Item 11.1
PLANNING AND COMMISSIONING COMMITTEE
MINUTES OF THE MEETING HELD ON WEDNESDAY 5 OCTOBER 2016,THE BOARD ROOM, WILBERFORCE COURT, ALFRED GELDER STREET, HULL, HU1 1UY
PRESENT:
J Parker, GP, NHS Hull CCG (Clinical Member) Chair
P Jackson, NHS Hull CCG (Lay Member / Vice Chair)
R Raghunath NHS Hull CCG,(Clinical Member)
A Oehring NHS Hull CCG,(Clinical Member)
B Dawson, NHS Hull CCG, (Head of Children, Young People & Maternity)
J Dodson, NHS Hull CCG, (Deputy Chief –Procurement/BI/Resources)
K Ellis, NHS Hull CCG, (Deputy Director of Commissioning)
C Robinson NHS Hull CCG,(Practice Manager Representative)
M Bradbury, NHS Hull CCG (Head of Vulnerable People Commissioning)
T Fielding, Hull City Council, (City Manager Integrated Public Health Commissioning)
S Lee, NHS Hull CCG (Head of Communications and Engagement)
D Storr, NHS Hull CCG (Deputy Chief Finance Officer)
IN ATTENDANCE:
G McNally, NECS (Strategic Lead Pharmacist)
Liz Lyle NECS (Locality Pharmacist for Hull)- For items 7.4, 7.57.6, 7.7, 7.8, 7.9
A Daniels, NHS Hull, (Commissioning Lead Children and Young People)
D Robinson, NHS Hull CCG, (Personal Assistant)
1.APOLOGIES FOR ABSENCE:
E Daley, NHS Hull CCG (Director of Integrated Commissioning)
P Davis, NHS Hull CCG, (Head of Primary Care)
K Billany, NHS Hull CCG, (Head of Acute Care)
K Martin, NHS Hull CCG (Head of Quality Clinical Governance/Deputy Nurse)
2.MINUTES OF THE LAST MEETING
The minutes of themeeting on 7 September 2016 were submitted for approval.
Resolved
(a) / The minutes of the meeting held on 7 September 2016 be taken as a true and accurate record.3.MATTERS ARISING FROM THE MEETING – 7 SEPTEMBER 2016
The Action List from the meeting held on 7 September 2016 was considered. All actions were reported on, a number of which were now complete and would be removed from the list, and the following updates were provided against remaining actions:
03.08.16
7.1
It was stated by the City Manager for Integrated Public Health Commissioning that the report on health checks was awaiting final approval and would be provided at the November 2016 Committee.The status of action would be changed to ‘Ongoing’.
03.08.16
7.4
It was stated that information was still awaited from the Consultants at Hull and East Yorkshire Hospital Trust (HEYHT) on the use of lidocaine patches. The status of action would be changed to ‘Ongoing’.
07.09.16
7.4
It was stated that Somatostatin Analogues had now been removedfrom the shared care framework. The status of action would be changed to ‘Completed’.
4. NOTIFICATION OF ANY OTHER BUSINESS
Any proposed items to be taken underAnyOtherBusinessmustberaisedand,subsequentlyapproved,atleast24 hours inadvance ofthemeetingbytheChair.
Resolved
(a) / There were no items of any other business to be discussed at this meeting.5. DECLARATIONS OF INTEREST
In relation to any item on the agenda of the meeting members were reminded of the need to declare:
(a)any interests which were relevant or material to the CCG;
(ii)any changes in interest previously declared; or
(iii)any pecuniary interest (direct or indirect) on any item on the agenda.
Any declaration of interest should be brought to the attention of the Chair in advance of the meeting or as soon as they become apparent in the meeting. For any interest declared the minutes of the meeting must record:
(a)the name of the person declaring the interest;
(ii)the agenda number item number to which the interest relates;
(iii)the nature of the interest and the Action taken
(iv)be declared under this section and at the top of the agenda item which it relates too;
Name / Agenda No / Nature of Interest / Action TakenAmy Oehring / 8.1 / Direct Pecuniary Interest – GP Partner at Sutton Manor Surgery
Raghu Raghunath / 8.1 / Direct Pecuniary Interest – GP Partner at James Alexander Family Practice
Resolved
(a) / Planning and Commissioning Committed noted the above declarations of interest.6. GOVERNANCE ITEMS
6.1REBATE PROPOSAL FOR NHS SUPPLY CHAIN
The Chief Finance Officer presented a report which outlined a proposed NHS Supply Chain rebate from Ontex for member’s approval.
Ontex (UK) Ltd was a supplier of continence products and, during 2015-16, supplied approximately 97% of the continence products issued to Hull service users.
In recognition of the anticipated projected volumes of continence products from Ontex in 2016-17; Ontex were offering, through NHS Supply Chain, a 3.5% rebate to the CCG in respect of the products to be supplied in 2016-17.
The rebate would be awarded in consideration of 90% of Ontex products being supplied to NHS Hull CCG service users for 12 months commencing 1 May 2016 to 30 April 2017.
Resolved
(a) / Members of the Planning and Commissioning Committee approved the Ontex rebate.6.2 FUTURE MEETINGS
Discussion took place regarding the start time and length of future Planning and Commissioning Committee meetings. It was agreed that the start time would remain at 1.00pm with the caveat that finishing times would fluctuate as required.
Resolved
(a) / Members of the Planning and Commissioning Committee noted the discussion.7.STRATEGY
7.1PUBLIC HEALTH WORK PLAN
The City Manager for Integrated Public Health Commissioning updated the Committee on the progress of the Public Health programme of work.
It was noted that the report incorporating GP health checks was awaiting final approval and would be provided at the November 2016 Committee.
It was stated that Fluoridation work was progressing well. A desktop feasibility exercise had been undertaken. A report had been produced which was being reviewed by the Chair of the Health and Wellbeing Board (HWBB), this would then be presented at a future H&WBB.
It was noted that there would be staff movement within Hull City Council (HCC) that would affect Public Health colleagues after the resent VE scheme. It was stated that no Public Health posts were being removed from the structure and changes would only occur if appropriate cover was in place.
It was acknowledged that ECigs would have a large impact on programmes of work and the population of Hull. It was agreed that a report highlighting issues and benefits would be brought to the November 2016 Planning and Commissioning Committee.
Resolved
(a) / Members of the Planning and Commissioning Committee acknowledged the update.(b) / An ECigs report would be submitted to the November 2016 Committee.
(c) / A Health Checks report would be submitted to the November 2016 Committee.
7.2CLINICAL POLICIES GENERAL
There were no clinical policies to report.
7.3PAPERS FROM THE HULL & EAST RIDING PRESCRIBING COMMITTEE (HERPC)
There were no papers from the Hull & East Riding Prescribing Committee (HERPC) to report.
It was stated that Ophthalmology preferred Age-Related Eye Disease Study 2 (AREDS 2) AREDS 2.
Resolved
(a) / Members of the Planning and Commissioning Committee noted the update.7.4NICE MEDICINE UPDATE
The Locality Pharmacist (Hull) provided the Nice Medicine update report to the Committeefor information purposes.
It was reported and noted that Cabazabazitaxel, Bosuntinib and Pemetrexed were secondary care drugs with the remainder being quality standard.
Resolved
(a) / Planning and Commissioning Committee Members noted the update.7.5PRIMARY CARE PRESCRIBING REBATE OFFER NHS HULL CCG
The Strategic Lead Pharmacist NECS presented a report to the Committee seeking approval of two primary care rebate offers fromAstraZeneca, Symbicort Turbohaler and Zoladex (both strengths).
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It was noted that the rebate scheme does not require a growth in the use of Symbicort Turbohaler and Zoladex (both strengths) to be part of the benefit scheme.
It was stated that Symbicort was second line on the formulary and that there was a high volume of use. Zoladex (both strengths) was a first line option in the formulary with a high volume of use.
It was acknowledged that Symbicort had been evaluated by PrescQIPP (Amber) as a ‘not fully appropriate’ scheme based on some of the elements within the contract. These elements were specifically the potential tiered system (greater rebate for increase in use) and requirements to provide data within a set period. It was considered appropriate for clinical and financial elements.
Zoladex (both strengths) had been evaluated by PrescQIPP (Grey) no significant reservation. In was stated that in line with the policy the use of Zoladex would not be promoted due to having a primary care rebate.
Discussion took place and it was conveyed that all elements of guidance had been worked through for both Symbicort and Zoladex (both strengths) and no changes had been made, assurance had been met for Zoladex (both strengths).
It was agreed that data would be input quarterly and that a like on like comparison report would be presented at a future Planning and Commissioning Committee.
Resolved
(a) / Planning and Commissioning Committee Members approved the primary care rebate offers for Symbicort and Zoladex in accordance to the principles outlined in the rebate policy(b) / Planning and Commission Committee would receive a comparison report in April 2017.
7.6MEDICINES OPTIMISATION WORKPLAN: PROPOSAL FOR PROGRAMME OF SWITCHING TO BETTER VALUE ORAL NUTRITIONAL SUPPLEMENTS
The Locality Pharmacist (Hull) presented a report to the Committee providing information in relation to a proposed workstream to reduce the costs of oral nutritional supplements.
It was stated that NHS Hull CCG had spent £1.4 million on sip feed products in 2015/16. Indications were that this sum would increase to £1.57 million 2016/17, spending for Q1 2016/17 was £250,000.
Dieticians have made changes to the way in which patients were discharged from hospital on oral nutritional supplements. It was stated that patients started?ward staff due to poor dietary intake should be clearly identified on the Immediate Discharge Summary (IDS) and arrangements for any proposed follow up. This should mean that GP’s were better informed as to whether the patient had been provided with dietetic support when receiving prescription requests for supplements.
It was stated that the Medicines Optimisation Team were proposing to:
Review practice records of all patients prescribed oral nutritional supplements (ONS).
Review patients who had not been reviewed in the previous 3 months, protocol to be determined
It was indicated that the highest prescribing practices would be targeted in the first instance excluding patients identified unsuitable for milkshake products. Dieticianswould be informed of all issues uncovered.
It was acknowledged that Nualtra the potential new provider of sip feeds had offered support to Pharmacist for patient reviews in larger practices, Pharmacists and the Medicines Optimisation Team Technicians.
Resolved
(a) / Planning and Commissioning Committee Members approved the worksteam to reduce sip feed cost.7.7PESCQIPP DROP (DRUGS TO REVIEW FOR OPTIMISED PRESCRIBING) LIST
The Locality Pharmacist (Hull) presented a report to the Committee of the updated drugs reviewed for optimised prescribing.
It was stated that items reviewed and discussed in 2015/16 were increasing in use and would be addressed with the individual prescribers by the Medicine Optimisation Team.
It was noted that there were a number of drugs that NHS Hull CCG do not routinely commission.
It was recognised that more consistency was required on the Drugs to Review for Optimised Prescribing (DROP) list for NHS Hull CCG andextensive detail and prioritisation was required in the ‘comments’ section of the DROP list review for NHS Hull CCG.
Resolved
(a) / Planning and Commissioning Committee Members noted the update.(b) / Revised DROP list be brought back to the November 2016 Planning and Commissioning Committee.
7.8PROGRAMME HIGHLIGHT REPORTS
Acute Care
In the absence of The Head of Acute Care the Deputy Director of Commissioning gave an update to the Committee on the current work programme.
Attention was drawn to the following areas:
QIPP was a large scale transformation programme and would be reinvesting in significant end to end care.
The Acute Care programme work plans had been populated to include the work streams for both the planned, unplanned and some work streams from the Accident and Emergency (A/E) improvement Board (previously System Resilience Group).
Work was being undertaken on Ear Nose and Throat (ENT) as targets were not being achieved.
Risks were in the process of being reviewed.
Resolved
(a) / Planning and Commissioning Committee Members noted the contents of the report.7.9PROGRAMME UPDATES BY EXCEPTION
New Models of Care / Primary Care Programme Update
No exceptions were reported.
Vulnerable People
The Head of Vulnerable People undated Planning and Commissioning Committee on the following exceptions:
CAMHS
A Children and Young People (C&YP) Mental Health (MH) website had recently been launched. The website provided appropriate supplementarywebsites and information along with support for CYP MH.
CYP Autism
The 18 week targets were still not being achieved.This was due to referrals continuing to be average 55 per month. The service was initially funded to deliver 30 per month therefore referrals were 45% above plan. Theconversion rate for CYP referral to diagnosis was 80%.
Adult Transformation Plan
Occupancy to Humber NHS FT had reduced from 97% to 93% occupancy.
Workwas progressing with NHS East Riding CCG on the development of a Crisis Pad.
Partnership working with Public Health wastaking place on the number of people who were admitted with a primary and secondary substance misuse issue.
Identifying suitable housing for people who were ready for dischargewas causing concern. This had been flagged with Hull City Council (HCC) and a meeting was due to take place in October 2016 to progress.
The local MIND organisationwere working with Humber FT and supporting prompt discharge for those people who required supported accommodation before moving into their own tenancy/property.
Transforming Care – Learning Disabilities
Admissions to Townend Court wereincreasing. NHSEngland (NHSE)had advised that the level of engagement with service users was adequate.However, of the 10 patients in Townend Court at present, 4 required accommodation in the community.
Dementia
Work was progressing slowly reviewing the primary care assessment and diagnosis service.
NHS Hull CCG were0.1% short of our local target of 80%.The national target was 67.3%.
Children Young People and Maternity
No exceptions were reported.
Resolved
(a) / Planning and Commissioning Committee Members noted the contents of the updates.7.10 BETTER CARE FUND
In the absence of the Director of Integrated Commissioning, the Deputy Director of Commissioning updated the Committee on the progress of the Better Care Fund (BCF).
It was stated that the BCF launch event took place on 26 September 2016. Collaborative working had commenced and all work steams were in place.
Resolved
a / Planning and Commissioning Committee Members noted the contents of the update.7.11UNPLANNED CARE – SYSTEM RESILIENCE (ACCIDENT AND EMERGENCY DELIVERY BOARD)
In the absence of the Director of Integrated Commissioning, the Deputy Director of Commissioning updated the Committee on the progress of the Unplanned Care – System Resilience Programme.
It was noted that the Winter Plan for NHS Hull CCG had been submitted. The main emphasis was on the lack of community beds therefore extra beds were being purchased.
It was stated that Hull & East Yorkshire Hospitals NHS Trust (HEYHT) had identified the need for beds in the community and have indicated that they would be purchasing an extra 25 beds which would be monitored by Primary Care. Additionally, it was conveyed that nursing care provision had been reduced in the city and obtainingextra beds may be problematic.
Resolved
(a) / Planning and Commissioning Committee Members noted the contents of the update.7.12FINANCIAL PLAN UPDATE
The Deputy Chief Finance Officer presented a report to update the Committee on the NHS Hull CCG financial Plan.
It was reported that the NHS Hull CCG 2016/17 financial plan was submitted to NHS England (NHSE) in May 2016 and would be used to monitor NHS Hull CCG’s financial performance throughout the year.
It was stated the NHS Hull CCG were currently forecasting to achieve a balanced position against the in year allocation. There was therefore no impact on the historic surplus of £7.82million.
It was acknowledged that there were some emerging financial risks associated with the acute contracts HEYHT, Spire Healthcare and mental health expenditure for patients placed out of area and looked after children, with an overspend of £6million.
NHS Hull CCG were currently forecasting a reduction in continuing healthcare cost which had a forecast underspend against budget.
It was stated that the Operational Planning Guidance for 2017-19 had been received whichsupported the implementation of the Five Year Forward View (5YFV) and Sustainable Transformational Plan (STP). It was stated that the financial plan had to be submitted by 23rd December 2016.
Concern was expressed in relation to each STP having financial control which would be the sum of all of the individual organisation control totals. There would be a process by which organisations within the STP could apply to flex their control.
Resolved
(a) / Planning and Commissioning Committee Members noted the contents of the report.7.13LOCAL DIGITAL ROADMAP
The Associate Director of IT gave a presentation onthe Local Digital Roadmap delivery plan for paper-free at the Point of Care the following points were highlighted;
Integration and interoperability of “paper-free” systems across health and social care providing:
- real time accessibility of care records and information at the point of care, enabling information empowered care and speedier, informed decision making,
- the operation of an integrated accountable care system
Digital access for patients, third sector and the public to care data, advice and information that would support greater self-care, prevention and community support
Data sharing to support data analytics, population health & wellbeing management and effective strategic/individual care commissioning
Maximum efficiency in back office and service delivery working practices including agile/mobile working, avoidance of duplication, and reduction in non-productive activities