South West London Committee for Collaborative Decision ......GP Centre. GP trainer and supervise OOH...
Transcript of South West London Committee for Collaborative Decision ......GP Centre. GP trainer and supervise OOH...
South West London Committee for Collaborative Decision Making (in public)
Tuesday 27th March 2018, 17:30 - 19:30 Venue: Meeting room(s) 6.2/6.3, 120 The Broadway, Wimbledon
Convenor: Carol Varlaam
AGENDA
1 17:30 Welcome, Introductions and Apologies Carol Varlaam
2
17:35
Declarations of Interest All members and attendees may have interests relating to their roles. These interests should be declared in the register of interests. While these general interests do not need to be individually declared at meetings, interests over and above these where they are relevant to the topic under discussion should be declared.
Carol Varlaam
Paper 01
3
17:40
Funding to Deliver Extended Access and Primary Care at Scale in 18/19
Lucie Waters
Paper 02
4
18:20
Developing a South West London Individual Funding Requests (IFRs) Triage Process and Panel
Jonathan Bates
Paper 03
5
19:00
Public Questions Members of the public present are invited to ask questions of the Committee relating to the business being conducted today. Priority will be given to written questions that have been received in advance of the meeting.
Carol Varlaam
6 19:15 Any Other Business Carol Varlaam
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Register of Declared Interests
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Carol Varlaam
CCDM convenor; Wandsworth
Clinical Commissioning Group
Lay Member
No Current Organisations
Parchmore Partnership
Partner XRoles and Responsibilities held
within member practices
To date Declare.
Discuss where relevant with Conflict of Interest Guardian
Haling Park Medical Practice
Partner XRoles and Responsibilities held
within member practices
To date Declare.
Discuss where relevant with Conflict of Interest Guardian
South Norwood Medical Practice
Partner XRoles and Responsibilities held
within member practices
To date Declare.
Discuss where relevant with Conflict of Interest Guardian
Croydon GP Collaborative
Parchmore Partnership, Haling Park Medical Practice and South
Norwood Medical Practice are shareholders
Declared March 2016
X Shareholding 2016 To date
Declare.
Discuss where relevant with Conflict of Interest Guardian
London School of General Practice
GP Trainer XPosition of Authority in an
organisation in the field of health
and social care
To date Declare.
Discuss where relevant with Conflict of Interest Guardian
Croydon Local Medical Committee
Member XPosition of Authority in an
organisation in the field of health
and social care
2002 12.5.17 Declare.
Discuss where relevant with Conflict of Interest Guardian
National NHS Pathways Governance Group (Royal College General
Practitioners)
Chairman
XPosition of Authority in an
organisation in the field of health
and social care
2009 To date Declare.
Discuss where relevant with Conflict of Interest Guardian
National Urgent and Emergency Care Steering Group - NHS
England
Member
XPosition of Authority in an
organisation in the field of health
and social care
01-Jul-16 Declare.
Discuss where relevant with Conflict of Interest Guardian
South London Faculty Board, Royal College of General Practioners
Member XPosition of Authority in an
organisation in the field of health
and social care
2012 To date Declare.
Discuss where relevant with Conflict of Interest Guardian
NHS England (London) - Pan London Integrated Urgent Care
Governance Group
Chairman
XPosition of Authority in an
organisation in the field of health
and social care
To date Declare.
Discuss where relevant with Conflict of Interest Guardian
London Ambulance Service Clinical Quality Group
GP Representative for NHS SW London XPosition of Authority in an
organisation in the field of health
and social care
To date Declare.
Discuss where relevant with Conflict of Interest Guardian
London Urgent and Emergency Care Clinical Leadership Group
Member XPosition of Authority in an
organisation in the field of health
and social care
To date Declare.
Discuss where relevant with Conflict of Interest Guardian
National NHS Pathways Programme Board (NHS England/Health &
Social Care Information Centre)
Member
Declared May 2016
X
Position of Authority in an
organisation in the field of health
and social care
To date Declare.
Discuss where relevant with Conflict of Interest Guardian
Health Education England South London
GP Trainer XPosition of Authority in an
organisation in the field of health
and social care
2012 To date Declare.
Discuss where relevant with Conflict of Interest Guardian
Russell School Trust (Royal Russell School)
Governor XOther 2006 To date Declare.
Discuss where relevant with Conflict of Interest Guardian
Croydon Clinical Commissioning
Group ChairDr Agnelo Fernandes
Action taken to mitigate risk
Nature of InterestDeclared Interest- (Name of the organisation and nature of
business)Name
Current position (s) held- i.e.
Governing Body, Member
practice, Employee or other
Date of InterestType of Interest
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Action taken to mitigate risk
Nature of InterestDeclared Interest- (Name of the organisation and nature of
business)Name
Current position (s) held- i.e.
Governing Body, Member
practice, Employee or other
Date of InterestType of Interest
Community Phlebotomy Service
Parchmore Partnership provides premises for this service XOther To date Declare.
Discuss where relevant with Conflict of Interest Guardian
Community Anti-Coagulation Service
Parchmore Partnership provides premises for this service to Boots
PLC
XOther To date Declare.
Discuss where relevant with Conflict of Interest Guardian
Community Minor Surgery Service
Parchmore Partnership provides premises for this service XOther To date Declare.
Discuss where relevant with Conflict of Interest Guardian
Community Diabetes Service - Bromley Healthcare
Parchmore Partnership provide the premises for this service XOther To date Declare.
Discuss where relevant with Conflict of Interest Guardian
Guy's, King's and St Thomas's Medical School
Parchmore Partnership Medical Learner Centre XOther To date Declare.
Discuss where relevant with Conflict of Interest Guardian
Dr ABC First Aid Training Company
Wife-owner. Provides training for schools/nurseries and some GP
practices (there is no link to the CCG or contracting)
XOther 2010 To date Declare.
Discuss where relevant with Conflict of Interest Guardian
Quintos Works Limited - Physiotherapy (non NHS)
Parchmore partnership provides the premises for this service XOther 2010 To date Declare.
Discuss where relevant with Conflict of Interest Guardian
Circumcision Centre
Parchmore Partnership provide the premises for this service
Declared October 2015
XOther To date Declare.
Discuss where relevant with Conflict of Interest Guardian
Lambeth, Southwark and Lewisham LIFTco.
Director. Representing class B shares
on behalf of Community Health Partnerships Ltd with the aim of
inputting local knowledge to the LSL LIFTco, for the following LIFT
companies: Building Better Health –Lambeth Southwark Lewisham
Limited
Building Better Health –Lambeth Southwark Lewisham (Holdco 2)
Limited Building Better Health –Lambeth Southwark Lewisham
(Holdco 3) Limited Building Better Health –Lambeth Southwark
Lewisham (Fundco 2) Limited Building Better Health –Lambeth
Southwark Lewisham (Fundco 3) Limited Building Better Health –LSL
(Fundco Tranche 1) Limited
Building Better Health –LSL (Fundco Holdco Tranche 1) Limited
Building Better Health –LSL Bid Cost Holdco Limited Building Better
Health –LSL Bid Cost Limited
Building Better Health - LSL (Holdco 4) Limited
Building Better Health - LSL (Fundco4) Limited
X
Shareholding To date Declare.
Discuss where relevant with Conflict of Interest Guardian
Lambeth Clinical Commissioning Group. Chief
Officer.
X 01/04/2013 To date Declare.
Discuss where relevant with Conflict of Interest Guardian
Married to Director of Performance and Delivery - Kings Health
Partners
X Personal 29/10/2012 To date Declare.
Discuss where relevant with Conflict of Interest Guardian
Eastbourne Homes Limited (Private company set up to provide
housing services to council tenants and lease holders)
Non Exec Director
X Non Exective Director 01-Sep-14 To date Highlighted in meeting if direct conflict
Croydon Clinical Commissioning
Group ChairDr Agnelo Fernandes
Andrew EyresChief Operating Officer, Croydon
CCG
Roger Eastwood Lay Member Croydon
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Action taken to mitigate risk
Nature of InterestDeclared Interest- (Name of the organisation and nature of
business)Name
Current position (s) held- i.e.
Governing Body, Member
practice, Employee or other
Date of InterestType of Interest
South East Independent Living Limited (Management of real estate)
Non Exec Director
X Non Exective Director 01-Sep-14 To date Highlighted in meeting if direct conflict
South Essex Homes Limited (management of council housing for
Southend-on-Sea Borough Council)
Non Executive Director
Declared 25 July 2016
X Non Exective Director 01-Jul-16 To date Highlighted in meeting if direct conflict
Eastwood Consultants Limited (Management consultancy activities)
Director and Co Owner
X X Non Exective Director 01-Sep-14 To date Highlighted in meeting if direct conflict
Eastbourne Housing Investment Company Limited (letting and
operating of real estate)
Non Exec Director
X Non Exective Director 01-Jul-16 To date Highlighted in meeting if direct conflict
South East Independent Living Limited
(provides supporting people services to over 65 year olds in East
Sussex for Eastbourne, Lewes and Wealden districts and
"Navigator" services for younger people with complex needs in East
Sussex)
Non Exec Director
X Position of Authority in an
organisation in the field of health
and social care
To date Highlighted in meeting if direct conflict
Elaine ClancyDirector of Quality and
Governance, Croydon CCG
Parent Governor- Langley Park School for Girls X
01/09/2017 To date Highlight in Meeting if direct conflict
Partner of The Groves Medical Centre. X Profit share
The Groves Practice has shares in the private provider New
Malden Diagnostic Centre.
Member of the Council of Governors for Kingston Hospital as a
CCG representative. Member of Governing Body, audit,
Information Governance, and Co-Chair Interim Transformation
Board.
The Groves Practice is part of the GP Federation Provider in
Kingston , Kingston GP Chambers
Chair of Remuneration Committee and member of Finance,
Audit and Clinical Governance Committees.X
Spouse is an employee of Kingston Hospital. Profit share
Partner Nelson Medical Practice
Partner and Chair of Executive Management Team.X X
Wife established Merton Against Trafficking for which I have
undertaken voluntary work for.X
Close friend set up Chapel Street (Charity) - runs services for
NHS but not Merton.X
Membership of Finance, Remuneration; and Integrated
Governance & Quality committee. X X 13/09/17 Present
Sarah BlowAccountable Officer
SWL CCG AllianceGovernor for Greenshaw Learning Trust X 01/01/14 present
Clare GummettMerton Clinical Commissioning
Group Lay MemberAge UK Merton - Chair of Trustees. X
Senior GP partner Hampton Practice, Practice is a member
RGPA, SCMO Your Healthcare.X
Member Kingston Richmond LMC. X X
Conflicted Agenda Item 3 Recused/Non-Voting Dr Naz Jivani
Kingston Clinical Commissioning
Group Chair
David KnowlesKingston Clinical Commissioning
Group Lay Member
Roger Eastwood Lay Member Croydon
Dr Graham LewisRichmond Clinical
Commissioning Group Chair
Dr Andrew MurrayMerton Clinical Commissioning
Group Chair
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Action taken to mitigate risk
Nature of InterestDeclared Interest- (Name of the organisation and nature of
business)Name
Current position (s) held- i.e.
Governing Body, Member
practice, Employee or other
Date of InterestType of Interest
Close friends working for NHS including HRCH. May 2017 Present
Director, MPL X May 2017 Present
Associate Director, Prolex Consultancy X
Susan Smith Richmond CCG Lay Member Nil return
Fergus KeeganDirector of Quality and
Governance, Richmond CCGNil return
GP Partner at Benhill and Belmont GP Centre. GP Centre is a
Member of the Sutton GP Federation.X X
Spouse is a Consulatant Gynaecologist/Infertility services at
Epsom and St. Helier NHS Trust and is Clinical Director for
Women's Health.
LMC Representative for Sutton LMC, Project lead for the new
Belmont surgery in developong the new Benhill and Belmont
GP Centre. GP trainer and supervise OOH shifts in SELDOC
for GP trainees.
<£1000 PA
Director Sutton Health Care. X
Sutton CCG Board Audit Committee,
Sutton CCG Executive Quality CommitteeX
STP Paediatric and Medicenes Management SRO X
Director – Susan Gibbin Consultancy Ltd. X
Corporate consultancy support to Carnall Farrar, Strategic
Health and Care ConsultancyX
Trustee and Board member of the Bourne Education Trust X
Chair of Governors – Downs Way School, Oxted.X
Managing Partner Brocklebank Group Practice and St Paul’s
Cottage Surgery. Both practices hold PMS contracts.X
Practice is a member of Wandsworth Integrated Healthcare
Limited –holds no director post and has no specific
responsibilities within that organisation other than those of other
member GPs.
X
Chair WCCG Board, Integrated Governance & Quality
Committee, St Georges Hospital Clinical Commissioning
Reference Group, System Resilience Group and Clinical Lead
for Transforming Primary Care Programme.
X
James Blythe
Managing Director, Merton and
Wandsworth Clinical
Commissioning Group
Wife is an employee of St George’s University Hospitals NHS
Foundation Trust and holds a speciality training number in
Obstetrics and Gynaecology with HEE South London.
X May 2017 Present
Does not participate in discussions or decisions
regarding clinical quality, safety or staff conduct within
the relevant departments at SGUHFT.
Dr Nicola JonesWandsworth Clinical
Commissioning Group Chair
Dr Chris Elliott Sutton CCG Clincial Chief Officer
Dr Jeffrey CroucherSutton Clinical Commissioning
Group Chair
Susan Gibbin
Sutton CCG Lay Member,
Performance
Sutton CCG
Member: Governing Body
Vice Chair:
Primary Care Commissioning
Committee
James Murray Interim CFO, SWL Alliance
Dr Graham LewisRichmond Clinical
Commissioning Group Chair
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Action taken to mitigate risk
Nature of InterestDeclared Interest- (Name of the organisation and nature of
business)Name
Current position (s) held- i.e.
Governing Body, Member
practice, Employee or other
Date of InterestType of Interest
Stephen HickeyWandsworth CCG Lay Member,
Audit and GovernanceTrustee for Merton Community Transport Charity X
Sam Page Independent Nurse, Wandsworth
CCG Governing Body member
Director Sam Page Consultancy - Consultancy to NHS, local
authority and voluntary sector organisations. X Jan-17 On-going
Interest to be declared as relevant with potential withdrawal
from discussion.
Less Ross Lay Member Sutton No current conflicts of interests Conflict of Interest training completed Feb 2018
Julie Hall Merton GB Nurse MemberDesignated Adult Safeguarding Nurse for Hillingdon CCG. (24th
Oct 2016 -)X
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PAPER 02
Page 1 of 2
Committee Date Tuesday, 27 March 2018
Presenter Lucie Waters
Author Annabel Appleby
Responsible Director
Lucie Waters
Clinical Leads Dr Nicola Jones
Confidential Yes ☐ No Items are only confidential if it is in the public interest for them to be so
The Board is asked to
Approve the recommended approach for apportioning funding across SWL CCGs in 18/19.
Summary of purpose and scope of report
The objective of this paper is to:
• Set out the background information regarding extended access and primary care transformation, as context for the decision that needs to be made by the Committee in Common
• Summarise the requirements for extended access and primary care transformation in 18/19
• Present a recommendation for apportioning the funding across CCGs in 18/19.
Quality and Safety/ Patient Engagement/ Impact on patient services
The report, and corresponding appendices, set out the requirements for extended access and primary care at scale in 18/19. The STP funding is dependent on the STP meeting these requirements.
Finance, resources and QIPP
• SWL’s funding for 18/19, to deliver extended access and transformation of primary care, is £8million
• The STP can determine the spread of allocations within their patch
• SWL has some flexibility in using the money across extended access and primary care transformation
• The paper presents a recommendation for apportioning the funding across CCGs in 18/19 which the Committee in Common is asked to approve.
Title of paper Funding to Deliver Extended Access and Primary Care at Scale in 18/19
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South West London Committee for Collaborative Decision Making
PAPER 02
Page 2 of 2
Equality / Human Rights / Privacy impact analysis
Equality impact assessments will be undertaken at CCG level as services are developed.
Risk Mitigating actions
If the STP does not meet the requirements set out in the specifications for extended access and primary care at scale then SWL may not receive the funding set out in the report.
The STP team will work closely with CCG primary care teams to develop plans and ensure these meet the national / London requirements.
CCGs will follow local governance arrangements to oversee the development of local plans.
SWL STP will have a QA process aligned to the London process.
Spend and delivery will be monitored on an ongoing basis by the Alliance SMT.
Supporting documents
N/A
Governance and reporting
(list committees, groups, other bodies in your CCG or other CCGs that have discussed the paper)
All SWL CCGs have discussed this paper internally and have advised their CiC representatives on their local CCG view.
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Funding to deliver Extended Access and Primary Care at Scale in 18/19
SWL Committee in Common27th March 2018
Start well, live well, age well 11 of 8
Purpose of paper
The objective of this paper is to:
• Set out the background information regarding extended access and primary care transformation, as context for the decision that needs to be made by the Committee in Common
• Summarise the requirements for extended access and primary care transformation in 18/19
• Present a recommendation for apportioning the funding across CCGs in 18/19
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Background
• The General Practice Forward View set out a requirement for each CCG to deliver Primary Care Extended Access; 8-8 7 days a week access to additional GP appointments
• In 17/18, SWL received £4.58m to implement extended access in primary care. Apportionment of this funding across CCGs was agreed by the previous SWL Chief Officers Group; the split was based on business cases submitted by CCGs and did not reflect weighted population
• Across SWL, CCGs have delivered the extended access requirement via a range of at-scale models and approx. 18,000 appointments per month have been created across the patch
• Moving forwards, CCGs will work with providers to fully embed the extended access services within the wider system (e.g. direct booking into services from 111 and ability for A&E to redirect patients into primary care)
• In addition to finalising the extended access specification, the national and London focus is moving onto transformation of primary care through at-scale working, which was also included as an ambition in the General Practice Forward View
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The 18/19 specification for extended access
This slide summarises some of the additional requirements of extended access services in 18/19. STP funding is dependent on the STP meeting this specification.
1. Coverage of a full 8-8 7 day a week GP primary care service must be in place – this as a minimum allows for an extended access GP service that is open weekday evenings 18:30 to 20:00 and 08:00-20:00 on the weekend. Appointments must be available each day for both in advance and same day booking. The service should support the provision of both additional routine and urgent primary care provision
2. Appointments in the extended access service must be directly bookable via; all local GP practices, 111 provider(s) (with services effectively prioritised on the DOS) and local urgent and emergency care provider(s), supporting the appropriate direction of service users
3. Provide 30 minutes of additional appointments per 1000 registered population per week, as a minimum
4. Providers of extended access services must have full access to patient medical records including read and write access, and have integrated systems which allow for transfer of patient information to support safe and effective care
5. The expectation is that service utilisation should be 90% as a minimum. It is noted that it may take time from the launch date of a new service to increase utilisation rates and the age of service delivery will be considered when assessing the reported utilisation figures
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The 18/19 requirement for primary care transformation
This slide summarises some of the requirements of primary care transformation through at scale working. The funding is dependent on the STP demonstrating tangible progress against this framework in 18/19.
1. Comprehensive population based care, operating on a scale large enough to support economies of scale, aligned with boundaries of the local care system and arranged into ‘primary care networks’ – groupings of practices with combined registered lists of 30-50,000
2. Responsibility for the delivery of core medical services, patient outcomes and continuous improvement across all practices
3. Developing organisational capabilities to support delivery including; access to legal, HR and financial advice, workforce planning and recruitment strategy, training and development programmes for staff
4. Effective governance and stewardship including; strategic direction, accountability, and creating a culture based on NHS values, trust, sharing of risk and patient safety
5. Building collaborative system partnerships; primary care demonstrating participation in and leadership of networks of providers within an Integrated Care System
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Key funding messages for SWL STP
• SWL’s funding for 18/19, to deliver extended access and transformation of primary care, is £8million
• The STP can determine the spread of allocations within their patch
• SWL has some flexibility in using the money across extended access and primary care transformation
• The funding is provided on the basis that:
– STPs are using this money for the purposes of continued delivery of extended access services. STPs must meet the core standards requirements as set out in the London 2018/19 Extended Access Guidance document and any noncompliance will lead to a review of commitment to access this funding
– An element of the funding will be used as a transformation fund to support primary care transformation work focussing on accelerating collaborative working and new models of working ‘at scale’
– CCGs commit to continue to invest in primary care services at the same level as they did for the previous year to achieve access and transformation
– The STP will be expected to develop and present plans on planned spend to deliver the shared vision. The STP will be expected to present this to London in April or May
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Proposed split of funding for 18/19
It is recommended that the STP split the funding across SWL CCGs based on the following principles:
• As the starting point, CCGs receive the same funding that they received in 17/18
• Additional funding is split across CCGs to level up the £/head funding that each CCG receives
• The table below shows how the 18/19 funding would be split by CCG, based on these principles
7
CCG 18/19 funding £/head
Croydon £2,036,353 £5.41
Kingston £987,034 £5.41
Merton £1,065,322 £5.41
Richmond £1,040,450 £5.41
Sutton £977,512 £5.41
Wandsworth £1,893,330 £5.41
SWL Total £8,000,000 -
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Recommendation
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The CCG Governing Body is asked to consider approving this approach for apportioning funding across SWL CCGs:
• CCGs will all receive £5.41 per head funding in 18/19
• CCGs will follow local governance arrangements to oversee the development of local plans
• SWL STP will have a QA process aligned to the London process; money will be released upon evidence of investment and assurance that plans meet the London specifications and will deliver required benefits
• Spend and delivery will be monitored on an ongoing basis by the Alliance SMT. The STP will in turn be monitored at London level; 50% funding will be released upon demonstration of robust plans, and 50% will be released at Month 6, upon assurance that delivery is to plan
• The SWL Transforming Primary Care Delivery Group should review progress and options for accelerating primary care transformation over the next six months to get maximum advantage from 19/20 funding
Does the CCG Governing Body agree with the recommended approach for apportioning funding across SWL CCGs?
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PAPER 03
Page 1 of 2
Date Tuesday, 27 March 2018
Presenter Jonathan Bates, Director of Commissioning Operations, SWL Alliance
Author Zoli Zambo, ECI Programme Lead, SWL Health and Care Partnership
Responsible Director
Jonathan Bates, Director of Commissioning Operations
SWL Alliance
Clinical Lead
Confidential Yes ☐ No Items are only confidential if it is in the public interest for them to be so
The Board is asked to:
AGREE to the formation of a single IFR service across SWL.
Summary of purpose and scope of report
The paper seeks to agree the alignment of the current IFR arrangements in SWL into a single IFR service for the population.
Quality & Safety/ Patient Engagement/ Impact on patient services:
IFR services remain governed by those responsibilities mandated to CCGs, with the delivery of the commissioner responsibilities pooled together for greater consistency of decision making.
Finance, resources and QIPP
Each month on average there are 15 IFR Triage Panel meetings and nine IFR Panel meetings across SWL; this is on average a total of 24 meetings per month across the six SWL CCGs. It is envisaged that in a single IFR model the number of meetings will reduce, with triage panels meeting weekly; and fortnightly IFR panel meetings held across SWL. This is being factored into the contractual negotiations with NEL CSU, who provide the administration for the meetings; and CCG resources supporting this will also be revised.
Equality / Human Rights / Privacy impact analysis
The single IFR service will make the decision making more robust and will improve the equity of services across SWL.
Risk Mitigating actions
Risks will be managed by the Directors of Commissioning group.
None.
Title of paper Developing a SWL Individual Funding Request (IFR) Triage Process and Panel
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PAPER 03
Page 2 of 2
Supporting documents
N/A
Governance and reporting
(list committees, groups, other bodies in your CCG or other CCGs that have discussed the paper)
All SWL CCGs have discussed this paper internally and have advised their CiC representatives on their local CCG view.
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P A G E 1 O F 9
Developing a SWL IFR Triage Process and Panel Author: Zoli Zambo Sponsor: Jonathan Bates Date: February 2018
Executive Summary
1. Context
Currently across South West London (SWL) there are six separate Individual Funding
Request (IFR) Triage Panels, one for each individual Clinical Commissioning Groups
(CCG). There are also three IFR Panels (Croydon, Richmond and a shared panel for
Kingston, Merton, Sutton and Wandsworth). This is a highly resource intensive. The
recently established Prior Approval Service has led to procedures previously being
managed through the IFR route now being more appropriately managed by Prior Approval.
In addition, having different processes across SWL can potentially lead to inconsistency in
decision making.
The proposal outlined in this paper is as follows:
Move to a single IFR Triage Panel that meets weekly
Move to a single SWL IFR Panel, with clinical representation from SWL CCGs that meets
fortnightly
Put in place an IFR Appeals Panel to review the limited number of contested IFR decisions
The proposed way forward would deliver the following benefits:
Greater consistency of decision-making
Improved expertise in a smaller number of CCG IFR representatives
Reduced costs
Greater alignment and service resilience across SWL.
2. Recommendation
The Committees in Common is asked to agree to the proposal outlined above.
Practical implementation will be overseen by the SWL Directors of Commissioning Group.
G O V E R N I N G B O D Y P A G E 1 O F 4
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P A G E 2 O F 9
Developing a SWL IFR Triage Process and Panel
1 . I N T R O D U C T I O N
The IFR process is used to consider individual requests for funding where a service,
intervention or treatment falls outside existing service agreements. Some treatments are
“not routinely funded” because either their clinical and cost effectiveness is marginal or
where NHS provision may be inappropriate (e.g. the benefits are purely cosmetic and not
clinical).
Prior to the procedure being undertaken, authorisation for these procedures must be
obtained by the treating clinician (i.e. the practitioner who is responsible for administering
the treatment). In this respect the requirement is the same as for those procedures that are
covered in the Prior Approval Scheme.
Any procedures not routinely funded can be requested via the IFR route. The IFR process
ensures that each request for individual funding is considered in a fair and transparent
way, with decisions based on the best available clinical evidence.
Completed IFR applications are approved only when the IFR panel agrees that the patient
is exceptional or the patient has a very rare clinical condition.
Exceptionality is defined as:
Significantly different from the general population of patient with the condition in
question; AND
Likely to gain significantly more benefit from the intervention than might normally be
expected for the average patient with the condition.
The IFR process has two stages for the commissioners. The IFR Triage Panel reviews all
IFR applications and ensures that all information from the applicant is available and
undertakes the necessary evidence review. Only those cases that are not rejected at this
stage proceed to the IFR panel for a full discussion.
2 . C U R R E N T A R R A N G E M E N T S I N S O U T H W E S T L O N D O N
Currently across SWL there are six separate IFR Triage Panels, one for each individual
CCG. Composition of triage panel members varies from CCG to CCG.
There are three IFR Panels across SWL:
1) Croydon
2) Richmond
3) Joint IFR Panel for Kingston, Merton, Sutton and Wandsworth.
As with the triage panels, composition of IFR panel members varies from CCG to CCG.
On average, each month there are 15 IFR Triage Panel meetings and 9 IFR Panel
meetings making an average total of 24 meetings per month for six SWL CCGs. In terms
of personnel, there are a total of 32 IFR Panel members across SWL.
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3 . C A S E L O A D
Currently the IFR services in SWL deal with cases, which evolved over time and are a
mixture of legitimate IFR applications and Prior Approval Scheme tickbox forms.
The legitimate IFR cases are based on exceptionality and rarity of the patients for
treatments that CCGs do not routinely commission (for example: cosmetic surgery).
The Prior Approval Scheme tickbox form cases are treatments, which are subject to
meeting predefined clinical criteria as defined in the SWL Effective Commissioning
Initiative (ECI) Policy. These procedures are now under the remit of the Prior Approval
Service, such as body contouring procedures and Open MRI scanning.
Commissioner
Legitimate IFR cases*
per year
Croydon CCG 25
Kingston CCG 11
Merton CCG 4
Richmond CCG 17
Sutton CCG 5
Wandsworth CCG 28
SWL total 90
* data based on 2017/18 (April to October 2017/18) extrapolated data
25% of the cases are drug cases, which will need to be the majority of the input from senior
pharmacists and the rest of the cases are for public health specialist to work up.
4 . C U R R E N T C O S T O F I F R P A N E L S
There are two components for each CCG to consider when evaluating the cost of running
the IFR process. Administration is currently provided by NEL CSU and is costed in the
CSU contract. The decision making personnel provided by CCGs is not budgeted for
directly as this is often provided as part of standard job descriptions or arrangements with
Local Authorities (for public health input). The CCG representation costs outlined below
are indicative and are modelled on figures from Croydon adjusted for each CCG according
to population size.
Cost of IFR service
NEL CSU
CCG
Representation
Total
Croydon £95,341 £40,955 £136,296
Kingston £51,531 £22,158 £73,689
Merton £54,478 £23,426 £77,904
Richmond £55,580 £23,899 £79,479
Sutton £49,320 £21,208 £70,528
Wandsworth £89,268 £38,385 £127,653
SWL £395,518 £170,031 £565,549
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5 . P R O P O S A L
Six individual IFR Triage Panels and three IFR Panels results in inconsistent panel
member composition, has significant potential to give rise to inconsistent decision-making,
and fails to make efficient use of CCG resources including the expense of panel members.
Some other parts of London have joint IFR triage and IFR panel across their multiple
CCGs.
It is proposed to move to a single joint IFR Panel across SWL along with a single SWL
single clinical triage panel.
We are working with current IFR triage and panel members in SWL and other joint IFR
services such as North West London to determine the final detail of the joint SWL IFR
service. Based on the current modelling the clinical triage would be undertaken weekly
with IFR Panel meetings taking place approximately every two weeks.
An Appeal Panel reviews applications where the applicant appeals the decision making
process of the IFR Panel. The membership of an Appeal Panel must exclude any persons
who have previously considered the application for which the decision is appealed. IFR
appeals are rare (approximately one case per year). We are working with other London
IFR services to ensure robust capability to be in place by working collaboratively with
them.
SWL CCGs would remain responsible for clinical oversight and for providing the clinical
input into the IFR Panel process.
There are a number of benefits associated with the proposed way forward:
Greater consistency in the application of the IFR policy and decision making
Improved expertise in a smaller pool of CCG IFR representatives
Reduced expense for CCGs by requiring representation at fewer IFR meetings
Alignment and enhanced joint working across the SWL STP footprint.
When all SWL CCGs are in agreement then the operational aspects of the service change
will be further developed and delivered through SWL Directors of Commissioning. This will
include, but not limited to:
Agreement of the proposal will require:
Recruiting IFR Triage, IFR Panel and Appeal Panel members
Redrafting the IFR Policy, Operating Procedures and Terms of Reference
Agreeing financial arrangements for IFR Triage and IFR Panel member costs
Agreeing the financial limit for the IFR Panel to agree funding for an individual case.
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The frequently asked questions relating to the implementation are collated and answered in
Appendix 2.
This is a relatively small commitment to deliver the benefits outlined and in Appendix 1 the
timelines for this is listed with those responsible. The SWL joint IFR service is scheduled to
go live in July 2018. Close monitoring of activity levels and Key Performance Indicators are
planned for the first 6 months, with a formal evaluation in January 2019.
6 . C O N C L U S I O N
The Committees in Common is asked to agree to the proposal outlined.
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Appendix 1 – Project timeline
Created by Zoli Zambo, ECI programme lead
No. Action Lead Update Due Status
1 Governance sign-off of Proposal principle ZZ On track to be completed Green
1.0 ECI group work up of proposal in principle ZZ Completed, discussed multiple times 12-Jan Complete
1.1 DoC agree proposal in principle AS Done, got the go ahead from them in principle 26-Jan Complete
1.2 SWL SMT agree proposal in principle ZZ Inform Accountable officers and Chairs 01-Feb Complete
1.3 CCG GB's to delegate authority ZZ Approved in all CCG GBs 15-Mar Complete
1.4 CiC to sign-off Proposal principle ZZ Scheduled for 27/3 27-Mar Green
2 Operational documentation
2.0 Feedback on proposal from IFR team AS Sought views in Q3 2017/18 30-Dec Complete
2.1 Visiting other IFR services ZZ Visited NWL (and CSU delivers joint Kent service) 27-Feb Complete
2.2 IFR member views sought on principle ZZSupporting in principle, operational questions
raised06-Mar Complete
2.3 IFR panel members workshop x 3 ZZScheduled to coincide with all three IFR panel
meetings09-Apr Green
2.4ECI group agree the updated Operational
Procedures suit of documentsAS/ZZ
Update current papers based on feedback and
examples from Kent and NWL25-Apr Green
2.5CDG to approve the updated Operational
Prcedures suit of documentsAS/ZZ To be scheduled into the agenda 04-May Green
2.6 SWL SMT to be provided update on progress ZZ To be scheduled into the agenda 11-May Green
3 Mobilisation CCG ZZ Green
3.0 Advertise jobs for triage and IFR panel ZZ Can give advance warning to IFR panels 11-May Green
3.1 Shortlisting ZZ Two IFR leads + ZZ 25-May Green
3.2 Interviews ZZ Interview panel with an IFR, ECI lead and HR 31-May Green
3.3 Appoint ZZ SRO for IFR to ratify panel decision 05-Jun Green
3.4 Training AS NEL CSU to provide if any training needed 30-Jun Green
3.5 Start joint service ZZExpecting some exisiting members to take on the
roles01-Jul Green
4 Mobilisation CSU AS Green
4.0 Service specification to be updated AS + ZZTo be based on the signed off Operational Prcedures
suits of documents31-May Green
4.1 Meetings to be scheduled from July onwards ASAs per the expected volumes with contingency for
excessive demand or unexpected issues31-May Green
4.2BlueTeq access to be provided for panel
membersAS
Move to paperless environment requires set-up and
possibly training as well as creating account15-Jun Green
4.3 Training for panel members AS NELCSU to provide if any training is needed 30-Jun Green
5 Evaluation ZZ Green
5.0 Month 1 activity and feedback report to CDG AS + ZZ To ensure that service delivers to KPIs 15-Aug Green
5.1 Summary report for the first quarter to CDG AS + ZZ To be scheduled in to agenda 15-Oct Green
5.2 Summary report for the first quarter to SMT ZZ To be scheduled in to agenda 30-Oct Green
5.3 Review after 6/12 to CDG ZZ To be scheduled in to agenda 30-Jan Green
SWL Joint IFR Service16/03/2018
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Appendix 2 – Frequently Asked Questions
1 . D O E S T H I S W O R K W E L L A N Y W H E R E ?
Yes, there are many regions that have single IFR panels in place for a larger footprint as this is about rare and exceptional cases, which are by definition few and far between. We are linking closely with NWL, who runs a similar set-up and some SWL IFR panel members also worked there so have first-hand experience of the workings.
2 . H A V E T H E L O C A L I F R T E A M B E E N I N V O L V E D I N D E V E L O P I N G T H E
S E R V I C E ?
This proposal was initiated by NEL CSU, who supports all six SWL CCGs in delivering the
IFR services administratively. They also run Joint IFR services elsewhere (e.g. Kent). In
addition feedback from IFR panel members and IFR leads has been sought and will
continue to be sought in finalising the operational aspects of the new service.
3 . I S T H E R E G O I N G T O B E A D E D I C A T E D I F R T E A M F O R S W L ?
Yes, it is the essence of the proposal to make the system more robust by building up skills and experience of staff by exposing them to more cases with adequate cover to ensure that all cases have appropriate level of specialist input (pharmacist or public health).
4 . H O W W I L L S T A F F I N G T H I S S E R V I C E W O R K ?
There will be a central team, just like there is currently, who will coordinate all
administration and provide the framework for the IFR service. The decision making
function will include clinicians who will be the members of the IFR triage and the IFR
panels. However, there will be fewer people involved as the number of cases are relatively
low at CCG or LDU level.
5 . T H E W O R K L O A D W I L L B E S I G N I F I C A N T L Y H I G H E R F O R P H A R M A C I S T
A N D P U B L I C H E A L T H I N P A R T I C U L A R ?
As there will be fewer individuals involved in the clinical preparation of the cases (pharmacists doing evidence reviews for drugs and public health for other treatments) expertise will be built up. The administration arm of the service can also support reviewers by screening requirements and proactively writing up simpler cases and proactively drafting requirement for additional information (as it is in North West London).
6 . D U R A T I O N O F T H E M E E T I N G S W I L L B E T O O L O N G I F T H E R E I S O N L Y
O N E T R I A G E O R I F R P A N E L .
Initial modelling undertaken by NEL CSU and feedback from NWL indicates that the
proposed weekly triage and fortnightly IFR panel meetings are sufficient even in the
transition stage. However, capacity will be built in to ensure more frequent meetings are
possible if necessary.
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IFR triage panel IFR panel
Number of cases for
discussion per meeting
15 4
Expected duration of each
meeting
3 hours 2 hours
7 . W H O W I L L B E O N T H E P A N E L A N D W H O W I L L D O T H E
A D M I N I S T R A T I O N ?
NEL CSU will continue to provide the administration to the service unless a different decision is made by the SWL CCGs. Current IFR panel members and other will be invited to apply for IFR triage panel and IFR panel roles. The proposed membership is below:
IFR triage panel
IFR panel
Lay member
GP GP
Consultant in public health (or delegate) Consultant in public health (or delegate)
Senior Pharmacist Senior Pharmacist
Commissioning manager Commissioning manager
IFR officer IFR officer
8 . H O W W I L L W E H A V E L O C A L C C G R E P R E S E N T A T I O N O N T H E I F R
P A N E L S ?
One of the proposals is to have a rotating chair on the IFR panel, such as a clinical chair
(as in North West London) or a senior clinician such as a CCG planned care clinical
director/lead. It is for the CCGs to determine the level and frequency clinical
representation.
9 . W H A T F E E D B A C K W I L L T H E C C G R E C E I V E O F T H E W O R K I N G S O F T H E
I F R S E R V I C E ?
There will be regular activity reports as there are now or on demand as well as annual
reports for the CCGs Quality Committees, or to other statutory bodies as required.
1 0 . W I L L T H E R E B E C A P A C I T Y F O R D E A L I N G W I T H U R G E N T C A S E S ?
Yes, the joint services will be able to turn around most requests quicker than the current arrangements as meetings are held more frequently and the expertise will have been developed further in processing cases.
1 1 . H O W M U C H W I L L T H E N E W S E R V I C E C O S T ?
The IFR service has two components, the NEL CSU administration and the CCG/Local Authority input. The NEL CSU contract is being renegotiated for SWL and the described efficiencies are part of the discussions. The costs associated with the CCG/LA input are currently subject to various local arrangements. These are yet to be finalised at an individual CCG and individual panel member level.
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1 2 . W I L L T H E I F R R E Q U E S T M O V E O N T O A N E L E C T R O N I C
P L A T F O R M ?
The IFR requests forms are being re-designed based on the feedback of users and are planned to be made electronic using the BlueTeq system. BlueTeq is also used for High Cost Drugs and the Prior Approval Service.
1 3 . W H A T A R E T H E S Y N E R G I E S W I T H T H E P R I O R A P P R O V A L
S E R V I C E ?
There are numerous synergies and this is part of the reason why the caseload for the IFR service is on a downward trajectory. In the future once the Prior Approval Service is established there are obvious reasons why these two should be brought under one umbrella and considerations could be given to the approach to High Cost Drugs too.
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