GOVERNING BODY
Tuesday 8th October 2013
Boardroom, Sedgefield Community Hospital
10.00am – 12.30pm
CONFIRMED MINUTES
Present:Annie Dolphin Lay Chair
Keith TallintireLay Member – Audit and Assurance
Dr Stewart FindlayChief Clinical Officer
Mike TaylorChief Finance and Operating Officer
Dr Dinah RoyDirector of Clinical Quality and Performance
Dr Satinder SangheraClinical Locality Lead – Durham Dales
Dr Helen MooreClinical Locality Lead – Sedgefield
Dr Stephen MuscatClinical Locality Lead – Easington
Peter CarrSecondary Care Clinician
Lynn WilsonPublic Health Consultant Durham County
Council (for Anna Lynch)
Denise ElliottStrategic Commissioning Manager, Durham
County Council (for Lesley Jeavons)
In Attendance:Clair WhiteHead of Corporate Services
Mark PickeringHead of Finance and Performance
Sarah BurnsHead of Planning and Contracting
Sue Humpish (Minutes)Executive Assistant
Fiona DukeLocality Team Administrator
Kirsty Kitching NECS item GB13/134
Apologies:David Taylor-GoobyLay Member – Patient and Public Engagement
Gillian FindleyDirector of Nursing
Joseph ChandyDirector of Primary Care and Engagement
Dr John McGuireSessional GP representative
Anna LynchDirector of Public Health, Durham County Council (Lynn Wilson deputising)
Lesley JeavonsHead of Adult Care, Durham County Council
(Denise Elliott deputising)
ActionGB/13/125 / Apologies for Absence
AD noted apologies and welcomed everybody to the meeting.
GB/13/126 / Declarations of Interest
Those present were reminded that the Declarations of Interest Register was a live document and all members were asked to check the register to ensure their entries were up to date as a matter of routine.
Dr Dinah Roy declared an interest in Enhanced Services when discussed as a matter arising from the minutes of 10 September.
Keith Tallintire declared and interest in Intermediate Care Business Plan during discussions.
GB/13/127 / Identification of any other business
There was no other business identified.
GB/13/128 / Minutes of the meetings held on 2 and 10 September 2013
2 September 2013 (Meeting in Common) – As part of that meeting, it was noted that the quorate Governing Body separately made a decision on the proposals. This was necessary because statutorily CCGs are not able to make decisions jointly. The minutes were agreed as a true record.
10 September 2013 – With a small number of amendments the minutes were agreed as a true record.
GB/13/129 / Matters arising from the meetings held on 2 and 10 September 2013
2 September 2013(Meeting in Common) – AD gave assurance that the issues identified in the Meeting in Common/Governing Body meeting were being taken forward in the oversight group which was attended by AD and JC. She added that the implementation period started on 7 October.
10 September 2013 – DR declared an interest in Enhanced Services and made a suggestion to remove the third bullet of the agreement summary in order that the working group was not restricted in terms of its membership. The conflict of interest issue was covered elsewhere in the agreement summary. It was agreed that this would be removed from the minutes.
ACTION: SH to amend the minutes of 10 September. / SH
GB/13/130 / Review of Action Log
The Action Log was reviewed and amended.
GB/13/131 / Intermediate Care Business Plan Presentation
Maggie Kenny, Peopletoo
Keith Tallintire had declared an interest in this item as he was a director of a social housing provider.
In MK’s absence, SF spoke to the item. It was pointed out that although the Business Case was labelled as strictly confidential, agreement had been given to take it to localities for consultation. It was marked confidential because the financial information was not yet finalised and it was pointed out that it was not a CCG document, but belonged to Peopletoo. For that reason it would not be placed on the CCG website.
It had been noted that intermediate care and other services provided by acute providers had issues which needed addressing and it was agreed that this would be done as a whole from a strategic perspective. A group was set up to do this, consisting of the two CCGs, Durham County Council and County Durham and Darlington Foundation Trust (CDDFT). This had since been expanded to include Darlington CCG and Darlington Council.
An outline Business Case was produced in April 2013 and this was discussed in localities where general agreement was given to the direction of travel. Unfortunately the final document, which was due in September, was not yet complete. MT and his counterparts were meeting to sort out some financial issues and the final Business Case should be ready for the Governing Body meeting in November.
It was hoped that, should the Governing Body agree to the Business Case in November, that implementation would begin immediately around quick wins, despite the formal ‘go live’ date now being December/January.
SF delivered a presentation covering:
- Primary objectives and fit for purpose services;
- Target group and potential cost savings;
- Admissions and discharge data;
- Current and proposed pathways;
- Referrals to RIACT based on new demand analysis;
- Suggested operating model;
- Single point of access phased introduction;
- Financial model.
KT asked if there was an intention to consult with stakeholders, especially around sheltered housing which he would be particularly interested in. AD added that this had been raised previously with Maggie Kenny and she was disappointed that it had not been picked up in the business case.
ACTION: SF to raise with MK.
The Governing Body:
- Received and discussed the latest version of the Business Case;
- Noted that work continued on financial plans;
- Noted that localities would have the opportunity to make comments;
- Noted that a request may be made to confirm financial support for an 18 month period.
GB/13/132 / Review of the Governing Body Terms of Reference – Section 4
Chief Finance and Operating Officer, Mike Taylor
MT spoke to a paper which was written in response to a request from the Governing Body that the description of lay member roles and quoracy be better defined. The amendments were highlighted in the report and colleagues confirmed that they were satisfied with the changes.
KT pointed out that further advice had recently been received from NHS England about making changes to the constitution to reflect,amongst other things, that employees of local authorities should not be shown as voting or non-voting Governing Body members, but shown as ‘in attendance’. The advice had not been received in time to include in this report and as it was a governance issue it was agreed that it would be considered at the next Audit and Assurance meeting.
The Governing Body:
- Considered the proposed revisions to the Terms of Reference and agreed that MT would make amendments as set out in the report;
- Agreed that in future, MT would report annually in March to the Governing Body on any required changes to the constitution after gaining agreement from the Audit and Assurance Committee.
GB/13/133 / Finance Update – Month 5
Chief Finance and Operating Officer, Mike Taylor
Head of Finance and Performance, Mark Pickering
MP presented the report which provided the Governing Body with an update regarding the financial position of DDES CCG as at the end of August 2013. He shared a summary presentation which included:
- Reassurance that the CCG was on track to meet targets in terms of: income and expenditure; capital; cash; Quality, Innovation, Productivity and Prevention, (QIPP); and Better Payment Practice Code (BPPC);
- Year to date variances, including areas of concern;
- Acute Healthcare (including whether patients/drugs were being allocated to the correct commissioner by the main providers);
- Prescribing forecast overspend;
- Forecast Outturn scenarios.
GB members discussed the forecast prescribing overspend of £900k (which could rise to £2m), noting that since the price cap for many drugs had been negotiated, pharmaceutical companies were selling drugs abroad to get a better price. This left UK GPs having to buy from abroad at a higher price to maintain their supply. The situation could have been worse if a lot of work had not been done by localities and practices by having dedicated prescribing leads, incentive schemes, the waste medicines campaign etc. All CCGs had seen an increase in their costs and the Area Team was aware of the situation. This was included in the Risk Register, though MP would check that the wording reflected the specific issues around supply and price cap.
ACTION: MP to check the wording of the Risk Register entry on prescribing to ensure that it reflected specific issues around supply and price cap.
KT suggested that hard data on what was driving this variance would be useful. MP confirmed that work had started on that.
ACTION: MP to report back to the next Governing Body with data on what was driving the prescribing variance.
SS asked about the impact of the Public Health spend that the paper referred to and LW responded that DDES costs would be £0.5m and that Public Health at Durham County Council would pick up this cost.
KT asked whether there were plans on how to address the worst case budget scenarios. MP responded that these were being worked on.
ACTION: KT to talk to MT to obtain information on financial scenarios and obtain assurance for planning to respond to them.
ACTION: MP to report on use of non-recurrent spend for the next meeting. / MP
MP
KT/MT
MP
GB/13/134 / Contract & Performance Update
Joseph Chandy, Director of Primary Care and Engagement
Kirsty Kitching of NECS attended the meeting to present the paper with DR in JC’s absence.
A presentation was shared (included in the papers) with attention being drawn to performance exception reports and key issues including:
- A&E waiting times, cancer waiting times and ambulance response times (recent figures showed that response in the DDES area had increased to 71.51% which could be as a result of the first responders coming on-stream, though detail was awaited);
- DDES CCG had its first MRSA case in September (patient in North Tees transferred to South Tees). This would impact on the quality premium;
- The CCG was within tolerances as far as C.Diff was concerned and this continued to be looked at with the Medicines Optimisation Team;
- Friends and Family Test continued to be a concern for CDDFT, though more widely the number of patient responses needed to be increased across the board.
ACTION: KK to find out what the C. Diff threshold refers to in the presentation and provide clarification to the Governing Body.
AD asked what the mechanisms were for obtaining updates on Healthchecks now that this was a Public Health target. It was noted that these should come through from NECS on dashboards on a monthly basis and be reported as part of primary care performance.
ACTION: DR/KK to obtain Healthchecks information as part of a primary care dashboard to share on a monthly basis with the Governing Body.
SS indicated that there was a need to obtain real time data on take up of flu vaccines in order that patients could be effectively targeted on a timely basis. LW indicated that monthly data should come from the Area Team and recognised that communication in this area was poor. Other organisations e.g. Sainsbury’s were making good progress in this area. SF added that data would be useful for the CCG to support practices that were performing poorly, but pointed out that practices could run their own reports and take positive action.
All agreed that the format and content of the report had improved. However, KT wanted to be able to see improvements in numbers as a result of action plans being put into place. He also wanted assurance that indicators linked specifically to DDES objectives, not just national NHS indicators.
ACTION: DR/KK to provide assurance to the Governing Body that indicators linked specifically to DDES objectives.
The Governing Body:
- Received the report, discussed the exceptions and noted the updates.
KK
DR/KK
DR/KK
GB/13/135 / Risk Management/Assurance Framework Update
Debra Elliott, Senior Governance Manager, NECS
DE spoke to a report, summarising the current risks facing the CCG in the delivery its functions during the current year and Assurance Framework development to date.
The paper gave the Governing Body assurance that risks were being managed appropriately and escalated properly when required. Five risks were highlighted as ‘red’ and DE added that work was being done to try and embed risk updates in the work of the CCG.
SM raised issues of joint commissioning, intermediate care and provision of beds in Easington, and it was agreed that the detail about these issues would be discussed in the next Quality, Finance and Performance group.
AD raised an issue regarding the format of the report, pointing out that it was not possible to read the white writing on pale yellow backgrounds. She also pointed out that data on the prescribing risk (No. 95) seemed to be out of date. MP responded that the report was based on September data and that it would need to be revisited now that the latest data had been received.
ACTION: MP to review risk no. 95 on prescribing to reflect the current situation.
KT pointed out that a large number of risks appeared to remain static, despite efforts to mitigate them. He was keen to see evidence that action was being taken in order to be further assured of appropriate management.
The Governing Body:
- Considered the key risks identified;
- Accepted the assurances that these were being managed appropriately;
- Noted the ongoing development and content of the Assurance Framework.
GB/13/136 / Clinical Quality Update
Dr Dinah Roy, Director of Clinical Quality and Performance
DR spoke to the paper summarising the activity in relation to clinical quality interventions and monitoring processes across DDES CCG and invited questions. It was noted that information from the Clinical Quality Review Group was contained in the Quality and Performance report.
AD asked about progress in producing the new format for reports in this area which were overdue. There was no information about patient experience. DR responded that a significant amount of work had been done with the Performance and Quality Teams to develop this reporting, but a gap in the narrative was still to be addressed. DR had raised this as an issue with NECS and was still not sure how long it would take for the new arrangements to be embedded.
On behalf of the Governing Body, AD expressed frustration at the lack of detailed reporting and the consequential lack of assurance regarding clinical quality.
ACTION: SF would speak to NECS in order to make progress. GF to be involved as lead in this area. The next report to contain more information about and update and proposals.
The Governing Body:
- Discussed the report which was received for information.
GF
GB/13/137 / Chief Clinical Officer Progress Report – September 2013
Stewart Findlay, Chief Clinical Officer
SF spoke to his report updating the Governing Body on key issues affecting DDES CCG. He drew particular attention to two items:
- Health and Wellbeing Board – JC had replaced DR as representative.
- The CCG had been nominated for two categories in the General Practice Awards (Commissioning Team of the Year and Respiratory Team of the Year).
SF responded that JC was aware of his conflicts of interest, though these were not particularly greater than those of DR or SF. He assured KT that there was a framework within which JC operated and therefore the primary care development aspect should not present any additional difficulty.
AD reminded CCG colleagues that as their accountabilities were changing, they would need to update the Declarations of Interest Register and the Who’s Who in DDES information.
ACTION: Directors to reflect changes in their titles and portfolios in the Declarations of Interest Register and ensure that their details were updated in the Who’s Who.
The Governing Body:
- Received the report;
- Noted progress to date.
GB/13/138 / Patient and Public Engagement Update
Clair White, Head of Corporate Services
CW spoke to the report in GF’s absence which provided the Governing Body with a regular monthly update on engagement activities across DDES CCG.
Particular attention was drawn to the menu of paid for activity being worked on with NECS and the DDES CCG website relaunch.
DE pointed out that Durham County Council had its own county-wide publication which DDES CCG could consider using to publicise its activity. CW and SF confirmed that the CCG had already made use of this in the past and that the charges were in the schedule.
AD added that a meeting of the DDES representatives on the Area Action Partnership Boards had taken place on 1 October. She summarised the agreed changes to attendance at the 9 different AAPs and indicated that buddying arrangements had been put in place to ensure that the CCG was always represented as a partner organisation. She asked Clinical Locality Leads to support their Project Leads in prioritising these important meetings.
ACTION: Clinical Locality Leads to support Project Leads in order that they could prioritise AAP meetings in future.
Members of the Governing Body queried progress towards commissioning intentions and planning for 2014/15. MT responded that he had just received a timetable from NECS with apologies for the lateness, which he would share with the Executive Committee and Governing Body. He understood that consultation would take place, not via a large scale event, but through existing meetings such as PRGs and AAPs.
DE, LW and PC left the meeting
SF indicated that organisations had been contacted through Jonathan Wrann, inviting ideas for future commissioning intentions. Some colleagues responded that this had not been done in a comprehensive way and they felt that members of the public preferred to give feedback in a more structured and focused way.
ACTION: Executive Committee to look at the engagement strategy for 2014/15 planning and ensure that patient and public groups are engaged MT/SF to make sure that the commissioning intention packs were sent to appropriate people and if any missing, undertake a mop up exercise.
SBpointed out that there was a Big Tent event taking place on 22 October, arranged by the local authority, where members of the public could submit their suggestions.
SF noted that with the possible future financial position, rather than consulting on commissioning intentions, the CCG were more likely to be talking about how to commission things in a more cost effective way rather than taking forward new ideas.
The Governing Body:
- Noted the activity since the last report.
Locality Leads
MT/SF
GB/13/139 / Call to Action
Joseph Chandy, Director of Primary Care and Engagement
The Governing Body received the paper which shared materials relating to the NHS England national initiative “A Call to Action” and AD asked how this would now be taken forward.
SF responded that the information had been only recently received and the intention of this report was to give the Governing Body early sight of what the CCG would be required to consult on with the public. The CCG would need to consider which forums the information was taken to.
SS indicated that at a recent PRG meeting she had attended, DTG had presented on A Call to Action and people had responded that they were uncomfortable feeding back on their own and would rather do this as a large group.
When AD asked for an engagement plan, MT responded that he had that same day received a copy of the Area Team’s Comms and Engagement Plan for A Call to Action and this was being shared with CCGs in order that they could co-ordinate the way forward as a group.
ACTION: MT to share with the Governing Body the joint CCG plans to engage the public in ‘A Call to Action’.
HM left the meeting
The Governing Body:
- Noted the information from NHS England.
GB/13/140 / Equality Delivery System - Equality Objectives 2013/14
Joseph Chandy, Director of Primary Care and Engagement
The Governing Body was provided with a paper to update on the Equality Delivery System, CCG gradings and action taken by the Executive Committee to approve the Equality Objectives for 2013/14.
The Governing Body:
- Noted the actions taken by the Executive Committee and received assurance on its statutory functions.
GB/13/141 / Minutes to be received
The following confirmed minutes were received and noted:
- Easington Locality Commissioning Board, 15th August;
- Quality, Finance and Performance Group, 27th August;
- Executive Committee, 27th August, 3rd and 17th September;
- Durham Dales Clinical Group, 22nd August;
- Sedgefield Locality Executive Committee, 19th June, 17th July, 21st August.
- Received and noted the content of the minutes.
GB/13/142 / Any other business
There was no other business.
Date and Time of Next Meeting
The next meeting was scheduled to take place in public on 12 November at The Hub, Lambton Road, Ferryhill.
Signed:…………………………………………..