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DRAFT Quality and Safety Committee Minutes PUBLIC Wednesday 22 June 2016 (0900-1100)

Perceval House: 3rd Floor; 14/16 Uxbridge Road, Ealing W5 2HL

In attendance: CHAIR: Philip Young (PY), Tessa Sandall (TS), Ann Coles (AC), Sue Pascoe (SP), Ian Robinson (IR), Jonathan Webster (JW), Richard Christou (RC), Tamsin Robinson (TR), Carmel Cahill (CC), Neha Unadkat (NU), Mohammad Alzarrad (MA), Serena Foo (SF), Raj Chandok (RJ), Vijay Tailor (VT), Mondel Mings (MM), Ayesha Ahdan (AA)

Apologies: Gordon Turner (GT), Serena Foo (SF)

Item Action 1 Welcome & Apologies (as above) 2 3.1 3.1

Declaration of Interests 3.1 Minutes of the Meeting 18 May 2016 agreed as accurate with the following updates: Item 4.1 – Combined Clinical Quality, Patient Safety & Performance Report - LNWHT: Cancer breaches were discussed. - LAS: will be discussed in greater depth following a deep dive in the private part of this meeting. - NHS 111: There was a clinical meeting being held on 21 June 2016 where performance and staffing were to be discussed. Item 5 – Quality Reports Complaints report: SP did not have anything to update the committee on regarding the complaints report. JW and Jan Norman to meet 23 June 2016 to discuss complaints report. LNWHT numbers of complaints are significantly higher than other providers. There needs to be a board to board meet set up. TS had flagged to MP that PY held serious concerns. Item 7 – Additional Reports Quality Account: The draft BHH response was agreed across the committee as inadequate and TS advised that the response had been retracted; as before distributing the response was not cited by Ealing CCG. PY has not seen at any quality accounts come through this committee meeting. CC advised since December there have been requests to cite reports. Committee want to invite Brent to the next committee meeting to discuss the process for agreeing quality accounts and how associate commissioners (and respective Q&S Committees) are involved. JW advised CHWEE has a clear process for quality accounts and gave a breakdown of process. Lead commissioner would share quality accounts with associates. TS asked for assurance that associate commissioners had been consulted with on the Quality Account for WLMHT. Minutes of 2 March 2016 meeting agreed as accurate. Infection control was discussed which JW is going to chase. Action logs not discussed

JW to discuss Quality accounts with Jan Norman. JW & TS will report back to committee. JW to chase up regarding Infection control.

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4.1

Quality, Performance and Provider Reports 4.1 Combined Clinical Quality, Patient Safety and Performance Report It was agreed that summaries from each of the CQG’s should be included in future reports to the committee. The key clinical metrics for giving assurance to the CCG need to be included and it was agreed that JW and GT would meet to discuss. It was also agreed that we need to include other smaller services in the reporting such as community cardiology and home ward. In order to ensure that the Committee has a wider understanding on quality with regard to the overall pathways, it was agreed that a number of thematic reviews are scheduled for the year, to include areas such diabetes and cardiology. Quarterly reporting gives greater depths.

LNW

There are stroke clinic issues at NWP which Brent CCG has raised with LNW this week. RJ to pick up at CQG.

LAS LAS performance has not improved and concerns were noted. LAS have failed to meet targets in relation to London-wide performance during M01. There is insufficient staffing to meet demand. An increase in call volume has also added pressure to front line resources.

Ealing UCC

• There is an improving trajectory, which has improved in June to 92% and 89% respectively.

• There have been a few isolated days with a large number of breaches, which the provider has acknowledged are largely preventable, and were caused by a failure in processes and SystmOne difficulties.

• The provider continues, unsuccessfully, to recruit a lead nurse for the UCC. As an interim measure they have sourced additional administrative support in order to allow the Service Manager to provide 2-days per week acting lead nurse.

• LNW raised staffing issue 2 years ago of Band 5 nurses. • Ealing CCG continues to hold weekly performance monitoring meetings with

Greenbrook Healthcare. This will continue until the paediatric transition has successfully taken place.

• They are sharing data on a weekly basis, but need to have focused discussions. Clear actions needed from the discussion being held next week. Establishing good working relationships between Care UK, STG and UCC.

NHS 111

Performance notice has been issued. There have been slight improvements but not good enough. There is new staff starting which should improve the service but require reassurance of how it will affect the service i.e. training up of new staff.

Imperial College Healthcare NHS Trust VT gave a short overview on Imperial. The Trust had presented a number of updates to the ICHT CQG, including an update to their 62-day PTL Backlog Reduction plan, a deep dive on diagnostics, specifically on managing abnormal

JW & GT to discuss key clinical metrics for giving assurance

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5 6

7

7a

results, and an update on their outpatient improvement plan. VT advised he had raised concerns at the CQG as it is not acceptable for a patient to wait a significant length of time just to know if they have cancer or not. There should be a timely discussion taking place between the patient and consultant. 98 patients have a benign diagnosis but have not been informed and discharged by the consultant, this figure has been reduced to 33 by the end of May 2016 and the figure is constantly being brought down.

There is no single solution for addressing RTT and a response across all 5 CCG’s needs to be agreed. It was considered that this was best addressed through the CWHEE wide quality committee. Imperial plan to consolidate centre number of services presenting at ED. If a patient presents to CXH A&E requiring cardiac, renal or haematology services; they are transferred to an 8 bed acute specialist unit. This is expected to improve patient outcome and the length of stay reduced by 2 days.

Referral to Treatment (RTT) performance targets Backlog for the CCG has decreased from 819 in M10 to 810 in M11. The Trust backlog remains at a high level and ICHT are not meeting the incomplete performance overall (90.5%). The Trust has reported that performance has been impacted by reduced capacity in Q1 due to the junior doctor strikes and operational issues on the non-elective pathway. The Trust has agreed a draft recovery trajectory plan which is in place and is projected to be delivered in August 2016. The Trust has agreed a trajectory to reduce the total RTT backlog to 3664 by the end of 2016/17. The Trust report that they continue to implement their plan to increase capacity within challenged specialties (General Surgery, Urology, T&O and ENT) with a 7% increase compared to Q3 2015/16. The trust are now looking (advanced stages of this) to add a mobile theatre to increase capacity in the next month or two. Quality Reports

• Risk register – committee noted report Safeguarding

• Safeguarding Children – AC had no exceptions to raise AC stated that on 13 June 2016 Ealing Children services will have Ofsted Inspection starting 14 July 2016 for four weeks. They will be interviewing staff members from the Ealing CCG; including the safeguarding team and paediatric clinical leads.

• Safeguarding Adults – RC had no exceptions to raise

Additional Reports Any Qualified Provider - Termination of pregnancy service (ToPS): MM presented report to give assurance that there are no quality concerns relating to current contracted services. PY raised concerns over 15 complications reported in the paper. Of the 15

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7b

8

9

10

reported complications in the report, 2 retained products of conception (medical) 4 retained products (Surgical), medication error – administration 3, continued pregnancy (surgical) 1, continued pregnancy (medical) 4, haemorrhage 1. PY disputed whether a haemorrhage should be reported as an SI; if following the NHS guidance. Also the medication error stated in the report depends on what the outcome was for it to be an SI or not. These numbers were confirmed by MM that they were just for Ealing. MM advised Marie Stopes follows robust governance procedures. As this is a non-NHS provider contract the learning is not being recorded on STEIS. It was agreed that there should be systems in place to report timely and appropriately; which are then benchmarked across all providers. The learning needs to be embedded and understood across the system. JW will work with BHH and the central contracts team to work through understand the issues. EPPR Annual Report Ensures that in case of a major incident, the CCGs have measures in place to minimise disruption to patients and clinical services. JW presented the report which outlined the activity for 15/16 relating to EPPR and provides information regarding the NHS England assurance process which deems the CCG compliant with the NHS England Emergency Preparedness Framework 2015. The 8 CCGs in NWL are fully engaged with local and regional emergency planning structures with regular representation at NWL and Borough Resilience forums and participation in multiagency exercises, which ensure a proactive and coordinated approach to emergency preparedness.

CHHWE is Substantially compliant with the majority of the standards, however there are two areas, which are ‘Amber’, in addition to this NHS England (London) made other recommendations to enhance our EPRR capability. Ealing not cited for local authority process. Committee cannot be assured as still requires clarification for ownership

Items for Noting:

(a) Minutes from the CWHHE Quality and Performance Committee (b) Draft Minutes from 111 Clinical Governance meeting (c) Medicines Management Working Group minutes

A.O.B. LNWHT – CQC Report update Report went live on 21 June 2016. The Quality summit will be held on 13 July 2016. This year will be held differently as it will be taking place the day before the CQC report is released; and is normally led by the CGC. Committee was asked to feed any questions or queries verbally or via email for TS or MP perusal. The format and structure of the meeting was discussed by committee and think if the meeting does not meet the CCG’s needs that a separate meeting should be held. Date of Meeting – 20 July 2016

JW to formally conduct a clinical review on the reported 15 complications as no assurance provided.

JW to escalate to CHWEE quality committee to compare across all 5 CCG’s

JW to review Business continuity plan

Information, Governance, Management and Technology Committee Thursday 26 May 2016, 10:00 – 12.30

Meeting Room 1 & 2, Ealing CCG, Perceval House

Item Action

1. Apologies and Declaration of Interest Members present: Arjun Dhillon (AD) Chair, Neha Unadkat (NU), Omesh Sharma (OS) Invited Guests: Ruhani Chowdhury (RC), Sue Clements (SC), Bill Sturman (BS), Dominic Brown (DM), Christine Dunne (CD), Jane Sagoo (JS), Naseem Issac (NI), Mike Davies (MD), Ben Hedgeland (BH), Keith Bird (KB), Sylvia Parry (SPa), Sonia Patel (SP), Paramjit Matharu (PM) Via conference call - Ruben Hugo (RH), John Keating (JK), Amanda Lucas (AL) Apologies: Beryl Bevan, Sally Armstrong, Fionnuala O’Donnell, Shanker Vijayadeva, Ian Riley, David Ashby, Piers Grace, Victoria Hamerton, Gordon Turner, David Thomas

2. Minutes from previous meeting (31 March 2016) The draft minutes of 31 March were agreed. Matters arising not covered on agenda Action log – The committee went through the action log

3. Projects and Operational Matters a) Practice migrations to SystmOne SC highlighted that no dates have been agreed for the Dormers Wells Medical Centre migration until all ongoing issues have been dealt with and added that Yeading Medical Centre had issues with Emis.

b) Utilisation dashboard and prioritisation This dashboard is linked to practice reports and is not for GP practices circulation. It is used for resources, tracking and monitoring programmes according to strategy and not designed for roadmaps. CD explained they are trying to establish a quick, friendly and better way of collating information and focus on providing support to practices based on activity and local intelligence.

c) Shared services IT support performance report There were several outages with NHS mail. Passwords were discussed. RC highlighted an issue regarding the new NHS Mail2 accounts. Each CCG was

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allocated 50 new NHS mail accounts which also included the 78 GP practices. Anything over that could not be created. As a result there were over 50 new accounts which could not be created. AD was concerned as this was a clinical risk. Action BS to forward email regarding NHS mail accounts to AD to take forward AD suggested keeping a log and track of colleagues who require new NHS mail accounts. There was a discussion around problems with N3 tokens. RC went through the ICT performance report and mentioned there were 11 calls breached, of which 6 were breached for 4 days. It was difficult to report why these were breached. Monthly comparisons and severity which was based on impact and urgency was discussed. NU requested a breakdown and issues for Ealing severity 3 and 5. The top 20 most frequent GP calls were discussed. It was suggested that figures should be displayed as eg pie chart with themes including Wi-Fi which will be easy to compare. AD suggested sending a monthly message relating to priority and severity.

BS

d) NWL ICT Service Operating Model JK explained this model was agreed in 2015 and is a single operating model for each CCG, which now has been amended. The updated North West London CCGs ICT Service Operating Model has been brought to this Committee for approval. JS suggested the font format on the document be changed. JK agreed and would re-send this. Action – JK to change font format for the Operating Model and re-send to the Committee. CHAIRS Action – as the members present were not quorate the Chair agreed to the operating model on behalf of the Committee. SharePoint – There were problems with the current SharePoint, originally from Hounslow PCT structure. The first move for the new SharePoint 2013 would be for Ealing as it has more users, followed by other CCGs. RH explained the process which would involve a new CWHHE link and access. Action – JK, NU, SP and JS to meet and discuss SharePoint. DB said transition would start on Friday night and continue in the weekend. There is a SharePoint meeting on 14 June regarding scoping. AD added he valued the work done on SharePoint and recognised the hard work and suggested integration with Yammer which is part of office 365. RH said there was no budget at the moment. AD suggested a business case and a workshop and suggested linking up NHS Mail2 and SharePoint. e) Out of Hospital There were issues with Ealing OOH template and software. NU mentioned a meeting for OOH IT template, to look at how we are doing, how impact on practices and support provided to practices eg contractors. BS responded that the group

JK JK/NU/ SP/JS

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recognised problems, made recommendations and monitored OOH as SystmOne has some limitations. NU mentioned the success of the diabetes template which shows reduction and clinical outcome. Action – NU to email OHH issues to JK

NU

f) Immunisation In April Sally Armstrong had conversations with NHS England and Public Health regard reminders for immunisations which were stopped. As a result there was a catch up campaign for those who were missed which NHS England was funding. AD highlighted concerns eg measles outbreak. g) Terms of Reference AD confirmed that the Ealing IGM&T committee was a subcommittee of the Governing Body and reported to F&P but felt the Execs should be involved. BS mentioned that IT was expanding to all 8 CCGs.

4.

Governance and IG a) WSIC ISA / WHYSE WSIC ISA The WSIC dashboard deployment is to be deployed to all practices across North West London. 255 practices out of a total of 389 have signed the WSIC ISA to date. A GP WSIC Dashboard deployment checklist has been developed as part of the Local Deployment Guide to inform the WSIC dashboard deployment process. Apollo Medical has built a query to extract data for all adults and over 65. AD said for whole system Ealing preference on query would be all adults as this better aligns to local models of care. AD explained surgeries like Argyle, Cuckoo Lane and Ealing Park usually take part as pilots and felt this was not ready to roll out to every surgery in Ealing (or even the pilot practice) as there were issues to sort out. AD expressed a preference for using the anonymised (or de-identified) data flow as the primary flow of data to Ealing practices. However AL explained that this would not fulfil the permitted purpose of information sharing as detailed in the ISA which is providing direct care to patients. AD advised that rather than prolong further discussion on data flows that a separate discussion should be set up outside of this meeting. Action BS, AD, SP and AL to meet to discuss WSIC WHYSE – There were issues regarding WHYSE which has been funded. Changes were due but are now delayed. There will be a re procurement for WHYSE and there needed to be lessons learnt as part of procurement.

BS/AD/SP/AL

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b) Digital CQUIN This CQUIN is related to this financial year with targets being achievable. There were steps to go paperless. The three papers circulated to the committee align to NHS England objective, as there is not enough funding this year. Areas like summary records, diagnostic cloud, improving GP communication, GP records and data quality were noted. Majority of the work focused on WLMHT integrated care planning. The Imperial CQUIN has not been finalised yet. Both MD and SP are involved with CQUINs. AD added that all CQUINs are aligned and planned. LNWLHT CQUIN is finalised and they have started to engage and are committed. Some CQUINs are co designed with CCG and Trust. Tenille Madigan is Head of Contracts for Ealing CCG.

c) Digital roadmap MD gave a summary of IT strategy for care community for the 8 boroughs. This Looked at current strategy via NHS England and local objectives via SDP. Three main areas:- 1) Care quality 2) Health and efficiency 3) Health and wellbeing There is a primary care transformation bid. The final draft is due in June then it is assured by NHS England as part of NHS for treasury for transformation. Funding was discussed. This was a 5 year forward view and we are now in the 2nd year. Ealing has got an integrated plan. WLMHT is using Rio for information which cannot be shared.

5. Any other business Digital innovation – SP introduced this item and mentioned how to support peer to peer and floor walkers. Primary care tech – SP stated that the final guidance has been provided, with bids at scale being favourable across NWL. These include:- 1) New models of care 2) Integrated standards 3) Video conferencing buying licence 4) Patient and primary care - telephone triage across the 8 5) Digital patients – how understand tools, local needs. 6) Care homes NU raised issues of governance and the Collaboration Board was mentioned. SP explained the process and said linked bids would go through to Brent (Brent being the key organisation for holding this) and shared services. From mid June, bids would be going to the Brent Board who then will write to all F&P boards to be indorsed and then Co commissioning group for all 8. Digital innovation log – DM introduced this item and was looking for approval. Aims at new digital technology, making things faster via prioritisation with right products, have resource and tracking. This has already been tested. The next steps would be to agree prioritisation products, establish digital group and publish road map to all

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parties. AD was concerned about the process ie slow and maintenance cost. DM responded that this will pay for itself ie savings and needed to run and test with clinical and commissioners input. This was agreed.

6. Date of next meeting 28 July 2016 Meeting Room 1&2 10.00-12.30 at Ealing CCG

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Minutes: ECCG Finance and Performance Committee Wednesday 27th July 2016 – 08.45 – 11.00

Meeting Rooms 1&2, Perceval House, Ealing Item Discussion Action

1 Welcome & Apologies Members present: Chair: Mohini Parmar, Elected GP, North Network, Chair of the Governing Body, Ealing CCG (MP) Tessa Sandall, Acting Managing Director, Ealing CCG (TS) Raj Chandok, Clinical Vice Chair, Elected GP from South Southall Network (RC) Eva Horgan , Deputy CFO, CWHHE CCGs (EH) Other attendees present: Neha Unadkat, Deputy Managing Director Out of Hours, Ealing CCG (NU) Helen Troalen – Deputy CFO, CWHHE CCGs (HT- via teleconference) Tara-Lee Bauhm, Deputy MD, Service Redesign, Ealing CCG (TLB) Frances Horne, Head of Integration, Ealing CCG (FH) Allison Bennett, Head of Strategic Delivery, Ealing CCG (AB) Naseem Isaq, Strategic Support Officer, Ealing CCG (NI- Minutes) Apologies: Philip Young, Keith Edmunds.

2 Declaration of Interests There were no additional declarations of interest stated at this meeting.

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3.1 Minutes of the meeting – 29th June 2016 Actions from last meeting summarized as below:

• 4b(ii)- Contract Issues- Action closed • 4(c)- KPI- EH to speak with Keith Edmunds re this – Action open • 4(i)- Care Navigation- Action closed • 4(k)- Disclosure of transfers- the process for DOI registers for members of

staff and clinical leads on CGG business is under review- Action closed • 4(l)- Paediatric Nursing Service- A Deep Dive will be conducted- Action closed • 5(a)- QIPP- A paper on cardiology will be discussed at Exec in 2 weeks’ time-

Action closed 3.2 Matters Arising There were no matters arising not already covered on the agenda.

Create an action log (NI)

4 Papers for discussion/approval

(a) Investment Prioritisation (Eva Horgan) The Committee is asked to:

• Approve the process for prioritizing investment. The discussion was summarized as below:

• MP noted this was a very helpful matrix, and will aid in assuring consistency of decision making for further investments

• MP also noted it important to look at totality of spending- especially if we want to look at how things can be done differently, taking into account any vacancies

TS to write to Maggie Wilson re school nursing TS/NU to meet with Andy re CVS

• It was requested affordability and financial risk also be included in this report • In considering further investments, existing budgets should be looked at to

see if these can be applied proactively to a changed model of care, and review the historical spend

• It was agreed we need to be proactive in our management of Ealing CVS- TS and NU to action this

• Regarding school nursing, TS to check this investment, including if all posts have been recruited to, and if not, what the vacancies are and how this money is being used to support the service

• The committee approved the paper and the use of the prioritisation framework

(b) Process for Review of services and schemes included in Section 75 Agreement for 2016/17 (Frances Horne) The Committee is asked to:

• Agree the Process for reviewing the services and schemes included in Section 75 Agreement for 2016/17

The draft recommendations are:

• The PIDs should be bought back to the F&P with a cover sheet with material changes clearly documented

• Spend must be clearly documented in the PIDs and a plan should be in place for any changes to the committed spend

• Schemes should be monitored and evaluated regularly using an evaluation matrix to understand how the services are delivering and whether the funding is being utilized for the appropriate schemes with the intended outcomes

• The CCG and LBE teams will develop the evaluation criteria together These will be signed off at the next F&P in August as part of the minutes.

(c) Commissioning Support Services, CWHHE Recharges, and Running Costs Budgets (Eva Horgan) The Committee is asked to:

• Approve the budgets as outlined below. The discussion was summarized as below:

• From an Ealing F&P perspective, there is a lack of assurance in the governance over and value for money offered by the CSS and shared costs

• It will be useful to have another look at how we are going to hold ourselves to account on spends that we have as a Collaborative and Federation and across NWL

• From an Ealing perspective, it is noted there is a reserve on running costs but we want to hold this in reserve and continue to stay tight on spend

• Ealing CCG will be recruiting to substantive posts and reduce interims and to ensure the needs of the population are met via the recruitment

• Want assurance from other CCGs that they are doing the same • HT noted she will be providing regular reports around the running costs for

each of the 5 CCGs, and this will be circulated monthly • This item was approved by the F&P Committee, subject to the above

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caveats, and on the understanding that a review of value for money will be undertaken in year.

(d) Out of Hospital Services (Narinder Sandhu)- This item was chaired by TS The Committee is asked to:

• Note the update of the Out of Hospital Services financial recommendations as part of the six month review process of services. The changes to the services of ABPM, Co-ordinate My Care and Wound Care were approved; the 2015/16 payment approach for Diabetes was approved.

• Approve the recommendations for ABPM, Co-ordinate My Care and Wound Care as presented to the Investment Committee.

Under the Out of Hospital Services programme, a six month review process was included to ensure services were fit-for-purpose and providers were enabled to deliver services on a population basis and thereby achieving clinical outcomes per service. The six month review process has convened for all services and a number of recommendations are made to the Investment Committee (14 July 2016) to approve. Services changes and financial impacts (based on activity from the 2014 business case) are tabled below:

Service Change Type Expected Impact ABPM Tariff Change +£7,600 Coordinate My Care Interim Tariff Change +£25,400 Wound Care (Complex & Simple)

Service Change Tariff Change

+£7,100

TOTAL: +£40,100 MP questioned the affordability of this. EH replied this is budgeted for and is affordable, especially as the main element is non-recurrent. NU further noted the planning assumptions will be better in a few weeks, and this will be closely monitored. The discussion was summarized as below:

• The Committee approved the proposal, subject to PY approving via email • Concerns were noted around mental health potential changes and the impact

this may have • It was agreed to conduct a affordability criteria to discuss the sustainability

and requirements associated with mental health

5 Regular Reports

(a) Month 3 2016/17 Ealing CCG Finance and Activity Performance (Eva Horgan) The Committee is asked to:

• Note the report EH noted that as month 3, the CCG is behind the planned year to date surplus target. In terms of maternity, at month 2, the number of births had increased, and the figures

EH to contact London North West to confirm our coding changes

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for antenatal pathways were also raised. This was noted as an element of double bookings happening, and this would be looked at in further detail. TS noted that in regards to QIPP, there are recovery plans in place. The other aspect of this will be to look at the CCG’s engagement plans at both GP Practice and Network levels, and focus on the practices we need to prioritize. TS also noted a QIPP pack had been created for each Trusts, The discussion was summarized as below:

• MP thanked EH for the report, acknowledging the financial position for Ealing CCG had deteriorated in Month 3

• The team was working towards meeting these challenges • The single maternity patient tariff would be looked at to try and reduce

double entries • To review the outpatient procedures at the Ealing Site, including ENT &

Cardiology, which may require a clinical audit • EH will contact London North West to confirm our coding changes • To follow up with contract leads at Hillingdon, Chelwest & Imperial to ensure

that Ealing challenges are being robustly represented • It was noted that Philip Young had expressed concerns that the gross risks

seemed to be larger than identified, and how this would be looked at further for next month. EH noted that once the acute figures were received, this would give us a better indication of the position next month

(b) 16/17 Month 02 QIPP Update (Allison Bennett) The Committee is asked to note the report:

• For information and have a sight of current performance of the schemes

The paper outlines the 16/17 QIPP with a planned initial gross saving of £11.4m, with £6.5m coming from Acute schemes and £3.1m coming from non-acute schemes. The net saving target (after re-investment) is £10.4m.To enable the delivery of the QIPP projects, a programme approach is planned to increase accountability, mobilise capabilities within the CCG and focus the organisation on delivery of QIPP as a whole. At M2 we have delivered 34% of the planned QIPP delivery, the primary QIPP schemes are not delivering as planned include Homeward, Out of Hospital Services and Community Cardiology. MP noted a clinical audit should be carried out for both services to be clear in the correct pathways for a patient, and maximising the clinical efficiency for this pathway. It was noted this item could be discussed further at the next SRG meeting. In regards to the dermatology service, the follow up ratios at Northwick Park Hospital, Ealing Hospital and St Mary’s Allergy Clinic need to be followed up. Regarding out of hospital over performance activity for anti-coagulation and diabetes, a letter needs to be sent to London North West to clarify patient should be seen in the community first, unless there is not in the patients’ interest.

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For the TACHS service, the CCG is working with the Local Authority, and have asked to attend the Nursing Homes Registered Managers Meeting. It was noted a focused QIPP discussion on TACHS at an Executive Committee meeting would be helpful. TS clarified the CCG had been briefed about the current financial position, our QIPP performance and the need to create a recovery plan. After discussion with the Senior Leadership Team, it has been agreed one member from each team will be released one d ay a week to form a recovery group. This item will be discussed regularly at Executive Committee meeting.

(c) Month 3 Budget Update – S&T (Jenny Greenshields) The Committee was asked to note the contents of the report:

• This paper provides the month 3 budget update for NWL-wide financial strategy/ SaHF including Strategy & Transformation programmes.

• It shows that the directorate is currently £1.8m overspent but this is in line with expectations and due to budget phasing rather than overspending issues. The Directorate plans to break even by the end of the year.

The report was noted.

(d) CWHHE Workforce Report, June 2016 (Eva Horgan) The Committee was asked to:

• Note the contents of the report EH commented it would be useful to invite HR to a future meeting to discuss this item further. The key thing was to note there was a lot of work going on in North West London to recruit to posts substantively, thereby reducing the use of interims and contractors. Within ECCG, two key posts had recently been recruited to. NU commented it would be useful to have a comparison of substantive and interim staff rates; and this would be feedback to HR. TS noted it was important to keep reminding the organization of completing mandatory training.

6 Items for Noting

(a) Integrated Wheelchair Service Contract –signed off (PRIVATE) (Usha Prema) This item was noted.

(b) S & T Quarter 1 Report (Apr-Jun 2016) (Jenny Greenshields) The Committee was asked to:

• Receive the report and provide feedback on progress including suggestions for future content

JG noted this was the first S&T quarterly report and requested feedback from the Committee. The discussion was summarised as follows:

• The report is very helpful • The next iteration of this report should include the milestones, including the

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various components of each workstream, what has been achieved and what has/has not worked well

• To include a summary of what is planned for 2016/17 & 2017/18 • Include a summary outlining the different workstreams

(c) Care Navigator Procurement- Update (verbal update) (Tessa Sandall) This item was discussed earlier in the meeting.

7 Minutes from other Committees

No minutes to note. 8 Exception report to the CWHHE Committee

This item was not discussed. 9 Any Other Business (AOB)

To move monthly Finance & Performance Committee to 10.30am-1.00pm; followed by a Governing Body Seminar. To invite Keith Edmunds to both meetings.

NI to action

10 Date of next meeting

Wednesday, 24th August 2016, 09:00-14:00, Meeting Rooms 1&2, PH

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Minutes of the Local Joint Primary Care Co-Commissioning (PCCC) Committee Meeting in Public

Wednesday 4th May 2016 Time: 09:30 – 10:00pm

Location: Meeting Rooms 1&2, Ealing CCG, Perceval House, 14/16 Uxbridge Road, Ealing W5 2HL

Present

Voting Members Ealing Clinical Commissioning Group (Ealing CCG)/Central London, West London, Hammersmith & Fulham, Hounslow and Ealing CCG Collaborative (CWHHE) Philip Young Lay Audit Committee Chair (Acting Chair of Local Joint

Committee) PY

Sally Armstrong Deputising for Jonathan Webster Governing Body Nurse, Director of Quality and Patient Safety

SA

Raj Chandok Vice Chair of Ealing CCG/by telephone RC Dr Alan Hakim Governing Body Secondary Care Consultant AH Dr Mohini Parmar Governing Body Chair MP Tessa Sandall Acting Managing Director TS Dr Shanker Vijayadeva Governing Body Nurse, Director of Quality and Patient Safety SV NHS England (NHSE) Rachel Donovan Assistant Head of Primary Care (NW London) RD Kenny Gibson Head of Early Years and Immunisations NHSE KG Nadra Abdi Immunisation Commissioning Manager NHSE / for part of the

meeting NA

Julie Sands Head of Primary Care (NW London) JS Non-Voting Advisors

Local Medical Committee (LMC) Dr Adam Jenkins LMC Representative AJ Ealing CCG/CWHHE/Health & Well Being Board (HWBB) Peter Buckman Head of Finance PB Dr Jackie Chin Director of Public Health JC Sue Hardy Head of Strategic Estate Development SH James Raymond Interim Primary Care Commissioning JR Jane Sagoo Member Engagement and Extranet Manager JSg Neha Unadkat Deputy Managing Director NU Judi George Primary Care Support JG Apologies

Voting Members Ealing CCG/CWHHE Philip Portwood (Chair of Local Joint Committee) Lay Member PP Keith Edmunds Chief Finance Officer (CWHHE) KE Clare Parker Accountable Officer (CWHHE) CP Jonathan Webster Governing Body Nurse, Director of Quality and Patient Safety JW NHSE David Finch Medical Director (NW London) DF Jo Ohlson Acting Director of Commissioning Operations NW London JO Mark Spencer Deputy Medical Director (London) MS Liz Wise Director of Primary Care (London) LW

Non-Voting Advisors Ealing CCG/CWHHE Christopher Cotton PCCC Lead (CWHHE) CC

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Item Agenda item Action

General Business 1 Welcome, Introduction & Apologies

PY welcomed all the committee members and non-voting advisors to the meeting. No questions had been received in advance from the public.

None

2 Apologies were noted from Philip Portwood as per the names on page 1.

None

3 Declarations of Interest PY queried the latest status of outstanding declarations of interest forms. JS and JG confirmed that all declarations of interest had been submitted and the central register updated accordingly. Committee members’ and non-voting advisors were asked to state any conflicts of interest in relation to the agenda items under discussion: There were no conflicts in this regard.

None

4 Minutes and actions from previous meeting 16th March In response to questions from PY, there were no questions from the Committee and accordingly, the minutes were agreed as a true and accurate record of the proceedings. Details in the action log were discussed as follows: - Personal Medical Services Update (PMS). Julie Sands stated that with regards to the PMS review and implementation of the commissioning intentions by Ealing CCG, progress was currently in a paused state. The final deadline date for completion of the review and its implementation was currently unclear but national guidance on timelines was expected by the end of the week. PY expressed a concern about the impact of the knock-on effect on other projects. NU explained that as a result of the current delay with PMS, calculations for affordability and business cases were yet to be completed. Issues at Primary Care Support Services/ IT. NU stated that IT were investigating individual practices around the status of internet explorer versions. Recent changes in Primary care – Burlington Gardens. RD updated the Committee to advise that Burlington Gardens was now closed. Final letters had been sent to circa 500 patients with a reminder for patients to re-register

JS to update at next meeting NU to confirm completion of IT checks

Items for Discussion 5 Recent Changes in local Primary Care / Ribchester

1.1. The paper entitled ‘Ribchester Medical Centre: Future provision of primary care services to registered patients’ dated 4th May 2016 had been circulated to the committee prior to the meeting.

1.2. Dr NN Patel, a single-handed contract holder in Perivale, had

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notified NHS England of his intention to retire and relinquish his GP contract with effect from 31st July 2016. The paper recommended asking patients to register with an alternative local practice of their choice. The key factors for this recommendation are summarised below: -

1.2.1. The list could be dispersed across the large number of

existing practices with no single practice likely to take a significant number of additional patients.

1.2.2. All practices within 1.5 miles had open lists and were registering new patients. Nine local practices had indicated that they had additional capacity to register large numbers of additional patients.

1.2.3. Patients would be able to choose from a large number of local practices.

1.2.4. Six practices are half a mile or less away from the current site which was a relatively short distance.

1.2.5. It was highly unlikely to be financially or commercially viable to procure a new contract for a list of this size. The core contract price of a new APMS contract was likely to be circa £148,057. This was compare to a current contract price of £139,658. There were also costs and resources associated with the procurement process. Procurement of a new provider was likely to take between 9-12 months and was unlikely to attract a significant interest from the market due to the size of the list, which was steadily falling.

PP, who had experienced travel delays to the meeting, joined the meeting and acted as Chair for the remainder of the meeting.

1.3. The main discussion points raised from members were are follows: -

1. MP emphasised the importance of: - a) informing patients and supporting practices without jeopardising business, workforce and plans for recruitment of staff; b) ensuring transfer of care for individual patients i.e., for repeat prescriptions; and c) the need for intensive management support at operational level. MP suggested phased transition that prioritises the transfer of vulnerable patients first.

2. PY asked whether a contingency plan existed? Also, whether a

TUPE obligation would apply if 50% of staff jobs were made redundant.

3. RD explained to the Committee that daily contact with

Ribchester would be in place until actual closure date.

• TS asked: -

a) how practices were measured to ensure quality and impact; and b) whether there was a plan for the surrounding practices to have CQC visits.

TS added that there was an importance to mitigate and address any risks (including the financial impact) to ensure that surrounding

RD to set up daily contact with Ribchester

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practices were in a position to cope with the possibility of 500 new patients within the next month.

• RD confirmed that the CQC still intend to visit all practices by

October. 2016. • SH pointed out that in Appendix 1, where Perivale’s list size was

stated at 6,366, this figure differed to Perviale’s reporting number of 3,650. The latter number had been received as part of the Primary Care Transformation Fund 16/17 bid.

• NU stated that due to Ribchester’s patient list being bigger than

Burlington Gardens, a detailed action plan was required. • TS requested that confirmation of [DDA compliance] for the

surrounding practices be obtained. • RD would provide responses and confirmations on the questions

raised. • RD was asked to share with the Committee a) the plan in place to

ensure the safe closure of the practice; and b) a plan to ensure that the neighbouring practices were able to accommodate these patients.

After detailed discussions, the committee agreed that the closure would progress based on the following process –

a) Option One known as dispersal would be taken. Patients would be registered with an alternative existing practice of their choice.

b) Among the issues to consider were: assurance that the care of patients currently registered at Ribchester Medical centre could be safely transferred to surrounding practices. The Committee were happy for such assurances to be received by email communication.

Post meeting Note Paper circulated on 10th June 2016

RD to update at the June Committee meeting RD to coordinate assurance by email

7 Minutes and actions from previous meeting • Review & agree accuracy

To be reviewed and agreed at the next meeting

Agree and review minutes of actions from May meeting

AOB 1. Future Local Joint PCCC meetings in public dates:-

2016/17 Wednesday 15th June 2016: Meeting Rooms 1& 2, Ealing CCG, Perceval House, 14/16 Uxbridge Road, Ealing W5 2HL at 9.30am

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