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NHS Wakefield District COMMISSIONING EXECUTIVE COMMITTEE Minutes of the meeting held on 1 September 2011 in the Boardroom, White Rose House Present

Dr Adam Sheppard Roger Grasby Ann Ballarini Jo Webster Andy Leary Dr Andrew Furber Dr Raj Aggarwal Dr Lutfe Kamal Dr Avijit Biswas Sam Pratheepan

In Attendance

Sarah Harrison Debra Taylor-Tate Matt England Angela Peatfield

Vice Chair NHSWD Chair Director of Commissioning and Service Development Clinical Commissioning Unit Director Director of Finance Director of Public Health Chair of South Elmsall & Rycroft Clinical Commissioning Group Chair of The Grange, Clinical Commissioning Group GP Alliance Board Member Director Adult Services, WMDC Public Health Registrar (shadowing Dr Andrew Furber) Senior Commissioning Manager Senior Commissioning Manager Minute Taker (Corporate Services)

11/136 Apologies Apologies were received from Dr Phil Earnshaw, Gill Galdins, Elaine McHale and Dr David Brown. 11/137 Welcome Dr Adam Sheppard welcomed Roger Grasby to the meeting. 11/138 a – Minutes of meeting held on 7 July 2011 The minutes were agreed as a correct record. b – Notes of informal meeting held on 4 August 2011 The informal notes were agreed as a correct record with the following amendment:

Item 16 – Local Carers Strategy Sam Pratheepan asked for it to be noted that although the minutes record that the local approach to the delivery of the Carers Strategy was agreed it would also be discussed at the Joint Strategic Commissioning Board. c – Matters arising 11/95 – Anti-Coagulation Service Jo Webster confirmed that a proposal for this service will be discussed at the Planned Care Clinical Commissioning Unit (CCU). Dr Aggarwal advised that three meetings have been scheduled to discuss this service and a paper will be brought to the CEC in December or January. 11/127 – Incentivising Primary Care Scheme Jo Webster confirmed that a business case will be presented to the Board on 28 September following outline discussions with the SHA to confirm the finances. 6 – Breastfeeding Peer Support Service (informal August meeting) Dr Kamal suggested that the decision regarding this proposal should be delayed until more information is available and raised concerns whether £400k will be sufficient for the operating costs. Jo Webster agreed it was important that maximum productivity is achieved for the costs involved and that the service specification provides details confirming that there is currently no change to the funding stream. As the service will be transferring to Public Health, Andrew Furber agreed to confirm the cost involved with Ian Carr, Head of Strategic Planning and Children’s Commissioning. d – Approval of decisions from 4 August 2011 meeting Following discussion the approval of the decisions made at the 4 August meeting were agreed. e – CEC Terms of Reference Jo Webster presented the updated CEC Terms of Reference explaining that they had been updated to reflect the membership changes including the addition of a named Vice Chair and amendment to show Chief Operating Officer as a member of the Committee. Roger Grasby commented that the membership did not show the inclusion of a Non Executive Member (NED) and asked for this to be added, a named NED Member is yet to be appointed. Roger advised that by the end of September there will be a single Cluster Board and the Clinical Commissioning Groups will be sub committees of the Cluster Board to achieve uniformity across the cluster. As part of the 2

Cluster Board membership it is intended that there will be NED Associates who will be lay members of the Board. It was RESOLVED to i

note the amended CEC Terms of Reference

11/139 Declarations of interest Dr Biswas declared an interest in Paper 7 – Development of new primary care premises in Castleford. 11/140 Community Specialist Obesity Service for Adults Andrew Furber presented this paper explaining that the CEC had requested further detail to be developed at the Prevention Clinical Commissioning Unit (CCU). This was undertaken at meetings in June and July and details finalised and communicated to the CEC under matters arising. To ensure robust governance regarding this commissioning decision this paper is requesting formal support by the CEC for the model recommended as follows: Stages 1-3 be commissioned from the Health Trainer Service Stages 4-5 be commissioned from Mid Yorkshire Hospitals Trust (MYHT) Exercise on referral to be commissioned from Wakefield Council and incorporated into stage 4 of the service. A full discussion followed with the following comments raised: Dr Kamal commented that as part of the stages 1-3 this will take place exclusively within GP practices across all three consortia and should improve the service Dr Aggarwal raised concerns regarding the cost of the health trainers and felt that the costings did not add up and productivity should be reviewed outside Payment by Results (PbR) Matt England explained that most of the activity is not consultant led and only when specialist opinion is sought does the PbR tariff apply Dr Biswas commented that we need to make sure the service is value for money and queried what assumptions had been taken regarding return patients Andrew Furber confirmed that a mechanism for patient relapse has been incorporated into the model Sam Pratheepan commented that it is difficult to monitor progress and there is a need to ensure links are in place with the Local Authority Jo Webster commented that outcomes will be measured long term and the using the health trainers in a different way.


It was RESOLVED to i ii

agree the adult obesity service model with a review in six months; and agree to release the remainder of the money intended for this service (approximately £500k) to QIPP

11/141 Oral Capacity Pressures Debra Taylor-Tate attended the meeting to present this paper advising that throughout 2011/12 the PCT and MYHT have been working to implement a range of measures in order to improve and sustain the delivery of local Oral surgery services in line with national access targets. It was noted that although numbers waiting over 18 weeks has reduced it has been identified that further actions are now required to address the ongoing capacity pressures and improve access to services for local patients in advance of the winter period. Debra outlined the additional short term options that are being proposed to further address capacity pressures at MYHT. It was noted that as part of the Service Transformation Programme, commissioner and stakeholder events have been scheduled for September and October respectively, where the opportunity to transform services will be explored. A full discussion took place noting that emergency commissioning arrangements are required to ensure that patients receive services within 18 weeks. It was also noted that it will take time for local dental practices to be accredited as there is a requirement for registration on the specialist dental register. It was RESOLVED to i ii iii

note the contents of the briefing paper and progress in relation to Plan B 18 week Recovery Plan actions’ approve Option 4 noting the risks outlined; and note the progress in relation to the long term service transformation developments.

11/142 Delivery of ‘Higher Risk/Primary Care’ element of the Specialist Alcohol Treatment Payment by Results (PbR) approach Dr Kamal presented this paper explaining that the Department of Health has committed to a project to develop Payment by Results (PbR) for Specialist Alcohol Treatment Services, noting that Wakefield is one of four national pilot sites. Spectrum Community Health has been funded to extend this work to include primary care based interventions and is seeking support from the CEC to recruit 10 Wakefield GP practices to take part in the 12 month pilot project. There is no cost to practices other than the time to participate. Each practice will nominate a lead GP and preferably a lead nurse supported by the practice manager. 4

Following discussion it was noted that a letter will be sent to all practices and practices with a high intake of the relevant patients would be encouraged to take part. It was RESOLVED to i

support the proposal for the pilot project to work with 10 Wakefield practices

11/143 Development of new primary care premises in Castleford – Progress Report Andy Leary presented this paper which updates the CEC on progress made to date. The project objective was to deliver improved primary care services to the population of Castleford from high quality fit for purpose buildings. A ‘Premises Development Strategy and Affordability Analysis’ document was produced following meetings of the Project Board and Project Team together with public and key stakeholder consultation. The full report is available but the attached paper provides the initial section of the report together with the conclusions and recommendations. It was noted that the full report was considered by the NHSWD Board at a private meeting and was approved subject to this project still being considered of high priority by GP commissioners. If the CEC approve this outline business case it will be developed to a full business case where it will need to be finally agreed following formal public consultation by the appropriate statutory body in place at that time. Currently this will be the PCT Board or its formally delegated Board and the Strategic Health Authority. A full discussion took place and Dr Biswas gave a bit of background to the project and confirmed that it was intended that approximately half of the space would be utilised by community services, noting that at present the two sites option is preferable. Roger Grasby highlighted that it is important that GPs are signed up to this project as any building will not take place until after the PCT comes to end and GP Commissioning commences. Andy Leary confirmed that the local district valuers will clarify what is allowed regarding size of the building/s and a full public consultation would take place. It was RESOLVED to i

support the development of new Primary Care Premises in Castleford


11/144 Demand Planning Matt England attended the meeting to present this paper which outlines the proposed approach and key phases of the demand planning process for 2012/13. Demand planning is the process of identifying the volume of patients that are likely to require a referral into secondary care services and formulating a detailed plan of what to purchase for the period. A proposed timeline and key milestones were shared for information. Jo Webster confirmed that this plan will run alongside and in partnership with the MYHT Capacity Plan. It was RESOLVED to i

approve the demand planning approach for 2012/12

11/145 Changes in Patient Flow Matt England presented this paper providing a brief overview of current 2011/12 activity trends at Secondary Care Providers comparing activity flows against the same time period from 2010/11. It was noted that there is an increase in daycase rates across the activity. The PbR system now incentivises providers to undertake specific procedures as daycases as they have made the tariff for those Healthcare Resource Groups more expensive when undertaken as a daycase. This is a likely explanation for the sudden increase in daycase rates. A discussion followed and it was agreed that this clinical information would be helpful to practices when looking at coding. Sam Pratheepan commented that the Local Authority produce similar information and a discussion will take place at the Joint Strategic Commissioning Board regarding patient flow and discharge planning. Roger Grasby informed members that details of the re-structuring of MYHT may be available to share at the next CEC meeting. Ann Ballarini advised that there is a meeting scheduled for 15 September for GP Board Members to discuss the MYHT service re-configuration. It was RESOLVED to i

note the content of the report and changes in activity trends

11/146 Any Other Business Input on commissioning in Leeds Dr Kamal raised a query regarding the PCT’s input on commissioning in Leeds. Jo Webster confirmed that she would discuss this with Leeds PCT as they are the host for Leeds Teaching Hospital and we are an associate PCT. 6

Carers Association Sam Pratheepan raised a query regarding the carers grant and how much funding had been identified as part of the Carers Strategy. Jo Webster and Andy Leary will discuss at the Joint Strategic Commissioning Board. Jo Webster and Andy Leary will be discussing this at the Joint Strategic Commissioning Board and a letter will be sent to the leader of the Council. 11/147 Date and Time of Next Meeting Thursday, 6 October 2011, 10.30 to 1.30 pm in the Boardroom, White Rose House.