Summary Sheet: Governing Body...Summary Sheet: Governing Body Date Tuesday, 12th November, 2013...

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Summary Sheet: Governing Body

Date Tuesday, 12th November, 2013

Presenter & Organisation

Committee Chairs

Author (multiple authors, see individual minutes)

Responsible Director

Philippa Jones, Managing Director H&F CCG

Clinical Lead Tim Spicer, Chair H&F CCG

Confidential Yes No (items are only confidential if it is in the public interest for them

to be so)

The Governing body is asked to:

The Governing body are required to note the minutes.

Summary of purpose and scope of report

Approved minutes from the following committees:

Out of Hospital Programme Board, 6th August 2013

IM&T Committee, 21st August 2013

OD and Governance Committee, 24th September 2013

Finance and Performance Committee, 24th September 2013

Quality & Safety/ Patient Engagement/ Impact on patient services:

N/A

Financial and resource implications

N/A

Equality / Human Rights / Privacy impact analysis

N/A

Part: 2 Enclosure: S

Title of paper Approved Committee Minutes

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Risk

N/A

Supporting documents

Approved minutes from the following committees:

- Out of Hospital Programme Board, 6th August 2013

- IM&T Committee, 21st August 2013

- OD and Governance Committee, 24th September 2013

- Finance and Performance Committee, 24th September 2013

Governance and reporting (list committees, groups, or other bodies that have discussed the paper)

Committee name Date discussed Outcome

Out of Hospital Programme Board

01/10/2013 The Committee approved the enclosed minutes

IM&T Committee 02/10/2013 The Committee approved the enclosed minutes

OD and Governance Committee


Finance and Performance Committee


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Out of Hospital Strategy Programme Board (minutes)

Tuesday 6th August 2013, 10-11.30am, Board Room 1, 5th floor, 15 Marylebone Rd

Present:

Martin Waddington Tri Borough Commissioning, Procurement, Business Intelligence and Workforce Director

MW

Tim Spicer Chair of H & F Clinical Commissioning Group TS

Susan McGoldrick Vice Chair of H & F Clinical Commissioning Group SM

Clare Graley H & F Clinical Commissioning Group CG

Rob Sainsbury Deputy Managing Director & Out of Hospital Programme Manager

RS

Neil Snee Interim Joint Director for Adult Social Care and Community Health

NS

Helen Mangan Service Director, WLMHT HM

In attendance:

Cath Attlee Joint Commissioning Director/Manager, Tri borough

CA

Sena Shah Project Manager WCCCC and EoL SS

Caroline Durack TAS Locality Implementation Lead and ICP Lead

ICP Lead

CD

Kay Fisher Commissioning Manager KF

Heena Iqbal Out of Hospital Business Analyst

HI

Matthew Mead MDG Manager, ICP Project MM

Emma Whiteford Interim Head of Operations EW

Eva Hrobonova Public Health EH

Item Agenda Item /Discussion Action Owner

1. Welcome

1.1 Apologies were received from Lydia Land, Philippa Jones,

2. Health and Social Care Coordination Project Evaluation

2.1

Ann Stuart gave an overview of the HSCC project. Key points to emerge included:

- Information Governance Issues - Poor Discharge Planning - Duplication - Care Fragmentation - Fax referral risk - Not enough direct access through to the GP - Significant risks for patients being discharged from Hospital

Report concluded that the HSCC’s do not need a professional qualification. Actions: The key points of learning will be used to support the HSCC role as part of the Virtual Ward A number of additional key points of information required, including origins for the data. Queries to Ann Stuart

RS All

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Public Health to be involved in further analysis of data and meet with Ann Stuart. The findings from the pilot and further analysis needs to be taken to Imperial UCB (operational). Need to ensure there is representation for Imperial at the OOH Board.

3. InterRai Options

3.1

David Evans presented key points of his review of the Agilisys PID with recommendations highlighted on Page 2 including Options A-C. Concern was expressed around the additional workload for the CIS in particular given the continuous number of pilots on-going with the team along with the acknowledgement that System 1 and Framework I roll out is also a factor to consider. The general feel from the OOH group was that Option C presented a form of respite for the individual sectors who have on-going IT projects at present. SM identified that Whole Systems could take over the Interai agenda for the CCG/TB. TS advised that the Governing Body and respective Cabinet and Board processes for the CCG, TB and CLCH would need to be the decision makers around this proposal.

4 Hybrid Worker Qtr1 Report

4.1

Kay Fisher gave an overview of the Hybrid workers pilot. Key points to note had been the difficulties in regards to the interface between the provider and Community Nursing and that the case management model is fragmented. The pilot had also challenged some early assumptions about the need for such a service with this cohort of patients. Learning points to be incorporated into the Virtual Ward model and Tri borough Homecare framework. The Board were advised of the recommendations from the pilot that it is terminated and further analysis in regards to lessons learned, demand profile and model conducted and felt that this was the correct course of action.

KF

5. Virtual Ward Model

5.1

RS and CD gave an overview of progress to date and advised that a further working group has been established in August 2013. Key issues to resolve include

- The medical element of the model - SPA and centralised vs Network

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6 Community Nursing Review Update

6.1

Neil gave an overview of the Community Nursing Survey with some key points of feedback given to the OOH Board members

7. Dashboard Prototype

7.1

The initial dashboard for Community Nursing was tabled.

8. System 1 Update and CLCH Update

8.1

Neil Snee gave an overview of progress to date updating that the review phase of the programme has been incorporated into the overall plan. The project plan was presented and Neil also provided an update for key areas of focus.

9. ICP Update

9.1

Matthew Mead fed back that the report for last month is still being pulled together. An overview was given of the Innovation pilots currently in place including, MOPS, Rapid Response Mental Health and Rapid Access elderly access clinic. MM gave an update on the Innovation initiatives to come to F&P. Care Navigation and support for high risk patients including co-ordination and the development of LTC information packs plus supporting vulnerable persons in Nursing/Residential Care. Action: MW requested that we have a greater understanding of scale for projects.

MM

10. Minutes

10.1 Agreed with no amendments.

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GOVERNING BODY OF THE CCG (Hammersmith and Fulham)

IM&T Committee

Wednesday 21st August, 1.00 – 3.00 pm, Richford Gate Practice

Present:

Tony Willis H&F Clinical Commissioning Group – GP (Chair) TW

Sena Shah IT Lead, H&FCCG SS

Laurie Slater GP, Brook Green Surgery LS

Tessa Sandall Deputy Managing Director, H&FCCG TS

David Waterton SystmOne Technical Project Manager, H&FCCG DW

Christine Dunne Head of Primary Care Systems, NWL CSU CD

Farid Fouladinejad Strategic IT Lead, CWHH FF

Hakan Akozek Chief Information Officer, NWL CSU HA

Helen Goodram Lead Pharmacist, H&FCCG HG

Briar Wilkinson Work Experience Student, Richford Gate BW

Margaret Kelly Interim Senior Commissioning Co-ordinator (minutes) MK


1. Welcome & Apologies

1.1 Introductions were provided.

1.2 Apologies were received from Philippa Jones and Vanessa Andreae.

2. Draft minutes of the previous meeting

2.1 The minutes of the last meeting were approved as an accurate record of the meeting.

3. Matters Arising

3.1 The outstanding actions were reviewed and discussed. Please refer to the actions table for updates.

4. GP migration to SystmOne highlight report

4.1 GP migration schedule SS presented the highlight report for GP migration to SystmOne. It was reported that all practices have now signed up to SystmOne. 10 practices (80,235 patients) have completed their migration process and have their records transferred across to SystmOne, with another 15 practices at various stages of the 12-week process and all practice due to migrate across by December 2013. Feedback from the lessons learnt workshop on the 24

th July was sent out to practices along with the data

checking documents. Positive feedback was received with regard to communication between CCG, TPP and practices with the smoothness with the first four migrations. TW discussed the migration free text data for prescribing and the issues with the way the migration has moved data from 2 fields in vision to single text fields in SystmOne, which is required for the EPS2 (electronic prescribing for controlled drugs) rollout. TPP have agreed to resolve this for practices going forward and to create a bulk tool to fix the issue in practices that have already migrated. A discussion was had on the rollout of EPS2. It was queried what benefits there are to the CCG given the technical, financial and logistic problems experienced with the rollout and given that there are low activity levels with only 5% of practices using it. How this service will be funded will need to be considered and if CCG money is to be used it will need to determine what the return is for this product. It was agreed that national examples of case studies from other areas should be looked at to ascertain what the benefits are for patients and practices prior to making any decisions. TW noted progress with the migration and thanked SS, DW and CW for their work.

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Actions: To chase timescales for migration free text data for prescribing for SystmOne

TW

4.2 Templates (clinical, referral, patient letters) CD explained that she has received a request to create 34 new templates. A discussion was had on how this request is to be managed; what the expectation is for these templates, what needs to be prioritised and the templates the benefit H&F specific. It was stated that some of the templates requests would be duplicates but that the content for Imperial and Chelsea and Westminster are slightly different. It was agreed that requests for templates should be sent in to a central point to DW to monitor the requests more effectively. It was explained that there is a different mechanism of referrals from different routes and it may need to set up a workshop to assist with the rollout to practices, in particular with the practice plan. It was reported that there are issues in making referrals in the address book, but should be resolved with a good address book in place by the end of October. It will need to work up the detail for H&F and Hounslow with joint resources with Central London and West London and prioritise these templates. It will need to consider the resources required to support CD and her team. It was proposed that a working group is established to list the queries for H&F, see what can be resolved for Hounslow and determine what can be factored into the business case. Actions: To prioritise the template list and scope out the work linking in with the key people to develop a shared process and link in with FF with regard to the resources required The process of change with the change control template development to be brought to the next meeting To establish a working group across H&F and Hounslow to support the issues with the template development

DW/CD SS FF

4.3 Risk Register SS presented the risk register and the medium and high-risk status. It was reported that the CCG are looking at the resources to support practices with their training for business process redesign. Data extraction using Apollo is in place with the DMIC team and the CSU to obtain extractions from SystmOne. A meeting will need to be held with the DMIC team to agree the process across CCGs. For the financial systems there needs to be a clear process for tracking expenditure across to ensure there is no overspend. Action: A report to be developed with more granular information to show H&Fs finances and spend to date to bring it to the next meeting

CA / SS

4.4 Change Control SS reported that the change control programme needs to be developed to support GP Practices to deliver continuous improved use of SystmOne. It was stated that train the trainers courses are being delivered over the next four weeks to build capacity across the CCGs. Courses and training programmes with training needs analysis will be offered to practices, with a programme being set up for SystmOne health checks.

4.5 Dashboard SS presented the SystmOne development dashboard. This piece of work is on going and will be brought back to the next meeting. It was reported that at the end of the month 50% of the practice population would be on SystmOne. It was reported that there are communication, hardware and some technical issues that need to be resolved and we need to decide how best to work with practices to resolve these issues. Hardware refreshes are impacting on some practice system functionality and presenting issues for business continuity. SystmOne migration then presents further problems for hardware or software than is not compatible. Anticoagulation monitoring was an example discussed and FF is going to take a proposal to the next F&P committee to seek funds in year to introduce INR Star. It was agreed that if a pause has been built in to use this time respond to practices and address their concerns. SS reported that practice issues are dealt with on a daily basis and the pause (week when there is not migration) will be used to develop core areas of functionality –referral and clinical templates and give time to enable planning for other practice migrations.

5. EMIS Report and meeting

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5.1 FF provided an update on the EMIS report and meeting. EMIS met with the CCG chairs and offered an enhanced support package to practices migrating to EMIS web rather than SystmOne. In Ealing it seems likely that at least some practices will choose to migrate to EMIS web rather than SystmOne. EMIS have been asked to submit their proposal and are awaiting a response. It was reported that EMIS is emailing practices to state that the CCGs have asked them to go to practices to discuss the offer and if they would like to complete and return the schedule A form. A counter e-mail has been sent on behalf of the CCGs to explain that the preferred solution (70-80% of the vote) was for a single system and that the majority vote went to SystmOne. EMIS are holding a joint event with Docman and are saying that the CCGs asked them to contact practices. Monitoring of practices in other areas is underway. It is estimated that 20% of H&F practices have yet to sign and return their forms, and are still being approached by EMIS. The CCG needs to continue communicating with these practices using good news stories via the newsletter and work closely with TPP to get these practices signed up to SystmOne. There is a real risk that two thirds of practices may not sign up to SystmOne. This is recorded on the risk log and will need to be raised further if considered a real risk.

6. CLCH and use of SystmOne to one GP Network

6.1 TW presented the CLCH PID and reported that the community Nursing service should be on SystmOne by the 28

th September and will be able record information for patients who are registered with GP Practices in

Network 1 - Richford Gate, Bush Doctors, Park Medical New Surgery and Ashchurch. Weekly meetings are taking place with CLCH to discuss project development, template development and clinical issues to ensure risks are being managed. A risk has been added to the risk log around how to ensure that GPs in Network 1 are fully included in the process. A Workshop is being planned to prepare Network 1 GP Practices to comment on and understand the processes being developed. CLCH are looking at the next phase and how best to expand use of SystmOne by CLCH –by network, GP Practices or DN teams. Patient consent and sharing of records have been discussed with a joint processes being developed with CLCH. Communications will be sent to patients in scope for this first phase and also to GP Practices outside Network 1. Information leaflets and a letter will be sent out to patients’ in-scope to inform them about the data sharing processes. TPP have produced a generic letter that can be adopted for practices to roll out with their patients. SS will use this and the Hounslow example to develop communications with CLCH. The Committee welcomed progress on this project and supported the focus and scope.

6.2 FF mentioned that a piece of work is taking place at the IT sector meetings around the electronic transfer of information from secondary care to primary care and he has come across some aspects of information sharing between hospital trusts. A meeting is taking place with C&W and Imperial to look how they can expand the scope sending electronic information to GP Practices. TS stated that the Strategy and Transformation Team is looking at non-electives with IT as a key enabler and suggested having joint discussions around these issues. It was queried what does this mean for those CCGs not in the NWL Strategy and asked for this to be raised at the next meeting in September.

7. Formulary and FDP pilot

7.1 Formulary HG presented the prescribing formulary options proposals for SystmOne. It was reported that the NWL Formulary is the best option to go onto SystmOne, but excludes feeds and dressings but these could be picked up separately. In H&F, GP practices have their own formulary with EMIS and Vision versions put onto H&F GP practice systems. It could look at using the NWL formulary but strip back for practices or use one standard formulary and replicate this. However, this would not be a publishable item via the SystmOne Trust Report Unit. It was suggested using the NWL formulary; obtain agreement on what to put on and establish a small group to work on the detail and address the clinical issues. It was stated that the NWL formulary needs primary care implementation. It was suggested using the NWL formulary, look at the top 30 drugs that practices prescribe which are the most commonly used and most expensive and agree what the dosage should be. The Medicine Management Team to produce a joint paper, take to the Governing Bodies and share with Hounslow to obtain their agreement on the principles of the formulary. Put the formulary on each practice system and add the finer detail over time. To include some information in the bulletin around the formulary once it has been agreed and to include the timescales.

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7.2 FDP Pilot HG presented the FDP pilot and explained that FDP medicine optimisation software is built around NICE risks; best practice guidance with all rules built in nationally that can integrate into SystmOne. Good feedback has been received from the pilot. The CCG will only consider FDP if it can pilot it for 3 months with Hounslow and select 5 H&F practices and 5 Hounslow practices, measure the outcomes and establish if any savings can be generated from the pilot and from script switch. It was agreed that FDP is a technical test of a product as an alternative to script switch. If the pilot was to start in September or October, it will need to consider how it negotiates the procurement with Script Switch as this contract ends in November and have an open and transparent process for selecting practices. It will need to look at how the service is to be evaluated given that the pilot is only for 3 months and how to procure the service going forward and ensure it fits in with the timeline. If it decides to procure this product with Hounslow, it will need to consider a 3-year contract to make the service worthwhile and have the procurement process signed off by the CWHH Finance and Performance Committee. It was agreed that 2 papers would need to be written on how to technical test it, inviting 10 practices to pilot it with 5 from H&F and 5 from Hounslow and to write out to those practices selected. Medicine Management input will be required in order to decide what the CCG wants from the product. Action: Joint papers to be produced for the FDP pilot on behalf of H&F and Hounslow with Medicine Management and IT input

FF&HG

8. Choose and Book update

8.1 LS provided a Choose and Book (CAB) update. LS stated that the referral template and address book is not very effective on SystmOne. When you make the referral and save the patient record, you then need to come out of the system and go back in to do the letter and then attach it and send. It was mentioned that there is a view section in CAB that allows you to pull in the data you require and attach a letter without having to come out of the system. It was agreed that the issues with the template and address book will need to be discussed further with TPP and to clarify if there is a problem with CAB or SystmOne. It was suggested speaking to Bush Doctors to find out if they are experiencing problems with SystmOne and if this has had any impact on CAB. A policy is being developed to roll out CAB and needs a solution when people go live with SystmOne. CAB utilisation across the 8 CCGs between April-June 2013 shows that H&F is the lowest performing CCG with update decreasing between April and June, achieving 16% in June compared to 53% for Westminster and 39% for K&C. It was noted that in higher performing Westminster has a referral management centre to monitor the level of referrals and also K&C incentivise practices. The CCG has a strategic objective to increase CAB usage and incentivise practices as part of the network plan for the % of CAB referrals made. It was agreed that the CCGs strategy should be developed further informed by what is happening in NWL and NHSE CAB Team and tap into their resources to support CAB in H&F. LS agreed to look at the level of referrals, feedback to NHSE at tomorrow’s CAB meeting and report back on what is working well. It was stated that Hounslow covers all referrals and if 2-week referrals for maternity were on CAB, H&Fs overall performance would increase. LS suggested incentivising practices further, to increase the CAB usage rate and get all practices using the system. Actions: To provide an update following CAB feedback to NHSE CAB Team and report back on what is working well To discuss with TPP the issues reported with CAB in using the template and address book To determine from Bush Doctors if they are experiencing problems with SystmOne and if this has had any impact on CAB

FF FF FF

9. Information Governance

9.1 LS stated that the IG agenda needs focusing to support record sharing and strengthen care in the community. Ben Westmancott is leading on CCG IG tool kit and the draft CWHH MoU document to the lawyers for comment before it goes to CWHH for sign off. It was considered that the broader audience for the working group would include LMC representatives and a small number of practices. For the next quarter, the MoU will be signed off and the working group will be established.

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10. IG toolkit submission

10.1 The committee noted the CCG IG toolkit update. SS stated that he had sent out documents from Ben Westmancott to the IM&T Committee for comment. It was reported that the CCG have implemented a number of policies and procedure to ensure and improve the level of IG compliance. A score of 59% is required for the CCG to achieve the level 2 compliance. The CWHH Working Group are updating the IG action plan to reflect recent updates and are working closely with the CCG IG leads to achieve level 2 compliance by the 31

st March 2014. Once the CCG becomes level 2 compliant this will change how the CCG can share patient

level information and who has access to this data. It was stated that the next stage could involve self-scoring and auditing and for this committee to be aware of this.

11. Extranet development

11.1 SS stated that the extranet would be trialled with practices prior to full rollout. The extranet will be launched on the 14

th September for a trial period with full rollout to follow.

12. CCG hardware rollout

12.1 FF provided an update on CCG hardware rollout. It was noted that Ipads have been dispersed on an adhoc basis. The rollout of software needs to be sorted out for CCG Board members and Senior Management Team to use the software. Once this is sorted, pilot trials will take place to determine if the software works and if successful a wider rollout will take place.

13. Feedback from NWL IT leads forum

13.1 FF provided an update from the NWL IT Leads forum. These meetings are held monthly with the 8 CCGs with LS attending the last meeting, which was a smaller group of SystmOne CCGs. TPP asked each CCG what they wanted from TPP and to send requests to them such as training support, user forums and modules. A list of requests and requirements has been passed to Emma the London representative. TPP have stated that this is not a problem apart from the development process, as they do not want the CCG inputting into this. TW is tracking what is happening with these requests and filtering this with what has previously been requested. The CCG need to ascertain from TPP what plans they have for further developments and pilots. It was reported that there are no big item requested outstanding and the requests are predominantly around whether the dashboards on laptops have feedback items and if e-mail addresses are generic. For online access from home, practices have 2 tokens and 2 laptops as standard but some practices have requested additional items. A policy needs to be in place to determine the number of laptops and domains each practice can have and the cost implications for these additional items. FF stated that he is staggering the number of laptops being rolled out as ample numbers were purchased based on GP list size and capitation based approach.

14. Any Other Business

14.1 No other business was discussed.

The next meeting will take place on Wednesday 2nd

October, 1.00 – 3.00 pm, Richford Gate Practice

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Finance and Performance Committee Meeting

Tuesday 24th September, 3.00 – 5.30 pm St Paul’s Church, Hammersmith

Present:

Rohan Hewavisenti Lay member (Chair) RH

Susan McGoldrick H&F Clinical Commissioning Group - GP SM

Paul Skinner H&F Clinical Commissioning Group - GP PS

Tony Willis H&F Clinical Commissioning Group - GP TW

Philippa Jones Managing Director, H&FCCG PJ

Clare Parker Chief Financial Officer, CWHH Clinical Commissioning Groups Collaborative CP

In attendance:

Christina Aathavan Head of Finance, NWL CSU CA

Bhavesh Patel Interim PMO Manager, Business and Development, H&FCCG BP

Tessa Sandall Deputy Managing Director, H&FCCG TS

Gabrielle Darby Out of Hospital and QIPP Delivery Manger, H&FCCG GD

Jenny Platt Deputy Out of Hospital Programme Manager, H&FCCG JP

Cerith Lewis Director of Contracts and Information Development, CWHH CL

Paul Towey Network co-ordinator, H&FCCG PT

Janice Woodruff Senior Commissioning Manager Mental Health, Joint Commissioning Tri Borough, NWLCSU NWL CSU

JW

Robert Kirton Senior Finance Consultant, NWLCSU RK

Margaret Kelly Interim Senior Commissioning Officer, Hammersmith and Fulham CCG (minutes) MK


1. Apologies

1.1 No apologies were received.

2. Minutes of the Previous Meeting

2.1 The minutes of the previous meeting were approved as an accurate record of the meeting.

3. Conflict of Interest

3.1 The general conflict of GPs as commissioners and providers was noted. Conflict of interest was also reported by TW and PS for agenda item 6.

4. Matters Arising

4.1 The outstanding actions were reviewed and discussed. Please refer to the actions table for updates.

5. Mental Health User Group Review

5.1 JW presented an update on the contract for the Mental Health User Group, the actions to date and asked for the committee’s agreement on the way forward. It was explained that the contract would expire at the end of March 14. It would like the contract to be extended for 12 months at a cost of £90k, to allow the service users to review the service, look at best practice, seek agreement with the tender process and look at joint funding going forward. The 3-year contract was already extended by one year, but requires a further year’s extension. CP suggested waiting for the outcome of the review, putting it through the standing financial instructions and tender before the end of March 14. The users are being asked to do more user engagement but there needs to be an independent assessment for groups of individuals and to look at benchmarking. It was stated that CCG leads have been involved with this piece of work, have outlined the parameters and looked at value for money. If the CCG are challenging what it spends it should consider whether to extend this contract. The cost of £500 per user was considered expensive and whether we should do some benchmarking and determine if Local Authority funding is available. The review which commenced 18 months ago should be complete by December 13.

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The committee did not extend the contract and asked for an update to include the outcomes from the review to come back to the committee for a decision. Action: An update on the Mental Health User Group Review to come back to a future committee meeting for a decision, once the outcomes of the review were complete

JW

6. ICP Business Case Patient Support for High Risk Groups

6.1 SM presented the ICP Business Case Patient Support for High Risk Groups in network 1, which was not approved at the July committee meeting as year 2 funding was being sought for the pilot to go ahead. The proposal has been brought back to this committee to decide if year 2 funding of £52,800 should be approved by the CCG. It was considered that there is a need for this service as Network 1 is more geographically central, has not previously received innovation funding, has high levels of deprivation and covers a population of 45,000 patients which includes some White City patients. It was suggested to have something built into the service for the provider to upscale the service and if positive feedback is received after 9 months, to roll out to the other networks and procure after a 2-year period. To include a break clause after 9 months, with 6 months’ notice if the service fails to deliver. It was noted that the CCG does not want to set a precedent in having 2-year pilots; guidance is being developed around this. As part of the QIPP process for 14/15 it needs to review the existing portfolio of pilots, determine if they deliver value for money and bring back to this committee for a decision and serve notice on those services that are not working. The committee approved the pilot with a break clause after 9 months and recommended to the Governing Body to approve the year 2 funding. Action: To recommend to the Governing Body to approve year 2 funding of the ICP Business Case Patient Support for High Risk Groups at November’s Governing body meeting

MK

7. Finance

7a Finance and Activity Performance Report Month 5

7.1 CP presented the month 5 report and reported that the CCG is reporting a surplus of £5.3m against a planned surplus of £3.9m, therefore exceeding the planned surplus by £1.385m. The forecast outturn position is £6k better than the planned outturn of £9.9m surplus. The year to date surplus is not carried through into the forecast position because of increased risk in the second half of the year, particularly relating to QIPP delivery, and because it has been assumed that the risk share between the 4 CCGs will need to operate to enable all CCGs to achieve their financial plan. While the overall financial position is in line with budget, the acute contracts are reporting a year to date overspend and £1.2m higher than plan, but overall performance is mitigated by the use of acute reserves and shows an overall variance against plan for acute services of £21k overspend. It was stated that the biggest risk is with over performance in the acute contracts, with £0.5m over performance in Imperial and C&W and £0.2m over performance in UCLH. A small level of risk also remains around maximum take for specialist commissioning in month 5. NHSE has confirmed that that the CCG can anticipate revenue resource limit (RRL) of £4.551m being returned, which will leave a risk of £614k. A further budget of £731k has been identified relating to CAHMS tier 4, which may form part of the specialist commissioning transfer. Opportunities have been identified to mitigate the risks such as contingencies, investment slippage and Imperial bond support to central not being required. The CCG must start to put forward Business Case proposals for GP investment, Winter Pressure Investment and uncommitted reserves to ensure the money is spent this financial year. It was explained that the reserve budget carried forward is not a balanced sheet item, but shows the underline position with £4.5m to spend for next year. The detailed breakdown of activity level data from Imperial (page 17 of the report) shows the variance between what the Trust says it is doing, and what is actually happening. Any large variance against plan would be a concern and the Trust would be asked to explain what is happening. For month 6 the report will also show the

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categories of spent. If the CCG had a referral management system or if referrals were coded correctly on the GP system this would assist in monitoring referrals more effectively. The committee asked if electives are under spent and if outpatient referrals are coming down and to see which specific specialties it relates to. The outpatient procedures adverse variance against plan of 95.5% was discussed, in particular Gynaecology to identify where the activity is being generated from. It was noted that the maternity pathway shows a reduction of 15% in the number of births with a cost variance below plan of 13.9% in line with activity. It was stated that a different counting mechanism has been used this year with a new process in place phased over a 2-year period, with payments based on 1

st attendance.

Actions: To cross reference with the 18 week speciality the YTD cost variance of £381,032 for elective inpatients To review the gynaecology data to ascertain where the activity is being generated To review the huge shift in data for the maternity antenatal pathway at Imperial

CL PJ & BP CL

7b Financial Risk Register

7.2 CP presented the Financial Risk Register, which shows the financial risks identified for H&FCCG and CWHH. It was stated that the significant risks are included in the BAF and if you match the financial risk register with the BAF, you will see similar risks. There are general themes around appropriate financial governance with the right systems in place, with the largest risk around the ledger system. There are national systems that the CCG and NHS have to use, which is badly implemented and makes it difficult to report financially. There is the risk that following transition from the PCTs to new organisations that sufficient budgets might not exist to cover all commissioning obligations. CWHH will also be looking into the risk that anyone in the country can post expenses to another’s books. It was noted that with regard to the allocations for next year, there should be few changes to the numbers in terms of targets. There is great enthusiasm to move to the new targets coming from some parts of NHSE, but this puts a lot of pressure on the CCGs who are losers under the new formula. The CCG is trying to mitigate the impact as far as possible and is feeding back to NHS England that worse than flat cash over the next few years would be hard for the CCG to manage. It was stated that what is included in the plan was not inconsistent with planning flat cash this financial year. It was noted that some of the leads have yet to be identified for some of the risk areas.

7c. Update on the process to reconcile specialist commissioning activity

7.3 CP presented the update on the process to reconcile specialist-commissioning activity and stated that the numbers are similar with no major risks. It is anticipated that the baseline will be signed off with NHSE on Monday week.

8. QIPP Update – month 5

8.1 BP presented the month 5 QIPP forecast update based on SUS data (freeze data for M1, 2 and 3 and flexed data for month 4) and explained that the year to date position for month 5 shows the CCG is reporting a shortfall of £257k (6.2%) against the planned savings of £4.1m. This is due to under delivery on non-electives of £257k and planned care schemes of £238k, which is offset by over performance on prescribing scheme of £202k. The current forecast for the year is to deliver total savings of £9.87m against the plan of £10.54m resulting in a gap of £674k. It was noted that data quality issues have affected the month 5 reporting for NEL schemes, due to changes in the previously frozen month 1 data, which shows an adverse impact of £67k and high levels of NEL activity at Imperial. Feedback is awaited on why the freeze data has changed. The HRG has been reviewed and shows that the NEL activity does not relate to any specific area. From next month we should be able to see what the activity levels and trend look like. CP stated that if the acute contract was signed off we would know what to put in the metrics to deliver the QIPP changes. However, because it is late and we do not know the metrics, it shows under delivery, but this has been flagged up with NHSE. Due to slippage, an additional line has been added to the plan to focus on whether transformation schemes are delivering the over inflated plan. It was reported that the actions around the MSK contract are being implemented over the next four weeks. It was stated that some practices continue to refer their MSK patients to Charing Cross with GPs making clinical

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decisions about where to send their patients and do not wish to use community services and a single point of access. It was stated that Hounslow CCG is using a single point of access; the Referral Management Service and are reporting high figures for Choose and Book. It was reported that the clinical leads for the planned care schemes will be undertaking wider clinical reviews of these schemes and the network co-ordinators will be communicating out messages to their networks on an on-going basis around what the schemes deliver, with regular updates on the weighting times and what the issues are. It was noted that some schemes have small numbers and it was asked what the contract value is for these schemes in comparison to what we would spend in acute. If the schemes are delivering value for money and whether the CCG should continue with these services in 14/15.

9. CCG performance and quality report month 4 – 2013/14

9.1 CL presented the CCG performance and quality report for month 4. It was reported that the CCG is meeting the RTT performance standards overall but not at a specialty level, due to performance at Imperial, C&W and RBH. Action plans are in place to improve the management of 18 week RTT at both Imperial and CW and the service specification for Imperial is being reviewed by the MBI team. It was reported that the 62 day treatment standard for cancer is not being met by Imperial and RBH following urgent referrals in M4 and Imperial are also not meeting the 31 days to treatment standard year to date. Imperial were the lowest in the country for the McMillan Cancer Care Survey but the Trust has agreed to reissue the survey to its patients in October or November. After October for the CCG to look at imposing penalties and contract notices on Imperial. At UCLH problems have been reported with the Trust’s waiting times for cancer. PJ stated that she had raised concerns that the contract has yet to be signed off due to issues with the host organisation, but this issue is being picked up with conversations taking place between the Chief Officer and Camden CCG. For HCAIs, 1 MRSA was reported in M4 by RBH. It was noted that C&W, Imperial and RBH will not meet the “zero tolerance” MRSA requirement for 2013/14. H&FCCG reported 16 C.Diff cases against a tolerance of 10 cases with no cases reported for month 4, with the majority of cases at Imperial but a few reported at C&W. HCAI’s was raised at the last Imperial CQG meeting and is being followed up by the quality team with a report being produced, but does not show any trends. Imperial and RBH are meeting the C.Diff tolerance in M4 but not for year to date. WLMHT has not met the 11% target for DNA follow-ups and 8.1% target for readmission with 30 days. This is being progressed through the Finance and Information Group. It was reported that contract penalties are being applied to all Trusts breaching the national standards with 1 breach at C&W and 2 breaches at RBH, with root cause analyses, exception reports and action plans required from the providers to be discussed at the relevant contractual meetings.

10. Strategic Performance Dashboard

10.1 PT presented the Strategic Performance dashboard, discussed the challenges with Information Governance (IG), the reasons for the absence of information from the CSU for the six areas and the actions being taken to obtain data for the October report. It was explained that issues are being worked through with the CSU around access to information. CP considered that the Data Management Integration Centre (DMIC) is the issue and stated that sharing of information does not break the IG rule. It was reported that all lines are doing okay apart from GP referred for Out-Patient first Attendance (OPFA) to acute which shows it is going the wrong way for three of the networks but is okay for networks 1 and 2. The committee discussed performance to date and agreed that the issue for the networks is the variation between practices, for each networks to receive more detailed schedules to look at the finer detail and practice specific data, determine which practices are performing poorly, report on what actions are being taken and report back to either this committee or to the Network Leadership Group. For the CCG to have an overview and focus on the overall performance. It was stated that the non-elective admissions are being reported on but are not part of the network plan. For the October report, to have the figures reported against the target and not the average.

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Actions: To discuss with the CSU access to information for the strategic dashboard To have the figures reported against the target and not the average

CP PT

11. Any Other Business

11.1 Additional IT Investment to support System One Migration

TS presented the Business Case for additional IT Investment to support System One Migration. Additional investment is being sought following the migration of phase one practices and the lessons learnt in this process. Feedback has highlighted the need to provide responsive support to practices post go live to help with the system being embedding into practices also to provide responsive trouble shooting support to practices. Furthermore, to resolve a medicines management issue with numeric data transfer to free test, which will not allow you to monitor data compliance without changing it manually. There there will also be specific resources available to assist practices with other issues that may arise and to develop templates, which can be built into the plan. The committee were supportive of the proposal, considered it will deliver benefits, was a key strategic priority and will start to address the risks in the business case. However, it was considered that the costs were a little high and that a salaried GP could be brought in to resolve the issues around scripts instead of recruiting specialist support. It was agreed that the costs will be revisited to ensure value for money. The committee recommended the business case for additional IT Investment to support System One Migration to the Governing Body for approval. Action: The business case for additional IT Investment to support System One Migration to be taken to November’s Governing Body meeting for approval

MK

The next meeting is scheduled to take place on Tuesday 29th

October, between 3.00 – 5.30 pm, in St Paul’s Church, Hammersmith

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NHS HAMMERSMITH AND FULHAM CCG OD and Governance Committee Minutes

1.00 - 3.00 Tuesday 24th September 2013

St Pauls Church

Elected Members present:

Name Role Organisation Initials

Vanessa Andreae Practice Nurse member (Chair) HFCCG VA

James Cavanagh GP member HFCCG JC

Rob Jenkins GP member HFCCG RJ Officers present:


Tessa Sandall Deputy Managing Director HFCCG TS

Rachel Stanfield Head of Governance and OD HFCCG RS

Gabrielle Darby Head of Strategic Planning and QIPP HFCCG GD

Gilbert George Board Secretary HFCCG GG

Mariama Mansaray Business Manager (minutes) HFCCG MM Observer:


Michele Davison GP member HFCCG MD

Apologies:


Billy Awan Practice Manager member HFCCG BA

Trish Longdon Lay member HFCCG TL

Item Agenda Item /Discussion

1. Welcome & Apologies

1.1 The Chair led a round of introductions which covered members of the Governing Body and those in attendance. Apologies were received from, Billy Awan and Trish Longdon

2. Minutes of the Previous Meeting

2.1 The committee accepted and approved the minutes of the meeting on Tuesday 27th August 2013.

3. Succession Planning

3.1 3.2 3.3

Rachel Stanfield presented a paper which provided Committee members with an overview of the organisation’s current succession planning issues and proposals for strengthening CCG succession planning in the medium term. The paper set out some immediate succession-related issues to be considered by the OD & Governance Committee which are listed below: Governing Body representation across Committees The OD & Governance Committee supported the following proposed changes:

Zohreen Ashraff and James Cavanagh to replace Nemonique Sam and Clare Graley on the Finance & Performance Committee

Paul Skinner to step down from the Quality, Patient Safety & Risk Committee

Christine Elliott not to be replaced on the OD & Governance Committee

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The Committee also asked for the membership of the IM&T Committee to be reviewed/discussed and included in the paper. ACTION: IM&T Committee membership to be included in paper (RS) Support for clinical leads/Governing Body members The Committee supported the proposal for CCG clinical leads and Governing Body members to be ‘paired up’ or ‘buddied’ with a member of the CCG management team. This arrangement is intended to allow clinical leads and Governing Body members to have a link person with whom they can raise any issues or questions. The Committee approved the suggested pairings outlined in the paper; however members commented that it should be made clear these links are explicitly outside of the formal performance management arrangements. ACTION: Process to be reviewed in 6 months’ time (RS) Collating the outputs of the performance reviews All CCG Governing Body members have been appraised and have discussed their objectives, or have this meeting scheduled. The outputs will be written up by the Chair and Vice Chair and reviewed by the Head of OD & Governance with a view to extracting and documenting identified development needs. Development needs may be specific to individuals or may apply to the Governing Body as a whole. A deadline has been agreed with the Chair and Vice Chair (30 September 2013) and the outputs will be brought to the OD & Governance Committee. The Committee expressed its support for this proposal. ACTION: Bring anonymised outputs of Governing Body performance reviews to a future Committee meeting (RS/MM) Developing Governing Body team working As Governing Body meetings have now moved to a bi-monthly schedule, there is the potential to use parts of Governing Body Seminars as dedicated time for members to provide updates to each other on their main CCG work, enabling an opportunity for the Governing Body to understand where key pieces of work are, understand risks, issues and challenges and support the resolution of these. The OD & Governance Committee supported this proposal and suggested some actions to support implementation, which included: ACTIONS:

Brief template / prompts to be agreed and three or four members of the Governing Body to test the process at the next Seminar (RS)

Fuller template to be developed to support members in providing updates (RS) As the CCG develops its PMO process and programmes of work are agreed for 14/15

updates to be a joint process between the clinical leads and management team (RS) Document and provide information on clinical lead and GB member work areas. (MM/RS)

Terms of service The paper identified the risk to the CCG Governing Body of losing members through the annual (re-) election process. The OD & Governance Committee supported actions to mitigate this risk as follows: setting a date for elections well in advance, asking Governing Body members to communicate their intentions each year well in advance, (over time) using the findings of exit interviews and appraisals to identify the issues that prompt Governing Body members to want to step down and developing a plan to manage these. In addition, the Committee recommended that:

Each Governing Body member should use their individual networks across the CCG in order to promote and support succession planning

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There should be a specific succession plan in place for the position of CCG Chair and Vice-Chair . ACTIONS:

Succession Planning paper to go to Governing Body Seminar for discussion (RS/MM) Updated succession plan to come back to November/December’s OD and Governance

Committee (RS/MM) Consider bringing in expert advice and support on succession planning (RS/TS)

4. Update on OD Plan

4.1 Rachel Stanfield provided the Committee with an update on the development of the CCG’s OD Plan since it was last reviewed by the Committee in April/May 2013. Her update also covered outstanding needs and development areas. The Committee agreed that network leadership group development was still a priority area as it was felt to be increasingly evident that networks required support in a number of areas e.g. how to write business cases. It was also noted that networks are at different stages of development and that there is currently no mechanism for sharing good behaviour or network plans. The Committee also expressed concerns around the LES review and the ability of practices/networks to meet the required timescales. Concerns were also raised about the appropriate level of support the CCG could give to practices as providers. The Committee recommended:

Exploratory discussions take place at the LMC and other similar bodies

The inclusion of a section in the commissioning intentions signalling the way forward for providers

The right level of OD support is provided for networks from a commissioning perspective Action

Develop an action plan for Network Leadership Group development with input from stakeholders and bring back to October’s OD and Governance Committee (RS)

As part of her update Rachel also presented a proposal that on-going OD planning be structured around the NHS England (NHSE) domains for assurance of organisational health and capability, as set out by the NHSE CCG Assurance Framework. The Committee expressed its agreement with this approach.

ACTION: Bring results of proposed Governing Body audit on progress against each of the six assurance domains to November’s OD and Governance Committee

5. Board Assurance Framework - Update

5.1 Following concerns raised at August’s OD & Governance Committee about the generic nature of the BAF and its lack of focus on local risks and controls, Vanessa Andreae met with Ben Westmancott, Director of Compliance (CWHH). Vanessa updated the group on these discussions. In short, due to the necessity for a collaborative perspective the BAF would continue to capture risk at collaborative level; however a local corporate risk register could be developed at CCG level to capture risks not included in the BAF. Vanessa also outlined the process for reviewing and updating the BAF – the BAF will be revised in two month cycles after Governing Body meetings with changes approved by Directors. The new draft will then be considered by CCG and Collaborative committees. Committee comments will then be fed into subsequent Governing Body meetings using a pro forma. The Governing Body will sign off the BAF in its current form as it has been through a process of review via the committees. The Committee expressed its agreement with approach outlined.

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6. HFCCG Corporate Risk Register Development - process

6.1 Gilbert George presented the Committee with an overview of the key risk management documents within the CCG – Risk Management Framework, Risk Management Strategy, Corporate Risk Register and BAF – that would be used to assess and manage risk. Local risk registers will need to tie in with BAF and collaborative and local risk management strategies and frameworks. Rachel Stanfield noted the need to determine what the right type of risk register for the organisation is and how to tie in the various projects in PMO. Committee members also highlighted the importance of ensuring responsibility for ownership of individual risks. Members also recommended that risks logged by each network co-ordinator and the safeguarding committee be included in the Corporate Risk Register and that a formal process for capturing all risks was required. It was also noted that the Corporate Risk Register should capture risks to objectives as opposed to strategic risks. Categorisation of risks was highlighted as key to the development of a Corporate Risk Register by members. ACTIONS:

Corporate Risk Register template to be populated and brought back to OD and Governance Committee prior to going to a Board Seminar. Road test with risks not captured by the BAF. Use matrix produced by NPSA which categorises risks as a starting point

7 Datix – update

7.1 Tessa provided a group with an update proposed the roll out of Datix or similar software. She

informed the Committee that a decision had been taken to use Ulysses as opposed to Datix, however

this will mean a lead in time from 30th

September of 6-8 weeks. A letter to practices is currently being

drafted to inform them of timescales for roll out and the process for them to communicate any

concerns or issues.

The Committee highlighted that there is currently confusion among practices around the

communication/feedback process which will need to be clarified.

ACTION: Include an explanation of what Ulysses is in letter to practices as well as clarifying the

process for roll out and communication of practice concerns (TS)

8 Any other business

8.1 No additional items were raised for discussion.

Next Meeting – Tuesday 29th October Venue: St Pauls Church, Hammersmith

Summary Sheet: Governing Body...Summary Sheet: Governing Body Date Tuesday, 12th November, 2013...

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