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NHS Wakefield District WAKEFIELD ALLIANCE CLINICAL COMMISSIONING EXECUTIVE Minutes of the meeting held on 20 December 2011 in the Boardroom, White Rose House Present

Dr Phil Earnshaw Heather O Donnell Dr Adam Sheppard Dr Avijit Biswas Dr Ann Carroll Dr Clive Harries Dr David Brown Dr Ivan Hanney Dr Paul Dewhirst Sandra Greenwood Sam Pratheepan Dr Andrew Furber Gill Galdins Gill Wainwright Rhod Mitchell Sandra Cheseldine Steve Bryan

In Attendance

Adam Bassett Lee Beresford Matt England Joanne Hinchcliffe

Chris Wathen

Caroline Abbott

Jez Mitchell

Andrea McCourt

Chair, Wakefield Alliance Vice Chair, Non-Executive Associate GP, Lupset Health Centre GP, Pinfold Surgery GP, Outwood Park Medical Centre GP, Chapelthorpe Surgery GP, Kings Medical Centre GP, College Lane Surgery GP, Queen Street Surgery (left the meeting following item 11/17) Nurse Manager, Ferrybridge Medical Centre Wakefield District Metropolitan Council Director of Public Health, NHS Wakefield District Chief Operating Officer, NHS Wakefield District Head of Commissioning Finance, NHS Wakefield District Non-Executive Associate Non Executive Director Practice Manager, Stuart Road Surgery Corporate Risk Manager Head of Commissioning, NHS Wakefield District Head of Contracting, NHS Wakefield District Public Health Commissioning Manager, NHS Wakefield District Minute 11/13 only Physical Activity Project Manager, NHS Wakefield District Minute 11/13 only Head of Public Health (Substance Misuse) NHS Wakefield District) Minute 11/14 only Public Health Commissioning Manager, NHS Wakefield District Minute 11/14 only Head of Corporate Governance, NHS Wakefield District Minute 11/18 only


Cat de Jonge

Senior Commissioning Manager, NHS Wakefield District Minute 11/19 only Head of Strategic Planning and Children’s Commissioning, NHS Wakefield District Minute 11/20 only Senior Commissioning Manager Minute 11/20 only

Ian Carr

Sharon Tinker

11/01

Apologies Apologies were received from Jo Webster, Elaine McHale, Jan Power and Dr Dinesh Nagi.

11/02

Opening Remarks Dr Phil Earnshaw noted that this was the first meeting of the Wakefield Alliance Clinical Commissioning Executive (CCE). He welcomed Heather O’Donnell to the meeting as Vice Chair but highlighted that Heather had decided to stand down from her role as a NonExecutive Associate at NHS Wakefield District. Dr Earnshaw reported that he would therefore be speaking to Angela Monaghan, Chair of the NHS Calderdale, Kirklees and Wakefield District PCT Cluster regarding the appointment of a new Vice Chair. Dr Earnshaw also welcomed Rhod Mitchell and Sandra Cheseldine to the meeting. Dr Carroll noted that there was a matter on the agenda (item 15 regarding the Early Intervention and Family Support Service) which identified her as the clinical lead for this paper. However she reported that she had not been advised in advance that this report would be coming to the meeting. Gill Galdins advised that Heads of Service should inform clinical leads in advance of any papers affecting their portfolios due to be considered at the CCE meeting. Gill Galdins confirmed that she would notify all Heads of Service of this.

11/03

Minutes of the meeting of the Wakefield Alliance Board held on 8 November 2011 The minutes were agreed as a correct record.

11/04

Matters arising from the minutes of the meeting of the Wakefield Alliance Board held on 8 November 2011 Item 7 (8 September 2011)

Authorisation Process

Dr Earnshaw noted that an assessment undertaken by the SHA had identified green ratings on all elements relating to the Wakefield Alliance. He also reported that a recent Board to Board meeting between the Alliance and the NHS Calderdale, Kirklees and Wakefield District PCT 2


Boards had gone well and the feedback received at the meeting had been very positive. Item 4f (11 October 2011)

Staffing

Dr Earnshaw highlighted that the high level staffing structure of the Wakefield Alliance had now been shared and the process for appointments would be confirmed in the New Year, with the aim to have this completed by the end of January. The Clinical Commissioning Executive noted how unsettling this period was for staff and the members offered their thanks for the work which had been undertaken on behalf of the Wakefield Alliance. Item 6 (11 October 2011)

Draft Partnership Agreement

Dr Earnshaw advised that a meeting had taken place on 19 December 2011 involving the Local Medical Committee. A further meeting with practices was scheduled to take place on 5 January 2012 with the aim of developing a Memorandum of Understanding between the Wakefield Alliance Board and its member practices. Item 5

Collaborative working

Dr Earnshaw noted that discussions were ongoing between The Grange and South Elmsall and Rycroft clinical commissioning groups (CCG) to become one CCG. With regard to working with CCGs outside of the Wakefield District Dr Earnshaw reported that he had met with Carol McKenna and David Kelly from North Kirklees Clinical Commissioning Group. Further discussions would be undertaken on collaborative working between CCGs across the Mid Yorkshire health economy. Item 12

Influenza vaccinations

An update on practice performance up to 30 November 2011 regarding influenza vaccinations was provided for Board members. 11/05

Minutes of the meeting of the Commissioning Executive Committee held on 8 November 2011 The minutes were agreed as a correct record.

11/06

Matters arising from the minutes of the meeting of the Commissioning Executive Committee held on 8 November 2011 11/162

GPs working in the Emergency Department at Pinderfields

Dr Earnshaw noted that a meeting had been arranged with Wakefield Council Family Services but the outcome of this was not yet known. A further update would be provided at the next meeting. 3


11/172

Wakefield College Wellbeing Service

This issue would now be considered at the January meeting. 11/174

Update on Urgent Care Specification and Procurement

Gill Galdins reported that the Department of Health had advised that they did not think there was a requirement for a consultation on the ‘111’ Service as this had previously been undertaken. It was further highlighted that the NHS Calderdale, Kirklees and Wakefield District PCT Cluster Board had approved the Business Case. 11/07

Declarations of Interest There were no declarations of interest Dr Earnshaw requested that all members of the Clinical Commissioning Executive complete a declaration of interest form in relation to their work with regard to the Wakefield Alliance. He requested that the relevant form was sent to all members from Corporate Governance He also noted that there was a NHS Wakefield District receipt of hospitality policy and the members of the Clinical Commissioning Executive were required to declare gifts up to the value of £25 received in relation to their work on this Committee. Gifts of a value in excess of £25 could not be accepted. The declaration forms were available from the Corporate Governance Department.

11/08

Shadow Accountable Officer Report Gill Galdins introduced this report noting the following: a)

NHS Operating Framework

Members were advised that the NHS Operating Framework 2012/13 had been published on 24 November 2011 and set out the business and planning arrangements for the NHS in the coming year. The new framework mandates strong financial management and control to ensure successful delivery through transition and into the new NHS landscape. It was noted that from 2013/14 the running cost allowance for Clinical Commissioning Groups (CCGs) was expected to be £25 per head of population. Gill Galdins highlighted that there may be some geographical weighting or consideration of levels of deprivation to the amount provided to each CCG but this was not yet known. Gill Galdins also provided an update on the development of Commissioning Support Units (CSU) and advised that a CSU was being developed on a West Yorkshire basis. It was anticipated that this would be overseen by the NHS Commissioning Board until 2016.

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b)

Mid Yorkshire Health Economy Clinical Services Strategy

Gill Galdins advised that the Mid Yorkshire Hospitals NHS Trust (MYHT) had established five options for changes to its clinical services which were outlined in the accompanying report. A series of meetings had been established across December and January for clinical commissioners and secondary care clinicians to engage and discuss the detail of these options in order to shape final decision making. This was planned to allow a review of and approval through Clinical Commissioning Executive’s, Cluster and MYHT Boards by March 2012. Dr Earnshaw advised that it would be important for the Wakefield Alliance to take its own view on the Strategy. c)

Emerging CCG Development and Authorisation

Gill Galdins advised that the next major authorisation process milestone was the required production of CCG plans by the end of January 2012. It was further noted that new draft guidance: Towards establishment: creating responsive and accountable clinical commissioning groups had recently been issued. d)

Board to Board

Members were informed that on 8 December 2011 Wakefield Alliance Board members participated in a Board to Board meeting with members of the NHS Calderdale, Kirklees and Wakefield District Cluster Board. Gill Galdins advised that the NHS Calderdale, Kirklees and Wakefield District Cluster Board had received a great deal of assurance and encouragement on the development of the Wakefield Alliance CCG and gave her congratulations for this. Sandra Cheseldine also stated that she had been very impressed by the Wakefield Alliance and the work which had been undertaken by all its members. f)

Stroke Services

Gill Galdins provided an update to the Clinical Commissioning Executive on Stroke Services and advised that there had been significant improvements in the service being provided and that a single telephone number was now available to contact Stroke Nurses. She further advised that feedback from a national peer review had been very positive. Dr Earnshaw noted that he would like to receive a paper on this item at a forthcoming meeting.

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11/09

Summary of Standing Orders, Financial Instructions and Corporate Governance Policies Gill Galdins introduced a report which provided a summary for staff on the current Standing Financial Instructions and Standing Orders agreed by the NHS Calderdale, Kirklees and Wakefield District Cluster Board. It was noted that it is the responsibility of all staff to be aware of and comply with the relevant policies summarised in the Staff Guide. This included those staff working with emerging clinical commissioning groups. The guide provided a summary of the key requirements including: Scheme of Delegation Decision making processes Standards of business conduct It was RESOLVED that

11/10

i)

the Standing Financial Instructions and Standing Orders Summary be noted.

ii)

Members of the Wakefield Alliance CCE agreed to ensure adherence to the Standing Financial Instructions and Standing Orders Summary.

Governance and Sub Group Terms of Reference Gill Galdins introduced a report which presented to the Clinical Commissioning Executive (CCE) the proposed terms of reference for meetings of key groups to be established within the Wakefield District. These groups supported the agreed delegation of authority from the NHS Calderdale, Kirklees and Wakefield District Cluster Board to the CCE and supported emerging clinical commissioning groups with progress towards establishment and authorisation. Attached to the report for approval were the terms of reference for the sub groups which reported to the CCE. These are: Finance and Performance Group Audit and Governance Group Quality Group It was highlighted that where there was more than one CCE the subgroups would cover all of these with the representation as agreed. Also attached for information were the final terms of reference for the Wakefield Alliance CCE.

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It was RESOLVED that i)

the draft terms of reference for the following groups be approved Finance and Performance Group Audit and Governance Group Quality Group

ii)

11/11

the agreed terms of reference for the Wakefield Alliance CCE be noted

Month 8 Finance Report Gill Wainwright introduced a report which presented the financial position as of month 8. It was highlighted this used month 6 flex information received from NHS Trusts and showed an overspend for the Wakefield Alliance of £1,242K. It was reported that the month 6 data for GP practices showed an overspend on the main Service Level Agreement with the Mid Yorkshire Hospitals NHS Trust. It was noted that there was work being undertaken that would reduce the current overspend and a breakeven position at year end was forecasted. It was also highlighted in the report that prescribing was forecast to achieve the QIPP savings target of £2m and was a further £745K underspent. It was RESOLVED that i)

11/12

the financial position as at month 8 be noted.

Practice Support Unit Tender Recommendations Dr Hanney introduced a report which detailed the process which had been followed to secure a successful supplier to advise on the best method which would help shape the future form and function of the Wakefield Alliance Practice Support Unit. It was noted that a small project team had successfully worked to establish and support the Wakefield Alliance and had formed the foundations of the Practice Support Unit (PSU). The next stage was to consider the PSU’s role in the future, how it might be resourced and how it might be integrated into the emerging structure of the Wakefield Alliance Clinical Commissioning Group. Subsequently a procurement process took place and nine suppliers were invited to tender. Following a robust panel evaluation of the tenders including presentations and scoring a preferred supplier was now recommended who had quoted a cost of £19,980 including VAT. Dr Hanney noted that the preferred supplier had included a total of 15 days to complete this piece of work within their bid but it was felt reasonable to 7


request flexibility around the days quoted to a maximum of 19 days to ensure the outputs identified within the specification were delivered robustly. It was highlighted that any further cost to this flexibility would be in accordance with the Standing Financial Instructions guidance and within the budget available. It was RESOLVED that i)

11/13

the recommendation of Change Academy as preferred supplier following the procurement process as described in the report for the proposal for the development of the Practice Support Unit.

Exercise on Referral Service Business Case Dr Andrew Furber introduced a report which sought to seek support to continue to commission Wakefield’s Get Active, Exercise on Referral (EoR) Service, currently provided by Wakefield Council. Without recurrent funding, the Exercise on Referral Service would no longer be funded beyond March 2012. Public Health commissioning intentions monies had been identified to fund the service for two years. The scheme would require non-recurrent one year funding of £85K and recurrent funding per annum of £100K. It was reported that separate funding had been identified for EoR to be incorporated into the Wakefield Adult Weight Management Service due to commence in January 2012. The report highlighted that locally 79% of Wakefield’s population did not achieve three times 30 minutes of activity a week. The primary and secondary care costs attributed to physical inactivity in Wakefield was £9,487,980. To assist in presenting the report Dr Furber was joined by Joanne Hinchcliffe, Public Health Commissioning Manager and Chris Wathen, Physical Activity Project Manager. A short presentation was provided which outlined the financial implications and investment and the pilot evaluation and findings. Attached to the report was a Business Case for the scheme. It was noted that this was supported by both the Long Term Conditions and Preventions Clinical Commissioning Units. Dr Earnshaw noted that the future costs of this scheme would need to be monitored to ensure that best value was being achieved. It was RESOLVED that i)

The continued commissioning of the Exercise on Referral service for two years be supported.

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11/14

Alcohol Liaison Service Business Case Dr Andrew Furber introduced a report which advised that the following business case set out a proposal for an Alcohol Liaison Service for Wakefield within the Mid Yorkshire Hospitals NHS Trust. This service would be located in Gastroenterology and supported by the Consultant Hepatologist. In order to present this report Dr Furber was joined by Caroline Abbott, Head of Public Health (Substance Misuse) and by Jez Mitchell, Public Health Commissioning Manager. A short presentation was provided which provided the following information: What is the problem? What could the service offer? How will the service operate? The Clinical Commissioning Executive (CCE) was advised that having a flexible approach the team would provide in-reach support, coordinating patient care across acute departments including Accident and Emergency and ensuring appropriate discharge. It was anticipated that through patient detection, assessment and specialist liaison that the service would prevent alcohol related hospital admissions and reduce the length of stay for those who were admitted and would improve discharge pathways. The CCE was informed that the proposed service would run for an initial two year pilot and require an initial investment of ÂŁ120,000 per annum. It was further reported that Wakefield Council had agreed to fund 50% of these costs. It was highlighted that this proposal was supported by the Prevention Clinical Commissioning Unit. It was RESOLVED that i)

11/15

the Alcohol Liaison Service Business Case be approved.

Winter Plan 2011/12 Dr Adam Sheppard introduced the Winter Plan 2011/12 and described the way in which the Mid Yorkshire Health economy would respond to the additional demands of winter 2011/12 and formed part of the wider Whole Systems Resilience Programme (Joint Surge and Escalation Plan). The plan was an operational document and it was intended that it was referred to throughout the winter for guidance. It therefore describes the content of the plan and the governance framework surrounding this, so that it could be implemented as required. Sandra Cheseldine highlighted that she felt it we be useful if a review was undertaken in April regarding the success of this plan. 9


It was RESOLVED that i) 11/16

the Winter Plan 2011/12 be supported.

Any Qualified Provider Matt England introduced a report which provided a outline of the current progress on Any Qualified Provider (AQP) and the requirements of the Department of Health (DH) policy on its development. Members were advised that AQP was a method of procuring services that used a cut down procurement process, previously known as Any Willing Provider. It was highlighted that the key difference between AQP and other types of procurements was that accredited providers were awarded contracts which had no guaranteed levels of activity within them. Also that there was no limitation on the number of providers who could apply and be accredited for a single service. The Clinical Commissioning Executive was informed that across the NHS Calderdale, Kirklees and Wakefield District Cluster three services had been identified for delivery of AQPs from 1 April 2012. These were: Adult hearing services: Cluster wide Access to diagnostics closer to home: Cluster wide Access to psychological therapies: Calderdale locality. An outline timetable had been produced for the implementation of the three selected AQP services which was outlined in appendix 1 to the report. It was reported that the development of the AQP policy did present risks to commissioners particularly in the following areas: Financial Transfer of Undertakings (Protection of Employment) TUPE Integration of Care It was RESOLVED that

11/17

i)

the contents of the report be noted

ii)

the proposed implementation plans be approved

iii)

the risks in relation to future AQP development be noted.

Planning Strategic Assurance for Wakefield Alliance Clinical Commissioning Group Lee Beresford introduced a report which advised that over the next year Clinical Commissioning Groups (CCGs) across the country would be facing the significant challenges of the authorisation process that were described in the Department of Health (DH) document: Developing clinical commissioning groups: Towards authorisation. In addition the NHS 10


Operating Framework for 2012/13 set out what needed to happen to business and planning arrangements over the coming year. The report outlined the context and reasons for robust planning by CCGs. As a consequence the development of a strategic assurance document to aid the Wakefield Alliance CCG in its journey towards authorisation was proposed. It was noted that the report proposed that a strategic assurance document would be best built around six outlined domains. A possible aid to further thinking about CCG strategic planning was attached as appendix 1 to the report and a draft strategic assurance document was attached as appendix 2. Lee Beresford provided Clinical Commissioning Executive members with details of a one page plan and advised that an electronic copy would be distributed. Dr Earnshaw requested that any comments be forward to Lee Beresford so that this could be discussed further at the next meeting. It was RESOLVED that i)

11/18

the development of a strategic assurance document that would substantially inform the expected requirement of a single CCG plan for 2012/13 be supported.

Individual Funding Reports 2010/11 and 6 months 2011/12 Gill Galdins introduced a report which advised that Individual Funding Requests (IFRs) were made by clinicians for interventions not covered by NHS Wakefield District’s commissioning policies. An IFR process was therefore in place to ensure that decisions made in relation to these requests were fair and consistent To assist in presenting the report Gill Galdins was joined by Andrea McCourt, Head of Corporate Governance. It was reported that there had been a significant level of IFR requests across the Wakefield District at 987 in 2010/11 and 404 requests in the first six months of 2011. The most frequent requests were for cosmetic procedures and weight management. Expenditure from IFR was approximately £1.2M in 2010/11 and was £365K for the first six months of 2011/12. The report further identified actions which referring clinicians could undertake to assist in ensuring appropriate requests were made that would enable a more efficient IFR service, that time was not spent on requests that were unlikely to be approved and to avoid delays in decision making. Andrea McCourt highlighted to the Clinical Commissioning Executive (CCE) that there was a shortage of clinical advice resource for panels / urgent cases and as a consequence there was an over reliance on a few clinicians. She enquired if any medical members of the CCE would be 11


willing to participate in these panels. Dr Adam Sheppard advised that he would be willing to become involved. It was also agreed that the relevant CCE members would enquire within those practices who submitted the most requests whether there were any medical staff who could participate. In addition it was agreed that Dr Earnshaw and Gill Galdins would send a joint letter to the top referring practices to request volunteers. It was RESOLVED that

11/19

i)

the IFR 6 month report for 2011/12 and the 2010/11 annual IFR report be noted

ii)

Dr Earnshaw and Gill Galdins would send a joint letter to all practices to request medical volunteers to participate in IFR panels.

iii)

that CCE members enquire within their practices whether any medical staff are able to participate in IFR panels.

iv)

the actions required of referring clinicians to submit appropriate IFR requests be noted.

Practice Based Commissioning Freed Up Resource Plans Update Dr Dewhirst had left the meeting prior to consideration of this item. Cat de Jonge introduced a report which advised that the Queen Street Surgery had requested that an extension of an additional 12 months be granted for the use of the 09/10 Freed Up Resources (FUR) plan due to delays in communicating their new art therapy and diabetes support services to patients which had affected their ability to use these resources within the allotted time frame. The Clinical Commissioning Executive was advised that the usual term of use for FUR under Practice Based Commissioning was two years. Under previous plans if these approved resources were not used within the two year term they would revert back to NHS Wakefield District. It was RESOLVED that i)

11/20

the extension of the term of use for Queen Street Freed Up Resources to 31 March 2013 be approved.

0-19 Public Health, Early intervention and Family Support Service: Heath Visitor and Family Nurse Partnership (FNP) investment and development plan YEAR 2 Dr Carroll introduced a report which outlined the proposal for the second year investment 2012/13 of a four year plan aimed at increasing the number of health visitors in post to the capacity required by the Department 12


of Health as recommended in the Health Visitor implementation plan 20112015 – A call to action. To present the report Dr Carroll was joined by Ian Carr and Sharon Tinker. The report sought approval to secure financial investment in health visitors by an additional 33.1 to a target of 106.2 whole time equivalents (WTE) by March 2015 and subsequently facilitate continual development of the Family Nurse Partnership Programme (FNP). During 2012/13 this would be to the sum of £400K and would enable the additional recruitment of eight health visitors, four of which would be added to the FNP Programme resulting in a full team of eight FNP nurses and one supervisor. The year one investment had been £366K resulting in a year one and two cumulative total of £766K. The Clinical Commissioning Executive (CCE) was advised that following an initial data cleansing exercise the Mid Yorkshire Hospitals NHS Trust had identified a further deficit to the initial baseline number which had then increased the overall deficit to 48.7 WTE. It was reported that commissioners are of the opinion that this further deficit would be the responsibility of the provider to address as sufficient funding was in place. It was further reported that there was a high risk that the target of 106.2 WTE may not be achieved by 2015 due to the fact that there are insufficient students undertaking health visiting training. Commissioners and providers were exploring recruitment ideas and training delivery models. During consideration of this item it was reported that year one of the scheme may not have received formal approval. If this was not the case the total amount requiring approval would be in excess of £500K and would therefore require approval by the NHS Calderdale, Kirklees and Wakefield District Cluster Board. Gill Galdins agreed that she would look further into this matter and identify if further approval was required. It was RESOLVED that

11/21

i)

funding of £400K for the second year of a four year investment plan be approved.

ii)

Gill Galdins would clarify the position regarding approval of year one of this scheme and clarify whether approval is required by the NHS Calderdale, Kirklees and Wakefield District Cluster Board.

Minutes of the Audit and Governance Group held on 22 November 2011 Sandra Cheseldine advised that this meeting had considered the Anti Bribery Policy and an Internal Audit report regarding Information Governance – Third Party Contracts.

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Two policies were recommended to the Clinical Commissioning Executive for approval as follows: Anti-Bribery Policy Safeguarding Children and Vulnerable Adults Commissioning Policy In addition an Information Governance Toolkit Baseline and action plan was also recommended to the CCE for approval. It was RESOLVED that

11/22

i)

the minutes of Audit and Governance Group held on 22 November 2011 be noted.

iii)

The Anti-Bribery Policy and Safeguarding Children and Vulnerable Adults Commissioning Policy be approved by the CCE.

iii)

The Information Governance Toolkit Baseline and action plan be approved by the CCE.

Minutes of the Finance and Performance Group held on 1 December 2011 Rhod Mitchell advised that this meeting had considered the Terms of Reference of the Finance and Performance Group, had received a finance presentation from Jonathan Molyneux and had considered QIPP costs in detail. The meeting had also received a performance report and it was noted by the Clinical Commissioning Executive (CCE) that they would like to receive an adjusted report on performance on a quarterly basis. It was agreed that the performance report which was considered by the Finance and Performance Group would be distributed to CCE members. It was RESOLVED that i)

11/23

the minutes of the Finance and Performance Group held on 1 December 2011 be noted.

Minutes if the Quality Group held on 9 December 2011 Heather O’Donnell advised that this meeting had considered a CQUINs quarter 2 exception report and a Quality and Patient Safety Report. In addition the an extension of the review date Quality Assurance Policy – Accreditation of Any Willing Provider to March 2012 was recommended to the Clinical Commissioning Executive for approval.

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It was RESOLVED that

11/24

i)

the minutes of the Quality Group held on 9 December 2011 be noted.

ii)

the Quality Assurance Policy – Accreditation of Any Willing Provider extension of review date to March 2012 be approved.

Any Other Business Dr Harries noted that a meeting was scheduled to take place between the South West Yorkshire Partnership NHS Foundation Trust and local GPs to consider reorganisation issues during January and he asked if any GPs were available could attend.

11/25

Date and Time of Next Meeting Tuesday, 24 January 2012, 1.00 to 5.00 pm, Kings Medical Centre, Normanton.

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