Nhs Durham Dales, Easington and Sedgefield

NHS DURHAM DALES, EASINGTON AND SEDGEFIELD

CLINICAL COMMISSIONING GROUP

GOVERNING BODY

14 MAY 2013

CONFIRMED MINUTES

Present:Annie DolphinLay Chair (Chair)

Keith TallintireLay Member, Audit & Assurance

Dr Stewart FindlayChief Clinical Officer

Gillian FindleyDirector of Nursing

Mike TaylorChief Finance & Operating Officer

Dr John McGuireSessional GP representative

Dr Stephen MuscatEasington Locality GP Lead

Anna Lynch Director of Public Health Durham County Council

Denise ElliottStrategic Commissioning Manager

Durham County Council

David Taylor-GoobyLay Member, Patient and Public

Involvement

Mark Pickering Head of Finance and Performance

Peter CarrSecondary Care Clinician

Dr Satinder SangheraDurham Dales Locality GP Lead

Joseph ChandyDirector of Performance & Information

In attendance:Lyndsey Jones-GeorgeGoverning Body Administrator

Deborah PerryCorporate Administrator

Deborah WardPlanning and Performance Manager,

NHS County Durham and Darlington (item 37)

Clair WhiteHead of Corporate Services

Apologies for absence
Apologies were received from Dr Dinah Roy andDr Helen Moore; Lesley Jeavonswas represented by Denise Elliott.
Annie Dolphin (AD) gave an introduction to the governing body and explained that this was the first meeting in public since becoming a statutory organisation on 1st April 2013. AD thanked the public for attending the meeting to observe how Durham Dales, Easington and Sedgefield Clinical Commissioning Group (DDES CCG) Governing Body (GB) handle their business.
AD said that as this was a meeting in public there would not be an opportunity for public participation during the formal part of the meeting but there would be the opportunity for informal discussions with GB members during the break and after the meeting.
GB members introduced themselves and the members of the governing body and the public made no objections when they were asked if pictures could be taken and used for CCG publications and on the website.
AD explained that after the action log review there would be 30 minutes set aside for a presentation by members of the Spennymoor Youth Forum, summarising an event that had taken place in Spennymoor Town Hall several weeks previously. This involved schools and the Youth Forum and focused on health issues. / Action
DDES-GB/13/21 / Declarations of Interest
SF declared a specific conflict of interest in respect of the Durham Dales Nursing Home Servicementioned in item GB/13/12 as his practice had previously provided this service.
Register of Interest
The register included in the papers had been updated and an amended version was tabled. The GB was asked to note that the register is a live document and needs to be updated at least on a monthly basis and as changes arose each individual was responsible for ensuring that the changes were reflected in the register. AD asked all members to check their entry to ensure that it reflected potential conflicts with their governing body roles and to notify changes as appropriate.
Action –GB members to ensure that the register is up to date and that any new items or amendments are sent to LJG. The register will be uploaded on to the website after each GB meeting. / All GB Members
DDES-GB/13/22 / Identification of any other business items
No additional items of business were identified.
DDES-GB/13/23 / Minutes of the Durham Dales, Easington and Sedgefield (DDES) Clinical Commissioning Group (CCG) governing body held on 9 April 2013
The minutes were agreed subject to 2 minor amendments:
GB/13/10, page 5. This should read North of England Commissioning Support (NECS).
GB/13/11, page 6. Gareth Chin is the CCG Cluster clinical lead for 111. Gillian Findley is the DDES CCG Director lead for 111.
DDES-GB/13/24 / Matters arising from the minutes of the DDES CCG governing body held 9 April 2013
They were no matters raised.
DDES-GB/13/25 / Action Log
The action log was updated and actions noted.
DDES-GB/13/26 / Spennymoor Young Peoples’engagement event
David Taylor-Gooby-Lay member, Patient & Public Involvement
WendyMinhinnett – SuccessNorth East
David Taylor-Gooby (DTG)introduced this item by summarising DDES CCG’s aimtokeepthe public upto date with what is happening and to be as transparent as possible. DTG arranged the event with Wendy Minhinnett as a result of speaking to her at anArea Action Partnership (AAP) meeting. Wendy is organiser for Success a community interest company which received funding from the Spennymoor AAP. This NHS event brought together the young people’s forum and the youth council to look at health and to capture the thoughts and views of the young. Dr Helen Moore and Annie Dolphin attended and also 4 older people who shared their experiences and views with the young people.
Wendy had prepared a report of the event and four of the young people involved attended the GB to present their findings in a presentation that was based on the report. This provided an overview of the engagement with the different generations, summarised the areas of health that the event looked at and the conclusions that were reached. These had been put together in a report which is now available on the CCG website.
As there was time available and it had been such an interesting presentation AD invited members of the public to participate in the follow up comments and questions. GB members thanked and congratulated the young people on their excellent and very interesting presentation. They were impressed with their knowledge and understanding of health issues and it was particularly good to hear the views of young people.
SF asked what communication medium would influence them most, where would they prefer to see/receive updates or information in connection with health. It was agreed that an application for smart phones was the preferred option and any social media site was the better way to link with the younger generation.
Anna Lynch said that it was thought provoking and that she would now look at a closer joint working model with young people when commissioning services for the elderly, there are several projects ongoing currently which will be reviewed to ensure that joint working approach.
Tony Cooke,a member of the public, mentioneda report that he is currently compiling and that he would like to incorporate the information from the presentation. It was agreed that the report and the presentation would be made available on the DDES website.
Action – LJG to ensure that this information is put on the website for public access / LJG
DDES-GB/13/27 / Ratification – Terms of Reference of Remuneration Committee
Chief Finance and Operating Officer - Mike Taylor
The report presented the terms of reference considered and agreed by the committee at its first meeting following authorisation. The previous terms of reference for the Remuneration and Terms of Services Committee that had previously been included with the CCG Constitution had been reviewed in the light of current guidance. The discussion also concentrated on membership and quoracy with confirmation that non-officer governing body members, not just lay members,would be required to attend if necessarywhere there were potential conflicts of interest. The amended terms of reference covered these issues.
The governing body approved the amended Remuneration Committee terms of reference.
CLINICAL QUALITY
DDES-GB/13/28 / Clinical Quality Summary Report
Director of Nursing- Gillian Findley
The purpose of the report was to provide DDES CCG with a monthly briefing of the headline issues relating to clinical quality with assurance that actions are being undertaken with providers where necessary. This report covered all information and issues received in March 2013.
The governing body was asked to note that information received from providers still relates to County Durham Primary Care Trust (CDPCT). It is expected that this will have been resolved in quarter one, and the next report to the governing body will be a live report.
The report highlighted the 111 and NEAS services: 111 serious incidents and the 111 and NEAS quality review mechanisms that were being developed.
Discharge issues still remain a common theme and the Clinical Quality Review Group (CQRG) are working with County Durham and Darlington Foundation Trust (CDDFT)and other providers on these issues.
C Difficile – DDES CCG’smain provider is CDDFT and they failed to hit the target last year, as did County Durham PCT. Work continues on improving performance against this increasingly challenging target.
PALS and Primary Care complaints –as noted in the report verbal and written primary care complaints were now directed to the NHS England Customer contact Centre in Redditch where decisions would be made about where the complaint should be handled. The Patient, Advice & Liaison Service (PALS) remains within the secondary care provider setting, but there is now no service for primary care which still remains an issue. Certain signposting elements of the previous PCT function are being picked up by HealthWatch and other primary care concerns will be directed to the NHSE contact centre.
SSinformed members that she is currently working with the Head of Diagnostics from CDDFT around inappropriate prescribing of antibiotics within Urgent Care Centres, and has asked CDDFT to compile an audit on this. This work is currently ongoing.
AD highlighted that Easington, who have the largest population, have a low rate of incident reporting. JCconfirmed that this is being addressed at a locality level and JF explained to the public that a higher level of reporting was to be encouraged as it showed that there was awareness of incidents and steps could then be taken to improve things.
AD referred to the section on acute and community services that said that quality reports were received quarterly. The Francis 2 report had a requirement for up to date and timely information and she asked for assurance about the active dialoguethat took place with CDDFT about this. GF responded that more active systems are needed but that any serious incident report is dealt with within 24hours through the North of England Commissioning Support (NECS) team, who highlight these to the CCGs. It was highlighted that positive and negative reporting also takes place in order that lessons can be learned and services improved.
Meetings have been set up with providers to look at the clinical risks arising from improvement plans aimed at generating savings which will require joint sign off from the Directors of Nursing and Finance. This will provide increased assurance about the impact of cost improvement plans on the quality of services.
The governing body noted and discussed the content of the summary report, and supported the actions being taken forward through the CQRG to improve quality and experience for patients.
DDES-GB/13/29 / CQUIN Update
Director of Nursing- Gillian Findley
The purpose of the report was to update the governing body on the CQUIN schemes between the CCG and providers for the 2013/14 financial year. The negotiations of the final schemes and financial weightings have been determined by the contract management groups and the CQUIN sub-groups with providers, as detailed in the Contract Mandate Process. A position statement on the 2012/13 CQUIN schemes was also included in the papers.
GF updated the governing body on CQUIN and how it relates to quality and innovation. 2.5% of the budget is given toquality and innovative schemes, which will include those from providers and hospices etc. This enables and encourages them to achieve certain standards. DDES are still waiting to see how this year’s schemes will be measured. Work is ongoing for 2013/14 and work for 2014/15 schemes has already begun.
DTG asked how successful the friends and family test patient survey was. Response rates are poor because they arecompleted in an A&E setting when a patient’s interest is focused elsewhere. It was suggested that a joined up approach with all organisations involved in an episode of care might be a better way of measuring effectiveness and of achieving more meaningful feedback.
The appropriateness of having an ambulance service incentive scheme when the service was not meeting the basic targets in DDES was discussed. GF explained that there are six elements of the CQUIN scheme for NEAS. One element is around ‘see and treat’ on scene so that patients avoid admission, and another around tackling issues for patients who wait a long time for transport. These all contribute to a better service and are innovative quality improvement schemes that are aimed at changing the traditional ways of doing things that should lead to a better service overall.
It was highlighted that the CCG we can do more work this year with CQUIN, that all indicators are linked to patient experience and can be used as an opportunity to integrate quality into contracts, working with our partners to influence providers. Penalties are not always the best way of achieving improvement, taking money away can destabilise services. Instead CCGs need moreincentives and joined up ways of working.
The governing body noted the content of the summary report and the position for the 2012/13 scheme. The GB also received the summary of the final schemes for information, supported the monitoring of the 2013/14 scheme and supported the development, consultation, negotiation, monitoring and approval of the 2014/15 CQUIN schemes, that would be considered in detail by the Executive Committee.
DDES-GB/13/30 / Independent Contractor Performance Triage Group
Director of Clinical Quality and Primary Care Development Locality Link Director – Sedgefield- Dr Dinah Roy
Stewart Findlay reported in Dinah Roy absence
The purpose of the report was to highlight to the governing body that General Practitioners are responsible for complying with the relevant standards set by their regulatory or professional bodies (e.g. the GMC’s good medical practice) and contract requirements and duties in accordance with the Performers List Regulations. A breach of such standards, contract or regulations might indicate a performance concern, which may be dealt with through this policy and procedure, independent of any action taken by the regulatory or professional body concerned. In such cases, performance concerns will be investigated fairly using a supportive approach with appropriate steps being taken to address the issues and prevent a recurrence.
As a CCG, DDES is responsible for any performance concerns that come to its attentionfrom its GP practices and staff, and theNHS England Area Team(AT) is responsible for contracts and professional performance issues. It was recommended thatthe threecluster CCGs set up a joint triage group to look at any concerns that arise such as complaints, prescribing issues, etc. and the group will make an informed decision based on an agreed process about what should happen. DDES is setting up a Quality Information Scheme (QIS) which will collate information from a number of different sources such as dashboards, RAIDR on referral rates and pick up issues from GPs, nursing colleagues etc. Any concerns that arise from this will be dealt with in accordance with the policy and may not necessarily be escalated to the AT for further investigation. There is a filter process that highlights which issues need to be escalated.
It was noted there was potential for conflicts of interest between GP commissioner and provider roles within the process and that the joint triage process gave assurance about impartiality. The policy has approval from NHS England and the other CCGs invoved.
KT queried why there was no lay member on the triage group as the previous PCT group did have lay presence. SF explained that the CCG triage group was the front part of the process rather than the end product. The clinical advisors who independently investigate appropriate concerns are now part of the Area Team. When concerns are referred on to the Area Team where formal action is needed the final part of the process is a performance panel which has an independent lay chair.
The governing body approved the Local Policy and Procedures for Management of General Practitioner Performance Concerns.
DELIVERY
DDES-GB/13/31 / Clinical Chief Officer Progress Report
Chief Clinical Officer - Dr Stewart Findley
The report provided an update on national policy and summarised the progress the CCG has made over the previous month.
The end of the last financial year has been an extremely busy time with the main focus being on finalising contracts with our provider organisations. The CCG has now reached agreement with all providers and apart from NEAS all have agreed to a block contract this year. This gives financial certainty over this first year of clinical commissioning and removes financial disincentives that, in the past, have prevented working together and created a barrier to moving services into community settings.