Minutes and Action Notes
Network Board Meeting
Thursday 16th December 2010 2- 4 pm
Holiday Inn, 888 Oldham Road,ManchesterM40 2BS
Attendance / InitialsAshish Sukthankar (Chair)
Rob Cookson
Wendy Alam / GUM Consultant, MRI
Director of Operations, LGF
Network Coordinator, GMSHN / AS
RC
WA
Helen Lacey / GUM Consultant, PANHT / HL
Diane Cordwell / Programme Manager, RU Clear, GMSHN / DC
Ranjana Rani / GUM Consultant, NHS T&G / RR
Sarah Stephenson / Project Manager - Commissioning, GMSHN / SS
Asha Kasliwal / Contraceptive Clinical Lead, Manchester PCT / AK
Neil Jenkinson / Director, GMSHN / NJ
Owen Roberts
Sameena Ahmad
Geoff Holliday
Daniel Murphy
Remmy Mukonka
Justine Mellor
Elaine Michel / Contraception Access Manager, NHS NW
GUM Consultant, UHSM
Head of Sexual Health, NHS Salford
Service Manager, GHT
Commonwealth Fellow, GHT
Health Adviser, NHS Trafford
Deputy Director of Public Health, NHS T&G / OR
SA
GH
DM
RM
JM
EMi
Apologies
Eleanor Roaf
Renata Hewart
Emile Morgan
Gundi Kiemle
Vinay Bothra
Laura Roberts
Andrew Turner
Bridget Hughes
Ellen Cooper
Debra Malone / Public Health Consultant, NHS Manchester
Lead Nurse/Service Manager, Bolton PCT
Clinical Lead, Bolton PCT
Cons. Clinical Psychologist, GM West MHT
CCDC, GM HPU
Lead CEO, NHS Manchester
Consultant Virologist, NHS Manchester
Public Health Manager, NHS Manchester
Public Health Specialist, NHS Stockport
Consultant in Public Health, NHS Bolton
Helen Hodgson / Matron, UHSM
Jeni Hirst
Christine Owen / Director of Sexual Health, BHA
Assistant Director of Performance, NHS Northwest
Ed Wilkins
Ben Goorney / HIV Lead, PAT
GU Consultant, NHS Salford
ACTION
044/10 / 1 Introductions
Ash Sukthankar chaired the meeting in the absence of Laura Roberts and Eleanor Roaf.
The group introduced themselves and a visitor seconded from Zambia to GHT was welcomed. It was agreed apologies would be added to the Minutes.
045/10 / 2 Chair’s Communications
None
039/10 / 3 Minutes of meeting held on 17/6/10 and matters arising
Previous minutes were accepted as a true and accurate record.
Action 07/09: Peer-to-peer review of clinical notes. Results will be collated and reported back at the next meeting – on-going
Action 23/09: AS confirmed that the report undertaken by a medical student re the rate ofcomplications from Chlamydia (e.g. PID, ectopic pregnancy) based on hospital coding has been finalised. It showed national rates of ectopic pregnancies per unit population have increased in the past few years but it was unclear whether this was due to the NCSP increasing the number of tests. As Chlamydia screening is a national programme it was felt it should produce national results. It was highlighted that coding in hospitals can be poor and patients may be missed by sub-standard testing which may account for not all ectopics being picked up. AS confirmed there was no direct correlation between global rates of +ve Chlamydia infection vs global rates of complications - completed
Action 04/10: ER on behalf of GMSHN Board to ask DPH group to ensure prevention agenda around sexual health is featured high on their agenda. No response. ER to chase again – completed
Action 10/10: OR to circulate cross-boundary report to Board members - completed / SS/WA
040/10 / 4 Performance
- Unify data
NJ confirmed ‘offered’ was still at 100% across the board, ‘seen’ at 90-91% across Greater Manchester, DNAs reduced and the ratio of new/follow-up patients at 0.4 was excellent. Nationally the NW is the highest performing SHA.
NJ hoped the GUM access target would be kept in the new operating framework as it is an excellent indicator. GH mentioned that in the new operating framework the Chlamydia target is to remain at 35% for next year. NJhighlighted there was discussions on the Chlamydia target based on a positivity target (2.7-3.3% of whole population). DC is awaiting confirmation whether the positivity will be based on national or PCT positivity rates. NJ commented that a new policy document is due out in Spring. SA felt that ‘seen’ rate need refining to take in to account demographic reasons why patients are not seen. NJ agreed that currently it is not particularly well coded but SRHAD is a much better dataset.
- Teenage Pregnancy
- Abortion/Repeat Abortion Rates
041/10 / 5 Public Health White Paper
NJ stated that the White Paper identifies sexual health as a key service within new arrangements and discussed need for integrated services. Sexual Health is seen as part of public health but debate is ongoing as to where HIV fits in but felt it essential that both go hand in hand whichever direction taken.
EMi questioned whether commissioning sexual health will still be at a local level if public healthmoved under the Local Authority. NJ stated that ideally a GM commissioning framework should be ready and able to be adapted to whichever commissioning arrangement is decided upon and although we cannot tell commissioners how it should be done we can give them some direction. To position ourselves as best we can to be ready and to “control our own destiny.” NJ remarked that early indications are that sexual health is moving to public health andmay be overseen by the Health & Well Being Boards. EMi commented that services will be following the money. RR felt the White Paper was not clear and sexual health money should be ring fenced. NJ felt that services would have to move to a tariff for the various levels and the Network will work towards this as the system cannot continue with current tariff arrangements. NJ confirmed that the recently requested baseline study is to help protect/identify and ensure services are not asset stripped under TCS. RC asked for more details regarding the ‘ladder of interventions’ as LGF/GHT fits in within this. NJ stated there were no more details but public health is pushing the ‘nudge’ idea and sexual health could possibly use this concept as an opportunity to deliver part of the strategy. EMi commented that the views of the Government in the public health paper is that it is “down to individuals” to take responsibility for themselves to spend less on treatment/services and people will start associating with alcohol/food industry who are seen as key players in changing behaviour which is a very simplistic view of PH and will be interesting to see the workstreams. NJ stressed that services need to ensure they provide services for more vulnerable groups.
042/10 / 6 Transforming Community Service Update
Nothing further to report
043/10 / 7Feedback from GM Commissioning Leads Meeting
SS informed the meeting that a Commissioners sub-group had met to discuss the future planning of data collection as OR’s post is to cease in April 2011 (see item 044/10 below).
- HIV Commissioning
HIV PBR Tariff Project
National PBR Tariff Group
- TheDH is supporting the ongoing development of an HIV PbR tariff based on their belief that it is consistent both the Operating Framework and the Government’s intentions although they do recognise the capacity limitations. National HIV PbR tariff is planned to be shadowed from April 2011.
- An impact assessment for each PCT and Acute/Foundation Trust is being prepared in order to demonstrate to DoF across the Network the value of collaboratively addressing HIV funding.
- Lack of human resource with appropriate skills remains a problem.
- Nothing to report since the last Board meeting.
- Still trying to audit primary care prescribing in secondary care clinics. Hindered by reduced capacity. North West and national colleagues have asked us to share our methodology.
- Log circulated and no new risks identified:
- The most relevant risks for this month are highlighted in blue (8, 12, 20, 45, 47)
- Risk 43 and 47 (difficulty getting contracting support from NWSCT, NWSCT) have been closed.
NoFOI requests or complaints since last Board meeting. Total number of FOI requests = 2
Complaints
No complaints since last Board meeting. Total number of complaints = 5
2.Other HIV issues
Sperm washing
- Policy is being finalised and is expected to be ready for approval by February.
- This policy has been circulated for comment and ratification subject to any amendments made since its circulation.
- The NW tender for branded drugs has been approved and will be operational from January 2011.
- HIV pharmacists agree that an HIV drug formulary is currently unrealistic.
- An impact assessment is being prepared for each PCT and Acute/Foundation Trust in collaboration with the NWCCA in order to demonstrate the value of home delivery of HIV drugs as they are VAT-exempt (approximately £500,000 VAT saved per annum).
SS stated that contract managers are to calculate those likely to go on home delivery and thus potential cost savings. AS commented that nationally haemophilia products are delivered at homeand patients have no option. HIV clinicians need to encourage patients to use this scheme. DM felt, however, that some people have had drugs delivered to the wrong address which has given the scheme a bad reputation. AS felt that the vast majority did not have problems and SA felt more patients were asking about this service. SS commented that a new patient leaflet for home delivery with amended wording is being trialled with the ‘Smart’ group.
Community and Voluntary Sector (CVS) contracting
f. It is expected this work will have to be put on hold as commissioning support has been unable to be secured.
044/10 / 8 Update
- National monies for improving access to contraception
Final year funding has now been allocated to all PCTs.
Commissioning sub-group has been formed to look at SRHAD and elements which can be picked up in the future, perhaps by the Network. Keen to include cross-boundary data and sub-group will make recommendations to commissioners of which data should be collected.
LARCs next wave out to tender and will proceed when process for £20k has been agreed by Manchester PCT. / OR
045/10 / 9 Greater Manchester Chlamydia Screening Programme
VSI predictions for Q2 were circulated. No PCT is currently predicted to hit target but as a programme overall screening rates have increased over the last year, nearly 3,000 more screens this November compared to November 2009.Positivity rate is approximately 8%. There were 50 requests for postal kits from Salford residents in the 2 hours following the sending out of ‘Invitation to screen’ letters.
DC circulated a draft proposal for dry blood spot testing to increase screening including HIV and syphilis at a competitive cost. RUc would work with the MRI and the HepC strategy. People would be triaged through the RUc website and experienced GU nurse and if high risk signposted to the appropriate service but the Programme would primarily be targeting low risk patients who are reluctant to attend clinics. DC felt the DBS would go someway to answering criticisms that patients sent for example to pharmacies for treatment were missing out on the offer of a full STI screen. DC stated that an invitation from PAG5 to form a sub-group to develop pathways has been circulated and funding from Gilead has been applied for.
Comments from Group
AS asked about the economic advantage of testing/targeting low risk people. DC felt because of the high numbers of HIV late diagnosis and the increasing STI risks for the >40s who will not walk in to clinics and who have had a risk. DC confirmed all concerns will need to be addressed. DC re-assured the group that the triage nurse would be employed by RUc (Sector Coordinators working for RUclear are all GU nurses) and additional training would be provided for results by the team. All requests would be through the website only via a self triage sheet and pathways from that sheet lead to speaking with an advisor if necessary. It is hoped it would encourage those who already access the website to take further tests and it would be aimed at all age ranges. RUc is a strong brand and increasing numbers of people are using the site for information. A pilot study will be undertaken to assess numbers with the cost absorbed by RUc. EMi felt that Chlamydia was viewed very differently to HIV and how likely were people to go through this type of approach. OR however, felt that those people who want Chlamydia & gonorrhoea initially and then want a further test and not have to go elsewhere for it are those that would be interested and it does encourage people to have a full-screen. DC confirmed pharmacies are also to be included and requested volunteers to form a sub-group. HL felt there were two different issues needing consideration (i) the quality should be of MEDFASH standard and people recommended to have HIV/syphilis test and (ii) expanding screening outside GU. AS noted that any suggestions/comments should be sent to DC. / DC
046/10 / 10 Policies & Guidelines
- Neonatal Policy – antenatal maternity care for HIV+ve women and newborns has been circulated to PAG5, the Board and Commissioning Leads and only 3 comments received(i) an appendix is needed to define what a high risk woman is (ii) several paragraphs removing the ambiguity around Septrin information and (iii) a reference to the voluntary sector as a source of funding for formula milk. AS commented that individual clinicians can direct patients to GHT/Barnardos for help but some are more difficult to help and guidelines should therefore state this. DM confirmed that GHT pay for the basic needs of asylum seekers/refugees but that other organisations pay for housing but more and more money is needed to pay for those basics. DM remarked it is a difficult situation as many want to remain “invisible” and outside the system. SS to feed back to the PAG5 group.
047/10 / 11 Emerging Vision for Integrated Sexual Health Services
A confidential paper on the vision for GM Sexual Health Services was distributed and NJ reiterated the need for the Board to ensure the future vision of a modern locally delivered, integrated SH service by multi-trained staff operating to shared care pathways,that a robust governance frameworkis developed and the work needed to facilitate this is outlined. The document included the challenge for the Network in how to make it easier for those with complicated needs to access services closer to their home/work by optimising the use of primary care and more appropriate community settings but emphasising that current arrangements cannot remain the same under TCS, White Papers, QIPP and increasing financial pressures. Aims and objectives, current targets and the necessary data input were described. NJ felt that in relation to modelling options and benefits appraisal that the Board would scoreagainst an agreed set criteria. NJ stated that CaSH clinics with part-time staff working 1 x 3hour session per week are probably not sustainable. Also some Consultants have shown concern about vacancies/recruitment freezes leading to poorer services and perhaps covering the whole GM patch with decreased numbers of Consultants should be scrutinised. NJ felt future hubs should preferably be located within town centres for easier accessibility by patients on public transport but acknowledged that this can not always be the case. One GM IT system, appropriateness of skill mix, increased services out of level 3 and a central booking system (which would also allow walk-ins) were also mentioned. The optimal model would be agreed by the Board and discussed with the future commissioning arrangements e.g. GP consortia. Key enablers would need to be looked at by the whole system and would include HR, Training & Development, IMT and centralised booking. NJ recommended that future Board meetings consider (a) design – commissioning framework; pathways & specifications and (b) delivery – providers/choice/competition/contestability and delivery models e.g. mutuals/ shareholding/social ventures/enterprises/partnerships. NJ stressed that this Government will push these types of services and as a Network we need to protect NHS employees terms & conditions.
Comments from Group
GH felt that estates costs need to be factored in especially where suitable premises cannot be found. NJ commented thatservices’ locations had improved over last the 5 years apart from one area but decent facilities are needed and to consider the cost of LIFT centres. GH felt it essential that if services move to Trusts and the PCTs estate issues not resolved there will be a shortfall over next 2/3 years.
EMi mentioned the very complex London CaSH tariff model and whether it would be rolled out nationally or for trial. NJ understood this was a pilot. In future Commissioners will want to know what they are paying at all levels and the profile and will want to restrict patients reaching level 3 because of cost.NJ agreed this may be better facilitated ifservices are in one provider organisation. SA commented that services in Manchester have a higher proportion of complicated cases compared to other areas of England. AK commented that although Tier 2 nurses were doing screening their role and responsibility was much greater providing governance and training in community settings. NJ felt that the skill mix in larger facilitieswould be more flexible and improve governance and quality.