BEXLEY FORMAL CLINICAL COMMISSIONING CABINET MEETING

19 JANUARY 2012, 1PM

DANSON ROOM, 221 ERITH ROAD, BEXLEYHEATH, DA7 6HZ

PRESENT:

Dr Bill Cotter (Chair) GP Clinical Commissioning Cabinet Member, Clocktower

Dr Howard Stoate GP Chair Clinical Commissioning Cabinet

(joined meeting item 5/12)

Dr Varun Bhalla GP Clinical Commissioning Cabinet Member, North Bexley

Dr Gunen Ucyigit GP Clinical Commissioning Cabinet Member, Salaried GPs

Dr Sid Deshmukh GP Clinical Commissioning Cabinet Member, Frognal

Dr Joanne Medhurst Managing Director and Medical Director Bexley BSU

Paul Cutler Bexley Care Trust Non Executive Director

Theresa Osborne Chief Financial Officer Bexley BSU

Co-optee Members

Cllr Eileen Pallen Non Executive Director Nominated by Bexley Council

Cllr John Davey Non Executive Director Nominated by Bexley Council

(joined meeting item 5/12)

David Parkins Clinical Quality Lead Bexley BSU

Formal Observer

Maureen Holkham Local Authority Representative Bexley Council

IN ATTENDANCE:

Beth Hill Clinical Cabinet Special Advisor Bexley BSU

Dr Dharini Shanmugabavan Graduate GP Bexley BSU

Maggie Williams Lead Continuing Healthcare Nurse Bexley BSU

(Item 10/12)

Mary Stoneham (Notes) Corporate Office Manager Bexley BSU

APOLOGIES:

Keith Wood Bexley Care Trust Vice Chair Non Executive Director

Pamela Creaven Managing Director and Director of Operations (Public Health) Bexley BSU

Sandra Wakeford Chair Bexley Patient Council Co-Optee Member Formal Meetings

2/12 / WELCOME AND APOLOGIES FOR ABSENCE
Dr Cotter welcomed Maureen Holkham as the Bexley Local Authority Representative to her first Bexley Clinical Commissioning Cabinet Meeting. Apologies had been received from Keith Wood, Pam Creaven and notification that Dr Howard Stoate and Cllr John Davey would be delayed.
3/12 / MINUTES OF THE FORMAL BEXLEY CLINICAL COMMISSIONING CABINET MEETING HELD ON 15 DECEMBER 2011
The minutes of 15 December 2011 were agreed as a true record of the meeting.
3/12 / MATTERS ARISING FROM THE MINUTES
The meeting discussed the 15 December 2011 action points which were amended with outstanding actions transferred to next meeting log.
156/11 PROPOSAL FOR RESTRUCTURING THE CURRENT INDIVIDUAL FUNDING REQUEST (IFR) PANELS INTO A SINGLE SEL IFP PANEL AND SEL IFR APPEALS PANEL
Letter sent to Cluster 22.12.11 – no response received to date.
Paul Cutler had met with Rose Echlin and confirmed he would chair three BBG meetings (no Bexley cases to consider) to clear the backlog of work.
Paul Cutler suggested that Cluster/Bexley BSU meet to clarify the expectations of each organisation and agree how to take this work forward. Rose Echlin had accepted comments regarding a NED Chair providing more transparency than a Medical Director Chair.
Action:
Dr Medhurst to email Rose Echlin and ask for a meeting to take place with Graduate GP to discuss IFR process in line with current staff/ financial resources. Paul Cutler to be copied into email and a link with SLHT to be considered.
Theresa to link with Bromley BSU to compare Cluster/Bromley process.
167/11 WINTER PLANNING
Dr Medhurst confirmed that Sue Robinson had met with Darent Hospital and agreed a series of actions to take work forward.
Concerns were raised regarding problems surrounding the discharge process of Bexley patients from Darent Hospital. Dr Medhurst confirmed that Sue Robinson was working closely with the hospital on this issues and Maureen Holkman confirmed that Dave Holman working to address social care issues.
Cllr Pallen highlighted concerns surrounding maternity capacity issues at Darent Hospital and that Bexley patients were experiencing long waits for appointments. Dr Ucyigit stated that concerns had been raised by the Bexley, Bromley & Greenwich Stakeholder Meeting regarding capacity issues and limited Patient Choice options offered by Bexley GPs. Dr Medhurst explained that in many cases patients booked with the hospital of their choice directly and capacity issues at hospitals resulted from Patient Choice. Bexley GPs explained the choices available to patients who then made the decision.
4/12 / DECLARATIONS OF INTEREST
There were no declared interests in respect of the meeting agenda.
Cllr John Davey notified the meeting that he was now a Governor of the New Horizons Federation and ceased being a Member of Bexley’s Pupil Referral Unit.
Action:
Mary Stoneham to update the Declarations of Interest Register.
5/12
6/12 / UPDATE FROM BEXLEY CLINICAL COMMISSIONING CHAIR
Dr Howard Stoate stated that discussions at the Clinical Strategy Group meeting had focussed on how London healthcare could work together and in particular the implementation of the 111 Pilot Programme and Cluster wide bariatric surgery. Bexley’s bid for the Productive Primary Care Programme had been approved and would be led by Gunen Ucyigit. Bexley had received notification that they were the only PCT in London in a position to take this work forward.
Dr Cotter explained that McKinsey’s work with Bexley included preparation for authorisation and the Department of Health National Assessment programme.
Joint BBG work was moving forward on MSK and the Quality Safety & Audit programmes.
UPDATE FROM BEXLEY CLINICAL COMMISSIONING GPs
Drs Cotter, Bhalla and Deshmukh confirmed that at the recent Locality Meetings discussions included the implementation of winter plans and the care management of patients, agreement of QoF pathways, the progression of the Clocktower’s Invitation to Tender and the implementation of the LPS across Bexley.
Concerns were raised at all the Locality meetings by Bexley GPs that primary care issues were not being address appropriately, the delay in the current payment system was causing problems, BBG access to Darent Hospital electronic system and the timing of the list cleansing programme.
Theresa Osborne explained that the new financial system now used had been implemented by Cluster as had the list cleansing programme and a further London wide list cleansing programme was being planned by the Department of Health.
In response to questions Dr Cotter explained that the BBG Cardiology collaborative approach programme was moving forward but was not at a decision making stage at present. It was planned that that Bromley would be included in the programme from April 2012 and that a prime contractor would be agreed by BBG through a transparent process that would provide good clinical and medical practice and assurance. The meeting confirmed that it was crucial that the criteria for the pilot and prime contractor were agreed through a transparent process agreed by BBG.
Dr Ucyigit confirmed that work was progressing across BBG on the redesign of elderly care and included common themes and guidance from the National Dementia Strategy & Falls Strategy.
Dr Medhurst explained that the Clinical Executive was looking to review systems across BBG and how to develop improved services which would be linked to the QMS Campus.
7/12 / UPDATE FROM BEXLEY BSU MANAGING DIRECTORS
Dr Joanne Medhurst explained that McKinsey’s, as discussed in the BCCC Chair update above, were reviewing where monies could be saved in Bexley and an integral part of the Queen Mary’s Campus programme.
Theresa Osborne explained that the Project Management Office (PMO) had now been established and consisted of three people who would need clinical support during the course of their work. Terms of Reference and governance issues were currently being discussed and would need to be agreed. Theresa confirmed that McKinsey’s and the PMO staff were being funded by the Department of Health and their workplans would be agreed to ensure there was no duplication or cross over of resources.
The PMO were meeting with Professor Littlejohn and Bexley Council to discuss obesity and NICE guidelines and David Parkins suggested that diabetes should be included in this work. A joint commissioning board paper was being discussed at the Health & Wellbeing Board later which reflected local joint partnership working. Dr Medhurst explained that John Grumitt would be reviewing red rated diabetic targets.
8/12 / Update from Chair of Bexley Patients Forum
No update given at meeting as Sandra Wakeford had sent apologies for meeting.
9/12 / STRATEGY FOR THE PROCUREMENT OF A 111 PILOT FOR SOUTH EAST LONDON
David Parkins presented the Strategy for the Procurement of a 111 Pilot for South East London which, although had been approved at the December Joint Cluster Board, required formal confirmation from the Clinical Commissioning Groups. The original proposal of a model which involved a consortium approach of existing NHSSEL providers had been deemed to contravene procurement rules. NHSSEL therefore confirmed to NHSL on 28 November 2011 that it intended to use the recommended accelerated competitive procurement process supported by NHSL.
David Parkins confirmed that the Department of Health had issued guidance that the 111 Pilots would be London wide with patient costs charged according to usage.
Following concerns raised by Bexley GPs regarding the one procurement process where patients would only be triaged once it was agreed that the process needed to include the addition of a GP in the process if required.
If the proposal was not to implement an integrated approach, then could be more costly if patients presented at A&E rather than their GP. Dr Bhalla stressed the need to ensure that demand management needs to be managed appropriately and Dr Stoate stressed the need to ensure that Bexley is part of the service design process for the SE London pilot. Dr Medhurst confirmed that the Clinical Strategy Group (which included Clinical Commissioning Chairs and Managing Directors from each borough) would be take this work forward and would need to ensure that South London Healthcare Trust were involved in the process.
Action:
Dr Medhurst explained that a Director in each Borough would lead on this pilot and agreed to meet with Maureen Holkman to discuss the implementation of the pilot.
David Parkins stated that the risk implications need to be addressed and a process agreed with the Clinical Strategy Group to feed back to the Joint Cluster Board and ensure monthly reports are provided to each borough.
Action:
David Parkins agreed to feedback to Cluster comments from the meeting and the inclusion of the addition of one GP session in the process.
The Bexley Clinical Commissioning Cabinet:
Confirmed that the SEL cluster proceeds with an accelerated competitive procurement process to procure the pilot 111 service for south east London.
Confirmed that it approved the proposed implementation approach for the 111 pilot in south east London in light of recent recommendations from NHS London.
10/12 / POLICY FOR THE PROVISION OF NHS CONTINUING HEALTHCARE: CHOICE, COST AND EQUITY FOR PATIENTS OF BEXLEY CARE TRUST
Maggie Williams, Bexley BSU Lead Continuing Healthcare Nurse, presented the Policy for the Provision of NHS Continuing Healthcare; Choice, Cost and Equity for patients of Bexley Care Trust.
Maggie Williams explained that the policy describes how Bexley Care Trust commission packages of care for those patients for whom the Trust is the responsible commissioner, where such patients have been assessed as the eligible for fully-funded NHS Continuing Care (CHC) in accordance with the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (2009). The policy details how quality care is delivered within the constraints of the Trust’s available financial resources, and to support consistency and equity of access to services for all NHS CHC patients for whom the Trust is responsible.
The meeting discussed the policy and Theresa Osborne explained that although Bexley increased this budget year on year, due to the elderly population in Bexley, the budget is always overspent as the need for continuing care is continually rising.
Lengthy discussion took place on the process regarding patients with very complex conditions approaching end of life and the commissioning of placements processes which were implemented in line with the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (2009). Paul Cutler asked for clarification on how equality was measured and reported upon to ensure that all patients were treated equitably.
Maggie Williams confirmed that Continuing Care Joint Assessment Panels (JAPs) were carried out by a multidisciplinary team every Friday and all patients could request to have a Continuing Care Assessment carried out. She explained Bexley NHS had received good feedback from the CHC on the implementation of this guidance and confirmed that legal advice had been sought and received on the meeting document. Maggie confirmed that patient choice was considered and implemented where appropriate and within the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (2009).
Action:
The Chair asked members to email comments on the policy to Mary Stoneham to collate and forward to Maggie Williams so that they could be considered and incorporated (as necessary) into the policy which would be discussed at the Formal Bexley Clinical Cabinet Meeting on 23 February 2012.
11/12 / OPERATING PLAN 2012/13
Beth Hill stated that the Bexley BSU had submitted the meeting SEL Cluster Template on 6 January 2012 and Performance Trajectories had been submitted separately. Cluster had confirmed that the gaps highlighted needed to be completed by Cluster and that all relevant information form the BSU had been received.
Bexley Clinical Commissioning Cabinet noted that this was the first draft of the document and further drafts will be submitted for their continued involvement in the development plan process and a key part of the process for agreeing the detail for a comprehensive Local Operating Plan.
Following discussion Beth Hill confirmed that the CSP and the Operating Plan had both been informed by the JSNA.
The BCCC noted the content of the first draft submission into Cluster.
12/12 / JOURNEY TO AUTHORISATION
Beth Hill provided an updated on the progress of the Organisational Development contract with McKinsey which supports the CCGs to prepare for authorisation. The Multi-professional Education and Training (MPET) Report
Outlined the activity up until the end of December 2011 and has been RAG rated as Green.
Discussion will continue between the Bexley Clinical Commissioning Cabinet and McKinsey’s to agree a way of working to achieve the aims of the programme.
The BCCC noted the contents of the Multi-professional Education and Training (MPET) Report and that the main risk to the Organisational Development Programme going forward the Authorisation Process is the time available for key cabinet members to attend development sessions at a time of high operational demands and a new approach has been agreed.
Beth Hill confirmed that development proposals had been agreed; 360 team assessments shared and meeting structures/agendas revised to reflect the development process.