DRAFT

BEXLEY FORMAL CLINICAL COMMISSIONING CABINET MEETING

27 SEPTEMBER 2011 AT 2 PM

THE GREAT HALL, HALL PLACE, BOURNE ROAD, BEXLEY, DA5 1PQ

PRESENT:

Dr Howard Stoate (Chair) Clinical Commissioning Cabinet Chair

Dr Varun Bhalla Clinical Commissioning Cabinet Member, North Bexley

Dr Bill Cotter Clinical Commissioning Cabinet Member, Clocktower

Dr Gunen Ucyigit Clinical Commissioning Cabinet Member, Salaried GPs

Keith Wood Bexley Care Trust Vice Chair Non Executive Director

Paul Cutler Bexley Care Trust Non Executive Director

Pamela Creaven Managing Director and Director of Operations

(Public Health) Bexley BSU

Dr Joanne Medhurst Managing Director and Medical Director Bexley BSU

Theresa Osborne Chief Financial Officer Bexley BSU

Cllr Eileen Pallen Bexley Care Trust Non Executive Director

Cllr John Davey Non Executive Director

David Parkins Clinical Quality Lead Bexley BSU

IN ATTENDANCE:

Beth Hill Clinical Cabinet Special Advisor Bexley BSU

Jon Winter Head of Communications, Engagement and

Complaints Bexley BSU

Mary Stoneham Corporate Office Manager Bexley BSU

Christine Taylor Senior PA Bexley BSU

Item 105/11

Joyce Dukes Commissioning Support Mgr Bexley BSU

Item 112/11

Michael Fairbairn Clinical and Corporate Risk Mgr Bexley BSU

Andrea Davis Clinical Governance Facilitator Bexley BSU

APOLOGIES:

Dr Sid Deshmukh Clinical Commissioning Cabinet Member, Frognal

Sandra Wakeford Chair of Bexley Patient Council

98/11 / WELCOME AND APOLOGIES FOR ABSENCE
Dr Howard Stoate welcomed everyone to the first Formal Clinical Commissioning Cabinet to be held in public. Apologies had been received from Dr Sid Deshmukh and Sandra Wakeford.
99/11 / MINUTES OF THE FORMAL BEXLEY CLINICAL COMMISSIONING CABINET held on 28 JULY 2011
The minutes of the meeting held on 28 July 2011 were agreed.
100/11 / MATTERS ARISING FROM THE MINUTES OF 28 JULY 2011
All matters arising had been actioned.
101/11 / DECLARATIONS OF INTEREST
Declarations of interest in the attached register were noted. There were no specific declarations of interest in respect of the agenda for this meeting.
102/11 / UPDATE FROM CHAIR OF BEXLEY CLINICAL COMMISSIONING
Dr Howard Stoate explained that a productive meeting had been held with Bexley, Bromley and Greenwich GPs and Managing Directors to discuss areas where shared clinical working would be beneficial and a meeting was being arranged to discuss Elderly Care across the three Business Support Units (BSUs).
Dr Stoate provided a brief update on current issues:
o  The budget for Multi Professional Educational Training (MPET) would be used to improve commissioning skills and development and McKinsey’s would be working with Bexley BSU to take this work forward.
o  An inaugural meeting of the Bexley Patient Council had taken place.
o  Bexley BSU was working on redesigning the Elmstead Rehabilitation unit.
o  Bexley Diabetes service had been nominated for a Health Service Journal Award.
o  Bexley BSU was developing a Strategic Outline Case in respect of the Queen Mary’s, Sidcup (QMS) Campus.
1032/11 / UPDATE FROM BEXLEY CLINICAL COMMISSIONING GPs
Dr Bill Cotter provided an brief update from Clocktower Locality:
o  Quality Outcome Framework (QoF) target areas had been agreed with a few QoF appeals from practices
o  Quality Innovation Productivity Prevention (QIPP) visits to GP Practices by BSU staff were well received. .
o  Some difficulties had arisen with regard to South London Healthcare NHS Trust (SLHT) discharge summaries and x-ray reporting. David Parkins advised that he was following this up.
o  SE London Cluster providing support to Bursted Woods tender and a pre-tender questionnaire had been devised. SE London Cluster were holding discussions with patients.
o  Action: David Parkins to follow up discharge summaries and x-ray reporting with SLHT.
Dr Varun Bhalla said that the Local Council had attended a recent North Bexley locality meeting to discuss joint working and generated a lot of good ideas by the GPs and the Council.
All GPs within North Bexley had agreed to sign the constitution as part of the Bexley Consortium, he felt this demonstrated the confidence GPs have in the Clinical Commissioning Cabinet.
North Bexley had looked at specific areas to target and these had been peer reviewed and demand management had been discussed and raised issues regarding some patient services at QMS.
David Parkins confirmed that he was working on Commissioning for Quality and Innovation (CQINs) for SLHT in order to monitor areas where improvements in services were required. Dr Bhalla requested more information on discharge summaries.
Action: David Parkins to follow up discharge summaries with SLHT.
Dr Sid Deshmukh was not present to give an update on the Frognal Locality.
104/11 / UPDATE FROM BEXLEY BSU MANAGING DIRECTORS
Dr Joanne Medhurst explained she was working on elderly care redesign as part of integrated care packages which was a big piece of work that would bring services together.
Pamela Creaven said that the GP Clinical Commissioning Group was going through authorisation to gain delegation of authority prior to the abolition of Bexley Care Trust. A reorganisation of Bexley Care Trust had taken place in the early part of 2011 in order to form Bexley Business Support Unit. The new organisation had far fewer staff and as it moved towards delegated authority, staff would need to be trained to give them the appropriate skills. SE London Cluster recognised the need to address this training need. The new Chief Executive of SE London Cluster, Andrew Kenworthy, would commence at the beginning of October.
105/11 / INDEPENDENT MENTAL HEALTH ADVOCACY (IMHA) CONTRACT
Joyce Dukes introduced the Independent Mental Health Advocacy (IMHA) Contract which Bexley, Bromley, Greenwich and Lewisham had agreed to collaborate on a contract to provide advocacy for mental health patients in forensic care. The current way of working was disjointed and the uptake of the service poor and commissioning the service collaboratively would be cost neutral for each BSU and would provide a seamless service.
Paul Cutler asked whether equality and diversity aspects had been considered and whether users of the service had been involved in the contract specification. Joyce Dukes confirmed that equality and diversity were part of the contract. However, many of the patients were severely mentally challenged and was unsure about their engagement in the consultation but would look into this issues and feedback to Paul.
Action: Joyce Dukes to find out whether patients had been involved in the IMHA contract specification.
Keith Wood asked whether local organisations would tender for the service. Joyce expected five or six applications from local organisations.
The Bexley Clinical Commissioning Cabinet ratified the decision made at the BSU Corporate Meeting on 1 September 2011.
106/11 / BEXLEY BSU ICT MOBILE DEVICE POLICY
David Parkins explained that the Bexley BSU ICT Mobile Device Policy icy had been updated to incorporate the use of iphones and ipads.
The Bexley Clinical Commissioning Cabinet ratified the Bexley BSU ICT Mobile Device Policy.
107/11 / UPDATE ON TOTAL HEALTH
Pamela Creaven gave a brief update on the Total Health programme and explained that in May/June 2010 Bexley Care Trust and London Borough of Bexley were required to assess and improve upon local working. This has resulted in the use of the Total Health Model which integrates health pathways, commissioning and prevention. The Shadow Health and Wellbeing Board had been developed and the two organisations have an agreed Statement of Intent regarding working together and have committed to develop a joint commissioning unit.
108/11 / UPDATE ON QMS CAMPUS
Dr Joanne Medhurst summarised a presentation on the QMS Health and Welling Being Campus which built upon the integrated care model. GPs from Bexley, Bromley and Greenwich were involved, together with Oxleas, SLHT and London Borough of Bexley. The goal was to work in partnership to deliver integrated working in order to keep residents well and active. There were various possibilities for the site such as a renal unit, radiotherapy and elective. A Strategic Outline Case (SOC) for the QMS Campus was being developed for submission on 13 October 2011 and there was considerable work still required on affordability and feasibility and if approved this would develop into an Outline Business Case. Bird College had expressed an interest in using the Frognal Centre and this had appeared in the local press. The future developments for the QMS site were in line with the A Picture of Health Consultation and consultation was taking place with LINks, Non Executive Directors, Councillors and local MPs.
109/11 / JOINT STRATEGIC NEEDS ASSESSMENT (JSNA)
Pamela Creaven explained that the Joint Strategic Needs Assessment (JSNA) looked at information and analyses and then considers strategies to address areas where improvements could be made. It had been considered by the Local Authority and the Shadow Health and Wellbeing Board. The JSNA would be uploaded on to the Local Authority website and a feedback form would be included to receive resident’s comments.
Cllr Eileen Pallen asked whether this document would be used as a snapshot of the current situation in order to monitor improvements in the future. Pamela Creaven explained that it gave an assessment of need and showed where the gaps and issues were. The London Borough of Bexley and Bexley BSU would then come to a decision about what and how needs would be addressed. She explained that a JSNA was a statutory requirement which needed to take place every two years. The findings of the JSNA would be incorporated into a refresh of the Commissioning Strategy Plan within Bexley BSU and the Local Authority Business Plan.
The Bexley Clinical Commissioning Cabinet endorsed the Bexley Joint Needs Assessment 2010-12 and noted the steps that will be taken to address areas for improvement identified in the JSNA.
110/11 / COMMISSIONING STRATEGY PLAN
Beth Hill presented the Commissioning Strategy Plan update which outlined the overall CSP process, key roles and responsibilities and key deadlines. The report provides an update on progress and provide greater detail of the engagement with stakeholders process.
The Bexley Clinical Commissioning Cabinet noted the contents of the Commissioning Strategy Plan report and that the BSU and BCCC are on track to meet reporting deadlines. They also noted the approach to engage stakeholders in the refresh of the five year plan.
111/11 / COMMISSIONED SERVICES QUALITY REPORT Q1
David Parkins stated that the Commissioned Sevices Quality Report Q1 ort examines the key quality domains (Patient Safety; Clinical Effectiveness; and Patient Experience) relating to services commissioned by Bexley Business Support Unit, NHS South East London (BBSU) and identifies the quality assurance process that has been developed for monitoring these services. This report is an outcome of this assurance process and is based on reports that have been approved at various external and internal committees. The report is designed as a quarterly review and is not designed to represent a real time snapshot of the quality of provider services. Where necessary, when there are urgent concerns around the safety or quality of provider services, these will be raised directly with the Bexley Clinical Quality Lead or the Medical Director and escalated as necessary.
David Parkins explained that key issues were highlighted in the report and confirmed that work was currently being undertaken with SLHT to improve access in relation to stroke and TIA units.
The Bexley Clinical Commissioning Cabinet noted that the reports contained have been received by the BCCC Clinical Quality Assurance Group who have agreed that quality concerns identified by the report are, or have been actively addressed through the appropriate groups.
112/11 / RISK MANGEMENT REPORT
The NHS SEL Assurance Framework identifies an integrated approach whereby risks in the respective risk registers are aligned to Corporate Objectives (without the need for an additional BAF) and was approved by the Joint Boards on 21.7.11. Bexley BSU has been developing risk management & risk registers to align with the Cluster framework. Local Clinical Commissioning Consortia input to and oversight of the management of risks identified by the individual BSUs are integral to this Framework
Theresa Osborne explained that some of the financial risks were under the control of the BSU could and others were the responsibility of Cluster and these would be clearly identified in future reports. It was agreed that it would be useful to see the whole of the Cluster Risk Register on a quarterly basis.
Action: Michael Fairbairn to provide quarterly Cluster Risk Registers to the Bexley Clinical Commissioning Cabinet.
The Bexley Clinical Commissioning Cabinet noted the risks identified to the BSU in the accompanying risk registers.
113/11 / FINANCE REPORT
Theresa Osborne outlined the main headlines from Month 4 Finance Report headlines. The Cluster is now responsible for preparing the monthly Finance report for the Care Trust Board and this brief report provides headlines for the Clinical Cabinet in respect of the financial position as reported at month 4. However, it should be read in conjunction with the full Month 4 Cluster Finance report (Appendix 1). It is hoped that for future months, Cluster will provide separate reports for each individual BSU. For ease of reference for month 4, in addition to the highlights provided, Bexley specific areas have been highlighted in the Cluster report.
Keith Wood asked if a financial update was available for Month 5. Theresa Osborne said that acute contracts had deteriorated and this meant that Bexley BSU was forecast to achieve break even rather than 1% surplus. The SLHT SLA still remained unsigned.
Paul Cutler asked if it would be possible to have an update on Individual Funding Requests for Bexley residents.
Action: Theresa Osborne to contact Una Hayles at SE London Cluster, to request an update on Individual Funding Requests for Bexley residents.
The Bexley Clinical Commissioning Cabinet noted the month 4 finance report.
114/11 / PERFORMANCE REPORT
Theresa Osborne presented the Month 4 Performance Report and asked the meeting to note areas of concern marked in red and areas to monitor marked in amber.
Pamela Creaven pointed out that the information on immunisation rates was incorrect. Although the information had been collected from GP practices this had not been uploaded due to some contractual issues with Oxleas, therefore reporting had not taken place for Q1.
The Bexley Clinical Commissioning Cabinet noted the Cluster Performance Report for month 4 of 2011/12.
115/11 / QIPP REPORT
Theresa Osborne presented the QIPP Report and stated that at the beginning of the year the Bexley BSU had to find £4.6m QIPP savings. They had worked with GPs and this gap had been closed completely. This was mainly as a result of reprioritisation and reduction of investments and further rationalisation of budgets. In relation to actual performance of QIPP, two schemes were on plan, one was underplan and one was significantly underplan at present. Dr Bill Cotter said that prescribing schemes take time to take effect and reported that extra pharmacy support was being considered. Concern was expressed that some contracts were still unsigned and reports on the situation were being sought.
The Bexley Clinical Commissioning Cabinet noted the contents of the QIPP Report and support the delivery of the QIPP agenda within Bexley.
116/11 / SUB COMMITTEE MINUTES
Medicines Management Draft Minutes 7 September 2011
The Bexley Clinical Commissioning Cabinet noted the Medicines Management Draft Minutes of 7 September 2011.
117/11 / COMMUNICATIONS AND PATIENT INVOLVEMENT UPDATE
The Bexley Clinical Commissioning Cabinet noted some of the key communications and engagement activity that has taken place over the last two months.
118/11 / PUBLIC QUESTION TIME
Q.  Will the QMS Health Campus be made up of independent providers?
A.  It was envisaged that there would be several providers, however there would be an overarching agreement that they should work together.
Q.  Will a GP Practice be part of the QMS Campus?
A.  There is an allocation for primary care space, however this could depend upon whether Bird College takes up the Frognal Centre space.
Q.  There are sometimes duplications of services, for example people who are seen in the Diabetes Clinic at QMS are also asked to attend their GP practices for checkups. Could this duplication be eliminated?
A. It was explained that acute trusts and GPs have different targets that
they need to meet so this sometimes leads to duplication for patients. Ideally diabetes patients should be managed by their GPs, this would avoid duplication. However, sometimes patients needed to be seen within acute settings and this therefore resulted in duplication. Ideally a service could be designed where information could be shared, such as the NW London Integrated Care Pilot.
119/11 / ANY OTHER BUSINESS
There was no other business.
120/11 / DATE AND TIME OF NEXT MEETING IN PUBLIC
Thursday, 27 October 2011, 1pm-3pm, venue to be arranged. John Davey gave his apologies for the next public meeting
121/11 / CLOSURE OF PART ONE
Representatives of the press and other members of the public were excluded from the remainder of the meeting having regard for the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest (Section 1(2) Public Bodies (Admissions to Meetings) Act 1960).

A partnership of Primary Care Trusts in Bromley, Greenwich, Lambeth, Lewisham, Southwark and Bexley Care Trust