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NHS Wakefield District COMMISSIONING EXECUTIVE COMMITTEE Minutes of the meeting held on 8 November 2011 in the Boardroom, White Rose House Present

Dr Phil Earnshaw Dr Adam Sheppard Gill Galdins Jo Webster Dr Andrew Furber Jonathan Molyneux Dr Raj Aggarwal

In Attendance

Dr David Brown Sam Pratheepan Sandra Cheseldine Gill Wainwright Susanne Gahlings Angela Peatfield

Chair Vice Chair Chief Operating Officer Clinical Commissioning Group Director Director of Public Health Interim Director of Finance and Efficiency Chair of South Elmsall & Rycroft Clinical Commissioning Group Wakefield Alliance CCG Director Adult Services WMDC Cluster Non Executive Director Head of Commissioning Finance Health Improvement Principal – Children and Young People Minute Taker (Corporate Services)

11/166 Apologies Apologies were received from Dr Lutfe Kamal, Dr Avijit Biswas, Ann Ballarini, Elaine McHale, Ann Ballarini 11/167 Welcome Dr Phil Earnshaw welcomed Dr David Brown and Jonathan Molyneux to their first meeting. Jonathan Molyneux explained that as part of his role as Interim Director of Finance and Efficiency for the Cluster he will be supporting the development of the Clinical Commissioning Groups (CCGs) and ensuring the appropriate systems and processes are in place. It was noted that a summary will be produced for CCGs detailing what was agreed at the November Cluster Board meeting with regard to CCEs. 11/168 Minutes of meeting held on 6 October 2011 The minutes were agreed as a correct record subject to the following amendments: Attendance – Jo Webster was shown as being present at the meeting but should have been shown in Apologies.

11/127 – Incentivising Primary Care Scheme Dr Raj Aggarwal asked for the last sentence to be amended to say that Dr Aggarwal has some concerns regarding the proposed scheme and to suggest that the key performance indicators should be kept simple. 11/169 Matters arising 11/155 – Funding Request for Rehabilitation Equipment Gill Wainwright confirmed that the funding for equipment had been clarified. Jo Webster explained that discussions had taken place at the Joint Strategic Commissioning Board and had subsequently agreed that this should be funded via winter planning monies as it related to additional beds. Jo also confirmed that it was non recurrent. 11/156 – Enhancing the Current Nephrology (Renal) Service Further work on the service proposal and the financial model is being undertaken. A revised paper on the business case will be presented in January 2012. Dr Phil Earnshaw commented that he and Dr Adam Sheppard had met with Jo Harcombe to discuss where the business case required strengthening. 11/162 – GPs working in ED at Pinderfields It was noted that Richard Sewell, Head of Unplanned Care and Long Term Conditions has arranged to meet with Rob Hurran, Family Services at the Local Authority. Sam Pratheepan asked for the detail regarding the specific cases concerned. Jo Webster confirmed she would send the report to both Rob Hurran and Sam Pratheepan. 11/164 – QOP QP indicators It was noted that members of the Performance Team would be supporting practices through the process and some practices have already started their peer review meetings. 11/170 Declarations of interest None 11/171 Future Governance Arrangements Gill Galdins presented this paper providing details of proposed terms of reference for meetings of key groups to be established within the Wakefield District which will support the delegation of authority from the Cluster Board to the Clinical Commissioning Executive and help emerging clinical commissioning groups (CCGs) with progress towards authorisation. It was noted that as part of the agreement of the revised governance structure, the Cluster Board agreed a terms of reference for CCEs within each of the member PCTs. Following consideration of the approved terms

of reference within the local Wakefield District a proposed terms of reference of the Wakefield Alliance CCE is presented with amendments highlighted in red for ease of reference. The terms of reference detail proposed membership and roles and duties of the Committee. Dr Phil Earnshaw asked for clarification on what had been agreed at the Cluster Board. Gill Galdins confirmed that both the Wakefield Alliance CCE and White Rose CCE were approved and further discussion will take place regarding The Grange CCE and the decision has been deferred for one month. Jo Webster confirmed that the link from the Wakefield Alliance CCE to the Cluster Board will be Sandra Cheseldine, Non-Executive Director and the link for White Rose CCE will be Roger Grasby, Non-Executive Director. Dr Andrew Sheppard queried whether the financial limit would remain the same as at present. Dr Phil Earnshaw confirmed that it would and when decisions were required in excess of this limit the CCEs would make a recommendation to the Cluster Board for approval. Jonathan Molyneux confirmed that director sign off would also be required as part of the audit process, as auditors would request to see a signed agreement by a director. Andrew Furber queried how issues that effect the whole of the district would be handled. Jo Webster commented that the CCGs would need to work collaboratively and further discussions would need to take place regarding the best way forward for the Clinical Commissioning Units. Sam Pratheepan suggested that the Well Being Board should be enhanced and Jo Webster agreed to provide amended wording for the CCE terms of reference to include the connection with the Local Authority and their links with the CCGs. Dr Phil Earnshaw advised that on page 4 of the terms of reference this should show two directors from the Local Authority as part of the membership. Also the wording on page 4, paragraph 4, requires amendment noting that the Wakefield Alliance CCE is not replacing the Wakefield Alliance Board. It is also proposed that three new groups are established and report directly to the CCE in the areas of finance and performance, audit and governance and quality. The sub groups will have no executive powers but will act in an advisory capacity to the CCE with decisions referred to the CCE on the recommendations of the group. It was noted that further clarification is being sought as to whether certain powers may be delegated. Following discussion it was suggested that these sub groups would work on a joint basis across the CCEs as it was felt they would not be sustainable individually. Sandra Cheseldine commented that it would be difficult to separate the business across three sets of sub groups for each CCE when looking at the support functions of statutory accounts etc. Gill Galdins commented that this is an opportunity to work smarter. Andrew Furber

added that care should be taken not to stifle innovation and this is a real opportunity as the CCGs know their population. Dr Phil Earnshaw commented that there are challenges to overcome in providing a safe and lean system. Jonathan Molyneux commented that the groups need to be made “real� and a framework set up. Further work outside of the group is required regarding Standing Financial Instructions and to confirm the process for governance issues as part of the 10 year agenda. It was agreed that this work would be brought back to the first meeting of the Wakefield Alliance CCE. It was RESOLVED to i ii

discuss and note changes and that the updated version will be presented at the first meeting of the Wakefield Alliance CCE; note that the appointment to the Chair and Vice Chair role for the Wakefield Alliance Clinical Commissioning Executive will be formally recommended to the Cluster Board for approval.

11/172 Wakefield College Well Being Service Suzanne Gahlings attended the meeting to present an update on the pilot well-being service developed across Wakefield College with the following key objectives: Access to appropriate services Provision of high quality services where and when required by the client group Early intervention and prevention Reduction in smoking, obesity, sexually transmitted infections, teenage pregnancy, alcohol and substance use It was noted that 115 students had directly accessed the service and presentations/interventions had been provided across all campuses during tutorial sessions. Suzanne commented that direct access to the service was only part of the pilot, training and support for staff enabling them to contribute to core interventions and facilitate referral to intermediate and complex interventions had also taken place. A full discussion took place. Dr Rag Aggarwal asked for further clarification on the numbers involved, Suzanne replied that this was difficult to quantify in such areas as attendance at A&E. Dr Phil Earnshaw felt there was a need for proof of concept. Although this work had been shared with the Clinical Commissioning Unit, members felt that further investigation and answers to queries were required. It was agreed that further detail would be presented at the next meeting. It was RESOLVED to i

note the report and receive an updated report at the next meeting to include more detailed information

11/173 Improving Access for Emergency Patient Opinion and Admission within MYHT Dr Adam Sheppard presented this paper providing an update of work to improve access for assessment and admission for patients to MYHT. Patient flow has long been an issue and GPs have experienced difficulties when requesting assessment and/or admission to hospital. By streamlining systems we will ensure that all GPs use the same telephone number which will be answered promptly. It was confirmed that the new model will be presented at the Executive Contracting Board on 9 November for approval. Dr Aggarwal raised a concern that MYHT accept responsibility for the current situation. Dr Adam Sheppard replied that the situation was not ideal but something needs to be done to make improvements. Jo Webster commented that this was about working differently and confirmed that the MYHT Management Team have found the current situation frustrating and are keen to see the system improve. Dr Phil Earnshaw thanked Dr Adam Sheppard for his contribution and support in developing this new model. It was RESOLVED to i

acknowledge and approve the implementation of this model to improve patient flow and experience

11/174 Update on Urgent Care Specification and Procurement Dr Adam Sheppard presented this paper providing an update on the DH and Yorkshire and the Humber position in relation to the 111 procurement programme. The paper also provides detail on the West Yorkshire and Wakefield District approach to procuring a local „consult and treat‟ service. It was noted that in order to ensure that we secure a local ‟consult and treat‟ service that meets the needs of our local population, a letter has been forwarded from Dr Adam Sheppard to all GPs and Practice Managers seeking volunteers to participate in a working group to develop the specification for the Wakefield and District urgent care „consult and treat‟ services. The meetings will take place during November. Also a multiagency stakeholder event is to be held in December to capture the views of the local health and social care economy. Dr Phil Earnshaw advised that there is a requirement to deliver the 111 procurement by April 2013 and that the re-provision of the out of hours service may take a little longer. This should be seen as a two stage process. The question was raised regarding public consultation and Gill Galdins agreed to discuss with Sue Ellis, Director of HR and Organisational Development.

It was RESOLVED to i ii

note the DH and Yorkshire and the Humber position in relation To the 111 procurement programme; and support the West Yorkshire and Wakefield District approach to Procuring a local „consult and treat‟ service.

11/175 Feedback from Clinical Commissioning Units Jo Webster presented feedback from the Clinical Commissioning Unit meetings for information. It was felt that further consideration is required as to the best way of sharing feedback from the Clinical Commissioning Units. 11/176 Any Other Business Briefing and next steps for Any Qualified Provider (AQP) Jo Webster presented this paper providing an overview of AQP and progress to date. AQP is part of a series of measures designed to further extend patient choice across the NHS. The goal is to enable patients to choose any qualified provider where this will result in better care. Appendix 1 of the paper details the Cluster‟s submission of the first tranche of services to be procured through AQP for 2012/13. It was noted that engagement with patients, patient representatives, Health and Wellbeing Boards (HWBs), healthcare professionals and providers on local priorities has taken place. Between April and September 2012 the Cluster will have implemented patient choice of AQP in those identified services agreed locally following the options appraisal and decisions taken. The next steps are for the contracting leads to work with their CCGs to construct a rolling programme for the continued implementation of AQP services for 2012/13 and beyond. It was RESOLVED to i

note for information

Closure of the Commissioning Executive Committee Dr Phil Earnshaw confirmed that the CEC was now formally closed. Members expressed their thanks to the Chair of the Committee. 11/177 Date and time of next meeting The first meeting of the Wakefield Alliance Clinical Commissioning Executive will take place on Tuesday, 20 December, 1.00 to 5.00 pm, Boardroom, White Rose House.