Sutton CCG Management Board – Wednesday 7th March 2012 – Att 1b

Beddington Medical CentreBenhill & Belmont GP CentreBishopsford Road Surgery
Carshalton Fields SurgeryCheam Family PracticeChesser SurgeryDrs. Elliott, Grice & Partners
Faccini House SurgeryGP Centre North CheamGreen Wrythe SurgeryGrove Road Practice
Carroll and Madina Medical PracticeMaldon Road SurgeryManor Practice
Dr Moola’s PracticeMulgrave Road PracticePark Road Medical Centre
Robin Hood Lane Health Centre (Dr Seyan)Shotfield Medical PracticeSutton Medical Centre
Wallington Family PracticeWallington Medical CentreWandle Valley Health Centre
Well Court SurgeryWrythe Green Surgery

SUTTON CLINICAL COMMISSIONING GROUP

EXTRAORDINARY MANAGEMENT BOARD MEETING

Wednesday 15th February 2012

The Good Shepherd Centre

Queen Mary’s Avenue, Carshalton Beeches, Surrey SM5 3LW

MINUTES

Present:
Dr Muhammad Amjad (MA) / GP, Manor Road Practice
Jonathan Bates (JB) / Chief Executive, The Sutton Consortium
Dr Cecilia Brennan (CB) / GP Centre – Dr Brennan
Dr Chris Elliott (CE) / GP, Benhill & Belmont GP Centre
Dr Simon Elliott (SE) / GP, Drs. Elliott, Grice and Partners
Dr Rohit Goel (RG) / GP, Carshalton Fields Surgery
Marion Gower (MG) / Practice Manager, Green Wrythe Surgery
Dr Tapan Halder / GP, Wallington Medical Centre
Dr Brendan Hudson (BH) (Chair) / GP, Grove Road Practice
Dr Suki K Kanthan (SK) / GP, Well Court Practice
Dr Heather Lings (HL) / GP, Shotfield Medical Practice
Dr Rashid Moola (RM) / GP, Dr Moola’s Practice
Dr Dino Pardhanani (DP) / GP, Mulgrave Road Practice
Dr Marion Rodin (MR) / GP, Robin Hood Lane Health Centre (Seyan)
Karol Selvey (KS) / Nurse Practitioner, Drs. Elliott, Grice and Partners
Dr Idress Said (IS) / GP, Green Wrythe Surgery
Dr Roshni Scott (RS) / GP, GP Centre – Dr Brennan
Dr Kanagalingah Sugumar (KSu) / GP, Maldon Road Surgery
Jan Underhill (JU) / London Borough of Sutton (representing Adi Cooper)
Apologies:
Dr Mansoor Ahmed (MA) / GP, Wallington Family Practice
Dr Kashif Aziz (KA) / GP, Sutton Medical Centre
Ms Sally Brearley (SB) / Patients’ Representative
Dr Chandrika Carroll (CC) / GP, Carroll and Madina Medical Practice
Dr Muneeb Choudhry (MC) / GP, Wandle Valley Health Centre
Dr Jonathan Cockbain (JC) / GP, Chesser Surgery
Dr Adi Cooper (AC) / Strategic Director Adult Social Services & Housing, London Borough of Sutton (represented by Jan Underhill)
Dr Jeffrey Croucher (JJC) / GP, West Sutton Locality Lead
Dr Ashrafal Mirza (AM) / GP, Faccini House Surgery
Dr Shilen Pattani (SP) / GP, Beddington Medical Centre
Dr Chandra Perera (CP) / GP, Bishopsford Road Practice (represented by Gillian McCarry)
Dr Tahir Toosy (TT) / GP, Park Road Medical Centre
Dr Mark Wells (MW) / GP, Wrythe Green Surgery
In attendance
Angela Burrows (AB) / Practice Manager, Wandle Valley Medical Centre
Evelyn Cupit (EC) / Practice Manager, Maldon Road Surgery
Dr Peter O’Donnell (POD) / GP, Drs Elliott, Grice and Partners
Michele Godbeer (MGm) / PA to Joint-Chairs (Minutes)
Siân Hopkinson (SH) / Acting Senior Performance & Information Analyst, The Sutton Consortium
Dr Adnan Malik / GP, Benhill & Belmont GP Centre
Dr Farhan Rabbani (FR) / GP, Wallington Medical Centre
Item / Action /
1 / Welcome and Introductions
BH welcomed all to the meeting noting the apologies given the conflict with school holidays.
2 / Apologies for Absence
MG read out apologies, as detailed above.
3 / St Helier Hospital Transaction Update
CE gave an update on the process to achieve a sustainable future for St Helier Hospital. CE advised that the merger between St George’s and St Helier had fallen through due to BSBV process and the potential implications for St George’s. Sutton CCG sent a letter to Matthew Hopkins, Chief Executive of St Helier Hospital offering support. CE and BH met with the Miles Scott, Chief Executive and Christopher Smallwood, Chairman of St George’s Trust and they are hopeful that once the BSBV process is completed that this will make St Helier more viable for a merger acquisition.
CE advised that the demerger of Epsom and St Helier will still go ahead aiming to have completed by March 2013. Ashford and St Peter’s merger with Epsom is still being worked through and is not yet concluded.
CE stated that GPs and Local Authority should have more active engagement in the future of St Helier going forward than had been possible through a formal transaction process.
BH advised the meeting of the ITV news appearance of Siobhain McDonagh who stated that GP Consortiums were to blame for St George’s pulling out of the merger. A meeting had taken place where it was explained that Siobhain McDonagh’s information was inaccurate with financial savings targets similar to other PCTs across London.
RM asked if the merger took place would this mean the closure of St Helier A&E. The merger itself would not lead to this but BSBV will lead to substantial service change and the outcome is a possibility.
CE reiterated that it is important that Sutton CCG has a voice on this important issue. BH stated that the best thing for Sutton CCG is to get authorised which will enable the group to have a bigger influence going forward.
4 / Consideration of CCG Constitution including structure, leadership and governance
JB presented the process towards authorisation noting the three phases, involving Strategic Health Authority (SHA) pre-assessment, application (probably in the Autumn) and the NHS Commissioning Board assessment. The configuration issue had now been resolved and the other areas of Phase 1 pre-assessment were governance, leadership, commissioning support and clarity on core infrastructure.
In order to move forward on governance, the constitution needs to be produced, signed and agreed with member practices.
The constitution will be a legal binding document which is currently with the solicitors being developed into a draft format initially. This document will include items that are essential requirements (as a statutory body) with some areas being flexible for discussion at the next Management Board meeting.
JB advised that the running cost allocation for Sutton CCG is £25 per head with the current CSO offering at £15 per head. There would be extensive challenge on this issue over coming weeks. The Management Board requested that other potential CSO offers are explored.
DP questioned whether members of the Governing Body will be employed by CCG. JB explained that some members will be employed, others will not (eg hospital consultant representative).
DP also asked for an update on the passage of The Health Bill. JB explained that the Bill was still in the Lords and that whilst some aspects of the proposed changes could be made without legislation, the removal and establishment of new statutory bodies, including Clinical Commissioning Groups, could not.
5 / Results of GP Practice Consultation Feedback
CE stated that decisions need to be made to move forward towards CCG authorisation. These decisions are not set in stone and may, in light of future events, need to be changed. These are required to move forward to secure authorisation in a timely way. Copies of feedback from 19 practices/individuals was circulated.
CE summarised the feedback:
·  Q8 Overall
Are you supportive of this proposed approach for the
Governance arrangements?
21 Responses / 16 Yes
1 No
1 Needs checks and balances
1 n/a
2 No comment
·  Q11 Board Structure
Do the membership arrangements of the Governing Body seem
appropriate?
21 Responses / 15 Yes
4 Yes – with comment
1 No
1 No comment
·  Q2 Localities
What are your views about locality configuration?
9 - No change to now / 10 - Yes – change required / 2 - No comment
·  Q14 Chair of Governing Body
Do you have specific preferences for the following:
1 - Lay / 14 - Clinician / 3 - No preference
·  Q12 Voting Arrangement (particularly important to make progress
with Chair’s appointment)
10 - One practice one vote / 2 - One partner one vote
7 - Weighted capitation / 2 - No comment
-  Communication will be key to the working of Sutton CCG especially if the Governing Body will be made up of approximately 12/14 people the feedback to practices will be essential. JB also added that there will be two ways for practices to be involved 1) through the locality meetings and 2) the quarterly plenary meetings where all practices will meet and be able to hold the Governing Body to account.
CE asked the meeting to note that two of the responses were not from practices but from Adam Wickings, PCT Borough Director, Sutton and Joy Tweed, non-executive Director Sutton and Merton, PCT.
CE reiterated that the Engine Room will be fundamental in the running of the Sutton CCG.
CE went through each question and requested any additional comments from the feedback questionnaire:
Q1: What ideas do you have to encourage active practice engagement in the work of the CCG - With the governance architecture? (engine room, governing body)? - With one another? - Within localities?
No additional comments.
Q2: What are your views about the locality configuration?
KS agreed with Adam Wickings’ comments suggesting a smaller number of localities. CE stated that to be mindful the bigger the locality the harder it is to communicate. RS stated that this is very relevant to the £25 per head and costs should be looked at too. CB requested more clarification and detailed report on the costings so GPs can be aware of the pros and cons of each option.
It was agreed that the DH Ready Reckoner analysis would be circulated, potentially for debate at the next meeting.
MR felt that the localities that are working well should be left to continue to develop productively.
BH felt that two localities may be best and noted the importance of this decision for external stakeholders including mental health and community services who want to realign to reflect locality structures. / JB
Q3: What are your views and ideas on how localities can work most effectively?
SE requested further clarification on Mulgrave Road practice’s comments. DP felt that practices should sign an agreement and if not engaging be held accountable.
Q4: Do the proposals for the locality leadership team seem appropriate?
No additional comments.
Q5: What are your views on the patient participation / engagement approach suggested?
No additional comments.
Q6: What name do you suggest for the ‘engine room’?
No additional comments.
Q7: Do the membership arrangements for the ‘engine room’ seem broadly appropriate?
No additional comments.
Q8: Should locality leads representation in the ‘engine room’ be mandatory?
No additional comments.
Q9: Do you feel patient engagement is best served by representation in the ‘engine room’?
No additional comments.
Q10: Any suggestions for ensuring effective ways of working and freeing up practices to ensure appropriate representation?
CE - remuneration will apply and this will also be a requirement of the new PMS contract.
Q11: Overall, do the membership arrangements for the governing body seem appropriate?
No additional comments.
Q12: Do you support the principle of one practice, one vote for the election stage of the appointment process to the Governing Body?
RM proposed one GP one vote. KS proposed one partner one vote. DP highlighted we need to make a decision and formalise this in a document for all to agree.
Q13: What involvement would you feel is appropriate from the Local Authority/Council?
No additional comments.
Q14: Do you have specific preferences for the following:
No additional comments.
Q15: Overall, are the proposed committee arrangements broadly appropriate?
No additional comments.
Q16: Do you support the idea and approach for a nomination committee?
No additional comments.
Q17: Which, if any, committees would you share across CCGs?
No additional comments.
Q18: OVERALL: Are you supportive of this proposed approach for the governance arrangements for Sutton CCG?
No additional comments.
CE highlighted the need for the Board to make a range of decisions today following the consultation.
Q8: Should locality leads representation in the ‘engine room’ be mandatory?
·  Majority Board vote of Yes.
Q11: Overall, do the membership arrangements for the governing body seem appropriate?
·  Majority Board vote of Yes.
Q2: What are your views about the locality configuration:
·  Mixed views but agreed current format is not viable.
Q14: Do you have specific preferences for the following:
Chair of Governing body:
There has been strong support for a clinical Chair to the group and this was formally endorsed by the Board.
Q12: Do you support the principle of one practice, one vote for the election stage of the appointment process to the Governing Body?
The majority of respondents had recommended one practice one vote; however, a significant number of respondents favoured some form of weighted voting based on practice list size. A number of members present at the meeting strongly supported this approach. It was agreed to vote on the decision with any vote being final, at least in relation to the appointment of the Chair which needs to happen over coming weeks, as all practices had been invited to send a representative to the meeting.
This vote went in favour of capitation weighted voting. After debate, it was agreed that voting for the Chairs should be based on one vote per 1000 population (rounded to the nearest 1000). It was further agreed that practices could split their vote between candidates but the Management Board representative would be responsible for submitting the final practice return. JB noted this was not what had been fed back by practices through the consultation. BH highlighted that every practice had been asked to send a representative and, as the Board was quorate, the Board decision to adopt weighted voting, as defined above, would apply at this time. JB confirmed this would be implemented for the Chair appointment.
JB to circulate job description for Chair position to the next Management Board. / JB
6 / Next Steps and timeline to authorisation
Discussions are ongoing with South London Commissioning Support Service (CSS), whose current offer to CCGs is for an “end to end” service costing £15.70 per head (on weighted capitation). This would encompass all CCG functions other than the Board and limited clinical engagement, so any in-house CCG staff would effectively be paid for twice as these costs would already be included within the CSS offer. This does not fit with the business model Sutton CCG has been working up, which is for a small in-house team of key staff, significant clinical engagement and leadership, supported by a CSS providing back office, IT, workforce and other functions best delivered at scale.
There is significant pressure from NHS London and NHS South West London to agree CSS functions before the end of March 2012. BH advised that the current offer from the CSS was undesirable and unaffordable for the smaller South West London CCGs, who would continue to press for an alternative offer of “core” services, with additional services provided for those CCGs who wished to commission them.
7 / Date and Venue of Next Meeting
Wednesday, 7th March 2012, 1:00pm – 3:00pm
Good Shepherd Centre, Queen Mary’s Avenue, Carshalton Beeches, SM5 4NP

Att 1b-Sutton CCG Mgt Board Minutes-15-02-12 page 6 of 6