NHS Wakefield Clinical Commissioning Group CLINICAL COMMISSIONING EXECUTIVE Minutes of the meeting held on 27 November 2012 Boardroom, White Rose House, Wakefield Present
Dr Phil Earnshaw
Chair, Clinical Leader NHS Wakefield Clinical Commissioning Group (CCG) GP, Lupset Health Centre GP, Pinfold Surgery GP, Outwood Park Medical Centre GP, Queen Street Surgery GP, College Lane Surgery GP, Chapelthorpe Surgery Practice Manager, Stuart Road Surgery Chief Officer Designate, NHS Wakefield CCG Interim Chief Financial Officer Chief Financial Officer Designate (Minute 12/260 onwards) Director of Public Health, Wakefield Council Non Executive Director Non Executive Associate Lay Member, Public and Patient Involvement Independent Consultant Member, Rotherham NHS Foundation Trust Corporate Risk Manager, NHS Wakefield District (NHSWD) Communications Manager, NHSWD Head of Contracting and Commercial Strategy, NHS Wakefield CCG (Minute Head of Medicines Management, NHS WD) (Minute 12/256 only) Chief Technician, NHSWD (Minute 12/256 only) Head of Strategy and System Reform, NHS Wakefield CCG (Minute 12/260 only)
Dr Adam Sheppard Dr Avijit Biswas Dr Ann Carroll Dr Paul Dewhirst Dr Ivan Hanney Dr Clive Harries Stephen Bryan Jo Webster Jim Hayburn Andrew Pepper Dr Andrew Furber Sandra Cheseldine Rhod Mitchell Stephen Hardy Dr Hany Lotfallah In Attendance
Adam Bassett Katie Lister Matt England
Lyndsey Clayton Lee Beresford
12/248 Apologies Apologies were received from Sandra Greenwood and Dr David Brown. 12/249 Declarations of Interest Dr Earnshaw reminded members of the requirement to declare any interests which related to any items on the agenda. This could either be undertaken at this point or when the matter was considered on the agenda. There were no interests declared. 12/250 Chairs Opening Remarks Dr Earnshaw noted that this would be Jim Hayburn’s final meeting as Interim Chief Financial Officer. He noted that Jim would be remaining with NHS Wakefield Clinical Commissioning Group (CCG) for a period on a part time basis, but he thanked him on behalf of the Clinical Commissioning Executive (CCE) for the work he had undertaken for the CCG. Dr Earnshaw noted that Sandra Greenwood would be standing down from her role on the CCE and he offered her his thanks for the work she had undertaken. He noted that Sandra’s role as nurse representative would be taken by Sharon Fox who would commence this responsibility in the new year. It was further reported that Dr Earnshaw had attended a meeting of the NHS Assembly at Doncaster Racecourse which had been a worthwhile national event. It was further noted that Jo Webster and Dr Earnshaw had attended the NHS Alliance Conference in Bournemouth on 22 November 2012. 12/251 Minutes of the meeting of the NHS Wakefield Clinical Commissioning Executive Meeting held on 23 October 2012 It was RESOLVED that i)
The minutes of the meeting of the NHS Wakefield Clinical Commissioning Executive Meeting held on 23 October 2012 were agreed as a correct record with the following amendments. Paragraph 2 of Minute 12/227 the word ‘details’ be amended to ‘detailed’.
12/252 Matters Arising from the Minutes of the Meeting of the NHS Wakefield Clinical Commissioning Executive held on 23 October 2012 Adam Bassett updated the Clinical Commissioning Executive (CCE) on progress of the actions discussed at the meeting on 23 October 2012. The following issue was also discussed:
Integrated Musculoskeletal Assessment and Treatment Service
Dr Harries noted that changes within the orthopaedic service may affect the way in which the Integrated Musculoskeletal Assessment and Treatment Service operated. Dr Earnshaw advised that he would raise this with Debra Taylor Tate, Senior Commissioning Manager and report back at the next meeting. 12/253 Chief Officer Designate Update Jo Webster introduced this report noting the following: a) NHS Wakefield Clinical Commissioning Group Authorisation The Clinical Commissioning Executive (CCE) was advised that NHS Wakefield Clinical Commissioning Group’s (CCG) response to the remaining five red criteria would be reviewed by the NHS Commissioning Board’s (NHS CB) Conditions Panel on 5 December, who would consider whether any of the criteria could be turned green. It was noted that the submission put the CCG into a strong position to only have one outstanding red criterion, relating to strategic and financial plans, which it was felt would be removed as part of a review in March 2013. b) Clinical Leadership Competency Framework The CCE was advised that as part of the authorisation process the NHS CB had placed a requirement on the CCG to ‘demonstrate that selection process for CCG clinical leads included assessment of leadership potential and competency’. In response the Clinical Leadership Competency Framework had been developed and then subsequently approved by the Local Medical Committee on 13 November 2012. This was to be shared with practices at the next quarterly meeting on 11 December 2012. The framework was attached at appendix B to the report. The Clinical Leadership Competency Framework was supported by the CCE. c) Running cost allowance The CCE was advised that the NHS CB has published the revised CCG running cost allowance for 2013/14. The revised allocation was circa £100k less than the CCG was planning for as part of its authorisation process. However it was reported that built into the planned CCG running costs were a number of financial flexibilities, such as funding for staff at the top of scale and non pay contingency. A further update on this would be brought to the December meeting. d) Staff transition
The CCE was advised that the pooling and matching process was now well underway with some staff having been slotted into posts. There were 21 vacancies remaining within the CCG, of which four were subject to interview. 35 NHS Wakefield District employees did not match to any roles. The CCE noted that this was very difficult time for staff. e) Quality Premium It was noted that engagement was taking place with CCGs about the quality premium which was currently being undertaken in an attempt to inform the legislative process. This would be funded from system running costs and would equate to a maximum of ÂŁ5 per patient. It was noted that discussions were taking place nationally regarding the type and number of measures which should be imposed. f) Practice Support Unit Update The CCE was informed that over the past few weeks the Practice Support Unit team (PSU) has supported the local clinical network meetings to discuss their future function, structure and operation. They had all had their first clinical local network meeting and had been asked to nominate a clinical chair. It was further noted that dates of meetings had been set up to December 2013. g) Neonatal services It was reported that in August 2012 the Mid Yorkshire Hospitals NHS Trust had closed four cots in the specialist care baby unit at Pinderfields as these were no longer required. This is a positive result of the Neonatal Outreach Service. h) Flu vaccinations The CCE received a paper which provided an update on vaccination uptake in the 2012/13 programme. It was RESOLVED that
the report be noted;
the Clinical Leadership Competency Framework be supported.
Finance Report â€“ Month 7 2012/13 Jim Hayburn introduced a report which presented the financial position of NHS Wakefield Clinical Commissioning Group (CCG) for October 2012/13 (month 7) and the forecast year end position based on this. It was highlighted that NHS Wakefield Clinical Commissioning Group was on target to achieve each of key financial performance indicators. It was reported that as at 31 October 2012 NHS Wakefield CCG had generated a 4
surplus of £2,829k which was made up of a planned surplus of £1,086k and an underspend on revenue budgets of £1,023k. The CCE was advised that the revenue surplus remained green mainly due to the inclusion of the latest prescribing data from the Prescription Pricing Authority (PPA) which was reflecting a significant forecast outturn under spend. It was reported that QIPP remained amber due to the Primary Care Transformation Scheme. Appendix 4 to the report outlined the 2012/13 capital planning position. It was reported that there had not been any expenditure this month. The CCE was advised that the position regarding the Stanley Health Centre under spend had been discussed with the SHA in relation to the reprovision of funding to complete the scheme during 2013/14. It was noted that there was an error in appendix 5 to the report, in that the forecast year end variance for PCT commissioning of £1,353k was referred to as an under spend. This was in actual fact a forecast overspend position. It was RESOLVED that i)
the revenue and capital planning positions at the end of October be noted.
Performance Report against Key Performance indicators for 2012/13 Matt England introduced a report which informed the Clinical Commissioning Executive (CCE) of performance against the 2012/13 NHS Operating Framework outcome measures together with other identified national and local priorities. Attached to the report was a summary position of NHS Wakefield Clinical Commissioning Group’s (CCG) performance against the 2012/13 NHS Operating Framework using a ‘dotty matrix tool’ which demonstrated the actual, year to date and forecast outturn and the direction of travel. The CCE gave detailed consideration to the following areas of performance and any actions being taken to improve performance where necessary: • • • • •
Ambulance Red 1 Healthcare associated Infections – MRSA Accident and Emergency waiting times 62 day cancer waits Transient Ischaemic Attack (TIA)
It was RESOLVED that i)
the NHS Wakefield Clinical Commissioning Group performance against key national and local priority measures be noted;
the additional actions outlined within the report to address areas of under performance be agreed.
ScriptSwitch Performance Summary and Explore the Market Exercise Joanne Fitzpatrick and Lyndsey Clayton attended the meeting to present a report which updated the Clinical Commissioning Executive (CCE) on ScriptSwitch (SS). The report also advised that a cost benefit analysis and scoping exercise had been undertaken to identify if there were any other providers of a similar software which could be an alternative to SS at a more competitive price, but with equivalent of better service provision, productivity and usability. However it was reported that it had been identified that there were no other equivalent or superior prescribing applications to consider as an alternative to SS. The CCE was advised that the estimated savings generated by SS in the period April 2011 to March 2012 was ÂŁ325,254.77. It was further highlighted that the financial implications of extending SS for a further year would be 0.37p plus VAT per registered patient with a standard fixed charge for King Street Walk in Centre. The cost of this during 2012-13 was ÂŁ130,269. It was acknowledged that the Prescribing Clinical Commissioning Unit had considered this paper in October 2012 and recommended that SS be procured for another 12 months starting in April 2013 with the condition that NHS Wakefield CCG was at the forefront of testing IT pilots that the company undertook to improve functionality. Following discussion it was suggested that the scheme be extended for three years. Jo Webster advised that in order to comply with Standing Financial Instructions, final approval of this scheme would be required from the Board of NHS Calderdale, Kirklees and Wakefield District. It was RESOLVED that i)
the re-procurement of ScriptSwitch for three years starting in April 2013 be supported and recommended to the Board of NHS Calderdale, Kirklees and Wakefield District for approval.
Contract Transition, Extension and Procurement It was agreed that this item would be deferred until the next meeting. It was RESOLVED that i)
this item be deferred until the next meeting.
Medicines Management and Prescribing Update
Dr Paul Dewhirst introduced a report which provided an update on prescribing and Medicines Management within NHS Wakefield Clinical Commissioning Group (CCG). Dr Dewhirst advised that to date this had been a very successful year for prescribing in NHS Wakefield CCG. Overall the projected prescribing underspend against practice prescribing budgets was estimated at £2.2m and prescribing spend for April to August 2012 was 1.5% less than the period April to August 2011. It was further noted that the majority of prescribing indicators in the Improvement in Prescribing Plan (ImPP) were showing marked improvement during the first five months of the plan. The Clinical Commissioning Executive (CCE) was also advised of a proposal to rename the Medicines Management Team to the Medicines Optimisation Team. It was agreed by the CCE that the name of the team should stay as it was, as this was clear for patients, unless there was a clear reason for this change. The CCE was also advised of the proposed service redesign and reprocurement of the nutritional feeds contract. The current contract had expired. The CCE was advised that taking nutritional products ‘off-script’ and maintaining control of supply and management of patients had been well received by CCG stakeholders and was a priority for NHS Wakefield CCG board members. It was noted that in order to undertake the service redesign it was proposed to enlist the services of the NHS Commercial Procurement Collaborative. It was RESOLVED that
the contents of the report be noted;
the re-procurement and service redesign of the nutritional feeds contract be supported.
Wakefield District Health and Wellbeing Board Terms of Reference Dr Andrew Furber introduced a report which introduced the Terms of Reference (ToRs) for the Wakefield District Health and Wellbeing Board. The Clinical Commissioning Executive (CCE) was advised that the Health and Wellbeing Board had met in shadow form since March 2011 to ensure that by 1 April 2013 there was genuine practical collaboration. It was noted that at the first meeting held on 28 March 2011, consideration was given to the draft ToRs. A commitment was given to reviewing them annually to ensure that they remained fit for purpose and took account of any national or local policy changes. The shadow Health and Wellbeing Board had considered and approved revisions to the ToRs which would be submitted to Wakefield Council’s full Council meeting to formally constituent the Board as a committee of the Council from 1 April 2013. 7
It was RESOLVED that i)
the Terms of Reference of the Wakefield District Health and Wellbeing Board, as approved by the Shadow Health and Wellbeing Board, on 13 September 2012 be noted.
NHS Mandate Lee Beresford introduced a report which presented the recently published NHS Mandate. The NHS Mandate: a Mandate from the Government to the NHS Commissioning Board: April 2013 to end of 2015 set out the governments ambitions for the NHS. It was reported that the mandate had been informed by a wide range of organisations and stakeholders across the health and social care system. It set 24 objectives and also described four further areas of priority as follows: • • • •
Freeing the NHS to innovate The broader role of the NHS in society Finance Assessing progress and providing stability
A full copy of the NHS Mandate was attached as appendix 1 to the report. Lee Beresford further advised that the direction and objectives set in the Mandate would be incorporated into the NHS Wakefield Clinical Commissioning Group Strategic Plan for 2013/14. A proposed timetable for this was outlined within the report. It was noted that the Strategic Plan would be brought back to the December meeting. The CCE discussed the input the network clinical leads would have into the development of the Strategic Plan. It was agreed that the Strategic Plan would therefore be updated to include information from the clinical leads. It was RESOLVED that
the NHS Mandate be noted;
the timetable for strategic planning be approved;
The Strategic Plan for 2013/14 to include far more information from the clinical leads.
Minutes of the Finance and Performance Group held on 11 October 2012 Rhod Mitchell presented these minutes to Clinical Commissioning Executive (CCE). He highlighted that the Finance and Performance Group had asked the CCE to note the following items:
Stanley Health Centre Capital Funding. It was noted that the potential requirement for funds to be spent in year had been discussed by the Senior Management Team.
Performance Issues affecting the Smoking Cessation Service. It was noted that the issue of the performance of this service was to be raised through the South West Yorkshire Partnerships NHS Foundation Trust Contract Board and that a deep dive exception report would be considered at the next meeting of the Finance and Performance Group.
Continuing Care Retrospective Assessment Process. The issue of potential liability due to the large number of retrospective assessment requests made was noted.
Primary Care Transformation Scheme. It was noted that a decision on fuding of this scheme was to be made by the NHS Wakefield District Governing Body during January 2013.
It was RESOLVED that i)
the minutes of the Finance and Performance Group held on 11 October be noted.
Minutes of the Finance and Performance Group held on 18 October 2012 It was RESOLVED that i)
the minutes of the Finance and Performance Group held on 18 October be noted.
Minutes of the Finance and Performance Group held on 30 October 2012 It was RESOLVED that i)
the minutes of the Finance and Performance Group held on 30 October be noted.
Minutes of the Finance and Performance Group held on 8 November 2012 Rhod Mitchell introduced these minutes and highlighted that the Finance and Performance Group had asked the Clinical Commissioning Executive to note the excellent performance which had been achieved in prescribing performance. It was RESOLVED that i)
the minutes of the Finance and Performance Group held on 8 November be noted.
Clinical Commissioning Units Update It was RESOLVED that i)
The Clinical Commissioning Units Update be noted.
12/266 Clinical Commissioning Executive (CCE) decisions for Inclusion in the Legacy Document There were no items highlighted for inclusion in the Legacy Document. It was RESOLVED that i)
there be no items highlighted to be included in the legacy document.
12/267 Items for referral to the Cluster Board or any of the Sub Groups It was agreed that the following item be referred to the Board of NHS Calderdale, Kirklees and Wakefield District: â€˘
The re-procurement of ScriptSwitch for a further three years.
It was RESOLVED that i)
The above item be referred to the Board of NHS Calderdale, Kirklees and Wakefield for approval.
12/268 Any Other Business There was no additional business 12/269 Date and Time of Next Meeting Tuesday, 18 December 2012, 1.00 pm Boardroom, White Rose House