Tuesday, 4 November 2014, 2.15-4.30pm
Ballroom, 58 Princes Gate, London SW7 2PG /
Minutes
Present
Name / Role/ organisation / InitialsDr Fiona Butler / GP member, Chair / FB
Daniel Elkeles / Chief Officer / DE
Louise Proctor / Managing Director / LP
Clare Parker / Chief Financial Officer, Deputy Chief Officer / CP
Simon Tucker / Lay member / ST
Dr Alan Hakim / Secondary Care Consultant / AH
Sonia Richardson / Patient representative / SR
Jonathan Webster / Director of Nursing, Quality & Patient Safety / JW
Dr Puvana Rajakulendran / GP member, Chair of Patient & Public Engagement Committee / PR
Dr Rachael Garner / GP member, Vice Chair, Chair of Quality, Patient Safety & Risk Committee and Commissioning Learning Sets / RG
Yvonne Fraser / Practice Manager representative / YF
Dr Andrew Steeden / GP member / AS
Dr Richard Hooker / GP member / RH
Dr Philip Mackney / GP member (item 4.3 onwards) / PM
In attendance
Name / Role/ organisation / InitialsKerry Doyle / Head of Corporate Services (minutes) / KD
Ben Westmancott / Director of Compliance / BW
Sarah Wheeler / Head of Finance / SW
Ian Boyle / Director of Finance / IB
Jayne Liddle / Assistant Director, Strategy / JL
Dr Mark Spencer / NHS North West London (item 4.4) / MS
Dr John Hutchins / Consultant Paediatrician, Ealing (item 4.4) / JH
Adèle Yemm / Project Lead, Community Independence Service (item 4.5) / AY
Apologies
Name / Role/ organisation / InitialsDr Shazid Karim / Salaried GP member (job share) / SK
Dr Naomi Katz / GP member, Vice Chair / NK
Philip Young / Lay member / PY
Simon Hope / Deputy Managing Director / SH
Note regarding agenda
The agenda items were taken in the following order:1; 2; 3; 4.1; 4.2; 4.3; 4.5; 4.4; 5; 6; 7; 8
Item / Action
1 / Introduction
1.1 / Welcome and apologies
The Chair welcomed members, attendees and members of the public to the meeting.
Apologies were noted as above.
1.2 / Declarations of Interest
It was noted that Governing Body members who were partners or employees in practices would have an interest in items 4.1 and 4.3.
2 / Minutes of the previous meeting
2.1 / Minutes of the meeting held on 16 September 2014
The minutes were agreed to be an accurate record of the meeting.
2.2 / Action log
The Governing Body reviewed the action log and noted that there were no actions outstanding.
2.3 / Matters arising
There were no matters arising.
3 / Reports from the Chair and the Chief Officer
3.1 / Chair
The Chair gave a verbal update to the Governing Body.
Care Quality Commission (CQC): inspection of Chelsea & Westminster Hospital
The Chair advised the Governing Body that the CQC report was now in the public domain and that West London CCG, as the lead commissioner, was working closely with the Trust to respond to the report’s recommendations and findings, which gave an overall rating of ‘requires improvement’.
It was noted that the hospital was a good hospital, and that the CCG should have confidence that the Trust could respond to the report’s recommendations and produce an action plan by the end of November 2014. The Governing Body was advised that consistency in applying process had been noted as an area for development.
The Governing Body supported the collaborative approach to working with the hospital, and noted that there would be a joint session with the Chelsea & Westminster team to develop the response to the report.
Care Quality Commission (CQC): Practice Visits
The Governing Body noted thatthe Care Quality Commission had visited 16 practices in Kensington & Chelsea as part of the pilot project for practice visits. The Governing Body noted that these were the only practices in North West London to participate in the pilot, and that the outputs would inform how the CQC would develop its site visits and support shared learning across the CCG.
It was confirmed that reports were available from the CQC website, and that all practices, including the pilot sites, would be visitedover the next three years.
Governing Body membership
The Chair informed the Governing Body that the salaried GP representative, Dr Shazid Karim, would be stepping down from the Governing Body at the end of December 2014 to take on a partnership at a practice in another CCG. The Governing Body thanked Dr Karim for his contribution and wished him well for the future.
The Interim Director of Finance, Ian Boyle, was thanked for his support whilst in the role, which ended at the close of November 2014. The Governing Body thanked him for his work to support the CCG and the Finance & Performance Committee.
The Governing Body noted that the Chief Officer, Daniel Elkeles, would be taking on a new role as Chief Executive of Epsom St Helier University Hospitals NHS Trust, and thanked him for his leadership of the CCGs and the Shaping a Healthier Future programme. It was noted that the recruitment process was underway, and that a successor would be appointed with input from the Governing Body.
The Governing Body noted the report.
3.2 / Chief Officer
The Chief Officer presented the report.
Commissioning Support Services
The Governing Body was advised that commissioning support services had been brought in-house, and new colleagues were welcomed to the CCG.
NHS five year forward view
It was noted that NHS England had published the document, which set out a vision for the future of the NHS, on 23 October 2014. The Governing Body was informed that the purpose of the document was todescribe why change was needed, what change might look like and how it could be achieved, including actions at local and national level.
The Governing Body considered how the forward view would affect NHS commissioning, and noted that it may have greater impact on providers in the NHS. The potential for primary care federations to support these changes through providing more services closer to home was noted.
Patient experienceand Better Care Fund
The Chief Officer advised the meeting that a project steering group to oversee the patient experience and self-management projecthad been established. It was confirmed that funding had been allocated to support organisations to ensure maximum engagement with users and to ensure on-going support for other Better Care Fund work streams if required.
Contracting
It was confirmed that the collaboration of North West London CCGs has given notice to providers of intended changes to the services being commissioned from them for 2015-16.
Hammersmith Hospital and Central Middlesex Hospital A&E closures
The Governing Body was advised that the closures of the two A&E units went ahead as planned on 10 September 2014. It was confirmed that 24 hour urgent care centres were in operation on those sites.
London North West Healthcare NHS Trust
It was confirmed that on 1 October, Ealing Hospital NHS Trust and The North West London Hospitals NHS Trust merged to form London North West Healthcare NHS Trust (LNWHT), covering:
-Central Middlesex Hospital;
-Community services across Brent, Ealing and Harrow, including Clayponds Rehabilitation Hospital;
-Meadow House Hospice, Denham Unit and Willesden Centre;
-Ealing Hospital;
-Northwick Park Hospital; and
-St Mark’s Hospital.
Macmillan patient experience league table
The Governing Body was advised that Macmillan had published its 2014 patient experience league table of trusts in England, and noted that the results showed that Imperial College Healthcare NHS Trust was the third worst performing trust. The Governing Body welcomed that the Trust was also in the top 15 most improved trusts in the country.
The Governing Body noted the report.
4 / Achieving strategic objectives
4.1 / Out of Hospital Services (OOHS) Business Case
The Deputy Chief Officer presented the report.
The Governing Body was informed that the business case to invest in out of hospital services through primary care federations had been scrutinised by the Finance & Performance Committee, and that the Committee’s recommendations had been included in the paper.
The consistent approach across the five CCGs was discussed, and the Governing Body welcomed increased lay member participation in the Investment Committee, where potential conflicts of interest were discussed.
The Governing Body noted that healthcare cost pressures would increase in future years, and that prices in the business case were the same or lower than in acute hospitals. It was confirmed that savings could be made by reducing spend on services in the acute sector.
Implementationof the Out of Hospital Strategy was discussed, and theGoverning Body welcomed the development of the services. Implications for primary care providers were considered,and it was confirmed that clinicians and representatives from London Medical Committees were involved in developing the tariff. The importance of ensuring that the process set a fair price for both primary care providers and the taxpayer was noted. National development of these services was considered, and the Governing Bodywas advised that there was no national tariff for these services.
It was confirmed that specifications for the enhanced access service were being developed.
The Governing Body discussed how to implement the services, and some expressed concern at the affordability for a number of primary care practices. The Chair advised that there would be a review after six months to ensure a fair price had been set.
Supporting delivery of services was considered, and the Governing Body was advised that primary care federations would decide the number of sites where services could be accessed, and how services would be delivered.
The Chair thanked the team for their work.
Recognising some concerns, overall the Governing Body:
-Agreed that the increase in Out of Hospital (OOH) service costs was affordable on the basis that notice was given to acute contracts, enabling the investment to be used for the OOH services;
-Agreed that practice transitional funding would be required in 15/16.
4.2 / Contracting intentions 2015/16
The Managing Director presented the report.
The Governing Body was advised that a draft document had been presented to the last meeting in September 2014, and that the final Contracting Intentions were circulated to providers on 30 September 2014. It was noted that the document outlined how the CCG’s plans would impact providers in the next financial year.
Using contracting intentions to support implementation of strategic programmes, such as Whole Systems and Shaping a Healthier Future were considered. The Governing Body welcomed the CCG’s ambition to deliver seamless, integrated care outside of hospital settings where appropriate. This will enable the CCG to improve quality of care while responding to a challenging QIPP plan.
It was noted that CQUINs (Commissioning for Quality and Innovation) supported integrated IT and improving information flow between hospitals and practices.
The Governing Body thanked the team for their work, including significant patient, public and member input to inform the Contracting Intentions.
The Governing Body noted the final Contracting Intentions for 2015/16.
4.3 / Primary Care Co-Commissioning
The Chair presented the report.
The Governing Body noted that work had been undertaken across North West London to develop proposals for co-commissioning with NHS England, including securing input from London Medical Committees.
It was noted that the proposals had been discussed previously with the Governing Body and presented at the plenary meeting on 21 October, where members had agreed that:
-Primary care co-commissioning would support the achievement of local visions for whole systems integrated care with general practice at its core by allowing local clinicians to have more influence over the commissioning of primary care services;
-The proposals to date reflected a sound approach to maximising the anticipated benefits and minimising the risks of primary care co-commissioning;
-West London CCG would, jointly with the other seven CCGs in North West London, enter into a shadow joint commissioning partnership with NHS England in November 2014, in a ‘Joint Committee’;
-In this arrangement, all decisions would continue to be ratified by the CCG and NHS England.
Using co-commissioning to support member practices was discussed, and the Governing Body noted that the arrangements would not include performance managing primary care contracts.
The Governing Body considered how the establishmentagreement would support agreement amongst three or more parties and preventing conflicts of interest, and it was noted that more explicit text was being developed, including lay representation and input. It was observed that the shadow period would test how the arrangements worked.
It was noted that since the papers were circulated to the Governing Body, national guidance on preventing conflict and grievances, and supporting resolution had been issued.
The Governing Body:
-Noted and endorsed members’ support of the recommendations made at the plenary meeting on 21 October;
-Agreed that continuing to explore options for co-commissioning would enable North West London to shape the process to meet specific local priorities;
-Noted that the Establishment Agreement set out how a shadow Joint Committee would function;
-Recognised that no formal changes to decision making were possible without a constitutional change that would require a mandate from CCG GP members;
-Noted that ‘go-live’ for fully established arrangements was anticipated to be April 2015; and
-Agreed to support the resulting requirement to engage further with GP members over the coming months.
4.4 / Planned transition of maternity, inpatient paediatrics and inpatient gynaecology services from Ealing Hospital
The Governing Body welcomed clinicians from North WestLondon, who presented the case for change in maternity services.
It was noted that there was an increasing number of women with complex healthcare needs during pregnancy, requiring increased consultant presence in obstetrics in order to reduce maternal mortality and poor outcomes. The Governing Body was advised that this could be achieved by consolidating maternity services on a smaller number of sites, with more consultant cover.
It was noted that the Quality, Patient Safety & Risk Committee had scrutinised the proposals previously.
The potential impact on patients was considered, and the Governing Body was advised that few patients in the CCG would be affected by the transition at Ealing. It was confirmed that midwives would be moved to services where there were more deliveries.
The Governing Body noted that there would be a change in flow of paediatric patients from Ealing to other hospitals. It was confirmed that non-emergency paediatric services would remain in Ealing. The potential for CCGs to be asked to support changes in staffing and estates was considered.
The Governing Body formally delegated the authority to Ealing CCG Governing Body to undertake on its behalf:
-The decision on when the maternity unit operating on the Ealing Hospital site should close, in accordance with the decisions of the Secretary of State for Health in October 2013, based upon the expectation that this closure would occur in early 2015 or as soon thereafter as possible.
-Decisions about the move and timing of any other necessary, clinically interdependent service changes resulting from this decision, based upon the expectation that this is in early 2015 or as soon thereafter as possible.
The Governing Body requested that the Chair, CCG Accountable Officer and the Chair of the Quality, Patient Safety & Risk Committee would advise the Governing Body if any major/significantunforeseen clinical or other issue arose.
4.5 / Integrated Community Independence Service Financial Model
The Project Lead, Community Independence Service, presented the report.
It was noted that the model had been discussed at the previous Governing Body meeting and theFinance & Performance Committee meeting in October 2014.
The Governing Body was advised that the model had been developed with the assumption that community care would be more cost-effective and better for patients than care provided in hospitals and care homes. Impact on delivery of services for patients was considered, and the Governing Body noted that this would have a positive impact on patient care in care homes, as well as palliative care provision.
It was noted that benefits included:
-Reducing A&E attendance;
-Reducing non-elective admissions;
-Entering care homes/ end of life care later.
Financial impact was considered, and the Governing Body was informed that modelling of the new integrated service predicted net benefits of £2.97m in 2015/16.
The Governing Body discussed how to take the proposals forward, and was advised that next steps includedreviewing existing contracts and services, recruiting a clinical lead, patient representation, and then interviewing potential providers.