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Minutes of the GHCC Executive Committee Meeting held on Thursday 23rd June 2011 at 9.00am in the Hargreaves Room at Broad Lea House, Bradley Business Park, Huddersfield Present: Tony Gerrard Rob Millington Steve Ollerton Judith Parker David Hughes Dil Ashraf Jane Ford Anuj Handa Karen Dean Nicky Hoyle Steve Brennan Rachel Carter Jan Giles Sarah Crossley

Non-executive Director and Chair Non-executive Director Shadow Board Chair part time Shadow Board Vice Chair part time Shadow Board member part time Shadow Board member part time Shadow Board member part time Shadow Board member part time Shadow Board member part time Public Health Consultant Acting Director of Finance Deputy Director of Commissioning - Head of Contracting Assistant Director of Commissioning Commissioning Facilitator

In attendance: Sarah Bow

Commissioning Manager (Agenda item GHCC/11/09)

The Chair opened this first meeting by welcoming all those in attendance and introductions were made. GHCC/11/01

Apologies for Absence

Two apologies for absence were received from Carol McKenna Executive Director of Commissioning and Paul Wilding – Shadow Board Member GHCC/11/02

Declarations of Interest

The declarations of Interest document outlining areas of interest for the Shadow Board members was received and reviewed. David Hughes declared an interest in the following agenda item. GHCC/11/09 AOB : Primary Care Ophthalmology Service GHCC/11/03 Context Setting and Terms of Reference The attendees reviewed the draft Terms of Reference and the following amendments were agreed: Discussion took place about the name of the Consortium in context of the outcomes of the Listening Exercise. It was agreed that the Greater Huddersfield Commissioning Page 1 of 6

Consortium (GHCC) name was inclusive enough and should remain unchanged unless further National Guidance was forthcoming Section 5. Quorum: To change the requirement for being quorate from 2 GP Shadow Board members being present to 4 GP Shadow Board members being present Section 9. Accountability – Discussion took place regarding the requirement for the Consortium chair to provide a written report to the Board and the format this should take. It was agreed that a highlight report identifying key points from the Consortium meetings minutes would suffice with an Annual report to be submitted at year end. GHCC/11/04

Update on NHS Transition

In the absence of Carol McKenna, Steve Ollerton and Jan Giles updated the attendees. The key areas discussed were as follows: Requirement for new members (secondary care consultant and nurse) to join Consortia Boards. Following a detailed discussion it was agreed that it was too early for the Shadow Board to take this further and to await further guidance from the Department of Health. GHCC/11/05

Finance Report

Steve Brennan introduced his report which updated the Shadow Board on its forecast financial performance for 2010/11, including associated risks and action being taken to manage those risks. He explained that the format ,mirrors that which is presented to the PCT Finance and Performance Committee and the Trust Board. However, he stressed that this format is a starting point only for the Consortium and that the purpose of this discussion is to explain what is currently in the report. A key piece of work going forward will then be to look at how the report can be made more useful and relevant to the Shadow Board as the year unfolds. The report presented is a sub set of the full Board report which covers 5 areas: NKHA, GHCC, Commissioning Body, Residual PCT and Public Health. These five areas then add back to one whole and where it is not currently possible to split out the costs exactly between these 5 areas they have been apportioned on percentage or weighted list size basis. Discussion took place regarding the allocation of budgets and fair share and it was acknowledged that this is an upcoming issue however as the allocation formula has not yet been published it was agreed to delay these discussions until more is known. The two key areas now are managing the contracts and delivering QIPP and both of these can be progressed without the allocation formula. Steve Brennan asked the Executive Committee to consider how they are going to agree to manage the finances and the level of reporting detail they will require. He highlighted the fact that the content of the report, as it is now, will change over the next few months, even if the numbers stay the same.

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Action: Steve Brennan and Steve Ollerton as GHCC lead for Finance and Performance to meet outside this meeting to discuss the content of the finance report in more detail and to consider format the Finance report may take in the future. It was agreed that Steve Brennan continue to bring the finance report to this meeting and depending on outcomes of the discussions with Steve Ollerton bring additional detail back to the Shadow Board for review. The Board RECEIVED and NOTED the contents of the Director of Finance’s Report and confirmed that they continue to support the work being done to address the forecast financial position of the Consortium. GHCC/11/06

Contracting Report

Rachel Carter presented the Contracting report also explaining that the format of this report for the Shadow Board is a starting point and the Shadow Board will have to consider the level of detail that they require. Rachel then ran through the report which is the latest contracting information available at PCT level. It was highlighted that although this information is consistent with, it is not always identical to, the finance information. The following key areas were discussed: Activity and Finance at CHFT – overall position of an overtrade of £3.6 million taking into account £0.9 million of successful challenges throughout the year. Quality measures. The Shadow Board enquired how they may influence the setting of CQUINS. Rachel confirmed that the setting of CQUINS is part of the contract negotiation process and progress against these is reported regularly via the Clinical Quality Board. Shelia Dilks is the lead Director for this Board. Yorkshire Ambulance Service (YAS). Detailed discussion took place regarding the performance of YAS highlighted in the Contracting Report and whether or not this was a key issue for this Consortium as the worst Kirklees performance of 23.8% (of a 75% target) was in Denby Dale and Kirkburton. It was agreed that more comprehensive information regarding YAS performance be brought to a future meeting to allow this area to be more fully explored and the Shadow Board to make an informed decisions regarding the identified poor performance in this area. Through the course of this discussion the Shadow Board also agreed to actively promote amongst their constituent practices the provision of direct access numbers for GPs to YAS for use in work hours only. ACTION: Direct access numbers for GPs to be made available to YAS as per their recent request. David Hughes as lead for Urgent Care to progress this. Rachel Carter provided a verbal update to the Shadow Board on current contracting position. The highlights were as follows:

Floor and ceiling arrangements to be in place for this year’s contract. Contract with CHFT hoping to be signed off in the next week.

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The contract will be traded out as per usual rules and this arrangement effectively provides some breathing space for commissioning plans to be lined up in this period of change. The floor and ceiling arrangement is a significant risk to CHFT as historically Kirklees have overtraded year on year on the contract. Therefore it has been agreed that as soon as an overtrade is identified that the PCT and the Trust will work together as a health economy to try and understand why the over trade is happening and the action required to tackle this robustly. Challenge Process – a risk sharing agreement has also been put in place because of the floor and ceiling arrangement to limit the amount of money that Kirklees may take back from CHFT via the contract challenge route for new areas identified. Action: Rachel Carter and Dil Ashraf as Consortium lead for Contracting to meet outside this meeting to discuss the content of the Contracting report and verbal update in more detail and to consider format the Contracting report may take in the future. The Shadow Board RECEIVED and NOTED the contents of the Contracting Report. GHCC/11/07

Performance Report

In the absence of Carol McKenna, Rachel Carter presented the Performance report to the Executive Committee. Rachel introduced the report confirmed that the PCT continues to be statutorily responsible for the PCT performance and that this report is the report that was submitted to the NHSK Finance, Performance and Strategy Committee on 22 June and is at PCT level. The intention is that the Shadow Board will receive performance reports at each of its executive committee meetings and work is ongoing to develop report at Consortium level. The Shadow Board were asked to consider the format of the performance report going forward. Rachel took the Shadow Board through the report and key items discussed were as follows: MRSA – initial work has been undertaken to split information out between Consortia but as this is work in progress for reporting purposes here this has been taken as all activity at CHFT reported under GHCC and all at Mid Yorkshire Hospitals Trust (MYHT) under North Kirklees Health Alliance (NKHA) Commissioning Consortium. 18 Weeks – delivery against this is a problem at MYHT and is showing as amber for NKHA but is a potential problem across the whole of the PCT with the issue of patient drift which could put additional pressure on CHFT going forward. Lung Cancer – there is a delay for patients requiring PET scan at Leeds. Rachel confirmed that Contracting are aware of this problem and are working on reducing this. The Shadow Board NOTED the performance against the key performance indicators. GHCC/11/08

Strategic Development – Update from 9th June Session

Jan Giles tabled a document outlining the principles and aims for the Shadow Board/ Consortium strategic plan and asked that the Shadow Board members take these away to consider and they will be discussed in detail at the next meeting. Page 4 of 6

ACTION: Principles and Aims – agenda item for next meeting. Jan outlined the next steps following the 9th June development session as follows: The development of a suite of documents to include: -


High level business plan Operational Plan Organisational Development Plan Communication Plan Finance Plan

Any Other Business

Meetings It was noted that a GHCC Executive committee meeting is scheduled for October half term week. It was agreed to leave the meeting as scheduled as long as attendance is still quorate. Discussion about the length of this meeting took place and it was agreed to leave this at 2 hours for the next few meetings to see how this works. The decision will be taken in October whether to extend the meeting to 3 hours. Paul Wilding joined the meeting. Primary Care Ophthalmology Service It was agreed that David Hughes should stay for this discussion but opt out of any decision making due to a potential conflict of interest as this service is currently available for patients of Elmwood, Oaklands and Slaithwaite practices. David Hughes is a GP at Elmwood Health Centre. The purpose of this discussion was to update the Shadow Board on the proposed revised cost for the primary care ophthalmology service. Sarah Bow provided a summary of the background of this service and the reason for its recent review. This service has been in place for a number of years and predates both PbR and PBC guidance. Detailed discussion took place regarding the history, current scope of the service and possible extension of this to other practices. Approval was given at Business and Financial Planning Committee in April 2011 to continue the existing service for the next 12 months and that further discussions regarding the extension of the provider base should take place through GHCC. These discussions should also take into account the previous agreements with Kirkburton, Newsome and University practices. Work has been carried in conjunction with finance and performance analyst to develop a robust bottom up costing of the service and Sarah Bow asked that the Shadow Board agree the proposal that negotiations for the single price of the service should start from a fixed price for the service which roughly equates to 85% of the current PbR tariff. The Shadow Board AGREED with the proposal. Page 5 of 6


Date and time of the next meeting

It was AGREED that the next meeting of the GHCC Shadow Board Sub – Committee would take place between 2 and 4 pm on Wednesday 27th July 2011 at Broad Lea House.

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