rushcliffe CCG and submitted before the deadline 29 August 2014

LH

CC/14/125 Primary Care streaming and ED

SS provided a verbal update on a request from both EMAS and NUH. EMAS have asked CCGs to agree a mechanism that there be a direct line to practices for ED to hand a patient back to the practice. NUH have asked CCGs to agree a mechanism around discharge and for each practice to have a dedicated number to call to hand a patient back to primary care. Clinical Cabinet AGREED to work with other CCGs to come up with proposals to fulfil the requests from NUH and EMAS

CC/14/126 Communication with ED and admitting specialities

As above

CC/14/127 GP Enhanced Specification

SS provided a verbal update on the GP Enhanced Specification: -

A Programme manager has been appointed – Emily Cousins

An implementation plan will be drawn up The Clinical Cabinet NOTED the update

CC/14/128 Collection and Reporting of GP Referrals Information

AH spoke to his paper which detailed the following points: -

The level of first outpatients continues to increase above contracted levels.

The CCG needs to support Practices in accessing timely information on GP referrals at a more granular level.

The proposed approach will be in 3 phases: o Immediate collection of limited referral information from Practices using

a simply spreadsheet; o Introduction of a clinical system template with corresponding extract

routines, minimising the workload on Practice staff; o Publication of reports via eHealthScope.

Practices should use the resultant reports to compare referral levels between

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individual GPs and compare these to variations in the number of respective clinical sessions and workload.

The output of any findings should be shared between clinicians to provide educational opportunities

SS highlighted that this exercise was for INTERNAL –practice use ONLY.

CC/14/129 PMs Challenge Fund

SS confirmed that Rushcliffe CCG had been awarded £740k as part of the Prime Ministers Challenge Fund (the letter detailing this was included in the papers).

Detailed plans will now need to be submitted to NHS England.

The Clinical Cabinet NOTED the update

CC/14/130 Patient Survey interim report

VB confirmed that the interim report was the first draft and did not as yet include any analysis of the focus groups which have been carried out. VB also confirmed that practice level data would be available once the work had been completed on the report. The Clinical Cabinet NOTED the update ACTION JK to send the full interim report to members

JK

CC/14/131 Practice Dementia Diagnosis Rates Performance Q1 2014/15

NP presented the Dementia Diagnosis Rates for Q1 which shows that all but one practice is not hitting the target. NP confirmed that Rushcliffe CCG is the worst performing CCG in the County. The report provided a variety of tools for practices to use in order to hit their target. The Clinical Cabinet NOTED the report ACTION NP to present a plan of action at the next Clinical Cabinet to ensure that all practices are hitting target

NP

CC/14/132 Practice Dementia Diagnosis Rates Performance Q1 2014/15

NP noted that the report highlights the progress made to date (and reported to the DAA) against the action plan alongside additional actions being progressed by the CCG during 2014/15 ACTION The Clinical Cabinet have asked for this topic to be an item at a future PLT event

JK/ Caroline

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Stevens

CC/14/133 Business Case: Rushcliffe CCG Community Fracture Liaison Service

This is a business case proposing the development of a Community Fracture Liaison

Service Pilot for Rushcliffe Patients. It is proposed that the service is piloted with East

Bridgford Medical practice as the lead provider.

The Clinical Cabinet AGREED that it was a favourable pathway however further work was needed on the costs and finances of the business case.

CC/14/134 End of Life & Bereavement Services

The purpose of this paper is to review the current services provided and for CCGs to agree commissioning intentions after 31st March 2015. The Clinical Cabinet decided NOT to support procurement option 1 and link with Nottingham City CCG in a joint competitive tendering process but instead to extend the contract which current exist.

CC/14/135 Quality Strategy

The Clinical Cabinet NOTED the strategy

CC/14/136 Health Profiles - Rushcliffe

The Clinical Cabinet NOTED the strategy

CC/14/137 Finance report

SA spoke to his paper which summarises the financial position of Rushcliffe CCG for the 3 months ending 30 June 2014. The following points were highlighted: -

There is a sizeable overspend on the budgets of continuing care, Circle and NUH

The financial position of the CCG has been maintained by drawing down on reserves. For the year to date £177k of reserves have been drawn down

The Clinical Cabinet NOTED the report

CC/14/138 QIPP group highlight & exception report

The key messages from the Finance & QIPP Group meeting held on the 23 July 2014 are as follows:-

QIPP forecast performance for 2014-15 is £2.9m against a target of £3.7m leaving a shortfall of £0.9m

McKinsey have completed their review of the CCG QIPP and how it impacts on NUH activity

A detailed review of the NUH provider led QIPP schemes is being undertaken to assess their delivery.

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The next finance and QIPP group meeting will focus on identification of additional schemes to bridge the gap between the forecast performance and the target.

The Clinical Cabinet NOTED the report

CC/14/139 Performance Report

AH spoke to the paper which provided an update on the following performance areas:- • Key issues and Concerns • Summary of CCG/PCT Performance • Summary of Provider performance The Clinical Cabinet NOTED the report

CC/14/140 Clinical Contracting Board

The Clinical Cabinet NOTED the update from the last Clinical Contracting Board meeting held on 15 July 2014

CC/14/141 Health & Wellbeing Board

The Clinical Cabinet NOTED the update

CC/14/142 IFR Report

The Clinical Cabinet NOTED the update from the last IFR meeting held on 10 July 2014 SO also noted that only exceptional cases were referred to the IFR panel and if particular cases were re occurring they would be referred to the Policy Committee which would review the policy around that particular issue.

CC/14/143 Messages for Practice Managers Forum, Governing Body and Patient Cabinet

Comments regarding the Urgent Care Centre are to be co-ordinated by Liz Harris, Senior Service Improvement Manager on behalf of NHS Rushcliffe CCG and submitted before the deadline 29 August 2014

EMAS have asked CCGs to agree a mechanism that there be a direct line to practices for ED to hand a patient back to the practice and NUH have asked CCGs to agree a mechanism around discharge and for each practice to have a dedicated number to call to hand a patient back to primary care. The Clinical Cabinet have AGREED to work with other CCGs to come up with proposals to fulfill the requests from NUH and EMAS

SS provided a verbal update on the GP Enhanced Specification: - An Programme manager has been appointed – Emily Cousins An implementation plan will be drawn up

SS confirmed that Rushcliffe CCG had been awarded £740k as part of the Prime Ministers Challenge Fund (the letter detailing this was included in the papers). Detailed plans will now need to be submitted to NHS England.

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VB confirmed that the Patient Survey interim report was the first draft and did not as yet include any analysis of the focus groups which have been carried out. VB also confirmed that practice level data would be available once the work had been completed on the report.

NP presented the Dementia Diagnosis Rates for Q1 which shows that all but one practice is not hitting the target.

CC/14/144 Any Other Business

There was no other business

Date and time of next meeting: Thursday 4 September 2014, 1.30 – 4.00pm