NHS Newark & Sherwood CCG Stakeholder Reference Group Sub ... · NHS Mansfield and Ashfield CCG...

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NHS Newark & Sherwood CCG Stakeholder Reference Group Sub Committee Held on Tuesday 25 October 2016 at 6.00 pm at Birch House, Ransomwood, Mansfield The minutes of this meeting will be reviewed and discussed at the NHS Newark and Sherwood CCG Governing Body meeting and will be available on the CCG’s website. Papers may also be released as part of a Freedom of Information request. Present: Mr Dennis Brown (N&S CCG Lay Member and Sub Committee Chair) Ms Viv Hall (Independent Member and Sub Committee Vice Chair) Ms Susie Crosby (Chair of East Notts Travellers Association) Ms Christine Ward (Independent Member) Mr Michael Wright (Men’s Life, Men’s Health) Mr Gerald Smith (Friends of Balderton Surgery) Mr Geoffrey Tinker (Southwell Medical Users Group Representative) Mrs Celia Flinton (Edwinstowe PPG Representative) Councillor Neill Misson (Newark and Sherwood District Council) Mr Richard Hayward (Lombard Patient Group) In attendance: Dr Amanda Sullivan, Chief Officer (N&S CCG) Ms Andrea Brown, Director of Programme Delivery (N&S CCG) Mrs Nicola Powell, Corporate Governance Support Officer (N&S CCG) Apologies: Mrs Elaine Moss, Chief Nurse and Director of Quality and Governance (N&S CCG) Mrs Marlene Ablewhite (Fountain Connections PPG Representative) Mr Tim Sedgwick (Barnby Gate PPG Representative) Mrs Gilly Hagen (Nominated Substitute Abbey Medical Partnership PPG) Mr David Ainsworth, Director of Primary Care (N&S CCG) Mr Tony Colton, (Chair of Newark CVS) Mr Anthony Berryman (Bilsthorpe Patients Surgery Group Representative) Non-Attendance (No Apologies received): Mr Martyn Llewellyn-Smith (Hounsfield Surgery PPG Representative) S/16/150 WELCOME AND INTRODUCTIONS Mr Brown welcomed everyone to the meeting. S/16/151 HOUSEKEEPING Mr Brown explained the housekeeping rules. S/16/152 APOLOGIES FOR ABSENCE Apologies were received and noted as outlined above. S/16/153 DECLARATIONS OF INTEREST 1

Transcript of NHS Newark & Sherwood CCG Stakeholder Reference Group Sub ... · NHS Mansfield and Ashfield CCG...

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NHS Newark & Sherwood CCG Stakeholder Reference Group Sub Committee Held on Tuesday 25 October 2016 at 6.00 pm at Birch House, Ransomwood, Mansfield The minutes of this meeting will be reviewed and discussed at the NHS Newark and Sherwood CCG Governing Body meeting and will be available on the CCG’s website. Papers may also be released as part of a Freedom of Information request. Present: Mr Dennis Brown (N&S CCG Lay Member and Sub Committee Chair) Ms Viv Hall (Independent Member and Sub Committee Vice Chair) Ms Susie Crosby (Chair of East Notts Travellers Association) Ms Christine Ward (Independent Member) Mr Michael Wright (Men’s Life, Men’s Health) Mr Gerald Smith (Friends of Balderton Surgery) Mr Geoffrey Tinker (Southwell Medical Users Group Representative) Mrs Celia Flinton (Edwinstowe PPG Representative) Councillor Neill Misson (Newark and Sherwood District Council) Mr Richard Hayward (Lombard Patient Group) In attendance: Dr Amanda Sullivan, Chief Officer (N&S CCG) Ms Andrea Brown, Director of Programme Delivery (N&S CCG) Mrs Nicola Powell, Corporate Governance Support Officer (N&S CCG) Apologies: Mrs Elaine Moss, Chief Nurse and Director of Quality and Governance (N&S CCG) Mrs Marlene Ablewhite (Fountain Connections PPG Representative) Mr Tim Sedgwick (Barnby Gate PPG Representative) Mrs Gilly Hagen (Nominated Substitute Abbey Medical Partnership PPG) Mr David Ainsworth, Director of Primary Care (N&S CCG) Mr Tony Colton, (Chair of Newark CVS) Mr Anthony Berryman (Bilsthorpe Patients Surgery Group Representative) Non-Attendance (No Apologies received): Mr Martyn Llewellyn-Smith (Hounsfield Surgery PPG Representative) S/16/150 WELCOME AND INTRODUCTIONS Mr Brown welcomed everyone to the meeting. S/16/151 HOUSEKEEPING Mr Brown explained the housekeeping rules. S/16/152 APOLOGIES FOR ABSENCE Apologies were received and noted as outlined above. S/16/153 DECLARATIONS OF INTEREST

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Progress report from the Patient Reference Groups; 15 December 2016

Key Achievements This report provides key messages arising from meetings of Patient Reference Groups that have taken place across Mid-Nottinghamshire as follows:

NHS Newark and Sherwood CCG Stakeholder Reference Group - 25 October 2016

Mid-Nottinghamshire Patient Reference Group - 1 November 2016

NHS Mansfield and Ashfield CCG Citizens’ Reference Panel - 8 November 2016 NHS Newark and Sherwood CCG Stakeholder Reference Group - 25 October 2016

Minutes The minutes of the Sub Committee’s meeting held on 27 September 2016 were ratified at the Sub Committee’s meeting on 25 October 2016 and these are attached to this report. The key actions from that meeting were reported to the September 2016 meeting of the Governing Body.

SRG Questions to the Governing Body: There are some problems with the handover at Kings Mill Hospital (KMH) by EMAS in that KMH shows the EMAS crew as an example, being registered arriving and leaving in under the agreed hour handover before the penalty kicks in but the EMAS crew are claiming that the handover took more than the hour. There is an investigation into this but apparently EMAS do not have the ability to check the claims of their crews against the claims of KMH.

Please would the Governing Body explain as to how:

The contract did not identify this.

What has been done?

Has this now been rectified?

Has the financial cost to the public purse been reconciled?

Other Items of Note:

Safe and Well: Mr Cropley from Nottinghamshire Fire Service delivered a presentation to the Sub-committee members on Safe and Well.

Appointment of the SRG Chair The Chair informed The Sub Committee of the process of appointing a new SRG Chair. The new Chair will commence the role in January for six months

Mid-Nottinghamshire Patient Reference Group – 1 November 2016 Discussion at the inaugural meeting of the Mid-Nottinghamshire Patient Reference Group focused on building group relationships through the sharing of information about members’ background, current groups and networks they are involved in and the most important considerations in setting up the group. Further refinements were suggested to the Terms of Reference prior to consideration by the Citizens’ Reference Panel (CRP) and Stakeholder Reference Group (SRG). Members agreed that the Mid-Nottinghamshire Patient Reference Group (MNPRG) should:

embrace the refreshed CCG Communications, Engagement and Patient Experience Strategy

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2016 – 2018

make best use of the community links and networks of the SRG, CRP and third sector partnerships and bring that intelligence to the MNPRG via its membership and

review the mapping of engagement activity

share SRG and CRP agenda and supporting documents with the Chairs of each group. NHS Mansfield and Ashfield CCG Citizens’ Reference Panel - 8 November 2016

Cancer Workshop The meeting of the Citizens’ Reference Panel held on 8 November 2016 focused on reviewing feedback from the cancer workshop held on 11 October 2016. The event was well attended by patients and service providers with clinical input provided by Dr. Carolina Rubio and Dr. Vicki Clarke, MacMillan GP. The Citizens’ Reference Panel identified the following key issues to highlight to the Governing Body in support of improving the cancer journey for patients and their families:

1) Families of cancer patients feel helpless and uninvolved. 2) Clinicians need to recognise the importance of the role of family in the cancer patient’s

recovery and include them on the journey. 3) At the point of discharge from a service, a support package for continuing support for the

patient and their family is required. 4) There is a lack of confidence in the NHS about how patients will be treated if they become

ill due to negative media coverage in relation to budgets and working hours. It was agreed that there were opportunities for the CCG to work closely with cancer service providers to improve the patient and family experience of the cancer journey.

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A copy of the register of interests was circulated at the meeting. Mr Brown invited any new interests to be declared. It was noted there were none in relation to the business to be conducted at the meeting. S/16/154 MINUTES OF THE STAKEHOLDER REFERENCE GROUP SUB COMMITTEE HELD ON 27 September 2016 The minutes of the meeting held on 27 September 2016 were presented by Mr Brown for approval by the Sub Committee. The Sub Committee APPROVED the minutes of its meeting held on 27 September 2016. S/16/155 MATTERS ARISING FROM MINUTES OF MEETING HELD ON 27 September 2016 AND ACTIONS LIST Mr Brown presented the Sub Committee’s action list and invited any matters arising from the minutes. The following updates were given on the Sub Committee’s action list:- Action S/16/016 – Guest Internet Access for Birch House: This item was on-going. Action S/16/060 – Prepare report to the Governing Body following further discussion with the Clinical Chair and Chief Officer. Mr Brown to write a departing report to the Governing Body. S/16/156 SRG Sub Committee Forward Planner The Forward Planner was discussed. It was agreed to add Mental Health to the forward planner. Ms Brown apologised to the group for the delay in arranging for an introductory meeting with Andy Sommers the clinical lead for Mental Health with SRG and CRP members. This meeting would be scheduled at the earliest opportunity. Mr Tinker requested an update on the Joint CCG and the Turnaround Board. Action: Mrs Powell to add items to the forward planner. S/16/157 Safe and Well Ms Ward introduced Richard Cropley from the Nottinghamshire Fire Service. Mr Cropley gave a presentation on Safe and Well. A Safe and Well check is a person-centred home visit carried out by highly professional and trained staff from Nottinghamshire Fire and Rescue Service. The visit expands the scope of its predecessor, the Home Safety Check. It involves the systematic identification of, and response to, health, wellbeing and home security issues in addition to focussing on fire risk reduction. An effective Safe & Well visit takes a holistic approach to reducing risk, this is achieved by considering the individual, their home environment and lifestyle, and it places emphasises on a person centred approach. This means that it places the wishes, beliefs, needs and abilities of the individual at the heart of the intervention. Value and respecting others

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is one of our core values and this is reflected in the services we provide to members of the public. Throughout a Safe & Well visit our aim is to empower and motivate people to make positive changes to their health, wellbeing and fire safety. By doing this the process should not be limited to merely signposting to other agencies, but will also look to reduce risks during the initial visit where appropriate. A Safe and Well Visit/Check will include: • A light touch health check of all individuals in the home; • Identification of risk factors while in the home; • Provision of brief advice or interventions; • Provision of appropriate risk reduction equipment; • Referral to specialist advice and support where appropriate; • Signposting to further useful information. Nottinghamshire Fire and Rescue Service’s core purpose is ‘Creating Safer Communities’ and by expanding the scope of our home visits to look at other risks alongside fire risk, we increase our ability to deliver against this core purpose and increase public value. We know that many causes of poor health outcomes are the same as the factors that increase the risk of fire. By tackling these causes Nottinghamshire Fire and Rescue Service will not only improve Public Health outcomes, but will reduce fire incidents, injuries and deaths amongst those communities who are most at risk. Mr Cropley invited the SRG members to the next Safe and Well Stakeholder meeting which will be held at Highfields Fire Station, Hassocks Lane, Beeston on 18th November at 9.30am. Ms Ward informed the SRG members that she had invited Mr Cropley to the meeting because as PPG representatives we can raise awareness in the GP Surgeries about the services the Fire and Rescue are offering. S/16/158 Appointment of SRG Chair At the last meeting it was agreed to go ahead with supporting an overarching patient group to be the interface with the new joint Governing Body, the SRG and the Mansfield and Ashfield Citizens Reference Panel (CRP). This was also dependent on appointing a replacement chair for when Mr Brown retires. Mr Brown informed the SRG members that he has had several meetings with the CCG about the process for appointing a new Chair. This process is likely to take several weeks. Mr Brown suggested to Dr Sullivan that an interim Chair should be appointed this would allow time and a process to take place and to enable the new patient reference group to be formed. Mr Tinker had been asked if he would like to undertake the role to which he had agreed. Mr Tinker will commence the role in January for six months. Mr Brown has asked Mr Tinker to join himself and Ms Hall in discussions with the Mansfield and Ashfield representatives in setting up the new patient group. Mrs Ablewhite had also been asked to be involved. The main item for the initial meetings will be setting the terms of reference.

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S/16/160 Events Ms Ward reminded the SRG members the Christmas meal will be on Monday 12th December and if they could pay in full at the next meeting. Members also need to choose what they would like off of the menu and email Ms Ward. S/16/161 Questions on Information Papers It was noted there were no questions on the information papers circulated to Members. S/16/162 PPG Local Issues Mr Hayward asked if there had been an update on the merger with SFH and NUH. Ms Brown informed the SRG members that Louise Scull and Peter Homa have stepped down from their role as Chair and Chief Executive at Sherwood Forest Hospitals NHS Foundation Trust (SFH), returning full-time to their equivalent roles at Nottingham University Hospitals NHS Trust (NUH). The merger will not take place in the foreseeable future. 7.30 Dr Sullivan joined the meeting Mr Brown told Dr Sullivan that he had informed the SRG members of the appointment of the interim Chair and when would the first joint Governing Body meeting take place. Dr Sullivan informed members the first joint meeting will be held 9th November 2016 S/16/163 Questions to the Governing Body A question had been raised for the Group to consider whether they should be asked of the Governing Body at their next meeting. There are some problems with the handover at Kings Mill Hospital (KMH) by EMAS in that KMH shows the EMAS crew as an example, being registered arriving and leaving in under the agreed hour handover before the penalty kicks in but the EMAS crew are claiming that the handover took more than the hour.

There is an investigation into this but apparently EMAS do not have the ability to check the claims of their crews against the claims of KMH.

Please would the Governing Body explain as to how:

• The contract did not identify this • What has been done • Has this now been rectified • Has the financial cost to the public purse been reconciled?

It was agreed that the question would go the next joint Governing Body’s meeting. S/16/164 Citizen’s Board Report The Citizen’s Board report was noted. S/16/165 Any Other Business

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Ms Ward informed the SRG members that North Notts EMAS Group is looking for people to come forward to join a sub group. Having people from different areas would be beneficial. There will be a meeting on 14th November. Mr Brown asked Ms Ward to circulate the details. Mrs Powell had circulated posters on behalf of Mrs Hagen advertising an up and coming Cancer Care event on 1st November. Could SRG members please note and circulate to their PPG’s. Mrs Hagen has worked on Cancer care for many years and is a member of the 3Cs Cancer group and the only Newark and Sherwood representative. If anyone is interested in learning more about the group with a view to joining please contact Mrs Hagen directly. Mrs Hagen suggested SRG members would find it useful to have a presentation about how the cancer pathways are developing within the Alliance. S/16/166 DATE OF NEXT MEETING The next meeting will be on Tuesday, 29 November 2016 at The Salvation Army, Balderton. Formal Sub Committee meeting 6.00 – 8.00pm The meeting closed at 7.45pm

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Minutes of Meeting of NHS Mansfield and Ashfield Clinical Commissioning Group Citizens’ Reference Panel (CRP)

held on Tuesday 8 November 2016 from 5 30 pm to 7.30pm in the Miller Suite, Ashfield Health & Wellbeing Centre, Portland Street, Kirkby in Ashfield, Notts,

NG17 7AE Present: Peter Robinson, Health Forum (Chair) Jane Stubbings, Healthwatch Nottinghamshire

Sarah Clark, Ashfield Young People Peter Green, Diabetes UK Lesley Watkins, Mansfield CVS Jean Lewis, Royal British Legion Julie McIntyre, Mansfield South PPGs Sarah Taylor, Ashfield Voluntary Action Elaine Moulton, Faith Groups John Childs, Mansfield North PPGs John Stocks, Ashfield South PPGs

In attendance: Dr. Amanda Sullivan, Chief Officer

Helen Banton, Communities and Engagement Officer

Attendees should note that the minutes of this meeting will be reviewed and discussed at NHS Mansfield and Ashfield CCG Public Governing Body meetings and will be available on the CCG website. Papers could also be released as part of a Freedom of Information request CRP/16/71 WELCOME AND INTRODUCTIONS Peter Robinson welcomed everyone to the meeting, particularly Lesley Watkins our latest member for Mansfield CVS and led a round of introductions. Peter also announced that Helen Banton would now be the CCG officer responsible for the Citizens Reference Panel as Julie Andrews had taken responsibility as the CCG officer for the Mid-Nottinghamshire Patient Reference Group. Peter wished it to be noted that out thanks are due to Annette Harpham for the contribution she made as Mansfield CVS member and she will be missed. CRP/16/72 APOLOGIES FOR ABSENCE Apologies for absence were received from: Jean Kirk

Cllr. Sharon Adey Cllr. Jim Aspinall Andrea Brown

Andrea Sharp Gary Baird

Dr Raian Sheikh CRP/16/73 DECLARATIONS OF INTEREST

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No declarations of interest were recorded. The register was available to members for updating and Peter Robinson asked all members who had not yet done so, to complete their declarations of interest form and return it to Helen Banton. ACTION: Remaining members who have not yet completed the Declaration of Interest form to do so, and return it to Helen Banton CRP/16/74 MINUTES OF LAST MEETING The minutes of the last meeting held on Tuesday 13 September 2016 were approved as an accurate record of the discussion that took place. CRP/16/75 MATTERS ARISING

CRP/16/36 FRIENDS AND FAMILY TEST IN GENERAL PRACTICE Following the report at the last meeting on the lack of attendance at the launch of the PPG Coffee Morning on 1 September 2016, a PPG Chairs meeting had been arranged for 17 November 2016 between the members of the CRP/02 worksteam and PPG Chairs to discuss the Friends and Family Test and enhancing engagement between PPGs and the CCG.

CRP/16/77 CITIZENS REFERENCE PANEL

a) Election of Chair and Vice Chair Helen Banton addressed those members present informing them that two nominations had been received for each of the two elected posts. Helen proceeded to inform members that Mr Peter Robinson had been nominated as Chair and Ms Julie McIntyre had been nominated as Vice Chair. The CRP members in attendance were asked if they approved the nominations. All members confirmed their approval and Helen congratulated both members on their posts and confirmed that the terms of office would run for a two year period.

b) Membership A list of all members of the CRP had been disseminated prior to the meeting. It was suggested that it would be useful to expand the list to include contact email addresses for each member. Peter Robinson explained that there were currently five PPG vacancies. Helen Banton confirmed that an application had been received for the vacant position in Ashfield North and it was noted that a further update on this post would be provided at the next meeting. Ongoing discussions were taking place with PPG Chairs about the most appropriate way to increase involvement of PPGs in the work of the CRP. It was announced that the ‘CRP In Brief’ bulletin would cease after December and would be replaced with a ‘You Said, We Did’ bulletin which would effectively demonstrate the engagement that had been conducted within the locality and the outcomes of this. Peter Green advised those members present that a new Youth Mayor had been elected and suggested that CRP should invite her to a future meeting. Sarah Clark suggested that in the event that health was not in the Youth Mayor’s manifesto, then Sarah could encourage involvement from members of the Youth Parliament. ACTION: Helen Banton to include email addresses in the membership document and circulate.

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ACTION; Helen Banton to provide an update on the application for the Ashfield North vacancy at the next meeting. ACTION; Helen Banton to contact the new Youth Mayor and liaise with Sarah Clark on the potential involvement of a Youth Parliament member within the CRP.

c) Development Plan Peter Robinson gave an overview of the outcomes of the Support & Development Reviews (SDR) that had taken place recently. It was noted that nine CRP members had undertaken the SDR and as some members were new, informal discussions had taken place with these members and they would have the opportunity to participate fully in 2017. Although the document had not yet been circulated to members, Peter explained how the process identified training and development requirements for CRP members and highlighted things that can be improved upon. The key themes identified during the SDR’s were:

• Method of working of the CRP • Partnership working • Training and development • Messages to the CCG

It was noted that a training plan would be supported by Arden Greater East Midlands (GEM) using the outcomes of this report, which would be shared with all members once it had been published. A discussion took place around the partnership working following the SDR. Sarah Taylor and Lesley Watkins informed the members present that they were in discussions around reconvening the Voluntary Sector Health Forum and would provide an update on any developments at a later date. ACTION: Helen Banton to include SDRs on the agenda for the next meeting for further comments. CRP/16/78 CANCER WORKSHOP – 11 OCTOBER 2016 Copies of a report summarising the purpose, content and outcomes of the Cancer Workshop held on 11 October 2016 had been circulated to members of the Citizens’ Reference Panel prior to the meeting. Sarah Taylor reported on the positive feedback that had been received from all attendees. It was noted that the clinical contributions made by Ruth Willis, Dr Vikki Clarke and Dr Carolina Rubio had been informative and extremely valuable. The highlights of the event were without question the personal and touching stories which had been shared by Jean Kirk and Kerry Brealey about their cancer journeys. These stories had also inspired attendees to complete the ‘More to me than Cancer’ template which in turn would be utilised to share positive patient stories with current cancer patients. Sarah proceeded to explain how discussion groups had been asked to consider one of following options which was most relevant to their situation.

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The questions asked were: 1) What are your views on the support available for patients and families? 2) Do you know what support is available for patients and families? 3) What are your views on the support available for patients and families during

your journey and experience of cancer? 4) What are your views on the support available for patients and carers living

beyond cancer? The key outcomes from participants was that there was room for improvement in terms of support available for families and patients as it was considered to be lacking during the patient journey but especially when treatment had been completed. It was agreed that the cancer patient and their families had long term concerns and their psychological needs were not being addressed. The points below would form the basis of recommendations to be presented to the NHS Mansfield and Ashfield CCG Governing Body.

1) Families of Cancer Patients feel helpless and un-involved. 2) Clinicians need to recognise the importance of the role of families in the Cancer

Patients recovery and include them on the journey. 3) At the point of discharge from a service there needed to be in place a support

package for continuing support for patients and families. 4) There is a lack of confidence in the NHS on how patients will be treated if they

become ill due to negative media coverage in relation to budgets and working hours.

It was suggested that this was the most successful event to date and it was noted that there was enough scope to hold a follow up event in the near future. It was also suggested that this event could be a culmination of the outcomes of both the Diabetes and Cancer workshops as there was considerable overlap in outcomes. Peter Robinson stated that it was imperative that the Board was provided with a wider view now that the CCG has a whole Nottinghamshire approach to sustainability. Jean Lewis suggested that this was an appropriate time to ensure the NHS Constitution underpinned the work of the Citizens’ Reference Panel. There were also some comments made on the suitability of the venue as it was raised that the acoustics were poor for people with hearing difficulties and due to the size of the venue there were several complaints made about the cold temperature. It was agreed that other venues should be considered for future workshops. ACTION: Helen Banton to source more suitable venues for future workshops. ACTION: Helen Banton to circulate the NHS Constitution to enable members to familiarise themselves with its content. CRP/16/79 REVISED GOVERNANCE FRAMEWORK Peter Robinson welcomed Dr Amanda Sullivan, Chief Officer at NHS Mansfield & Ashfield CCG and NHS Newark & Sherwood CCG to the meeting. Amanda informed the members present of the significant financial position currently being faced by the CCG. Amanda clarified that efficiency savings of £20 million needed to be achieved by 31st March 2017, Amanda proceeded to re-assure members that this financial position was not unique to the CCG, as many of the NHS organisations were facing similar challenges.

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Amanda confirmed that to date, £7.3 million had been delivered in savings which was a positive outcome but there was still much to be done to achieve overall financial balance especially as the CCG would soon be facing winter pressures. As a consequence of being faced with making these savings, the CCG had considered ways in which they could streamline processes in order to make rapid decisions whilst maintaining locality links with a Mid-Nottinghamshire focus. A working group was formed where it was agreed that the best way forward was to reduce the Governing Body membership so that it was in line with National Guidance. A proposal was finally approved by the CCG Joint Governing Body which had resulted in only one lay member on the Governing Body for patient and public involvement. Amanda described the composition of the new Joint Governing Body. John Stocks requested clarification of the rationale behind compromising the representatives around the table as it did not appear to have any financial benefits. Amanda confirmed that although there were no significant cost savings associated with the revised Governing Body structure, it did provide savings in time and in terms of speed of decision making which in times of fast paced change was crucial to service delivery. John Stocks asked if there was a potential opportunity to become a Nottinghamshire wide organisation as the Sustainability Transformation Plan (STP) worked across the whole of Nottinghamshire. Amanda responded that there were currently no plans to become a Nottinghamshire wide organisation and as the NUH / SFHT merger was no longer going ahead this would strengthen this position. John Childs asked Amanda if the Mid-Nottinghamshire CCGs’ budgets were perceived as one, as opposed to being two separate amounts. Amanda replied that as the two Mid-Nottinghamshire CCGs are individual statutory bodies and the healthcare budget was allocated based on population size for each locality there were no plans to change this. The reporting was done individually to NHS England but as there were similarities across both they also provided an overarching Mid-Nottinghamshire status. Amanda confirmed that the CCG would have to make difficult decisions over the next few months and the role of the lay members was crucial in strengthening the links into local groups and encouraging and capturing dialogue from a community perspective. Amanda thanked all members for their on-going support to improving the healthcare of the local population. CRP/16/80 MAKING A DIFFERENCE CRP Members agreed to present their key findings from the Cancer Workshop to the Governing Body. CRP/16/81 NHS MANSFIELD AND ASHFIELD CCG’S CHIEF OFFICER REPORT Copies of the NHS Mansfield and Ashfield CCG’s Chief Officer Report as presented to the CCG Governing Body on 15 September 2016 had been circulated to CRP members prior to the meeting. The report provided an update on the financial position, the CCG rating for 15/16, the Annual Public Meeting and the planned merger of SFHT and NUH. The content of the report was noted. CRP/16/82 Better Together Update

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The members were provided with copies of the minutes of the Citizens Board meetings which took place on 30 September and 28 October 2016 prior to the meeting. The content of both reports were noted. CRP/16/84 HEALTH AND WELLBEING BOARD SUMMARY Copies of the Health and Wellbeing Board Summary providing a summary of the meeting held on 7 September 2016 had been circulated to CRP members prior to the meeting. The report summarised discussion about the following:

• Update on the Sustainability & Transformation Plans • Showcase on Rushcliffe New Care Model for Health • Development of integrated workforce development strategy and plan – progress

report • Children and Young People’s Mental Health and Wellbeing Transformation Plan • Better Care Fund (BCF) performance, 2016/17 plan & update and Disabled

Facilities Grant The content of the report was noted. CRP/16/85 DATE OF NEXT MEETING A discussion ensued in relation to the dates of future meetings as now that the Mid-Nottinghamshire Patient Reference Group (MNPRG) had been formed it would be imperative that all meetings dates are aligned to the MNPRG meetings which take place prior to the Governing Body meetings. Peter Robinson informed members that the first three meetings in 2017 saw a change to the dates and suggested that the 7th March 2017 meeting was changed to the 28th February 2017 because it was currently after the MNPRG 6th March 2017 meeting. Peter proceed to ask members for approval on this change. Members confirmed that they were happy with this amendment. CRP members noted the following meetings:

• Networking Event, 13 December 2017 in Kevin Bird Suite, One Call Stadium, Mansfield, Notts, NG18 5DA

• CRP Formal Business Meeting, 3 January 2017 in the Training Room, Mansfield

CVS, Wood Street, Mansfield, Notts. NG18 1QA

ACTION: Helen Banton to amend meeting dates schedule to reflect date change.

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Minutes of inaugural meeting of the Mid Nottinghamshire Patient Reference Group

held on Tuesday 1 November 2016 in Meeting Room 1, Hawthorn House, Mansfield.

Present: Peter Robinson, Chair Marlene Ablewhite Dennis Brown Peter Green Viv Hall Julie McIntyre Sarah Taylor Geoff Tinker Officers in attendance: Julie Andrews, Communities and Engagement Manager Andrea Brown, Director of Programme Delivery

Attendees should note that the minutes of this meeting will be reviewed and discussed at the Joint Public Governing Body Meeting of NHS Mansfield and Ashfield

CCG and NHS Newark and Sherwood CCG and will be available on the CCGs’ websites. Papers could also be released as part of a Freedom of Information request.

MNPRG/1/16 Welcome and introductions Peter Robinson extended a warm welcome to everyone present at the inaugural meeting of the Mid-Nottinghamshire Patient Reference Group (MNPRG) and led a round of introductions. Peter Robinson reminded members that he had been appointed by the CCG to the position of Chair of the MNPRG until the SRG had appointed its Chair to succeed Dennis Brown who would be retiring at the end of November 2016. The draft Terms of Reference included provision for the MNPRG to appoint a Vice-Chair to deputise for the Chair when needed and that the Chair and Vice-Chair would not be from the same PRG. Geoff Tinker indicated that he would succeed Dennis Brown as Chair of the SRG and at this point would become Vice-Chair of the MNPRG. Everyone was invited to share information about their background, current groups and networks they are involved in and the most important considerations in setting up the group. MNPRG/1/17 Declaration of Interests No declarations of interest were declared.

MNPRG/1/18 Terms of Reference Copies of the draft Terms of Reference that incorporated comments from members of the SRG and CRP were tabled at the meeting.

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Peter Robinson advised of a meeting involving Dennis Brown, Dr. Amanda Sullivan, Chief Officer and himself to discuss the draft Terms of Reference. Dr. Sullivan supported the direction of travel of the group as stated in the draft Terms of Reference and had agreed that patient experience should have more prominence on the agenda for the Joint Governing Body meetings and this would be addressed over time. Following discussion, members agreed the following revisions to the Terms of Reference:

Strengthen the wording of the objectives.

Include an additional objective that patient experience should be central to the work of the Joint Governing Body and a patient experience item should feature on the agenda at the beginning of every meeting.

Add Director of Programme Delivery and Communities & Engagement Manager to the membership of the group.

Chair and Vice Chair would in future be elected from the membership of the MNPRG having successfully met the requirements of the Joint Governing Body Competency Framework yet to be defined.

In the absence of the Chair, the Vice-Chair of the Mid-Nottinghamshire Patient Reference Group will deputise at meetings of the Joint Governing Body.

The Chair of the MNPRG who is also Lay Member on the Joint Governing Body will attend all three sections of that meeting.

Highlight reports prepared by the Citizens’ Reference Panel (CRP) and Stakeholder Reference Group (SRG) will be shared with the Chair and Vice-Chair of the MNPRG.

Mode of working will include reference to the development of a workplan that is mindful of Alliance and CCG priorities and supports members to have a better awareness of the two communities and more focus on Mid-Nottinghamshire. The work plan would include completion of a mapping exercise to identify current communications, engagement and patient experience activity across Mid-Nottinghamshire.

Clarification would be sought regarding sharing confidential items on the Joint Governing Body agenda with the MNPRG. It was noted that items are usually confidential because they are either third party documents or commercially sensitive.

Meetings of the SRG, CRP and MNPRG would be appropriately aligned to ensure timely information flow.

A review would be requested of the Lay Members Payment and Expenses Policy with specific reference to the remuneration of the Chair and Vice-Chair that reflects their increased workload.

Venues for meetings would be rotated across Mansfield, Ashfield, Newark and Sherwood using community centres and practice premises.

It was agreed the MNPRG Terms of Reference would be presented to the CRP and SRG for approval prior to being presented to the Joint Governing Body. Action: Andrea Brown to request clarification regarding sharing of confidential agenda items with the MNPRG. Action: Andrea Brown to request a review of the remuneration of the Chair and Vice-Chair of the MNPRG. Action: Julie Andrews to update the Terms of Reference and circulate to the Group. Schedule the Terms of Reference for inclusion on the CRP and SRG agendas. MNPRG/1/19 Engaging our Communities Peter Robinson referred to the recently refreshed Communications, Engagement and Patient Experience Strategy 2016 – 2018 and invited suggestions from Luke Barrett and members

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about how the MNPRG could more effectively market itself to support wider engagement with its communities. Following discussion, the group agreed MNPRG would:

embrace the refreshed CCG Communications, Engagement and Patient Experience Strategy 2016 – 2018

make best use of the community links and networks of the SRG, CRP and third sector partnerships and bring that intelligence to the MNPRG via its membership and

review the mapping of engagement activity

share SRG and CRP agenda and supporting documents with the Chairs of each group.

Action: Julie Andrews to request sharing of SRG agenda and supporting documents. MNPRG/1/16 Work Plan Due to time constraints this item was deferred to the next meeting. MNPRG/1/16 Date of next meeting The next meeting of the MNPRG will take place on Monday 12 December 2016 from 2 pm to 4 pm at a venue in Newark.

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Progress report from the Quality and Risk Committee

Date of committee: 31 October 2016

Key Achievements The Committee received a report on the progress of a range of actions to address workforce and organisational development issues in the local health community. The Committee requested an update for the New Year to include a timetable of actions, and analysis on short, medium and long term risks. The development of the CCGs’ own workforce was also discussed and it was agreed that the CCGs’ Staff Engagement Group be tasked with examining this in more detail. Workforce indicators on the Quality Dashboard were also noted as a concern, with indicators such as sickness and appraisal rates remaining an outlier across all providers. There was a discussion regarding how this situation could be improved, what were the risks, and what actions were being undertaken. It was agreed there was a need to understand what action providers were taking and whether this area was an outlier in national comparisons. A report will be drafted for the next meeting. The Committee received a draft of the CCGs’ End of Life Strategy prior to approval by the Clinical Executive. The Committee asked for the Strategy to be updated to include further information on support for carers; how the utilisation of new technologies could provide transformational change; explicit links to Vanguard, the Alliance and Better Together; and the strengthening of the equality and diversity section. The Committee also recommended the inclusion of a year one action plan as an appendix to allow the Clinical Executive to oversee progress on the implementation of the Strategy. The risks to the implementation of the Strategy would be placed on the Committee’s Risk Register. The Committee approved the CCGs’ Security Policy and received an update on 360 Assurance’s security management service, which provided security management support to the CCGs. Risk assessment work to identify security risks within the organisations had been undertaken and work plans were in place to ensure the CCGs achieved ‘green’ status. The Committee approved the CCGs’ Flexible Working Policy, which had been drafted in consultation with ARDEN GEM HR Services and had been through a consultation process via the CCGs’ Staff Engagement Group. Issues Actions The Committee noted a rising level of concern on a number of services at NUH.

A report will be brought to the next committee.

Risks Actions No risks were identified that required escalation.

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QUALITY AND RISK COMMITTEE

Held on 31 October 2016, 1pm

Hawthorn House, Ransomwood Business Park Present: Elaine Moss Chief Nurse, NHS Mansfield & Ashfield CCG and NHS Newark &

Sherwood CCG (Chair) Eleri de Gilbert Lay Member, NHS Mansfield & Ashfield CCG & NHS Newark and

Sherwood CCG Dr Nigel Marshall Clinical Advisor, NHS Newark & Sherwood CCG Ruth Lloyd Susan Crosby Sue Bateman Coral Osborn David Ainsworth Dr Gavin Lunn Sue Barnitt

Head of Corporate Governance, NHS Mansfield & Ashfield CCG and NHS Newark & Sherwood CCG Lay Member, NHS Newark and Sherwood CCG Head of Patient Safety and Experience, NHS Mansfield & Ashfield CCG and NHS Newark & Sherwood CCG Senior Prescribing (North) and Governance Advisor on behalf of Mid and South Notts CCGs Director of Primary Care, NHS Mansfield & Ashfield CCG & NHS Newark and Sherwood CCG Clinical Lead, NHS Mansfield and Ashfield CCG Head of Quality and Adult Safeguarding, NHS Mansfield & Ashfield CCG and NHS Newark & Sherwood CCG

CCG Staff In attendance: Sally Bird Clare Frank Glenna Gash Kelvin Langford Sue Wass (minutes)

Head of Infection Prevention and Control Team, NHS Mansfield and Ashfield CCG End of Life Programme Manager, NHS Newark and Sherwood CCG (item QRC/16/102) Quality and Patient Safety Manager/Complaints Manager, NHS Mansfield & Ashfield CCG and NHS Newark & Sherwood CCG (item QRC/16/104) 360 Assurance (item QRC/16/108) Corporate Governance Officer, NHS Mansfield & Ashfield CCG and NHS Newark & Sherwood CCG

WELCOME AND INTRODUCTIONS (QRC/16/91) The Chair welcomed members to the meeting and introduced Mrs Sue Barnitt, the recently appointed CCG Head of Quality and Adult Safeguarding. The item on the End of Life Strategy was taken out of turn on the agenda to allow Mrs Frank to leave the meeting. APOLOGIES FOR ABSENCE (QRC/16/92) Apologies were received from Mrs Waddingham. The meeting was declared quorate. DECLARATIONS OF INTEREST (QRC/16/93) All members confirmed that their declaration of interests were as detailed on the register. It was noted that Mrs Barnitt’s declarations of Interest would be added to the register for the next meeting and she declared no interests in any of the items on the agenda. No additional interests were declared on any items on this agenda by the rest of the Committee members.

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MID NOTTS END OF LIFE STRATEGY (QRC/16/102) The Chair asked the Committee to note that this item was not for approval, as stated in the paper, but for input by the Committee prior to approval by the Clinical Executive. Mrs Frank gave an overview of the Strategy, which had been drafted and updated to ensure a consistent approach across both CCG areas. It had been consulted upon widely and its ambition was to provide a compassionate approach, capturing a broad spectrum of choices available to end of life patients. Mrs de Gilbert noted evidence of good engagement but questioned whether the Strategy needed strengthening in terms of support for carers, both before and after the death of the patient; and what could be learnt from their experiences. Mrs Frank agreed to strengthen the Strategy in this respect. It was also noted that all numbers in the Strategy should be put into percentages to provide consistency. Dr Marshall asked how the three risks described in the paper were being monitored. It was noted that sustainability of providers was a concern as costs were capped at 30% in the specification. It was agreed to bring together the risks as one risk to be placed on the Risk Register and monitored by this Committee. Mr Ainsworth asked whether the Strategy was ambitious enough. It was agreed to include how the utilisation of new technologies could provide transformational change. Links to Vanguard, the Alliance and Better Together also needed to be explicit in the document. It was noted that the Equality and Diversity section required strengthening and Mrs Frank would work with Mrs Bateman to achieve this. The Committee also recommended the inclusion of a year one action plan as an appendix to allow the Clinical Executive to oversee progress on the implementation of the Strategy. The Strategy was noted. ACTIONS:

• CF to update the Strategy in line with the discussions to include support for carers, reference to new technologies, strengthen equality and diversity, include reference to Vanguard, the Alliance and Better Together and include a year 1 action plan.

• CF to draft a risk for monitoring on this Committee’s Risk Register MINUTES OF THE QUALITY AND RISK COMMITTEE MEETING HELD ON 3 OCTOBER 2016 (QRC/16/94) The minutes of the meeting held on 3 October were accepted as representing an accurate record of discussions. MATTERS ARISING (QRC/16/95) The following items were noted as being in progress:

• QRC/16/88 Incident Reporting Policy – actions were being undertaken to highlight the key elements of the Policy to staff. It was suggested that the reporting flow chart could also be moved to the front of the Policy.

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• QRC/16/73 CQUIN 1 – Mrs Lloyd was developing health and wellbeing measures that could be incorporated into the Corporate Governance Report going forward.

• QRC/16/83 Serious Incident Report – Mrs Bateman had asked the South CCGs to

undertake a trend analysis on the never events that had occurred at NUH. If this was not available for the next Committee meeting, the matter would be escalated.

Regarding the discussion at the last meeting regarding the SFH CDU, it had been agreed to meet with the Trust on a quarterly basis. All other actions were noted as completed or on the Committee’s forward work plan. ITEM REMOVED: LES BASKET (QRC/16/96) It was noted that as the FDGP had stopped the business case so the requirement for the Committee to assess the risks to the decommissioning of this project was not required. WORKFORCE UPDATE (QRC/16/97) Mrs Barnitt introduced the paper, which had been brought to update the Committee on the progress of a range of actions to address workforce and organisational development issues in the local health community. Five priority areas had been identified by the Sustainability and Transformation Planning (STP) process, as detailed in the paper. Mrs de Gilbert asked whether a baseline assessment of the current skills of the workforce had been undertaken across all providers, whether there was yet a timetable of actions, and whether any analysis had been undertaken on short, medium and long term risks. Mrs Moss noted that as this was a STP-focused area of work, the missing element was the development of the CCGs’ own workforce. It was agreed that the Staff Engagement Group be tasked with examining this in more detail and Mr Ainsworth agreed to discuss this at the next Staff Engagement Group. Mr Ainsworth noted concern that there was potential to duplicate actions in the working groups; and that the proposed place-based solutions had the potential to create different models of care. This was an issue he would pick up with the CCG Workforce Lead outside of the meeting. It was agreed that an update would be given at the next meeting on CCG workforce issues and that an update would be requested for the February meeting on wider workforce issues, which would focus on progress being made against deliverables and any changes to risks. The report was noted. ACTIONS:

• DA to take the issue of CCG workforce development to the next SEG and report back to the December Committee

• SW to ask Charlotte Lawson for an update on progress of the workforce Workstream for the February Committee

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MID NOTTINGHAMSHIRE CCGS SOUTHERN HEALTH REVIEW ACTIONS UPDATE (QRC/16/98) Mrs Barnitt asked the Committee to note progress on the action plan that had been developed following the publication of the independent review of deaths of people with a Learning Disability or Mental Health problem who had come into contact with Southern Health NHS Foundation Trust April 2011 to March 2015. There were nine recommendations, two of which were completed, with the remaining seven having an expected completion date of the end of the calendar year. The Chair asked the Committee to note that the CCGs’ Safeguarding Committee was overseeing the progress of actions for all Nottinghamshire CCGs and an exception report would be brought back to the Quality and Risk Committee on any actions that had not been completed by the set timescales. The Committee discussed broader issues surrounding patients with learning disabilities, and asked for assurance of an integrated approach to the commissioning of services. It was agreed that Mrs Bateman would work with colleagues from the Contracting Team to examine any gaps and/or risks to services for these patients. The report was noted.

• ACTION: SBATEMAN to work with colleagues in the Contracting Team to draft a paper for the February Committee to examine any gaps and/or risks to services for patients with learning disabilities.

PROACTIVE CARE HOMES WORKING GROUP UPDATE – OCTOBER 2016 (QRC/16/99) Mrs Firmin gave the background to the report. The proactive care homes working group was set up as a task and finish group in June 2016 to scope opportunities to design a service that would provide a single integrated Proactive Care Homes Service across the Mid-Notts CCGs. The current service provider of the Mansfield & Ashfield Care Homes Service (MACHS), CHP, via a caretaker arrangement had expired in September 2016, but had subsequently been extended. Mr Ainsworth and Dr Lunn discussed how the Primary Care Hubs could provide a more proactive service and that the service would benefit from greater GP input. Mrs Bird noted that the south CCGs had an effective service model, which could be considered. It was agreed that this was part of a much larger issue and there were a number of actions being taken forward on care home provision, with an agreement of the need not to continue with existing models. It was agreed to bring a project plan, with input from clinical advisors for discussion at the next meeting. The report was noted.

• ACTION: DN to work with the Service Improvement Team to bring a draft nursing support project plan on future care home provision for the next Committee.

SAFE MANAGMENT OF CONTROLLED DRUGS REPORT APRIL 15 - MARCH 16 (QRC/16/100) Mrs Osborn gave the Committee an overview of the report, which detailed the work undertaken by the 5 Nottinghamshire CCGs during 2015/16. The report highlighted key areas of action. Regarding incidents, it was noted that all were classified as moderate or low and learning had been undertaken on all of them and shared via newsletters and with

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individual practices. Policies and procedures on controlled drugs had been reviewed and updated. Dr Marshall raised a query over medicines wastage and was there any monitoring undertaken on appropriate amounts. It was noted further work would be undertaken this year. The Chair asked whether staff were fully aware of incident reporting procedures and it was noted that work had been undertaken over the communication of the national reporting tool. The report was noted. NOTTINGHAMSHIRE INTEGRATED CHILDREN’S COMMISSIONING HUBSPECIAL EDUCATIONAL NEEDS AND DISABILITY (SEND) REPORT (QRC/16/101) Mrs Barnitt asked the Committee to note that the report, which covered the first two quarters of the year (2015/16), demonstrated that the CCGs were meeting their statutory requirements. It was noted that there would shortly be a cross-agency meeting to examine what actions needed to be taken forward following the CQC/Ofsted inspection of Nottinghamshire SEND services, which had been brought to the previous committee. Any actions or significant risks would be overseen by the CCGs’ Nottinghamshire-wide Safeguarding Committee.

Mrs de Gilbert noted that the report discussed the increased demand for ECHP requests but at the time the reason for the increase was not understood. She asked whether there had been any progress on this issue. Mrs Barnitt agreed to investigate and report back to the next Committee meeting.

The report was noted.

• ACTION: SBARNITT to ask Nicola Hodson to investigate reasons for the increase in ECHP demand and report back to the next Committee meeting.

QUALITY DASHBOARD (QRC/16/103) The Chair introduced the report, which had been tabled. Areas of good practice and improvement were highlighted as being improvement in HCAI and HMSR rates and continuing sustained improvement within SFH. Areas requiring improvement were noted as NUH ED performance and the CCG was working with colleagues in the south to oversee actions being undertaken. An Oversight Group had been established following the CQC inspection of EMAS and it was noted this was the beginning of what could be a complex process. It was noted that workforce indicators such as sickness and appraisal rates remained an outlier across all providers. There was a discussion regarding how this situation could be improved, what were the risks, and what actions were being undertaken. The Chair noted that although ultimate accountability lay with the individual organisations and there was no ‘one size fits all’ approach, there was a need to understand what action providers were taking and whether this area was an outlier in national comparisons. There was also a need to take into account staff turnover and vacancy rates. It was agreed to investigate whether national comparators could be compiled for the next Committee meeting. Regarding United Lincolnshire Hospitals, it was noted that the Quality Team would be accompanying the lead commissioners on a visit; and a report would be given to the next Committee.

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A report on issues at NUH was also requested. The report was noted. ACTIONS:

• SBARNITT to work with Charlotte Lawson to report on actions providers were taking on workforce indicators, to form part of the paper for the February meeting , ref QRC/16/97 above and to report whether the indicators were an outlier in national comparisons for the next Committee meeting.

• SBARNITT to report on the ULH visit to be given to the next Committee. • SBARNITT to report on issues at NUH to be given to the next Committee.

PATIENT STORY (QRC/16/104) Mrs Gash reported on a story regarding the community heart failure service. Dr Marshall asked whether there was any awareness of FLO in the support group, which would be a medium for raising awareness of the benefits of it. Mrs Crosby noted that awareness of the condition needed raising. It was agreed this would be incorporated into feedback on the Story. Mrs Barnitt asked the Committee to note that going forward, patient stories would concentrate on how patients moved through the health system and it was agreed individuals would be asked to come to the Committee to talk about their experiences in using services such as IAPT, the care home service and PHBs.

• ACTION: GG to feedback comments on the Story and incorporate them into learning from the Story.

QUARTER 1 GP FEEDBACK REPORT (QRC/16/105) Mrs Bateman introduced the reports for Mansfield and Ashfield and Newark and Sherwood. It was noted that the issues were similar in both CCG areas, with a key and recurring theme being referrals, medication or treatments, and service provision relating to SFHFT. There was a discussion concerning how to gain assurance that SFHFT was being responsive to the concerns raised; and the role of the CCG in influencing services not commissioned by the CCGs, notably Primary Care Support. It was also noted by Dr Marshall that the present reporting system was cumbersome for GPs. It was agreed there needed to be a more dynamic system that provided feedback to GPs on actions and solutions put in place in response to their feedback. Regarding PCSE, it was agreed that although it was not a service commissioned by the CCGs, it was having a significant on primary care, and as such should sit on the CCGs’ risk register. Mr Ainsworth offered to ask a representative from NHSE to the next meeting and to draft a risk for the next Committee for discussion. ACTIONS:

• DA to ask a representative from NHSE to the next meeting to discuss issues with PCSE and draft a risk for the next Committee for discussion.

• SBATEMAN to examine the internal management of GP feedback and report to the next Committee meeting

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ESCALATION OF RISKS ARISING FROM QUALITY/EQUALITY IMPACT ASSESSMENTS (QRC/16/106) A risk had been brought to the Committee on the proposal to decommission an element of the IRIS project. The process for the escalation of QIAs and EIAs was discussed and clarification was sought on the role of the Committee in the process. In light of an urgent decision about this project being required, it was agreed to pursue this QIA with the Contracting Team outside of the meeting and to re-visit the issue at the next meeting when action had been undertaken to ensure a robust process was in place. It was noted that it may entail QIA escalations to be circulated to the Committee virtually outside of the committee cycle, with formal ratification at the next committee.

• ACTION: RW/RL to update at the next meeting on the role of the Committee in the escalation of QIA process.

CCGs’ INTERNAL AUDIT ACTIONS REGISTER (QRC/16/107) The Chair asked the Committee to note that the register had been compiled to give assurance that all actions from internal audits were being progressed in a timely manner. The register would be presented to the Committee on a quarterly basis as an exception report to flag actions that were not progressing to plan. This would enable the Committee to take a view on the risk to the organisation of any delay in taking forward actions from internal audit reports. SECURITY MANAGEMENT (QRC/16/108) • QUARTER 2 REPORT • SECURITY MANUAL • SECURITY POLICY • SECURITY RISK ASSESSMENTS Mr Kelvin Longford reported to the Committee on the work carried out by 360 Assurance’s security management service to provide security management support to the CCGs. This included examining the security of personnel, premises, property and assets. Risk assessment work to identify security risks within the organisations had been undertaken and work plans were in place to ensure the CCGs achieved ‘green’ status. A manual had been produced to assist all employees to understand and play their part in maintaining a safe environment for staff and visitors; and a policy had been drafted. Risk assessments had been undertaken at CCG premises at Hawthorn House and Birch House and an assessment on Balderton PCC was imminent. Mrs Lloyd noted that there was more work to do in the Security Manual to support lone working and would work with 360 Assurance to ensure guidance was in place.

• ACTION: RL to work with 360 Assurance to ensure guidance on lone working was in place.

The Security Policy was approved.

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FLEXIBLE WORKING POLICY (QRC/16/109) Mrs Lloyd reported that following the last Committee meeting, the policy had been re-drafted in line with the discussion to separate the formal contractual changing of an individual’s hours; and the informal, temporary or ad-hoc changes to employees’ working hours or patterns. The Committee approved the Flexible working policy. CONFLICTS OF INTEREST POLICY (QRC/16/110) The Chair reported that the policy had been updated to ensure that it was compliant with revised NHSE guidance. Changes would necessitate a greater focus on the management of potential conflicts of interest at the agenda setting stage of meetings. It was agreed to share the draft for comment, with formal approval sought at the next Committee meeting.

• ACTION: SW to circulate the draft Conflicts of Interest Policy with the minutes of this meeting.

RISK MANAGEMENT STRATEGY (QRC/16/111) The Chair asked the Committee to note that the Risk Management Policy had been approved by the Audit and Governance Committee. There had been no significant changes and had been presented to the Committee for noting. The Risk Management Policy was noted. ANY OTHER BUSINESS (QRC/16/112) There was no other business. AGREEMENT OF KEY MESSAGES FOR FEEDBACK TO GOVERNING BODIES (QRC/16/113) Key messages were:

• The need for a baseline and action plan on provider and CCG workforce indicators • Support for the End of Life Strategy with inputs from the Committee • Noted rising level of concern over NUH in the Dashboard • Approval of the Flexible Working policy and Security policy

DATE OF NEXT MEETING: Monday 12 December, Balderton Primary Care Centre

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Progress report from the

Committee

Date of committee: A&E Delivery Board 18th October 2016

Key Achievements - Winter plan submitted to NHSE - Joint intelligent streaming up and running at the SFD at KMH - All EMAS green 4 dispositions now receiving clinical triage by 111 - Nature of call and dispatch on disposition have gone live at EMAS

Issues Actions NEMS don’t have access to SFHFT data, limiting work that can be done on extending pathways for PC24 Green 2 dispositions cannot be progressed as cost implications C4C still underutilised Community contract underperforming

Need for data sharing agreement to be escalated by CCG DHU and EMAS to share thoughts on how working together differently could offset cost implications System wide C4C utilisation meeting to be organised to address what actions can be taken LP holding urgent internal meeting to analyse reasons for underperformance and to report back to Director of Contracting

Risks Actions Phase 2 of IHS is predicated on release of T2A funding

Implementation plan for phase 2 of IHS required

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Minutes of the Mid Notts Local A&E Delivery Board

Held on Tuesday 18th October 2016 at 11.00am Held in meeting room 1, Hawthorn House

MINUTES

Present: Amanda Sullivan, Chair (AS) Ian Ellis (IE) Elizabeth Cowley (EC) Rashid Sohail (RS) Peter May (PM) Jo Dixon (JD) Liz Hallam (LH) dialled in at 12.00pm Fay Bradley, minutes (FB)

Job Title: Chief Operating Officer, Mid Notts CCGs Director of Contracting and Urgent Care, Mid Notts CCGs Programme Manager, Mid Notts CCGs Deputy Medical Director, EMAS Deputy Chief Exec, NEMS DHU Nottinghamshire Healthcare NHS FT PA to Director of Contracting, Mid Notts CCGs

Apologies: Bob Winter (BW) Pauline Hand (PH) Diane Butcher (DB) Sue Batty (SB) Roz Howie (RH) Julie Hankins (JH)

Medical Director, EMAS Managing Director, DHU 111 (East Midlands) CIC Head of Information and Performance, Mid Notts CCGs Service Director, Nottinghamshire County Council Assistant Chief Operating Officer, SFHFT Medical Director, Nottinghamshire Healthcare NHS FT

ITEM

TO ACTION

1 Welcome and introductions AS welcomed everyone to the meeting and introductions were made. The group were reminded that a deputy needs to be in attendance where possible if they are unable to attend the meeting themselves for any reason.

2 Apologies As noted above.

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Winter plan submission The group was informed that the final winter plan had now been submitted to NHSE. It has been brought to this meeting to share and gain a final sense check, as well as progress check against actions. As of yet there has been no feedback to the plan from NHSE. A&E streaming Joint clinical triage commenced on 4th October. NEMS are now sitting alongside ED staff and are picking patients out of the queue. NEMS are now seeing a higher percentage of patients (16.1% mid-week and 29.3% at weekends), overall they are seeing 20% but this needs to increase to 30% or more; in order to reach 30% a step

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change in working is required. NEMS have now stopped their 12am – 4am triage but will continue to see patients streamed to them in this time, the money for this will be re-invested in busier periods of the day to improve triage times. It was noted that there was a big percentage swing at weekends, and as a result there were suggestions to do an audit to see if more patients could be seen overnight. IE stated that at the single front door meeting there was an agreement to undertaken a retrospective audit to understand why NEMS are only streaming at 20% and if this can be increased. PM noted that as yet NEMS did not have access to the Trusts data in order to look at minosr activity in ED. ACTION: IE to pick up data access issue with Andy Haynes. The joint clinical triage working will now continue throughout winter with regular reviews. It was reported that part of the CDU pathway had changed. There are also some on-going teething issues between NEMS and SFHFT around safeguarding which is being passed back and forth. ACTION: PM to share CDU information that he received from the Trust. ACTION: The Trust to provide an update on ambulatory emergency care outside of the meeting. Clinical Advisors JD informed the group that the green 4 conveyances being passed to clinical advisors are up and running following on from the pilot, however green 2’s are not as yet due to cost implications; a paper has been put together and they are awaiting approval to continue green 2 conveyances as more nurses would be required. In regards to green 2’s there have been discussions across stakeholders around using clinical capacity differently. AS questioned if there was flexibility with EMAS to work jointly to utilise clinicians; RS stated that EMAS could look into this however JD noted that additional work currently being carried out for Lincolnshire CAS is putting pressure on 111 from a nursing perspective. ACTION: RS and JD to discuss with their organisations outside of the meeting to understand if there are different ways of joint working between 111 and EMAS without any additional cost. PM noted that in South Notts there is an A&E disposition filter that may be worth looking at for Mid Notts. Ambulances Nature of Call (NoC) and Dispatch on Disposition (DoD) have both gone live, but no impact has been seen as yet. At the moment only certain sites are piloting DoD, however this will be rolled out to all sites in phase 2. This involves giving call handlers 4 minutes before the clock starts in order to decide what resource is required. Patient Flow

IE

PM

RH

RS/JD

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ACTION: Trust to provide update at next meeting. Discharge The IHS is due to start on 24th October. Additional staff have been recruited to take step up and step down patients, as there is a larger cohort of patients being targeted in order to stop avoidable admissions and reduce length of stay. Health Partnerships are currently recruiting for the Newark and Sherwood phase of IHS, however this is tied up in T2A funding; beds are being taken out of Berry Hill in order to get the funding required. A plan and implementation date is needed. It was noted that this was also linked to Call for Care; it was agreed that rolling communications are required. OPAT and CDU patients will be focussed on first for the community IV service. It was agreed that the plan should be brought back to future meetings in order to monitor actions against trajectory.

RH

4 Activity trends ED attendances

• 111 continues to see an increase in calls and there is a continued increase in conveyances to ED

• M5 activity is up this year compared to last year • The community contract is below plan for first contact and follow ups • Call for care is currently under utilised • Some T2A beds will be decommissioned as utilisation is poor

JD reported that when there is new staff in the system, an increase in dispositions can be seen; calls to 111 have also increased. Information has been requested in regards to Call for Care and Pathfinder to understand if they are being fully utilised. There is also work to be done in order to unpick and understand what is driving the increase in conveyances. It was agreed that a meeting should be arranged for the CCG, NEMS, EMAS and Health Partnerships to discuss and take forward these issues. ACTION: FB to arrange utilisation meeting to include CCG, NEMS, EMAS and Health Partnerships. Discussions to be reported back at the next meeting. CDU A business model review and audit has been completed, and a report is being written. A portion of activity is being badged as urgent outpatients; counting and coding issues and CDU activity issues are to be discussed at a meeting arranged for tomorrow evening. Community contracts Underperformance on community contracts also need to be understood; discussions with Health Partnerships are required. The contract is currently being unpicked. It was noted the LICT activity is higher in M&A than N&S, what are the problems in N&S? LH reported that an internal meeting is taking place tomorrow to discuss these issues and agreed to feedback after the meeting.

FB

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Page 4 of 5

ACTION: LH to feedback discussions from internal HP meeting at next meeting. AS noted that there were broader strategic implications as there is national interest in activity levels and why admissions are high. It is therefore a key strategic issue that needs to be looked at as one system.

LH

5 Any other business No further business for discussion.

6 For information

A letter was provided to the group for information on the regional A&E Board decision on local footprint and chairing variation request.

Date & Time of Next Meeting Tuesday 1st November at 11.00pm in meeting room 2, level 3, Trust Admin Building, KMH.

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ACTION LOG

Agenda item Date of

Meeting Action Owner Date for

completion Update

(to be submitted before the meeting)

3. Winter Plan A&E Streaming

18.10.16 IE to pick up NEMS data access issue with Andy Haynes.

IE 01.11.16 Complete but issue not resolved

3. Winter Plan A&E Streaming

18.10.16 PM to share CDU information that he received from the Trust.

PM 01.11.16

3. Winter Plan A&E Streaming

18.10.16 The Trust to provide an update on ambulatory emergency care outside of the meeting.

RH 01.11.16

3. Winter Plan Clinical Advisors

18.10.16 RS and JD to discuss with their organisations outside of the meeting to understand if there are different ways of joint working between 111 and EMAS without any additional cost.

RS/JD 01.11.16

3. Winter Plan Patient Flow

18.10.16 Trust to provide patient flow update at next meeting.

RH 01.11.16

4. Activity Trends ED attendances

18.10.16 FB to arrange utilisation meeting to include CCG, NEMS, EMAS and Health Partnerships. Discussions to be reported back at the next meeting.

FB 01.11.16 Complete

4. Activity Trends Community Contracts

18.10.16 LH to feedback discussions from internal HP meeting at next meeting.

LH 01.11.16

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Progress report from the

Clinical Executive Sub-Committee

Date of committee: 8 September 2016

Key Achievements • APPROVED the medicines waste plan and associated actions to complement existing

strategies to form a comprehensive local solution. • NOTED progress made in delivering of the GP-Pharmacy Transformation Programme, which

utilised community pharmacists in a new clinical role and complemented the national clinical pharmacist in GP practice pilot. Up to the end of June 2016, the project pharmacists had delivered consultations which were estimated to have saved over 1000 hours of GP time, which could be used to create 800 additional appointments per month; and identified safety and quality improvements.

Issues Actions As at Month 4 the pressures experienced during the last quarter of 2015/16 and the first months of 2016/17 had continued, with cost pressures being seen in all key areas.

The CCG was starting to progress through the financial recovery procedure. The Financial Recovery Plan had been developed in order to address some of the financial gap and demonstrated that additional actions had been put in place to reduce the forecast movement to £5.1m. Joint Governing Body working arrangements would be implemented to enable a more responsive meeting structure in order to support the CCG through this challenging financial time.

At the end of July the shortfall in delivery of QIPP was £973k, giving 69% delivery of the year to date target. Delays in the confirmation of Vanguard funding had an adverse impact on QIPP delivery, with slippage being experienced due to a pause in development of some of the schemes whilst confirmation was being received.

Maximise delivery of QIPP Schemes in year and development of further schemes for 2016/17. The CCG needed to be clear on what it was delivering and have clear sight of any slippage. Focused work was being undertaken to reduce spend on acute and continuing healthcare schemes.

Concern expressed that approximately £700k in medicines were wasted each year across mid-Notts.

A waste plan had been developed which recognised the work already taking place and recommended new actions to complement the existing strategies. It was hoped that the development of a waste hotline would allow for easy reporting of waste issues. The waste campaign would be widely advertised to raise awareness of issues and change behaviour.

Members noted that there had been some concern expressed by some GPs who had perhaps misunderstood the intention of the Policy for Procedures of Low Clinical Value.

Members advised that in light of the financial climate and growing demand of healthcare services, it was felt that the policy should be enforced as much as possible. The approach was to prioritise what was spent in order that the population accessed the healthcare most needed. Patients would be referred if it was clinically appropriate to do

1

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so. If a patient challenged a decision, it was felt that a letter should be sent to the patient in support of the GP.

An issue was identified with orthotics and charges being applied every time a patient was seen as being a ‘new assessment’.

It was agreed that consideration be given to how these were charged, i.e. there would be a follow-up charge applied for follow-up appointments rather than a ‘new assessment’ charge.

Risks Actions No additional risks were discussed.

2

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Minutes of the NHS Mansfield and Ashfield Clinical Commissioning Group Clinical Executive Sub-Committee

Held on

Thursday 8 September 2016 at 1:00pm Meeting Rooms 2/3, Birch House

Present: Hilary Lovelock Deputy Clinical Chair (Chair) David Ainsworth Director of Primary Care Sarah Bray Chief Finance Officer Ian Jackson Governing Body Practice Nurse Piyush Oza Governing Body GP Carter Singh Governing Body GP Prabu Raman Locality Chair Milind Tadpatrikar Locality Chair In attendance: Rachel Bradley Executive Assistant to Chief Officer (minutes) Cathy Quinn Pharmacist Clinical Lead

Item Action EM/16/131 Apologies for absence

Apologies were received from:

• Dawn Atkinson • Andrea Brown • Khalid Butt • Gavin Lunn • Peter Macdougall • Neil Moore • Elaine Moss • Andrew Pountney • Amanda Sullivan

EM/16/132 Declarations of Interest Declarations of Interest were as reported on the Register of Interest

EM/16/133 Minutes and actions from the meeting held on 11 August 2016

The minutes of the meeting held on 11 August 2016 were agreed as an accurate record of discussion.

EM/16/134 CCG Feedback Mr Ainsworth reported that Dr Sullivan and Ms Pledger had attended a meeting with Dr Paul Watson, Regional Director (Midlands and East), to discuss what had led to the CCG’s financial

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Item Action difficulties and how they would be addressed to deliver the CCG’s agreed financial targets for 2016/17. A follow-up meeting had taken place on 5 September and the revised Financial Recovery Plan was presented, which outlined the areas the CCG was working on to create more headroom and mitigate risk. The level of risk within the plan was discussed and it was recognised there was a higher level of risk with the additional mitigating actions. It had been agreed that mid-Nottinghamshire CCGs would remain at this current level of escalation and would not be escalated back to the regional team. It was noted that a further meeting would take place in 2 months to review progress and there would be monthly meetings taking place with the Local Finance Director. Mr Ainsworth made reference to the GP Forward View and advised that there would be 82 different national schemes to support the transformation of general practice. It was not yet known what these schemes would be and when they would be published, but timescales, criteria and due diligence would be different. It was noted that the Vulnerable Practice Scheme had reduced and there would be £75k available across mid-Nottinghamshire. A discussion ensued in regard to the Policy for Procedures of Low Clinical Value. Reference was made to a discussion which had taken place at the LMC where concern had been expressed that some GP’s had perhaps misunderstood the intention of the policy. Mr Ainsworth reported that the policy was a clinically driven written policy which had been around for approximately 10 years. Demand for healthcare was greater than what could be funded and therefore the approach was to prioritise what was spent in order that the population accessed the healthcare most needed. It was agreed that patients would be referred if it was clinically appropriate to do so. However, in light of the poor financial climate and growing demand of healthcare services, it was felt that the policy should be enforced as much as possible. It was noted that there would be occasions where difficult discussions would need to take place. If a patient challenged a decision, it was felt that a letter should be sent to the patient in support of the GP. A discussion ensued in regard to referral forms and that direct access forms should be used if it was a direct referral. It was felt there could be an issue if the GP chose to refer someone for a procedure from the Policy for Procedures of Low Clinical Value as there was a different form for each procedure. It was hoped that there would not be a need to complete lots of forms. Dr Prabu arrived at 1.25pm. ACTION: Clarification on the referral process was sought from Mrs Elaine Moss. Dr Lovelock stated it was important to be acting in the patients’ best

SB

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Item Action interest, but to also be mindful about the whole population. The importance of policies being applied across practices was stressed. It was felt that there should be ‘open’ criteria and GPs should be able to justify referrals. Mr Ainsworth reported that the 2 hubs selected for the Vanguard process was Ashfield North and South; and Newark. It was noted that business cases required working up in order to start testing the model of working. Mr Ainsworth informed members they were aiming for 1 October. It was reported that the proposed merger of Sherwood Forest Hospitals NHS Foundation Trust and Nottingham University Hospitals NHS Trust was now likely to happen in 2017.

EM/16/135

Locality Group Feedback Mansfield South Locality Dr Tadpatrikar reported the following:

• Call for care discussion with CHP. It was noted that District Nurses were sending swabs and urine samples, but not inputting them on Systm1 causing issues for clinicians as they had not been provided with enough clinical information.

• Discussion had taken place in regard to patients repeatedly attending A&E. It was felt that PRISM needed to be looked at.

• Mr Ryan Cope had demonstrated the new risk tool. Members felt that this provided them with much more confidence as it gave ‘real time’ data. It was felt a medium/long-term approach perhaps needed to be taken for those patients with a lack of knowledge or suffered from loneliness. It was agreed that opportunities for e-technology should be explored.

• Discussion had taken place in regard to their Vanguard bid which was unsuccessful. A positive approach had been taken and they would come up with new ideas in the future.

Ashfield South Locality Dr Prabu reported the following:

• Increasing A&E activity was discussed. It was noted that the majority of practices had appointments available during the day. Data for late Wednesday and Saturday opening had been reviewed and this had not had a major impact on figures. It was not known why. They had requested further data on outpatients to look at resolving the problem.

• CHP capacity and problems accessing Call for Care had

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Item Action been discussed.

Ashfield North Locality Dr Lovelock reported the following:

• Felt that there was a short timescale for the Vanguard bid as they had no meeting scheduled between the request for bids and the deadline, however a bid was submitted. It was noted that the themes of the bid were around capacity and workforce, demand management and self-care, IAPTS within localities and whether paramedics should be employed.

• Mr Gerald Ellis had attended to discuss the Diabetes Prevention Programme.

• Mr Ryan Cope had attended to demonstrate the new risk tool. It was noted that the tool included what was being seen by CHP and it was felt could be strengthened if general practice activity could be seen.

A discussion ensued in regard to Vanguard monies and some members expressed disappointment that monies would go towards the financial deficit and therefore not an incentive for GPs. Mrs Bray stated that monies would in some way close the gap and also provided confidence and assurance. If the CCGs could retain control of its finances it would cover its own cost and bring benefit. The future of primary care needed to be secured.

EM/16/136

Financial Performance Report Mrs Bray reported that during Month 4 the pressures experienced during the last quarter of 2015/16 and the first months of 2016/17 had continued, with cost pressures being seen in all key areas, including prescribing and continuing healthcare. Further to the heavy utilisation of contingency and flexibility funds seen at Month 3, the CCG was already in a pressured financial position going into Month 4. At month 3 the CCG was showing a year to date deficit of £739k, this however improved slightly in Month 4 to a year to date deficit position of £698k, mainly due to underspends in acute services although this was offset by continuing pressures in prescribing and continuing healthcare. Although the CCG was still reporting a forecast to deliver the required position by the end of the financial year, there was a significant level of risk to this position which still needed to be fully considered, and worked through in detail. Running costs were currently on plan. The CCG met targets to pay 95% of suppliers within 30 days and remain within the maximum cash drawdown.

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Item Action At the end of July the shortfall in delivery of QIPP was £973k giving 69% delivery of the year to date target. Delays in the confirmation of Vanguard funding have had an adverse impact on QIPP delivery, with slippage being experienced due to a pause in development of some of the schemes whilst confirmation was being received. In addition the CNCS administration has had a knock-on effect to delivery of year to date savings, particularly in relation to single front door schemes, and there continued to be delays with delivery of CHC savings. Mrs Bray reported that the Financial Recovery Plan demonstrated that additional actions had been put in place to reduce the forecast movement to £5.1m. It was noted that NHS England had recognised the considerable work that had taken place to make progress in a short timeframe. For example, implementation of joint Governing Body working arrangements to allow efficiencies in taking decisions to both boards and the appointment of the Turnaround Director. NHS England had recognised there was a higher level of risk with the additional mitigating actions. It was noted that had the mid-Nottinghamshire CCGs not delivered a balanced financial plan, they would have moved into direct management by NHS England. Monthly meetings would take place with NHS England to ensure the CCGs were delivering as part of routine monitoring and assurance. Mrs Bray advised that she expected that figures were likely to get worse until November when the impact of the actions detailed in the Financial Recovery Plan would be seen. Members congratulated the team in getting to the position outlined. The NHS Mansfield and Ashfield Clinical Commissioning Group Clinical Executive Sub-Committee NOTED the update.

EM/16/138 Mid-Nottinghamshire Waste Plan Ms Quinn reported that it was estimated that £1.2million in medicines were wasted each year across Mid Nottinghamshire, which equated to approximately £700,000 for Mansfield & Ashfield CCG. The PCT and CCGs had undertaken work over many years to try to tackle the issue. Many factors contribute to the waste problem, so a solution must take a holistic view and address all influences. A waste plan had been developed to recognise that everyone had a contribution to make to reduce avoidable waste; from GP practices and community pharmacists, to patients and the public. It recognised the work already taking place; supported the need to strengthen this and recommended new actions to complement the existing strategies, to form a comprehensive local solution.

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Item Action The plan has been agreed by the Prescribing Subgroup and engagement with the Local Pharmaceutical Committee had started. Members queried how avoidable waste and pharmacy over-ordering could be monitored. Ms Quinn stated that they received ad-hoc information on an ongoing basis and it was hoped that the development of a waste hotline would allow for easy reporting of waste issues. Members suggested that a system-wide approach of practice audits could be adopted. Ms Quinn advised that the team were not planning on adopting this approach as resource was required in other ways. Ms Quinn explained that some additional Pharmacist and Technician investment may be required, noting that there were already some practice staff that could look at this as part of their daily work. The waste plan also included an action to develop a new enhanced service for community pharmacy, which would require a business case to be presented to a future meeting of the Clinical Executive Sub-Committee for approval. The waste plan would form part of the Financial Recovery Plan for the CCGs. A discussion ensued in regard to pharmacists ordering the maximum number of items as they were paid per item. CQ clarified that the global sum, which funded dispensing fees, was finite and meant that the cost paid per item reduced as number of items increased. It was suggested that the ordering of prescriptions by pharmacies on the patients’ behalf be stopped and another system implemented. Ms Quinn agreed that there were certainly instances where improvements could be made and added that if central ordering was put in place, it would take the control away from patients which she felt was not the right approach. Members agreed that the waste campaign needed to be widely advertised to raise awareness of issues and change behaviour. Dr Prabu suggested that Systm1 required a ‘specialist’ module for prescriptions requests. This would allow ‘as required’ medicines to be recorded and ordered separately and not included with regular repeat medicines, which were required each month. Members agreed this was a good idea. ACTION: Ms Quinn to follow up. Ms Quinn reported that a pilot had been undertaken in one Mansfield care home which had educated them in good repeat ordering processes. This pilot resulted in a reduction in avoidable waste of 54%, with an estimated annual value of £6,200. It was noted that roll out of this project could achieve £165,000 reduction in waste across Mid Nottinghamshire. This was already included in the prescribing plans. However, some additional Pharmacist and Technician investment may be required to roll this out at pace. A business case would be considered as part of the Turnaround process.

CQ

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Item Action Members suggested that it would be a good idea to have a Locality Pharmacist to really understand patients and look at pharmacies in a joined up and coordinated way. Ms Quinn explained that the national pilot tended not to use community pharmacists. The importance of building skills in the right workforce was stressed, along with ensuring a fair and equitable pharmacy service across the area. The NHS Mansfield and Ashfield Clinical Commissioning Group Clinical Executive Sub-Committee APPROVED the waste plan and associated actions and would receive the community pharmacy enhanced service business case once developed for consideration.

EM/16/139 GP Pharmacy Transformation Project Update Ms Quinn provided an overview of progress made in delivering of the GP-Pharmacy Transformation Programme and highlighted the emerging outcomes. The programme utilised community pharmacists in a new clinical role. It complemented the national clinical pharmacist in GP practice pilot, but offered a different approach in contracting, and advantages to community pharmacy integration with GP practices. Since its launch in July last year, the GP-Pharmacy Transformation Programme had worked steadily to extend its scope and deliver its objectives. From April 2016, all 6 pilot sites across Nottinghamshire and Derbyshire were live. Some of the programme highlighted included:

• Up to end of June 2016, the project pharmacists had delivered over 5600 consultations.

• These consultations were estimated to have: o Saved over 1000 hours of GP time, which can be

used to create 800 additional appointments per month

o Resulted in changed medication in 56% of patients. This includes stopping medicines in 13.5% of patients due to them not being taken or not needed

o Identified safety and quality improvements. • The average cost per consultation was a third less than a

standard GP consultation. • Patient satisfaction was extremely high, with 100% of

patients being pleased with their consultation and happy to recommend a pharmacist consultation to family and friends.

Ms Quinn also provided an update on delivery up to end August. The Programme was due to end by November 2016 and therefore the project team were currently exploring possible funding

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Item Action opportunities so that the benefits being realised were not lost. Ms Quinn reported that the annual cost for the project was approximately £250K. Members queried how many of the pilot sites had pharmacies within the premises or were next door. Ms Quinn advised that there were 2 in the same building, one next door and the others were separate. It was noted that one was a hospital pharmacy. Members agreed that there needed to be strict criteria applied if utilising a community pharmacist in a clinical role. Members queried how patient direction could be prevented. Ms Quinn advised that generally this was not seen to be an issue with the pilot due to the pharmacists professionalism, the geography of the pilot sites and the inclusion of pilots that did not include the local pharmacist. Those practices whose pharmacies were on site generally utilised the on-site pharmacy anyway. Dr Lovelock emphasised the importance of patient choice. An Action Learning Set was in place to provide peer support. Mr Ainsworth suggested connecting with enhanced practitioner training to help get the workforce required for locality based working. ACTION: Mr Ainsworth to liaise with Ms Quinn. The NHS Mansfield and Ashfield Clinical Commissioning Group Clinical Executive Sub-Committee NOTED the update.

DAin

EM/16/140 QIPP Update on Schemes Dr Lovelock reported that at Month 4 the CCG's position was behind plan, delivering £2,198k (69%) of QIPP year to date against a plan of £3,170k. The following programmes were behind against year to date plan:

• The CCGs had set a challenging target for continuing healthcare of £1,420k; a detailed action plan was in place and the forecast was for delivery of £801k (56%).

• Elective care was below plan year to date delivering £93k (19%) from a plan of £487k. The programme was currently forecasting delivery of £1,886k (59% of expanded plan).

• The urgent and proactive care programme was below plan year to date delivering £633k (50%) from a plan of £1,263k. The programme was currently forecasting delivery of £5,291k (86% of expanded plan).

• The CCGs had further stretched the medicines management programme with a significantly expanded plan for both organisations. Delivery to date has been positive with £645K delivered against plans of £304k, of which the majority of these savings were from category M drugs.

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Item Action Ms Bray reported that at Month 5, all schemes and delivery had been reviewed and they were close to 90% of the QIPP target. People were getting behind the programme and driving forward the agenda. It was noted that a data cleansing exercise had been undertaken with Citycare to review those patients where there had been no activity for a long time. Members suggested that the proactive hub should look into out of hours admissions. It was noted that there was a 20% increase in the number of patients being admitted from nursing homes which should be looked into. Dr Lovelock referred to packages charged incorrectly for continuing healthcare and the impact of community DOLs on funding. ACTION: Mrs Bray to query with Mrs Moss. Members advised that there was an issue with orthotics and being charged every time a patient went in for a new splint for example. It was agreed that a follow-up charge was probably required rather than a charge for a new assessment. Consideration to be given to how these were charged. ACTION: Mrs Bray to raise with Mr Ellis. The NHS Mansfield and Ashfield Clinical Commissioning Group Clinical Executive Sub-Committee NOTED the QIPP update on schemes.

SB

SB

EM/16/141 Better Together Programme Update Mr Ainsworth provided an overview on each of the projects under the clinical and enabling programme areas. The KPI information showed the latest performance information for mid-Nottinghamshire activity at Sherwood Forest Hospitals NHS Foundation Trust. Discussion at the Alliance Leadership Board focused on the urgent and proactive care and the elective programme delivery. Information was presented detailing additional actions that were being undertaken to recover the BT system objective performance and support the CCG financial recovery plan: Key actions related to:

• MSK programme • Referral management • Local Integrated Care Team productivity, Call for Care and

Specialised Intermediate Care Team implementation • Single Front Door – ED and PC24 • Non-elective activity over performance

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Item Action Reference was made to the change in Urology from community to secondary. Members sought clarification on specific costs from community to secondary. If the costs were different it was felt that the provider would need to be held to task. Dr Lovelock stated that she felt she had more confidence in the Single Front Door. It was noted that there had been a plan and study to approach ED streaming during August to improve patient triage. Dr Lovelock advised that A&E nurses managed to get the average triage time to 10 minutes (benchmark was under 15 minutes). A retrospective profile of discharge activity would be undertaken to ensure staff were proportionate to activity. Dr Lovelock advised that workforce was getting traction. It was noted that there would be a dedicated Workforce and Education Training Group at the LMC with Mr Ainsworth, Ms Quinn and Ms Lawson, Programme Manager for the Workforce Workstream, representing the CCG. The NHS Mansfield and Ashfield Clinical Commissioning Group Clinical Executive Sub-Committee RECEIVED the update.

EM/16/142 Proactive and Urgent Care Dashboard Dr Lovelock gave an overview of the latest position on A&E attendances and emergency admissions for Mansfield and Ashfield CCG. This was presented in the proactive and urgent care dashboard which was updated monthly on the CCG intranet site. Dr Lovelock reported that both A&E attendances and emergency admissions had seen an increase in 2016/17 quarter 1 compared to the previous year. It was noted that there had been a steady reduction in the number of A&E attendances for patients aged over 80 in the last few months. The CCG continued to perform well for reducing inappropriate A&E attendances which have reduced by 2.2% compared to the same period last year mainly in the over 80 age group which were down by 4.8% A discussion ensued in regard to the glaucoma clinic and whether reviews took place within A&E. ACTION: Mrs Bray to check with Mr Ellis. The NHS Mansfield and Ashfield Clinical Commissioning Group Clinical Executive Sub-Committee RECEIVED the proactive and urgent care dashboard update.

SB

EM/16/143 To note the Minutes from CCG sub-committees

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Item Action The following minutes which were approved by the Chair of the respective meetings were circulated with the papers. No issues were raised by the members of the meeting in relation to these minutes. • Primary Care Commissioning Committee • Prescribing Sub-Committee

EM/16/144 Summary Points to Feedback to Members • Financial position. • Waste plan.

EM/16/145 Any Other Business There was no other business.

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Schedule of Actions

Agenda ref Action Responsibility Progress

EM/16/103 Minutes and actions from

the meeting held on 14 July 2016

Mr Ellis to provide a progress update in regard to the Elective Access, Booking and Choice Policy.

IE To be fed back at next meeting.

EM/16/134 CCG Feedback

Clarification on the referral process/forms was sought from Mrs Moss. Post-meeting note: It had been agreed to use separate forms to make it easier for clinicians in order that they would not need to look up criteria in the policy. However a form with ‘drop-down’ menus was being looked into. Alternatively a simple form could be used, but clinicians would have to ensure they evidenced that the patient met the criteria which would mean writing a narrative which the project team felt might be more cumbersome for GP’s. PLCV Policy and discussions with patients: The expectation was that clinicians would be open with their patients at the point of making a referral. If GP’s were following the guidance they should not be referring patients unless they met the criteria. However if approval was declined a letter would not go back to the GP or consultant – this was not a change in process as this happened already for some cosmetics and IFR. GP’s have been provided with an updated leaflet which would help them to discuss this with their patient. Guidance about the process was available on the clinical pathways website. There was currently a lot of work taking place in regard to Ophthalmology Direct access pathways and the PLCV policy and prior approval process would be part of the new pathways being developed. It was understood the referral would be sent from an optometrist to GP then to triage.

SB Completed.

EM/16/138 Mid-Nottinghamshire

Waste Plan

Ms Quinn to follow up the implementation of a ‘specialist’ module for prescription requests on Systm1.

CQ Completed - Mrs Hale discussed with Dr Prabu. Module already in place.

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EM/16/139

GP Pharmacy Transformation Project

Update

Mr Ainsworth to liaise with Ms Quinn in regard to enhanced practitioner training to help get the workforce required for locality based working.

DA Completed – would be built into the project.

EM/16/140 QIPP Update on

Schemes

Reference was made to care packages being charged incorrectly for continuing healthcare and the impact of community DOLs on funding. Mrs Bray to query with Mrs Moss.

SB

EM/16/140 QIPP Update on

Schemes

Mrs Bray to liaise with Mr Ellis in regard to how orthotics were being charged.

SB

EM/16/142 Proactive and Urgent

Care Dashboard

Mrs Bray to check with Mr Ellis in regard to whether glaucoma reviews took place within A&E.

SB

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Progress report from the

Clinical Executive Sub-Committee

Date of committee: 13 October 2016

Key Achievements • NOTED and DISCUSSED the joint Governing Body structure which had been approved at the

Extraordinary Governing Body. • RECEIVED an overview of the financial performance of the CCG to the period ending August

2016. • RECEIVED the QIPP report for Month 5, which reported that the CCG position was now only

slightly behind plan, delivering 96% of QIPP year to date. • RECEIVED the revised PMO report for Better Together which reflected the CCG’s focus on

financial recovery and continued focus on the delivery of the new care models. • RECEIVED an update on the Better Care Fund, noting that at the end of Q1, 3 indicators were

on track. These were permanent admissions of older people to residential and nursing care homes, proportion of older people who were still at home 91 days after discharge from hospital into rehabilitation services and permanent admission of older people to residential and nursing care homes directly from a hospital setting per 100 admissions.

Issues Actions As at Month 5, cost pressures continued across all key areas. Deterioration had been seen in the overall position.

Robust monitoring and scrutiny required via the Turnaround Board to ensure delivery of the financial surplus.

At the end of August the shortfall in delivery of QIPP was £148k. This had improved at month 5 and was due to additional savings from a detailed review of continuing healthcare accruals and additional prescribing savings.

Maximise delivery of QIPP Schemes in year. The CCG needed to be clear on what it was delivering and have clear sight of any slippage. Internal venues would be sourced for all meetings and external venues used if they were the only option. These must be flagged as an exception and approval obtained.

Concern had been expressed in regard to the recruitment process for GP Governing Body members. It was felt that representatives who had previously been elected and were now part-way through their original term, should not have to reapply for a position on the Governing Body.

Members were assured that the election process was the fairest and most transparent way to recruit members to the Governing Body. The restructure of the Governing Bodies had been necessitated by the financial turnaround process to enable a more responsive meeting structure to support the CCG through the financial challenge it currently faced.

Concern was expressed that the locality meetings were every two months and were not always attended by Finance and Contracting; which was felt would lead to disengagement amongst practices.

Officers to look into how they were going to manage attendance at the locality meetings going forward.

The Self-Care hub was currently RAG rated Red as it was not delivering as planned.

A meeting had been held with Self-Care UK to commence the review process. A detailed action plan was being developed and would include a deep dive of activity for Q1 and Q2.

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Risks Actions There was a risk that the IAPT (Improving Access to Psychological Therapies) target would not be maintained due to clinical variations in referral rates and complexity of patients accessing the IAPT which would lead to non-achievement of the target and poorer outcomes for patients.

New providers had begun providing services from July 2016, significantly increasing capacity in the system. The 4th provider would go live in Q4. The information received from current providers in terms of output and quality of service would be analysed. Findings would be fed back to a future meeting.

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Minutes of the NHS Mansfield and Ashfield Clinical Commissioning Group Clinical Executive Sub-Committee

Held on

Thursday 13 October 2016 at 1:00pm Meeting Rooms 2/3, Birch House

Present: Gavin Lunn Clinical Chair (Chair) Dawn Atkinson Head of Business Change and Implementation Sarah Bray Chief Finance Officer Ian Ellis Director of Contracting and Urgent Care Ian Jackson Governing Body Practice Nurse Khalid Butt Governing Body GP Piyush Oza Governing Body GP Peter Macdougall Governing Body GP Andrew Pountney Governing Body GP Carter Singh Governing Body GP Prabu Raman Locality Chair In attendance: Rachel Bradley Executive Assistant to Chief Officer (minutes)

Item Action EM/16/145 Apologies for absence

Apologies were received from:

• David Ainsworth • Barbara Brady • Andrea Brown • Hilary Lovelock • Neil Moore • Elaine Moss • Amanda Sullivan • Milind Tadpatrikar

EM/16/146 Declarations of Interest Declarations of Interest were as reported on the Register of Interest.

EM/16/147 Minutes and actions from the meeting held on 8 September 2016 The minutes of the meeting held on 8 September 2016 were agreed as an accurate record of discussion, with the exception that Ms Atkinson was not in attendance and had sent apologies to the meeting.

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Item Action EM/16/148 CCG Feedback

Mr Ellis reported that the Governing Body had approved the decision to reform the Governing Body structure and this had now been communicated to all practices. The strengthened governance structure would be delivered through a joint Governing Body whilst the CCG’s remained separate legal statutory bodies. Mr Ellis advised members that the follow-up escalation meeting with NHS England to discuss progress made on the Financial Recovery Plan would be taking place on Thursday 20 October. It was noted that on Wednesday 19 October it was the CCGs Q2 Assurance meeting with NHS England. Mr Ellis reported that the quarter 4 planning and contracting round had been brought forward. Two year contracts for 2017/18 and 2018/19 would be agreed by 23 December 2016. The Vanguard value proposition would be refreshed to attract more money into the system for the next financial year; this was caveated on showing delivery within this financial year. Following Dr Lunn’s communication to Executive clinicians in regard to the status of the nursing homes services, Mr Ellis reported that a telephone discussion had taken place with CHP in regard to the extension of the caretaker arrangements. CHP had been asked to produce a service offer that considered the LICT and SICT services being delivered in order that we achieved maximum efficiency in the system. It was noted that CHP were currently providing the service on a rolling month by month basis. A discussion ensued in regard to the level of support provided. Ms Atkinson reported that in regard to the specialist intermediate care they had moved to the advanced nurse practitioner model. Ms Steph Haslam was providing officer support, with clinical support from Dr James Mills. Ms Atkinson welcomed wider GP engagement welcome. Dr Pountney and Mr Jackson offered to provide support as appropriate. It was agreed that the new service model would need to follow the business case governance process and be presented to the Financial Delivery and Performance Group prior to presentation at the Clinical Executive Sub-Committee. Members agreed that the return on investment and pace of delivery was critical. Members stated that they felt schemes had not worked as well as they could have done in the past due to not having a realistic envelope of provision to deliver high quality care. In addition, it was noted that recruitment into the nursing home service had proved difficult. Members recognised that there had been challenges previously experienced with workforce and acknowledged that

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Item Action these issues may be encountered going forward. Dr Macdougall arrived at 1.30pm. Members requested that they would like a timescale on progress; appreciating that a lot of work had already been undertaken and the CCG had ‘changed the goalposts’. A discussion ensued and it was agreed that it was reasonable to request a solution by December 2016. ACTION: Mr Ellis and Ms Atkinson to feedback anticipated timescale, project plan and conceptualisation of what the CCG was receiving from the increased service. Mr Ellis to undertake a deep dive into the contract in order to understand what the CCG was paying for as underperformance was being seen in some areas of the contract.

IE/DAt

IE

EM/16/149 Governance Structure Dr Lunn reported that the joint Governing Body structure had been approved on 7 October at the Extraordinary Governing Body. The original suggestion of 3 GPs on the Governing Body had increased to 4 GP members in order to allow alignment with geographical localities and was taken in response to member feedback. The location for the joint Governing Body was likely to be Birch House due to closing times of the building. The recruitment process for GP Governing Body members would be via an Expression of Interest, competency assessment and election process. It was noted that interviews would take place on 27 October. The joint Governing Body would commence from November. The structures for the underlying committees, including the Clinical Executive Sub-Committee, would then be looked at. Members queried why representatives who had previously been elected and were now part-way through their original term, were now having to reapply for a position on the Governing Body. Dr Lunn stated that the initial plan had been to reduce to 3 GP members but this had been increased to 4. This change was taken in response to member feedback and demonstrated the CCG had listened and responded to those member practices who submitted their comments. Dr Lunn stated that the election process was seen as the fairest and most transparent way to recruit members to the new Governing Body. Members queried whether the Turnaround Director was a voting member. Dr Lunn confirmed that she was. Dr Lunn stated that the process had been decided and ratified and they were open for receiving Expressions of Interest.

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Item Action Members sought clarification on whether there would be a redundancy-type process given that some Governing Body members were part-way through their fixed-term contract. Dr Lunn assured members that HR advice had been sought and advised that contracts could be terminated with a period of notice. It was noted that 2-3 year fixed-term contracts would have no doubt remained had the CCG’s not been in financial turnaround. The re-structure of the Governing Bodies had been necessitated by the financial turnaround process to enable a more responsive meeting structure in order to support the CCG through this challenging financial time. Dr Prabu arrived at 1.50pm. Dr Lunn assured members that a lot of GP input was still required to ensure service redesign was right. The NHS Mansfield and Ashfield Clinical Commissioning Group Clinical Executive Sub-Committee NOTED the update.

EM/16/150

Locality Group Feedback Mansfield North Locality Dr Butt reported the following:

• Orchard Medical Practice had been rated as ‘Outstanding’ following their CQC visit in August.

• Mr Ainsworth had attended the development session to discuss the Vanguard bid and opportunities for Mansfield North going forward.

• Discussions had taken place around support from PICS. • Contracting had attended the meeting to explain the PLCV

policy and members had felt more reassured. Members had noted the importance of ensuring referral letters had sufficient background detail. Information was readily accessible via the clinical pathways website. It was noted that from 1 September 2016 procedures of limited clinical value that were carried out without having had prior approval to do so would not be paid.

• There would be a presentation by the pain management team at the PLT in January 2017 which could help with discussions around Nefopam use.

Dr Butt encouraged attendance at the PLT in November which would be focused on GP Update. Ashfield North Locality

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Item Action Dr Lunn reported the following:

• CHP had attended to provide an update on integrated community services.

• Prescribing finance showed a variance of £261K. A discussion had taken place in regard to Nefopam and to avoid using due to growth and cost.

• There had been above average referrals for geriatric medicine, ENT and Ophthalmology for some practices

Ashfield South Locality Dr Prabu reported the following:

• CHP had presented call for care data and information to the group and encouraged practices to take up the offer.

• Discussed the community ultrasound pathway and how referrals were made.

• The group felt that though the PLCV would save money for the CCG, there would be more paperwork for general practice to complete. It was noted that there was a ‘tick box’ form which should be completed in order to obtain approval to refer a patient for a procedure of limited clinical value. The importance of following due process was stressed.

A discussion ensued in regard to referral management. Members were reminded members that the Clinical Executive had approved the referral model of looking at pathways and peer review. It was noted that the Referral Management Centre was still on the agenda for NHS England. Concern was expressed that the locality meetings were every 2 months and key people from Finance and Contracting were not always attending meetings which could disengage members. Officers confirmed that there should be a Finance or Contracting person at each meeting.

EM/16/151 CCG Assurance Framework and Risk Register Mrs Lloyd presented the CCG Assurance Framework and Risk Register. Mrs Lloyd highlighted that there was one risk which came under the responsibility of the Clinical Executive Sub-Committee: There is a risk that the target will not be maintained due to clinical variations in referral rates and complexity of patients accessing the IAPT (Improving Access to Psychological Therapies which will lead to non-achievement of the target and poorer outcomes for patients. Members queried how close the CCG was towards meeting its target. Mr Ellis advised that no improvement had been seen as yet. It was noted that new providers had begun providing services from

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Item Action July 2016 significantly increasing the capacity in the system. The 4th provider (Turning Point) would go live in Q4. Mr Ellis advised that postcards containing details of the service providers had now been distributed to practices. It was noted that each of the providers were also featured on the pathways website. Mr Ellis advised that waiting times were known for Insight and Lets Talk Wellbeing and once all waiting times were known, these would be communicated to practices. It was not known why patients were not accessing the services – whether it was difficult accessing the service or whether patients were not engaging. It was understood that patients were being told they were only undertaking group therapy sessions rather than individual sessions which was felt could put some people off. It was noted that Newark and Sherwood CCG generally met the access targets. Mr Ellis queried the sign off process for the risk and advised that risks being included on the Risk Register required Director ‘sign-off’ to ensure they had been allocated to the correct committee. ACTION: Ms Lloyd to check who had included the risk and whether it was being presented to the correct committee. Ms Atkinson added that she was working with Ms Cowley and Mr Allen to look at what information was being received from the current providers in terms of output and quality of service. In addition why the ‘drop-out’ rate was high within Mansfield and Ashfield, for example, had the provider failed to make contact with the patient. ACTION: Ms Atkinson to feedback findings to a future meeting.

RL

DAt

EM/16/152

Financial Performance Report Mrs Bray gave an overview of the financial performance of the CCG to the period ending August 2016. It was noted that pressure continued across all key areas, including acute, prescribing and continuing healthcare. Month 5 had seen deterioration in the overall position to £812k Mrs Bray reported that although the CCG had produced a financial recovery plan to deliver the required surplus position by the end of the financial year, there was a significant level of risk to this position which would require robust monitoring and scrutiny via the recently established Turnaround Board to ensure delivery of the financial surplus. Running costs are currently on plan. The CCG had met targets to pay 95% of suppliers within 30 days and remain within the maximum cash drawdown Mrs Bray advised that at the end of August the shortfall in delivery

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Item Action of QIPP was £148k. This had substantially improved at month 5 and was due to additional savings from a detailed review of continuing healthcare accruals and additional prescribing savings. This was mitigating the impact of the low year to date acute performance, caused by the problems with the single front door provider, a delay in implementing MSK developments and progress in implementing SICT due to delay in the notification of Vanguard funding. Mrs Bray informed members that the CCG was in a positive position given that the CCG was undertaking everything that it had agreed to at the escalation meeting with NHS England. Members queried the use of external venues, specifically Edwinstowe House. Mrs Bray advised that internal venues would be sourced in the first instance and external venues used if they were the only option. These must be flagged as an exception and approval for use obtained. The NHS Mansfield and Ashfield Clinical Commissioning Group Clinical Executive Sub-Committee RECEIVED the financial performance update.

EM/16/153 QIPP Update on Schemes Ms Cannon reported that at month 5, the CCG's position was now only slightly behind plan, delivering £3,871k (96%) of QIPP year to date against a plan of £4,020k.

• The CCG had set a challenging target for continuing healthcare of £1,420k; a detailed action plan was in place and the forecast was for delivery of £1,029k (73%).

• Elective care was below plan year to date delivering £261k from a plan of £637k. The programme was currently forecasting delivery of £1,670k (60% of expanded plan).

• The urgent and proactive care programme was below plan year to date delivering £1,267k (79%) from a plan of £1,612k. The programme was currently forecasting delivery of £3,183k.

• The CCG had further stretched the medicines management programme with a significantly expanded plan. Delivery to date has been positive with £1,036k delivered against plans of £378k, of which the majority of these savings were from category M drugs.

The NHS Mansfield and Ashfield Clinical Commissioning Group Clinical Executive Sub-Committee RECEIVED the QIPP update on schemes.

EM/16/154 Better Together Programme Update Ms Atkinson presented the revised PMO reporting format which

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Item Action reflected the CCG’s focus on financial recovery and continued focus on the delivery of the new care models. The report was also presented to the Alliance Leadership Board and provided specific detail on the following areas:

• Delivery of Activity and Finance • System performance • New care models and intervention

Ms Atkinson referred members to the Self-Care Hub which was currently RAG rated as Red as it was not delivering as planned. It was noted that a meeting had been held with Self Care UK to commence the review process on 16 September. A detailed action plan was now being developed and would include deep dive of activity for quarter 1 and 2, targeted work (e.g. cancer pathway and diabetes), pilot in place for a self-care advisor to work one session a week in a GP practice and review of other models. A discussion ensued in regard to the Self-Care Hub offer and the signposting of patients. It was noted that the hub was supposed to formulate plans for patients. Dr Singh made reference to a Self-Care information book which listed contact details for all services which he used to also provide helpful information to patients. Members felt that the location also may discourage patients from attending as some may feel it was too far. Ms Atkinson reported that she was undertaking a compare and contrast exercise in order to compare the current service with what was originally set up. The benefit of what the service was providing for the population would be reviewed, along with changes needed in order to move forward. Ms Atkinson added that suggestions, feedback and any ideas were welcomed. The NHS Mansfield and Ashfield Clinical Commissioning Group Clinical Executive Sub-Committee RECEIVED the Better Together Programme update.

EM/16/155 Nottinghamshire Better Care Fund 2016/17 Q1 Update Dr Lunn provided an update on the Better Care Fund and an update on plans post March 2017. It was noted that at the end of Quarter 1 three indicators were on track:

• Permanent admissions of older people to residential and nursing care homes, per 100,000 population.

• Proportion of older people who were still at home 91 days

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Item Action after discharge from hospital into reablement / rehabilitation services.

• Permanent admissions of older people to residential and nursing care homes directly from a hospital setting per 100 admissions of older people to residential and nursing care homes.

And three indicators were off track with actions in place:

• Total non-elective admissions in to hospital (general & acute), all-age, per 100,000 population.

• Delayed transfers of care (delayed days) from hospital per 100,000 population (average per month).

• Question 32 from the GP Patient Survey: In the last 6 months, have you had enough support from local services or organisations to help manage long-term health condition(s)

The NHS Mansfield and Ashfield Clinical Commissioning Group Clinical Executive Sub-Committee RECEIVED the Better Care Fund update.

EM/16/156 To note the Minutes from CCG sub-committees The following minutes which were approved by the Chair of the respective meetings were circulated with the papers. No issues were raised by the members of the meeting in relation to these minutes. • Primary Care Commissioning Committee – 28 July 2016. Reference was made to the need to continue with the local prevention programmes for pre-diabetic patients and the issue of clinical variation due to some of the GP diabetes registers not being as complete as they should be. Dr Lunn advised that Mr Gerald Ellis was the lead for this area of work and was the person to link into. Members noted that in regard to the Estates and Technology Transformation Fund (ETTF) there had been an action for Mr Ainsworth to share the ETTF priority bid list with practices, but this had not yet been seen. Dr Lunn stated that the fund was not likely to be a significant amount of money from NHS England. It was noted that the fund was oversubscribed. ACTION: Dr Lunn to request an update from Mr Ainsworth.

GL

EM/16/157 Summary Points to Feedback to Members • Discussion with CHP on developing SICT service would be

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Item Action ongoing.

• Governing Body joint committee structure. • QIPP / finance – positive feedback received, but challenge

would increase at the end of the year. • Self-care hub.

EM/16/158 Any Other Business There was no other business.

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Schedule of Actions

Agenda ref Action Responsibility Progress

EM/16/103 Minutes and actions from

the meeting held on 14 July 2016

Mr Ellis to provide a progress update in regard to the Elective Access, Booking and Choice Policy.

IE Completed.

EM/16/140 QIPP Update on

Schemes

Reference was made to care packages being charged incorrectly for continuing healthcare and the impact of community DOLs on funding. Mrs Bray to query with Mrs Moss.

SB To be fed back at next meeting.

EM/16/140 QIPP Update on

Schemes

Mrs Bray to liaise with Mr Ellis in regard to how orthotics were being charged.

SB To be fed back at next meeting.

EM/16/142 Proactive and Urgent

Care Dashboard

Mrs Bray to check with Mr Ellis in regard to whether glaucoma reviews took place within A&E.

SB To be fed back at next meeting.

EM/16/148 CCG Feedback

Mr Ellis and Ms Atkinson to feedback at the next meeting the anticipated timescale of the nursing home service model, project plan and conceptualisation of what the CCG was receiving from the increased service. Mr Ellis to undertake a deep dive into the CHP contract in order to understand what the CCG was paying for as underperformance was being seen in some areas of the contract.

IE/DAt

IE

Discussions with Nottinghamshire Healthcare were still on-going in relation to the future care homes service and model Briefing distributed in relation to activity delivered against plan for the 2016/17 CHP contract.

EM/16/151 CCG Assurance

Framework and Risk Register

Ms Lloyd to check who had included the IAPT risk on the Risk Register and whether it was being presented to the correct committee. Ms Atkinson to feedback findings to a future meeting in regard to output/quality of service of IAPT providers.

RL

DAt

To be fed back at a future meeting.

EM/16/156 To note the Minutes from

CCG sub-committees

Dr Lunn to request an update from Mr Ainsworth in regard to the sharing of the Estates and Technology Transformation Fund (ETTF) priority bid list with practices as agreed at the Primary Care Commissioning Committee. (Post-meeting note: the list had not yet been shared due to the ETTF ‘goalposts’ changing. Communication distributed to practices on 28 October).

GL Completed.

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Progress report from the Newark & Sherwood Clinical Executive Sub-Committee

Date of committee: Thursday 6th October 2016

Key Achievements

• Cessation of prescribing prioritised list of premium priced non-formulary medicines.

• Cessation of prescribing of branded medicines where less costly generic versions are

available.

• Cessation of prescribing of medicines where purchase by patients is appropriate for self-care.

Issues Actions CHEC – PLT contract. Current contract runs to March 2017.

Contracting Team preparing options appraisal paper for future provision of PLT’s from April 2017.

Risks Actions Risk CE11 has been re-written and risk score re-assessed. Risk CE15 on-going discussions as to whether it should be transferred to Quality & Risk Committee.

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Attendees should note that the minutes of this meeting will be reviewed and discussed at Newark & Sherwood CCG Public Board meetings and will be available on the CCG website. Papers could also be released as part of a Freedom of Information request.

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MINUTES OF A MEETING OF THE

Clinical Executive Sub-Committee Held on

Thursday 6th October 2016 - 2.30pm, Balderton Primary Care Centre

Present: Dr Mark Jefford (Chair) Clinical Lead

Donna Smith Integrated Care Team Leader

Dennis Brown Lay Member

Luella Robb Practice Nurse, Crown Medical Centre

Dr Lesley Campbell GP, Barnby Gate Surgery

Paula Longden Assistant Director of Finance

Dr Subash Das GP, Sherwood Medical Partnership

Ian Ellis Director of Contracting & Urgent Care (via Vidyo link)

Dr Lesley Campbell GP, Barnby Gate Surgery

Peter Richards Prescribing Advisor

Rick Gooch Practice Manager, Abbey Medical Group

In Attendance:

Sue Cox (minutes) Team Secretary – Primary Care Team

Anne Pridgeon (EG/16/131) Senior Public Health Manager

Craig Dodds (EG/16/131) Dietitian, Everyone Health Service

Sally Bird (EG/16/132) Head of Infection Control

No. Item EG/16/125 Welcome, Introductions & Apologies

Dr Mark Jefford welcomed everyone to the meeting. Apologies were received from:

Dr Thilan Bartholomeuz – Clinical Lead

Barbara Brady – Interim Director of Public Health

Dr Amanda Sullivan – Chief Officer

Elaine Moss – Director of Quality & Governance

Marcus Pratt – Deputy Chief Finance Officer

Ruth Lloyd – Head of Corporate Governance

Sarah Bray – Director of Finance

Dawn Atkinson – Head of Business Change and Implementation

Clare Frank – Programme Manager

Andrea Brown – Director of Programme Delivery

EG/16/126 Declaration of any Conflicts of Interest No expressions of interest were declared.

EG/16/127 Approval of the Notes from the Previous Meeting, Action Log & Matters Arising The minutes were agreed as a true and accurate recording of the meeting. The action log was updated.

EG/16/128 Confidential Section Dr Mark Jefford presented for information a confidential progress report and confidential minutes from the chair of the Joint Clinical and Cost Effectiveness Committee. No further items were discussed in this section.

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No. Item EG/16/129 Feedback and Insight from Clinical Members

No items were discussed in this section.

EG/16/130 Any Other Business CHEC – PLT Contract – Dr Mark Jefford asked if Ian Ellis could present an options appraisal paper at the November 2016 meeting of the Clinical Executive as the Education Committee needed to decide whether PLT would be re-contracted to CHEC or whether provision would be made ‘in house’ at the CCG. Action:- Ian Ellis to present options appraisal at November 2016 meeting. Spirometry - Luella Robb raised the issue that all practitioners who carry out spirometry tests in practices will need to have extra training to allow them to be placed on a national register. The training cost is circa £550 per person supplied by Education for Health. Rick Gooch agreed to discuss this at the next Newark & Sherwood Practice Managers Forum. Dennis Brown announced that he due to retire from the CCG at the end of November 2016. His last Clinical Executive meeting would be 3rd November 2016. A replacement Lay Member will be sought to join the Clinical Executive Sub-Committee. Dr Mark Jefford steps down from his role as Clinical Lead for Newark & Sherwood CCG at the end of October 2016. Ian Ellis thanked Dr Mark Jefford for his leadership and guidance over the last 4+ years. Dr Thilan Bartholomeuz will take over the Clinical Lead role and also chair the Clinical Executive meetings going forward.

EG/16/131 Weight Management T3 – T4 Integrated Care Procedure Anne Pridgeon from Public Health, Nottinghamshire County Council and Craig Dodds from Everyone Health Service joined the meeting to present the integrated care protocol for weight management Tier 3 – Tier 4. Circulated papers were discussed. Patients who have bariatric surgery procedures carried out under the NHS have follow-up within specialist services for the first 1 – 2 years post surgery. The integrated care protocol is aimed at all non-specialist clinicians, dietitians and nurses to aid management of these patients once they are discharged back to primary care and aid management of any patient where follow up guidance by the surgical team was not issued. This includes the expectation of GP’s to carry out annual blood tests and specialist reviews. Craig Dodds reported that the Tier 3 service is currently managing many patients with a good percentage of weight loss.

EG/16/132 Guidance for Minor Surgery in Primary Care Sally Bird joined the meeting. Recent Infection Prevention and Control audits have identified a number of GP practices with treatment rooms that are not fit for purpose as per current guidance when providing minor surgery through a direct Enhanced Services contract. The Infection Control Lead for GP practices has developed guidance on the environmental requirements for minor surgery taking place in practices to ensure that patients are treated in a clean, safe and appropriate environment. Sally Bird reported that practices should adapt the guidance to improve quality of

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No. Item service for both staff and patients.

EG/16/133 Care Homes Services Business Case Deferred due to business case now being updated.

EG/16/134 Prescribing Initiatives update Papers were presented by Peter Richards requesting approval of the following:- Target List – Cessation of prescribing of a prioritised list of premium priced non-formulary medicines. Branded Medicines – Cessation of prescribing of brands where less costly generic versions are available. Self-Care – Cessation of prescribing of medicines where purchase by patients is appropriate for self-care. Gluten Free Products – Cessation of prescribing gluten free foods. A discussion took place around the prescribing of Pregabalin by its generic name has no immediate benefit in terms of cost to the CCG. Where it is appropriate to prescribe Pregabalin as the Alzain brand, this would mean a 40% less than current cost of Pregabalin or Lyrica.

EG/16/135 Review of Risk Register & Assurance Framework The CCG’s Assurance Framework version 20 was presented for information.

Risk CE11 (Preferred place to die), this risk has been reworded and the risk score reassessed.

Risk CE15 (SFHFT not delivering quality service/quality care), this risk has been reworded and is being re-scoped. Discussions are on-going as to whether this risk continues as a Clinical Executive risk or transferred to Quality and Risk Committee.

EG/16/136 EG/16/137

Finance update Paula Longden presented the Finance Report. A finance recovery plan has been signed off by NHSE, which includes regular assurance reviews and monitor of performance by them. Although the financial recovery plan produced plans to deliver the required surplus position by the end of the financial year, there is a significant level of risk. In-efficiencies in the system must be tightened up, and all coding and counting issues must be challenged. The financial position will be closely and regularly reviewed by the Newark & Sherwood CCG Turnaround Board, led by the Turnaround Director. In the period April – August 2016 pressures continue across all key areas, including acute, prescribing and continuing healthcare. At the end of August 2016 the shortfall in QIPP delivery was £685k giving 74% delivery of the year to date target. QIPP Performance Report The latest QIPP report was presented by Paula Longden. At the end of August 2016 the shortfall in QIPP delivery was £685k giving 74% delivery of the year to date target. The CCG continues to be below the year to date plan, however during month 5 there has been further improvement. Continuing Healthcare is also behind plan but the forecast has improved reflecting the

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No. Item EG/16/138

progress against the detailed action plan. Elective Care is below plan. The shortfall is due to delays in progressing the new MSK pathway. The urgent and pro-active care programme is below plan. The medicines management programme has been further stretched. Items to receive No items were presented.

EG/16/139 Date & Time of Next Meeting

Thursday 3rd November 2016, 2.30pm – Rainworth Primary Care Centre.

Exec Group Meeting Attendance Table 2016/17

Name

May 16

Jun 16

Jul 16

Aug 16

Sep 16

Oct 16

Nov 16

Jan 17

Feb 17

Mar 17 %

Mark Jefford / Thilan Bartholomeuz

x X x x x x 100

Lesley Campbell x X x x 68

Subash Das x X x x x x 100

Luella Robb x x x x 68

Sharon Smithurst x X x x x 85

Donna Smith x X x x x 85

Dennis Brown x x x x 68

Barbara Brady x X x x x 85

Amanda Sullivan X x x 50

M Pratt / S Bray / P Longden x X x x x x 100

Clare Frank X x x 50

Elaine Moss / Rosa Waddingham x 17

Peter Richards x x x 50

Ruth Lloyd x x 34

David Ainsworth / Hazel Taylor / C Quinn

x X x x x 85

Simon Parkes / Rick Gooch x X x x 68

I Ellis / R Cope x x x x x 85

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Information Governance, Management & Technology (IGMT) Committee Highlight Report

23 September 2016 NHSmail The Committee received an overview and update for the migration to NHSmail. Following the introduction of the new Information Standards Board (ISB) 1596 Secure Email Specification the CCGs agreed to migrate the existing email system to NHSmail rather than upgrade. All staff nhs.uk email accounts would be migrated across to nhs.net accounts and all emails into the nhs.uk would be forwarded onto the nhsmail accounts. During the period of migration, users would have both accounts running concurrently, this was expected to be for approximately three months. The standard mailbox size for nhs.net accounts was 4GB, all staff were being asked to manage their accounts within this. Further guidance regarding branding for email addresses was awaited and further information would be communicated to staff when available Information Governance Management Framework The Committee APPROVED Information Governance Management Frameworks. The frameworks set out the CCGs’ process for managing Information Governance and assurance and was key evidence for IGT standard 14- 130. Two frameworks were presented for approval, one for Mid Nottinghamshire CCGs and one for South Nottinghamshire CCGs. Information Asset Register Procedure The Committee APPROVED an Information Asset Register Procedure. The procedure ensured a robust process for the management of the organisations’ Information Assets. The procedure was an operational document that set out the key responsibilities for Information Asset Owners and Information Asset Assistants as well as the assurance process for Senior Information Risk Owners (SIROs). Electronic Remote Working Policy The IGM&T Committee APPROVED an Electronic Remote Working policy. The policy set out the responsibilities of staff with regard to the confidentiality and security of information when working remotely. The policy referred to iPads and iPhones and included responsibilities of local organisations to audit. The Information Governance, Management and Technology Committee is managed by Rushcliffe Clinical Commissioning Group (CCG) on behalf of Nottingham West CCG, Nottingham North and East CCG, Mansfield and Ashfield CCG and Newark and Sherwood CCG

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Records Management Policy The IGM&T Committee APPROVED a Records Management Policy. This Policy set out the approach taken within the CCG to provide a robust Records Management system for the management of corporate and clinical information. The previous policy had been updated to bring together the Information Lifecycle Management Policy and Records Management Policy. The policy covered both the management of clinical and corporate records, however, focus on corporate records given the nature and business of CCGs. The update also reflected the new ‘20 year rule’ and incorporated updates from the Records Management Code of Practice for Health and Social Care 2016. Information Governance Working Group Terms of Reference The IGMT Committee APPROVED the Information Governance Working Group Terms of Reference. The terms of reference had been reviewed by the IG leads operational group and set out the responsibilities of the group. The group would support the Nottinghamshire Clinical Commissioning Groups to ensure that best practice was applied in the sharing and management of information and as a forum to discuss and resolve common issues or queries in relation to the Information Governance agenda and IG Toolkit standards (as required). The group reported into the IGMT Committee. eDischarge The IGMT Committee received an update regarding eDischarge. As part of the Transfer of Care initiative supported by NHS Digital the 2016/17 NHS standard contract set out requirements that stated there must be electronic delivery of e-Discharge summaries between Primary Care and Acute, Mental Health and Community Providers (all NHS funded care including independent sector) by 1 December 2016. This initiative was aligned to the National Information Board and NHS England five year forward plan and as such formed part of our Local Digital Roadmap core objectives. The Committee noted that local providers were expected to meet the deadline of 1 December 2016. Assurance had already been gained from Sherwood Forest Hospitals Trust (SFHT) and Nottinghamshire Healthcare Trust (NHCT), and confirmation of position from Nottingham University Hospitals (NUH) would be received the following week. GP practices would require some help to start receiving e-Discharges. At the time of the meeting, there was variation in how practices received this information. NHS Network Assurance Report The Committee received an update on network assurance. NHIS had been requested to provide the Committee with assurances regarding the proactive nature of what NHIS did in exploring the world of threats and what products, techniques and processes could be put in place to reduce these threats to a manageable level. NHIS had a number of existing assurances in place and had also engaged with 360 Assurance to commission a piece of work around an assurance framework for clients. An update paper would be provided to the Committee in March 2017.

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MINUTES OF THE INFORMATION GOVERNANCE, MANAGEMENT AND TECHNOLOGY COMMITTEE

Friday 23 September 2016, 1.30 pm – 4.00 pm, Meeting rooms 2 and 3, Birch House, Mansfield

MEMBERSHIP Andy Hall Bronwyn Jackson Paul Gardner Sarah Bray (A) Nichola Bramhall Dr Mike O’Neil Hazel Buchanan Elaine Moss Paul Morris (A) Dr Sean Ottey (A) Eddie Olla

Director of Outcomes and Information & SIRO (Chair) Information Governance Manager, Mid Nottinghamshire Information Governance Lead, South Nottinghamshire Chief Finance Officer and Senior Information Risk Owner Director of Nursing and Quality & Caldicott Guardian Clinical Representative & SIRO Director of Operations & SIRO Director of Quality and Governance & Caldicott Guardian Lay Member General Practitioner & Clinical Representative Director of Health Informatics

Nottingham South CCGs Arden and GEM CSU Nottingham City CCG Mansfield & Ashfield CCG and Newark & Sherwood CCG Nottingham South CCGs Nottingham West CCG Nottingham North and East CCG Mansfield & Ashfield CCG Newark and Sherwood CCG Rushcliffe CCG NHIS

IN ATTENDANCE Jacqueline Taylor (A) Gina Holmes Marcus Pratt Caroline Stevens Craig Sharples (A) Diane Butcher (A) Sergio Pappalettera Andy Evans Jason Mather (A) Debbie Pallant Gareth Jones Jules Williams Helen Ben-Fredj

Head of Transformation Corporate Governance Officer Deputy Chief Finance Officer Governance Officer Head of Governance Head of Information & Performance Contract and Information Manager Programme Director Primary Care Development and Service Integration Manager Corporate Governance Manager Assurance Lead Officer Programme Manager Project and Business Change Manager

NHIS Mansfield & Ashfield CCG and Newark & Sherwood CCG Mansfield & Ashfield CCG and Newark & Sherwood CCG Rushcliffe CCG Nottingham West CCG Mansfield & Ashfield CCG and Newark & Sherwood CCG Nottingham North and East CCG Connected Nottinghamshire NHS Nottingham City CCG NHIS Nottingham North and East CCG NHIS NHIS

(A) Depicts Absent/Apologies

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Item No. AGENDA ITEM - KEY POINTS OF DISCUSSION Actions

IGMT/16/093 Welcome and Introductions AH welcomed all to the meeting and a round of introductions took place.

IGMT/16/094 Apologies Apologies were received from Jaki Taylor, Di Butcher, Sean Ottey, Sarah Bray and Paul Morris.

IGMT/16/095 Declarations of Interest There were no declarations of interest

IGMT/16/096 Minutes of Meeting held on 27 May 2016 The minutes of the last meeting held on 27 May 2016 were agreed as an accurate record with the following amendment.

IGMT/16/097

Matters Arising from previous meeting (not picked up within agenda): IGMT/16/066 – NHIS penetration testing was presented to Partnership Board in May. All actions were completed IGMT/15/152 – GH had resent the GP server refresh project board update to CS and this had been disseminated to members IGMT/16/072 – GH had forwarded the GP server Privacy Impact Assessment to CS and this had been disseminated to members IGMT/16/072 – PG and AH had drafted a risk regarding the Sherwood Forest Hospitals Trust (SFHT) and Nottingham University Hospitals (NUH) partnership for the risk register, this was on the meeting agenda IGMT/16/072 – PG and SP had not drafted a risk regarding patients opting out following legislation for the risk register, however, there had been a discussion with Carl Davis, Head of Data Management, this was agreed as an issue rather than risk and would be included on future issues logs. Action: PG to include on issues log IGMT/16/073 – NHIS had made changes to the performance report from September 2016 format to allow comparison with previous month’s performance IGMT/16/074 – JT had discussed sponsorship of non-NHS organisations by the CCGs for access to the Community of Interest Network (COIN) to ensure sponsorship did not present an undue risk for the CCGs. Nigel Callaghan, NHIS had written a paper on the risks of sponsorship and this had been sent to MO for review. Action: To be presented at future IGMT Committee meeting IGMT/16/081 – CS had changed the agenda description for Nottingham

PG JT

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City CCG ICT Committee from minutes to update following agreement that the minutes would no longer be presented at the meeting IGMT/16/086 – NHIS had contacted other organisations to confirm password reset requirements. This had now been agreed and was set to 90 days with stronger passwords required for all users from 3 October 2016 IGMT/16/087 – NHIS had considered new technologies to support telemedicine following patient story. Mike Press, NHIS proposed setting up a sub-committee of the IGMT Committee to pilot these technologies. AE noted that the Sustainable Transformation Plan (STP) included an area on telemedicine with particular growing focus on assisted technology with the aim of supporting patients to live independently and longer at home. AE had identified five different groups looking at telemedicine and was keen under the banner of the STP to align those and bring all learning together. Action: AE to liaise with Mike Press to align existing groups IGMT/16/088 – AH had forwarded TPP QRisk Calculator communication to Mid Nottinghamshire CCG colleagues for dissemination to practices. IGMT/16/090 – GH had developed an overview of indicators where Mid Nottinghamshire CCGs had achieved level 3. This would be reviewed at the following Information Governance (IG) Leads meeting. Action: PG to include on next IG Leads agenda IGMT/16/091 – JT and CS had populated the forward plan with NHIS projects including a review of EDSM IGMT/16/092 – SIROs had reviewed and fed back regarding the Privacy Notice, this had required further amendments following initial submission and the updated version was on the agenda. IGMT/16/069 – Terms Of Reference and membership had been agreed, however attendance of some members was low. The Committee was keen that attendance was reiterated to Governing Bodies Action: Members to highlight at Governing Body meetings All other actions were agreed complete

AE PG ALL

IGMT/16/098

NHSmail2 HBF attended the Committee to deliver an update regarding NHSmail2. Following the introduction of the new Information Standards Board (ISB) 1596 Secure Email Specification the CCGs agreed to migrate the existing email system to NHSmail rather than upgrade. NHSmail was a national system supported by NHS Digital and the CCGs had agreed to migrate with support of Accenture. HBF explained that all staff would have a nhs.net email account created

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Item No. AGENDA ITEM - KEY POINTS OF DISCUSSION Actions

through NHSmail unless they already had an account. All emails within staff nhs.uk accounts would be migrated across to their new nhs.net accounts and all emails into the nhs.uk would be forwarded onto the nhsmail accounts. During the period of migration, users would have both accounts running concurrently, this was expected to be for approximately three months. In answer to a question, HBF explained that nhs.uk emails would be mirrored in nhs.net accounts rather than emails forwarded so should not be transferring confidential data insecurely between the two accounts. Action: HBF to clarify process for mirroring to ensure data transfer is secure The branding of the new accounts was still unclear, however, further national guidance was expected in October 2016. Branding would be limited to 15 characters, and GP practices would be linked to their CCG rather than including a practice name. South Nottinghamshire CCGs had agreed not to include ‘CCG’ in the email branding, just including the geographical e.g. Rushcliffe, however, Mid Nottinghamshire would include CCG, e.g. NewarkandSherwoodCCG. Accenture were highlighting branding issues with NHS Digital. The standard mailbox size for nhs.net accounts was 4GB, although it had been identified that some staff members across the CCGs and practices currently had larger mailboxes. Whilst it was possible to accommodate larger mailboxes, there would be a cost attached to this, therefore, all users had been asked to ensure that mailboxes were managed within the standard 4GB. Email management guidance had been disseminated, however, there was no guidance on archiving and use of pst files as this was not supported by NHIS due to risk of loss and storage issues. There would be a charge for each user migrated so NHIS had run a baseline of existing users. This had highlighted some accounts for staff that had left the organisations which had since been archived. Information about the migration had been communicated to all CCG staff and NHIS had engaged with Practice Manager Forums and patient groups about the migration. Technical policies were in the process of being drafted including a starters’ and leavers’ policy. Email account authorisation forms had also been sent to all organisations to list all accounts that required migrating and a Frequently Asked Questions document would be available on the NHIS portal. Exact dates for the migration were not yet known, however, it had been scheduled to pilot the migration with 360 Assurance and PICS ahead of rolling out to CCGs. HBF noted that during migration, users could seek advice and support through the NHIS online customer portal. Three specific staff members would be in post to take calls and resolve portal queries relating to migration. There would also be a trainer attached to the project who

HBF

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would attend the practices to support onsite and training resources would be made available to all staff ahead of the migration. New accounts would need to be activated via Webmail and then mobile devices and Outlook could be configured to access. Accounts would need to be managed for starters, leavers and long term absence. Passwords for accounts would need to be changed every 90 days. If accounts were not accessed for 90 days they would be archived and if not accessed for a further 90 days after archiving accounts would be deleted with no option to retrieve. The Committee asked if a mechanism could be established to notify Practice Managers or CCG leads of inactive accounts. Action: HBF to enquire regarding notification of inactive accounts In answer to a question PG agreed to forward on the completed Privacy Impact Assessment (PIA) for NHSmail to those involved in the project. Action: PG to forward PIA for NHSmail onto to project board members In answer to a question HBF explained that other CCGs had started their migration as part of wave one, however, there was no learning from this as not yet completed. The Committee NOTED the update

HBF PG

IGMT/16/100 Information Governance Management Framework PG and BJ presented the frameworks to the Committee for approval. The frameworks set out the CCGs’ process for managing Information Governance and assurance and was key evidence for IGT standard 14- 130. Two frameworks were presented for approval, one for Mid Nottinghamshire CCGs and one for South Nottinghamshire CCGs. The Committee noted that the frameworks were reviewed and approved annually. The Committee APPROVED the frameworks.

IGMT/16/101

Information Asset Register Procedure PG presented Procedure to the Committee for approval. The information asset management procedure ensured a robust process for the management of the organisations’ Information Assets. The procedure was an operational document that set out the key responsibilities for Information Asset Owners and Information Asset Assistants as well as the assurance process for Senior Information Risk Owners (SIROs). The Committee APPROVED the procedure

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Item No. AGENDA ITEM - KEY POINTS OF DISCUSSION Actions

IGMT/16/102 Electronic Remote Working Policy PG presented the Policy to the Committee for approval. The Electronic Remote Working Policy set out the responsibilities of staff with regard to the confidentiality and security of information when working remotely. The policy referred to iPads and iPhones and included responsibilities of local organisations to audit. PG expected that some small changes would need to be made to align with the National Data Guardian review. Committee members noted the following amendments:

• Section 1.3, acronym for Bring Your Own Device required explained

• Section 5.2, requests could also be made via the NHIS online portal

• Appendix A, an updated form for application for remote access was now available

The IGM&T Committee APPROVED the policy with the above amendments

IGMT/16/103 Records Management Policy CS presented the Policy to the Committee for approval. This Policy set out the approach taken within the CCG to provide a robust Records Management system for the management of corporate and clinical information. The previous policy had been updated to bring together the Information Lifecycle Management Policy and Records Management Policy. The policy covered both the management of clinical and corporate records, however, focus on corporate records given the nature and business of CCGs. The update also reflected the new ‘20 year rule’ and incorporated updates from the Records Management Code of Practice for Health and Social Care 2016. Records management was an individual CCG function and did not form part of the contracts with Nottingham City CCG or Arden and GEM CSU. PG had shared Nottingham City’s policy and provided advice to the CCGs on policy development. The policy would be reviewed this year as part of the IG toolkit audit The Committee noted its thanks to PG for his support in the policy’s development The IGM&T Committee APPROVED the policy

IGMT/16/104 Information Governance Working Group Terms of Reference PG presented the Information Governance Working Group Terms of Reference to the Committee for approval. The terms of reference had been reviewed by the IG leads operational

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group and set out the responsibilities of the group. The group would support the Nottinghamshire Clinical Commissioning Groups to ensure that best practice was applied in the sharing and management of information and as a forum to discuss and resolve common issues or queries in relation to the Information Governance agenda and IG Toolkit standards (as required). The group reported into the IGMT Committee. Minimal changes had been made to the previous version. The IGMT Committee APPROVED the terms of reference

IGMT/16/106 eDischarge AE presented the paper to the Committee for discussion. As part of the Transfer of Care initiative supported by NHS Digital the 2016/17 NHS standard contract set out requirements that stated there must be electronic delivery of e-Discharge summaries between Primary Care and Acute, Mental Health and Community Providers (all NHS funded care including independent sector) by 1 December 2016. This initiative was aligned to the National Information Board and NHS England five year forward plan and as such formed part of our Local Digital Roadmap core objectives. In October 2015 providers had to meet a related deadline to remove the use of faxes and adopt an alternative secure mode of transfer e.g. NHS.net email. This latest initiative was the second phase. AE noted that GP practices would require some help to start receiving e-Discharges. At the time of the meeting, there was variation in how practices received this information, some were receiving in one system, downloading and then uploading into another system, some were receiving via email and some were receiving as intended under this initiative. In answer to a question about how the CCGs would gain assurance that providers were compliant, AE explained that a paper would be presented to the IM&T SRO Programme Board the following week regarding e-Discharge. AE confirmed that local providers were expected to meet the deadline of 1 December 2016. Assurance had already been gained from Sherwood Forest Hospitals Trust (SFHT) and Nottinghamshire Healthcare Trust (NHCT), and confirmation of position from Nottingham University Hospitals (NUH) would be received the following week. In answer to a question, AE explained that costs to the CCGs for this phase of the initiative would only include support to practices for implementation of changes to system where needed. Changes had been communicated to practices nationally.

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The IGM&T Committee NOTED the paper

IGMT/16/107 NHIS Network Assurance Report EO provided an update to the Committee on network assurance for discussion.

NHIS had been requested to provide the Committee with assurances regarding the proactive nature of what NHIS did in exploring the world of threats and what products / techniques / processes could be put in place to reduce these threats to a manageable level. NHIS had a number of existing assurances in place:

• IG Toolkit submission for version 13 was at 73% and NHIS were working towards version 14. Evidence was provided to the CCGs’ IG Leads in year for the Information Security assurance section of their toolkits.

• Cyber Essentials Certification had recently renewed for 2016-17. In answer to a question, DP explained that this was the basic certification and that plus certification had been delayed due to the merger

• Vulnerability testing had been completed, a number of recommendations were being reviewed and implemented, however, no major issues were identified. Further testing was planned for the CoIN infrastructure when deployed.

• ISO27001 certification was slightly delayed by the merger, however, an initial confirm and challenge audit was scheduled at the end of 2016 and in completion expected in 2017.

• CareCERT bulletins were reviewed each week for vulnerabilities and risks. Urgent high level threats were reviewed immediately and assurances circulated to partners and customers; advice notes regarding new ransomware signatures and guidance notes for staff.

• NHIS had signed up for the Care ASSURE early adopter scheme, which would provide an assessment of NHIS’ cyber security preparedness.

NHIS had also engaged with 360 Assurance to commission a piece of work around an assurance framework for clients. This would take the form of the following activities, planned to take place in Quarter 4 2016/17:

• Review of the reporting metrics proposed by NHIS to challenge whether they provide optimum information for clients, regarding the cyber security/information security framework in place.

• Arranging a client workshop to discuss the above, the client needs and develop the optimum reporting framework.

• Providing assurance over response to CareCERT alerts, ensuring that there were robust internal processes in place to ensure actions were logged, evaluated and addressed.

• Providing NHIS with an assessment against the data security

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standards in the National Data Guardian Report and current assurances in place (as above).

The Committee noted that NHIS would provide an update paper having been reviewed by 360 Assurance and having undertaken a client workshop to the March 2017 Committee meeting. The IGM&T Committee NOTED the paper

IGMT/16/108 Portal Update AE provided an update to Committee regarding progress of the portal

The governance around the portal had been a challenge and a steering group and project board had been established. There was concern around decision making, although, work had been progressing. Phase one would be live in October 2016, this included internal systems at SFH and NUH. The connection of NHCT had been slightly delayed and was expected early 2017. In answer to a question, AE stated there was a risk to delivery as at that time, it had not yet started, however, JT was now taking oversight of the delivery and there was a good understanding of what was needed across the community. The IGM&T Committee NOTED the update

IGMT/16/109 360 Assurance Briefing paper on National Data Guardian and Care Quality Commission reports PG presented the paper to the Committee for discussion.

The purpose of the paper was to provide the Committee with a summary of the National Data Guardian Report and CQC Report ‘Safe Data, Safe Care’ collated by 360 Assurance.

The consultation closed on 7 September 2016 and finalised recommendations were awaited. The Head of Information Governance and Information Governance Leads for the CCGs would ensure the Committee was kept up to date on any significant changes in this area and that appropriate assurances were provided that the CCGs were meeting any new obligations. The IGM&T Committee NOTED the paper

IGMT/16/110 Information Governance Risk Register and Issues Log PG presented the updated risk register and issues log to the Committee for discussion. The Committee agreed there was no further update to the existing risks recorded and agreed an additional risk regarding the merger of Sherwood Forest Hospitals Trust and Nottingham University Hospitals (NUH) Trust. The Committee noted that the partnership arrangements would continue and assurances had been received from NUH that

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nothing would get worse although there was still risk related to the transition of merging. The Committee NOTED the register

IGMT/16/111

NHIS Update Performance Report EO presented the performance report to the Committee for information. EO highlighted the call abandonment standard that was missed. EO explained that focus on the merger could explain some reduction in performance. The Committee noted that a separate contract meeting with NHIS was held every month. The Committee NOTED the report

IGMT/16/112 NHIS Update Project Status Report JW presented the project status report to the Committee for information The COIN project had encountered some issues. These had been escalated to BT and NHIS met with BT last week, although there are still a number of issues. A letter of complaint had been written to BT’s Chief Executive to highlight this. Connections were now in place at Kings Mill Hospital and the Mary Potter Health Centre and the remaining should be in place by the following week. The PC Refresh project had to be extended to accommodate this. In answer to a question, JW confirmed that all practices in Mid Nottinghamshire had now migrated to new GP servers, however, if the COIN was not ready the following week, this project would stand still. AE confirmed that a response had been received from the BT Chief Executive quickly and the issue was being resolved within contractual requirements. AE highlighted that NOTIS was not working and NUH had offered a solution for this. Action: NHIS to take away and investigate The Committee NOTED the report

NHIS

IGMT/16/113

Capital Bids – Projects Financial Status AE presented the capital bid documents to the Committee for noting. AE noted that there were some anomalies with reporting, with expense to Rushcliffe CCG and not recharged, therefore, so not all finances were exact. Overviews were presented for the following projects:

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• GP mobile working • GP PC refresh (JT had reported that the estate was in a good

position and the digital maturity assessment would demonstrate this).

• GPRCC (this project was progressing well and at pace). The funds for this project had now been spent and the income stream would now change to vanguard funds for Mid Nottinghamshire

• GP server was progressing • Seven day working • GP systems migration, AE noted that there was an accounting

error, not recharged back from CCG expenditure • Interoperability Portal

Action: AE and JT to review and resolve The IGM&T Committee NOTED the reports

AE and JT

IGMT/16/114 Project Briefs The Committee NOTED that there were no Project Briefs

IGMT/16/115 CfH Exit and Transition EO provided an update to the Committee regarding the Connecting for Health (CfH) exit and transition The CfH contract had ended on 7 July 2016. All GP practices were moved across onto the General Practice System of Choice (GPSoC) contract in advance of this date. The contract for TPP SystmOne Community units (not including Nottingham CityCare and Notts Healthcare as they did their own procurement) had been set up with SFHT being the contract holder. NHIS would be sending the recharge invoices out soon as agreed previously. Costs would be slightly less than the paper presented previously quoted for the annual charges as this year would run from July until the end of March. AE highlighted that East Midlands Ambulance Service (EMAS) had not progressed their system since funding had ceased as at the end of the contract the cost of the licence could not be met, this had left a shortfall of between £1.1 and £1.5 million. This would be discussed at the IM&T SRO Programme Board the following week. The Committee agreed to keep this standing agenda item for a further meeting The Committee NOTED the update

IGMT/16/116 Accessible Information Standard AH provided an update to the Committee regarding progress with the implementation of the Accessible Information Standard. National deadlines for implementation had now passed. Local guidance

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for SystmOne practices had been developed locally on how to set up alerts/ flags for patients with coded communication needs and guidance had been shared with practices about how to email with patients. NHIS were setting up generic NHS.net accounts as requested to support email with patients and consent forms for patients to complete regarding emailing personal information had been disseminated. The Committee NOTED the update.

IGMT/16/117 Privacy Impact Assessments Overview/ Summary PG and BJ presented the Privacy Impact Assessment (PIA) summary to the Committee for information. Consent for secondary use was still being agreed and guidance had been discussed at the Records and Information Group meeting. The Committee NOTED the summary

IGMT/16/118 Cyber Security Bulletin – reporting framework DP presented the paper to the Committee for information. At the Committee meeting in May 2016, a paper was presented setting out the cyber security assurances across both NHIS and the CCGs. This paper set out a framework for reporting assurances that cyber security alerts were managed within the terms of the contract with NHIS. NHIS proposed monthly reporting to SIROs by exception, and quarterly reporting to the Committee summarising actions undertaken by NHIS to mitigate cyber threats. The Committee NOTED the summary

IGMT/16/119

National Updates AE highlighted the Dr Robert Wachter report, that concluded the paperless by 2020 goal as “unrealistic”. Recommendations included taking the learning from the National Programme for Information Technology (NPfIT), extending funding further to support the goal and working to develop clinicians to have better understanding of technology MP highlighted a recent King’s Fund paper on the digital agenda and plans for implementation. The report looked at the key commitments made and what was known about progress to date, grouped under three broad themes: • interoperable electronic health records • patient-focused digital technology • secondary use of data, transparency and consent.

It identified barriers to further progress and opportunities for delivering on the digital agenda. Action: MP to send link to report to CS for dissemination to Committee members

MP and CS

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EO highlighted a webinar on Introducing NHS Digital and the National Informatics Board programmes scheduled for 7 October 2016 Action: EO to send details of webinar to AE and AH The Committee NOTED the updates

EO

IGMT/16/120 Nottingham City CCG ICT Committee Meeting Update This item was deferred in JM’s absence

IGMT/16/121 Partnership Board update AH provided an update to the Committee regarding the Partnership Board. A meeting was scheduled for the following week and an update would be circulated following this. The Committee discussed the implications of the merger and the pause of the merger on service delivery. The Service Level Agreement with NHIS was annual and would be honoured by NUH. NUH had been asking for detail to inform the target operating model to which the CCGs had responded. Action: EO to share the target operating model with members The Committee NOTED the update

EO

IGMT/16/122 Data Management Group minutes AH presented the minutes of the last two Data Management Group meetings. The meetings had now moved to quarterly. MO noted that great progress had been noted with over 90 practices now receiving data through the General Practice Repository for Clinical Care (GPRCC) and 120 registered to also receive. AH also noted that hem MO and Carl Davis, Head of Data Management were liaising with the Vanguard in Rushcliffe to discuss future plans for use. The Committee the significant step forward in achieving this and congratulated all involved. The Committee NOTED the minutes

IGMT/16/123 IG Leads meeting update PG provided an update from the IG leads meeting to the Committee for information. The group had last met 8 September 2016 and reviewed the policies and

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terms of reference presented for approval to this committee. The next meeting was scheduled for December and would review the IG toolkit position. The group also reviewed the Care Quality Commission (CQC) guidance highlighting that CQC would now be monitoring practice IG Toolkit scores as part of inspections. The group noted that additional support may be required for practices. CCGs had responsibility for this, however, additional provision would also be available as NHS Midlands and Lancashire CSU had been commissioned nationally to support GP practices with elements of information governance. Further information would be disseminated to practices. The Committee NOTED the update

IGMT/16/124 Records and Information Group Update PG provided an update on the Records and Information Group (RIG) to the Committee for information The group had revised the consent model and Electronic Data Sharing Model (EDSM) guidance. Implied consent had been agreed to be in best interest of patients. The group were also developing a guidance document for secondary use PG noted that the group was still seeking a clinical chair. An email would be circulated to clinicians inviting candidates, the Committee agreed that a clinician with a Caldicott Guardian role was required. AH reported that Dr. Ian Trimble previously a Nottingham City GP, had recently retired and was now recruited as an independent GP advisor to Rushcliffe CCG and clinical lead for Connected Nottinghamshire, would also provide the IM&T Clinical Safety Officer role previously held by Dr George Ewbank. The IGM&T Committee NOTED the update and report

IGMT/16/125 Quarterly Data Quality Report AH presented the Quarterly Data Quality Report to the Committee for information. The report assured members of the Committee of the overall data quality by providing reports on Secondary Uses Services (SUS) data submitted by Trusts relating to their patients. The validity of a number of key data items was presented at National, North Midlands Area Team and Provider level The Committee noted that improvements had been seen in Sherwood Forest Hospitals Trust (SFHT) in last couple of months. The Committee NOTED the report

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IGMT/16/126 Quarterly Information Governance Report PG presented the Quarterly Information Governance Report to the Committee for information. The purpose of the paper was to provide the Committee with an update with regards to all the reporting requirements within the Information Governance agenda and provide assurance that the requisite compliance areas were being met. Furthermore the report provided an update with regards to any national developments that may have an impact on the CCGs. The Committee noted there were no areas of risk or concern and the CCGs were in line with and complying with requirements. The Committee NOTED the report

IGMT/16/127 Local Digital Roadmap AE provided an update to the Committee regarding the Local Digital Roadmap (LDR) for information The initial submission in July 2016 had been well received by NHS England. AE explained that this was the technical component supporting the Sustainable Transformation Plan (STP). The LDR had been recognised as business case ready and was being used by NHS England as an exemplar. AE noted that it was a working document and that an extra Workstream had been added for assisted technology. The Committee agreed to receive an overview of the Local Digital Roadmap at the December 2016 Committee meeting Action: CS to add to December agenda The Committee NOTED the update

CS

IGMT/16/128 Privacy Notice AH provided an update to the Committee regarding the Privacy Notice for information AH reported that the CCG privacy notice had been updated to support the NHS Digital Data Access Request Service (DARS) and Accredited Safe Haven (ASH) application. The updated version had been sent to all CCGs for uploading that day. The committee noted that the updated version needed to be live that day. The Committee NOTED the update

IGMT/16/129 Forward Programme Action: ALL members should forward any other agenda items to CS

ALL

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IGMT/16/092

Any Other Business No other business was noted

Date and Time of Next Meeting 1.30 pm – 4.00 pm on Friday 16 December 2016 Clumber Meeting Room, Easthorpe House, Ruddington ‘Members should inform the meeting secretary of any apologies and deputies attending on their behalf at least 10 working days prior of the next meeting. This is to ensure that the meeting is quorate and any action from potential declarations of interest are handled appropriately in advance’.

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Abbreviation Meaning ADT Admissions Discharges and Transfers AHP Allied Health Professional AHR Access To Health Record request AQP Any Qualified Provider ASH Accredited Safe Haven AUP Acceptable Use Policy BAU Business As Usual BC Business Continuity CAB/C&B Choose and Book CAG Confidentiality Advisory Group CCG Clinical Commissioning Group CDS Commissioning Data Set CfH Connecting for Health (now replaced by NHSE and

HSCIC) CG Caldicott Guardian CSU Commissioning Support Unit DH/DoH Department of Health DMIC Data Management Information Centre (old name for

DSCRO) DPA Data Protection Act DR Disaster Recovery DSA Data Sharing Agreement DSC Data Sharing Contract DSCN Data Set Change Notice DSCRO Data Service for Commissioners Regional Office EPR Electronic Patient Record EPS Electronic Prescribing Services FOI(A) Freedom of Information (Act) GEMCSU Greater East Midlands Commissioning Support Unit GP General Practice GPES General Practice Extraction Service HES Hospital Episode Statistics HIS Health Information Service/System HPA Health Protection Authority HSCIC Health & Social Care Information Centre IAA Information Asset Administrator IAO Information Asset Owner ICO Information Commissioners Office IG Information Governance IGSoC Information Governance Statement of Compliance IGT Information Governance Toolkit IGTT Information Governance Training Tool ISA Information Sharing Agreement ISP Information Sharing Protocol KPI Key Performance Indicator LA’s Local Authorities LES Local Enhanced Service The Information Governance, Management and Technology Committee is managed by Rushcliffe Clinical Commissioning Group (CCG) on behalf of Nottingham West CCG, Nottingham North and East CCG, Mansfield and Ashfield CCG and Newark and Sherwood CCG - 17 -

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Abbreviation Meaning LSP Local Service Provider NACS (Now ODS) National Administrative Codes Service NHSCB NHS Commissioning Board (old name for NHSE) NHSE NHS England NWW NHS Wide Web ODS (Previously NACS) Organisation Data Service PCD Personal Confidential Data PHE Public Health England PIA Privacy Impact Assessment QIPP Quality Innovation Productivity and Prevention QOF Quality Outcome Framework RA Registration Authority SAR Subject Access Request SBS Shared Business Service SI/SUI Serious Incident/Serious Untoward Incident SIRO Senior Information Risk Owner SUS Secondary Use Service VSO Voluntary Services Organisation ….. Definitions Primary Use of data – is when information is used for healthcare and medical purposes. This would directly contribute to the treatment, diagnosis or the care of the individual. This also includes relevant supporting administrative processes and audit/assurance of the quality of healthcare service provided Weak pseudonym (such as NHS number or postcode) The classification of a weak pseudonym stems from the fact that unless a user has access to another system that requires authorisation and user authentication etc (eg Exeter or the Spine) then the individual cannot be identified from the NHS number alone.

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