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NHS Rushcliffe Clinical Commissioning Group Minutes of the Clinical Cabinet Meeting

Thursday 7 March 2013 1.30 - 4.00 pm

Clumber Meeting Room, Easthorpe House All attendees should be aware of Nottinghamshire County Teaching PCT’s participation in the Freedom of Information Act. The minutes and papers from this meeting could be published on 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)

Vicky Bailey (VB) Chief Officer

Tim Daniel (TD) GP, Orchard Surgery

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

Neil Fraser (NFr) GP, East Leake Medical Centre

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

Helen Griffiths (HG) Assistant Chief Officer

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

Alex Macdonald (AM) GP, Belvoir Health Group

Corrina Small (CS) GP, Keyworth Medical Practice

Sean Ottey (SO) GP, West Bridgford Health Centre

Nick Foster (NF) GP, Orchard Surgery A

Ian McCulloch (IM) GP, Musters Medical Practice A

Lynn Ovenden (LO) GP, Southview Surgery

Nick Page (NP) GP, Ludlow Hill Surgery

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

Bakula Patel (BP) GP, Compton Acres Medical Centre

Clive Rix (CR) Lay Member, Governing Body

Stephen Andersen (SA) Head of Finance

Kate Robertson (KR) Falls Clinical Specialist, CHP

Mike Spencer (MS) GP, Ruddington Medical Centre

Andy Warren (AW) Patient Cabinet representative

In Attendance

Andy Hall (AH) Director of Outcomes and Information (NW, NNE & R CCG)

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

Cheryl Crocker (CC) Director of Quality and Patient Safety and Executive Nurse

Jonathan Bemrose (JB) Director of Finance (NW, NNE & R CCG) A

Nicky Tyler (NT) Practice Manager, East Leake Medical Group

Jan Clements (JC) Practice Manager, Soar Valley Surgeries

Liz Harris (LH) Service Improvement Manager

Beth Carney (BC) Prescribing Advisor

John Kemp (JK) Practice Liaison Officer (minutes)

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ACTION CC/13/178 Apologies and Welcome SS welcomed everyone to the meeting specifically Jan Clements, Practice Manager at Soar Valley Surgeries, Nicky Tyler, Practice Manager at East Leake Medical Group.

CC/13/179 Declarations of Interest A standing general declaration of interest was acknowledged in respect of:

(i) All participants who have provider contract(s) with the PCT. (ii) All participants with membership of Nottingham Emergency Medical

Services.

CC/13/180 Minutes from the previous meeting The Notes from the meeting held on 7 February 2013 were agreed as an accurate record.

CC/13/181 Schedule of Actions from previous the meeting CC/13/160 Draft Integrated Business Plan for CHP – HG confirmed that she would circulate the document CC/13/162 Commissioning Outcomes Framework Implementation - Gateway leads are in the process of submitting the information requested CC/13/165 Risk Stratification pilot at East Leake – NFr provided a demo of the Devon tool at the Clinical Cabinet CC/13/166 Review of the NHS Rushcliffe Clinical Assessment Service (CAS) – CL-B will bring further details to a future Clinical Cabinet meeting CC/13/168 IFR Panel – SO provided a financial breakdown as requested and will do so for future Clinical Cabinet meetings CC/13/171 GP Pay – VB noted that there had been three responses to her email – two against and one for. Of those responses received it was agreed there would be no uplift to current payments. CC/13/175 Wound Care – BC was in attendance to provide an update from the LPC. It was noted that some prescribing practices may be adversely affected by these changes and it was felt that more time was needed to explore and understand the impact to support these practices in adapting to the new pathways. The options provided were as follows: -

1. Continue as planned 2. Continue as planned but with more time 3. Don’t proceed at all 4. Complete a pilot and evaluate the benefits

After discussion the Clinical Cabinet decided on option 2. This would allow for the unintended consequences of the new system to be understood and support to be implemented for those practices affected.

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CC/13/183 Francis Report CC spoke to her presentation which was an overview and summary of the Francis Report. The report builds on the Independent Inquiry, published in 2010 following the failings in Mid Staffordshire NHS Foundation Trust between 2005 and 2009. It is reported that patients were failed first and foremost by the Mid Staffordshire hospital but also at a national level by the regulatory and supervisory system which should have secured the quality and safety of patient care. During the ensuing discussion the following points were raised: -

CC noted that the Department of Health are due to respond to the report by May 2013 in response to a question from SS.

AW stated that fundamental standards were too high and that delivery of basic care was needed.

MS commented that he felt there was nothing new in the report and that the recommendations should already be happening. MS also noted that feedback needed to be logged properly

RP asked if there would be more resources for extra staff and noted that when staff were too busy that it was the quality of care that suffered. CC responded that no additional funding had been provided to bring in the recommendations

AM argued that it was difficult to measure care and that the culture of the NHS had to change to make sure that patient was the priority

CC confirmed that the Francis Report would have a large impact on Practices and that a sub group of the ? and Risk Committee will be established to address the recommendations

The Clinical Cabinet NOTED the presentation and summary report

CC/13/184 Primary Care Development Centre VB spoke to her paper which detailed the proposal/business plan for the establishment of a primary care development centre for Nottinghamshire City and County. VB explained that the idea of a Primary Care Development Centre had come been developed by the LMC subgroup and that the NHS Rushcliffe CCG representative on this had noted the 14 out of the 16 Rushcliffe PMs wanted support. VB asked whether practices should deal with their own training or a collaborative programme developed. AW suggested that lay member training might be able to be incorporated too. ACTION VB will bring alternative options to the next Clinical Cabinet

VB

CC/13/185 eHealthscope/Devon tool NFr spoke provided a demonstration of eHealthscope/Devon tool and talked through its practical uses. AH added that all of the data used by the tool is from the data warehouse and there

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was additional secondary care extraction facilities included. AH also noted that the data will be governed by Practices and not the CCG. ACTIONS

NFr will email out details of alternative options to the Devon tool

Mike O’Neil will be asked to provide a master class on eHealthscope

NFr AH

CC/13/186 The Sound Doctor NFr spoke to his paper regarding The Sound Doctor which is an audio-visual interactive website which supports self-care and management, it including a chat room for patients, designed to help people get the most out of life with a long-term condition. Its aim is to help people understand their condition better so they can cope more effectively at home and improve their quality of life. The paper also details the benefits and cost of the service as well as its practical applications for patients as a self-care tool. AW noted that the Sound Doctor was a good idea and provided good reliable information. SS suggested patient groups should be used to spread the word about this newly commissioned self-help tool. The Clinical Cabinet NOTED the paper

CC/13/187 Provision of Services by Voluntary Sector in Rushcliffe CCG HG spoke to the paper which provided an outline of the current provision of services by the third sector for the Rushcliffe CCG patient population. HG noted that agreement across the practices is required regarding how services provided by the voluntary sector could be supported in terms of access/costs to accommodate. A specific issue was in relation to the accommodation provided to Cruse and the proposed renter costs being suggested by Notts Healthcare Trust. SS stated that the CCG should be supporting the third sector organisations and should therefore either be charging no fee or paying on their behalf. VB summarised that it was the right principle and asked HG to draft how the CCG will manage this in the future. ACTION HG to do further work and report back to the Clinical Cabinet at a future meeting.

HG

CC/13/188 OOH Tender VB spoke to her paper which was a briefing paper regarding Out Of Hours Procurement for Nottinghamshire, January 2013.

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The following points were raised during the ensuing discussion: -

VB noted that the process was complex, particularly in view of managing conflict of interests of stakeholders. Current engagement with patients suggests that patients would prefer their own practices to provide their out of hours provision.

SS asked that the decision ideally needed to be in the best interests of the population of Rushcliffe and the option appraisal being drawn up was essential

MJ questioned whether there should be a Rushcliffe based out of hours service

TD reported that current negotiations required ongoing scrutiny and are being lead of Nottingham City CCG. Ongoing representation on the stakeholder group were essential.

ACTIONS LH to attend next meeting (Friday 8 March 2013) The following requirements were sought: -

Terms of reference for the group

Confirmation of representation on the stakeholder group

CC/13/189 Closure of Lings Bar nurse dermatology service VB reported on the closure of the Lings Bar nurse dermatology service. Although there is a limited activity/use of services, the contracting team are in contact with NUH due to the lack of consultation regarding the service being decommissioned. ACTION Consideration will also be given to future local need The Clinical Cabinet NOTED the verbal update

RP

CC/13/190 MSK Physiotherapy VB explained that the three year contracts for MSK Physiotherapy services are coming up for renewal and currently providers were in communication with the CCG regarding future plans. ACTIONS VB asked for Clinical Cabinet members to email her any issues that she can carry forward in the physiotherapy service commissioning process.

Clinical Cabinet

CC/13/191 Finance Report SA spoke to his paper which provided the following headlines: -

The CCG has delivered an under spend of £1,071 thousand for year to date to 31st January 2013, but is below the surplus target by £278 thousand for the period.

The CCG is short of the QIPP target plan for the period April – January by £330 thousand.

The CCG is expected to be within the published indicative running cost

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allowance for the CCG. SA confirmed that the QIPP savings for 2013/14 was £2.5 million. The Clinical Cabinet NOTED the paper CC/13/192 Performance Report AH spoke to his paper which provided the following summary: - CCG/PCT Indicators out of trajectory -

2 week wait: Breast Symptoms (Page 2) – Performance in December fell below the 93% standard to 91.78%. Year to date performance remains above the standard and is currently at 94.39%.

A&E Waiting Time (Page 3) – In January, SFHT A&E waiting time performance was below standard at 94.47%. Year to Date performance remains below standard at NUH and SFHT.

NUH Indicators out of trajectory -

Cancer 62 Day Referral to Treatment Standard (Page 4) – Performance in December is above standard for the first time in 2012/13, year to date remains below the standard at 82.38%. As a result a first exception report has been issued to NUH. Methods to improve performance continue and include: - Detailed tertiary referral analysis - Potential changes to indicator construction around breach assignment to

providers - Daily review of underperforming specialties to identify additional capacity

requirements

Cancer 2 Week Wait: Breast Symptoms (Page 4) – The 93% standard failed to be met for the first time in 6 months, this has resulted in year to date performance dropping below the standard. There were 7 breaches in December all of which were a result of patient choice. Actions for improving performance continue and include: - Working with GPs to stress the importance of being seen within 2 weeks of

referral

RTT (Page 6-9) – Performance at NUH for T&O patients (including spines) continues to improve with the number of long waiting patients reducing. Actions for improving performance continue and include: - Offering patients the choice of transferring to alternative providers - Additional clinical sessions being undertaken at NUH - Establishment of a Clinical Spinal Network to ensure pathways are

appropriate, and service configuration and capacity is being planned accordingly.

A&E Waiting Time (Page 10-11) – Performance in the latest period (Jan 13) was above the national standard for the first time since May 12. Despite this, year to date performance remains below the required standard. Actions to improve performance include: - Improving discharge processes; - Implementation of actions as per Remedial Action Plan

Cancelled Operations (Page 12-14) – The cancelled operations standard has

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not been met in January. The trust has an improvement plan that focuses on reducing all cancellations (on the day and prior to the day). Actions to improve performance include: - Improved communication and escalation within NUH; - Additional clinical leadership; - Improved scheduling.

Slot Unavailability (Page 14) – Performance in Jan 13 was above the 4% standard for the 4th month out of the last 5, year to date performance remains below the standard at 5.72%.

EMAS (Page 17-18) – Category A performance remains below standard for the 8 and 19 minute targets. Comparative performance across ambulance trusts is shown on page 18.

CC/13/193 Plan on a page The Clinical Cabinet NOTED the paper

CC/13/194 IFR Meeting report The Clinical Cabinet NOTED the paper CC/13/195 HWB summary JG spoke to his paper and provided the following summary: -

The papers include a report on the Sherwood Forest Trust regarding the mortality rates which had implications on NHS Rushcliffe CCG patients who attended at this hospital

The budget for Public Health was detailed at £35 million of which £1.2 million has been put aside for an innovation pot

The Clinical Cabinet NOTED the paper

CC/13/196 Nottinghamshire LMC General Practice Awards 2013 VB spoke to her paper which detailed the Nottinghamshire LMC General Practice Awards 2013 and asked the Clinical Cabinet whether the CCG should nominate for the awards or allow the PPGs and practices to do so instead. The Clinical Cabinet agreed that nomination choices should be lead by patients.

CC/13/197 Any other business There was no other business Date of Next Meeting Thursday 4 April 2013 1.30 - 4.00 pm Clumber Meeting Room, Easthorpe House